Effectiveness of a virtual-reality anti-stigma application to reduce the stigma of depression: a randomized controlled trial (Preprint)

BACKGROUND Public stigma against depression contributes to low employment rates among individuals with depression and self-stigmatization of people with depression. Contact-based educational (CBE) interventions, either using in-person contact or video-based contact, have been shown to reduce stigma against mental illness effectively. In-person contacts can stimulate empathy in participants but are challenging to arrange, while video-based contact is cost-effective but encounters difficulty stimulating empathy towards the patient. In this paper, we examined the usefulness of the virtual-reality anti-stigma (VRAS) application to reduce public stigma. OBJECTIVE To develop and evaluate a VRAS application that could provide CBE intervention without using real patients. METHODS Sixteen medical students were recruited and randomized 1:1 to intervention and control groups. Participants in the intervention group (VRAS group) used the VRAS application, while those in the control group watched video material on depression. Participants' depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD), both pre-and post-intervention. The feasibility of both the VRAS application and video, and the utility of the VRAS application was also evaluated post-intervention. RESULTS Feasibility score was significantly higher in the intervention group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). This result indicates that the VRAS application promoted an understanding of stigma in participants. However, no significant differences were apparent between the intervention and control groups for DSS (intervention: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (intervention: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease, but the stigma-reducing effects of the VRAS application were not statistically significant for either DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). CONCLUSIONS No significant differences in mean DSS or ASD were seen between VRAS and control groups. However, one item in the feasibility score showed a significant difference, and feedback comments suggested that VRAS was effective in educating about the stigma of depression. CLINICALTRIAL University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049109