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Table 1 Summary of study characteristics and outcomes

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

A. Studies using theatre interventions [11 studies]
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) Change in stigma (Difference of means)
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 14–18a 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.
B. Studies using multiple art forms [23 studies]
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) Change in stigma
(Difference of means between experimental and control groups)
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 14–15a 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 14–15a 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 20–25a 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 15–16a 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 19–25a 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 10–14a 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 11–15a 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 13–18a 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
C. Studies using film [17 studies]
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) Change in stigma
(Difference of means between experimental and control groups)
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. −1.36a − 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
D. Studies using role play [3 studies]
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) Change in stigma
(Difference of means between experimental and control groups)
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 19–25a 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
E. Studies using other art forms (dance/creative writing/music) [3 studies]
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) Change in stigma
(Difference of means between experimental and control groups)
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
  1. aestimated based on educational level suggested in study