1. “Let’s Talk” (LT) is a community-based media
program for suicide prevention. This intervention
model is “grassroots” insofar as the model recruits
members (from the same population as the
audience) to write and perform an original play about
suicide and depression, drawing from their
knowledge and prior experiences.
Fact: Montana has the highest suicide rates in
the nation and has ranked in the top five states
for the past 30 years.
RQ 1. Do Eastern Montana youth report personal or
general experiences with stigma towards mental
illness?
RQ2. Do Eastern Montana youth believe there is a
stigma towards professional counseling and/or other
types of mental health treatment?
RQ3. What barriers to mental well-being are
identified by Eastern Montana youth?
RQ4. What barriers to mental health treatment and
accessing professional counseling are identified by
Eastern Montana youth?
INTRODUCTION
Suicidal Ideation in Rural Montana and
the Associations with Social Isolation and Stigma
Vanessa McNeill & Kristin Neva
Department of Communications & Theatre
METHODS
ACKNOWLEDGMENTS
CONCLUSIONS
Mentors:
Dr. Sarah Keller - Communication & Theater (MSU Billings)
Dr. Joy Honea – Sociology (MSU Billings)
Dr. Caroline Graham Austin – Business (MSU Bozeman)
Dr. Elizabeth Ciemins, PhD. (Billings Clinic)
Research reported in this publication was supported by the National Institute of General Medicine Sciences of the
National Institutes of Health under Award Number P20GM103474. The content is solely the responsibility of the authors
and does not necessarily represent the official views of the National Institute of Health.
The content analysis shows that stigma may have a
strong role in reproducing or maintaining disparities
in access to mental health care. The content also
points to the role of social isolation as an important
mediator of stigma on suicidal impulses.
We believe that future interventions need to attempt
to reduce stigma against mental health problems and
treatment in eastern Montana.
Recommendations for effective suicide prevention
curricula for rural community schools, US veteran
agencies and college campuses will be an important
outcome of this study. Future work will involve a case
control trial of the Let’s Talk program.
Researchers conducted a content analysis of video
footage of a community-based theatre program for
suicide prevention. The video content included 5
performances by eastern Montana high school and
college students conducted over 3 years, as part of
Let’s Talk. This project was designed to assess
attitudes towards suicide and depression, as well as
attitudes towards accessing prevention services for
depression and suicide. Because the majority of
content analysis involves subjective interpretation of
data, care was taken to ensure the validity and
reliability of results. Validity was achieved through
clearly defined research questions and
operationalized themes and concepts, while
reliability was generally ensured via the correlation of
results by multiple coders.
Coding categories included:
• perceived stigma towards mental illness and
treatment
• barriers to mental well-being and treatment
• modeling of effective communication among peers
• reported sources of perceived stress and social
support
• Attitudes towards help-seeking
RESULTS
Experience with Stigma
43% of performance content was coded as showing
personal experience with stigma against:
mental illness, mental health treatment, needing
help, and sharing emotional vulnerability.
DISCUSSION
Results demonstrated that stigma is a significant
barrier to help-seeking and a significant factor of
suicide.
All of the plays underlying themes depicted stigmatic
experiences within one’s self, home, or social circles
and how today’s young adults are coping.
Much of the stigma expressed involves stigma
against oneself. Self-stigma takes many forms: Self-
hatred, lack of authenticity, lack of interpersonal
communication skills, fear of being shunned,
experience of being shunned, disconnection from
others, thwarted belongingness, perceived
burdensomeness, and belief that one’s death would
be worth more than one’s life.
Defense Avoidance comprised subcategories:
Truancy, Substance Abuse, Maladaptive Coping
Strategies, Reactance (Blame the messenger),
Defensiveness, and Denial.