Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People with Severe Mental Illness— A Randomized Control Trial with Six-month Follow-up

Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People with Severe Mental Illness— A Randomized Control Trial with Six-month Follow-up | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People with Severe Mental Illness— A Randomized Control Trial with Six-month Follow-up Daniel Kim-Wan YOUNG, Petrus Yat-Nam NG, Patrick CORRIGAN, Renee CHIU This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7175089/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives. The aim of this study was to evaluate the longer-term impact of a 12-session Expanded Coming Out Proud (ECOP) delivered by social worker with the skills of empowerment and transformation of negative self-stigmatising beliefs to reduce self-stigma in people with severe mental illness. Methods . This study was a multicentre, randomized controlled trial with 6-month follow-up. The intervention group received the ECOP in addition to treatment as usual (TAU), which included interest classes and recreational activities, while the control group received TAU. Results. Group x time repeated measures of analysis of covariance demonstrated that the ECOP, as compared with the control group, was effective on helping people with high self-stigma to achieve significant larger improvement in self-stigma, depressive symptoms and self-esteem at post-intervention, with these intervention effects being well sustained up to 6-month follow-up. Conclusion. The results of this study demonstrate the efficacy of the ECOP on improving self-stigma. Health sciences/Diseases Health sciences/Health care Biological sciences/Psychology Social science/Psychology Cognitive behavioural therapy Coming out proud Randomised controlled trial Self-stigma Mental illness Figures Figure 1 Introduction People with severe mental illness, including those diagnosed with schizophrenia, bipolar disorder or major depression, often experience social stigma that negatively impact their recovery (Wood et al., 2017). In Chinese societies, stigmatising attitudes are common among residents, employers, carers and mental health professionals, such that people with mental illness are perceived as unpredictable, dangerous, abnormal, strange, introverted and with low self-esteem (Authors, 2016; Yin et al., 2020). Self-stigma refers to the extent to which people with severe mental illness endorse the negative beliefs and feelings associated with the publicly stigmatised identity for themselves (Fox et al., 2018). While approximately one-third (31.3%) of people with severe mental illness in all countries report self-stigma (Dubreucq et al., 2021; Gerlinger et al., 2013), the prevalence rate of self-stigma among people with severe mental illness was 38.8% in Hong Kong and 49.5% in China (particularly Guangzhou) (Authors, 2015). Self-stigma is associated with negative effects on individuals’ recovery by lowering quality of life, self-esteem, self-efficacy and empowerment, and reducing treatment adherence, which in turn leads individuals to refuse psychiatric medication, increase psychiatric symptoms and even relapse (Authors, 2020; Du et al., 2023; Dubreucq et al., 2021; Gerlinger et al., 2013; Lamarca et al., 2024). Therefore, it is important to develop therapeutic interventions that reduce the self-stigma of people with severe mental illness to facilitate their recovery. Studies have suggested that it is feasible to reduce self-stigma of this population through short-term groups for Western (Griffiths et al., 2014; Lamarca et al., 2024; Yanos et al., 2015). Cognitive behavioural therapy group has been shown to be effective in reducing self-stigma in Chinese and Asian people with severe mental illness (Authors, 2018; Authors, 2020b; Lamarca et al., 2024; Shimotsu et al., 2014; Wood et al., 2018). According to cognitive behavioural therapy, self-stigmatising beliefs are considered irrational beliefs that are maintained by the person with severe mental illness (Authors, 2013b). The development of personal self-stigmatising beliefs involves four progressive stages of cognitive processes, including: awareness of the public’s stigmatising beliefs about mental illness, personal agreement with the public’s negative stigmatising beliefs, self-concurrence in which the person applies the public's stigmatising beliefs to themselves, and self-harm. In fact, the degree of self-concurrence of these stigmatising beliefs varies from person to person; thus, there are individual differences in the degree of self-stigma. Recently, a culturally adapted cognitive behavioural therapy group has been shown to be effective in reducing self-stigma in Chinese people with mental illness by helping individuals to change self-stigmatising beliefs such as "shame"," "fate" and "being a burden to others" that are shaped by Chinese culture (Authors, 2018; Authors, 2020b). In addition, the Coming Out Proud model has been developed to empower people with severe mental illness in their decisions about disclosing or concealing their mental illness in different settings (Authors, 2013a). According to this model, empowerment counteracts self-stigma, and an appropriate level of disclosure of one’s experience of mental illness can reduce self-stigma and promote recovery (Authors, 2013a). Research studies have shown the effectiveness of Coming Out Proud in reducing self-stigma, stigma stress and depressive symptoms (Lamarca et al., 2024; Rüsch & Kösters, 2021). A new intervention called the Expanded Coming Out Proud (ECOP) group has been developed (Authors et al., 2025) that aims to integrate the Coming Out Proud (Authors, 2013a; Rüsch & Kösters, 2021) and cognitive behavioural therapy (Authors, 2018) for people with severe mental illness to reduce self-stigma. A previous pilot randomized controlled trial has shown the effectiveness of ECOP in improving self-stigma with a medium effect size (Hedges g = 0.6), reducing depressive symptoms with a medium effect size (Hedges g = 0.6) and anxiety symptoms with a medium effect size (Hedges g = 0.5) (Authors et al., 2025). However, whether these intervention effects could be maintained at the 6-month follow-up remains unclear, as a 6-month follow-up study on ECOP is lacking. Research Method Aims and Hypothesis. The aim of this study was to investigate the effectiveness of ECOP in people with severe mental illness at post-intervention, 3-month follow-up, and 6-month follow-up periods. This study also aimed to investigate and compare the intervention effects of ECOP for people with high and low self-stigma respectively, and to investigate the predictive power of improvement in self-stigma and empowerment on improvement in intervention outcomes, as there have been few studies in these areas to date. Hypotheses : After completing the intervention group, both participants with high self-stigma and low self-stigma showed significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up. After completing the intervention group, participants with high self-stigma, compared to control group participants, showed a significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up. After completing the intervention group, participants with low self-stigma, compared to control group participants, showed a significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up. The improvement in self-esteem and reduction in depressive symptoms are predicted by the improvement in self-stigma and improvement in empowerment. Research Design. This study was a multicentre randomized controlled trial. Participants were recruited from four different community-based mental health centres through open recruitment via promotional activities and referrals from these centres. Participants who consented to participate in this research project were randomly assigned to a treatment group or control group using computer software administered by a research team member who did not collect data or implement the ECOP group. Block randomisation was performed to ensure that the treatment and control groups had the same number of participants. The control group received treatment as usual (TAU) provided by a community mental health centre, including interest classes and recreational activities. In addition to TAU, the intervention group received an ECOP group led by an experienced social worker from a community mental health centre. To compare the effects of the intervention group on participants with high and low self-stigma, the intervention group was categorized into two groups, i.e. high and low self-stigma groups. Both the high and low self-stigma groups received the same ECOP intervention. A research assistant conducted data collection and outcome assessment at baseline, post-treatment, 3-month and 6-month follow-ups. See Figure 1 for the flow of participants through each phase of the study. Inclusion criteria of subjects. The inclusion criteria included: (1) 18 years of age or older; (2) received a diagnosis of a mental illness from their medical officers in accordance with the criteria of the Diagnostic and Statistical Manual of Mental Disorder (Fifth edition) (American Psychiatric Association, 2013); and (3) receiving community mental health service provided by collaborative local non-governmental organisations. Sample Size. The sample size was calculated using G*Power 3.1 software. Previous literature on intervention groups indicated a small to medium effect size with Cohen’s d between 0.2 and 0.9 (Mittal et al., 2012; Authors, 2018). In order to achieve statistical power of 0.80, a minimum sample size of 64 subjects is required to demonstrate an effect size of 0.4. Assuming a dropout rate of 20%, a total of eighty participants are required. Of these, 40 participants were randomly assigned to the treatment group, while a further 40 participants were randomly assigned to the control group. Intervention and Control group. The ECOP program aimed to integrate Coming Out Proud and cognitive behaviour therapy. The ECOP was conducted in collaborating community mental health centres over an intervention period of 12 weeks with one session per week, each session lasting for about 1.5 hours. A program manual with standardized and detailed guidelines were designed and written by the research team. In this study, the ECOP consisted of 12 sessions, covering the following topics: sharing the experience of stigma (session 1); challenging social stigmatized beliefs (session 2); transforming self-stigmatized beliefs with CBT skill, e.g. guided discovery, pie-chart, behavioural experiment, (session 3–6); relaxation and social skill training on facing social stigma situations (session 7–8); reflecting the risks and benefits of secrecy and disclosure of mental illness (session 9); explore the five levels of disclosure, which range from the lowest level of maintaining secrecy to the highest level of broadcasting one’s experience with mental illness (session 10); learning to share own story with a mental illness (session 11); summary (session 12). A standardised group manual was developed for use in the ECOP group intervention. The 1 st to 8 th sessions of the ECOP were conducted by an experienced social worker, while the 8 th to 11 st sessions of the ECOP were co-led by a social worker and a peer support worker. Both the social worker and the peer support worker received training from the research team. In the study, participants in the control group received treatment as usual, including interest classes and leisure activities provided by collaborating community mental health centres. Outcome Assessment Tools. The Chinese Internalised Stigma of Mental Illness (ISMI; Authors, 2016) is a 24 -item self-reported scale to measure changes in self-stigma with good validity and reliability (α = 0.93). It consists of four subscales that measure shame/alienation, stereotype endorsement, perceived discrimination and social withdrawal. Each item is rated with a score on a 4-point scale which ranges from strongly agree “1” to strongly disagree “4”. Item scores are averaged, with a higher score indicating greater self-stigma. The Chinese Beck Depression Inventory (BDI; Byrne et al., 2004) is a 21-item self-reported scale to measure depressive symptoms with good validity and reliability (α = 0.91). As suggested by previous studies (Beck et al., 1996), a BDI score ≥ 14 is considered to be the cut-off point for clinical depression, which was adopted in the present study. The Personal Empowerment Self-Assessment Scale (PESAS; Authors, 2013a) is a 10-item self-reported scale to measure an individual's perception of their own empowerment. Each item is rated on a 5-point scale with scores ranging from 1 “strongly disagree” to 5 “strongly agree”. The PESAS was developed as part of the Coming Out Proud with satisfactory reliability and validity (Authors, 2013a). Data Analysis. For all analyses, two-tailed p values of < 0.05 is considered statistically significant. Data analyses will be performed using SPSS 29.0 (IBM Corporation, 2024). For hypotheses (1), within group intervention effects on all outcome assessment scores were investigated by using repeated measures of analysis of variance (ANOVA). For hypotheses (2) and (3), group x time repeated measures of covariance (ANCOVA) controlling for baseline outcome assessment scores were used to compare changes in outcomes of all comparison groups for the improved ISMI, BDI and RSE scores at post-intervention, 3-month and 6-month follow-ups, while group x time repeated measures of repeated measures of variance (ANOVA) were used to compare changes in outcomes of all comparison groups for the improved PESAS score at post-intervention, 3-month and 6-month follow-ups. Effect sizes for the ANOVA and ANCOVA were calculated using partial η2, with values of 0.01, 0.06 and 0.14 considered small, moderate and large effects, respectively (Cohen, 1988). For hypothesis (4), the predictive power of the improved ISMI and PESAS scores from pre-intervention to post-intervention on the improved BDI and RSE score were investigated and compared using multiple linear regression analysis, using stepwise selection procedure to investigate the relative predictive power of the improved ISMI score and PESAS score. Research Results This study was conducted from October 2022 to September 2023. 