Table 1 Summary of study characteristics and outcomes

Author/s, Year

Country

Sample size

Age [mean (SD)/ range]

Participant profile

Study Design

Intervention description

Duration (frequency)

Number of follow-ups (times)

Description of change in all stigma dimensions (knowledge (K), attitude (A) and behaviour (B)

K

A

B

Faigin DA & Stein C, 2008 [38]

USA

303

19/ 18–40

College students (Health professionals in-training)

Controlled clinical trial

Live and video-taped theatrical performance

70 min (once)

2 (immediately post and after 1 month)

More benevolent attitudes. Students gained more knowledge through lesson plans than theatre.

–

0.18

0.15

Gliksman DL et al., 1983 [41]

Canada

716

14–18^a

School students

Cohort analytic (two group pre and post)

BOOZE- series of five skits and theatre-based lesson plan

5 h (Not Reported (NR))

1 (1 week post)

Significant change in attitude to alcohol use between groups (p < 0.03). No change in attitude towards alcohol abuse/ alcohol education. Live theatre stimulated thought and discussion on effects of drugs (53% learnt something new).

–

–

–

Harding C et al., 1996 [74]

USA

580

14–18

School students

Qualitative research

Captain Clean- Professional musical play (18 performances)

30 mins (once)

1 (2 weeks post)

94 individual counselling requests (increase); 60% would stand up against drugs; “true friends would not involve them in drug-related activities”

–

–

–

Jones N et al., 2014 [47]

UK

594

75% < 30 years

Miltary personnel

Cohort analytic (two group pre and post)

Stand-up comedy show

(once)

2 (immediately post and after 3 months)

No significant effect on RIBS after controlling for baseline score; but borderline significant effect at follow-up.

Significant change in knowledge between baseline and posttest, but no significant effect at follow up (p = 0.15).

0.37

0.01

0.3

Pitre N et al., 2007 [57]

Canada

185

8–12

School students

Controlled clinical trial

Puppet show on schizophrenia, dementia and anxiety/ depression

45 min (once)

1 (day aft48intervention for experimental group and 2 weeks after for control group)

Significant change in restrictive attitude towards people with mental health problems. Experimental group preferred significantly lower Separatism (p < 0.01), and Stigmatization (p < 0.025). However, stereotyping was not significantly different.

–

–

–

Roberts G et al., 2007 [60]

UK

2500

14–22

School students

Cohort (one group pre-post design)

71 performances

4 h in 3 weeks (NR)

2 (1–2 weeks post and after 6 months with a subgroup)

Significant increase in student willing to seek help (5.4% change from baseline to posttest and 1.7% change from baseline at follow up). Significant positive change in beliefs about treatment, dangerousness and difficulty in talking to people with mental health problems. Participants showed significant gain in knowledge about where to go for help, including clinical options.

–

–

–

Rowe N et al., 2013 [75]

Malaysia

5

20–22

College students (Theatre major)

Qualitative research

Collaborative theatre with people living with mental health problems

8 months (NR)

NR details of follow up after the project

Process helped to acknowledge labels. Change from initial hypersensitivity, cautiousness and awkwardness or pity to – ‘I want to make people aware that difference is not dangerous.’- Normal, not taboo, ordinary relationship and comfortable were words used to describe social contact. Participants understood that depression, anxiety, panic and stress are related to mental health.

–

–

–

Safer LA & Harding CG., 1993 [61]

USA

278

10–12

School students

Cohort analytic (two group pre and post)

Captain Cle–n - live musical play and role play

30 min (NR)

1 (2–3 weeks posttest)

19% students requested counselling. More positive attitudes at post-test with no change in control group.

–

–

–

Starkey F & Orme J., 2001 [84]

UK

285

10–11

School students

Mixed method (based on a one group pre-post design)

Interactive drama production and workshop

One day (once)

1 (4 weeks post)

‘A person who lost a bag of drugs is not silly/ stupid (3.5% change; p < 0.01).

