Mental illness and help-seeking behaviours among Middle Eastern cultures: A systematic review and meta-synthesis of qualitative data

Characterisation of treatment resistant mood disorder patients in the United Arab Emirates

There is paucity of mental health epidemiological data from the Middle East. Therein we present detailed clinical characterization of mood disorders patients from a university tertiary clinic established in the United Arab Emirates. The majority of patient experienced depressive and anxiety symptoms largely in the moderate range according to both self-rated and clinician rated scales, accompanied by significant co-morbidities, functional impairment, mild reduction in cognitive function, and a significant ruminative thinking style. These preliminary findings support the need for larger-scale research in the Middle East to address the burden of poor mental health affecting communities.

Transforming mental health care in the Arab World: A scoping review of Arab TMS studies for psychiatric disorders

BACKGROUND

The mental health landscape in the Arab world has undergone significant changes, highlighting the need for innovative treatment methods like Transcranial Magnetic Stimulation (TMS). Historically, mental health was stigmatized and under-addressed, leading to a reliance on traditional remedies.

METHOD

This scoping review utilized the Arksey & O'Malley framework to examine TMS's application, effectiveness, and challenges in treating psychiatric disorders in Arab countries. A comprehensive search was conducted across six databases, and studies published between 2018 and 2024 were included, focusing on various mental health conditions treated with rTMS.

RESULTS

Nineteen studies were reviewed, with findings indicating that TMS is a promising, non-invasive alternative to traditional treatments like electroconvulsive therapy. Benefits included minimal side effects, quick sessions, complementary treatment options, and cumulative therapeutic effects. However, high costs, lack of trained professionals, and social stigma were significant challenges.

DISCUSSION

The integration of rTMS can enhance mental health care in the region. Addressing economic barriers and increasing awareness through public campaigns could improve accessibility and acceptance of rTMS as a viable treatment option.

CONCLUSION

The findings underscore the need for further research, training for healthcare providers, and public awareness campaigns to promote TMS, ultimately contributing to a healthier societal perspective on mental well-being.

Examining the burden of mental disorders in Jordan: an ecological study over three decades

BACKGROUND

Mental disorders are a major public health issue, causing 4.9% of global disability-adjusted life years (DALYs). In Jordan, factors like regional conflicts, economic changes, and population growth contribute to this burden. This study examines the trends and risk factors of mental disorders in Jordan from 1990 to 2021 using Global Burden of Disease (GBD) data.

METHODS

We analyzed prevalence, deaths, and DALYs of mental disorders from the GBD 2021 dataset, reporting both all-age numbers and age-standardized rates. Key risk factors, including behavioral risks, bullying, childhood sexual abuse, and substance use, were assessed.

RESULTS

Mental disorder cases in Jordan rose by 279.8%, from 514,234 in 1990 to 1,953,087 in 2021. Anxiety and depression were the most common in 2021. All-age DALYs increased by 649.6%, while age-standardized DALY rates showed a slight 4.3% rise. Females had higher mental disorder prevalence and DALY rates, while males had higher substance use disorder rates. Behavioral risks, bullying, and childhood sexual abuse were major contributors.

CONCLUSION

The burden of mental disorders in Jordan has grown significantly over three decades. Limited resources, stigma, and regional instability worsen the issue. Policies focusing on stigma reduction, mental health integration, and prevention are essential.

Digital Surveillance of Mental Health Care Services in Saudi Arabia: Cross-Sectional Study of National e-Referral System Data

Background

Mental illness affects an estimated 25% of the global population, with treatment gaps persisting worldwide. The COVID-19 pandemic has exacerbated these challenges, leading to a significant increase in mental health issues globally. In Saudi Arabia, the lifetime prevalence of mental disorders is estimated at 34.2%, yet 86.1% of those with a 12-month mental disorder report no service use. To address these challenges, digital health solutions, particularly electronic referral (e-referral) systems, have emerged as powerful tools to improve care coordination and access. Saudi Arabia has pioneered the nationwide Saudi Medical Appointments and Referrals Centre (SMARC), a centralized e-referral system using artificial intelligence and predictive analytics.

objectives

This study aims to analyze Saudi Arabia's novel nationwide e-referral system for mental health services, using SMARC platform data to examine referral patterns, and service accessibility. This study also aims to demonstrate how digital health technology can inform and improve mental health care delivery and policy making.

Methods

This retrospective, cross-sectional study used secondary data from SMARC on 10,033 psychiatric e-referrals in Saudi Arabia during 2020-2021. Referrals were assessed by patient sociodemographic variables, geographic data, and e-referral characteristics including date, type, bed type, and reason for e-referral. Descriptive statistical analyses identified referral patterns, while regression modeling determined predictors of external referrals to other regions.

