Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals

Feten Fekih-Romdhane; Haitham Jahrami; Manel Stambouli; Amthal Alhuwailah; Mai Helmy; Hanaa Ahmed Mohamed Shuwiekh; Cheikh Mohamed Fadel Mohamed Lemine; Eqbal Radwan; Juliann Saquib; Nazmus Saquib; Mirna Fawaz; Btissame Zarrouq; Abdallah Y Naser; Sahar Obeid; Souheil Hallit; Maan Saleh; Sanad Haider; Suhad Daher-Nashif; Lahmer Miloud; Manal Badrasawi; Ayman Hamdan-Mansour; Mariapaola Barbato; Aisha Bakhiet; Najat Sayem; Samir Adawi; Fatheya Grein; Wissal Cherif; Nasr Chalghaf; Mariwan Husni; Maha M Alrasheed; Majda Cheour

doi:10.1007/s00127-022-02403-x

Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals

Soc Psychiatry Psychiatr Epidemiol. 2023 Apr;58(4):641-656. doi: 10.1007/s00127-022-02403-x. Epub 2022 Dec 30.

Authors

Feten Fekih-Romdhane^{1

2}, Haitham Jahrami^{3

4}, Manel Stambouli^{5

6}, Amthal Alhuwailah⁷, Mai Helmy⁸, Hanaa Ahmed Mohamed Shuwiekh⁹, Cheikh Mohamed Fadel Mohamed Lemine¹⁰, Eqbal Radwan¹¹, Juliann Saquib¹², Nazmus Saquib¹², Mirna Fawaz¹³, Btissame Zarrouq¹⁴, Abdallah Y Naser¹⁵, Sahar Obeid¹⁶, Souheil Hallit¹⁶, Maan Saleh¹⁷, Sanad Haider¹⁸, Suhad Daher-Nashif¹⁹, Lahmer Miloud²⁰, Manal Badrasawi²¹, Ayman Hamdan-Mansour²², Mariapaola Barbato²³, Aisha Bakhiet²⁴, Najat Sayem²⁵, Samir Adawi²⁶, Fatheya Grein²⁷, Wissal Cherif^{5

6}, Nasr Chalghaf²⁸, Mariwan Husni³, Maha M Alrasheed²⁹, Majda Cheour^{5

6}

Affiliations

¹ Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia. feten.fekih@gmail.com.
² The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, 2010, Manouba, Tunisia. feten.fekih@gmail.com.
³ College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
⁴ Ministry of Health, Manama, Kingdom of Bahrain.
⁵ Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
⁶ The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, 2010, Manouba, Tunisia.
⁷ Department of Psychology, Kuwait University, Kuwait, Kuwait.
⁸ Psychology Department, Faculty of Arts, Menoufia University, Shebin El-Kom, Egypt.
⁹ Department of Psychology, Fayoum University, Faiyum, Egypt.
¹⁰ Psychiatry Department, IBN HASSAN Hospital, HASSAN II University Hospital Center, Fès, Morocco.
¹¹ Department of Biology, Faculty of Science, Islamic University of Gaza, Gaza Strip, Palestine.
¹² College of Medicine, Clinical Sciences Department, Sulaiman AlRajhi University, Bukariyah, Al-Qassim, Saudi Arabia.
¹³ Nursing Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon.
¹⁴ Faculty of Medicine and Pharmacy, Laboratory of Epidemiology and Research in Health Sciences, Fez, Morocco.
¹⁵ Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan.
¹⁶ Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
¹⁷ Department of Psychiatry Khobar, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
¹⁸ Faculty of Medicine and Health Sciences, Behavioral Sciences Dep. A, Aden, Yemen.
¹⁹ College of Medicine, QU Health, Qatar University, Doha, Qatar.
²⁰ The National Centre of Research in Social and Cultural Anthropology, Oran, Algeria.
²¹ Department of Nutrition and Food Technology, Faculty of Agriculture and Veterinary Medicine, An-Najah National University, Nablus, Palestine.
²² School of Nursing, The University of Jordan, Amman, Jordan.
²³ Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, UAE.
²⁴ Department of Psychiatry, University of Khartoum, Khartoum, Sudan.
²⁵ Psychology Department, Sanaa University, Sanaa, Yemen.
²⁶ College of Medicine and Health Sciences, Behavioural Medicine, Sultan Qaboos University, Muscat, Oman.
²⁷ Sebha Psychiatry Center, Sebha, Libya.
²⁸ Higher Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
²⁹ Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia.

PMID: 36583767
DOI: 10.1007/s00127-022-02403-x

Abstract

Background: There is evidence that culture deeply affects beliefs about mental illnesses' causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking.

Methods: We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public.

Results: More than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p < .001), knowledge (F = 88.7, p < .001), and help-seeking attitudes (F = 32.4, p < .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants.

Conclusion: Interventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.

Keywords: Causal attributions; Help-seeking; Mental illness; Stigma; The Arab world.

MeSH terms

Arabs
Attitude
Cross-Cultural Comparison
Cross-Sectional Studies
Female
Help-Seeking Behavior*
Humans
Male
Mental Disorders* / psychology
Mental Disorders* / therapy
Patient Acceptance of Health Care
Social Stigma