An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = -4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment.

Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis

While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.

Mental illness stigma as a moderator in the relationship between religiosity and help-seeking attitudes among Muslims from 16 Arab countries

BACKGROUND

Determining the potential barriers responsible for delaying access to care, and elucidating pathways to early intervention should be a priority, especially in Arab countries where mental health resources are limited. To the best of our knowledge, no previous studies have examined the relationship between religiosity, stigma and help-seeking in an Arab Muslim cultural background. Hence, we propose in the present study to test the moderating role of stigma toward mental illness in the relationship between religiosity and help-seeking attitudes among Muslim community people living in different Arab countries.

METHOD

The current survey is part of a large-scale multinational collaborative project (StIgma of Mental Problems in Arab CounTries [The IMPACT Project]). We carried-out a web-based cross-sectional, and multi-country study between June and November 2021. The final sample comprised 9782 Arab Muslim participants (mean age 29.67 ± 10.80 years, 77.1% females).

RESULTS

Bivariate analyses showed that less stigmatizing attitudes toward mental illness and higher religiosity levels were significantly associated with more favorable help-seeking attitudes. Moderation analyses revealed that the interaction religiosity by mental illness stigma was significantly associated with help-seeking attitudes (Beta = .005; p < .001); at low and moderate levels of stigma, higher religiosity was significantly associated with more favorable help-seeking attitudes.

CONCLUSION

Our findings preliminarily suggest that mental illness stigma is a modifiable individual factor that seems to strengthen the direct positive effect of religiosity on help-seeking attitudes. This provides potential insights on possible anti-stigma interventions that might help overcome reluctance to counseling in highly religious Arab Muslim communities.

Chinese college students' help-seeking behavior: An application of the modified theory of planned behavior

Chinese college students have a high incidence of psychological problems but rarely seek professional psychological help. Despite this fact, there have been few studies of the help-seeking behavior of Chinese college students with mental health problems. This research aims to use a modified model based on the theory of planned behavior (TPB) to explore the intentions and behaviors of Chinese college students with psychological problems in seeking professional psychological help. A total of 319 Chinese college students were recruited to measure attitude, stigma, coping efficiency, help-seeking intention, help-seeking behavior, and demographic variables. The results showed that attitudes were the most powerful predictor of intentions to seek help, followed by coping effectiveness and stigma. In addition, a multigroup analysis showed that the model was valid across genders. Our research results show that the TPB-based model can effectively explain the intentions and behaviors of college students with psychological problems in seeking professional help. Using our results, families, schools, and society could design intervention measures to enhance students' help-seeking intentions and behaviors.

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

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.

Palestinian Muslim College Students' Attitudes to Mental Health Treatment: A Comparative Study

This study examined the association between the degree of religiosity, combined with cultural beliefs, social stigmas, and attitudes towards mental-health treatment in two groups, who, despite having similar cultural and religious affiliation, have experienced different socio-political contexts: Palestinian Muslim college students living in the Occupied Palestinian Territory (OPT) and Israel. The study was guided by Tanhan and Young's (2021) conceptual framework. Methods: A snowball recruitment strategy was applied, using a cross-sectional survey. A total sample size was 214 students, 105 from the OPT and 109 from Israel. Results indicate that students from the OPT (n = 105) did not differ from those living in Israel (n = 109) on religiosity using the Islamic Belief scale, or Attitudes Towards Mental Health treatment (F(1, 189) = 1.07, p = 0.30). However, students from the OPT had higher confidence in mental-health professionals (M = 15.33) than their counterparts (M = 14.59), and women had higher confidence (M = 16.03) than men (M = 13.90). The reliance on traditions for Muslim students over Western mental-health approaches is a critical factor in predicting the attitudes towards students' mental problems and their chosen treatment. Sociopolitical context played a significant role in shaping attitudes toward mental-health providers.

Mental health outcomes and help-seeking behaviours among Egyptian medical students: A cross-sectional study

AIM

Approximately half of the population in Egypt is under the age of 25. Globally, mental illness represents the highest burden of disease in this age group. Yet in Egypt, there is still no youth-specific mental health system in place and the vast majority of young people do not have access to any professional mental health support. The objective of this study was to describe the mental health needs of Egyptian youth and the resources they use when seeking help.

