Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals.
Causal attributions
Help-seeking
Mental illness
Stigma
The Arab world
Journal
Social psychiatry and psychiatric epidemiology
ISSN: 1433-9285
Titre abrégé: Soc Psychiatry Psychiatr Epidemiol
Pays: Germany
ID NLM: 8804358
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
17
03
2022
accepted:
12
12
2022
medline:
4
4
2023
pubmed:
31
12
2022
entrez:
30
12
2022
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 36583767
doi: 10.1007/s00127-022-02403-x
pii: 10.1007/s00127-022-02403-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
641-656Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Baumeister H, Härter M (2007) Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol 42(7):537–546
pubmed: 17516013
doi: 10.1007/s00127-007-0204-1
Steel Z et al (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980–2013. Int J Epidemiol 43(2):476–493
pubmed: 24648481
pmcid: 3997379
doi: 10.1093/ije/dyu038
Al-Khathami AD, Ogbeide DO (2002) Prevalence of mental illness among Saudi adult primary-care patients in Central Saudi Arabia. Saudi Med J 23(6):721–724
pubmed: 12070556
Mahfouz AA et al (2009) Adolescents’ mental health in Abha city, southwestern Saudi Arabia. The Int J Psychiatry Med 39(2):169–177
pubmed: 19860075
doi: 10.2190/PM.39.2.e
Chahine M et al (2020) Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry 20(1):304
pubmed: 32539735
pmcid: 7296775
doi: 10.1186/s12888-020-02726-6
Sfeir E et al (2020) Alexithymia, aggressive behavior and depression among Lebanese adolescents: a cross-sectional study. Child Adolesc Psychiatry Ment Health 14(1):1–7
doi: 10.1186/s13034-020-00338-2
Ghanem M et al (2009) National survey of prevalence of mental disorders in Egypt: preliminary survey. EMHJ-East Medit Health J 15(1):65–75
doi: 10.26719/2009.15.1.65
Ghuloum S et al (2014) 2014 Lifetime prevalence of common mental disorders in Qatar using WHO Composite International Diagnostic Interview (WHO-CIDI). Int J Clin Psychiatry Mental Health 2(10):2310–8231
Ismayilova L et al (2013) Depressive symptoms among Jordanian youth: results of a national survey. Community Ment Health J 49(1):133–140
pubmed: 22820930
doi: 10.1007/s10597-012-9529-7
Faten E et al (2017) Évolution après la révolution de Jasmin des troubles mentaux en Tunisie. PSN 15(2):7–17
Obermeyer CM (2015) Adolescents in Arab countries: health statistics and social context. DIFI Family Res Proc 2015(1):1
Kayrouz R et al (2018) Acceptability of mental health services for anxiety and depression in an Arab sample. Community Ment Health J 54(6):875–883
pubmed: 29368132
doi: 10.1007/s10597-018-0235-y
Organization WH, Mental health atlas, (2017) resources for mental health in the Eastern Mediterranean Region. WHO, Geneve
Merhej R (2019) Stigma on mental illness in the Arab world: beyond the socio-cultural barriers. International Journal of Human Rights in Healthcare. Emerland
Aloud N, Rathur A (2009) Factors affecting attitudes toward seeking and using formal mental health and psychological services among Arab Muslim populations. J Muslim Mental Health 4(2):79–103
doi: 10.1080/15564900802487675
Rudwan SJ, Al Owidha SM (2019) Perceptions of mental health disorders: An exploratory study in some Arab societies. Int J Devel Res 9(01):25369–25383
Clement S et al (2015) What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 45(1):11–27
pubmed: 24569086
doi: 10.1017/S0033291714000129
Schnyder N et al (2017) Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 210(4):261–268
pubmed: 28153928
doi: 10.1192/bjp.bp.116.189464
Zolezzi M et al (2018) Stigma associated with mental illness and its treatment in the Arab culture: a systematic review. Int J Soc Psychiatry 64(6):597–609
pubmed: 30019976
doi: 10.1177/0020764018789200
Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54(9):765
pubmed: 10510666
doi: 10.1037/0003-066X.54.9.765
Angermeyer MC, Matschinger H, Schomerus G (2013) Attitudes towards psychiatric treatment and people with mental illness: changes over two decades. Br J Psychiatry 203(2):146–151
pubmed: 23787060
doi: 10.1192/bjp.bp.112.122978
Corrigan PW, Shapiro JR (2010) Measuring the impact of programs that challenge the public stigma of mental illness. Clin Psychol Rev 30(8):907–922
pubmed: 20674114
