Top

International Journal of Bipolar Disorders

Published in:

Open Access 01-12-2014 | Research

Using theatre to address mental illness stigma: a knowledge translation study in bipolar disorder

Authors: Erin E Michalak, James D Livingston, Victoria Maxwell, Rachelle Hole, Lisa D Hawke, Sagar V Parikh

Published in: International Journal of Bipolar Disorders | Issue 1/2014

Abstract

Background

Reduction of the stigma of mental illness is an international priority; arts- and contact-based approaches represent a promising mode of intervention. This project was designed to explore the impact of a one-woman theatrical performance on attitudes towards bipolar disorder (BD) on people with BD and healthcare providers.

Methods

A playwright and actress who lives with BD developed a stage performance - 'That’s Just Crazy Talk’ - targeting stigmatizing attitudes towards BD. Prospective, longitudinal and sequential mixed methods were used to assess the impact of the performance on people with BD (n = 80) and healthcare providers (n = 84). Qualitative interviews were conducted with 33 participants (14 people with BD and 19 healthcare providers).

Results and Discussion

Quantitatively, healthcare providers showed significantly improved attitudes immediately post-performance, but this change was not maintained over time; people with BD showed little quantitative change. Qualitatively, both people with BD and BD healthcare providers showed enduring and broadly positive changes. A theatrical presentation designed to reduce stigma produced immediate impact on healthcare providers quantitatively and significant qualitative impact on people with BD and healthcare providers. Additionally, the utility of using mixed-method approaches in mental health research was demonstrated.

Available only for authorised users

Angermeyer MC, Matschinger H: Public beliefs about schizophrenia and depression: similarities and differences. Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 526–534. 10.1007/s00127-003-0676-6CrossRefPubMed

Aydemir Ö, Akkaya C: Association of social anxiety with stigmatisation and low self-esteem in remitted bipolar patients. Acta Neuropsychiatr. 2011, 23: 224–228. 10.1111/j.1601-5215.2011.00565.xCrossRefPubMed

Braun V, Clark V: Using thematic analysis in psychology. Qual Res Psychol. 2006, 3: 77–101. 10.1191/1478088706qp063oaCrossRef

Cerit C, Filizer A, Tural Ü, Tufan AE: Stigma: a core factor on predicting functionality in bipolar disorder. Compr Psychiatry. 2011, 53: 484–489.CrossRefPubMed

Corrigan PW: Research and the elimination of the stigma of mental illness. Br J Psychiatry. 2012, 201: 7–8. 10.1192/bjp.bp.111.103382CrossRefPubMed

Creswell JW, Clark VLP: Designing and conducting mixed methods research. Thousand Oaks: Sage; 2011.

Crisp AH, Gelder MG, Rix S, Meltzer HI, Rowlands OJ: Stigmatisation of people with mental illnesses. Br J Psychiatry. 2000, 177: 4–7. 10.1192/bjp.177.1.4CrossRefPubMed

Day EN, Edgren K, Eshleman A: Measuring stigma toward mental illness: development and application of the Mental Illness Stigma Scale. J Appl Soc Psychol. 2007, 37: 2191–2219. 10.1111/j.1559-1816.2007.00255.xCrossRef

Durand-Zaleski I, Scott J, Rouillon F, Leboyer M: A first national survey of knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in France. BMC Psychiatry. 2012, 12: 128–135. 10.1186/1471-244X-12-128PubMedCentralCrossRefPubMed

Eakin JM, Endicott M: Knowledge translation through research-based theatre. Healthc Policy. 2006, 2: 54–59.PubMedCentralPubMed

Faigin D, Stein C: Comparing the effects of live and video-taped theatrical performance in decreasing stigmatization of people with serious mental illness. JMH. 2008, 17: 594–606.

