Efficacy of the peer-led ''Honest, Open, Proud'' group program to improve stigma stress and quality of life in adolescents with mental illness: randomized controlled trial

Abstract Adolescents with mental illness (MI) often experience public stigma and self-stigma and struggle with the dilemma whether to disclose their MI, which may reduce their quality of life (QoL). Disclosure decisions are central in coping with MI and stigma, as disclosure may improve well-being and facilitate help-seeking, but can be risky. The peer-led Honest, Open, Proud (HOP) group program was developed to support disclosure decisions and to reduce self-stigma. In this two-arm 2:1-randomized controlled trial, 113 adolescents with MI aged 13–21 years and at least moderate disclosure-related distress were recruited from three Departments of Child and Adolescent Psychiatry and an outpatient practice for child and adolescent psychiatry in Southern Germany. Participants were assigned to HOP plus treatment as usual (TAU) or to TAU alone. Primary outcomes (stigma stress and QoL, both at T1) and secondary outcomes were assessed at baseline (T0), post-intervention (T1, 5 weeks after T0) and at follow-up 6 months after baseline (T2) and analyzed with mixed-model repeated measures. Compared to control, HOP significantly reduced stigma stress at T1 and T2. A significant increase in QoL was observed at T2, not T1. HOP led to improvements in attitudes to disclosure at school, university or work at T1, self-stigma and disclosure-related distress at T2, and empowerment at T1 and T2. Disclosure decisions at baseline did not moderate HOP effects. Since HOP reduces stigma stress and leads to broader improvements over time, it should be offered as a peer-led program to support adolescents in their coping with MI stigma.