The prevalence of psychiatric disorders among visitors to faith healers in Saudi Arabia

Workforce estimate to treat mental disorders in the Kingdom of Saudi Arabia

BACKGROUND

Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased.

METHODS

We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition.

RESULTS

The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population.

CONCLUSION

Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

The Good, the Bad, and the Ugly of Faith Healers and Psychiatric Illnesses: A Systematic Review of the Literature in the Arab World

Faith healing is a traditional healing method involving spiritual and faith-based practices performed by a religious medicine man referred to here as a faith healer. The practice of faith healing is widespread in the Arab World for treating a range of mental disorders. This research aims to review the literature concerned with faith healing practice in the Muslim Arab population. Based on the results of the review, there are seven distinct aspects of faith healing. These include the characteristics of persons who visit faith healers, the rate of visits, the symptoms for which visits are made, the treatment methods, the general stigma and prevalent attitudes toward mental disorders in the Arab world, and the perceived effectiveness of faith healing as applied to mental disorders. The results of the review show that many patients with mental disorders, as a first resort, prefer to seek the help of faith healers (or other non-professional trusted counselors) rather than approach mental health services. This is due to several factors: the misconceptions around causes of mental illness in Arab traditions and culture and the stigma associated with mental illness. As an overall determination derived from the literature, Arabs remain highly reliant on faith healers as helpful resources for dealing with mental health problems. In conclusion, the recommendation to public health authorities is to consider including faith healers in the support system for mental health and cease viewing them as barriers to optimal care.

Barriers to Mental Illness Treatment in Saudi Arabia: A Population-Based Cross-Sectional Study

BACKGROUND

Mental illness is a disorder that can cause impairment and disability, affecting mood, thinking, and behavior; therefore, early intervention will reduce morbidity. This study aims to evaluate all the personal, family, societal, and medical barriers that prevent mental health patients from seeking consultation and treatment.

METHODS

In Saudi Arabia, a cross-sectional study was conducted on 463 individuals aged 18 and above. Data were collected by face-to-face interviews using a validated questionnaire, which consisted of two parts. The first part included sociodemographic data, while the second part contained subsections of society/family, personal, and medical barriers.

RESULTS

The results showed that 379 (81.9%) indicated that society and family barriers impacted them, whereas 325 (70.3%) believed that personal barriers hindered seeking help. However, 294 (63.5%) opted for medical barriers as a hindrance. Regarding the highest barriers, 120 of the total respondents (25.9%) saw psychiatric illness as a source of shame and stigma, 166 respondents (35.9%) said that the psychiatric patient is seen as crazy, 159 of them (34.3%) believed it is tough for anyone to talk about their feelings and emotions and 183 respondent (39.5%) feared that psychiatric illness would decrease the chance of marriage to the appropriate person. Our findings also indicated a low trust in hospital treatment, hence a loss of confidence in using medications.

CONCLUSION

The findings of this study indicate that societal stigma is the most common barrier preventing people from seeking mental health consultation. Many barriers differ significantly between males and females.

Cultural adaptation and validation of the mental illness associated stigma scale for Arabic-speaking population in Saudi Arabia

Objective

This research aimed to culturally adapt and validate the MIAS scale for Arabic-speaking individuals within the Saudi Arabian general population, with an emphasis on cultural, societal, and individual nuances.

Methods

An initial pilot testing with a small group ensured the scale's clarity. Subsequently, two cross-sectional studies involving 189 participants to assess structural validity of the Arabic MIAS scale, and 38 participants to assess the test-retest reliability. Descriptive statistics, Cronbach's α, Intraclass Correlation Coefficient (ICC), and Confirmatory Factor Analysis (CFA) were employed for data analysis.

Results

The Arabic MIAS scale demonstrated good internal consistency and acceptable test-retest reliability (ICC α = 0.631). A three-factor model emerged (CFI = 0.890, TLI = 0.845, RMSEA = 0.094), including "Outcomes," "Negative Stereotypes," and "Recovery," closely mirroring the original study's structure. one item was excluded from the model since it didn't align with any of the three factors.

