Rüsch Nicolas, Helms Christian, Hörger Jana, Höhle Burkhard, Bernert Hendryk, Muschner Patric, Rose Carolyn, Corrigan Patrick W, Mulfinger Nadine, Zimmermann Peter, Willmund Gerd-Dieter
Department of Psychiatry II, Ulm University and BKH Günzburg, Ulm/Günzburg, Germany.
Center for Military Mental Health, Berlin, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2025 Jul 22. doi: 10.1007/s00127-025-02960-x.
Due to widespread stigma in the military, many military servicemembers with mental illness struggle with discrimination, self-stigma and decisions whether to disclose their condition. This study had the aim to evaluate the efficacy of Honest, Open, Proud (HOP), a four-session peer-led group program adapted to support military personnel with disclosure decisions and to reduce stigma's impact, in the German military.
Ninety-nine active servicemembers with mental illness were randomized to HOP and treatment as usual (TAU) or to TAU alone. The two primary endpoints were stigma stress three weeks after baseline (T1/after HOP for HOP participants) and psychological quality of life six weeks after baseline (T2/after the HOP booster session). This randomized-controlled trial was registered before recruitment onset at ClinicalTrials.gov (NCT03218748).
Compared to the control group, stigma stress decreased significantly among HOP participants at T1 (d = 0.64), while there was no significant effect of HOP on psychological quality of life at T2. HOP had significant positive effects on secondary outcomes at T2: overall quality of life, self-stigma, depressive symptoms, empowerment, well-being, attitudes to disclosure and to help-seeking, and secrecy. Reductions in stigma stress, secrecy, and marginally in overall quality of life (p = 0.055), remained significant twelve weeks after baseline (T3).
This trial provides initial evidence that HOP for active military servicemembers is feasible and effective in terms of stigma stress, disclosure decisions, depressive symptoms, quality of life and well-being. HOP may be a valuable addition to mental health services and peer support in the military.
由于军队中普遍存在的污名化现象，许多患有精神疾病的军人面临歧视、自我污名化以及是否披露病情的抉择困境。本研究旨在评估“诚实、开放、自豪”（HOP）项目的效果，这是一个由同伴主导的四阶段团体项目，旨在帮助德国军队中的军人做出披露病情的决定，并减少污名化的影响。
99名患有精神疾病的现役军人被随机分为HOP组和常规治疗组（TAU），或者仅纳入常规治疗组。两个主要终点分别是基线后三周的污名压力（T1/HOP参与者在HOP项目结束后）以及基线后六周的心理生活质量（T2/HOP强化课程结束后）。这项随机对照试验在招募开始前已在ClinicalTrials.gov上注册（NCT03218748）。
与对照组相比，HOP参与者在T1时的污名压力显著降低（d = 0.64），而HOP在T2时对心理生活质量没有显著影响。HOP在T2时对次要结局有显著的积极影响：总体生活质量、自我污名化、抑郁症状、赋权、幸福感、对披露和寻求帮助的态度以及保密情况。在基线后十二周（T3），污名压力、保密情况以及总体生活质量的轻微下降（p = 0.055）仍然显著。
本试验提供了初步证据，表明针对现役军人的HOP项目在污名压力、披露决定、抑郁症状、生活质量和幸福感方面是可行且有效的。HOP可能是军队心理健康服务和同伴支持的一项有价值的补充。
