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Analytical studies

Cochrane Review of Evidence: Discrimination Outcomes (CREDO)


Mental health-related stigma and discrimination are widespread and have significant adverse effects on the lives of people with mental ill health. A range of strategies have been used in efforts to reduce such stigma and discrimination, either at the individual-, community- or population-level. Policymakers, and other bodies working for change, often wish to bring about change in mass audiences, and in this situation one-to-one communication is by definition impossible.

Consequently, a mass media approach is often used. As such interventions can be resource-intensive and vary in their format, intensity, duration, and content, it is important that policymakers and campaigners have a comprehensive and systematic overview of the evidence about whether such interventions work and about what works best. There are currently no existing systematic reviews of mass media anti-stigma interventions relating to mental health and we aim to fill this important knowledge gap. This Cochrane review forms part of a knowledge synthesis on mass-media interventions to reduce mental health-related stigma and discrimination, the other part being the MOSAIC study.      


To strengthen the evidence base on mass-media interventions to reduce mental health-related stigma in order to inform those wishing to combat stigma and discrimination at the population level. This will be achieved by conducting a Cochrane systematic review to assess the effects of mass media anti-stigma interventions on mental health-related attitudes and behaviour.


The review followed the standard Cochrane methodology appropriate for complex interventions.  The search strategy included electronic searches, reference checking, and consultation with expert informants. We included randomised controlled trials and interrupted time series analyses. There were no language restrictions.  Participants were members of the general population or any of its constituent groups, including children. The only exclusion was participants of interventions directed exclusively at people with mental ill health (as a separate Cochrane review addressing this topic is registered with the Cochrane Schizophrenia Review Group).

The interventions were mass media interventions (including internet, television, film, radio, newspaper/magazine adverts, posters, leaflets etc.). An intervention could be multi-faceted, and may involve multiple forms of mass media and / or non-mass media interventions in addition to the mass media one(s).  The comparator may be either an inactive control or no intervention. The primary outcomes were attitudes (prejudice) and behaviour (discrimination).   

Progress to date and future plans:

A full protocol has been published (Clement et al 2011) in the Cochrane Library. The review has also now been completed. It identifyed and synthesised 22 eligible studies. The review has been submitted and published (Clement et al 2013). 


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