80 participants were recruited from four local community mental health centres. Initially, 40 participants were randomly allocated to the treatment group, while another 40 participants were randomly allocated to the control group. After group allocation, two participants in the intervention group and 15 of the 40 participants in the control group dropped out of the study without completing the whole set of outcome assessment scale nor receive the intervention. After completing the baseline outcome assessment, the intervention group categorized into two groups according to baseline ISMI score, i.e. high self-stigma group (i.e., baseline ISMI score ≥ 2.5); and low self-stigma group (i.e., baseline ISMI score < 2.5). Figure 1 shows the Consort Flow Diagram. The modified intention-to-treat (mITT) principle was applied so that those participants who did not receive the intervention after group allocation were excluded from the analysis. The final analysis included the high self-stigma group ( n = 13), the low self-stigma group ( n = 25) and the control group ( n = 25). The results of the chi-square tests and ANOVA revealed no significant differences between the participants who dropped out and those who did not on any of the baseline demographic variables. All missing data were treated with the multiple imputation method prior to data analysis. Participant Characteristics. As shown in Table 1, results of ANOVA and chi-square tests showed no significant differences in demographic variables between the high self-stigma group, the low self-stigma group and the control group, except gender. The low self-stigma group had a higher percentage of male participants than the other groups. All participants ( n = 63) had a mean age of 47.19 years (SD = 13.46). The majority were female (73.02%, n = 46), single (66.67%, n = 42), lived with family (73.02%, n = 46), completed secondary school (58.73%, n = 37). About two thirds received a diagnosis of schizophrenia (62.91%, n = 39), followed by depression (24.19%, n = 15), and anxiety (11.29%, n = 7). On average, they had been suffering from a mental illness for around 12 years ( M = 12.57, SD = 1.52), and had admitted into mental hospital twice ( M = 2.13, SD = 2.67). [Invert Table 1 about here] Baseline Outcome Assessment Scores . The results of ANOVA showed that the participants of the high self-stigma group, the low self-stigma group and the control group differed in their baseline ISMI score, BDI score and RSE score, but not in PESAS score. Specifically, the high self-stigma group as compared to the control group, reported significantly higher baseline ISMI score (mean difference (SE): 0.37 (0.13), p < 0.001, 95% CI [0.04, 0.69]) and baseline BDI score (mean difference (SE): 11.48 (4.61), p = 0.047 < 0.05, 95% CI [0.11, 22.84]), but showed on difference in baseline RSE and PESAS scores. The low self-stigma group, as compared to the control group, reported significantly lower baseline ISMI score (mean difference (SE): -0.42 (0.11), p = 0.00 < 0.01, 95% CI [-0.69, -0.14), but showed on difference in BDI, RSE and PESAS scores. The high self-stigma group as compared to the low self-stigma group, reported significantly higher baseline ISMI score (mean difference (SE): 0.78 (0.13), p < 0.001, 95% CI [0.45, 1.11]), baseline BDI score (mean difference (SE): 17.68 (4.61), p < 0.001, 95% CI [6.31, 29.04]), baseline RSE score (mean difference (SE): -5.62 (1.72), p = 0.005 < 0.01, 95% CI [-9.86, -1.40]), but showed on difference in PESAS score. [Invert Table 2 about here] Dropout Rate. The dropout rate for the high self-stigma group ( n = 13) was 7.69% ( n = 1) at post-intervention, 7.69% ( n = 1) at 3-month and 7.69% ( n = 1) at 6-month follow-up. The dropout rate for the low self-stigma group was 4.00% ( n = 2) at post-intervention, 12.00% ( n = 3) at 3-month, and 12.00% ( n = 3) at 6-month follow-up. The dropout rate for the control group was 0.00% ( n = 0) at post-intervention, 0.00% ( n = 0) at 3-month and 8.00% ( n = 2) at 6-month follow-up. Intervention Outcomes At post-intervention. Within group intervention effect. As shown in Table 3, results of repeated measures ANOVA demonstrated that there was a significant improvement in the high self-stigma group from pre-intervention to post-intervention with a large effect size in ISMI score ( F (1, 11) = 28.77, p < 0.01, η 2 = 0.71), BDI score ( F (1, 11) = 22.55, p < 0.01, η 2 = 0.65) and RSE score ( F (1, 11) = 12.40, p < 0.05, η 2 = 0.51) as well as a close to significantly improvement in PESAS ( F (1, 11) = 3.94, p = 0.07 < 0.1, η 2 = 0.25). The low self-stigma group showed a significant improvement with a large effect size from pre-intervention to post-intervention in ISMI score ( F (1, 23) = 6.79, p < 0.05, η 2 = 0.22), BDI score ( F (1, 23) = 37.99, p < 0.01, η 2 = 0.61), and RSE score ( F (1, 23) = 8.74, p < 0.01, η 2 = 0.27), and PESAS ( F (1, 23) = 16.14, p < 0.01, η 2 = 0.40). The control group a significant improvement in the high self-stigma group from pre-intervention to post-intervention with a large effect size in ISMI score ( F (1, 23) = 5.30, p < 0.05, η 2 = 0.18), but did not show any significant improvement in BDI, RSE and PESAS scores. The high self-stigma group showed the largest within group effect size (η 2 = 0.71), followed by the low self-stigma group ( η 2 = 0.22) and the control group ( η 2 = 0.18). Between group intervention effect. Results of the 2 (time: t1 vs t2) x 3 (group) repeated measures ANCOVA demonstrated that, after controlling baseline outcome assessment score, the high self-stigma group, the low stigma group and the control group had a had a significant difference from pre-intervention to post-intervention with a large effect size in the improvement in BDI score ( F (2, 59) = 8.29, p < 0.01, η 2 = 0.22), but not in RSE, ISMI and PESAS scores. The results of pairwise comparison analysis showed that the high self-stigma group, compared to the control group, had a significant larger improvement in BDI score from pre-intervention to post-intervention (mean difference (SE): -6.69 (2.60), p = 0.024 < 0.05, 95% CI [-12.71, -0.67]), while the low self-stigma group, compared to the control group, did not show a significant improvement in BDI score from pre-intervention to post-intervention. At 3-month and 6-month follow-up. Within group intervention effect. Results of repeated measures ANOVA demonstrated that the high self-stigma and low self-stigma groups showed no any significant change in ISMI, BDI, RSE and PESAS scores from post-intervention to 3-month follow-up as well as from 3-month follow-up to 6-month follow-up. Additionally, the high self-stigma group showed a significant improvement from pre-intervention to 6-month follow-up with a large effect size in ISMI score ( F (1, 11) = 12.34, p < 0.01, η 2 = 0.51), BDI score ( F (1, 11) = 8.47, p < 0.05, η 2 = 0.41) and RSE score ( F (1, 11) = 7.07, p < 0.05, η 2 = 0.37) and a close to significant improvement in PESAS ( F (1, 11) = 3.67, p = 0.08 < 0.1, η 2 = 0.23). Similarly, the low self-stigma group showed a significant improvement from pre-intervention to 6-month follow-up with a large effect size in ISMI score F (1, 23) = 7.18, p < 0.05, η2 = 0.23), BDI score ( F (1, 23) = 23.45, p < 0.01, η 2 = 0.49) and PESAS score ( F (1, 23) = 6.71, p < 0.05, η 2 = 0.22), and a close to significant improvement in RSE ( F (1, 11) = 3.52, p = 0.07 < 0.1, η 2 = 0.13). These results showed that the effects of the intervention in improving ISMI, BDI, RSE and PESAS scores in the high and low self-stigma groups at post-intervention was well sustained at the three-month and six-month follow-up. Between group intervention effect. Results of the 3 (time; t1 vs t2 vs t3) x 3 (group) repeated measures ANCOVA and ANOVA demonstrated that, after controlling baseline outcome assessment score, the high self-stigma group, the low self-stigma group and the control group had a significant difference from pre-intervention to 3-month follow-up, in their improvement in ISMI score with a large effect size ( F (2, 59) = 5.36, p < 0.05, η 2 = 0.15), BDI score with a large effect size (F(2, 59) = 8.25, p < 0.01, η 2 = 0.22) and RSE score with a moderate effect size ( F (2, 59) = 3.77, p < 0.05, η 2 = 0.09), but not in PESAS score. Similarly, the results of the 4 (time; t1 vs t2 vs t3 vs t4) x 3 (group) repeated measures ANCOVA and ANOVA demonstrated that these three groups also showed a significant difference from pre-intervention to 6-month follow-up in their improvement in ISMI score with a large effect size ( F (2, 59) = 5.42, p < 0.05, η 2 = 0.16), BDI score ( F (2, 59) = 5.46, p < 0.05, η 2 = 0.16) and RSE score ( F (2, 59) = 4.71, p < 0.05, η 2 = 0.14), but not in PESAS score. The pairwise comparison analysis showed that the high self-stigma group, as compared with the control group, had a significant larger improvement in ISMI score from pre-intervention to 3-month follow-up (mean difference (SE): -0.23 (0.07), p = 0.009 < 0.01, 95% CI [-0.41, -0.05]), ISMI score from pre-intervention to 6-month follow-up (mean difference (SE): -0.24 (0.09), p = 0.03 < 0.05, 95% CI [-0.45, -0.02]), RSE score from pre-intervention to 3-month follow-up (mean difference (SE): 1.99 (0.75), p = 0.03 < 0.05, 95% CI [0.15, 3.85]), RSE score from pre-intervention to 6-month follow-up (mean difference (SE): 2.41 (0.84), p = 0.017 < 0.05, 95% CI [-0.35, 4.48]), BDI score from pre-intervention to 3-month follow-up (mean difference (SE): -7.52 (2.42), p = 0.009 < 0.01, 95% CI [-13.48, -1.56]) and a close to significant improvement in BDI from pre-intervention to 6-month follow-up (mean difference (SE): -6.35 (2.62), p = 0.06 < 0.1, 95% CI [-12.81, 0.11]), but showed no significant difference in PESAS scores from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up. The pairwise comparison analysis also showed that the low self-stigma group, as compared with the control group, had a significant larger improvement in BDI score from pre-intervention to 3-month follow-up (mean difference (SE): -6.77 (1.95), p = 0.03 < 0.05, 95% CI [-11.56, -1.97]) and BDI score from pre-intervention to 6-month follow-up (mean difference (SE): -6.14 (2.11), p = 0.02 < 0.05, 95% CI [-11.34, -0.94]), but showed no significant difference in ISMI, RSE and PESAS scores from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up. [Invert Table 3 about here] Predictive variable for rBDI and rRSE scores. The results of the one-way ANOVA and Spearman correlation analysis within the two intervention groups ( n = 38) indicated that the rBDI and rRSE from pre-intervention to post-intervention, from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up were not related to any demographic variables, and thus the improvement in BDI and RSE were not predicted by any demographic variables. Table 4 provides the results of linear regression analyses within the two intervention groups ( n = 38) for rBDI and rRSE, with rISMI and r PESAS as dependent variables. At post-intervention. The multiple linear regression model for the rBDI score from pre-intervention to post-intervention was significant ( F (1, 36) = 10.25, p < 0.001) and explained 23% of the total variance. The multiple linear regression model for the rRSE score was significant ( F (1, 36) = 13.56, p < 0.001) and explained 29% of the total variance. The rBDI score and rRSE score from pre-intervention to post-intervention were significant predicted by both rISMI score and rPESAS score from pre-intervention to post-intervention respectively. At 3-month and 6-month follow-up. The multiple linear regression analyses for rBDI score from pre-intervention to 3-month follow-up was significant ( F (1, 36) = 6.80, p < 0.05) and explained 9% of the total variance. The multiple linear regression model for the rBDI score from pre-intervention to 6-month follow-up was also significant ( F (1, 36) = 10.13, p < 0.01) and explained 13% of the total variance. The rISMI score from pre-intervention to post-intervention was the only predictive variable for the rBDI score from pre-intervention to 3-month follow-up as well as from pre-intervention to 6-month follow-up. The multiple linear regression model for rRSE score pre-intervention to 3-month follow-up was significant ( F (1, 36) = 8.74, p < 0.001) and explained 20% of the total variance. The multiple linear regression model for the rRSE score from pre-intervention to 6-month follow-up was also significant ( F (1, 36) = 10.64, p < 0.01) and explaining 14% of the total variance. rPESAS from pre-intervention to post-intervention was the only predictive variable for rRSE score from pre-intervention to 3-month follow-up as well as from pre-intervention to 6-month follow-up. [Invert Table 4 about here] Discussion In general, the demographic characteristics and baseline clinical variables of this research sample are very similar to those of a larger cross-sectional study of self-stigma in people with severe mental illness involving 474 subjects in Hong Kong and Guangzhou societies (Authors, 2016). Self-stigma is common among people with mental illness worldly, including Chinese societies (Dubreucq et al., 2021; Fox et al., 2018; Authors, 2015). Self-stigma has negative impacts on individual’s recovery by lowering quality of life, lowering self-esteem, reducing treatment compliance, increasing psychiatric symptoms, and even relapse (Du et al., 2023; Dubreucq et al., 2021; Authors, 2020). Thus, it is important to develop therapeutic interventions that reduce the self-stigma of people with mental illness to facilitate their recovery. A new intervention ECOP group was developed (Authors, 2025), which aimed to integrate the Coming Out Proud (Authors, 2013; Rüsch et al., 2014) and cognitive behavioural therapy (Authors, 2018), for people with severe mental illness to reduce self-stigma. The aim of this study was to investigate the effectiveness of ECOP for people with mental illness in Hong Kong at the post-intervention, three-month follow-up, and six-month follow-up periods. Additionally, this study also aimed to investigate and compare the efficacy of the ECOP for people with severe mental illness with high and low self-stigma. Hypothesis 1 is supported. The research results show that the ECOP group was effective on helping participants with high and low self-stigma to reduce their self-stigma, reduce depressive symptoms and improve self-esteem and self-empowerment from pre-intervention to post-intervention, and that these intervention effects were well sustained at the 3-month and 6-month follow-ups. Hypothesis 2 and 3 are partially supported. The research results suggest that the ECOP group was more effective for participants with high self-stigma than participants with low self-stigma. Specifically, the ECOP group was shown to be more effective than the control group on helping participants with high self-stigma group to have significant improvement on most intervention outcomes, including self-stigma, depressive symptoms and self-esteem at the 3-month or 6-month follow-ups. On the other hand, the ECOP group is shown to be more effective than the control group in helping participants with low self-stigma group to have significant improvement in depressive symptoms at the 3-month or 6-month follow-ups. Hypothesis 4 is partially supported. The improvement in depressive symptom and self-esteem at post-intervention were predicted by both the improvement in self-stigma and self-empowerment at post-intervention, which is consistent with the hypothesis 4. However, research results indicated that the reduced depressive symptoms at post-intervention, 3-month and 6-month follow-ups were predicted by the improved self-stigma at post-intervention. The improved self-esteem at post-intervention, 3-month and 6-month follow-ups were predicted by the improved self-empowerment at post-intervention. Implications in Mental Health Services . The findings and experiences of this study have implications for mental health professionals in the development and implementation of ECOP for people with severe mental illness in different countries, that deserve more discussions. First, beneficial target groups . High self-stigma is associated with lower quality of life, lower self-esteem, reduced treatment compliance, increased psychiatric symptoms, and even relapse (Du et al., 2023; Dubreucq et al., 2021; Authors, 2020). As shown in this research study, those people with high self-stigma may benefit more from the ECOP group. In the future, community mental health services should recruit people with mental illness to receive ECOP to reduce their self-stigma and promote their recovery. Second, combined intervention over single intervention . Previous studies demonstrated that cognitive behaviour therapy group (Wood et al., 2018; Authors, 2018; Authors, 2020b) and Coming Out Proud (Authors, 2013a; Rüsch & Kösters, 2021) as a single intervention are effective on improving self-stigma and depressive symptoms, but their intervention effects on self-esteem and self-empowerment remain uncleared. The research findings of this study demonstrate that ECOP, that combined both Coming Out Proud and cognitive behaviour therapy group, is effective in improving self-stigma, depressive symptoms, self-esteem and self-empowerment for people with severe mental illness. These results suggest that combined intervention, i.e. ECOP, yields better intervention effects over that of single intervention, which is supported by a recent research review (Lamarca et al., 2024). Third, underlying mechanism of change . Interestingly, the research findings showed that the improved self-stigma contributes significantly