Mental Health Stigma, Misconceptions, and Help-seeking among University Students. Experimental Evidence from Kenya

Participants are randomized into one of three groups:
- A first treatment arm which receives infographics on experiences with mental health support and intentions to seek help for mental health from a sample of university students. The statistics provided are based on data collected among university students in Nairobi between October and December 2021.
- A second treatment arm which receives testimonials from university students in one of the participating universities who tried counseling and volunteered a testimonial on their experience.
- A pure control group which receives no information.

2022-07-04

2022-09-30

- Posterior beliefs on each of the two statistics provided in the first treatment arm
- Stereotypical beliefs
- Efficacy beliefs
- Extensive and intensive margin of demand for mental health support. The extensive margin is measured through a binary choice which captures interest in a counseling voucher offered at a subsidized price. The intensive margin is an incentivized measure of willingness to pay for the counseling voucher.

Stereotypical beliefs are elicited by referring to the character of a vignette. The first measure relies on agreement with two statements borrowed from the psychological literature on stigma attached to help-seeking for mental health. The second measure relies on the assessment of two traits of the character of the vignette. In both cases, answers are measured on a Likert-type scale and will be converted in a standardized index.

Efficacy beliefs are elicited both by referring to the character of the vignette and to the respondent. The questions assess the likelihood of symptoms remittance for the character of the vignette in the absence of therapy, the hypothetical likelihood of symptoms remittance if the respondent experienced similar symptoms, and expected benefits from counseling for the respondent. For each question, answers are measured on a Likert-type scale and will be converted in a standardized index.

Willingness to pay is measured using a Becker-deGroot-Marschak procedure in which participants formulate a bid for the counseling voucher. The bid is compared to a price determined by a random number generator on Qualtrics. If the participant's bid is greater than the price, they participate in a lottery for the vouchers and if they win, they pay for the voucher using the participation token.

- Second-order stereotypical beliefs
- Binary choices for two hypothetical vouchers for a counseling session, in which the location of the session is varied compared to the primary outcome
-Demand for a mental health app: extensive and intensive margin assessed in the same way as for the counseling voucher, and clicking behavior to capture download of the free version of the app
- Incentivized willingness to disclose interest in the counseling vouchers with peers
- Self-reported help-seeking behavior and intentions, and mental health status measured at follow-up. Mental health status will be measured using the brief screening tool PHQ-4.

The study relies on an incentivized online survey experiment. Participants will be assigned at random into one of three groups:
- A first treatment arm which is exposed to two infographics based on data collected in two smaller-scale surveys targeting university students in Nairobi. The infographics will report: the share of students who reported ever seeking professional mental health support, and the share of students who made a bid for a voucher for one online counseling session at a subsidized price.
- A second treatment which is exposed to two testimonials from a male and a female student from one of the participating universities who volunteered a testimonial about their own experience with psychological counseling.
- A pure control group which receives no information.

After exposure to the information treatments, I will elicit posterior beliefs and demand for mental health support options, which will constitute the primary outcomes of the empirical analysis.

Students are invited to participate in the main survey, which will include both pre-treatment information about prior beliefs, socio-demographics, and post-treatment elicitation of posterior beliefs and outcome variables. After 2 to 3 weeks after participating in the main survey, participants will receive an invitation to participate in a short follow-up survey, which aims to test for persistent effects on help-seeking behavior and mental health.

Randomization done in Qualtrics using a random number generator.

Randomization is at the individual level.

No

1500 students recruited from three different universities in Nairobi.

1500 students recruited from three different universities in Nairobi.

500 assigned to treatment 1, 500 assigned to treatment 2, 500 assigned to control.