{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:13:42Z","timestamp":1788286422452,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Developmental Exchange Service"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Mental health stigma remains a major barrier due to limited mental health promotion and care among adolescents in low- and middle-income countries (LMICs), due to a lack of mental health literacy, sociocultural beliefs, and misconceptions which contribute to delayed help-seeking and poor mental health outcomes. In Ethiopia, stigma surrounding mental illness can result in social exclusion, discrimination, and abandonment by family members. This study evaluated the effectiveness of a culturally adapted, school-based mental health literacy and anti-stigma intervention among secondary school students in Addis Ababa, Ethiopia. The intervention was culturally adapted in collaboration with local mental health experts and adolescent students to ensure relevance to the Ethiopian context. Using a train-the-trainer approach, seven school nurses and health extension workers were trained to deliver the intervention to 186 students across four secondary schools. Implemented over one week, the intervention utilized three components: (1) an interactive mental health literacy curriculum delivered through PowerPoint presentations and participatory activities, (2) a contact-based session involving a person with lived experience of mental illness, and (3) mental health promotion materials, including posters and bookmarks displaying anti-stigma messages. Outcomes were assessed using self-administered questionnaires completed before the intervention and three weeks after its completion. Following the intervention, students demonstrated improved mental health knowledge and more positive attitudes toward mental illness (t(185) = 8.67, p\u2009&lt;\u20090.001). Social distance, avoidance, and discomfort toward individuals with mental health problems were reduced, while intentions to seek help increased, with participants reporting greater willingness to seek support from formal and informal sources. These findings suggest that a culturally adapted, school-based mental health literacy and anti-stigma intervention was associated with improving adolescents\u2019 mental health knowledge, reduce stigmatizing attitudes, and strengthening help-seeking intentions. Such interventions represent a promising strategy for supporting adolescent mental health and addressing stigma in Ethiopia and other LMIC settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0007153","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:23:33Z","timestamp":1788283413000},"page":"e0007153","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["From stigma to support: Assessing the impact of school mental health literacy program in Addis Ababa, Ethiopia"],"prefix":"10.1371","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2288-8437","authenticated-orcid":true,"given":"Lidia","family":"Veliaminova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0054-5911","authenticated-orcid":true,"given":"Surafel","family":"Worku Megersa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finina","family":"Abebe Ware","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1076-0227","authenticated-orcid":true,"given":"Paula","family":"Gerbig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Dehning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Girma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Jobst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"9","key":"pgph.0007153.ref001","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S2215-0366(24)00163-9","article-title":"The Lancet Psychiatry Commission on youth mental health","volume":"11","author":"PD McGorry","year":"2024","journal-title":"Lancet Psychiatry"},{"issue":"3","key":"pgph.0007153.ref002","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5498\/wjp.v14.i3.350","article-title":"Digital psychiatry in low-and-middle-income countries: New developments and the way forward","volume":"14","author":"S Chakrabarti","year":"2024","journal-title":"World J Psychiatry"},{"issue":"3","key":"pgph.0007153.ref003","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1001\/archpediatrics.2011.592","article-title":"Prevalence of child mental health problems in sub-Saharan Africa: a systematic review","volume":"166","author":"MA Cortina","year":"2012","journal-title":"Arch Pediatr Adolesc Med"},{"key":"pgph.0007153.ref004","article-title":"Mental health service provision in low- and middle-income countries","volume":"10","author":"S Rathod","year":"2017","journal-title":"Health Serv Insights"},{"key":"pgph.0007153.ref005","doi-asserted-by":"crossref","first-page":"2133","DOI":"10.1016\/S0140-6736(24)00757-8","article-title":"Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"403","author":"AJ Ferrari","year":"2024","journal-title":"The