METHODS

An online cross-sectional survey was distributed among medical students at Tanta University in Egypt. Of the 707 individuals who completed the survey (90.9% response rate), 60.5% were female, 62.0% lived in urban and suburban areas, and the mean age of the sample was 20.5 (±1.8) years old.

RESULTS

More than half (54%) of the students reported that they had been affected by mental health problems at some point in their lives. Anxiety and depression were the most common problems. Regarding help-seeking behaviours, participants mainly searched the web or spoke to peers and relatives; few reported approaching medical professionals. The majority of participants (59.7%) reported being disappointed with the current mental health care system in Egypt.

CONCLUSIONS

There is a high prevalence of mental challenges among Egyptian youth and the health care system is not adequately prepared to respond to their needs. E-Mental Health and online interventions seem to be a promising solution that could increase access to mental health services for Egyptian youth.

Suicidal ideation, suicide literacy and stigma, disclosure expectations and attitudes toward help-seeking among university students: The impact of schizotypal personality traits

BACKGROUND

Similarly to patients with schizophrenia, non-clinical individuals with schizotypal traits have been reported to show an increased risk for suicide-related outcomes. We aimed to assess suicidal ideation, and to determine factors that may have associations with help-seeking attitudes in high schizotypal individuals as compared to low schizotypal individuals.

METHOD

We carried out a cross-sectional survey. The Schizotypal Personality Questionnaire, the attitudes toward seeking professional psychological help scale-short form, the disclosure expectations scale, the scale of suicide ideation, the stigma of suicide scale-short form, the literacy of suicide scale, and the depression anxiety stress scales were administered to 504 college students. A total of 51 students were classified in the high-schizotypy group, and 50 were classified in the low-schizotypy group.

RESULTS

High-schizotypal students experienced significantly more suicidal ideation, had greater literacy of suicide, had more glorification of suicide, had higher anticipated risks of disclosure and more negative help-seeking attitudes than low-schizotypal students. After controlling for sociodemographic (age, gender, income and tobacco use) and psychosocial variables (personal psychiatric history, family history of suicide, personal history of suicide attempt[s]), depression and suicide ideation), disclosure expectations had both a significant negative independent effect through anticipated risks, and a positive independent effect through anticipated benefits, on high-schizotypal students' help-seeking attitudes.

CONCLUSION

The apprehension and reluctance to seek help found in high-schizotypal students highlight an urgent need to further understand barriers to help-seeking among at-risk adolescents, and what may motivate them to reach out for support when they are more at-risk for suicide.

Validation study of a wellbeing scale (SPANE) in the Arab Gulf region: A multicountry study

The Scale of Positive and Negative Experience (SPANE) is an emerging wellbeing scale to measure the frequency of positive and negative emotions. This study explores the psychometric properties of SPANE on a sample from the Arab Gulf region. The Arab Gulf region shares cultural elements with the broader Muslim and Arab world, but maintains distinct features that warrants validation studies for psychological instruments. There were 1393 participants from Saudi Arabia, Oman, Kuwait and other Arab Gulf countries. The factorial structure of SPANE was examined using a principal axis factor analysis, followed up with a confirmatory factor analysis. The convergent validity was examined by correlating SPANE with the Satisfaction with Life Scale (SWLS). The findings confirmed a two-factor structure of SPANE, and demonstrated adequate psychometric properties and convergent validity. In conclusion, this study indicates that SPANE shows sufficient validity for use as a measure of wellbeing in the Arab Gulf region.

The Impact of Child Abuse and Dissociation on Psychiatric Comorbidity and Self-Concealment Among Prisoners in China

Child abuse is a common experience among prisoners in China and associated with elevated psychiatric comorbidity. However, the association between child abuse profiles and dissociation is unclear. The extent to which the relationship between these profiles and dissociation might influence psychiatric comorbidity and self-concealment is also unclear. This study examined the impact of this relationship on the preceding outcomes among prisoners in China using Latent Class Analysis. Four hundred and ninety-six male prisoners from China completed questionnaires measuring child abuse, dissociation, self-concealment, and psychiatric comorbidity. A three-class solution was achieved: Class 1 (neglected with moderate dissociation) prisoners had a minimal level of abuse, the highest level of neglect experience, and a medium level of dissociation; Class 2 (low neglect with low dissociation) prisoners also had a minimal level of abuse but lower levels of neglect experience and dissociation; Class 3 (abused and neglected with high dissociation) prisoners had high levels of child abuse, neglect, and dissociation. Controlling for age, Class 3 reported significantly higher psychiatric comorbidity and self-concealment than the other two classes. Class 1 was more depressed than Class 2; Class 2 was more likely to engage in self-concealment than Class 1. To conclude, the kinds of childhood maltreatment experienced by prisoners and their readiness to detach from distressing emotions can influence the severity of current distress symptoms and the tendency to conceal things about themselves.

