This community-based media project called "Let's Talk Billings" uses theater to address Montana's high suicide rate. Actors develop and perform an original play about suicide and depression. The study uses focus groups to evaluate how exposure to the play impacts audiences. Results show increases in participants' self-efficacy, recognition of suicide severity, and willingness to seek help. The experience provides social support that boosts coping skills for life stressors like suicide and depression.

1. “Let’s Talk Billings” (LT) is a community-based media project 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.
Fact: Montana has one of the highest suicide rates in the nation
and has ranked in the top five states for the past 30 years.
Research Questions (RQ):
RQ1: Does exposure to LT play correlate with increased Self-
Efficacy?
RQ2: Does exposure to LT play correlate with increased
Response-Efficacy?
RQ3: Does exposure to LT play correlate with increased Perceived
Severity and / or Susceptibility of Suicide?
RQ4: Does exposure to LT play correlate with Behavioral
Intentions for Help-Seeking?
INTRODUCTION
Figure 1. Pre- and post-play comparisons regarding stigma.
Stigma, Stress, and Cowboying-Up: A Qualitative Evaluation of
Attitudes & Beliefs about Suicide in Montana
Vanessa McNeill, Kristin Neva, & Danielle Arnoux
Department of Communications & Theatre
METHODS
ACKNOWLEDGMENTS
DISCUSSION
CONCLUSIONS
RESULTS
Mentors: Dr. Sarah Keller - Communication & Theater
(MSU Billings), Dr. Caroline Graham Austin – Business
(MSU Bozeman), and 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.
A quasi-experimental, pre-/post-intervention design with two
treatment and two control groups (n=16). Focus groups were
conducted with MSUB men and women ages 18 to 45. The
“treatment” group participated in Let’s Talk Billings through script
development, QPR training, and ten theatre performances with
Q&A sessions. “Control” groups were members of the audience,
interviewed before and after seeing the play.
Focus groups explored if actors & audience members experienced
increases in: awareness of suicide and depression; feelings of
self-efficacy and self-empowerment in regard to talking about
suicide and depression; and behavioral intentions for seeking
help. Scripts of the sessions were analyzed using grounded theory
to determine common themes related to the research questions.
Qualitative Analysis of Focus Groups
Five variables emerged from a preliminary coding analysis:
stigma, awareness of suicide, experience with suicide, help-
seeking attitudes and effects of the play. Colors were used to
facilitate text coding and inter-rater reliability for these variables
was tested and scored with at least two coders per transcript.
Changes and patterns in these variables have provided
confirmation of increased competence and self-efficacy for
providing and seeking help. Secondary analysis will focus on
theoretical fit of Self Determination Theory and the Extended
Parallel Process Model.
Simplified Codes
Yellow = stigma toward mental illness or treatment this includes
reports, expressions or indictors (Social stigma, a severe social
disapproval of personal characteristics or beliefs that are against
cultural norms)
Green = awareness of suicide as a problem/threat (is the ability to
perceive, to feel, or to be conscious of events, objects, thoughts,
emotions, or sensory patterns.)
Red = experience w/ suicide or mental illness (yourself or others)
Pink = general attitudes towards help-seeking and/or coping
(vehicle for exploring and understanding patient delay and
prompt action)
Blue = effects of play (cognitive, emotional, behavioral)
Results indicate both participants and actors demonstrated
strong increases in self-efficacy, response-efficacy, perceived
severity and/or susceptibility of suicide, and behavioral
intentions for help-seeking.
The LT experience (for both actors & audience members)
provided social support that increased coping skills for handling
life stressors related to suicide and depression.
Based on measured increases in social support, and perceived
self-efficacy and response efficacy for seeking help – this
approach appears to increase behavioral intentions for help-
seeking.
I think the biggest
thing that people
can do to help
someone who’s going
through depression
and suicidal thoughts
is truly just… be
there for them and
make sure that
they’re not afraid to
talk. That is the
biggest thing
is…talking about it.
~Sadie
Figure 2. Experience (post-play)
Figure 3. Help-seeking (post-play).
Figure 4. Awareness (post-play).
The LT experience (for both actors & audience members)
provided social support that increased coping skills for handling
life stressors related to suicide and depression.
Based on measured increases in social support, and perceived self-
efficacy and response efficacy for seeking help – this approach
appears to increase behavioral intentions for help-seeking.
Limitations
Small N. This project centered around the subjective experiences
of the actors. It would be difficult to generalize to a larger
population. Qualitatively, we opted for depth versus breadth. We
do have significant depth and reliability.
Corroboration & Collaboration
This research has been has been repeated three years running in
three separate communities. All results for all three years
corroborate. Strong qualitative and quantitative data has produced
a bottom-up research paradigm, affording us the necessary
protocols to collect and capture categorical and continuous
variables both reflective and fixed. In addition, because there are
so many dynamics, qualitative analysis is the preferred approach to
encapsulate the many moving parts.
The voices of each-and-every community need to be embraced.
The many voices representing from different community
viewpoints enriches our data and results.
Reach out to someone. ~Sadie
Get some help. It will help you. ~Moriah
It might not get better, but you will get stronger.
~Casey
You’re worth everything. ~Meagan