pmcid: 2952670
doi: 10.1016/j.cpr.2010.06.004
Pescosolido BA et al (2013) The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. Am J Public Health 103(5):853–860
pubmed: 23488508
pmcid: 3698809
doi: 10.2105/AJPH.2012.301147
Choudhry FR et al (2016) Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatr Dis Treat 12:2807–2818
pubmed: 27826193
pmcid: 5096745
doi: 10.2147/NDT.S111543
Gulliver A, Griffiths KM, Christensen H (2010) Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 10:113
pubmed: 21192795
pmcid: 3022639
doi: 10.1186/1471-244X-10-113
Angermeyer MC et al (2017) Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys. World Psychiatry 16(1):50–61
pubmed: 28127931
pmcid: 5269489
doi: 10.1002/wps.20383
Mahmoud I, Saravanan C (2019) Prevalence of mental disorders and the use of mental health services among the adult population in United Arab Emirates. Asian J Epidemiol 13:12–19
doi: 10.3923/aje.2020.12.19
Qassim S, Boura F, Al-Hariri Y (2018) Public knowledge and attitude toward depression and schizophrenia: findings from quantitative study in UAE. Asian J Pharm Clin Res 11(7):402–406
doi: 10.22159/ajpcr.2018.v11i7.26160
Eapen V, Ghubash R (2004) Help-seeking for mental health problems of children: preferences and attitudes in the United Arab Emirates. Psychol Rep 94(2):663–667
pubmed: 15154199
doi: 10.2466/pr0.94.2.663-667
Alsubaie S et al (2020) A survey on public attitudes toward mental illness and mental health services among four cities in Saudi Arabia. Neuropsychiatr Dis Treat 16:2467
pubmed: 33149588
pmcid: 7603407
doi: 10.2147/NDT.S265872
El-Gilany A-H, Amr M, Iqbal R (2010) Students’ attitudes toward psychiatry at Al-Hassa medical college. Saudi Arabia Acad Psychiatry 34(1):71–74
pubmed: 20071736
doi: 10.1176/appi.ap.34.1.71
Fekih-Romdhane F et al (2021) Knowledge, attitude and behaviours toward mental illness and help-seeking in a large nonclinical Tunisian student sample. Early Interv Psychiatry 15(5):1292–1305
pubmed: 33300260
doi: 10.1111/eip.13080
Fekih-Romdhane F et al (2022) Attitudes toward schizophrenia among Tunisian family medicine residents and non-medical students. Psychosis. https://doi.org/10.1080/17522439.2022.2032291
doi: 10.1080/17522439.2022.2032291
Dardas LA et al (2019) Psychosocial correlates of Jordanian adolescents’ help-seeking intentions for depression: findings from a nationally representative school survey. J Sch Nurs 35(2):117–127
pubmed: 28946797
doi: 10.1177/1059840517731493
Rayan A, Jaradat A (2016) Stigma of mental illness and attitudes toward psychological help-seeking in Jordanian university students. Res Psychol Behavioral Sci 4(1):7–14
Gabra RH et al (2020) Knowledge, attitude and health-seeking behavior among family caregivers of mentally ill patients at Assiut University Hospitals: a cross-sectional study. Middle East Curr Psychiatry 27(1):1–8
doi: 10.1186/s43045-020-0015-6
Angermeyer MC et al (2016) Cultural differences in stigma surrounding schizophrenia: comparison between Central Europe and North Africa. Br J Psychiatry 208(4):389–397
pubmed: 26585098
doi: 10.1192/bjp.bp.114.154260
Naeem F et al (2016) A qualitative study to explore patients’, carers’ and health professionals’ views to culturally adapt CBT for psychosis (CBTp) in Pakistan. Behav Cogn Psychother 44(1):43–55
pubmed: 25180541
doi: 10.1017/S1352465814000332
Pratt R et al (2016) Perceptions of mental illness in the Somali community in Minnesota. Int J Mig 12(1):16–25
Sewilam AM et al (2015) Suggested avenues to reduce the stigma of mental illness in the Middle East. Int J Soc Psychiatry 61(2):111–120
pubmed: 24957595
doi: 10.1177/0020764014537234
Al-Krenawi A et al (2009) Cross-national comparison of Middle Eastern university students: help-seeking behaviors, attitudes toward helping professionals, and cultural beliefs about mental health problems. Community Ment Health J 45(1):26–36
pubmed: 19067161
doi: 10.1007/s10597-008-9175-2
Al-Krenawi A et al (2004) Cross-national study of attitudes towards seeking professional help: Jordan, United Arab Emirates (UAE) and Arabs in Israel. Int J Soc Psychiatry 50(2):102–114
pubmed: 15293428
doi: 10.1177/0020764004040957
Ciftci A, Jones N, Corrigan PW (2013) Mental health stigma in the Muslim community. Journal of Muslim Mental Health 7 (1).
