Public stigma toward people with mental illnesses involves negative beliefs held by members of the general population, which may lead them to act in a discriminatory manner,1 including avoiding some situations, social distancing, adopting paternalistic views, and supporting coercive policies.2 A meta-analysis recommended both contact-based interventions with individuals in stigmatized groups and educational interventions as successful strategies for reducing public stigma.3 The Mental Health Supporter Training Program project has been implemented as a national project in Japan, with the aim of establishing a comprehensive care system by raising public awareness.4 We previously reported that the fiscal year (FY) 2022 program improved mental health literacy (Cohen's d = 0.49 [95% confidence interval (95% CI), 0.39–0.60] for knowledge; Cohen's d = 0.25 [95% CI, 0.14–0.35] for attitude) and knowledge of mental health (Cohen's d = 0.48 [95% CI, 0.38–0.59]) until 6 months later; there were also significant effects on public stigma immediately after the intervention (Cohen's d = 0.33 [95% CI, 0.25–0.41]), but it disappeared 6 months later (Cohen's d = −0.004 [95% CI, −0.11–0.10] at T3).5 This result could be attributed to the educational focus of the program, with little contact-based intervention. Therefore, the purpose of this study was to modify the program evaluated in the previous study5 and verify its effectiveness for participants in the FY2023 program. This was a single-group pretest/posttest intervention. The target population consisted of residents in Japan. To assess the effectiveness of the program, a self-report survey was conducted at baseline before the training program (T1), immediately post-intervention (T2), and after the 3-month follow-up (T3). In the modified program, the lived experiences of two individuals with mental illness were added as videos (approximately 2 min each). In addition, participants were introduced to longer videos (about 25 min each), which were posted on the program's website. Each survey participant provided informed consent. This study was approved by the Research Ethics Committee at the National Centre of Neurology and Psychiatry (No. A2021-084). This trial was registered in the Japan Registry of Clinical Trials (No. jRCT1030210433). As an outcome variable, the Japanese Version of the Reported and Intended Behaviour Scale (RIBS-J) was used to assess the future behavioral intentions of people with mental health problems. The responses were measured using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree), with higher scores indicating more favorable behavioral intentions.6, 7 The internal reliability and validity have been confirmed. The T2 survey evaluated implementation outcomes (acceptability, feasibility, and satisfaction), using the Implementation Outcome Scales for Digital Mental Health (iOSDMH).8 For the statistical analysis, a conditional growth model and an analysis of variance model were used. Other analyses were performed with adjustments for age and gender. Participants who responded to T1 were included in the analysis (n = 2421). We also calculated effect sizes and 95% CIs, using Cohen's d for survey completers at each time point (T1, T2, and T3). The results showed that the program had a significant pooled effect on the future behavioral intention score after adjusting for covariates (t = 10.86, p < 0.001). When compared at each time point, both T1–T2 (t = 9.51, p < 0.001) and T1–T3 (t = 4.14, p < 0.001) were significantly different. The effect sizes were also significant at T2 (Cohen's d = 0.28 [95% CI, 0.22–0.34]), and T3 (Cohen's d = 0.15 [95% CI, 0.08–0.22]). In the iOSDMH, more than 95% of respondents positively evaluated the program. The details are shown in Table 1. The findings of this study suggested that the combination of educational and contact-based interventions might reduce public stigma toward people with mental health problems immediately post-intervention, an effect that persists 3 months later. Although this result might be overestimated due to the low follow-up rate at T3 and could not make a definitive conclusion, the modified program involving contact-based intervention might have an impact on reducing stigma at least up to 3 months later. However, the immediate post-intervention effect size of the modified program was smaller than in the previous study (Cohen's d = 0.33 in the previous study versus 0.28 in the present study, although the difference in effect size was not statistically examined).5 A previous study focusing on stigma eradication reported that the most effective way to reduce stigma is through interventions based on the principle of social contact (whether in person, virtual, or indirect).2 Including a video in the modified program was considered appropriate, but featuring only two 2-min videos in the program may not have been intense enough to increase the effect size significantly. There are some limitations in our study: there was no control group, the participants were not chosen at random, the follow-up rate was low, and we used self-reported questionnaires. Despite these limitations, it might be worthwhile to implement this modified version of the program with a larger number of participants in the future and to disseminate it more widely among the Japanese population. Daisuke Nishi was responsible for the conduct of this study, supervised the process, and organized the study design. Megumi Hazumi and Daisuke Nishi wrote the study protocol. Kentaro Usuda, Megumi Hazumi, Ikue Umemoto, Naoaki Kuroda, Hironori Kuga, Chiyo Fujii, and Daisuke Nishi contributed to the development of the program. Kentaro Usuda contributed to the data collection and curated the data. Utako Sawada and Mako Iida analyzed the data and wrote the first draft of the manuscript. Kentaro Usuda, Megumi Hazumi, Ikue Umemoto, Naoaki Kuroda, Hironori Kuga, Chiyo Fujii, and Daisuke Nishi critically revised the manuscript. All authors approved the final version of the manuscript to be published. The Mental Health Supporter Training Program is a project of the Ministry of Health, Labour and Welfare. We would like to express our deep appreciation to Ms. Tomomi Sato, Mr. Satoru Katayama, and Mr. Kazuyuki Morisaki for sharing their valuable experiences with the program. We would also like to thank all the municipalities and instructors in the Mental Health Supporter Training Program who cooperated with this project. We are grateful to Ms. Makiko Kitamura for her assistance with the data aggregation in this research, and to Ms. Emi Okazaki, Ms. Kanako Ogura, Ms. Mayumi Kataoka, Dr. Natsu Sasaki, Dr. Yasutaka Ojio, Dr. Asami Matsunaga, Ms. Miyuki Makino, Ms. Ayako Nakashita, Ms. Chiaki Kamikawa, Ms. Tomoe Shimada, Ms. Emiko Anazawa, Ms. Wakako Suzuki, and Ms. Akiko Sakuraba for their general support. Furthermore, we would like to thank Ms. Ayaka Ishi, Dr. Takamichi Ito, Dr. Kotaro Otsuka, Mr. Shinozaki Yasuyuki, Mr. Tetsushi Tsujimoto, Dr. Yuki Miyamoto, and Mr. Goro Yoshitani for their advice. This work was supported by a project grant for Mental Health Supporter Training Program. This work was also financially supported by the Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry. Dr. Hironori Kuga is an Editorial Board member of Psychiatry and Clinical Neurosciences Reports and a co-author of this article. To minimize bias, he was excluded from all editorial decision-making related to the acceptance of this article for publication. This study was approved by the Research Ethics Committee of the National Centre of Neurology and Psychiatry (No. A2021-084). Informed consent was obtained from all survey participants. This trial was registered in the Japan Registry for Clinical Trials (No. jRCT1030210433).
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