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 1 2, Haitham Jahrami 3 4, Manel Stambouli 5 6, Amthal Alhuwailah 7, Mai Helmy 8, Hanaa Ahmed Mohamed Shuwiekh 9, Cheikh Mohamed Fadel Mohamed Lemine 10, Eqbal Radwan 11, Juliann Saquib 12, Nazmus Saquib 12, Mirna Fawaz 13, Btissame Zarrouq 14, Abdallah Y Naser 15, Sahar Obeid 16, Souheil Hallit 16, Maan Saleh 17, Sanad Haider 18, Suhad Daher-Nashif 19, Lahmer Miloud 20, Manal Badrasawi 21, Ayman Hamdan-Mansour 22, Mariapaola Barbato 23, Aisha Bakhiet 24, Najat Sayem 25, Samir Adawi 26, Fatheya Grein 27, Wissal Cherif 5 6, Nasr Chalghaf 28, Mariwan Husni 3, Maha M Alrasheed 29, Majda Cheour 5 6

Affiliations

01 April 2023

-

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.

Similar articles

Causal beliefs of mental illness and its impact on help-seeking attitudes: a cross-sectional study among university students in Singapore.

Tan GTH, Shahwan S, Goh CMJ, Ong WJ, Samari E, Abdin E, Kwok KW, Chong SA, Subramaniam M.BMJ Open. 2020 Jul 28;10(7):e035818. doi: 10.1136/bmjopen-2019-035818.PMID: 32723737 Free PMC article.

Stigma associated with mental illness and its treatment in the Arab culture: A systematic review.

Zolezzi M, Alamri M, Shaar S, Rainkie D.Int J Soc Psychiatry. 2018 Sep;64(6):597-609. doi: 10.1177/0020764018789200. Epub 2018 Jul 18.PMID: 30019976 Review.

Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia.

Ibrahim N, Amit N, Shahar S, Wee LH, Ismail R, Khairuddin R, Siau CS, Safien AM.BMC Public Health. 2019 Jun 13;19(Suppl 4):544. doi: 10.1186/s12889-019-6862-6.PMID: 31196033 Free PMC article.

Stigma towards mental illness and help-seeking behaviors among adult and child psychiatrists in Hungary: A cross-sectional study.

Őri D, Szocsics P, Molnár T, Ralovich FV, Huszár Z, Bene Á, Rózsa S, Győrffy Z, Purebl G.PLoS One. 2022 Jun 10;17(6):e0269802. doi: 10.1371/journal.pone.0269802. eCollection 2022.PMID: 35687584 Free PMC article.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review.

Wei Y, McGrath PJ, Hayden J, Kutcher S.BMC Psychiatry. 2015 Nov 17;15:291. doi: 10.1186/s12888-015-0681-9.PMID: 26576680 Free PMC article. Review.

Cited by

An investigation of knowledge and attitudes towards antidepressants: a cross-sectional survey of Jordan's six medical schools.

Abdallat M, Murshidi R, Taha H, Jaber DZ, Hammouri M, Al-Huneidy L, Aljayeh M, Ghanem HH, Bedros AW, Al-Omairi J, Abbas R, Abu-Usba MI, Alkayed Z, Banimustafa R, Al-Ani A.BMC Psychiatry. 2023 Aug 18;23(1):604. doi: 10.1186/s12888-023-05037-8.PMID: 37596589 Free PMC article.

Psychometric properties of the Arabic versions of the Three-Item Short Form of the modified Weight Bias Internalization Scale (WBIS-3) and the Muscularity Bias Internalization Scale (MBIS).

Fekih-Romdhane F, He J, Malaeb D, Dabbous M, Hallit R, Obeid S, Hallit S.J Eat Disord. 2023 May 23;11(1):82. doi: 10.1186/s40337-023-00805-z.PMID: 37221616 Free PMC article.

Decreased insight, but not self-stigma or belief about medicine, is associated with greater severity of delusions in a sample of long-stay patients with schizophrenia: a cross-sectional study.