Likely to call the police if they found drugs and were able to identify names of drugs.

–

–

–

Twardzicki M., 2008 [65]

UK

67

16–19

College students (general major)

Cohort (one group pre-post design)

Collaborative art through social contact

3 years (3 half days + performance)

0

Students expressed willingness to help people with mental health problems or visit a relevant organisation. 18/43 participants showed a more positive attitude. 30/43 showed improved understanding of mental health.

–

–

–

Welch TR & Welch M., 2008 [77]

Canada

80

NR

College students (Health professionals in-training)

Qualitative research

Bearing Witness- play about an abuse survivor (3 performances and a staged production)

NR (once)

1 (after 4 months)

Participants related at a cognitive and emotional level. Personal stories aroused empathy. Ability to engage and yet ‘step away’ was important. Participants’ gained clinical knowledge.

–

–

–

Author/s, Year

Country

Sample size

Age [mean (SD)/range]

Participant profile

Study Design

Brief intervention description

Intervention Duration (frequency)

Number of follow-ups (times)

Description of change in all stigma dimensions (knowledge (K), attitude (A) and behaviour (B)

K

A

B

Chan HV & Pervanas HC., 2014 [32]

USA

24

11–12

College students (Health professionals in-training)

Post-test only for one group

Video skit and interactive visual material

NR (once)

NA

Raised awareness of drug and alcohol abuse (no specific changes)

–

–

–

Duryea E et al., 1984 [36]

USA

155

14–15^a

School students

Cohort (one group pre-post design)

Film, role play, slide show

6 school days (1 h per day)

2 (1 week post and after 6 months)

Ability to refute pro-drinking arguments by treatment (p < 0.005) and time (p < 0.001). Significant increase in ability to answer multiple choice questions on alcohol (p < 0.001).

1.82

0.27

–

Gilfoy K & Young A, 2001 [73]

UK

NR

13–21

Youth in a community setting

Qualitative research

Co-creation music, documentary and visual arts

2 weeks during summer (NR)

0

Focus on awareness, not changing views. Raising awareness within the peer group explored.

–

–

–

Stevens V et al., 2000 [62]

Belgium

1465

13–16

School students

Cohort (one group pre-post design)

Film and role play

6.6 h or 400 min (NR)

2 (after 6 months of baseline and after 12 months)

Most students reported a negative attitude towards bullying behaviours, but few of them intervened.

–

0.05

0.22

Jones S et al., 2011 [48]

UK

109

14–15^a

School students

Post-test only for one group

Video, word association and role pay

50 min (once)

1 (immediately post)

Dispelled stereotypes that people with mental illness do not look scary among 25% participants. About 40% gained knowledge that mental illness is common, 20% learnt about anxiety, depression and < 1% reported learning about where to seek help.

–

–

–

Kassam A et al., 2011 [50]

UK

65

22.8(4.4)

College students (Health professionals in-training)

Controlled clinical trial

Presentation and role play

1 h 30 mins

1 (1 week post)

Factual knowledge improved significantly (p < 0.001). However, there was no change in attitudes and behaviour.

1.4

0.6

–

Marques Filho et al., 2007 [81]

Brazil

94

20–25^a

College students (Health professionals in-training)

Mixed methods

Mind fingers song

NR (NR)

0

Reflection group using lyrics helped in minimization of resistances to do with talking about drug use, attitudes about understanding psychoactive substances, contemplating use and abstinence, facilitating the transmission of knowledge to students.

–

–

–

Kalafat J & Elias M., 1994 [49]

USA

253

15–16^a

School students

Controlled clinical trial (Solomon group design)

Role play, video and didactic session on how to respond

45 min (3 sessions)

1 (immediately post)

Significant overall group effects on knowledge (p < 0.001), attitude (p < 0.03) and behaviour (p < 0.002). Participants more likely to take effective action for a troubled peer/ self: call a hotline (p < 0.05) or take a friend’s advice (p < 0.05). Participants more likely to disagree with negative statements about seeking help and intervening with suicidal individuals and with stereotypes that suicide runs in families (males commit it more often and people who talk about it do not do it).