Results

Analysis of 10,033 psychiatric e-referrals revealed that 58.99% (n=5918) were for patients aged 18-44 years, 63.93% (n=6414) were for men, and 87.10% (n=8739) were for Saudi nationals. The Western Business Unit generated 45.17% (n=4532) of all e-referral requests. Emergency cases were the most common type of referral overall, followed by routine inpatient and routine outpatient department referrals. However, in the Northern Business Unit, routine inpatient referrals were most frequent. Two-thirds of requests were for ward beds, while critical beds were rarely requested. "Unavailable subspecialty" was the primary reason for referrals across all regions. The utilization of the mental health e-referral system varied across regions, with the Northern Border and Albaha regions showing the highest rates, while Madinah, Eastern, and Riyadh regions demonstrated lower use. Temporal analysis showed almost similar monthly patterns in 2020 and 2021. There was an overall increase in referrals in 2021 compared with 2020.

Conclusions

This pioneering study of mental health e-referrals in Saudi Arabia demonstrates how digital health transformation, particularly through an e-referral system, has significantly enhanced access to mental health services nationwide in Saudi Arabia. The success of this digital initiative demonstrates how digital health solutions can transform health care access, particularly in mental health services, offering a valuable model for other health care systems.

Assessing attitudes toward seeking psychological professional help among adolescents: the roles of demographics and self-esteem

BACKGROUND

Various factors associated with attitudes toward the utilization of professional psychological help among the school-going population have been explored, but studies from Arabian Gulf countries are lacking. This study aimed to assess attitudes toward seeking professional psychological help, examine how demographic factors and self-esteem are associated with seeking psychological help, and understand the interaction between these variables.

METHODS

A cross-sectional correlational design was used. A random sample of Omani secondary school students (n = 2165) aged 15-18 years completed the demographics sheet, the Scale of Attitudes Toward Seeking Professional Psychological Help (SATSPH), and the Rosenberg self-esteem scale. Hierarchical regression analysis with interaction was performed to test the moderating role of self-esteem in the relationship between selected demographics and attitudes toward seeking professional psychological help (ATSPH).

RESULTS

Most of the adolescents exhibited poor attitudes toward ATSPH. The findings demonstrated a significant moderating effect of self-esteem on the relationship between demographics (sex and age) and ATSPH (ΔR 2 = 0.002, F (7, 2156) = 4.839, p < 0.001). In terms of sex, women may have more positive attitudes toward seeking help than men. However, when self-esteem is considered, the positive effect of being female can reverse at higher levels of self-esteem, suggesting that men with higher self-esteem may have more positive attitudes toward seeking help than women with higher self-esteem. Furthermore, initially, age was not significant. However, when self-esteem was introduced as a moderator, age was a significant predictor. These findings indicate that the effect of age on seeking professional psychological help is influenced by self-esteem.

CONCLUSIONS

This study highlights that attitudes toward seeking professional psychological help among Omani adolescents are generally poor and are influenced by both demographic factors and self-esteem. Although women tend to have more positive attitudes than men do, this can change with varying levels of self-esteem. Similarly, the effect of age on these attitudes is dependent on self-esteem levels. This underscores the complex interplay between demographic factors and self-esteem in shaping attitudes toward psychological help-seeking behaviors. Therefore, more studies of this nature are warranted.

Stigma of mental illness: a comparative study of demographic and cultural correlates among nursing students and registered nurses in Jordan

PURPOSE

This study aims to compare the stigma associated with mental illness between nursing students and registered nurses in Jordan and identify the influence of sociodemographic factors and cultural misconceptions on mental illness stigma.

DESIGN

This research employed a comparative, cross-sectional design. Data were gathered through an online self-administered questionnaire. The survey included information about demographic characteristics, mental illness stigma, and cultural misconceptions about mental illness.

SETTINGS

Government mental health facilities and private universities in Jordan.

PARTICIPANTS

The study was completed by 233 nursing students and 157 registered nurses.

RESULTS

Nursing students exhibited significantly higher mean stigma scores (M = 47.84, SD = 7.67) than registered nurses (M = 40.70, SD = 11.82), P < 0.001. This stigma varies significantly based on gender (P = 0.018), history of psychiatric treatment (P < 0.001), and educational progression among nursing students (P < 0.001). Additionally, registered nurses with advanced academic qualifications, such as a master's degree, reported lower levels of stigma (P = 0.013). The results also indicated that participants who hold stigmatizing cultural beliefs, such as seeing mental illness as a divine punishment or attributing it to supernatural forces, tend to exhibit significantly higher stigma scores in both groups.