Al-Adawi S et al (2002) Perception of and attitude towards mental illness in Oman. Int J Soc Psychiatry 48(4):305–317
pubmed: 12553410
doi: 10.1177/002076402128783334
Mothersill D et al (2021) Knowledge, attitudes, and behaviours towards schizophrenia, bipolar disorder, and autism: a pilot study. Ir J Psychol Med 3:1–7
doi: 10.1017/ipm.2021.81
Firdos S, Amanullah M, Mobarki AO (2021) Labeled as mentally ill: community perspective toward mental illness in Al Ahsa, Saudi Arabia. Cureus 13(12):e20127
pubmed: 34984157
pmcid: 8720389
Vasantha Raju N, Harinarayana N (2016) Online survey tools: A case study of Google Forms. In : National Conference on Scientific, Computational & Information Research Trends in Engineering, GSSS-IETW, Mysore
von Elm E, STROBE initiative (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147:573–577
doi: 10.7326/0003-4819-147-8-200710160-00010
Abi Doumit C et al (2019) Knowledge, attitude and behaviors towards patients with mental illness: results from a national Lebanese study. PLoS ONE 14(9):e0222172
pubmed: 31525219
pmcid: 6746362
doi: 10.1371/journal.pone.0222172
Taylor SM, Dear MJ (1981) Scaling community attitudes toward the mentally ill. Schizophr Bull 7(2):225–240
pubmed: 7280561
doi: 10.1093/schbul/7.2.225
Evans-Lacko S et al (2010) Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry 55(7):440–448
pubmed: 20704771
doi: 10.1177/070674371005500707
Fischer EH, Farina A (1995) Attitudes toward seeking professional psychologial help: A shortened form and considerations for research. Journal of college student development
Heath PJ, Vogel DL, Al-Darmaki FR (2016) Help-seeking attitudes of United Arab Emirates students: examining loss of face, stigma, and self-disclosure. Couns Psychol 44(3):331–352
doi: 10.1177/0011000015621149
Friendly M (2002) Corrgrams: exploratory displays for correlation matrices. Am Stat 56(4):316–324
doi: 10.1198/000313002533
Steele L, Dewa C, Lee K (2007) Socioeconomic status and self-reported barriers to mental health service use. The Canadian Journal of Psychiatry 52(3):201–206
pubmed: 17479529
doi: 10.1177/070674370705200312
Tan GTH et al (2020) Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore. BMJ Open 10(7):e035818
pubmed: 32723737
pmcid: 7389507
doi: 10.1136/bmjopen-2019-035818
Nolan A, O’Connor C (2019) The effect of causal attributions for depression on help-seeking and treatment preferences. J Affect Disord 257:477–485
pubmed: 31319339
doi: 10.1016/j.jad.2019.07.017
Salmerón R, García C, García J (2018) Variance inflation factor and condition number in multiple linear regression. J Stat Comput Simul 88(12):2365–2384
doi: 10.1080/00949655.2018.1463376
Goujon A, Weber D, Loichinger E (2016) Demographic profile of the Arab region: Realizing the demographic dividend
Abbott SG, Stivachtis YA (2019) Demography, migration and security in the middle east, in regional security in the middle east: sectors variables and issues. E-International Relations
Coker EM (2005) Selfhood and social distance: toward a cultural understanding of psychiatric stigma in Egypt. Soc Sci Med 61(5):920–930
pubmed: 15955396
doi: 10.1016/j.socscimed.2005.01.009
Abolfotouh MA et al (2019) Attitudes toward mental illness, mentally ill persons, and help-seeking among the Saudi public and sociodemographic correlates. Psychol Res Behav Manag 12:45–54
pubmed: 30679929
pmcid: 6338115
doi: 10.2147/PRBM.S191676
Fekih-Romdhane F et al (2021) Attitudes and beliefs of Tunisian High-School teachers about schizophrenia: The impact of vignette gender. Int J Soc Psychiatry. https://doi.org/10.1177/00207640211057726
doi: 10.1177/00207640211057726
pubmed: 34903062
Vally Z et al (2018) Public stigma and attitudes toward psychological help-seeking in the United Arab Emirates: the mediational role of self-stigma. Perspect Psychiatr Care 54(4):571–579