Conclusion

The study contributes a culturally adapted, validated, non-condition-specific tool to gauge public attitudes toward mental health stigma in an Arabic context. It highlights the need for culturally sensitive stigma research and interventions and underscores the importance of improving such tools for cross-cultural applicability and comparability.

The Proportion of Complementary and Alternative Medicine Utilization Among Saudi Population for Eye Care: Cross-Sectional Study

Purpose

To estimate the prevalence, determinants and perceived benefit of complementary and alternative medicine (CAM) use for ophthalmic purposes among the Saudi population.

Methods

A cross-sectional study was carried out in 2019 targeting visitors of King Khaled Eye Specialist Hospital (KKESH), Riyadh, Saudi Arabia. The survey had 18 questions in Arabic regarding the use of CAM for eye ailments. The magnitude was associated to the demographic and eye-related factors.

Results

We interviewed 999 participants. The prevalence of CAM usage was 21.9% (95% confidence interval 19.3; 24.5). Castor oil (49.3%), antimony (khohl alethmed) (40.6%), chamomile (19.6%), and green tea leaves (11.4%) were the most common medications used. Other traditional eye treatments included eye vitamins, faith healing (prayer, reciting Quran, Zamzam water), cautery, cupping, and acupuncture.

Conclusions

One in five Saudi eye patients used CAM. The factors governing this health behavior should be studied to change this practice pattern.

Understanding factors affecting breastfeeding practices in one city in the Kingdom of Saudi Arabia: an interpretative phenomenological study

Background

Breastfeeding duration has declined in the Kingdom of Saudi Arabia (KSA) in recent decades, although accurate national data about different breastfeeding indicators by infant age are lacking. This qualitative study, the first in KSA, aimed to understand the factors affecting mothers’ decisions and experiences regarding any breastfeeding practices.

Methods

A qualitative phenomenological approach was used to investigate mothers’ experiences of breastfeeding. Non-probability convenience sampling and snowballing strategies were designed to recruit participants. Semi-structured interviews were conducted with 16 mothers, from two hospitals and three primary health clinics in Al-Madinah city, from December 2017 to March 2018. Interpretative phenomenological analysis was the analysis framework.

Results

Three themes were identified: 1) ‘Up against the system’: policies, staff and systems were the main barriers to exclusive breastfeeding; 2) ‘Social support and negativity’: family support in the first 40 postpartum days protected breastfeeding continuation and was highly appreciated, but negative comments limited breastfeeding practices thereafter; and 3) ‘Managing tensions’: mothers’ religious beliefs about breastfeeding boosted their decisions; however, the challenge of managing tensions influenced mothers to stop breastfeeding earlier than they wished. The study revealed that mothers had no doubts about wanting to breastfeed their babies; but continuation was adversely affected by unhelpful hospital policies and staff actions, the lack of ongoing social support, and by others people’s negativity, rather than by the mothers’ own views. Stopping breastfeeding earlier than planned was a complex decision for most mothers. However, mothers said that they intended to breastfeed their next baby successfully.

Conclusions

Healthcare professionals (maternity staff, paediatricians and pharmacists) need education and training to support exclusive breastfeeding effectively. Increasing the number of hospitals with Baby Friendly Hospital Initiative accreditation, which includes staff practice changes, is needed to protect and support exclusive breastfeeding. Ongoing professional and peer support, and improving conditions at workplaces and universities, are needed to help mothers to continue breastfeeding successfully. Effective, coordinated national policies can support mothers’ decisions in relation to breastfeeding. Such changes will reduce the tensions experienced by women and help them to achieve their breastfeeding goals and to breastfeed for longer.