Beainy C, Haddad C, Fekih-Romdhane F, Hallit S, Haddad G.BMC Psychiatry. 2023 Apr 3;23(1):222. doi: 10.1186/s12888-023-04711-1.PMID: 37013492 Free PMC article.

KMEL References

https://pubmed.ncbi.nlm.nih.gov/

References

  1.  
    1. Baumeister H, Härter M (2007) Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol 42(7):537–546 - PubMed - DOI
  2.  
    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 - PMC - DOI
  3.  
    1. 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
  4.  
    1. Mahfouz AA et al (2009) Adolescents’ mental health in Abha city, southwestern Saudi Arabia. The Int J Psychiatry Med 39(2):169–177 - PubMed - DOI
  5.  
    1. Chahine M et al (2020) Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry 20(1):304 - PubMed - PMC - DOI
  6.  
    1. 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
  7.  
    1. 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
  8.  
    1. 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
  9.  
    1. Ismayilova L et al (2013) Depressive symptoms among Jordanian youth: results of a national survey. Community Ment Health J 49(1):133–140 - PubMed - DOI
  10.  
    1. Faten E et al (2017) Évolution après la révolution de Jasmin des troubles mentaux en Tunisie. PSN 15(2):7–17
  11.  
    1. Obermeyer CM (2015) Adolescents in Arab countries: health statistics and social context. DIFI Family Res Proc 2015(1):1
  12.  
    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 - DOI
  13.  
    1. Organization WH, Mental health atlas, (2017) resources for mental health in the Eastern Mediterranean Region. WHO, Geneve
  14.  
    1. Merhej R (2019) Stigma on mental illness in the Arab world: beyond the socio-cultural barriers. International Journal of Human Rights in Healthcare. Emerland
  15.  
    1. 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
  16.  
    1. 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
  17.  
    1. 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 - DOI
  18.  
    1. 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 - DOI
  19.  
    1. 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 - DOI
  20.  
    1. Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54(9):765 - PubMed - DOI
  21.  
    1. 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 - DOI
  22.  
    1. 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 - PMC - DOI
  23.  
    1. 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 - PMC - DOI
  24.  
    1. Choudhry FR et al (2016) Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatr Dis Treat 12:2807–2818 - PubMed - PMC - DOI
  25.  
    1. 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 - PMC - DOI
  26.  
    1. 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 - PMC - DOI
  27.  
    1. 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
  28.  
    1. 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
  29.  
    1. 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 - DOI
  30.  
    1. 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 - PMC - DOI
  31.  
    1. 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 - DOI
  32.  
    1. 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 - DOI
  33.  
    1. 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
  34.  
    1. 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 - DOI
  35.  
    1. 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
  36.  
    1. 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
  37.  
    1. 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 - DOI
  38.  
    1. 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 - DOI
  39.  
    1. Pratt R et al (2016) Perceptions of mental illness in the Somali community in Minnesota. Int J Mig 12(1):16–25
  40.  
    1. 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 - DOI
  41.  
    1. 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 - DOI
  42.  
    1. 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 - DOI
  43.  
    1. Ciftci A, Jones N, Corrigan PW (2013) Mental health stigma in the Muslim community. Journal of Muslim Mental Health 7 (1).
  44.  
    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 - DOI
  45.  
    1. 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
  46.  
    1. 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 - PMC
  47.  
    1. 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
  48.  
    1. 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
  49.  
    1. 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 - PMC - DOI
  50.  
    1. Taylor SM, Dear MJ (1981) Scaling community attitudes toward the mentally ill. Schizophr Bull 7(2):225–240 - PubMed - DOI
  51.  
    1. Evans-Lacko S et al (2010) Development and psychometric properties of the Mental Health Knowledge Schedule. Can J Psychiatry 55(7):440–448 - PubMed - DOI
  52.  
    1. Fischer EH, Farina A (1995) Attitudes toward seeking professional psychologial help: A shortened form and considerations for research. Journal of college student development