–

–

–

Mora M et al., 2015 [54]

Spain

200

12–15

School students

Controlled clinical trial

Interactive multimedia and performing “Teen Spirit,” a professionally scripted play

120 min (10 sessions)

3 (post-test after 1 month, and after 5 and 13 months)

Change in attitude towards eating disorders through reduced thin-ideal internalization.

–

–

–

Paukste E & Harris N., 2015 [82]

Australia

18

14–18

School students

Mixed methods

Creative workshops and educational sessions

1–2 h (7 weeks)

1 (final week of the workshop)

Understanding of risk and changed perspectives on alcohol, tobacco and other drugs

–

–

–

Altindag AM et al., 2006 [30]

Turkey

60

19–25^a

College students (Health professionals in-training)

Cohort analytic (two group pre and post)

Education (2 h lecture), social contact and film on schizophrenia (A beautiful mind)

One day (once)

1 (1 month post)

Attitudes towards social distance towards people living with Schizophrenia and willingness to work with a person living with Schizophrenia

–

–

–

Friedrich B et al., 2013 [40]

UK

1452

23.5

College students (Health professionals in-training)

RCT

Time to Change END intervention; short lecture, professional role play and feedback

Three years (NR)

2 (immediately post and after 6-months)

Participants had a significantly greater improvement in intended behaviour, attitude (2/3 item–s – easy to recognise a person with MI and frightening to have people with MI in the neighbourhood) and knowledge than the control group. While knowledge changed significantly at follow up, behaviour showed no change and attitude changed only for one item.

–

–

–

Van Schoiack-Edstrom, L et al., 2002 [66]

USA

714

10–14^a

School students

Cohort analytic (two group pre and post)

Videotaped vignettes, reading newspaper stories and role play

One semester (15 lessons; 8 lessons)

1 (Between 1 and 5 weeks post)

Reduced endorsement of verbal derogation and social exclusion in relation to physical aggression

–

–

–

Essler V et al., 2006 [37]

UK

104

13–14

School students

Cohort (one group pre-post design)

Professional theatre, quiz, drama and games

NR (NR)

1 (1 month post“)

“stay friends”-; risk of violence by mental health persons reduced p = 0.015) increase in median scores; p = 0.015 (no comparison or baselines data); significant increase in knowledge of incidence of symptoms

–

–

–

Wasserman C et al., 2012 [86]

11 European countries

12,395

14.9 (0.9)/ 14–16

School students

Mixed methods (based on a RCT)

Graphic booklet, role play and posters

5 h in four weeks (weekly)

2 (after 3 months and after 12 months)

desire to help persons in need; increased general mental health awareness and self-recognition

–

–

–

Woodside et al., 1997 [69]

USA

588

11–15^a

School students

Cohort analytic (two group pre and post)

The Images Within– Visual art, learner’s guide and brochures

NR (once)

1 (immediately post)

Increase in student referrals from 50 to 113%. Significant improvement in attitude to helping a friend from an alcoholic family between treatment-control (p < 0.001) and between pre-test- post-test (p < 0.009). Knowledge about alcohol improved by 15.2% (change in score), its effects on the family improved by 12.7% and significant changes between treatment-control (p < 0.001) and pre-test-posttest (p < 0.001) regarding the need for help.

–

–

–

Rabak-Wagener J et al., 1998 [58]

USA

105

18–23

College students (Health professionals in-training)

Cohort analytic (two group pre and post)

Slim Hopes video, advertisements and magazine photographs, collage-making and discussion

1 h 35 min in 4 sessions (weekly)

1 (3 weeks after pre-test)

High agreement on beliefs and behaviours related to body image.