pubmed: 29667204
doi: 10.1111/ppc.12282
Dardas L, Simmons LA (2015) The stigma of mental illness in Arab families: a concept analysis. J Psychiatr Ment Health Nurs 22(9):668–679
pubmed: 26118332
doi: 10.1111/jpm.12237
Henning-Smith C et al (2013) Stigma, discrimination, or symptomatology differences in self-reported mental health between US-born and Somalia-born Black Americans. Am J Public Health 103(5):861–867
pubmed: 23488506
pmcid: 3698822
doi: 10.2105/AJPH.2012.301184
May S et al (2014) Mental health literacy among refugee communities: differences between the Australian lay public and the Iraqi and Sudanese refugee communities. Soc Psychiatry Psychiatr Epidemiol 49(5):757–769
pubmed: 24248469
doi: 10.1007/s00127-013-0793-9
Slewa-Younan S et al (2014) Mental health literacy of resettled Iraqi refugees in Australia: knowledge about posttraumatic stress disorder and beliefs about helpfulness of interventions. BMC Psychiatry 14(1):1–8
doi: 10.1186/s12888-014-0320-x
Assad T et al (2015) Role of traditional healers in the pathway to care of patients with bipolar disorder in Egypt. Int J Soc Psychiatry 61(6):583–590
pubmed: 25575578
doi: 10.1177/0020764014565799
Sherra KS, Shahda M, Khalil DM (2017) The role of culture and faith healers in the treatment of mood disorders in rural versus urban areas in United Arab Emirates. Egyptian J Psychiatry 38(2):79
doi: 10.4103/1110-1105.209678
Al-Rowais N et al (2010) Traditional healers in Riyadh region: reasons and health problems for seeking their advice. A household survey. The J Altern Complement Med 16(2):199–204
pubmed: 20105037
doi: 10.1089/acm.2009.0283
Khiari H et al (2019) Pathways to mental health care for patients with severe mental illness in Tunisia. Pan Afr Med J 34:118
pubmed: 31934259
pmcid: 6945374
doi: 10.11604/pamj.2019.34.118.19661
Organization WH (2005) The World health report: 2005: make every mother and child count. World Health Organization
Alenezi AF et al (2021) Translation and validation of the Arabic version of the barrier to access to care evaluation (BACE) scale Mental Health and Social Inclusion. Emerland, UK
Al-Darmaki FR (2003) Attitudes towards seeking professional psychological help: what really counts for United Arab Emirates university students? Soc Behav Personal Int J 31(5):497–508
doi: 10.2224/sbp.2003.31.5.497
Chowdhury N (2016) Integration between mental health-care providers and traditional spiritual healers: contextualising Islam in the twenty-first century. J Relig Health 55(5):1665–1671
pubmed: 27156001
doi: 10.1007/s10943-016-0234-7
Wang PS et al (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370(9590):841–850
pubmed: 17826169
pmcid: 2847360
doi: 10.1016/S0140-6736(07)61414-7
Al-Darmaki FR (2014) Predictors of counseling center use among college students in the United Arab Emirates. Int Perspec Psychol 3(1):48–61
Ghuloum S, Bener A, Abou-Saleh MT (2011) Prevalence of mental disorders in adult population attending primary health care setting in Qatari population. JPMA-J Pakistan Med Assoc 61(3):216
Al-Krenawi A, Graham JR, Kandah J (2000) Gendered utilization differences of mental health services in Jordan. Commun Ment Health J 36(5):501–511
doi: 10.1023/A:1001963714338
Hamdan A (2009) Mental health needs of Arab women. Health Care Women Int 30(7):593–611
doi: 10.1080/07399330902928808
Al-Samadi A (1994) Yarmouk University students’ attitudes toward counseling. Derasat 21(4):277–297
Hall RA (2021) No assistance necessary: Arab Men’s attitudes towards health issues and help-seeking. Open J Soc Sci 9(11):9–23
Flink IJ et al (2013) The role of maternal perceptions and ethnic background in the mental health help-seeking pathway of adolescent girls. J Immigr Minor Health 15(2):292–299
pubmed: 22527744
doi: 10.1007/s10903-012-9621-7