Mental Health Literacy Scale Arabic Version: A Validation Study Among Saudi University Students

Mental health problems significantly affect students' university education. However, studies about mental health literacy (MHL) among Saudi university students are very limited. The two-fold objective of this study was to validate an Arabic version of the Mental Health Literacy Scale (MHLS) and assess the MHL of university students. The study participants involved 339 female students. Psychometric evaluation of the MHLS-Arabic version was conducted, and correlation and regression analyses were performed. The scale was successfully cross culturally adapted and found to be valid and reliable. The highest MHL indicator was the students' perception of confidence in using a computer or telephone to inquire about mental illness data. Conversely, the lowest MHL indicator was the student's disagreement with the notion that mental infirmity is not an actual medical challenge. Marital status, college attended, and academic level were found to have statistically significant effects on the MHL of university students. The Arabic version of the MHLS validly and reliably assessed MHL. This work adds to existing evidence for assessing MHL and can help administrators formulate better strategies to improve the MHL of university students.

Spiritual and Religious Healing Practices: Some Reflections from Saudi National Center for Complementary and Alternative Medicine, Riyadh

Traditional practices constituting spiritual and religious (S/R) healing are an important component of the holistic healthcare model and are used in health, well-being, and treating a variety of diseases around the world. The main focus of this review is to summarize the Complementary and Alternative Medicine (CAM) studies that especially target S/R healing practices in Saudi Arabia (SA) and discuss the results in light of relevant international literature. From year 2013-2017, electronic searches of PubMed, OvidSP, Google Scholar, and two publishing housing Web sites (Sciencedomain.com and Dove Medical Press.com) were made using key words and Boolean operators and retrieved thousands of published papers from peer-reviewed journals. Two independent reviewers decided to include a total of 108 articles: 48 from SA and 60 from other international literature. The sociodemographic variables of the participants varied in local studies and were comparable with international data. The frequency and types of religious and spiritual practices reported in local and international zones varied in accordance with religious belief, gender, age, education, and prevalent chronic diseases. Most of professionals and practitioners showed fairly good knowledge and positive attitude toward spiritual and religious practices used in diverse clinical and non-clinical situations across the world. Furthermore, it was observed that in the international scenario, S/R researches using specific religious screening tools have been conducted on different aspects of clinical application including self-care, social cohesion, negative impact, and child development, whereas regional studies targeting varied participants mainly focused on the epidemiological trends of S/R therapies in Saudi Arabia. CAM practitioners and public tend to show great interest in prescribed and self-use of religious and spiritual therapies across the world because of multiple dynamic forces, including positive effects on health, sense of well-being and disease control, cost-effectiveness, easy access to services, and improvement in quality of life. Further studies are needed to assess the effectiveness of different types of religious and spiritual therapies and practices used in specific diseases, their role in promotion of health and well-being, and prevention of diseases nationwide and across the world. Besides integration of S/R into mainstream treatment modalities, medical education curriculum, continuous medical education, and training programs are needed for bridging the knowledge, attitude, and practice gaps concerning CAM in targeted population groups such as medical professionals, CAM practitioners, medical students, public and traditional healers, not only in SA but also around the world.

A Survey on Public Attitudes Toward Mental Illness and Mental Health Services Among Four Cities in Saudi Arabia

PURPOSE

Our objectives are to assess the public attitude toward mentally ill people and mental health services and to compare the attitudes of those who have past history of mental illness, those who have been exposed to mentally ill people, and those who have not.

MATERIALS AND METHODS

We conducted a cross-sectional study among subjects (n=1268) in four Saudi Arabian cities (Riyadh, Abha, Dammam, and Jizan), recruiting participants from malls and parks. All participants were administered "the knowledge and attitudes toward mental illness and mental health services scale".