to the reduced depressive symptoms, while the improved self-empowerment contributes significantly to the improved self-esteem. These results point to the underlying mechanism of change through ECOP. Future development of ECOP should focus more on strengthening these two essential service components to improve self-stigma and self-empowerment. Limitations and recommendation for future direction. In this study, the research design did not include a rigorous comparison on the intervention effects and effect sizes of ECOP with those of single intervention of cognitive behaviour therapy and Coming Out Proud. The superiority of combined intervention, i.e. ECOP, over single intervention, e.g. Coming Out Proud, should be interpreted with caution. In future, four-arm randomized control trial should be conducted to compare the intervention effects and effect sizes of ECOP with those of the single intervention of cognitive behaviour therapy and Coming Out Proud and the control group. Conclusion For people receiving a diagnosis of mental illness with self-stigma, the ECOP group is effective in reducing self-stigma and depressive symptoms, and improving self-esteem, with these intervention effects being well maintained up to 6-month follow-up. Interestingly, the improvement in self-stigma was found to contribute significantly to the reduction in depressive symptoms, while the improvement in self-confidence contributed significantly to the improvement in self-esteem. Future development of ECOP should focus more on strengthening these two essential components of performance, i.e. improving self-stigma and self-empowerment. Declarations Declarations of Conflicting Interests The author(s) declared no competing interests. Ethical Approval The ethical considerations of this study were evaluated and approved by the Research Ethics Committee of XXX University (Ref. No.: 12609519, dated January 1, 2021). All procedures followed in this study complied with the ethical standards and research protocols of XXX University and the tenets of the Declaration of Helsinki. Informed consent for participation and publication was obtained from all participants. Each participant received a consent form and an information sheet in person prior to the group intervention. The dates of informed consent collection were organized by group: Group 1 (20 July 2022), Group 2 (8 October 2022), Group 3 (21 January 2023), and Group 4 (8 May 2024). Participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time by submitting a request to the researcher. As research output would be reported in aggregate terms, individual data would be destroyed 12 months after the study completed. Funding The authors declared that this research was fully supported by the General Research Fund, Research Grant Council, Hong Kong Special Administrative Region [Ref. No. 12606320]. Author Contribution Kim-wan YOUNG’s role: Corresponding author; Study concept and design, analysis and interpretation of data, and preparation of manuscriptPetrus NG's role: Study concept and design, negotiating with other social service organizations involved in this project, acquisition of subjects and data, analysis and interpretation of data, and review of manuscriptPatrick CORRIGAN's role: Study concept and design, analysis and interpretation of data, and review of manuscriptRenee Chiu's role: Analysis and interpretation of data, and review of manuscript Acknowledgement Acknowledgments The authors would like to express their sincere gratitude to the participants and collaborative agencies for their cooperation and support in this research study.Declaration of Conflicting Interests The author(s) declared no competing interests.Funding The authors declared that this research was fully supported by the General Research Fund, Research Grant Council, Hong Kong Special Administrative Region [Ref. No. 12606320].Ethical Approval The ethical considerations of this study were evaluated and approved by the Research Ethics Committee of Hong Kong Baptist University (Ref. No.: 12609519, dated January 1, 2021). All procedures followed in this study complied with the ethical standards and research protocols of Hong Kong Baptist University and the tenets of the Declaration of Helsinki. Informed consent for participation and publication was obtained from all participants. Each participant received a consent form and an information sheet in person prior to the group intervention. The dates of informed consent collection were organized by group: Group 1 (20 July 2022), Group 2 (8 October 2022), Group 3 (21 January 2023), and Group 4 (8 May 2024). Participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time by submitting a request to the researcher. As research output would be reported in aggregate terms, individual data would be destroyed 12 months after the study completed References Authors (2013a) Authors (2013b) Authors (2016) Authors (2018) Authors (2020a) Authors (2020b) Authors (2025) Byrne BM, Stewart S, Lee PWH (2004). Validating the Beck Depression Inventory–II for Hong Kong community adolescents. Int. J. Test 4(3):199–216 https://doi.org/10.1207/s15327574ijt0403_1 Cohen J. (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, New York Du N, Chong ESK, Wei D et al (2023) Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis. J Affect Disord 332:327–340 https://doi.org/10.1016/j.jad.2023.04.013 Dubreucq J, Plasse J, Franck N (2021) Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences. Schizophr Bull 47(5):1261–1287 https://doi.org/10.1093/schbul/sbaa181 Fox AB, Earnshaw VA, Taverna EC et al (2018) Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma Health 3(4):348–376 https://doi.org/10.1037/sah0000104 Gerlinger G, Hauser M, De Hert M (2013) Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry 12(2):155–64 https://doi.org/10.1002/wps.20040 Griffiths KM, Carron-Arthur B, Parsons A et al (2014) Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry13(2):161–75. https://doi.org/10.1002/wps.20129 IBM Corp. (2024). IBM SPSS statistics for Windows, version 29.0. IBM Corp. Lamarca M, Espinosa V, Acuña V et al (2024) Reducing self-stigma in psychosis: A systematic review and meta-analysis of psychological interventions. Psychiatry Res 342:116262 https://doi.org/10.1016/j.psychres.2024.116262 Rüsch N, Kösters M (2021) Honest, Open, Proud to support disclosure decisions and to decrease stigma's impact among people with mental illness: conceptual review and meta-analysis of program efficacy. Soc Psychiatry Psychiatr Epidemiol 56(9):1513–1526 https://doi.org/10.1007/s00127-021-02076-y Shimotsu S, Horikawa N, Emura R et al (2014) Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients. Asian J Psychiatr 10:39–44 https://doi.org/10.1016/j.ajp.2014.02.006 Wood L, Byrne R, Burke E et al (2017) The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalized shame and self-esteem. Psychiatry Res 255:94–100 https://doi.org/10.1016/j.psychres.2017.05.016 Wood L, Byrne R, Enache G et al (2018) A brief cognitive therapy intervention for internalized stigma in acute inpatients who experience psychosis: A feasibility randomized controlled trial. Psychiatry Res 262:303–310 https://doi.org/10.1016/j.psychres.2017.12.030 Yanos PT, Lucksted A, Drapalski AL et al (2015) Interventions targeting mental health self-stigma: A review and comparison. Psychiatr Rehabil J 38(2):171–178 https://doi.org/10.1037/prj0000100 Yin H, Wardenaar KJ, Xu G et al (2020) Mental health stigma and mental health knowledge in Chinese population: a cross-sectional study. BMC Psychiatry 20(1):323 https://doi.org/10.1186/s12888-020-02705-x Tables Table 1 Demographic characteristics of study participants Characteristics Intervention group Control group Total c 2 / F HSS Gp LSS Gp (n = 13) (n = 25) ( n = 25) ( n = 63) ( p ) Age, mean ( SD) (years) a 54.15 (11.39) 43.24 (13.63) 47.52 (13.22) 47.19 (13.46) 3.01 (0.06) Female, n (%) b 12 (92.31) 13 (52.00) 21 (84.00) 46 (73.02) 9.59 (0.01) Marital status, n (%) b 5.58 (0.69) Single 7 (53.85) 16 (64.00) 19 (76.00) 42 (66.67) Married 4 (30.77) 4 (16.00) 3 (12.00) 11 (17.46) Divorce/Separated/ Widowed 2 (15.38) 4 (16.00) 3 (12.00) 9 (14.29) Education level, n (%) b 4.33 (0.63) Degree / College 4 (30.80) 9 (36.00) 11 (44.00) 24 (38.10) Secondary 9 (69,20) 16 (64.00) 12 (48.00) 37 (58.63) Primary or none 0 (0.00) 0 (0.00) 2 (8.00) 2 (3.17) Employment status, n (%) b 14.66 (0.26) Full-time job 1 (7.69) 4 (16.00) 6 (24.00) 11 (17.46) Part-time job 2 (15.39) 5 (20.00) 6 (24.00) 13 (20.63) Shelter job 0 (0.00) 4 (16.00) 1 (4.00) 5 (7.94) Retired, housewife, retired 6 (46.15) 4 (16.00) 7 (28.00) 17 (26.98) Others 4 (30.77) 8 (16.00) 5 (20.00) 17 (26.98) Source of income, n (%) b 6.84 (0.34) Work 1 (7.69) 7 (28.00) 9 (36.00) 17 (26.98) Family support 4 (30.77) 3 (12.00) 4 (16.00) 11 (17.46) Governmental income support 6 (46.15) 14 (56.00) 11 (44.00) 31 (49.21) Others 2 (15.39) 1 (4.00) 1 (4.00) 4 (6.35) Living situation, n (%) b 2.08 (0.72) Alone 4 (30.77) 7 (28.00) 5 (20.00) 16 (25.40) With family members 9 (69.23) 18 (72.00) 19 (76.00) 46 (73.01) Others 0 (0.00) 0 (0.00) 1 (4.00) 1 (1.59) Diagnosis, n (%) b 4.52 (0.61) Schizophrenia 7 (53.85) 16 (64.00) 16 (66.66) 39 (62.91) Depression 3 (23.08) 6 (24.00) 6 (25.00) 15 (24.19) Anxiety 3 (23.08) 3 (12.00) 1 (4.16) 7 (11.29) Other 0 (0.00) 0 (0.00) 1 (4.16) 1 (1.61) Period of mental illness, mean ( SD) a 11.91 (3.44) 12.40 (2.48) 13.51 (2.82) 12.57 (1.62) 0.20 (0.82) Hospitalization (yes), mean ( SD) a 2.00 (2.70) 2.00 (2.58) 2.33 (2.84) 2.13 (2.67) 0.11 (0.90) Notes: * = significant at p < 0.05; ** = significant at p < 0.01; SD = standard deviation; Abbreviations: a = ANOVA; b = Pearson Chi-Square; F = ANOVA; HSS Gp: High self-stigma group. LSS Gp: Low self-stigma group Table 2 Baseline Outcome Assessment Scores of study participants Intervention group Control gp HSS gp vs Control gp LSS gp vs Control gp HSS gp vs LSS gp HSS gp LSS gp mean diff. ( p ) [95% CI] mean diff. ( p ) [95% CI] mean diff. ( p ) [95% CI] mean (SD) mean (SD) mean (SD) Baseline ISMI 2.83 (0.30) 2.05 (0.34) 2.47 (0.47) 0.37 (0.03)* [0.04, 0.69] -0.42 (0.00)** [-0.69, -0.14] 0.78 (<0.001)** [0.45, 1.11] Baseline BDI 46.08 (14.60) 28.40 (11.13) 34.60 (14.99) 11.48 (0.04)* [0.11, 22.84] -6.20 (0.33) [-15.60, 3.20] 17.68 (<0.001)** [6.31, 29.04] Baseline RSE 20.69 (0.02) 26.32 (4.61) 24.80 (5.40) -4.11 (0.06) [-8.34, 0.12] 1.52 (0.87) [-1.98, 5.02] -5.63 (0.01)* [-9.86, -1.40] Baseline PESAS 31.92 (6.80) 34.08 (6.47) 35.24 (5.52) -3.32 (0.36) [-8.52, 1.19] -1.16 (1.00) [-5.47, 8.52] -2.16 (0.93) [-7.36, 3.05] Notes: * = significant at p < 0.05; ** = significant at p < 0.01; SD = standard deviation; Abbreviations: Mean diff. = mean difference; ISMI = Internalized Stigma of Mental Illness; ISMI_A= ISMI Alienation subscale; ISMI_SE = ISMI Stereotype Endorsement subscale; ISMI_PD = ISMI Perceived Discrimination subscale; ISMI_SW = ISMI Social Withdraw subscale; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale; PESAS-SE = PESAS Self-Empowerment subscale; PESAS-CE = PESAS Community-Empowerment subscale; HSS gp: High self-stigma group; Low SS gp: Low self-stigma group; Control gp = Control group Table 3 Results of Repeated Measures ANCOVA for Outcome Measures over 6-month follow-up period Variable Group Change Score Within Group Comparison Within Group Comparison (Time x Group) T1-T2 T2-T3 T3-T4 T1-T4 T1-T2 T2-T3 T3-T4 T1-T4 Mean ± SD Mean ± SD Mean ± SD Mean ± SD F a ( p ) η2 F ( p ) η2 F a ( p ) η2 F a ( p ) η2 Time F b & F c ( p ) η2 ISMI HSS gp (n = 13) -0.53 ± 0.35 0.01 ± 0.40 -0.04 ± 0.25 -0.56 ± 0.47 28.77 (<0.001)** 0.71 0.00 (0.96) 0.00 0.33 (0.58) 0.03 12.34 (0.00)** 0.51 T1-T2 2.17 (0.12) 0.07 LSS gp (n = 25) -0.20 ± 0.38 -0.04 ± 0.39 -0.12 ± 0.26 -0.36 ± 0.52 6.79 (0.02)* 0.22 0.31 (0.58) 0.01 5.11 (0.03) 0.18 7.18 (0.01)* 0.23 T1-T3 5.36 (0.01)* 0.15 CG (n = 25) -0.18 ± 0.38 0.10 ± 0.74 -0.05 ± 0.45 -0.13 ± 0.31 5.30 (0.03)* 0.18 0.44 (0.52) 0.02 0.36 (0.55) 0.02 1.20 (0.29) 0.05 T1-T4 5.42 (0.01)* 0.16 BDI HSS gp (n = 13) -19.62 ± 14.90 7.47 ± 15.03 0.96 ± 10.22 -11.18 ± 14.58 22.55 (<0.001)** 0.65 3.22 (0.10) 0.21 0.12 (0.74) 0.01 8.47 (0.01)* 0.41 T1-T2 8.29 (<0.001)** 0.22 LSS gp (n = 25) -16.99 ± 13.78 12.06 ± 12.46 -0.77 ± 5.77 -5.70 ± 9.39 37.99 (<0.001)** 0.61 23.42 (<0.001)** 0.49 0.45 (0.51) 0.02 23.45 (<0.001)** 0.49 T1-T3 8.25 (<0.001)** 0.22 CG (n = 25) -3.68 ± 13.30 3.08 ± 16.09 -3.26 ± 16.12 -3.86 ± 14.52 1.91 (0.18) 0.07 0.92 (0.34) 0.04 1.02 (0.32) 0.04 1.03 (0.32) 0.04 T1-T4 5.46 (0.01)* 0.16 RSE HSS gp (n = 13) 5.10 ± 5.22 0.14 ± 4.08 0.78 ± 4.71 6.02± 6.98 12.40 (0.00)** 0.51 0.02 (0.90) 0.00 0.35 (0.56) 0.03 7.07 (0.02)* 0.37 T1-T2 2.52 (0.09) 0.08 LSS gp (n = 25) 2.08 ± 3.51 -0.79 ± 2.94 1.12 ± 4.08 2.41 ± 5.37 8.74 (0.01)** 0.27 1.79 (0.19) 0.07 1.89 (0.18) 0.07 3.52 (0.07) 0.13 T1-T3 3.77 (0.03)* 0.09 CG (n = 25) 0.76 ± 4.59 0.04 ± 3.03 -0.24 ± 3.18 0.56 ± 2.96 0.68 (0.42) 0.03 0.00 (0.95) 0.00 0.14 (0.71) 0.01 0.53 (0.48) 0.02 T1-T4 4.71 (0.01)* 0.14 PESAS HSS gp (n = 13) 2.28 ± 4.14 0.81 ± 3.30 -0.10 ± 3.44 2.99 ± 4.95 3.94 (0.07) 0.25 1.16 (0.30) 0.09 0.29 (0.60) 0.02 3.67 (0.08) 0.23 T1-T2 1.39 (0.26) 0.04 LSS gp (n = 25) 2.42 ± 3.00 -0.19 ± 2.20 0.27 ± 2.62 2.50 ± 4.97 16.14 (<0.001)** 0.40 0.01 (0.97) 0.00 0.76 (0.39) 0.03 6.71 (0.02)* 0.22 T1-T3 1.39 (0.26) 0.04 CG (n = 25) -1.16 ± 3.88 1.76 ± 5.07 -0.49 ± 3.01 0.11 ± 2.81 2.23 (0.15) 0.09 3.89 (0.06) 0.14 1.68 (0.21) 0.07 1.91 (0.18) 0.07 T1-T4 1.40 (0.26) 0.04 Notes: * = significant at p < 0.05; ** = significant at p < 0.01; *** = significant at p < 0.001; SD = standard deviation; p = p-value; Abbreviations: ISMI = Internalized Stigma of Mental Illness; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale; Partial η2 = Partial Eta Square; T1: Pre-intervention; T2: Post-intervention; T3: Three-month follow-up; T4: Six-month follow-up; HSS gp: High self-stigma group; Low SS gp: Low self-stigma group; CG = Control group; F a = Repeated measures of ANOVA; F b = Group x time repeated measures of ANOVA; F c = Group x time repeated measures of ANCOVA controlling for baseline outcome assessment scores. Table 4 Stepwise multiple linear regression analysis for the intervention group (n=38) Item Predictor Adj. R 2 F (p) B β t ( p ) Collinearity Tolerance VIF Dependent variable: ΔBDI from t1 to t4 Model 0.13 10.13 (0.00)** Predicting Variables (Constant) 1.80 -1.64 (0.10) ΔISMI from t1 to t2 3.85 0.38 3.18 (0.00)** 1.00 1.00 Dependent variable: ΔBDI from t1 to t3 Model 0.09 6.80 (0.01)* Predicting Variables (Constant) 1.74 -1.27 (0.21) ΔISMI from t1 to t2 3.72 0.32 2.61 (0.01)* 1.00 1.00 Dependent variable: ΔBDI from t1 to t2 Model 0.23 10.25 (<0.001)** Predicting Variables (Constant) 2.04 -4.10 (0.00)** ΔISMI from t1 to t2 4.73 0.32 2.65 (0.01)* 0.84 1.20 Δ PESAS from t1 to t2 0.27 -0.28 -2.29 (0.03)* 0.84 1.20 Dependent variable: ΔRSE from t1 to t4 Model 0.14 10.64 (0.00)** Predicting Variables (Constant) 0.63 -- 3.33 (0.00)* Δ PESAS from t1 to t2 0.09 0.39 3.23 (0.00)* 1.00 1.00 Dependent variable: ΔRSE from t1 to t3 Model 0.20 8.74 (<0.001)** Predicting Variables (Constant) 0.51 -- 1.94 (0.06) ΔISMI from t1 to t2 1.19 -0.31 -2.50 (0.02)** 0.84 1.20 Δ PESAS from t1 to t2 0.07 0.26 2.06 (0.04)** 0.84 1.20 Dependent variable: ΔRSE from t1 to t2 Model 0.29 13.56 (<0.001)** Predicting Variables (Constant) 0.58 -- 1.71 (0.09) ΔISMI from t1 to t2 0.08 0.35 3.02 (0.00)** 0.84 1.20 Δ PESAS from t1 to t2 1.36 -0.31 -2.66 (0.01)* 0.84 1.20 Notes: *=significant at p < .05; **= significant at p < .01; p = p value; Abbreviations: Adj. R 2 : Adjusted R square. ISMI = Internalized Stigma of Mental Illness; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale T1: Pre-intervention; T2: Post-intervention. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7175089","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":514297034,"identity":"81e23294-9eea-414c-b05f-1834f8b3ab48","order_by":0,"name":"Daniel Kim-Wan YOUNG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDCCM1Can4GxAcI6wMAGY+LXItnA2NhAmhaDAzBrCGnhO3PGTOJj2x27zccPtz/mbWOQ47uRwPZwBh4tkmd7zCRntj1L3nYmsbEZqMVY8kYCu+EGPFoMzvNuk+ZtO5xsdoMRrCVxA9AWyQfEaDGeAdFST1jL2V6wFjsDCYiWBAOQFnwOkzxz/rPljHOHEySAfpk555yE4cwzD9sk8Xmf70xa4o0PZYft+duPP/jwpsxGnu948jHJHjxagIBFAkgkNgAJJh4GEBt/RIIA8wcgYQ9iMf4gpHYUjIJRMApGJAAA5LFYBaAUThwAAAAASUVORK5CYII=","orcid":"","institution":"City University of Hong Kong","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"Kim-Wan","lastName":"YOUNG","suffix":""},{"id":514297037,"identity":"6a22ddca-45df-4913-881a-b91948cb34a2","order_by":1,"name":"Petrus Yat-Nam NG","email":"","orcid":"","institution":"Hong Kong Shue Yan University","correspondingAuthor":false,"prefix":"","firstName":"Petrus","middleName":"Yat-Nam","lastName":"NG","suffix":""},{"id":514297038,"identity":"42374b28-9aec-4398-84c9-d11438192d16","order_by":2,"name":"Patrick CORRIGAN","email":"","orcid":"","institution":"Illinois Institute of Technology","correspondingAuthor":false,"prefix":"","firstName":"Patrick","middleName":"","lastName":"CORRIGAN","suffix":""},{"id":514297039,"identity":"2ef8258f-8152-4469-a748-1604fbd35871","order_by":3,"name":"Renee CHIU","email":"","orcid":"","institution":"Chinese University of Hong Kong","correspondingAuthor":false,"prefix":"","firstName":"Renee","middleName":"","lastName":"CHIU","suffix":""}],"badges":[],"createdAt":"2025-07-21 08:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7175089/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7175089/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91617161,"identity":"945010e9-367b-4f27-8f20-fce3deef8230","added_by":"auto","created_at":"2025-09-18 10:52:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":138852,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConsort Flow Diagram\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7175089/v1/78fe803d3e5eded1bc077af7.png"},{"id":108184720,"identity":"f541d02c-8dac-490c-a7f7-99bddf2e5a3e","added_by":"auto","created_at":"2026-04-30 09:04:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":840018,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7175089/v1/e92ed28d-6efa-4cf5-b16f-7650ae7ceb6c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eExpanded-Coming-Out-Proud Group on Reducing Self-stigma for People with Severe Mental Illness— A Randomized Control Trial with Six-month Follow-up\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeople with severe mental illness, including those diagnosed with schizophrenia, bipolar disorder or major depression, often experience social stigma that negatively impact their recovery (Wood et al., 2017). In Chinese societies, stigmatising attitudes are common among residents, employers, carers and mental health professionals, such that people with mental illness are perceived as unpredictable, dangerous, abnormal, strange, introverted and with low self-esteem (Authors, 2016; Yin et al., 2020).\u003c/p\u003e\n\u003cp\u003eSelf-stigma refers to the extent to which people with severe mental illness endorse the negative beliefs and feelings associated with the publicly stigmatised identity for themselves (Fox et al., 2018). While approximately one-third (31.3%) of people with severe mental illness in all countries report self-stigma (Dubreucq et al., 2021; Gerlinger et al., 2013), the prevalence rate of self-stigma among people with severe mental illness was 38.8% in Hong Kong and 49.5% in China (particularly Guangzhou) (Authors, 2015). Self-stigma is associated with negative effects on individuals\u0026rsquo; recovery by lowering quality of life, self-esteem, self-efficacy and empowerment, and reducing treatment adherence, which in turn leads individuals to refuse psychiatric medication, increase psychiatric symptoms and even relapse (Authors, 2020; Du et al., 2023; Dubreucq et al., 2021; Gerlinger et al., 2013; Lamarca et al., 2024). Therefore, it is important to develop therapeutic interventions that reduce the self-stigma of people with severe mental illness to facilitate their recovery. Studies have suggested that it is feasible to reduce self-stigma of this population through short-term groups for Western (Griffiths et al., 2014; Lamarca et al., 2024; Yanos et al., 2015).\u003c/p\u003e\n\u003cp\u003eCognitive behavioural therapy group has been shown to be effective in reducing self-stigma in Chinese and Asian people with severe mental illness (Authors, 2018; Authors, 2020b; Lamarca et al., 2024; Shimotsu et al., 2014; Wood et al., 2018). According to cognitive behavioural therapy, self-stigmatising beliefs are considered irrational beliefs that are maintained by the person with severe mental illness (Authors, 2013b). The development of personal self-stigmatising beliefs involves four progressive stages of cognitive processes, including: awareness of the public\u0026rsquo;s stigmatising beliefs about mental illness, personal agreement with the public\u0026rsquo;s negative stigmatising beliefs, self-concurrence in which the person applies the public\u0026apos;s stigmatising beliefs to themselves, and self-harm. In fact, the degree of self-concurrence of these stigmatising beliefs varies from person to person; thus, there are individual differences in the degree of self-stigma. Recently, a culturally adapted cognitive behavioural therapy group has been shown to be effective in reducing self-stigma in Chinese people with mental illness by helping individuals to change self-stigmatising beliefs such as \u0026quot;shame\u0026quot;,\u0026quot; \u0026quot;fate\u0026quot; and \u0026quot;being a burden to others\u0026quot; that are shaped by Chinese culture (Authors, 2018; Authors, 2020b).\u003c/p\u003e\n\u003cp\u003eIn addition, the Coming Out Proud model has been developed to empower people with severe mental illness in their decisions about disclosing or concealing their mental illness in different settings (Authors, 2013a). According to this model, empowerment counteracts self-stigma, and an appropriate level of disclosure of one\u0026rsquo;s experience of mental illness can reduce self-stigma and promote recovery (Authors, 2013a). Research studies have shown the effectiveness of Coming Out Proud in reducing self-stigma, stigma stress and depressive symptoms (Lamarca et al., 2024; R\u0026uuml;sch \u0026amp; K\u0026ouml;sters, 2021).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; A new intervention called the Expanded Coming Out Proud (ECOP) group has been developed (Authors et al., 2025) that aims to integrate the Coming Out Proud (Authors, 2013a; R\u0026uuml;sch \u0026amp; K\u0026ouml;sters, 2021) and cognitive behavioural therapy (Authors, 2018) for people with severe mental illness to reduce self-stigma. A previous pilot randomized controlled trial has shown the effectiveness of ECOP in improving self-stigma with a medium effect size (Hedges g = 0.6), reducing depressive symptoms with a medium effect size (Hedges g = 0.6) and anxiety symptoms with a medium effect size (Hedges g = 0.5) (Authors et al., 2025). However, whether these intervention effects could be maintained at the 6-month follow-up remains unclear, as a 6-month follow-up study on ECOP is lacking.\u003c/p\u003e"},{"header":"Research Method","content":"\u003cp\u003e\u003cstrong\u003eAims and Hypothesis.\u0026nbsp;\u003c/strong\u003eThe aim of this study was to investigate the effectiveness of ECOP in people with severe mental illness at post-intervention, 3-month follow-up, and 6-month follow-up periods. This study also aimed to investigate and compare the intervention effects of ECOP for people with high and low self-stigma respectively, and to investigate the predictive power of improvement in self-stigma and empowerment on improvement in intervention outcomes, as there have been few studies in these areas to date.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHypotheses\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eAfter completing the intervention group, both participants with high self-stigma and low self-stigma showed significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up.\u003c/li\u003e\n \u003cli\u003eAfter completing the intervention group, participants with \u003cem\u003ehigh\u003c/em\u003e self-stigma, compared to control group participants, showed a significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up.\u003c/li\u003e\n \u003cli\u003eAfter completing the intervention group, participants with \u003cem\u003elow\u003c/em\u003e self-stigma, compared to control group participants, showed a significantly greater improvement in self-stigma, depressive symptoms, self-esteem and self-empowerment at post-intervention, 3-month follow-up and 6-month follow-up.\u003c/li\u003e\n \u003cli\u003eThe improvement in self-esteem and reduction in depressive symptoms are predicted by the improvement in self-stigma and improvement in empowerment. \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Design.\u0026nbsp;\u003c/strong\u003eThis study was a multicentre randomized controlled trial. Participants were recruited from four different community-based mental health centres through open recruitment via promotional activities and referrals from these centres. Participants who consented to participate in this research project were randomly assigned to a treatment group or control group using computer software administered by a research team member who did not collect data or implement the ECOP group. Block randomisation was performed to ensure that the treatment and control groups had the same number of participants. The control group received treatment as usual (TAU) provided by a community mental health centre, including interest classes and recreational activities. In addition to TAU, the intervention group received an ECOP group led by an experienced social worker from a community mental health centre. To compare the effects of the intervention group on participants with high and low self-stigma, the intervention group was categorized into two groups, i.e. high and low self-stigma groups. Both the high and low self-stigma groups received the same ECOP intervention. A research assistant conducted data collection and outcome assessment at baseline, post-treatment, 3-month and 6-month follow-ups. See Figure 1 for the flow of participants through each phase of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria of subjects.\u0026nbsp;\u003c/strong\u003eThe inclusion criteria included: (1) 18 years of age or older; (2) received a diagnosis of a mental illness from their medical officers in accordance with the criteria of the \u003cem\u003eDiagnostic and Statistical Manual of Mental Disorder\u003c/em\u003e (Fifth edition) (American Psychiatric Association, 2013); and (3) receiving community mental health service provided by collaborative local non-governmental organisations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size.\u0026nbsp;\u003c/strong\u003eThe sample size was calculated using G*Power 3.1 software. Previous literature on intervention groups indicated a small to medium effect size with Cohen\u0026rsquo;s d between 0.2 and 0.9 (Mittal et al., 2012; Authors, 2018). In order to achieve statistical power of 0.80, a minimum sample size of 64 subjects is required to demonstrate an effect size of 0.4. Assuming a dropout rate of 20%, a total of eighty participants are required. Of these, 40 participants were randomly assigned to the treatment group, while a further 40 participants were randomly assigned to the control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention and Control group.\u0026nbsp;\u003c/strong\u003eThe ECOP program aimed to integrate Coming Out Proud and cognitive behaviour therapy. \u0026nbsp;The ECOP was conducted in collaborating community mental health centres over an intervention period of 12 weeks with one session per week, each session lasting for about 1.5 hours. A program manual with standardized and detailed guidelines were designed and written by the research team. In this study, the ECOP consisted of 12 sessions, covering the following topics: sharing the experience of stigma (session 1); challenging social stigmatized beliefs (session 2); transforming self-stigmatized beliefs with CBT skill, e.g. guided discovery, pie-chart, behavioural experiment, (session 3\u0026ndash;6); relaxation and social skill training on facing social stigma situations (session 7\u0026ndash;8); reflecting the risks and benefits of secrecy and disclosure of mental illness (session 9); explore the five levels of disclosure, which range from the lowest level of maintaining secrecy to the highest level of broadcasting one\u0026rsquo;s experience with mental illness (session 10); learning to share own story with a mental illness (session 11); summary (session 12). A standardised group manual was developed for use in the ECOP group intervention. The 1\u003csup\u003est\u003c/sup\u003e to 8\u003csup\u003eth\u003c/sup\u003e sessions of the ECOP were conducted by an experienced social worker, while the 8\u003csup\u003eth\u003c/sup\u003e to 11\u003csup\u003est\u003c/sup\u003e sessions of the ECOP were co-led by a social worker and a peer support worker. Both the social worker and the peer support worker received training from the research team.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the study, participants in the control group received treatment as usual, including interest classes and leisure activities provided by collaborating community mental health centres.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome Assessment Tools.\u0026nbsp;\u003c/strong\u003eThe \u003cem\u003eChinese Internalised Stigma of Mental Illness\u003c/em\u003e (ISMI; Authors, 2016) is a 24 -item self-reported scale to measure changes in self-stigma with good validity and reliability (\u0026alpha; = 0.93). It consists of four subscales that measure shame/alienation, stereotype endorsement, perceived discrimination and social withdrawal. Each item is rated with a score on a 4-point scale which ranges from strongly agree \u0026ldquo;1\u0026rdquo; to strongly disagree \u0026ldquo;4\u0026rdquo;. Item scores are averaged, with a higher score indicating greater self-stigma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003eChinese Beck Depression Inventory\u003c/em\u003e (BDI; Byrne et al., 2004) is a 21-item self-reported scale to measure depressive symptoms with good validity and reliability (\u0026alpha; = 0.91). As suggested by previous studies (Beck et al., 1996), a BDI score \u0026ge; 14 is considered to be the cut-off point for clinical depression, which was adopted in the present study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe \u003cem\u003ePersonal Empowerment Self-Assessment Scale\u003c/em\u003e (PESAS; Authors, 2013a) is a 10-item self-reported scale to measure an individual\u0026apos;s perception of their own empowerment. Each item is rated on a 5-point scale with scores ranging from 1 \u0026ldquo;strongly disagree\u0026rdquo; to 5 \u0026ldquo;strongly agree\u0026rdquo;. The PESAS was developed as part of the Coming Out Proud with satisfactory reliability and validity (Authors, 2013a).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis.\u0026nbsp;\u003c/strong\u003eFor all analyses, two-tailed p values of \u0026lt; 0.05 is considered statistically significant. Data analyses will be performed using SPSS 29.0 (IBM Corporation, 2024). For hypotheses (1), within group intervention effects on all outcome assessment scores were investigated by using repeated measures of analysis of variance (ANOVA). For hypotheses (2) and (3), group x time repeated measures of covariance (ANCOVA) controlling for baseline outcome assessment scores were used to compare changes in outcomes of all comparison groups for the improved ISMI, BDI and RSE scores at post-intervention, 3-month and 6-month follow-ups, while group x time repeated measures of repeated measures of variance (ANOVA) were used to compare changes in outcomes of all comparison groups for the improved PESAS score at post-intervention, 3-month and 6-month follow-ups. Effect sizes for the ANOVA and ANCOVA were calculated using partial \u0026eta;2, with values of 0.01, 0.06 and 0.14 considered small, moderate and large effects, respectively (Cohen, 1988). For hypothesis (4), the predictive power of the improved ISMI and PESAS scores from pre-intervention to post-intervention on the improved BDI and RSE score were investigated and compared using multiple linear regression analysis, using stepwise selection procedure to investigate the relative predictive power of the improved ISMI score and PESAS score.