Psychotherapy in the Kurdistan region of Iraq (KRI): Preferences and expectations of the Kurdish host community, internally displaced- and Syrian refugee community

BACKGROUND AND AIM

The Kurdish Region of Iraq (KRI) is home to Kurds, internally displaced persons, and Syrian refugees. In the last decades, its inhabitants have witnessed a great deal of political instability, which has led to increased rates of psychological distress. Mental illness contrasts with limited access to and availability of mental health services - and so the treatment gap remains high. This study aims to investigate the perspectives, perceptions, and expectations of Syrian refugees, internally displaced persons and KRI host community members concerning mental health care in the governorate of Duhok. Attitudes and perspectives regarding psychotherapy, such as satisfaction with services, effects of therapy, bias toward therapy, and stigma, are explored.

METHODS

One hundred one participants were recruited from hospitals, clinical settings, and institutions from the governorate of Duhok in the KRI. Participants received the Patient Satisfaction Questionnaire (PSQ) and were asked to evaluate services through four subscales: patient satisfaction, effects of therapy, bias toward therapy, and stigma.

RESULTS

Results revealed overall high satisfaction with services and effects of therapy. In contrast, both bias and stigma subscales were rated more ambivalently.

CONCLUSION

Patient satisfaction is key for assessing health care quality, understanding attitudes toward therapy, and help-seeking behavior. Results offer insight for stakeholders in the psychosocial field allowing for a better understanding and improvement of availability and access to quality-driven mental health care services.

Knowledge, attitude and behaviours toward mental illness and help-seeking in a large nonclinical Tunisian student sample

BACKGROUND

Mental disorders are widespread among students. However, mental health help-seeking remains low. Several reviews and meta-analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help-seeking intentions and comfort with disclosing a mental illness.

METHOD

The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9).

RESULTS

We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help-seeking intentions (p < .001) and knowledge of mental illness (p = .019). Students' age negatively correlated with knowledge (p < .001, r = -.147). Pearson correlations indicated that help-seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p < .001, r = .103) and greater mental health knowledge (p < .001, r = .163); and that comfort with disclosing significantly and negatively correlated with attitudes (p < .001, r = -.125).

CONCLUSION

To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group.

Greater loss of face and family honor values are associated with greater positive expectancies and substance abuse among Middle Eastern/Northern African U.S. college students

BACKGROUND

Traditional cultural orientation is protective against substance use for Asian Americans and Latinos. However, little empirical research has examined traditional cultural values and substance use among Middle Eastern and North African (MENA) individuals. MENA cultures tend to emphasize maintaining family honor and personal social integrity, which may influence substance use cognitions and behavior.

OBJECTIVE

Test whether loss of face and family honor influenced risky alcohol/cannabis use via positive expectancies. We expected that greater loss of face and family honor values would predict lower positive expectancies and risky substance use.

METHODS

MENA college students (N = 246; 58.6% women) were recruited via Qualtrics Panels and completed an online survey. We tested path models, estimating direct and indirect effects of cultural predictors, adjusting for age, gender, generation status, marital status, and living situation. Substance use was modeled as risk categories (low- versus high-risk) and as count-type outcomes using zero-inflated models.

RESULTS

Greater family honor values predicted higher positive alcohol and cannabis expectancies (b = .24-.32, p < .001). Greater loss of face values also predicted more positive expectancies (b = .22-.24, p < .001). Mediation analysis generally indicated that cultural factors were indirectly associated with risky use via positive expectancies.

CONCLUSION

MENA college students' greater family honor and loss of face values are associated with greater alcohol and cannabis use, in part through positive expectancies. Cultural pressures may enhance the perceived benefits of alcohol and cannabis use. Substance use intervention programs should integrate MENA college students, and address family honor and loss of face as culturally-salient risk indices.

