***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Facing frequent stigma and discrimination , many people with mental illness have to choose between secrecy and disclosure in different setting s. Coming Out Proud ( COP ) , a 3-week peer-led group intervention , offers support in this domain in order to reduce stigma 's negative impact . AIMS To examine COP 's efficacy to reduce negative stigma-related outcomes and to promote adaptive coping styles ( Current Controlled Trials number : IS RCT N43516734 ) . METHOD In a pilot r and omised controlled trial , 100 participants with mental illness were assigned to COP or a treatment-as-usual control condition . Outcomes included self-stigma , empowerment , stigma stress , secrecy and perceived benefits of disclosure . RESULTS Intention-to-treat analyses found no effect of COP on self-stigma or empowerment , but positive effects on stigma stress , disclosure-related distress , secrecy and perceived benefits of disclosure . Some effects diminished during the 3-week follow-up period . CONCLUSIONS Coming Out Proud has immediate positive effects on disclosure- and stigma stress-related variables and may thus alleviate stigma 's negative impact BACKGROUND Internalised stigma in young people meeting criteria for at-risk mental states ( ARMS ) has been highlighted as an important issue , and it has been suggested that provision of cognitive therapy may increase such stigma . AIMS To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial . METHOD Participants meeting criteria for ARMS were recruited as part of a multisite r and omised controlled trial of cognitive therapy for prevention and amelioration of psychosis . Participants were assessed at baseline and at 6 , 12 , 18 and 24 months using measures of psychotic experiences , symptoms and internalised stigma . RESULTS Negative appraisal s of experiences were significantly reduced in the group assigned to cognitive therapy ( estimated difference at 12 months was -1.36 ( 95 % CI -2.69 to -0.02 ) , P = 0.047 ) . There was no difference in social acceptability of experiences ( estimated difference at 12 months was 0.46 , 95 % CI -0.05 to 0.98 , P = 0.079 ) . CONCLUSIONS These findings suggest that , rather than increasing internalised stigma , cognitive therapy decreases negative appraisal s of unusual experiences in young people at risk of psychosis ; as such , it is a non-stigmatising intervention for this population BACKGROUND Many mental health service users delay or avoid disclosing their condition to employers because of experience , or anticipation , of discrimination . However , non-disclosure precludes the ability to request ' reasonable adjustments ' . There have been no intervention studies to support decision-making about disclosure to an employer . AIMS To determine whether the decision aid has an effect that is sustained beyond its immediate impact ; to determine whether a large-scale trial is feasible ; and to optimise the design s of a larger trial and of the decision aid . METHOD In this exploratory r and omised controlled trial ( RCT ) in London , participants were r and omly assigned to use of a decision aid plus usual care or usual care alone . Follow-up was at 3 months . Primary outcomes were : ( a ) stage of decision-making ; ( b ) decisional conflict ; and ( c ) employment-related outcomes ( trial registration number : NCT01379014 ) . RESULTS We recruited 80 participants and interventions were completed for 36 out of 40 in the intervention group ; in total 71 participants were followed up . Intention-to-treat analysis showed that reduction in decisional conflict was significantly greater in the intervention group than among controls ( mean improvement -22.7 ( s.d . = 15.2 ) v. -11.2 ( s.d . = 18.1 ) , P = 0.005 ) . More of the intervention group than controls were in full-time employment at follow-up ( P = 0.03 ) . CONCLUSIONS The observed reduction in decisional conflict regarding disclosure has a number of potential benefits which next need to be tested in a definitive trial OBJECTIVE Self-esteem is widely used as an outcome variable in studies of psychiatric rehabilitation , based on the assumption that improved functional status leads to higher self-esteem . Little is known , however , about the determinants of self-esteem among adults with severe mental illness . The utility of a popular measure of global self-esteem-the Rosenberg Self-Esteem Scale-as  an outcome measure was examined in this population . METHODS A total of 143 participants enrolled in a study of vocational rehabilitation were assessed at baseline and six , 12 , and 18 months later using measures of  self-esteem , symptoms , life satisfaction , work status , housing status , and total income . RESULTS Scores on the Rosenberg Self-Esteem Scale did not vary with work status or other functional outcomes but instead were strongly related to measures of life satisfaction and affective symptoms . CONCLUSIONS The