VR-assisted Curriculum on Depression for Stigma Reduction

Reducing Stigma Against Depression: Designing and Implementing a VR-assisted Curriculum to Reduce Students' Perceptions of Patients With Depression

Two randomised controlled trials will be conducted to evaluate a virtual reality (VR) simulation designed to reduce stigma against depression. Qualitative interviews will also be carried out to evaluate the VR simulation.

The investigators examine the impact of a VR-assisted curriculum on stigma reduction towards individuals with depression. This is done through the development and evaluation of a VR-assisted curriculum that promotes stigma reduction towards depression among tertiary-aged students. Collection of data will provide insights about the effectiveness of VR's immersive quality in enhancing stigma reduction skills through measures of attitudes, beliefs and knowledge about depression. In the first study, VR is compared with traditional pamphlets in an information sharing booth about depression. In the second study, participants attend a 30-min session where they undergo an educational curriculum with either a VR or standard video as adjunctive tools.

virtual reality, stigma reduction, depression, mental health campaigns, user experience, enjoyment, presence

Participants watch a 4-minute virtual reality video, on top of reading a brochure, then answer post-intervention questionnaires.

Participants read an informational brochure about depression, then answer post-intervention questionnaires. After that, they will be given a chance to watch the VR video at the end of their participation session.

Participants watch a 4-minute standard video. After which, using a video, a discussion of the video will be facilitated for participants to contextualise and understand the video better. Then, participants answer post-intervention questionnaires.

Participants answer pre-questionnaires, then watch a 4-minute virtual reality video. After which, using a video, a discussion of the video will be facilitated for participants to contextualise and understand the video better. Then, participants answer post-intervention questionnaires.

The 4-minute virtual reality video depicts a day in a life of a student with depression. The one-take video, filmed with a 360° camera, is designed to provide users with an immersive experience that simulates what it feels like to have depression. The user interface consisted of a Google Cardboard VR headset attached to a smartphone.

Participants read an informational brochure about depression depicting standard information about depression, including symptoms and information on how to support someone with depression.

The 4-minute standard video depicts a similar storyline as was shown in the VR video. The standard video is filmed from a third-party perspective with multiple takes edited into a final video, following the standard filming style of these videos. The standard video will be viewed from a laptop with headphones attached.

The extent of agreement with negative beliefs and stereotypes about depression will be adapted from the 10-item agreement sub-scale of the Self-Stigma of Mental Illness Scale.

Stigmatising attitudes refer to the opinions that one has towards persons with depression, and how they would interact with these group of people. This will be measured using an adapted version of the Attribution Questionnaire-27.

A Depression Literacy measure will be used to assess participants' understanding and knowledge of depression.

In the VR condition, enjoyment of the VR simulation will be assessed through five items on a video enjoyment questionnaire created by the researchers, that includes items such as "I found the video interesting" and "The video made me more interested in the topic" on a visual analog scale. The scale was anchored between 0 indicating "Strongly Disagree" to 10 indicating "Strongly Agree".

Presence felt in the VR simulation will be assessed through four items on a video presence questionnaire, that includes items such as "How aware were you of events happening in your actual surroundings outside of the video?" and "How strong was your sense of 'being there' in the video environment?" on a visual analog scale. The questions were adapted from the original Presence Questionnaire by Witmer and Singer (1998) that outlined four sub-factors of control, sensory, distraction and realism; items in our questionnaire were carefully selected to represent all of the factors. The scale ranged from 0 indicating "Not At All" to 10 indicating "Very Much So".

Participants' mood will be assessed using the Positive and Negative Affect Scale (PANAS) as a secondary measure of user experience with the respective videos. The PANAS consists of two 10-item subscales assessing positive and negative affect, and is rated on a 5-point scale ranging from 1 representing "Very Slightly or Not at All" to 5 representing "Extremely".

Changes in heart rate, assessed live during the video viewing duration, will be measured as a physiological measure of user experience.

Participants will be invited to give feedback on their VR experience. Questions in the qualitative interview will address (1) their thoughts on mental health awareness amongst the public, (2) their experience watching the VR simulation and (3) reasons for stopping, or not, at similar mental health booths with VR simulations in the future.

Inclusion Criteria: Tertiary students from NUS and Yale-NUS only Exclusion Criteria: History of medical or psychiatric disorder; History of motion sickness, dizziness or epilepsy; (For reliability and safety of heart-rate monitoring) Tattoos near the wrist and/or nickel or acrylate allergies