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Introduction. Obsessive-compulsive disorder (OCD) is a serious and disabling mental illness that presents a high delay in help seeking. Various studies suggest that stigma and mental health literacy (MHL) are two very important factors that favour this delay and that they vary depending on OCD symptoms. Considering that, the aim of this study is to, firstly, analyze the stigma and OCD literacy in relation to the different obsessive-compulsive symptom contents in the general population and, secondly, assess the impact of an intervention carried out through a mobile application (esTOCma) that has been gamified to decrease stigma and increase OCD literacy.
Method. A group of 357 people (39.66 (SD = 16.88) years; 66.7% women) were drawn from the general population and randomly assigned to 6 vignettes that describe different obsessive-compulsive contents (OC) (i.e., aggression/harm; sexual; religious/blasphemous/immoral; contamination/washing; doubts/checking; superstition/symmetry/order). Sociodemographic information was collected as well as data regarding desired social distance (SDS), knowledge about OCD (MHL), both at a general level and associated with the vignette, and stigma (AQ-27). Then, participants completed the application and filled out the assessment instruments for a second time. Descriptive statistics, simple variance analyses and repeated measures analysis of variance with Bonferroni adjustments were performed.
Results. The analyses show that, prior to the intervention, there were significant small-moderate effect size differences in stigmatizing attitudes (F(5, 351) = 2.561, p = 0.027, ƞ2p = 0.035), social distance desire (F(5, 351) = 2.41, p = 0.036, ƞ2p = 0.033) and MHL (F(5, 351) = 4.698, p = < 0.001, ƞ2p =0.063) between the OC contents. First, regarding stigma, fear and attribution of danger were significantly higher towards the content of aggression/harm, and avoidance was significantly higher towards the religious/blasphemous/immoral OC content. Second, MHL was significantly lower in the doubts/checking content compared to others (aggression/harm; sexual; religious/blasphemous/immoral; contamination/washing); and significantly higher in superstition/symmetry/order compared to religious/blasphemous/immoral. After the intervention, and regardless the OC content dimension, there were significant changes with large effect sizes. Specifically, there was a significant decrease in stigma (F(1, 351) = 111.285, p <0.001, ƞ2p = 0.241) and in desired social distance (F(1, 351) = 120.945, p < 0.001, ƞ2p =0.256). In addition, knowledge about OCD has increased significantly (F(1, 351) = 85.122, p < 0.001, ƞ2p =0.195) in all content groups except for moral.
Discussion. Consistent with other studies, these results show that there are relevant differences in stigma between OC contents. Also, regarding the intervention, esTOCma seems to be a useful resource to improve general knowledge about OCD and to reduce stigma, and it could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing of OCD patients. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals.
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