Lancet"},{"key":"pgph.0007153.ref006","doi-asserted-by":"crossref","first-page":"101675","DOI":"10.1016\/j.eclinm.2022.101675","article-title":"Quantifying the global burden of mental disorders and their economic value","volume":"54","author":"D Arias","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pgph.0007153.ref007","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1017\/S0033291714000129","article-title":"What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies","volume":"45","author":"S Clement","year":"2015","journal-title":"Psychol Med"},{"key":"pgph.0007153.ref008","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1146\/annurev.soc.27.1.363","article-title":"Conceptualizing Stigma","volume":"27","author":"BG Link","year":"2001","journal-title":"Ann Rev Sociol"},{"issue":"10361","key":"pgph.0007153.ref009","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1016\/S0140-6736(22)01470-2","article-title":"The Lancet Commission on ending stigma and discrimination in mental health","volume":"400","author":"G Thornicroft","year":"2022","journal-title":"Lancet"},{"key":"pgph.0007153.ref010","doi-asserted-by":"crossref","first-page":"102612","DOI":"10.1016\/j.eclinm.2024.102612","article-title":"Anti-stigma interventions in low-income and middle-income countries: a systematic review","volume":"72","author":"T Majeed","year":"2024","journal-title":"EClinicalMedicine"},{"issue":"10","key":"pgph.0007153.ref011","doi-asserted-by":"crossref","first-page":"995","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_667_23","article-title":"Stigma towards mental illness in Asian nations and low-and-middle-income countries, and comparison with high-income countries: A literature review and practice implications","volume":"65","author":"M Vaishnav","year":"2023","journal-title":"Indian J Psychiatry"},{"issue":"12","key":"pgph.0007153.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0082116","article-title":"Public stigma against people with mental illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia","volume":"8","author":"E Girma","year":"2013","journal-title":"PLoS One"},{"issue":"5","key":"pgph.0007153.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-112423","article-title":"Breaking barriers: mental health literacy and stigma in Addis Ababa\u2019s schools - a qualitative study in Ethiopia","volume":"16","author":"SW Megersa","year":"2026","journal-title":"BMJ Open"},{"key":"pgph.0007153.ref014","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13034-015-0072-5","article-title":"Parents\u2019 perception of child and adolescent mental health problems and their choice of treatment option in southwest Ethiopia","volume":"9","author":"M Abera","year":"2015","journal-title":"Child Adolesc Psychiatry Ment Health"},{"issue":"1","key":"pgph.0007153.ref015","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1186\/s12913-023-09294-x","article-title":"What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review","volume":"23","author":"S Saade","year":"2023","journal-title":"BMC Health Serv Res"},{"key":"pgph.0007153.ref016","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1038\/s41380-021-01161-7","article-title":"Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies","volume":"27","author":"M Solmi","year":"2022","journal-title":"Mol Psychiatry"},{"issue":"1","key":"pgph.0007153.ref017","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12916-018-1237-x","article-title":"Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review","volume":"17","author":"CG Kemp","year":"2019","journal-title":"BMC Med"},{"issue":"9801","key":"pgph.0007153.ref018","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/S0140-6736(11)60754-X","article-title":"Poverty and mental disorders: breaking the cycle in low-income and middle-income countries","volume":"378","author":"C Lund","year":"2011","journal-title":"Lancet"},{"issue":"3","key":"pgph.0007153.ref019","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00127-017-1341-9","article-title":"Interventions to reduce discrimination and stigma: the state of the art","volume":"52","author":"PC Gronholm","year":"2017","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"3","key":"pgph.0007153.ref020","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1177\/0706743715616609","article-title":"Mental health literacy: past, present, and future","volume":"61","author":"S Kutcher","year":"2016","journal-title":"Can J Psychiatry"},{"issue":"1","key":"pgph.0007153.ref021","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/eip.12793","article-title":"Mental health literacy programs for school teachers: a systematic review and narrative synthesis","volume":"14","author":"S Yamaguchi","year":"2020","journal-title":"Early Interv Psychiatry"},{"key":"pgph.0007153.ref022","article-title":"The effectiveness of anti-stigma interventions for reducing mental health stigma in young people: a systematic review and meta-analysis","volume":"10","author":"N Song","year":"2023","journal-title":"Glob Ment Health (Camb)"},{"key":"pgph.0007153.ref023","doi-asserted-by":"crossref","first-page":"1012257","DOI":"10.3389\/fpsyt.2022.1012257","article-title":"Efficacy of school-based interventions for mental health problems in children and adolescents in low and middle-income countries: a systematic review and meta-analysis","volume":"13","author":"AJ Grande","year":"2023","journal-title":"Front Psychiatry"},{"issue":"10023","key":"pgph.0007153.ref024","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/S0140-6736(15)00298-6","article-title":"Evidence for effective interventions to reduce mental-health-related stigma and discrimination","volume":"387","author":"G Thornicroft","year":"2016","journal-title":"Lancet"},{"key":"pgph.0007153.