CONCLUSION

Nursing curricula should address stigma and cultural misunderstandings about mental illness. In-service training for registered nurses is essential to correct misconceptions and promote culturally competent mental healthcare.

Tackling Loneliness Among Patients With Borderline Personality Disorder in the Arab World: A Sociocultural Perspective

Loneliness, a complex and multifaceted global issue, often affects individuals with borderline personality disorder (BPD), characterized by unstable relationships, poor self-image, and impulsive behavior. This paper explores the experience of loneliness among Arab patients with BPD, highlighting sociocultural challenges and barriers to seeking help. Cultural stigma, often tied to religious beliefs, significantly impedes mental healthcare in Arab societies. BPD is frequently misunderstood as divine punishment, leading individuals to seek faith healers instead of professional help. High expressed emotion (EE) in caregivers, stigma from healthcare providers, and disruptions due to wars further exacerbate isolation and loneliness among patients with BPD. Addressing BPD in the Arab world requires culturally and religiously informed approaches. Public awareness campaigns and collaboration with media and local authorities are essential to destigmatize BPD. Integrating traditional healing practices with therapy, tailored family interventions, and culturally adapted dialectical behavior therapy (DBT) can improve treatment outcomes. Islamic-based psychotherapy (IBP) offers a promising approach, combining social connection and evidence-based techniques. This multifaceted approach can create a supportive environment, ultimately reducing loneliness.

Advancing mental health in the Middle East: A Paradigm Shift

Mental health is a vital part of the bigger well-being picture in the Middle East, which faces specific challenges. In history, mental health has had a bad reputation and low access to services but this is changing as stakeholders are now promoting mental wellbeing. This literature review examines new ways to advance mental health in the Middle East. It explores cultural context, educates on mental health issues, integrates primary care and mental health services, uses technology for communication purposes, builds community support, and advocates for policy reform towards improved mental healthcare outcomes. A comprehensive review across all academic databases was published between 2018 and 2023 using search terms "mental health" and "Middle East". The study highlights the importance of understanding cultural and social factors that contribute to people's comprehension of their minds. Additionally, it suggests methods of raising awareness against stigma like digital platforms and community-based education among others. It also points out two measures: first, it indicates that integrating MHI into Primary Health Care (PHC) Systems increases accessibility; secondly, it proposes that a technology-supported personalized approach can be used to support individuals when needed. On this note, the paper underscores the necessity of utilizing local players within communities at large. The review puts a lot of stress on the significance of approaches that are community-based and involve all people living within an area. This review is very timely and comprehensive in its framework meant to improve mental health in the Middle East. The results could be useful in providing insights for devising appropriate culturally sensitive interventions aimed at promoting mental health in this region. In highlighting particular difficulties as well as possibilities, however, the review guides policy makers, healthcare practitioners, and societies aiming to improve their collective response to mental health problems.

Premenstrual Syndrome and the Attitudes Toward Seeking Professional Psychological Help Among College Students in Oman

Background

This study examines the relationship between premenstrual syndrome (PMS) and the attitude toward seeking professional psychological help among Omani college students.

Method

This study used a cross-sectional design with a convenience sampling approach. The date was issued between January and March 2024. A sample of 601 undergraduate female students completed the study questionnaires, including (1) a sociodemographic questionnaire, (2) the Premenstrual Syndrome Scale and (3) the attitude toward seeking professional psychological distress scale.

Results

The study included 601 eligible participants of age 18-29 years who were mostly single (83.7%) and living on campus (68.6%). PMS prevalence was high at 87.9%, with a mean score of 109.4, indicating low severity for most (62.1%). Participants generally had positive attitudes toward seeking psychological help (41.6% high willingness). A linear regression showed a positive link between PMS severity and help-seeking attitudes.

Conclusion

This study highlights a significant association between the experiences of PMS and attitudes toward seeking professional psychological help among Omani female undergraduate students. With a high prevalence of PMS reported, the findings suggest that cultural factors and support systems play crucial roles in shaping these attitudes. The positive inclination toward seeking help indicates a growing awareness of mental health issues within this demographic. Enhancing mental health services and fostering supportive environments in educational settings can further empower students to address PMS-related challenges.

The community health worker experience and perception toward mental illness: A multi-settings cross-sectional study in Indonesia

BACKGROUND

The experiences and perceptions of Community Health Workers toward mental illness are vital for tailoring interventions, reducing stigma, improving access to services, and fostering community engagement in mental health initiatives.

AIMS

This study investigates the experiences of community health worker and their perception of mental illness.