\u003c/p\u003e"},{"header":"Research Results","content":"\u003cp\u003eThis study was conducted from October 2022 to September 2023. 80 participants were recruited from four local community mental health centres. Initially, 40 participants were randomly allocated to the treatment group, while another 40 participants were randomly allocated to the control group. After group allocation, two participants in the intervention group and 15 of the 40 participants in the control group dropped out of the study without completing the whole set of outcome assessment scale nor receive the intervention. After completing the baseline outcome assessment, the intervention group categorized into two groups according to baseline ISMI score, i.e. high self-stigma group (i.e., baseline ISMI score \u0026ge; 2.5); and low self-stigma group (i.e., baseline ISMI score \u0026lt; 2.5). Figure 1 shows the Consort Flow Diagram. The modified intention-to-treat (mITT) principle was applied so that those participants who did not receive the intervention after group allocation were excluded from the analysis. The final analysis included the high self-stigma group (\u003cem\u003en\u003c/em\u003e = 13), the low self-stigma group (\u003cem\u003en\u003c/em\u003e = 25) and the control group (\u003cem\u003en\u003c/em\u003e = 25). The results of the chi-square tests and ANOVA revealed no significant differences between the participants who dropped out and those who did not on any of the baseline demographic variables. All missing data were treated with the multiple imputation method prior to data analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Characteristics.\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eAs shown in Table 1, results of ANOVA and chi-square tests showed no significant differences in demographic variables between the high self-stigma group, the low self-stigma group and the control group, except gender. The low self-stigma group had a higher percentage of male participants than the other groups. All participants (\u003cem\u003en\u003c/em\u003e = 63) had a mean age of 47.19 years (SD = 13.46). The majority were female (73.02%, \u003cem\u003en\u003c/em\u003e = 46), single (66.67%, \u003cem\u003en\u003c/em\u003e = 42), lived with family (73.02%, \u003cem\u003en\u003c/em\u003e = 46), completed secondary school (58.73%, \u003cem\u003en\u003c/em\u003e = 37). About two thirds received a diagnosis of schizophrenia (62.91%, \u003cem\u003en\u003c/em\u003e = 39), followed by depression (24.19%, \u003cem\u003en\u003c/em\u003e = 15), and anxiety (11.29%, \u003cem\u003en\u003c/em\u003e = 7). On average, they had been suffering from a mental illness for around 12 years (\u003cem\u003eM\u003c/em\u003e = 12.57, \u003cem\u003eSD\u003c/em\u003e = 1.52), and had admitted into mental hospital twice (\u003cem\u003eM\u003c/em\u003e = 2.13, \u003cem\u003eSD\u003c/em\u003e = 2.67).\u003c/p\u003e\n\u003cp\u003e[Invert Table 1 about here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBaseline Outcome Assessment Scores\u003c/strong\u003e. The results of ANOVA showed that the participants of the high self-stigma group, the low self-stigma group and the control group differed in their baseline ISMI score, BDI score and RSE score, but not in PESAS score. Specifically, the high self-stigma group as compared to the control group, reported significantly higher baseline ISMI score (mean difference (SE): 0.37 (0.13), \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [0.04, 0.69]) and baseline BDI score (mean difference (SE): 11.48 (4.61), \u003cem\u003ep\u003c/em\u003e = 0.047 \u0026lt; 0.05, 95% CI [0.11, 22.84]), but showed on difference in baseline RSE and PESAS scores.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe low self-stigma group, as compared to the control group, reported significantly lower baseline ISMI score (mean difference (SE): -0.42 (0.11), \u003cem\u003ep\u003c/em\u003e = 0.00 \u0026lt; 0.01, 95% CI [-0.69, -0.14), but showed on difference in BDI, RSE and PESAS scores.\u003c/p\u003e\n\u003cp\u003eThe high self-stigma group as compared to the low self-stigma group, reported significantly higher baseline ISMI score (mean difference (SE): 0.78 (0.13), \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [0.45, 1.11]), baseline BDI score (mean difference (SE): 17.68 (4.61), \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001, 95% CI [6.31, 29.04]), baseline RSE score (mean difference (SE): -5.62 (1.72), \u003cem\u003ep\u003c/em\u003e = 0.005 \u0026lt; 0.01, 95% CI [-9.86, -1.40]), but showed on difference in PESAS score.\u003c/p\u003e\n\u003cp\u003e[Invert Table 2 about here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDropout Rate.\u0026nbsp;\u003c/strong\u003eThe dropout rate for the high self-stigma group (\u003cem\u003en\u003c/em\u003e = 13) was 7.69% (\u003cem\u003en\u003c/em\u003e = 1) at post-intervention, 7.69% (\u003cem\u003en\u003c/em\u003e = 1) at 3-month and 7.69% (\u003cem\u003en\u003c/em\u003e = 1) at 6-month follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe dropout rate for the low self-stigma group was 4.00% (\u003cem\u003en\u003c/em\u003e = 2) at post-intervention, 12.00% (\u003cem\u003en\u003c/em\u003e = 3) at 3-month, and 12.00% (\u003cem\u003en\u003c/em\u003e = 3) at 6-month follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe dropout rate for the control group was 0.00% (\u003cem\u003en\u003c/em\u003e = 0) at post-intervention, 0.00% (\u003cem\u003en\u003c/em\u003e = 0) at 3-month and 8.00% (\u003cem\u003en\u003c/em\u003e = 2) at 6-month follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAt post-intervention.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eWithin group intervention effect.\u0026nbsp;\u003c/em\u003eAs shown in Table 3, results of repeated measures ANOVA demonstrated that there was a significant improvement in the high self-stigma group from pre-intervention to post-intervention with a large effect size in ISMI score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 28.77, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.71), BDI score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 22.55, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.65) and RSE score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 12.40, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.51) as well as a close to significantly improvement in PESAS (\u003cem\u003eF\u003c/em\u003e(1, 11) = 3.94, \u003cem\u003ep\u003c/em\u003e = 0.07 \u0026lt; 0.1, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.25).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe low self-stigma group showed a significant improvement with a large effect size from pre-intervention to post-intervention in \u0026nbsp; ISMI score (\u003cem\u003eF\u003c/em\u003e(1, 23) \u0026nbsp;= 6.79, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.22), BDI score (\u003cem\u003eF\u003c/em\u003e(1, 23) = 37.99, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.61), and RSE score (\u003cem\u003eF\u003c/em\u003e(1, 23) = 8.74, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.27), and PESAS (\u003cem\u003eF\u003c/em\u003e(1, 23) = 16.14, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.40). The control group a significant improvement in the high self-stigma group from pre-intervention to post-intervention with a large effect size in ISMI score (\u003cem\u003eF\u003c/em\u003e(1, 23) \u0026nbsp; = 5.30, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.18), but did not show any significant improvement in BDI, RSE and PESAS scores.\u003c/p\u003e\n\u003cp\u003eThe high self-stigma group showed the largest within group effect size (\u0026eta;\u003csup\u003e2\u003cem\u003e\u0026nbsp; =\u0026nbsp;\u003c/em\u003e\u003c/sup\u003e0.71), followed by the low self-stigma group (\u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.22) and the control group (\u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.18).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBetween group intervention effect.\u0026nbsp;\u003c/em\u003eResults of the 2 (time: t1 vs t2) x 3 (group) repeated measures ANCOVA demonstrated that, after controlling baseline outcome assessment score, the high self-stigma group, the low stigma group and the control group had a had a significant difference from pre-intervention to post-intervention with a large effect size in the improvement in BDI score (\u003cem\u003eF\u003c/em\u003e(2, 59) = 8.29, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.22), but not in RSE, ISMI and PESAS scores.\u003c/p\u003e\n\u003cp\u003eThe results of pairwise comparison analysis showed that the high self-stigma group, compared to the control group, had a significant larger improvement in BDI score from pre-intervention to post-intervention (mean difference (SE): -6.69 (2.60), \u003cem\u003ep\u003c/em\u003e = 0.024 \u0026lt; 0.05, 95% CI [-12.71, -0.67]), while the low self-stigma group, compared to the control group, did not show a significant improvement in BDI score from pre-intervention to post-intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAt 3-month and 6-month follow-up.\u0026nbsp;\u003c/strong\u003e\u003cem\u003eWithin group intervention effect.\u0026nbsp;\u003c/em\u003eResults of repeated measures ANOVA demonstrated that the high self-stigma and low self-stigma groups showed no any significant change in ISMI, BDI, RSE and PESAS scores from post-intervention to 3-month follow-up as well as from 3-month follow-up to 6-month follow-up.\u003c/p\u003e\n\u003cp\u003eAdditionally, the high self-stigma group showed a significant improvement from pre-intervention to 6-month follow-up with a large effect size in ISMI score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 12.34, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.51), BDI score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 8.47, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.41) and RSE score (\u003cem\u003eF\u003c/em\u003e(1, 11) = 7.07, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.37) and a close to significant improvement in PESAS (\u003cem\u003eF\u003c/em\u003e(1, 11) = 3.67, \u003cem\u003ep\u003c/em\u003e = 0.08 \u0026lt; 0.1, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.23). Similarly, the low self-stigma group showed a significant improvement from pre-intervention to 6-month follow-up with a large effect size\u003cem\u003e\u0026nbsp;\u003c/em\u003ein ISMI score \u003cem\u003eF\u003c/em\u003e(1, 23) = 7.18, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u0026eta;2 = 0.23), BDI score (\u003cem\u003eF\u003c/em\u003e(1, 23) = 23.45, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.49) and PESAS score (\u003cem\u003eF\u003c/em\u003e(1, 23) = 6.71, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.22), and a close to significant improvement in RSE (\u003cem\u003eF\u003c/em\u003e(1, 11) = 3.52, \u003cem\u003ep\u003c/em\u003e = 0.07 \u0026lt; 0.1, \u003cem\u003e\u0026eta;\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.13).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese results showed that the effects of the intervention in improving ISMI, BDI, RSE and PESAS scores in the high and low self-stigma groups at post-intervention was well sustained at the three-month and six-month follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBetween group intervention effect.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eResults of the 3 (time; t1 vs t2 vs t3) x 3 (group) repeated measures ANCOVA and ANOVA demonstrated that, after controlling baseline outcome assessment score, the high self-stigma group, the low self-stigma group and the control group had a significant difference from pre-intervention to 3-month follow-up, in their improvement in ISMI score with a large effect size (\u003cem\u003eF\u003c/em\u003e(2, 59) = 5.36, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.15), BDI score with a large effect size (F(2, 59) = 8.25, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.22) and RSE score with a moderate effect size (\u003cem\u003eF\u003c/em\u003e(2, 59) = 3.77, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.09), but not in PESAS score. Similarly, the results of the 4 (time; t1 vs t2 vs t3 vs t4) x 3 (group) repeated measures ANCOVA and ANOVA demonstrated that these three groups also showed a significant difference from pre-intervention to 6-month follow-up in their improvement in ISMI score with a large effect size (\u003cem\u003eF\u003c/em\u003e(2, 59) = 5.42, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.16), BDI score (\u003cem\u003eF\u003c/em\u003e(2, 59) = 5.46, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.16) and RSE score (\u003cem\u003eF\u003c/em\u003e(2, 59) = 4.71, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05, \u003cem\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e = 0.14), but not in PESAS score.\u003c/p\u003e\n\u003cp\u003eThe pairwise comparison analysis showed that the high self-stigma group, as compared with the control group, had a significant larger improvement in ISMI score from pre-intervention to 3-month follow-up (mean difference (SE): -0.23 (0.07), \u003cem\u003ep\u003c/em\u003e = 0.009 \u0026lt; 0.01, 95% CI [-0.41, -0.05]), ISMI score from pre-intervention to 6-month follow-up (mean difference (SE): -0.24 (0.09), \u003cem\u003ep\u003c/em\u003e = 0.03 \u0026lt; 0.05, 95% CI [-0.45, -0.02]), RSE score from pre-intervention to 3-month follow-up (mean difference (SE): 1.99 (0.75), \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e0.03 \u0026lt; 0.05, 95% CI [0.15, 3.85]), RSE score from pre-intervention to 6-month follow-up (mean difference (SE): 2.41 (0.84), \u003cem\u003ep\u003c/em\u003e = 0.017 \u0026lt; 0.05, 95% CI [-0.35, 4.48]), BDI score from pre-intervention to 3-month follow-up (mean difference (SE): -7.52 (2.42), \u003cem\u003ep\u003c/em\u003e = 0.009 \u0026lt; 0.01, 95% CI [-13.48, -1.56]) and a close to significant improvement in BDI from pre-intervention to 6-month follow-up (mean difference (SE): -6.35 (2.62), \u003cem\u003ep\u003c/em\u003e = 0.06 \u0026lt; 0.1, 95% CI [-12.81, 0.11]), but showed no significant difference in PESAS scores from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up.\u003c/p\u003e\n\u003cp\u003eThe pairwise comparison analysis also showed that the low self-stigma group, as compared with the control group, had a significant larger improvement in BDI score from pre-intervention to 3-month follow-up (mean difference (SE): -6.77 (1.95), \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e0.03 \u0026lt; 0.05, 95% CI [-11.56, -1.97]) and BDI score from pre-intervention to 6-month follow-up (mean difference (SE): -6.14 (2.11), \u003cem\u003ep =\u0026nbsp;\u003c/em\u003e0.02 \u0026lt; 0.05, 95% CI [-11.34, -0.94]), but showed no significant difference in ISMI, RSE and PESAS scores from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up.\u003c/p\u003e\n\u003cp\u003e[Invert Table 3 about here]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictive variable for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003erBDI and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003erRSE scores.