One of the most important problems among young people today is the lack of knowledge about mental health issues. The World Health Organization [1
] estimates that 10–20% of the world’s teenagers are at risk of developing various psychological disorders. For this reason, it is of utmost importance to promote good health to prevent and mitigate the effects of such illnesses.
Challenges to this important cause include the fact that many educators recognize that they are unable to detect or properly address these disorders among students [2
]. Additionally, there is a great deal of doubt and confusion among students themselves regarding the truth about psychological disorders and what they can do to respond to them [3
These issues are closely related to the social stigma that currently exists towards mental health disorders. This stigma is marked by widespread ignorance and erroneous information regarding psychological disorders. Moreover, ignorance and misinformation are not only limited to the general population but are also common among students, healthcare professionals, relatives of patients, and patients themselves [4
]. This lack of understanding is a concern as stigma toward mental health can complicate treatment and rehabilitation [7
In response to this reality, various public institutions are undertaking different programs to raise awareness about stigma in mental health. Most of these programs are based on three key strategies, which can be applied independently or in combination: (1) Provide information about psychological disorders, prognoses, and available resources for treatment; (2) facilitate contact with mental health patients so others have the opportunity to meet them personally, thereby dispelling many misconceptions; and, (3) organize public demonstrations to increase the visibility of the mental health population [8
In terms of the format of intervention programs to help decrease stigma toward and increase awareness of psychological health, it is important to adapt to modern means of communication used by young people so they may more easily relate to the programs. For example, electronic resources, such as video games, are increasingly more popular among teenagers [11
]. The use of serious games is also growing in a wide range of fields, including psychology, medicine, and education [13
In the present case, the game, called Stigma Stop, depicts four characters who experience various psychological disorders (i.e., depression, agoraphobia, schizophrenia and bipolar disorder). Over the course of the game, players are provided with information about these illnesses and they are guided along as they learn about a variety of response strategies. Stigma Stop has been shown to be effective in reducing stigma among high school students. (i.e., secondary school and baccalaureate studies) between the ages of 14 and 18 [15
]. In addition, with psychology students, it has been shown to be slightly superior in some dimensions to a talk by professionals and equivalent to a life history by mental health users [16
]. However, secondary school and university students have not been compared jointly to determine whether significant differences exist between the two groups.
Similarly, one variable that may influence the usefulness or interest of students for the serious game is the time typically spent playing video games, or game preference, of the participants. For example, some studies have found that socially isolated individuals tend to prefer violent video games [17
], but it is unclear whether spending more time playing video games or having a preference for a particular type of game can also determine the usefulness of a serious game among students, as in the case of Stigma-Stop, or if this same group would be interested in such a game.
In this way, the objectives of the present study were, firstly, to test the effectiveness of the serious game among secondary school, baccalaureate and university students and, secondly, to determine if the results can be influenced by familiarity and the type of video games that young people usually play.
After applying Stigma Stop to a sample consisting of both high school and university students, it was confirmed, as in previous studies [15
], that the serious game helped to reduce stigma in the total sample, this reduction did not occur in the control group. The stigma factor that was most sensitive to these changes was the variable social distance, while the decrease was less for the variable stereotypes. These findings are important when considering that the image of violence and threat is the most common stigmatizing notion associated with severe psychological disorders [23
When the sample is divided between high school students and university students, a slightly higher effect is observed for the former group. It is also shown that high school students possessed higher initial stigma values. While stigma was significantly lowered in the university students, the effect was slightly smaller compared to the high school students as the university students initially displayed lower levels of stigma.
With regard to the university students, it is observed that stigma was lower in the pre-test evaluation, revealing that more years of education may have an influence on the reduction of stigma [24
]. Nonetheless, as various studies confirm, university students also possess stigmatizing ideas similar to those of the general population, although to a lesser extent, and this is even the case among students enrolled in healthcare studies, such as medicine and nursing [25
]. Thus, there is evidently a need to carry out interventions that specifically target this group [25
]. Furthermore, many professionals working in the education sector recognize that they lack the training to properly respond to the needs of individuals with psychological disorders [28
], revealing that they also require tools that would be useful in their field.
With regard to the demographic variables, it was observed that Stigma Stop had a similar effect among male and female students. No significant differences were found in the results following the intervention, neither when analysed separately nor when gender was evaluated in combination with education level.
As for the students’ evaluation of the game, they gave it a high score for its usefulness and a slightly lower score for its entertainment value. Most participants also stated they would recommend the game to a friend. In this regard, slightly higher scores were registered among high school students than university students.
Regarding the effect that familiarity and time students habitually spend playing video games can have, we found no significant relationship. This finding may own to the fact that Stigma-Stop is a serious game, that is, a game with educational purposes, and students understand that it is “different” from games whose only purpose is to entertain. Indeed, students gave the game a higher score for usefulness than for entertainment. In any case, in future studies it would be interesting to examine this point further, perhaps resorting to a qualitative methodology that could provide more information on the opinion of the participants related to these aspects [29
Pertaining to the limitations of this study, we acknowledge that no follow-up on the results was conducted to see if the reduction in stigma persisted over time. Moreover, the sample of university students was comprised of only individuals from the Schools of Education and Social Sciences and it would be prudent to carry out the intervention with other degree programs as well. Similarly, the number of participants in the control group was lower than in the experimental group.
Finally, as for future research lines, we believe that it is very important that new works focus on stigma towards disorders other than schizophrenia, such as the other illnesses presented in Stigma-Stop (i.e., depression, agoraphobia and bipolar disorder). Furthermore, it would be beneficial to analyse the combined effect of applying a serious game in conjunction with other traditional interventions (such as a talk by a professional or direct contact with mental health patients).