METHODS

A multi-settings cross-sectional study was conducted among 487 Community Health Workers. Their experience and perception toward mental illness were studied with questionnaires, which examined their general perception, religious-related perception, cause, treatment, and expectation for mental treatment.

RESULTS

Most participants concurred that serving as a community health worker enhances their communication abilities (90.4%), strengthens connections with community health center staff (84.8%), boosts self-confidence (84.6%), and refines their capacity to identify signs of mental disorders (77%). Most notably, they consider their fellow community health workers essential to their extended family. Furthermore, a notable proportion associates' mental illness with religious elements, with 19.5% believing it can result from a lack of religious worship and a minority attributing it to witchcraft or black magic (3.5%). In terms of treatment, 14.2% think Ruqyah can cure mental illness, 6.4% believe in treatment by religious scholars, and a similar percentage (6.4%) think no medication or treatment is necessary for mental problems.

CONCLUSION

Participants overwhelmingly recognize the positive impact of serving as community health workers, citing improvements in communication, relationships with health center staff, self-confidence, and mental disorder identification. The strong bond among community health workers, likened to an extended family, emphasizes their collective importance. Additionally, the majority advocates for compassionate treatment of individuals with mental illness. These findings underscore the complex interplay of professional, communal, and cultural elements in addressing community mental health.

Golden steps: A nursing approach for vitality, agility, and rumination in geriatric clients with depressive disorders through mindful walking

BACKGROUND

Depression is a prevalent issue among older adults and can significantly impact their overall quality of life. While traditional treatments may not always be sufficient or suitable for all individuals, the potential of alternative interventions, such as mindful walking, offers a ray of hope. This study aimed to evaluate the impact of mindful walking on rumination, agility, vitality, and mindfulness in geriatric patients with depressive disorders.

METHOD

A prospective quasi-experimental design was employed with a purposive sample of 35 clients in the intervention group and 33 in the control group. This study utilized the Ruminative Responses Scale - Short Form (RRS-SF) and Five Facet Mindfulness Questionnaire (FFMQ) to measure the primary outcome. The Timed Up and Go Test (TUG) and State-Level Version of the Subjective Vitality Scale (SVS) were used to measure the secondary outcomes.

RESULTS

Mindful walking significantly affected vitality, mindfulness, and rumination, with effect sizes (ղ2 = 0.168, 0.137, and 0.127), respectively. On the other hand, the intervention had a less significant effect on agility, with an effect size (ղ2 = 0.047).

CONCLUSION

This study revealed that geriatric clients with depressive disorders showed more significant improvements in vitality, followed by improvement in rumination and agility. Integrating mindful walking as a part of care plans for those clients would promote their physical activity and mental well-being.

Perceptions of mental disorder causes, treatments, and prevention among the general population in Saudi Arabia

This study investigates the community's perception of mental health in Saudi Arabia, emphasizing its influence on attitudes toward the causes, treatment, and prevention of mental health issues. This understanding is vital for creating evidence-based mental health interventions. A cross-sectional national mental health screening was conducted in 2023, utilizing proportional quota sampling for age, gender, and regional representation among 4547 Saudi participants aged 18-90, randomly selected from national databases. Data were gathered using the ZDataCloud system. The study covered all 13 administrative regions of Saudi Arabia: Riyadh, Makkah, Madinah, Qassim, Eastern Province, Asir, Tabuk, Hail, Northern Borders, Jazan, Najran, Baha, and Al-Jouf. The majority (86.5%) had no personal history of mental health diagnosis or treatment. Key findings identified psychological trauma (78.36%) and substance abuse (72.88%) as primary perceived causes of mental disorders. Preferred treatments included non-pharmacological psychotherapies (74.97%) and pharmacological methods (71.08%). Prevention strategies focused on raising awareness of mental illness (80.4%) and enhancing positive relationships (70.6%). A multivariate logistic regression analysis revealed significant associations between demographic variables and perceptions of mental disorder causes, treatments, and prevention strategies. Females were more likely than males to perceive psychological trauma, drug and alcohol abuse, and domestic violence and sexual harassment as causes of mental disorders. Regarding treatments, females and those with personal or close connections to mental health issues were more likely to endorse non-pharmacological psychotherapy and Roquia in the Qur'an. For prevention strategies, females, those with a mental health diagnosis, and those living with someone diagnosed with a mental disorder were more likely to endorse increasing awareness, positive social relationships, and physical activity. The study suggests integrating religious and social beliefs into mental health programs to enhance community engagement and effectiveness.