–

−2.93

–

Watson R & Vaughn LM, 2006 [67]

USA

54

19.21 (1.67)/ 18–25

Female college students (general major)

Cohort analytic (two group pre and post)

Video, popular magazine images, role play, homework and discussion

1.5 h and 1.5 h × 4 weeks (weekly)

1 (immediately post-test)

A long-term media literacy intervention was more effective at decreasing body dissatisfaction than a similar short term. Video only, short-term interventions did not have an effect on awareness. Change in awareness in pre-test to post-test was observed in the long term condition, t(14, 15) =4.617, p < 0.01.

–

–

–

Stuart H, 2006 [63]

Canada

571

13–18^a

School students

Cohort (one group pre-post design)

Video (20 mins), role play and discussion

NR (Once)

1 (after 3 weeks)

14% increase in number of students who were not afraid to talk to someone who had schizophrenia. Students were about 4 times more likely to achieve a high knowledge score (80% or greater) but only about twice as likely to achieve a high distance score. Improvement in knowledge at post-test (p < 0.001).

–

–

–

Kusel A, 1999 [53]

USA

172

9–12

School students

RCT

Videos, magazine review and discussion

Two days

1 (1 month after pre-test)

Significant decrease in internalization of body stereotypes over time and between treatment-control. Findings show that young girls were able to critically analyse portrayals of body types in the media.

–

–

–

Pervanas, et al., 2014 [56]

USA

24

11–17

Boys and girls clubs

Cohort (one group pre-post design)

Video and role play on substance abuse

Single session

1 (immediately post)

Improved knowledge about safety and dangers of taking drugs and getting sick.

–

–

–

Gubner, J. et al., 2020 [78]

USA

52

–

Undergraduate college students (54% majoring in Health Sciences)

Qualitative research

Music, filmmaking, reflective essay writing and service at local dementia care settings

Three consecutive semesters

Multiple times; throughout the course duration

Music and filmmaking enable students to share individual stories about dementia and reflective writing supports students to gain self-awareness related to dementia stigma by processing experiences.

–

–

–

Hui, C.L.M. et al., 2018 [44]

Hong Kong

4520

12–17

Secondary school students

Cohort (one group pre-post design)

“School Tour” – drama and presentation on psychosis; exercises and yoga

1 h

1 (immediately post-test)

Significant improvements in knowledge and attitude towards psychosis between pre-test and post-test.

–

0.1

–

Author/s, Year

Country

Sample size

Age [mean (SD)/range]

Participant profile

Study Design

Brief intervention description

Intervention Duration (frequency)

Number of follow-ups (times)

Description of change in all stigma dimensions (knowledge (K), attitude (A) and behaviour (B)

K

A

B

Aseltine R. et al., 2004 [31]

USA

2100

14–18

School students

RCT

Video and discussion

2 days (over two months)

1 (immediately post-test)

Help-seeking behaviour did not change significantly between treatment and control group. Participants showed more adaptive attitudes and greater knowledge relate to depression and suicide (effect size = 0.35, p = 0.007).

0.69

0.25

–

Clement S et al., 2012 [34]

UK

216

23.9 (6.9)

College students (Health professionals in-training)

RCT

DVD and live social contact

71 min (once)

2 (immediately post and after 4 months)

Participants who watched the DVD had better attitude and behaviour scores than the lecture group (p = 0.004), the latter difference maintained at 4 months.

−0.02

−1.67

0.23

Penn DL et al., 2003 [55]

USA

163

18.85

College students (general major)

Controlled clinical trial

Documentary on Schizophrenia

70 min (once)

1 (immediately after)

No significant impact on intended behaviour. Less blame and responsibility for their disorder was placed on people with schizophrenia (p < 0.05).