Fear of Evaluation and Online Self-Disclosure on WeChat: Moderating Effects of Protective Face Orientation

Fear of evaluation is a key factor that affects how social media users present themselves to others, but little is known about the effects and mechanisms involved, especially on the relationship between fear of positive evaluation and online self-disclosure. This study explores how fear of evaluation affects online self-disclosure and examines how this relationship is moderated by protective face orientation in the Chinese context. A total of 750 Chinese WeChat users constituted the sample for a questionnaire-based analysis and regression analysis. The results showed that both fear of positive evaluation and fear of negative evaluation had a significant negative effect on the amount of online self-disclosure and a significant positive effect on the depth of online self-disclosure. Protective face orientation had a moderating effect on the relationship between fear of evaluation and online self-disclosure for both the amount and depth of online self-disclosure. Our findings suggest that social network site (SNS) users' fear of evaluation can be attributed to their cognitive attitude toward the external environment, and the loss of face in the Chinese context can be included in the social context.

Distress disclosure and psychological Distress among men: the role of feeling understood and loneliness

We examined whether men’s distress disclosure would be indirectly associated with psychological distress through feeling understood by others and loneliness as serial or parallel mediators. We conducted path analyses (N = 1827 adult men; mean 37.53 years, SD = 14.14) to test the mediators while controlling for race/ethnicity. Post-hoc multi-group analysis was conducted to examine differences across White and Asian men. The serial mediation model fit the data better than the parallel mediation model. Controlling for race/ethnicity, a significant partial indirect association was found between greater distress disclosure and lower psychological distress through greater feelings of being understood and lower feelings of loneliness. Post-hoc multi-group analysis suggested that the hypothesized paths fit equivalently across White and Asian men, and the direct effect was not significant for Asian men. Our hypothesized serial model also fit the data significantly better than alternative models with distress and the mediators predicting disclosure. Distress disclosure may be a socially conducive strategy for men to feel understood and socially connected, a process that may be associated with lower psychological distress.

Positive psychology interventions in the United Arab Emirates: boosting wellbeing - and changing culture?

As the science of wellbeing has grown, universities have adopted the challenge of prioritizing the wellbeing of students. Positive psychology interventions (PPIs), activities designed to increase the frequency of positive emotions and experiences, which help to facilitate the use of actions and thoughts that lead to human flourishing, are being increasingly used worldwide. Known to boost wellbeing and a number of other variables, it nonetheless remains unknown whether their use can influence other variables in non-Western cultures. In this study, we determined the impact of PPIs on a variety of wellbeing outcomes. The 6-week PPI program was conducted in the United Arab Emirates on Emirati university students (n = 120) who reported more positive emotion and overall balance of feelings that favored positivity over time relative to a control group. Yet, there was no effect found on negative emotions, life satisfaction, perceived stress, fear of happiness, locus of control, or somatic symptoms, and no effect on levels of collectivism or individualism. Our findings nonetheless support the use of PPIs in higher education as they show an increase in the experience of positive emotion, with this in itself bringing positive life outcomes, and no negative impact on culture. Our findings serve to build a foundation for understanding for whom PPIs work best - and least - around the world.

Characterizing individuals accessing mental health services in the UAE: a focus on youth living in Dubai

Background

Most mental health issues develop during adolescence, therefore identifying youth mental health needs and pathways to care is critical to improve prevention. To date, studies have typically focused on Western samples, while the impact of cultural diversity on perception of health and illness, and pathways to care, remain poorly understood. To address the shortage of studies conducted in the Arab world, and particularly in the United Arab Emirates (UAE), the present investigation aims to identify the characteristics of youth accessing mental health services in Dubai.

Methods

Data was collected retrospectively from patients’ records at Rashid Hospital Child Psychiatry Service. Information collected included demographics, life stressors, symptoms duration, main diagnosis, and presence/absence of psychotic features in patients’ symptomatology. The relationship between demographic and clinical variables was explored using Chi-square tests and negative binomial regression models.