RESULTS

Participants were divided into three groups; non-exposed to mental illness group (n=687, 54.1%), exposed to mental illness group (n=305, 24%), and having past history of mental illness group (n=276, 21.8%). Results revealed that non-exposed group had the lowest knowledge about mental illness (p <0.001). Exposed group had the best attitude toward mentally ill people (p=0.002), mental health services (p< 0.001), the lowest impact of traditional beliefs (p<0.001), and the best help-seeking decisions (p = 0.001). Regression models show the variables that predicted attitude toward the mentally ill were the attitude toward mental health services (p=0.001), impact of traditional beliefs (p=0.001), and residency (p=0.04). The predictors of attitude toward mental health services were impact of traditional beliefs (p<0.001), knowledge (p<0.001), and residency (p=0.028). And the variables that account for predicting future decisions were impact of traditional beliefs (p<0.001), attitude toward mental health services (p=0.001), and having past history of mental illness (p=0.006).

CONCLUSION

This study demonstrates significant differences in attitudes toward mental illness among different groups of participants. Lesser impact of traditional beliefs and better knowledge about mental illness were the factors most associated with better attitudes toward mentally ill people and mental health services and with better help-seeking behavior.

Faith healers are taking over the role of psychiatrists in Iraq

Background: Due to lack of education and awareness, faith healing has become a popular way of treating psychiatric patients. Objective: To ascertain the role of faith healers in the treatment of psychiatric illnesses by exploring the percentage of patients attending those healers. Methods: A semi-structured questionnaire was applied through a direct face-to-face interview with the patients and their companions; it inquired whether the patient has ever visited faith healers, the method of treatment the patients were subjected to, and their opinion about the benefit they got regarding improvement in their condition. Results: Among the total 482 cases; 279 (57%) reported going to faith healers (FHs) at any time before, during, or after a psychiatric consultation. Of those, 84.6% reported visiting FHs less than 10 times, while 15.4% went 10 times or more; 36.9% still believe that the treatment of FHs is accepted or even good (21.5%), while 30.9% realized that it is useless, and 10.7% think it is bad. No association was found between going to FHs and patient age or gender, while there was a significant association with marital status (p < 0.02) and with education (p < 0.001). Patients with schizophrenia/psychosis or bipolar disorders visited FHs significantly more often than those with other diagnoses. Conclusion: Faith healing is prevalent in Iraq and FHs may overwhelm the role of psychiatrists in treating mental illnesses. Sincere efforts are needed to help build public awareness and to improve accessibility and utilization of mental health services for this vulnerable group.

Public Awareness, Beliefs, And Attitudes Toward Bipolar Disorder In Saudi Arabia

OBJECTIVES

To examine public's knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA).

METHODS

A cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale.

RESULTS

Of 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively ‎(86%)‎, have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP.

CONCLUSIONS

This study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP.

Depression literacy in women attending university hospital clinics in Riyadh Saudi Arabia

BACKGROUND

Depression literacy in general population constitutes an ability to understand depression, with knowledge of disease, its risk factors and symptoms. High levels of depression literacy promote early intervention, potentially reducing related disability.

AIM

This study investigated the depression literacy in women visitors to clinics of a tertiary care hospital in Riyadh, Saudi Arabia.

METHODS

Women of 18 and more years were surveyed during their visit to primary and other healthcare clinics of a public hospital in Riyadh. Knowledge on depression symptoms, causes and management approaches identified depression literate women scoring more than 30 points on a 42-item tool.

RESULTS

Of the 409 participants, 65.5% were depression literate, 50% educated as college and above, 64.3% married, 50.7% housewives, 62.4% reported use of multiple information sources (range, 0-8) and had a mean age of 34.9 (standard deviation ( SD), 12.4) years. In a logistic regression model, participants scoring less than 30 for depression literacy were significantly associated with women having less than college-level education, divorced marital status and use of decreasing number of learning resources.

CONCLUSION

Women with low education divorced; using fewer information sources need specific considerations by healthcare providers for assessment of depressive disorders in this setting.

