Cluster-Randomized Trial of a Multilevel Parish-Based Intervention to Improve Mental Health Literacy and Reduce Stigma in Hispanic Communities.

Purpose: Greater risk for stigma and low mental health literacy have been attributed to the longstanding mental health treatment disparities experienced by the U.S. Hispanic population. Limited research has focused on developing and evaluating effective interventions targeting these disparities. We examined the effectiveness of a multilevel, multicomponent, parish-based intervention involving a partnership between the Diocese of San Bernardino and the National Alliance on Mental Illness in which contact-based education was delivered to Hispanic church attendees. Methods: This cluster-randomized trial enrolled 1,715 participants who were recruited from 14 parishes that were randomly assigned to the intervention (N = 911) or wait-list condition (N = 804). Baseline and 12-month surveys assessed outcomes related to mental health stigma and literacy, support provided to individuals with mental health problems, mental health service use, and psychological distress. Results: Intent-to-treat analyses indicated no significant intervention effects. Only 45% (N = 412) of respondents within the intervention parishes reported exposure to at least one intervention activity. As-treated analyses showed that compared to control parish participants, intervention parish participants who were exposed were significantly less likely to social distance from and more likely to provide support to individuals with mental illness and had greater decreases in rates of serious psychological distress. Conclusions: This study demonstrated when exposed to a multilevel, multicomponent stigma intervention within a faith-based congregational setting long-term positive outcomes could be achieved. Findings reinforce how partnerships with faith communities can play an integral role in addressing stigma and unmet mental health needs. ClinicalTrialsgov Identifier: NCT03631745.