–

−1.6

−2

Hecht ML et al., 1993 [43]

USA

465

14–18

School students

RCT

Film docudrama and live musical (Killing Time)

34 min (once)

1 (1 month post-test)

Discussion in addition to watching the film did not impact negative attitudes towards drug use, but increased confidence to resist drugs. Discussions neither detracted nor added to the effectiveness of film.

–

–

–

Hawke LD et al., 2014 [42]

Canada

28

21.2 (2.5)

College students (Health professionals in-training)

Cohort (one group pre-post design)

That’s Just Crazy Talk – DVD of a filmed play

50 min (once)

2 (immediately post and after 1 month)

Participants desired less social distance over time (p = .012) and significantly increased student willingness to interact with individuals with Bipolar Disorder. No significant change in stigma-related attitudes. Characteristics of this intervention were not suited to youth.

–

−0.07

0.25

Jerome lW., 1992 [46]

USA

184

14–18

School students

Cohort (one group pre-post design)

Film presentation

NR (Once)

2 (post-test at three weeks and after 18 months)

Participants showed an increase in knowledge about bulimia (maintained at 18 months).

–

–

–

Reis J et al., 2000 [59]

USA

4695

16–25

College students (general major)

Cohort analytic (two group pre and post)

Interactive software with animation, and three videos with choices

NR (Once)

NR details of repeat measures

Less positive attitude towards alcohol’s effects. Increased knowledge of symptoms of overdose, when to intervene, how many drinks it may take to reach intoxication (significant).

–

–

–

Kerby J et al., 2008 [51]

UK

46

21

College students (Health professionals in-training)

Controlled clinical trial

Two anti-stigma films to challenge stereotypes

27 min (once)

2 (immediately post and after 8 weeks)

Reduced social distance in the intervention group over the three time points (p < 0.001). Scores significantly increased at follow up (p = 0.03). Between baseline and post-test there was a significant decline in stigmatizing attitudes (p = 0.009).

–

0.75

−1

Tucker JB et al., 1999 [64]

USA

115

5–8 grade

School students

Post-test only for one group

Videos on violence, dealing with anger and gunshot victim

4 components, no info on duration

1 (immediately post)

Recall and identification of violence as a problem was high. 90% of students correctly identified the main message. Commercial and rap music video rated higher than trauma resuscitation video and discussion of anger.

–

–

–

Woods DW & Marcks BA, 2005 [68]

USA

180

22.33 (5.89)

College students (Health professionals in-training)

Controlled clinical trial

Video clips of a person with Tourette Syndrome and depression

20 min (once)

0

Higher social acceptability among the experimental group for people living with Tourette Syndrome.

–

–

–

Irving LM & Berel SR, 2001 [45]

USA

110

18–38

Female college students (general major)

RCT

Slim Hopes video

45 min (once)

1 (immediately post)

Participants were more sceptical about media images, related to body image.

–

− 0.8

–

Chan J et al., 2009 [33]

Hong Kong

255

14.6

School students

Controlled clinical trial

The Same or Not the Same- featuring life experience of four 18–24 year olds diagnosed with schizophrenia

NR (Once)

2 (immediately post and after 1 month)

Reduced social distance in the intervention group and more positive attitudes towards people with schizophrenia (p < 0.05). Participants in the education–video group had higher level of knowledge about schizophrenia than those in the video–education group (p < 0.05) at post-test. At follow-up, the effect size of the condition effect was moderate (p < 0.001).

−0.16

0.08

0.04

Fernandez A et al., 2016 [39]

Malaysia

102

20–23

College students (Health professionals in-training)

RCT

Video contact

40–45 min video & 1 h lecture (once)

1 (after 1 month)

Significantly reduced social distance and more positive attitudes between pre-test and post-test and after 1 month follow up (p < 0.001).

–

–

–

Conrad et al., 2014 [35]

Germany

515

15.6 [10–20]

Adolescent film festival

Cohort (one group pre-post design)

Five feature films and documentaries on mental health and wellbeing of adolescents

464 min (7.7 h)

1 (immediately post)

The effect on social distance and help-seeking attitudes towards people with mental health problems depended heavily on the respective film or documentary.