The prevalence extent of Complementary and Alternative Medicine (CAM) use among Saudis

Introduction: There is worldwide interest in the use of CAM. Studying CAM in Saudi population is important as it will reflect the influence of psychosocial, cultural and religious factors on health beliefs and behaviors. The objective of this study was to present an updated review on the use of CAM practices in Saudi Arabia including commonly used types, common conditions for which it has been used and who uses CAM. Methods: This review used data from national surveys conducted in Saudi Arabia and published between 2000 and 2015. The literature search was performed considering standards adopted such as Moose guidelines for observational studies. Two authors independently reviewed each article. The search yielded 73 articles, and a total of 36 articles were included. Further careful data extraction was carried out by two independents reviewers. Results: Most of the reviewed studies were cross-sectional in design and were published between 2014 and 2015, and mostly in Riyadh region. Substantial difference in the findings for the patterns of CAM use was revealed. The most commonly employed practice was of spiritual type such as prayer and reciting Quran alone or on water. Other types include herbs (8-76%), honey (14-73%) and dietary products (6-82%). Cupping (Alhijamah) was least used (4-45%). Acupuncture was more practiced among professionals. Conclusion: The utilization of CAM is widely practiced in Saudi Arabia. There is need for efforts to promote research in the field of CAM to address each practice individually. Population surveys should be encouraged supported by mass media to raise knowledge and awareness about the practice of different CAM modalities. The national center of CAM should play a major role in these efforts.

Mental Health Literacy Among Undergraduate Students of a Saudi Tertiary Institution: A Cross-sectional Study

The issue of mental health literacy has been widely studied in developed countries, with few studies conducted in Arab countries. In this study we aimed to investigate mental health literacy and attitudes towards psychiatric patients among students of Jazan University, Kingdom of Saudi Arabia. A crosssectional study was conducted among undergraduate students using a validated Arabicversion questionnaire. A total of 557 students were recruited from different Jazan university colleges. The majority of students (90.3%) have intermediate mental health literacy. Regarding the etiology of mental illness, students agreed that genetic inheritance (45.8%), poor quality of life (65%) and social relationship weakness (73.1%) are the main causes of mental illness. The majority thought that mentally ill people are not capable of true friendships (52.5%) and that anyone can suffer from a mental illness (49.4%). Students’ attitudes towards psychiatric patients were mixed, with 68.7% reporting that they could maintain a friendship with a mentally ill person and that people with mental illness should have the same rights as anyone else (82.5%). Mental health literacy among university students was intermediate. There is an urgent need for health educational programs to change the attitudes of students regarding this important health issue.

The stigma of mental illness in Arab families: a concept analysis

ACCESSIBLE SUMMARY

The stigma of mental illness varies significantly from culture to culture and from person to person. To date, little is known about how mental illness stigma manifests within the Arab community. This study aimed at bringing clarity to the concept of 'mental illness stigma' as it applies to Arab families. Nursing's holistic and patient-centered approach is integral to helping Arab patients and their families appropriately incorporate individual values, beliefs, and cultural perspectives into treatment plans. This study establishes a scientific alert for professionals at all levels to avoid making false generalizations about a specific culture that are not based on specific research findings from that culture.

ABSTRACT

Accessing mental health services is a critical step towards reducing the burden of mental illness. The stigma of mental illness is one of the most common reasons for not seeking mental health care leading to negative health consequences and undue suffering for many individuals and their families. Stigma is embedded in its social context. What may be considered acceptable in one society may be considered unacceptable and open to stigmatization in other societies. Arabs have a shared set of values, beliefs, and traditions that are substantially different from those of Westerners. Further, in most Arab countries, formal mental health resources are scarce and people with mental illness experience the compounded disadvantages of poverty and illness stigma. To date, little is known about how mental illness stigma manifests within the Arab community making it difficult to design and test interventions that support Arab individuals with mental illness and their families in treatment seeking and adherence. Using Rodger's concept analysis method, we examined how 'mental illness stigma' operates within an Arab context as a first step towards elucidating culturally competent approaches to treatment. This analysis provides a foundation for future work in the areas of mental illness diagnosis, education, and treatment that reflect the unique characteristics of Arab culture.