Fung KM, Tsang HW, Corrigan PW: Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatr Rehabil J. 2008, 32: 95–104.CrossRefPubMed

Greenhalgh T, Hurwitz B: Narrative based medicine: why study narrative? BMJ. 1999, 318: 48.PubMedCentralCrossRefPubMed

Hawke LD, Michalak EE, Maxwell V, Parikh SV: Reducing stigma toward people with bipolar disorder: impact of a filmed theatrical intervention based on a personal narrative. Int J Soc Psychiatry 2013. doi:10.1177/0020764013513443

Hinshaw SP, Stier A: Stigma as related to mental disorders. Annu Rev Clin Psychol. 2008, 4: 367–93. 10.1146/annurev.clinpsy.4.022007.141245CrossRefPubMed

Kassam A, Glozier N, Leese M, Henderson C, Thornicroft G: Development and responsiveness of a scale to measure clinicians’ attitudes to people with mental illness (medical student version). Acta Psychiatr Scand. 2010, 122: 153–61. 10.1111/j.1600-0447.2010.01562.xCrossRefPubMed

Kirby M: Mental health in Canada: out of the shadow forever. CMAJ. 2008, 178: 1320–2. 10.1503/cmaj.071897PubMedCentralCrossRefPubMed

Klassen AC, Creswell J, Plano Clark VL, Smith KC, Meissner HI: Best practices in mixed methods for quality of life research. Qual Life Res. 2012, 21: 1–4.

Kondrat DC, Early TJ: An exploration of the working alliance in mental health case management. Res Soc Work. 2010, 34: 201–11. 10.1093/swr/34.4.201CrossRef

Livingston JD, Boyd JE: Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010, 71: 2150–61. 10.1016/j.socscimed.2010.09.030CrossRefPubMed

Lorenz K, Steckart M, Rosenfeld K: End-of-life education using the dramatic arts: the Wit educational initiative. Acad Med. 2004, 79: 481–6. 10.1097/00001888-200405000-00020CrossRefPubMed

Michalak EE, Yatham LN, Kolesar S, Lam RW: Bipolar disorder and quality of life: a patient-centered perspective. Qual Life Res. 2006, 15: 25–37. 10.1007/s11136-005-0376-7CrossRefPubMed

Michalak EE, Yatham LN, Maxwell V, Hale S, Lam RW: The impact of bipolar disorder upon work functioning: a qualitative analysis. Bipolar Disord. 2007, 9: 126–43. 10.1111/j.1399-5618.2007.00436.xCrossRefPubMed

Michalak EE, Livingston JD, Hole R, Suto M, Hale S, Haddock C: 'It’s something that I manage but it is not who I am’: reflections on internalized stigma in individuals with bipolar disorder. Chronic Illn. 2011, 7: 209–24. 10.1177/1742395310395959CrossRefPubMed

Michalak EE, Hole R, Livingston JD, Murray G, Parikh SV, Lapsley S, McBride S: Improving care and wellness in bipolar disorder: origins, evolution and future directions of a collaborative knowledge exchange network. Int J Ment Health Syst. 2012, 6: 16–34. 10.1186/1752-4458-6-16PubMedCentralCrossRefPubMed

Mileva VR, Vázquez GH, Milev R: Effects, experiences, and impact of stigma on patients with bipolar disorder. Neuropsychiatr Dis Treat. 2013, 9: 31–40.PubMedCentralCrossRefPubMed

Quinn N, Shulman A, Knifton L, Byrne P: The impact of a national mental health arts and film festival on stigma and recovery. Acta Psychiatr Scand. 2011, 123: 71–81. 10.1111/j.1600-0447.2010.01573.xCrossRefPubMed

Reavley NJ, Jorm AF: Stigmatizing attitudes towards people with mental disorders: findings from an Australian National Survey of Mental Health Literacy and Stigma. Aust NZ J Psychiatry. 2011, 45: 1086–93. 10.3109/00048674.2011.621061CrossRef

Ritsher JB, Otilingam PG, Grajales M: Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003, 121: 31–49. 10.1016/j.psychres.2003.08.008CrossRefPubMed

Roberts G, Somers J, Dawe J, Passy R, Mays C, Carr G, Shiers D, Smith J: On the edge: a drama-based mental health education programme on early psychosis for schools. Early Interv Psychiatry. 2007, 1: 168–76. 10.1111/j.1751-7893.2007.00025.xCrossRef

Rossiter K, Gray J, Kontos P, Keightley M, Colantonio A, Gilbert J: From page to stage: dramaturgy and the art of interdisciplinary translation. J Health Psychol. 2008, 13: 277–86. 10.1177/1359105307086707CrossRefPubMed