Mental health stigma: a conundrum for healthcare practitioners in conservative communities

This paper presents perspectives on the stigma and shame around mental health in conservative communities, and some of the issues faced by health systems in those communities. The various causes of stigma are explored, and how these are often more pronounced in culturally reserved, conservative communities. While health systems are supposed to provide support for mental health sufferers, this stigma sometimes even extends to healthcare workers, which can discourage patients from asking for assistance. Solutions and reforms are needed, for example education programs; addressing gender norms, and the consideration of culture and religion, to form effective solutions. It is also suggested that alternative therapies and support mechanisms, including digital solutions such as artificial intelligence chatbots, may be useful to provide much needed support to individuals with poor mental health. Along with integrating options such as CBT (cognitive behavioral therapy), it may be useful to draw on indigenous psychologies, such as Islamic psychology, as a way of decolonizing approaches. Therefore, when considering solutions, cultural and religious norms must be considered to ensure their efficacy and acceptance.

Mental health and psychosocial support programmes for displaced populations in low- and middle-income countries (LMICs): A systematic review of process, perspectives and experiences

Displacement exerts an ongoing negative impact on people's mental health. The majority of displaced populations are hosted in the global south, yet there is a paucity of evidence synthesis on the implementation of mental health and psychosocial support (MHPSS) programmes in those contexts. We undertook a systematic review of factors influencing the delivery and receipt of MHPSS programmes for displaced populations in low- and middle-income countries to address this gap. A comprehensive search of 12 bibliographic databases, 25 websites and citation checking were undertaken. Studies published in English from 2013 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in, or programmes providers involved in delivering, MHPSS programmes. Fifteen studies were critically appraised and synthesised. Studies considered programme safety as a proxy for acceptability. Other acceptability themes included stigma, culture and gender. Barriers to the accessibility of MHPSS programmes included language, lack of literacy of programme recipients and location of services. To enhance success, future delivery of MHPSS programmes should address gender and cultural norms to limit mental health stigma. Attention should also be given to designing flexible programmes that take into consideration location and language barriers to ensure they maximise accessibility.

Prevalence and Clinical Profile of Adults with ADHD Attending a Tertiary Care Hospital for Five Years

(1) Objectives: This study aimed to assess the 5-year prevalence and clinical profile of attention deficit hyperactive disorder (ADHD) among adult patients seeking care in a tertiary care hospital in Oman. (2) Methods: The data were analysed using descriptive and inferential statistics and standardised prevalence estimates were calculated. (3) Results: Of the 39,881 hospital visits, 1.77% were made by adults with ADHD. This is equivalent to 17.8 visits per 1000 outpatients. The year 2021 saw the highest prevalence among the five years considered, while 2020 had the lowest prevalence. Although the age distribution indicated that the age group 'under 20' had the highest prevalence, the gender distribution showed that ADHD was more common among adult men. Among the various subtypes of ADHD, inattention was the most common. (4) Conclusions: This study specifically compared the prevalence and associated factors between an adult cohort with ADHD and those other psychiatric clinic attendees during the same period. The study offers important information on the prevalence and clinical profile of adults with ADHD in the population under consideration.

Anxiety disorders among children and adolescents during COVID-19 lockdowns and school closures: a cross-sectional study in Kuwait

Introduction

Investigating the epidemiology of mental health disorders resulting from COVID-19 intervention measures, primary school closures, and social isolation in children and adolescents needs to be prioritized over adults at the post-pandemic stage. Most preliminary psychosocial studies conducted during the pandemic have demonstrated that younger age groups are the most vulnerable to such implications. Thus, this study aims to estimate the probable prevalence of specific anxiety disorders in children and quantify their relationships with relevant demographic risk factors.

Methods

We used a cross-sectional study comprising 430 children aged between 8- and 18 years old living in Kuwait during the period of school closures as well as full and partial lockdowns. The survey included questions about participants' characteristics, children's anxiety using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED) scale, and children's emotions and behaviours using the Strengths and Difficulties Questionnaire (SDQ). Univariate and multivariate logistic regression analyses were used to summarize the demographic and characteristics of the participants and their association with general, social, and generalized anxieties, as well as behavioural and emotional difficulties.

Results

We inferred that 24.83% of our participants had at least one anxiety disorder, while 20.19% were classified as abnormal on the SDQ scale. Our multivariate analysis revealed that lockdown duration and sex of the child were consistently significant predictors (p-values < 0.05) of the broad spectrum of selected mental disorders. Additionally, we inferred notable increases in the likelihood of mental disorders associated with the increased duration of lockdowns.

Conclusions

Our findings revealed preliminary insights into the vulnerability of young populations to the indirect negative impacts of strict public health measures during pandemic emergencies. Thus, authorities should consider such implications when planning and implementing similar interventions in future pandemics.