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While suicide rates in Montana are alarmingly high, little is known about how to develop and deploy interpersonal communication strategies that target high-risk groups. In particular, strategies to improve interpersonal communication about suicide, a known protective factor against suicide risk, remain limited, and strategies to reduce stigma against open disclosure of suicidal symptoms remain unidentified. Research shows that interpersonal communication about psychological stress increases well-being and reduces the likelihood of suicide and depression (Howard-Pitney et al., 1992; Thompson, Eggert, & Herting, 2000; Ye, 2006). Embeddedness in a social network is believed to enhance an individual’s well-being by providing a predictable and stable environment, fostering confidence and a positive mindset (Barrera, 1986). Fawcett, Leff and Bunney (1969) call for increased attention to interpersonal behavior as a basis for more accurate recognition and more successful long-term treatment of the high risk suicidal patient. However, it remains unknown how to increase interpersonal communication about suicidal risk and perceived social support. There is a critical need to identify mechanisms of action for suicide prevention interventions.

The overarching goal of this project is to reduce suicidal risk by increasing help-seeking behavior among high-risk individuals. The overall objective for this proposal is to generate pilot data supporting the feasibility of using interpersonal communication about suicide to promote help-seeking behavior and reduce suicidal behavior. Our central hypothesis is that community-based theater will promote open communication and reduce stigma surrounding suicidal ideation and symptoms. Our hypothesis is based, in part, on our own strong preliminary findings demonstrating that stigma against mental health illness and professional counseling discourages open dialogue about suicide and suicidal ideation. Evidence was also found in our previous research that open dialogue, in the form of a community-based theater program for suicide prevention, appears to buffer the negative effects of stigma by providing participants (both actors and audience members) with emotional and informational support. Participants reported increased awareness of how to access professional counselors, hotlines, and support centers, as well as increased perceptions of understanding from their peers. Our hypothesis is also based upon existing literature demonstrating the protective nature of interpersonal communication among individuals at high risk of suicide.

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Specific Aims

  1. Identify key communication-related factors that will reduce the risk of suicide among high-risk groups. Our hypothesis is that promoting such interpersonal communication reduces the risk of suicide.
  2. Identify key elements of community-based theater contributing to interpersonal communication about suicide. Our hypothesis is that the sharing of personal stories, open dialogue, supportive environment and participatory nature of community-based theater will increase interpersonal communication about suicide.
  3. Test the association between community-based theatre and increased help-seeking behavior. Our hypothesis is that community-based theater will reduce barriers to seeking professional help for suicidal ideation.
  4. Determine the role of public and self-stigma in contribution to suicidal behavior. Our hypothesis is that stigma contributes to suicide behavior through decreased open dialogue about ideation and symptoms, discouraging recognition of individuals at risk and willingness to seek help.


Individuals living with depression and suicidal ideation are frequently isolated; especially in rural communities with limited access to professional counseling services or where talking about depression and suicide is profoundly stigmatized. Communication advances have reduced the isolation associated with living in rural areas of the United States (Fuguitt, Brown, & Beale 1989; Kline 2000). However, many services are still not adequately delivered to this population. Professional counseling care is one such service.  Typically, rural residents access medical care from large hospitals located in metropolitan areas designed to serve regional populations, forcing individuals to consider whether preventive care, such as regular psychological therapy, is worth the trip (Slesinger 1991).

The situation becomes more critical for people in rural areas in need of specialized care.  In particular, residents of rural mountain states (e.g., Montana, Alaska, Colorado, Utah) experience excess mortality from suicide, at almost twice the national average, with 23.9 per 100,000 in Montana compared to 13 per 100,000 nationally (Centers for Disease Control and Prevention [CDC] 2014). Reasons for higher death rates from suicide include a lack of mental health awareness, inadequate availability of mental health services, widespread use of firearms, and social isolation. Suicide rates are increasingly higher as counties became less urbanized. The age-adjusted suicide rate in rural counties is 1.7 times the rate for large central metropolitan counties (17.6 compared with 10.3 deaths per 100,000) (Ingram & Franco 2015).

Primary Contact

Sarah Keller skeller@msubillings.edu