Okasha A, Karam E, Okasha T (2012) Mental health services in the Arab world. World Psychiatry 11(1):52–54
pubmed: 22295010
pmcid: 3266748
doi: 10.1016/j.wpsyc.2012.01.008
Office of the Surgeon, G., S. Center for Mental Health, and H. National Institute of Mental, Publications and Reports of the Surgeon General, in Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. 2001, Substance Abuse and Mental Health Services Administration (US): Rockville (MD)
Bener A, Ghuloum S (2011) Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. Int J Soc Psychiatry 57(5):480–486
pubmed: 20591923
doi: 10.1177/0020764010374415
Wahass S, Kent G (1997) A comparison of public attitudes in Britain and Saudi Arabia towards auditory hallucinations. Int J Soc Psychiatry 43(3):175–183
pubmed: 9347419
doi: 10.1177/002076409704300303
Aljabri MK et al (2018) Barriers to special care patients with mental illness receiving oral healthcare. A cross sectional study in the Holy City of Makkah. Saudi Arabia. Saudi Med J 39(4):419–423
pubmed: 29619496
doi: 10.15537/smj.2018.4.21560
El Rhermoul F-Z et al (2018) A qualitative study to explore views of patients, carers and mental health professionals’ views on depression in Moroccan women. Int J Cult Ment Health 11(2):178–193
doi: 10.1080/17542863.2017.1355397
Ali SH, Agyapong VIO (2016) Barriers to mental health service utilisation in Sudan - perspectives of carers and psychiatrists. BMC Health Serv Res 16:31
pubmed: 26818754
pmcid: 4729143
doi: 10.1186/s12913-016-1280-2
Krumpal I (2013) Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quant 47(4):2025–2047
doi: 10.1007/s11135-011-9640-9
Frost J (2019) Regression analysis: An intuitive guide for using and interpreting linear models. Statisics By Jim Publishing
Evans-Lacko S et al (2014) Effect of the Time to Change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003–13: an analysis of survey data. The Lancet Psychiatry 1(2):121–128
pubmed: 26360575
doi: 10.1016/S2215-0366(14)70243-3
Pawluk SA, Zolezzi M (2017) Healthcare professionals’ perspectives on a mental health educational campaign for the public. Health Educ J 76(4):479–491
doi: 10.1177/0017896917696121
Sartorius N, Schulze H (2005) Reducing the stigma of mental illness: A report from a global association. Cambridge University Press
doi: 10.1017/CBO9780511544255
Nortje G et al (2016) Effectiveness of traditional healers in treating mental disorders: a systematic review. The Lancet Psychiatry 3(2):154–170
pubmed: 26851329
doi: 10.1016/S2215-0366(15)00515-5
Organization WH (2013) WHO traditional medicine strategy: World Health Organization
Qureshi NA, Al-Habeeb AA, Koenig HG (2013) Mental health system in Saudi Arabia: an overview. Neuropsychiatr Dis Treat 9:1121
pubmed: 23966783
pmcid: 3743653
doi: 10.2147/NDT.S48782
Sharkey T (2017) Mental health strategy and impact evaluation in Qatar. BJPsych International 14(1):18–21
pubmed: 29093929
pmcid: 5618826
doi: 10.1192/S2056474000001628
Amer MM, Hovey JD (2007) Socio-demographic differences in acculturation and mental health for a sample of 2nd generation/early immigrant Arab Americans. J Immigr Minor Health 9(4):335–347
pubmed: 17340173
doi: 10.1007/s10903-007-9045-y
Kira IA et al (2014) The traumatogenic dynamics of internalized stigma of mental illness among Arab American, Muslim, and refugee clients. J Am Psychiatr Nurses Assoc 20(4):250–266
pubmed: 24994879
doi: 10.1177/1078390314542873
Vermette D et al (2015) Healthcare access for Iraqi refugee children in Texas: persistent barriers, potential solutions, and policy implications. J Immigr Minor Health 17(5):1526–1536
pubmed: 25236769
doi: 10.1007/s10903-014-0110-z
Corrigan PW (2011) Best practices: Strategic stigma change (SSC): Five principles for social marketing campaigns to reduce stigma. Psychiatr Serv 62(8):824–826
pubmed: 21807820
doi: 10.1176/ps.62.8.pss6208_0824