Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents

Importance: Transphobia and stigma remain barriers to seeking mental health care for gender-diverse adolescents. Objective: To examine the utility of brief social contact-based video interventions of transgender protagonists with depression to reduce transphobia and depression-related stigma and increase treatment-seeking intentions among adolescents in the general population. Design, Setting, and Participants: During August 2021, a total of 1437 participants were recruited and randomly assigned to 1 of 4 video-based conditions in a 2:2:1:1 ratio: (1) transgender adolescent girls, (2) transgender adolescent boys, (3) cisgender adolescent girls, or (4) cisgender adolescent boys. Interventions: In each of the approximately 110-second videos, an empowered presenter shared their personal story about coping with depression and reaching out for help. Main Outcomes and Measures: The primary outcome was the score on the Attitudes Toward Transgender Men and Women (ATTMW) scale. Secondary outcomes were (1) a "gender thermometer" rating for warmth in transgender perception, (2) the Depression Stigma Scale (DSS) score, and (3) the General Health-Seeking Questionnaire (GHSQ) score. Results: Of the 1437 randomized participants, 1098 (76%) completed the postintervention assessment and passed all the validity tests (mean SD age, 16.9 1.2 years; 481 44% male; 640 58% White). A significant change in attitudes toward transgender youth was found within the intervention group only (mean SD ATTMW scores: intervention group, 34.6 23.1 at baseline to 32.8 24.2 after intervention; P < .001; control group, 33.5 23.4 at baseline to 32.4 24.1 after intervention; P = .01). The mean (SD) total DSS scores decreased significantly across study groups (intervention: 1.3 3.3; control: 1.7 3.3; P < .001). A significant increase in intention to seek help from a parent was found in the intervention (mean SD GHSQ score, 0.2 1.1) and control (mean SD GHSQ score, 0.3 1.2) groups (P < .001), as was a decrease in those not wanting to seek help from anyone (mean SD GHSQ score: intervention, 0.2 1.6, P = .009; control, 0.3 1.2, P < .001) Secondary analyses revealed significant differences in baseline ATTMW scores and intervention effects between transgender and gender-diverse and cisgender participants and between lesbian, gay, bisexual, or queer (LGBQ) and straight participants (F = 36.7, P < .001) and heterosexual participants (F = 37.0, P < .001). A significant difference was also found in mean (SD) transgender warmth scores from baseline to after intervention between groups (2.6° 13.1° in the intervention group vs 0.4° 8.3° in the control group; P < .001). Conclusions and Relevance: In this randomized clinical trial, brief social contact-based videos proved efficacious in reducing transphobia and depression-related stigma and in increasing treatment-seeking intentions among adolescents in the general population. By personifying, individualizing, and providing face and voice to the experience of transgender youth, other adolescents, especially those who are cisgender and/or of a heterosexual orientation, can gain empathetic insights into the lives of their often marginalized and stigmatized fellow youth. Trial Registration: ClinicalTrials.gov Identifier: NCT04969003.