Portraying life lived with bipolar disorder

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Dr. Jamie Livingston presents findings from a CREST.BD study evaluating a theatrical performance as an intervention for reducing mental illness stigma. Dr. Livingston describes details of the research design and the preliminary findings from the study's two target audiences, healthcare providers and people living with bipolar disorder. Originally presented at the Mental Health Commission of Canada's Together Against Stigma conference in Ottawa, Ontario on June 5th, 2012. Victoria Maxwell also performed her one woman stage play 'That's Just Crazy Talk' a theatrical performance which is the focus of this research.

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  • Background:An effective, multi-faceted strategy to prevent and reduce stigma would include creative arts and contact-based approaches. The power of the creative arts lays its potential to reach and speak to an audience that may not be responsive to conventional methods for addressing stigma.Research Objective:To examine the impact of a brief, contact-based, theatrical intervention on attitudes toward people with bipolar disorder among healthcare providers and people who live with bipolar disorder.Hypothesis: Attitudes toward bipolar disorder will be significantly more positive following the intervention. This study was embedded within a larger CIHR-funded project, led by Drs. Michalak and Parikh, to advance knowledge translation in bipolar disorder.
  • Portraying life lived with bipolar disorder

    1. 1. Portraying Life Lived with Bipolar Disorder: Evaluation of a Contact- Based Theatrical Performance Jamie Livingston, Ph.D. Erin Michalak, Ph.D. Sagar Parikh, M.D., F.R.C.P.C. Victoria, Maxwell, B.F.A. Vytas Velyvis, M.A. Sharon Hou, B.A.
    2. 2. Intervention• 1-hour theatrical performance.• Designed and delivered by Victoria Maxwell, a woman who lives with bipolar disorder.• Uses dramatic narrative to portray life lived with bipolar disorder and stigma.• Performed to a mixed audience in Vancouver and Toronto, Canada.
    3. 3. Design People with Bipolar Healthcare Service Disorder ProvidersT1 (Pre) DMISS, ISMI DMISS, MICA-4 Intervention Intervention DMISS, ISMI DMISS, MICA-4T2 (Post) Process Evaluation Process Evaluation DMISS , ISMI DMIS, MICA-4T3 (3 months) Qualitative Qualitative Interview Interview DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007) MICA: Mental Illness: Clinicians’ Attitudes Scale – Version 4 (Kassam et al., 2010) ISMI: Internalized Stigma of Mental Illness (Ritsher et al., 2003)
    4. 4. Sample Items• DMISS (7-point scale, 28 items, 7 subscales and total score) – I don’t think it is possible to have a normal relationship with someone with bipolar disorder.• MICA-4 (6-point scale, 16 items, total score only) – Working in the mental health field is just as respectable as other fields of health and social care.• ISMI (4-point scale, 29 items, 5 subscales and total score) – I feel out of place in the world because I have a mental illness.
    5. 5. Participants People Service with BD Providers (N = 80) (N = 84)Gender, % women 84% 71%Years of age, M (SD) 42.4 (12.2) 40.2 (12.9)Performance location Vancouver 70% 64% Toronto 30% 36%Seen Victoria Maxwell 16% 24%perform before, % yes
    6. 6. Learned something new?
    7. 7. Emotional impact on you?
    8. 8. Could this performance change public acceptance of bipolar disorder?
    9. 9. Summary: EvaluationThe intervention was perceived positively by thelarge majority of audience members.
    10. 10. Change in Attitude among People with Bipolar Disorder: DMISS T1 T2DMISS (α=0.88) M SD N M SD N Repeated t-test d Treatability 2.48 1.16 80 2.33 1.19 80 t(79)=1.61, p>0.05 0.17 Relationship 3.22 1.23 80 3.00 1.22 80 t(79)=2.42, p<0.05 0.27 Hygiene 2.44 1.30 80 2.35 1.36 80 t(79)=0.98, p>0.05 0.11 Anxiety 1.97 0.99 80 1.97 0.99 80 t(79)=0.03, p>0.05 0.00 Visibility 3.57 0.80 80 3.68 0.85 80 t(79)=-1.10, p>0.05 0.14 Recovery 3.59 1.87 80 3.58 1.95 80 t(79)=0.69, p>0.05 0.07 Professional 3.18 1.52 80 2.99 1.53 80 t(79)=1.39, p>0.05 0.15 efficacy TOTAL 2.79 0.74 80 2.70 0.80 80 t(79)=1.76, p>0.05 0.19 DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007)
    11. 11. Change in Attitude among People with Bipolar Disorder: ISMI T1 T2ISMI (α=0.94) N SD N M SD N Repeated t-test d Alienation 2.35 0.70 78 2.23 0.77 78 t(77)=2.61, p<0.05 0.31 Stereotype 1.55 0.45 77 1.56 0.45 77 t(76)=-0.48, p>0.05 0.04 Discrimination 2.20 0.63 75 2.24 0.72 75 t(74)=-0.61, p>0.05 0.08 Withdrawal 2.04 0.68 79 2.05 0.75 79 t(78)=-0.32, p>0.05 0.02 Resistance 2.02 0.61 77 1.93 0.58 77 t(76)=1.14, p>0.05 0.14 TOTAL 2.01 0.49 75 1.98 0.55 75 t(74)=1.00, p>0.05 0.13 ISMI: Internalized Stigma of Mental Illness (Ritsher et al., 2003)
    12. 12. Summary: People with BDThe intervention produced limited overall change inattitudes among people who live with bipolardisorder.Small to medium effects were observed:  Improved beliefs about the potential of having a positive relationship with a person who has bipolar disorder.  Decreased subjective feelings of being devalued by society as a result of bipolar disorder.
    13. 13. Change in Attitude among Healthcare Providers: DMISS & MICA-4 T1 T2DMISS (α=0.87) M SD N M SD N Repeated t-test d Treatability 1.74 0.76 84 1.52 0.54 84 t(83)=2.94, p<0.01 0.32 Relationship 2.38 0.99 84 2.06 0.94 84 t(83)=4.35, p<0.001 0.48 Hygiene 1.93 0.99 84 1.67 0.87 84 t(83)=3.42, p<0.01 0.37 Anxiety 1.72 0.89 84 1.60 0.82 84 t(83)=2.14. p<0.05 0.24 Visibility 3.40 0.84 84 3.40 0.83 84 t(83)=0.01, p>0.05 0.00 Recovery 2.55 1.31 84 2.20 1.38 84 t(83)=2.44, p<0.05 0.27 Professional 2.74 1.35 85 2.53 1.32 85 t(83)=1.78, p>0.05 0.20 efficacy TOTAL 2.26 0.63 84 2.07 0.61 84 t(83)=5.55, p<0.001 0.58MICA-4 (α=0.66) 30.6 6.5 82 29.8 6.7 82 t(81)=1.56, p>0.05 0.17 DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007) MICA: Mental Illness: Clinicians’ Attitudes Scale – Version 4 (Kassam et al., 2010)
    14. 14. Summary: Healthcare Providers• The intervention produced medium to large effects.• Statistically significant and pragmatically meaningful improvements in attitudes among those who provide healthcare services to people with bipolar disorder were achieved.
    15. 15. Conclusion The study findings support the inclusion of the creative arts and contact-based approaches in strategies that seek to foster positive attitudes among healthcare providers toward people with bipolar disorder.

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