Compared to the matched general population control group, directors and screenwriters had significantly lower SDS and DS scores, indicating a more positive attitude toward patients with mental disorders. Female gender was associated with a more negative attitude in the directors and screenwriters group. Familiarity with mental disorders was not significantly different between the groups. Additionally, in both groups, ‘How would you feel about someone with severe mental disorder marrying your children?’ and ‘How would you feel about someone with severe mental disorder taking care of your children for a couple of hours?’ received the most negative feedback among the SDS items, and ‘there should be a law forbidding a former mental patient the right to obtain a hunting license’ received the most negative feedback among the DS items.
We found that directors and screenwriters had a more positive attitude toward patients with mental disorders which might be due to artists’ flexibility and craving for creativity, exposure to cultural diversity, and being inspired by the artworks created by artists struggling with mental disorders. However, in contrast to previous studies, we did not find any association between familiarity with patients with mental disorders and the stigmatizing attitude toward them [14–17] which can raise questions about the specific nature of contact and familiarity that could foster a more empathic mindset. Encouraging direct, regular and interactive contact with these individuals may allow for a deeper understanding of their experiences, challenges, and strengths as people can witness the resilience and humanity of those with mental disorders, challenging preconceived notions and dispelling stereotypes [18–20].
Female gender was previously reported to be associated with positive attitude toward patients with mental disorders [21]. However, based on our results, female gender was associated with a more negative attitude in the directors and screenwriters group. Although, the small number of female participants in this group makes this finding inconclusive.
We did not find any significant correlations between education and stigmatizing attitude. Although, it has been reported that higher education is associated with a more positive attitude toward patients with mental disorders [22].
The study of Eissazade et al. which was conducted to investigate the attitude of Iranian theater artists toward patients with mental disorders, did not find any associations between demographic data and stigmatizing attitude. Moreover, compared to the study of Eissazade et al., the mean scores of SDS (12.51 ± 3.8 vs. 10.67 ± 4.92) and the DS (33.53 ± 7.03vs. 28.87 ± 10.291) were higher in our study. Although, we investigated different groups of artists with different sample sizes [23].
In the directors and screenwriters group, among the SDS items, ‘How would you feel about someone with severe mental disorder taking care of your children for a couple of hours? (similar to the study of Eissazade et al.), and ‘How would you feel about someone with severe mental disorder marrying your children?’ received the most negative feedback. Some concerns exist surrounding the ability of patients with severe mental disorders to ensure children’s safety and welfare, as these disorders can sometimes be accompanied by impaired judgment or erratic behavior. However, most child abuse perpetrators are reportedly among families or acquaintances [23, 24]. And in line with the study of Eissazade et al., ‘there should be a law forbidding a former mental patient the right to obtain a hunting license’ received the most negative feedback among the DS items. Mental disorders can sometimes be associated with impaired judgment or impulsivity, raising apprehensions about the individual's ability to handle firearms responsibly that may lead to accidental shootings, acts of self-harm, or even acts of violence toward others. However, no clear link has been found between mental disorders and violence, without substance use. Also, there has been no substantial report of gun-related murders by patients with mental disorders in Iran over the past years [23, 25]. Gaining insight into the factors that contribute to violence can help with reducing stigma and overcoming barriers faced by these patients.
Limitations
Our study was limited by a small sample size, cross-sectional design, participation bias, self-report bias, and limited choice of questionnaire. Regarding the importance and prevalence of mental disorders, further studies with larger sample sizes among artists of different fields are needed to achieve comprehensive results.
Implications for Research, and Policies
Anti-stigma programs for mental health stigma and discrimination are needed to reduce the negative attitudes that can prevent patients from seeking treatment by raising awareness (offering educational materials and resources), improving access to mental health care, and supporting advocacy efforts to promote mental health policy and legislation that helps advance human rights and equality. Directors and screenwriters have a significant impact on shaping the public attitude toward mental disorders as they can reach a large and diverse audience and use their platforms to educate the public, trigger warnings, and advocate for policy changes. Cinema and television can be adopted as powerful tools for reducing the stigmas surrounding mental disorders by presenting realistic portrayals, increasing awareness and understanding of these conditions, breaking down harmful stereotypes, and contributing to promoting empathy and social inclusion for patients with mental disorders. Therefore, it is necessary to prioritize education and create safe spaces for individuals to openly discuss their experiences with mental health [26–29].