hypothesis that working leads to improved self-esteem for people with severe mental illness was not supported . For this population , self-esteem , as measured by the Rosenberg Self-Esteem Scale , appears to be a relatively stable trait that reflects general life satisfaction and affective symptoms rather than objective functional status Low  self esteem in individuals with a psychotic disorder is common and may be related to poorer clinical outcomes . However , there has been little research on devising treatment methods to improve self-esteem either generally or in psychotic patients in particular . The aims of this study were to evaluate the efficacy of a simple cognitive behavioural intervention to improve self esteem in psychotic patients who scored poorly on a self-esteem measure . This pilot study was a r and omised control trial with a convenience sample of chronic psychotic in patients . The cognitive behavioural self-esteem intervention , as an adjunct to treatment as usual ( TAU ) , was compared to TAU alone in patients with psychosis . The individual self-esteem intervention as described by Tarrier ( The use of coping strategies and self-regulation in the treatment of psychosis . ( 2001 ) ) consisted of working with participants to elicit positive self-attributes and then identify specific behavioural examples to provide evidence of this attribute . Emphasis was given to any consequential change in the patient 's belief that they had the attribute . The results indicated that this cognitive behavioural treatment for self-esteem used as an adjunct treatment in psychosis , result ed in clinical benefits in terms of increased self-esteem , decreased psychotic symptomatology and improved social functioning . These benefits were largely maintained at 3-month follow-up OBJECTIVES Psychoeducational approaches are promising interventions for the long-term management of bipolar disorder . In consultation with professionals , patients , and their families we have developed a novel web-based psychoeducational intervention for bipolar disorder called Beating Bipolar . We undertook a preliminary exploratory r and omized trial to examine efficacy , feasibility and acceptability . METHODS This was an exploratory r and omized controlled trial of Beating Bipolar ( current controlled trials registration number : IS RCT N81375447 ) . The control arm was treatment-as-usual and the a priori primary outcome measure was quality of life [ measured by the brief World Health Organization Quality of Life ( WHOQOL-BREF ) scale ] . Secondary outcomes included psychosocial functioning , insight , depressive and manic symptoms and relapse , and use of healthcare re sources . Fifty participants were r and omized to either the Beating Bipolar intervention plus treatment-as-usual or just treatment-as-usual .  The intervention was delivered over a four-month period and outcomes were assessed six months later . RESULTS There was no significant difference between the intervention and control groups on the primary outcome measure ( total WHOQOL-BREF score ) but there was a modest improvement within the psychological subsection of the WHOQOL-BREF for the intervention group relative to the control group . There were no significant differences between the groups on any of the secondary outcome measures . CONCLUSIONS Beating Bipolar is potentially a safe and engaging intervention which can be delivered remotely to large numbers of patients with bipolar disorder at relatively low cost . It may have a modest effect on psychological quality of life . Further work is required to establish the impact of this intervention on insight , knowledge , treatment adherence , self-efficacy and self-management skills This study assessed the Anti-Stigma Project workshop , a contact/education intervention developed by On Our Own of Maryl and , Inc. and the Maryl and Mental Hygiene Administration . Two separate r and omized controlled trials administered pre- and post-test question naire assessment s. One included people with mental illness ( N = 127 ) and a second included mental health providers ( N = 131 ) . Post-intervention , people with mental illness were more aware of stigma , had lower levels of prejudice , and increased belief in recovery . Providers were more aware of stigma , had lower levels of prejudice , and increased concurrence in self-determination of people with mental illness . Increasing providers ’ stigma awareness and recognition can promote higher quality service delivery . Increasing stigma awareness and recognition for people with mental illness can foster confidence in overcoming psychiatric disabilities . Using a participatory action research team , our protocol included extant and newly developed stigma change tools . Organizations seeking to conduct effective evaluation studies should consider collaborative processes including the expertise of affected constituents Elevated internalized stigma is common and is