Rossiter K, Kontos P, Colantonio A, Gilbert J, Gray J, Keightley M: Staging data: theatre as a tool for analysis and knowledge transfer in health research. Soc Sci Med. 2008, 66: 130–46. 10.1016/j.socscimed.2007.07.021CrossRefPubMed

Sartorius N, Schulze H: Reducing the stigma of mental illness: a report from a global programme of the World Psychiatric Association. New York: Cambridge University Press; 2005.CrossRef

Schomerus G, Schwahn C, Holzinger A, Corrigan P, Grabe H, Carta M, Angermeyer MC: Evolution of public attitudes about mental illness: a systematic review and meta‒analysis. Acta Psychiatr Scand. 2012, 125: 440–52. 10.1111/j.1600-0447.2012.01826.xCrossRefPubMed

Shapiro J, Hunt L: All the world’s a stage: the use of theatrical performance in medical education. Med Educ. 2003, 37: 922–7. 10.1046/j.1365-2923.2003.01634.xCrossRefPubMed

Stuart H, Arboleda-Florez J, Sartorius N: Paradigms lost: fighting stigma and the lessons learned. New York: Oxford University Press; 2012.CrossRef

Suto M, Livingston JD, Hole R, Lapsley S, Hale S, Michalak E: 'Stigma Shrinks my Bubble’: a qualitative study of understandings and experiences of stigma and bipolar disorder. Stigma Res Action. 2012, 2: 85–92.

Tsang HW, Fung KM, Chung RC: Self-stigma and stages of change as predictors of treatment adherence of individuals with schizophrenia. Psychiatry Res. 2010, 180: 10–5. 10.1016/j.psychres.2009.09.001CrossRefPubMed

Twardzicki M: Challenging stigma around mental illness and promoting social inclusion using the performing arts. J R Soc Promot Health. 2008, 128: 68–72. 10.1177/1466424007087804CrossRefPubMed

Vázquez G, Kapczinski F, Magalhaes P, Córdoba R, Lopez Jaramillo C, Rosa A, Sanchez de Carmona M, Tohen M: Ibero-American Network on Bipolar Disorders group. Stigma and functioning in patients with bipolar disorder. J Affect Disord 2011, 130: 323–27. 10.1016/j.jad.2010.10.012CrossRefPubMed

Weiss MG, Ramakrishna J, Somma D: Health-related stigma: rethinking concepts and interventions. Psychol Health Med. 2006, 11: 277–87. 10.1080/13548500600595053CrossRefPubMed

Yap MBH, Wright A, Jorm AF: The influence of stigma on young people’s help-seeking intentions and beliefs about the helpfulness of various sources of help. Soc Psychiatry Psychiatr Epidemiol. 2011, 46: 1257–65. 10.1007/s00127-010-0300-5CrossRefPubMed

Title: Using theatre to address mental illness stigma: a knowledge translation study in bipolar disorder
Authors: Erin E Michalak
James D Livingston
Victoria Maxwell
Rachelle Hole
Lisa D Hawke
Sagar V Parikh
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Bipolar Disorders / Issue 1/2014
Electronic ISSN: 2194-7511
DOI: https://doi.org/10.1186/2194-7511-2-1

At a glance: The STEP trials

Springer Medicine

Using theatre to address mental illness stigma: a knowledge translation study in bipolar disorder

Abstract

Background

Methods

Results and Discussion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results and Discussion

Please log in to get access to this content

Other articles of this Issue 1/2014

Letter to the editor: is it valid to break down results from long-term trials in bipolar disorder by polarity of relapses?

Lithium as add-on to quetiapine XR in adult patients with acute mania: a 6-week, multicenter, double-blind, randomized, placebo-controlled study

Circadian biomarkers in patients with bipolar disorder: promising putative predictors of lithium response

Are rates of pediatric bipolar disorder increasing? Results from a nationwide register study

Impulsivity: present during euthymia in bipolar disorder? - a systematic review

Immunological and neurotrophic markers of risk status and illness development in high-risk youth: understanding the neurobiological underpinnings of bipolar disorder