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/14635240.2026.2649630","article-title":"Effectiveness of school-based interventions to improve mental health and wellbeing of students: an umbrella review","author":"MS Uddin","year":"2026","journal-title":"Int J Health Promot Educ"},{"issue":"6","key":"pgph.0007153.ref026","article-title":"A school-based intervention for mental illness stigma: a cluster randomized trial","volume":"145","author":"BG Link","year":"2020","journal-title":"Pediatrics"},{"issue":"1","key":"pgph.0007153.ref027","first-page":"44","article-title":"Changing knowledge and attitudes with a middle school mental health education curriculum","volume":"1","author":"OF Wahl","year":"2011","journal-title":"Stigma Res Action"},{"key":"pgph.0007153.ref028","article-title":"Toward integration of life course intervention and youth participatory action research","volume":"149","author":"EJ Ozer","year":"2022","journal-title":"Pediatrics"},{"issue":"4","key":"pgph.0007153.ref029","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1177\/0004867413512687","article-title":"Impact of the \u201cLike Minds, Like Mine\u201d anti-stigma and discrimination campaign in New Zealand on anticipated and experienced discrimination","volume":"48","author":"C Thornicroft","year":"2014","journal-title":"Aust N Z J Psychiatry"},{"issue":"1","key":"pgph.0007153.ref030","doi-asserted-by":"crossref","first-page":"30715","DOI":"10.1038\/s41598-024-79656-w","article-title":"Help-seeking intention for mental illness and associated factors among Dessie town residents in Northeast Ethiopia","volume":"14","author":"H Gelaye","year":"2024","journal-title":"Sci Rep"},{"issue":"7","key":"pgph.0007153.ref031","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1016\/j.adolescence.2014.08.001","article-title":"Effects of a classroom-based educational resource on adolescent mental health literacy: a cluster randomized controlled trial","volume":"37","author":"Y Perry","year":"2014","journal-title":"J Adolesc"},{"issue":"4","key":"pgph.0007153.ref032","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1007\/s12310-020-09379-6","article-title":"Experimental evaluation of a school-based mental health literacy program in two Southeast Asian nations","volume":"12","author":"AJ Nguyen","year":"2020","journal-title":"School Ment Health"},{"issue":"3","key":"pgph.0007153.ref033","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1017\/S0033291708003929","article-title":"Pathways to psychiatric care in Ethiopia","volume":"39","author":"YY Bekele","year":"2009","journal-title":"Psychol Med"},{"issue":"1","key":"pgph.0007153.ref034","doi-asserted-by":"crossref","first-page":"148","DOI":"10.15566\/cjgh.v11i1.795","article-title":"Providing mental healthcare through faith-based entities in Africa: a systematic review","volume":"11","author":"N Nanji","year":"2024","journal-title":"Christian J Glob Health"},{"issue":"1","key":"pgph.0007153.ref035","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1177\/0020764019879943","article-title":"Cultural adaptation framework of social interventions in mental health: evidence-based case studies from low- and middle-income countries","volume":"66","author":"M Fendt-Newlin","year":"2020","journal-title":"Int J Soc Psychiatry"},{"issue":"1","key":"pgph.0007153.ref036","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13033-022-00526-x","article-title":"Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation","volume":"16","author":"D Mabunda","year":"2022","journal-title":"Int J Ment Health Syst"},{"key":"pgph.0007153.ref037","doi-asserted-by":"crossref","DOI":"10.1016\/j.jadohealth.2021.10.037","article-title":"Agents of change for mental health: a survey of young people\u2019s aspirations for participation across five low- and middle-income countries","volume":"72","author":"G Pavarini","year":"2023","journal-title":"J Adolesc Health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:23:46Z","timestamp":1788283426000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0007153"}},"subtitle":[],"editor":[{"given":"Theingi Maung","family":"Maung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":37,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0007153","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}