  53.  
    1. 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
  54.  
    1. Friendly M (2002) Corrgrams: exploratory displays for correlation matrices. Am Stat 56(4):316–324 - DOI
  55.  
    1. 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 - DOI
  56.  
    1. 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 - PMC - DOI
  57.  
    1. 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 - DOI
  58.  
    1. 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
  59.  
    1. Goujon A, Weber D, Loichinger E (2016) Demographic profile of the Arab region: Realizing the demographic dividend
  60.  
    1. 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
  61.  
    1. Coker EM (2005) Selfhood and social distance: toward a cultural understanding of psychiatric stigma in Egypt. Soc Sci Med 61(5):920–930 - PubMed - DOI
  62.  
    1. 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 - PMC - DOI
  63.  
    1. 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 - PubMed
  64.  
    1. 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 - DOI
  65.  
    1. 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 - DOI
  66.  
    1. 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 - PMC - DOI
  67.  
    1. 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 - DOI
  68.  
    1. 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
  69.  
    1. 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 - DOI
  70.  
    1. 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
  71.  
    1. 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 - DOI
  72.  
    1. 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 - PMC - DOI
  73.  
    1. Organization WH (2005) The World health report: 2005: make every mother and child count. World Health Organization
  74.  
    1. 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
  75.  
    1. 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
  76.  
    1. 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 - DOI
  77.  
    1. 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 - PMC - DOI
  78.  
    1. Al-Darmaki FR (2014) Predictors of counseling center use among college students in the United Arab Emirates. Int Perspec Psychol 3(1):48–61
  79.  
    1. 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
  80.  
    1. 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
  81.  
    1. Hamdan A (2009) Mental health needs of Arab women. Health Care Women Int 30(7):593–611 - DOI
  82.  
    1. Al-Samadi A (1994) Yarmouk University students’ attitudes toward counseling. Derasat 21(4):277–297
  83.  
    1. Hall RA (2021) No assistance necessary: Arab Men’s attitudes towards health issues and help-seeking. Open J Soc Sci 9(11):9–23
  84.  
    1. 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 - DOI
  85.  
    1. Okasha A, Karam E, Okasha T (2012) Mental health services in the Arab world. World Psychiatry 11(1):52–54 - PubMed - PMC - DOI
  86.  
    1. 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)
  87.  
    1. 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 - DOI
  88.  
    1. 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 - DOI
  89.  
    1. 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 - DOI
  90.  
    1. 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
  91.  
    1. 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 - PMC - DOI
  92.  
    1. Krumpal I (2013) Determinants of social desirability bias in sensitive surveys: a literature review. Qual Quant 47(4):2025–2047 - DOI
  93.  
    1. Frost J (2019) Regression analysis: An intuitive guide for using and interpreting linear models. Statisics By Jim Publishing
  94.  
    1. 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 - DOI
  95.  
    1. 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
  96.  
    1. Sartorius N, Schulze H (2005) Reducing the stigma of mental illness: A report from a global association. Cambridge University Press - DOI
  97.  
    1. Nortje G et al (2016) Effectiveness of traditional healers in treating mental disorders: a systematic review. The Lancet Psychiatry 3(2):154–170 - PubMed - DOI
  98.  
    1. Organization WH (2013) WHO traditional medicine strategy: World Health Organization
  99.  
    1. Qureshi NA, Al-Habeeb AA, Koenig HG (2013) Mental health system in Saudi Arabia: an overview. Neuropsychiatr Dis Treat 9:1121 - PubMed - PMC - DOI
  100.  
    1. Sharkey T (2017) Mental health strategy and impact evaluation in Qatar. BJPsych International 14(1):18–21 - PubMed - PMC - DOI
  101.  
    1. 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 - DOI
  102.  
    1. 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 - DOI
  103.  
    1. 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 - DOI
  104.  
    1. 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 - DOI

Page Navigation