Results

The sample included 99 treatment-seeking young patients (mean age 15.3; SD = 1.7); 47.5 % were Emirati (UAE national) and 52.5 % were non-Emirati patients. In our treatment-seeking youth sample Depressive disorders represented the most frequent diagnosis, followed by Bipolar and related disorders, Anxiety and stress related disorders, and Schizophrenia and psychotic disorders. Compared to Emirati patients, non-Emirati patients were more likely to report relationships with friends as a source of stress. Female help-seekers, compared to males, were more likely to report stressful relationships with family members, and to receive a diagnosis of Depressive disorders. The duration of symptoms before seeking help was significantly predicted by family stress, gender, self-harm behavior, a symptomatology with psychotic features, and a diagnosis of Anxiety disorders.

Conclusions

The present study contributes to characterizing youth accessing mental health services at Rashid Hospital’s Child Psychiatry service in Dubai. An overall prevalence of poor family functioning among help-seeking youth, and the importance of peer support for expatriate youth were highlighted. Gender differences in perceived stressors, diagnoses and help-seeking behavior suggest the need to promote help-seeking among young boys. While presentation with psychotic features seems to lead to quicker access to medical care, self-harm and anxiety appear to delay help-seeking. The potential implications of our results for promoting youth wellbeing in the region are discussed.

Mental distress, perceived need, and barriers to receive professional mental health care among university students in Ethiopia

BACKGROUND

There is limited evidence on the extent of the perceived need and barriers to professional mental health service delivery to university students with mental distress in low- and middle-income countries (LMICs). This study was designed to assess the prevalence of mental distress, perceived need for professional mental health care and barriers to the delivery of services to affected undergraduate university students in Ethiopia.

METHODS

A multi-stage sampling technique was used to recruit 1135 undergraduate university students. Symptoms of mental distress were evaluated using the Self-Reported Questionnaire (SRQ-20) and a score of above seven was used to identify positive cases. The perceived need for professional mental health care was assessed using a single 'yes or no' response item and barriers to mental health care were assessed using Barriers to Access to Care Evaluation (BACE-30) tool. Percentage, frequency, mean, and standard deviation were employed to summarize demographic characteristics of the participants and to identify common barriers to mental health care service. Moreover, the association of demographic variables with total mean scores of BACE-III sub-scales was modeled using multiple linear regression.

RESULTS

The prevalence of mental distress symptoms was 34.6% and the perceived need for professional mental health care was 70.5% of those with mental distress. The top five barriers to receiving professional mental health service were (a) thinking the problem would get better with no intervention, (b) being unsure where to go to get professional help, (c) wanting to solve the problem without intervention, (d) denying a mental health problem existed, and (e) preferring to get alternative forms of mental care. Coming from a rural background, being a second and fourth-year student, and a family history of mental illness were significantly associated with barriers to receive professional mental health service.

CONCLUSION

The high prevalence of mental distress, the paucity of mental health care, and the report of barriers to access what professional mental health care there is among Ethiopian undergraduate students is a call to address the disparity.

Stigma, Loss of Face, and Help-Seeking Attitudes Among South Korean College Students

In this study, we investigated empirical associations between others’ stigma regarding seeking psychological help (predictor), self-stigma regarding seeking help (mediator), loss of face concerns (moderator), and professional help-seeking attitudes (outcome) among 485 South Korean college students. We also explored the dimensionality of close others’ stigma and public stigma using a bifactor analysis. We recruited participants from several universities in South Korea. They completed an online survey containing demographic questions and study measures. Bifactor analysis results indicated that close others’ stigma and public stigma may be better treated as a unidimensional construct (i.e., others’ stigma). Mediation and moderated mediation analyses indicated that others’ stigma predicted self-stigma, which in turn predicted help-seeking attitudes. Furthermore, this mediation model was moderated by loss of face, in that as loss of face increased, the negative indirect effect of others’ stigma on help-seeking attitudes through self-stigma became weaker. We discuss implications for research and practice.