\u0026nbsp;\u003c/strong\u003eThe results of the one-way ANOVA and Spearman correlation analysis within the two intervention groups (\u003cem\u003en\u003c/em\u003e = 38) indicated that the\u0026nbsp;rBDI and\u0026nbsp;rRSE from pre-intervention to post-intervention, from pre-intervention to 3-month follow-up and from pre-intervention to 6-month follow-up were not related to any demographic variables, and thus the improvement in BDI and RSE were not predicted by any demographic variables. Table 4 provides the results of linear regression analyses within the two intervention groups (\u003cem\u003en\u003c/em\u003e = 38) for\u0026nbsp;rBDI and\u0026nbsp;rRSE, with\u0026nbsp;rISMI and\u0026nbsp;r\u0026nbsp;PESAS as dependent variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAt post-intervention.\u0026nbsp;\u003c/strong\u003eThe multiple linear regression model for the\u0026nbsp;rBDI score from pre-intervention to post-intervention was significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 10.25, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and explained 23% of the total variance. The multiple linear regression model for the\u0026nbsp;rRSE score was significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 13.56, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and explained 29% of the total variance. The\u0026nbsp;rBDI score and\u0026nbsp;rRSE\u0026nbsp;score from pre-intervention to post-intervention were significant predicted by both\u0026nbsp;rISMI score and\u0026nbsp;rPESAS score from\u0026nbsp;pre-intervention to post-intervention respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAt 3-month and 6-month follow-up.\u0026nbsp;\u003c/strong\u003eThe multiple linear regression analyses for\u0026nbsp;rBDI score from pre-intervention to 3-month follow-up was significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 6.80, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05) and explained 9% of the total variance. The multiple linear regression model for the\u0026nbsp;rBDI score from pre-intervention to 6-month follow-up was also significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 10.13, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01) and explained 13% of the total variance. The\u0026nbsp;rISMI score from pre-intervention to post-intervention was the only predictive variable for the\u0026nbsp;rBDI score from pre-intervention to 3-month follow-up as well as from pre-intervention to 6-month follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe multiple linear regression model for\u0026nbsp;rRSE score pre-intervention to 3-month follow-up was significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 8.74, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and explained 20% of the total variance. The multiple linear regression model for the\u0026nbsp;rRSE\u0026nbsp;score from pre-intervention to 6-month follow-up was also significant (\u003cem\u003eF\u003c/em\u003e(1, 36) = 10.64, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01) and explaining 14% of the total variance. \u0026nbsp;rPESAS from pre-intervention to post-intervention was the only predictive variable for\u0026nbsp;rRSE\u0026nbsp;score from pre-intervention to 3-month follow-up as well as from pre-intervention to 6-month follow-up.\u003c/p\u003e\n\u003cp\u003e[Invert Table 4 about here]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn general, the demographic characteristics and baseline clinical variables of this research sample are very similar to those of a larger cross-sectional study of self-stigma in people with severe mental illness involving 474 subjects in Hong Kong and Guangzhou societies (Authors, 2016).\u003c/p\u003e\n\u003cp\u003eSelf-stigma is common among people with mental illness worldly, including Chinese societies (Dubreucq et al., 2021; Fox et al., 2018; Authors, 2015). Self-stigma has negative impacts on individual\u0026rsquo;s recovery by lowering quality of life, lowering self-esteem, reducing treatment compliance, increasing psychiatric symptoms, and even relapse (Du et al., 2023; Dubreucq et al., 2021; Authors, 2020). Thus, it is important to develop therapeutic interventions that reduce the self-stigma of people with mental illness to facilitate their recovery.\u003c/p\u003e\n\u003cp\u003eA new intervention ECOP group was developed (Authors, 2025), which aimed to integrate the Coming Out Proud (Authors, 2013; R\u0026uuml;sch et al., 2014) and cognitive behavioural therapy (Authors, 2018), for people with severe mental illness to reduce self-stigma. The aim of this study was to investigate the effectiveness of ECOP for people with mental illness in Hong Kong at the post-intervention, three-month follow-up, and six-month follow-up periods. Additionally, this study also aimed to investigate and compare the efficacy of the ECOP for people with severe mental illness with high and low self-stigma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 1 is supported. The research results show that the ECOP group was effective on helping participants with high and low self-stigma to reduce their self-stigma, reduce depressive symptoms and improve self-esteem and self-empowerment from pre-intervention to post-intervention, and that these intervention effects were well sustained at the 3-month and 6-month follow-ups. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 2 and 3 are partially supported. The research results suggest that the ECOP group was more effective for participants with high self-stigma than participants with low self-stigma. Specifically, the ECOP group was shown to be more effective than the control group on helping participants with high self-stigma group to have significant improvement on most intervention outcomes, including self-stigma, depressive symptoms and self-esteem at the 3-month or 6-month follow-ups. On the other hand, the ECOP group is shown to be more effective than the control group in helping participants with low self-stigma group to have significant improvement in depressive symptoms at the 3-month or 6-month follow-ups. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHypothesis 4 is partially supported. The improvement in depressive symptom and self-esteem at post-intervention were predicted by both the improvement in self-stigma and self-empowerment at post-intervention, which is consistent with the hypothesis 4. However, research results indicated that the reduced depressive symptoms at post-intervention, 3-month and 6-month follow-ups were predicted by the improved self-stigma at post-intervention. The improved self-esteem at post-intervention, 3-month and 6-month follow-ups were predicted by the improved self-empowerment at post-intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications in Mental Health Services\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eThe findings and experiences of this study have implications for mental health professionals in the development and implementation of ECOP for people with severe mental illness in different countries, that deserve more discussions.\u003c/p\u003e\n\u003cp\u003eFirst, \u003cem\u003ebeneficial target groups\u003c/em\u003e. High self-stigma is associated with lower quality of life, lower self-esteem, reduced treatment compliance, increased psychiatric symptoms, and even relapse (Du et al., 2023; Dubreucq et al., 2021; Authors, 2020). As shown in this research study, those people with high self-stigma may benefit more from the ECOP group. In the future, community mental health services should recruit people with mental illness to receive ECOP to reduce their self-stigma and promote their recovery.\u003c/p\u003e\n\u003cp\u003eSecond, \u003cem\u003ecombined intervention over single intervention\u003c/em\u003e. Previous studies demonstrated that cognitive behaviour therapy group (Wood et al., 2018; Authors, 2018; Authors, 2020b) and Coming Out Proud (Authors, 2013a; R\u0026uuml;sch \u0026amp; K\u0026ouml;sters, 2021) as a single intervention are effective on improving self-stigma and depressive symptoms, but their intervention effects on self-esteem and self-empowerment remain uncleared. The research findings of this study demonstrate that ECOP, that combined both Coming Out Proud and cognitive behaviour therapy group, is effective in improving self-stigma, depressive symptoms, self-esteem and self-empowerment for people with severe mental illness. These results suggest that combined intervention, i.e. ECOP, yields better intervention effects over that of single intervention, which is supported by a recent research review (Lamarca et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThird, \u003cem\u003eunderlying mechanism of change\u003c/em\u003e. Interestingly, the research findings showed that the improved self-stigma contributes significantly to the reduced depressive symptoms, while the improved self-empowerment contributes significantly to the improved self-esteem. These results point to the underlying mechanism of change through ECOP. Future development of ECOP should focus more on strengthening these two essential service components to improve self-stigma and self-empowerment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and recommendation for future direction.\u0026nbsp;\u003c/strong\u003eIn this study, the research design did not include a rigorous comparison on the intervention effects and effect sizes of ECOP with those of single intervention of cognitive behaviour therapy and Coming Out Proud. The superiority of combined intervention, i.e. ECOP, over single intervention, e.g. Coming Out Proud, should be interpreted with caution. In future, four-arm randomized control trial should be conducted to compare the intervention effects and effect sizes of ECOP with those of the single intervention of cognitive behaviour therapy and Coming Out Proud and the control group.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor people receiving a diagnosis of mental illness with self-stigma, the ECOP group is effective in reducing self-stigma and depressive symptoms, and improving self-esteem, with these intervention effects being well maintained up to 6-month follow-up. Interestingly, the improvement in self-stigma was found to contribute significantly to the reduction in depressive symptoms, while the improvement in self-confidence contributed significantly to the improvement in self-esteem. Future development of ECOP should focus more on strengthening these two essential components of performance, i.e. improving self-stigma and self-empowerment.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eDeclarations \u003cstrong\u003eof Conflicting Interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe author(s) declared no competing interests.\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eThe ethical considerations of this study were evaluated and approved by the Research Ethics Committee of XXX University (Ref. No.: 12609519, dated January 1, 2021). All procedures followed in this study complied with the ethical standards and research protocols of XXX University and the tenets of the Declaration of Helsinki. Informed consent for participation and publication was obtained from all participants. Each participant received a consent form and an information sheet in person prior to the group intervention. The dates of informed consent collection were organized by group: Group 1 (20 July 2022), Group 2 (8 October 2022), Group 3 (21 January 2023), and Group 4 (8 May 2024). Participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time by submitting a request to the researcher. As research output would be reported in aggregate terms, individual data would be destroyed 12 months after the study completed.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe authors declared that this research was fully supported by the General Research Fund, Research Grant Council, Hong Kong Special Administrative Region [Ref. No. 12606320].\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eKim-wan YOUNG\u0026rsquo;s role: Corresponding author; Study concept and design, analysis and interpretation of data, and preparation of manuscriptPetrus NG\u0026apos;s role: Study concept and design, negotiating with other social service organizations involved in this project, acquisition of subjects and data, analysis and interpretation of data, and review of manuscriptPatrick CORRIGAN\u0026apos;s role: Study concept and design, analysis and interpretation of data, and review of manuscriptRenee Chiu\u0026apos;s role: Analysis and interpretation of data, and review of manuscript\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eAcknowledgments The authors would like to express their sincere gratitude to the participants and collaborative agencies for their cooperation and support in this research study.Declaration of Conflicting Interests The author(s) declared no competing interests.Funding The authors declared that this research was fully supported by the General Research Fund, Research Grant Council, Hong Kong Special Administrative Region [Ref. No. 12606320].Ethical Approval The ethical considerations of this study were evaluated and approved by the Research Ethics Committee of Hong Kong Baptist University (Ref. No.: 12609519, dated January 1, 2021). All procedures followed in this study complied with the ethical standards and research protocols of Hong Kong Baptist University and the tenets of the Declaration of Helsinki. Informed consent for participation and publication was obtained from all participants. Each participant received a consent form and an information sheet in person prior to the group intervention. The dates of informed consent collection were organized by group: Group 1 (20 July 2022), Group 2 (8 October 2022), Group 3 (21 January 2023), and Group 4 (8 May 2024). Participants were informed that their involvement was entirely voluntary and that they could withdraw from the study at any time by submitting a request to the researcher. As research output would be reported in aggregate terms, individual data would be destroyed 12 months after the study completed\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAuthors (2013a)\u003c/li\u003e\n\u003cli\u003eAuthors (2013b)\u003c/li\u003e\n\u003cli\u003eAuthors (2016)\u003c/li\u003e\n\u003cli\u003eAuthors (2018)\u003c/li\u003e\n\u003cli\u003eAuthors (2020a)\u003c/li\u003e\n\u003cli\u003eAuthors (2020b)\u003c/li\u003e\n\u003cli\u003eAuthors (2025)\u003c/li\u003e\n\u003cli\u003eByrne BM, Stewart S, Lee PWH (2004). Validating the Beck Depression Inventory\u0026ndash;II for Hong Kong community adolescents. Int. J. Test 4(3):199\u0026ndash;216 https://doi.org/10.1207/s15327574ijt0403_1\u003c/li\u003e\n\u003cli\u003eCohen J. (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, New York\u003c/li\u003e\n\u003cli\u003eDu N, Chong ESK, Wei D et al (2023) Prevalence, risk, and protective factors of self-stigma for people living with depression: A systematic review and meta-analysis. J Affect Disord 332:327\u0026ndash;340 https://doi.org/10.1016/j.jad.2023.04.013\u003c/li\u003e\n\u003cli\u003eDubreucq J, Plasse J, Franck N (2021) Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences. Schizophr Bull 47(5):1261\u0026ndash;1287 https://doi.org/10.1093/schbul/sbaa181\u003c/li\u003e\n\u003cli\u003eFox AB, Earnshaw VA, Taverna EC et al (2018) Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma Health 3(4):348\u0026ndash;376 https://doi.org/10.1037/sah0000104\u003c/li\u003e\n\u003cli\u003eGerlinger G, Hauser M, De Hert M (2013) Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry 12(2):155\u0026ndash;64 https://doi.org/10.1002/wps.20040\u003c/li\u003e\n\u003cli\u003eGriffiths KM, Carron-Arthur B, Parsons A et al (2014) Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry13(2):161\u0026ndash;75. https://doi.org/10.1002/wps.20129\u003c/li\u003e\n\u003cli\u003eIBM Corp. (2024). IBM SPSS statistics for Windows, version 29.0. IBM Corp.