Effectiveness of arts interventions to reduce mental-health-related stigma among youth: a systematic review and meta-analysis

Abstract

Background Educational interventions engage youth using visual, literary and performing arts to combat stigma associated with mental health problems. However, it remains unknown whether arts interventions are effective in reducing mental-health-related stigma among youth and if so, then which specific art forms, duration and stigma-related components in content are successful. Methods We searched 13 databases, including PubMed, Medline, Global Health, EMBASE, ADOLEC, Social Policy and Practice, Database of Promoting Health Effectiveness Reviews (DoPHER), Trials Register of Promoting Health Interventions (TRoPHI), EPPI-Centre database of health promotion research (Bibliomap), Web of Science, PsycINFO, Cochrane and Scopus for studies involving arts interventions aimed at reducing any or all components of mental-health-related stigma among youth (10–24-year-olds). Risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Data were extracted into tables and analysed using RevMan 5.3.5. Results Fifty-seven studies met our inclusion criteria (n = 41,621). Interventions using multiple art forms are effective in improving behaviour towards people with mental health problems to a small effect (effect size = 0.28, 95%CI 0.08–0.48; p = 0.007) No studies reported negative outcomes or unintended harms. Among studies using specific art forms, we observed high heterogeneity among intervention studies using theatre, multiple art forms, film and role play. Data in this review are inconclusive about the use of single versus multiple sessions and whether including all stigma components of knowledge, attitude and behaviour as intervention content are more effective relative to studies focused on these stigma components, individually. Common challenges faced by school-based arts interventions included lack of buy-in from school administrators and low engagement. No studies were reported from low- and middle-income countries. Conclusion Arts interventions are effective in reducing mental-health-related stigma to a small effect. Interventions that employ multiple art forms together compared to studies employing film, theatre or role play are likely more effective in reducing mental-health-related stigma.

“Every day I grew stronger and stronger being there”.: empowerment through land-and art-based Peer Leader retreats with Indigenous and Northern young people

“…For example, arts-based research with Arctic youth in Canada facilitated self-connectedness and acceptance, healthy decision making, identity building, meaning-making, and emotional processing [ 11 ]. Participatory art-based processes with youth can also reduce stigma [ 18 ] and promote social inclusion [ 17 ].…”

Investigation of a group of Iranian theater artists' mental health and attitude toward patients with mental disorders

“…Most anti-stigma interventions and campaigns have been conceptualized using knowledge-attitude-behavior paradigm ( 18 ), i.e., experiential learning (learning through reflection on doing), empathy building, interactive and prolonged exposure to anti-stigma content ( 35 , 36 ).…”

“…Further investigations should be done among artists, and if needed, we can provide them with anti-stigma activities and interventions, i.e., workshops, screening films or performing plays about mental disorders, and discussion classes that have been suggested by previous studies for other groups ( 13 – 18 ).…”

“…There have been reports of the possibility for the role of the dramaturg ( 13 ), live presentations ( 14 ), applied drama ( 15 ), performing arts ( 16 ), and theatrical presentations ( 17 ) in reducing stigma. A review for evaluating the impact of mass media interventions including film, photographs, radio and comics reported that art interventions are generally effective when they use multiple art forms, but with a small effect ( 18 ).…”

Evaluation of a Pilot, Community-Led Mental Illness De-stigmatization Theater Intervention in Rural Uganda

“…10 However, despite promising results, the intervention's impact on audience members' knowledge, attitudes, and practices (KAP) was not directly measured; 10 to our knowledge, this is the rst study attempting to quantify impact that theatrical performances may have on mental illness stigma in a rural community in a LIC. 11 To assess the potential of culturally-speci c theater programs to change community attitudes and reduce mental health stigma in LICs, we developed and pilot-tested a community-led performance in the Busoga region of eastern Uganda which depicted an individual's struggle with mental illness and journey to receive appropriate care. By showing this man's progression from being severely debilitated to becoming integrated as a productive member of society, the goal was to ascribe a face and voice to similar individuals whose suffering is very real and humanize their di culties for the rest of the community.…”