Psychotherapy in Jordan: An Investigation of the Host and Syrian Refugee Community's Perspectives

Little is known about patient satisfaction, bias, stigma, and the effects of psychotherapy within the Kingdom of Jordan or the Arab world in general. The purpose of this study was to explore the perceptions of both the Jordanian host and refugee community members from the psychotherapeutic services offered at various mental health care settings in Jordan. A sample of 100 patients who received psychosocial expert interventions was recruited between October and December 2017 in Amman, Jordan. Participants were either from the host or Syrian refugee community or contacted through multiple organizations working in the mental health field. The Patient Satisfaction Questionnaire, which consists of four subscales covering 1) patient satisfaction, 2) bias toward therapy, 3) effects of therapy, and 4) stigma, was administered. As a means of investigation and exploration, descriptive statistics of participant responses are displayed. Results revealed overall high rates of satisfaction with provided services and perceived benefits of psychotherapeutic interventions. However, respondents showed ambivalence regarding bias and stigma. Subsample analyses indicated no significant differences between both communities. These findings give an understanding of perceptions surrounding psychotherapy in Jordan and some insights on therapeutic processes that may be useful for clinical applications and future research.

Self-Reported Likelihood of Seeking Social Worker Help Among Older Men in Israel

The current study assessed the association between demographic factors (age, relationship status, and education), psychosocial factors (self-rated health and self-reported loneliness), and factors related to attitudes and behaviors associated with seeking help (prior experience with social workers, attitudes towards social workers, and the stigma attached to seeking help from social workers, and the self-reported likelihood of seeking social workers' help among older men in Israel. The data were collected through structured questionnaires, administered to a sample of 256 older men. The findings indicated several avoidance factors which might discourage older men from seeking social worker help. Older men who are more educated, experience less loneliness, report lower self-rated health, have no prior experience with social workers, have less positive attitudes towards social workers and higher stigma attached to seeking social workers' help, are less likely to seek social workers' help. The research conclusion is that it is important to develop tools and interventions aimed at helping older men deal with such avoidance factors affecting their tendency to refrain from seeking social worker help, as well as to develop practices adapted to their unique needs.

Public stigma and attitudes toward psychological help-seeking in the United Arab Emirates: The mediational role of self-stigma

PURPOSE

Scholars argue that public stigma is predictive of self-stigma, and self-stigma is a primary predictor of attitudes toward seeking psychological help (ATPH). This assertion remains undetermined outside of the United States. This study examines a potential mediational model in which internalized stigma was hypothesized to mediate the relationship between public stigma and ATPH using a sample in the United Arab Emirates.

DESIGN AND METHODS

Cross-sectional, correlational design; 114 students completed measures of public stigma, self-stigma, and ATPH.

FINDINGS

Full mediation occurred. The sample exhibited high levels of both public stigma and self-stigma. Psychology students manifested diminished levels of stigma and more favorable ATPH. Results are discussed in relation to the prevalent cultural and contextual factors.

PRACTICE IMPLICATIONS

Stigma reduction campaigns in this locale should target internalized stigma and its associated socio-cultural nuances.

Focus Groups Investigating Mental Health Attitudes and Beliefs of Parents and Teachers in South Lebanon: Are They Culturally Determined?

Introduction: The wars that Lebanon had endured led to a devastating number of deaths, injuries, and displacements. Such tragedies have detrimentally affected its civilians psychologically. Purpose: To identify knowledge, attitudes, and practices of teachers and parents concerning child/adolescent mental health. Method: Using purposeful sampling, five focus groups were conducted with teachers and parents of students from elementary, middle, and secondary levels in two private hub schools in South Lebanon. Results: A total of 27 teachers and 18 parents participated separately in focus groups. Three themes emerged: (a) Mental health care is a priority for overall health, (b) Mental illness is a cultural taboo, and (c) There is a need for better education and cultural understanding about mental health. Discussion: This is the first study in Lebanon directly targeted at parents’ and teachers’ mental health concerns. Such findings will add to transcultural nursing knowledge about the importance of mental health care.

Stigma of Seeking Psychological Services: Examining College Students Across Ten Countries/Regions

Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. samples. The goal of this research was to provide a first step in understanding the relationship between public stigma, self-stigma, and attitudes toward seeking psychological services in international contexts ( N = 3,276; Australia, Brazil, Canada, Hong Kong, Portugal, Romania, Taiwan, Turkey, United Arab Emirates, and United States). Using structural equation modeling, we found that self-stigma mediated the relationship between public stigma and attitudes toward seeking services among college students in each country and region. However, differences in path strengths emphasize the need to pay attention to the role of public and self-stigma on attitudes toward seeking psychological services throughout the world.