\u003c/li\u003e\n\u003cli\u003eLamarca M, Espinosa V, Acu\u0026ntilde;a V et al (2024) Reducing self-stigma in psychosis: A systematic review and meta-analysis of psychological interventions. Psychiatry Res 342:116262 https://doi.org/10.1016/j.psychres.2024.116262\u003c/li\u003e\n\u003cli\u003eR\u0026uuml;sch N, K\u0026ouml;sters M (2021) Honest, Open, Proud to support disclosure decisions and to decrease stigma\u0026apos;s impact among people with mental illness: conceptual review and meta-analysis of program efficacy. Soc Psychiatry Psychiatr Epidemiol 56(9):1513\u0026ndash;1526 https://doi.org/10.1007/s00127-021-02076-y\u003c/li\u003e\n\u003cli\u003eShimotsu S, Horikawa N, Emura R et al (2014) Effectiveness of group cognitive-behavioral therapy in reducing self-stigma in Japanese psychiatric patients. Asian J Psychiatr 10:39\u0026ndash;44 https://doi.org/10.1016/j.ajp.2014.02.006\u003c/li\u003e\n\u003cli\u003eWood L, Byrne R, Burke E et al (2017) The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalized shame and self-esteem. Psychiatry Res 255:94\u0026ndash;100 https://doi.org/10.1016/j.psychres.2017.05.016\u003c/li\u003e\n\u003cli\u003eWood L, Byrne R, Enache G et al (2018) A brief cognitive therapy intervention for internalized stigma in acute inpatients who experience psychosis: A feasibility randomized controlled trial. Psychiatry Res 262:303\u0026ndash;310 https://doi.org/10.1016/j.psychres.2017.12.030\u003c/li\u003e\n\u003cli\u003eYanos PT, Lucksted A, Drapalski AL et al (2015) Interventions targeting mental health self-stigma: A review and comparison. Psychiatr Rehabil J 38(2):171\u0026ndash;178 https://doi.org/10.1037/prj0000100\u003c/li\u003e\n\u003cli\u003eYin H, Wardenaar KJ, Xu G et al (2020) Mental health stigma and mental health knowledge in Chinese population: a cross-sectional study. BMC Psychiatry 20(1):323 https://doi.org/10.1186/s12888-020-02705-x\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u003cem\u003eDemographic characteristics of study participants\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"581\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003eIntervention group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003ec\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e/ F\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eHSS Gp\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eLSS Gp\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cem\u003e(n\u0026nbsp;\u003c/em\u003e= 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cem\u003e(n\u0026nbsp;\u003c/em\u003e= 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u0026nbsp;\u003c/em\u003e= 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e(\u003cem\u003en\u0026nbsp;\u003c/em\u003e=\u0026nbsp;63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAge, mean (\u003cem\u003eSD)\u0026nbsp;\u003c/em\u003e(years)\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e54.15 (11.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e43.24 (13.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e47.52 (13.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e47.19 (13.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e3.01 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eFemale, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12 (92.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e13 (52.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e21 (84.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e46 (73.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e9.59 (0.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eMarital status, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e5.58 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (53.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e19 (76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e42 (66.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (12.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11 (17.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Divorce/Separated/\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (15.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (12.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e9 (14.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEducation level, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e4.33 (0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Degree / College\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (30.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e9 (36.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11 (44.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e24 (38.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e9 (69,20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12 (48.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e37 (58.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Primary or none\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (8.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEmployment status, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e14.66 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Full-time job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11 (17.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Part-time job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (15.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e13 (20.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Shelter job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (7.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Retired, housewife, retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (46.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (28.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e17 (26.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e8 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e17 (26.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSource of income, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e6.84 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (7.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (28.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e9 (36.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e17 (26.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Family support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (12.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (16.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11 (17.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Governmental income support\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (46.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e14 (56.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11 (44.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e31 (49.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2 (15.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (6.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eLiving situation, \u003cem\u003en\u003c/em\u003e (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e2.08 (0.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e4 (30.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (28.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e5 (20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (25.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; With family members\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e9 (69.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e18 (72.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e19 (76.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e46 (73.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (1.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eDiagnosis, n (%) \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e4.52 (0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Schizophrenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (53.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e16 (66.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e39 (62.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (23.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e6 (25.00)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e15 (24.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (23.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e3 (12.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.16)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e7 (11.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (4.16)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e1 (1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePeriod of mental illness,\u0026nbsp;mean (\u003cem\u003eSD)\u003c/em\u003e\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e11.91 (3.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12.40 (2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e13.51 (2.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e12.57 (1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.20 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eHospitalization (yes),\u0026nbsp;mean (\u003cem\u003eSD)\u003c/em\u003e\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2.00 (2.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2.00 (2.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2.33 (2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e2.13 (2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.11 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes:\u003c/em\u003e * = significant at p \u0026lt; 0.05; ** = significant at p \u0026lt; 0.01; \u003cem\u003eSD\u003c/em\u003e = standard deviation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u0026nbsp;\u003c/em\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e= ANOVA; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003e= Pearson Chi-Square; \u003cem\u003eF\u003c/em\u003e = ANOVA; HSS Gp: High self-stigma group. LSS Gp: Low self-stigma group\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u0026nbsp;\u003c/strong\u003e\u003cem\u003eBaseline Outcome Assessment Scores of study participants\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"603\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003eIntervention\u0026nbsp;\u003c/p\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003eControl gp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eHSS gp vs\u003c/p\u003e\n \u003cp\u003eControl gp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eLSS gp vs Control gp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eHSS gp vs\u003c/p\u003e\n \u003cp\u003eLSS gp\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eHSS gp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003eLSS gp\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003emean diff. (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e[95% CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 114px;\"\u003e\n \u003cp\u003emean diff. (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e[95% CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003emean diff. (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e[95% CI]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cem\u003emean (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cem\u003emean (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cem\u003emean (SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eBaseline ISMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.83\u003c/p\u003e\n \u003cp\u003e(0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003cp\u003e(0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e2.47\u003c/p\u003e\n \u003cp\u003e(0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e0.37 (0.03)*\u003c/p\u003e\n \u003cp\u003e[0.04, 0.69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e-0.42 (0.00)**\u003c/p\u003e\n \u003cp\u003e[-0.69, -0.14]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e0.78 (\u0026lt;0.001)**\u003c/p\u003e\n \u003cp\u003e[0.45, 1.11]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eBaseline BDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e46.08\u003c/p\u003e\n \u003cp\u003e(14.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28.40\u003c/p\u003e\n \u003cp\u003e(11.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e34.60\u003c/p\u003e\n \u003cp\u003e(14.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e11.48\u0026nbsp;(0.04)*\u003c/p\u003e\n \u003cp\u003e[0.11, 22.84]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e-6.20 \u0026nbsp;(0.33)\u003c/p\u003e\n \u003cp\u003e[-15.60, 3.20]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e17.68 (\u0026lt;0.001)**\u003c/p\u003e\n \u003cp\u003e[6.31, 29.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eBaseline RSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20.69\u003c/p\u003e\n \u003cp\u003e(0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e26.32\u003c/p\u003e\n \u003cp\u003e(4.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e24.80\u003c/p\u003e\n \u003cp\u003e(5.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e-4.11\u0026nbsp;(0.06)\u003c/p\u003e\n \u003cp\u003e[-8.34, 0.12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e1.52 \u0026nbsp;(0.87)\u003c/p\u003e\n \u003cp\u003e[-1.98, 5.02]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-5.63 (0.01)*\u003c/p\u003e\n \u003cp\u003e[-9.86, -1.40]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003eBaseline PESAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e31.92\u003c/p\u003e\n \u003cp\u003e(6.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e34.08\u003c/p\u003e\n \u003cp\u003e(6.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e35.24\u003c/p\u003e\n \u003cp\u003e(5.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e-3.32 (0.36)\u003c/p\u003e\n \u003cp\u003e[-8.52, 1.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e-1.16 (1.00)\u003c/p\u003e\n \u003cp\u003e[-5.47, 8.52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e-2.16 (0.93)\u003c/p\u003e\n \u003cp\u003e[-7.36,\u0026nbsp;3.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes:\u003c/em\u003e * = significant at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05; ** = significant at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01; \u003cem\u003eSD\u003c/em\u003e = standard deviation;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e Mean diff. = mean difference; ISMI = Internalized Stigma of Mental Illness; ISMI_A= ISMI Alienation subscale; ISMI_SE = ISMI Stereotype Endorsement subscale; ISMI_PD = ISMI Perceived Discrimination subscale; ISMI_SW = ISMI Social Withdraw subscale; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale; PESAS-SE = PESAS Self-Empowerment subscale; PESAS-CE = PESAS Community-Empowerment subscale; HSS gp: High self-stigma group; Low SS gp: Low self-stigma group; Control gp = Control group\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cem\u003eResults of Repeated Measures ANCOVA for Outcome Measures over 6-month follow-up period\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"908\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 60px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 230px;\"\u003e\n \u003cp\u003eChange Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" style=\"width: 413px;\"\u003e\n \u003cp\u003eWithin Group Comparison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eWithin Group Comparison (Time x Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eT2-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eT3-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 109px;\"\u003e\n \u003cp\u003eT2-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003eT3-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 112px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eF\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026eta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eF\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e\u0026eta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\"\u003e\n \u003cp\u003eF\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026eta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eF\u003csup\u003ea\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 38px;\"\u003e\n \u003cp\u003e\u0026eta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003eF\u003csup\u003eb\u003c/sup\u003e \u0026amp; F\u003csup\u003ec\u0026nbsp;\u003c/sup\u003e(\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 37px;\"\u003e\n \u003cp\u003e\u0026eta;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003eISMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eHSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.53 \u0026plusmn; 0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.01 \u0026plusmn; 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.04 \u0026plusmn; 0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-0.56 \u0026plusmn; 0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e28.77 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.00 (0.