linked to subjective and objective outcomes for severe mental illness . The authors developed a manualized group-based intervention ( Narrative Enhancement/Cognitive Therapy ; NECT ) to address internalized stigma in severe mental illness . The purpose of the present study was to evaluate the feasibility and effectiveness of NECT . In total , 144 individuals were screened at two sites to evaluate if they met criteria for " elevated " internalized stigma ; 39 and were eligible were r and omized to NECT or to treatment as usual ( TAU )  and were assessed at baseline , posttreatment , and 3-month follow-up . Fifteen of the 21 individuals assigned to NECT were classified as " exposed " to treatment . Intent-to-treat analyses found no significant difference between the NECT and TAU groups . A comparison of exposed versus unexposed participants noted trends for exposed participants to have improved more in two aspects of self-stigma as well as insight . We conclude that NECT is feasible and tolerable , but findings did not support the hypothesis that NECT was more effective than TAU , although small sample size and significant dropout may have restricted the ability to detect an effect OBJECTIVE Research has shown that people are reluctant to seek professional help for depression , especially from mental health professionals . This may be because of the impact of stigma which can involve people 's own responses to depression and help-seeking ( self stigma ) as well as their perceptions of others ' negative responses ( perceived stigma ) . The aim of this article was to examine community help-seeking intentions and stigmatizing beliefs associated with depression . METHOD A total of 1,312 adults r and omly sample d from the Australian community completed a question naire providing a depression vignette and measures of self- and perceived-stigmatizing responses , source -specific help-seeking intentions , current depressive symptoms and depression experience , and demographics . RESULTS Many people reported they would feel embarrassed about seeking help from professionals , and believed that other people would have a negative reaction to them if they sought such help . Some expected professionals to respond negatively to them . Responses varied according to the sources of professional help . Self-embarrassment and expectations that others would respond negatively predicted the likelihood of help-seeking from professional sources . CONCLUSION Self- and perceived-stigmatizing responses to help-seeking for depression are prevalent in the community and are associated with reluctance to seek professional help . Interventions should focus on minimizing expectations of negative responses from others and negative self-responses to help-seeking , and should target younger people This study evaluated the effectiveness of a cognitive behaviour therapy Internet program ( MoodGYM ) for depressive symptoms , attributional style , self‐esteem and beliefs about depression , and on depression and depression‐vulnerable status in male youth . A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to st and ard personal development activities . Outcomes were measured before commencement , post‐program and 16 weeks post‐program . There were no significant between‐group differences in change scores pre‐ to post‐ or pre‐ to follow‐up using the intention to treat sample or for participants with post‐ and /or follow‐up data . For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms ( Effect Size , ES = 0.34 ) , attributional style ( ES = 0.17 ) and self‐esteem ( ES = 0.16 ) at post‐program , although only the effect for self‐esteem was sustained at follow‐up . Both groups showed improvement in their beliefs about depression at follow‐up , with the control group showing a moderate relative benefit ( ES = 0.40 ) . While the numbers are small , there was a reduction in the risk of being depressed in the MoodGYM group of 9 % at post‐treatment compared with a slightly increased risk for the control group . The risk of being classified as vulnerable to depression reduced by 17 % in the MoodGYM group at post‐treatment compared with no change in risk for the control group . These reductions in risk for the MoodGYM group were not sustained at follow‐up . The limitations of the study highlight several important challenges for MoodGYM and other self‐directed Internet cognitive behaviour therapy programs . These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it , and how to enhance the sustainability of any benefits Forty-two Black clients referred for outpatient treatment were r and omly assigned to receive existing brochures about services or a psychoeducational booklet about stigma based on 
    Output:
    
None of the individual studies found sustainable effects on other outcomes , including recovery , help-seeking behaviour and self-stigma .
Conclusions : The effectiveness of interventions against self-stigma is uncertain .