–

0.42

−0.01

Koike, et.al., 2018 [52]

Japan

259

20 (1.2)

Young adults in the general population

RCT

Repeated filmed social contact

30 min

6 (immediately post followed by every two months)

A sustained effect on reducing stigma, measured by a scale of intended behaviour towards people with mental illness.

–

–

0.7

Petkari, 2017 [83]

UAE

26

20 (1.4)

Psychology students

Mixed methods

Film followed by 1 h moderated discussion

10 weeks

1 (immediately post)

No significant differences in overall attitudes towards people with mental illness (^anegative difference indicates lower stigma at post-test (see column. To the right); specific perceptions changed significantly.

–

−1.36^a

− 1.15

Ta Park, et al., 2020 [85]

USA

118

22.1 (1.6)

College students

Mixed methods

16 episodes of School 2013, a Korean drama

1 (immediately post)

Knowledge, attitude and behavior towards bullying changed.

Participants reported that they “love” the drama, felt an emotional connection, and realized that mental health issues are stigmatized topics. Participants want to see stress, depression and emotional strain addressed in the K-drama.

0.12

0.07

0.06

Author/s, Year

Country

Sample size

Age [mean (SD)/range]

Participant profile

Study Design

Brief intervention description

Intervention Duration (frequency)

Number of follow-ups (times)

Description of change in all stigma dimensions (knowledge (K), attitude (A) and behaviour (B)

K

A

B

Kimber B., 2012 [70]

Sweden

561

7–10 & 11–16

School students

Post-test only for one group compared to

Didactic sessions and role play

45 min for one year (weekly)

2 (after 2 years and after 5 years)

Medium effect sizes for a significantly more positive body image among 11–16-year-olds, compared to 7–10-year-olds.

–

−0.3

King KA et al., 2011 [71]

USA

1030

14.1 (0.78)/ 14–18

School students

Cohort (one group pre-post design)

Role play and discussion

50 min (four sessions)

2 (immediately post and after 3 months)

Significant increase in likely behaviour to inform an adult of suicidal feelings of self or friends across all time points.

–

–

–

Roberts LM et al., 2008 [72]

UK

332

19–25^a

College students (Health professionals in-training)

RCT

Role play

40 min (once)

1 (1 week post)

Significant increase in desired social distance, but no change in attitude towards people with mental health problems. Significant changes by gender (female) and people with previous experience of mental health problems.

–

−0.24

0.29

Author/s, Year

Country

Sample size

Age [mean (SD)/range]

Participant profile

Study Design

Brief intervention description

Intervention Duration (frequency)

Number of follow-ups (times)

Description of change in all stigma dimensions (knowledge (K), attitude (A) and behaviour (B)

K

A

B

Salmon D et al., 2005 [76]

UK

249

14.3/ 11–19

School students

Qualitative research

Dance performance competition

One day (once)

2 (at the finale and 1 month after)

Recalled drug-free messages and pledge

–

–

–

Frey KS et al., 2005 [79]

USA

1023

7–11

School students

Mixed methods (on a controlled clinical trial)

Steps to Respect –(Creative word and literature lessons)

3 h (weekly)

2 (at 6 months follow up)

Bullying behaviour decreased. The experimental group found bullying and aggression less acceptable.

–

−0.11

−0.09

Harris, et al., 2019 [80]

USA

62

18–29/ 20.5

Undergraduate college students

Mixed methods (based on four cohorts)

Intergenerational choir rehearsals, socialization with people living with dementia and a concert

10 weeks (90 min rehearsals per week)

2 (half-way; post-test)

Use of more positive words to describe images of people living with dementia (55% change from negative words to positive) at post-test; improved understanding of dementia, avoiding labels, recognizing capabilities

–

–

–