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.33 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e12.34 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.17 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eLSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.20 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.04 \u0026plusmn; 0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.12 \u0026plusmn; 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-0.36 \u0026plusmn; 0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e6.79 (0.02)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.31 (0.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e5.11 (0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7.18 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5.36 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCG\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-0.18 \u0026plusmn; 0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.10 \u0026plusmn; 0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.05 \u0026plusmn; 0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-0.13 \u0026plusmn; 0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e5.30 (0.03)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.44 (0.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.36 (0.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.20 (0.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5.42 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003eBDI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eHSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-19.62 \u0026plusmn; 14.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e7.47 \u0026plusmn; 15.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.96 \u0026plusmn; 10.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-11.18 \u0026plusmn; 14.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e22.55 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3.22 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.12 (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e8.47 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e8.29 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eLSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-16.99 \u0026plusmn; 13.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e12.06 \u0026plusmn; 12.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.77 \u0026plusmn; 5.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-5.70 \u0026plusmn; 9.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e37.99 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e23.42 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.45 (0.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e23.45 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e8.25 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCG\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-3.68 \u0026plusmn; 13.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e3.08 \u0026plusmn; 16.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-3.26 \u0026plusmn; 16.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e-3.86 \u0026plusmn; 14.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.91 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 36px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.92 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.02 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.03 (0.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e5.46 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003eRSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eHSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.10 \u0026plusmn; 5.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.14 \u0026plusmn; 4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.78 \u0026plusmn; 4.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e6.02\u0026plusmn; 6.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e12.40 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.02 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.35 (0.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e7.07 (0.02)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.52 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eLSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.08 \u0026plusmn; 3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.79 \u0026plusmn; 2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e1.12 \u0026plusmn; 4.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.41 \u0026plusmn; 5.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e8.74 (0.01)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1.79 (0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.89 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e3.52 (0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e3.77 (0.03)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCG\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e0.76 \u0026plusmn; 4.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.04 \u0026plusmn; 3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.24 \u0026plusmn; 3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.56 \u0026plusmn; 2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.68 (0.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.00 (0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.14 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.53 (0.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.71 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003ePESAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eHSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.28 \u0026plusmn; 4.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e0.81 \u0026plusmn; 3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.10 \u0026plusmn; 3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.99 \u0026plusmn; 4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3.94 (0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e1.16 (0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.29 (0.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e3.67 (0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.39 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eLSS gp\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.42 \u0026plusmn; 3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.19 \u0026plusmn; 2.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.27 \u0026plusmn; 2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e2.50 \u0026plusmn; 4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e16.14 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.01 (0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e0.76 (0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e6.71 (0.02)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.39 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eCG\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(n = 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-1.16 \u0026plusmn; 3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1.76 \u0026plusmn; 5.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e-0.49 \u0026plusmn; 3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e2.23 (0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e3.89 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 46px;\"\u003e\n \u003cp\u003e1.68 (0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.91 (0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eT1-T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.40 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes:\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e* = significant at p \u0026lt; 0.05; ** = significant at p \u0026lt; 0.01; *** = significant at p \u0026lt; 0.001; SD = standard deviation; p = p-value;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e ISMI = Internalized Stigma of Mental Illness; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale; Partial \u0026eta;2 = Partial Eta Square; T1: Pre-intervention; T2: Post-intervention; T3: Three-month follow-up; T4: Six-month follow-up; HSS gp: High self-stigma group; Low SS gp: Low self-stigma group; CG = Control group; F\u003csup\u003ea\u003c/sup\u003e = Repeated measures of ANOVA; F\u003csup\u003eb\u003c/sup\u003e = Group x time repeated measures of ANOVA; F\u003csup\u003ec\u003c/sup\u003e = Group x time repeated measures of ANCOVA controlling for baseline outcome assessment scores. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003cem\u003eStepwise multiple linear regression analysis for the intervention group (n=38)\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"600\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eItem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eAdj. R\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003eF (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 43px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003et (\u003cem\u003ep\u003c/em\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eCollinearity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eTolerance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;BDI from t1 to t4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 303px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 10.13 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-1.64 (0.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta;ISMI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e3.18 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;BDI from t1 to t3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 303px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;6.80 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-1.27 (0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta;ISMI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e2.61 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;BDI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 303px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 10.25 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-4.10 (0.00)**\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta;ISMI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e4.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e2.65 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta; PESAS from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e-0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-2.29 (0.03)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;RSE from t1 to t4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 29%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;10.64 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e3.33 (0.00)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta; PESAS from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e3.23 (0.00)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;RSE from t1 to t3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 29%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 8.74 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e1.94 (0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta;ISMI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-2.50 (0.02)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta; PESAS from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e2.06 (0.04)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\" valign=\"top\" style=\"width: 600px;\"\u003e\n \u003cp\u003eDependent variable: \u0026Delta;RSE from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" style=\"width: 391px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 13.56 (\u0026lt;0.001)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003ePredicting Variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e--\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e1.71 (0.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta;ISMI from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e3.02 (0.00)**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026Delta; PESAS from t1 to t2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.5%;\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.3333%;\"\u003e\n \u003cp\u003e-2.66 (0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes:\u003c/em\u003e *=significant at \u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; .05; **= significant at \u003cem\u003ep\u003c/em\u003e \u0026lt; .01;\u003cem\u003e\u0026nbsp;p =\u003c/em\u003e \u003cem\u003ep\u003c/em\u003e value;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations:\u003c/em\u003e Adj. R\u003csup\u003e2\u003c/sup\u003e:\u0026nbsp;Adjusted R square. ISMI = Internalized Stigma of Mental Illness; BDI = Beck Depression Inventory; PESAS = Personal Empowerment Self-Assessment Scale T1: Pre-intervention; T2: Post-intervention.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cognitive behavioural therapy, Coming out proud, Randomised controlled trial, Self-stigma, Mental illness","lastPublishedDoi":"10.21203/rs.3.rs-7175089/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7175089/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjectives.\u003c/strong\u003e The aim of this study was to evaluate the longer-term impact of a 12-session Expanded Coming Out Proud (ECOP) delivered by social worker with the skills of empowerment and transformation of negative self-stigmatising beliefs to reduce self-stigma in people with severe mental illness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e. This study was a multicentre, randomized controlled trial with 6-month follow-up. The intervention group received the ECOP in addition to treatment as usual (TAU), which included interest classes and recreational activities, while the control group received TAU.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults.\u003c/strong\u003eGroup x time repeated measures of analysis of covariance demonstrated that the ECOP, as compared with the control group, was effective on helping people with high self-stigma to achieve significant larger improvement in self-stigma, depressive symptoms and self-esteem at post-intervention, with these intervention effects being well sustained up to 6-month follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion.\u003c/strong\u003e The results of this study demonstrate the efficacy of the ECOP on improving self-stigma.\u003c/p\u003e","manuscriptTitle":"Expanded-Coming-Out-Proud Group on Reducing Self-stigma for People with Severe Mental Illness— A Randomized Control Trial with Six-month Follow-up","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-18 10:52:45","doi":"10.21203/rs.3.rs-7175089/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b702ddc5-02ef-444d-87c1-4c7fb96a0292","owner":[],"postedDate":"September 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54937421,"name":"Health sciences/Diseases"},{"id":54937422,"name":"Health sciences/Health care"},{"id":54937423,"name":"Biological sciences/Psychology"},{"id":54937424,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-04-30T00:54:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-18 10:52:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7175089","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7175089","identity":"rs-7175089","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}