The Development and Implementation of a Custom-Tailored Suicide Response Training for Muslim Communities

Research indicates that the suicide attempt rate among American Muslims is at least twice the rate of the national US average and follows a different trend of suicide behavior compared to other groups. Religious leaders, such as Imams, are commonly sought out for support, but many lack training in mental health crisis management. The Stanford Muslim Mental Health and Islamic Psychology Lab created the Muslim Community Suicide Response Manual and its accompanying training modules to address this issue. This paper describes the creation, evolution, and future directions of the Suicide Response Training from an Islamic perspective to reduce suicide risk in Muslim communities.

An Exploratory Qualitative Analysis of the Stanford-Templeton Convenings on Islam and Suicide

For over 70 years, studies have reported lower rates of completed suicide in Muslim-majority countries and individuals who identify as Muslim. To this point, the mechanisms underlying the relationship between Islam and lower risk of suicide remain understudied. In an effort to advance our understanding, we convened a bilingual international interdisciplinary panel of experts for a discussion of the current state and future directions of the field. In this paper, we present an exploratory qualitative analysis of the core themes that emerged from the group interviews. We also derive a general theoretical model of the association between Islam and suicide risk.

The Development of a Novel Suicide Postvention Healing Model for Muslim Communities in the United States of America

Suicide among American Muslims is understudied, despite recent research  highlighting increased suicide attempts among this population. While suicide is forbidden in Islam, formal guidelines for addressing and responding to suicide within Muslim communities did not exist until recently. The Stanford Muslim Mental Health and Islamic Psychology Lab has responded to a number of suicides in Muslim communities across North America and implemented an original model for suicide response and community healing. This approach incorporates Islamic principles and values to create a culturally and religiously congruent response to suicide that can support loss survivors and steer impacted communities toward healing. The Muslim Postvention Community Healing session described in this paper aims to provide a safe space for individuals impacted by suicide to come together and process their emotions, while also using Islamic teachings to guide the healing process. This unique model has the potential to serve as a valuable resource for Muslim communities across North America, and beyond, in addressing and responding to suicide.

A Brief Overview of the Islamic Ethics of Suicide and Suicide-Related Contemporary Issues from a Sunnī Perspective: A Primer for Clinicians and Researchers

Suicide is a growing global health concern with complex socioeconomic implications. Understanding psychosocial resiliency factors may facilitate suicide prevention. Religious moral objections to suicide, including those inspired by the Islamic faith, appear to promote resilience to suicide. However, few English-language resources provide an overview of Islam's moral and ethical position on suicide, potentially hindering treatment of, and research on, suicide risk among Muslims. In the current paper, Islam's unanimous prohibition of suicide is explored and contextualized within the religion's foundational principles regarding the sanctity of life, the role and necessity of hardships, and one's responsibility to care for their body and to maintain their rights to their community. The role of harsh deterrents to suicide are contrasted with the impetus to show compassion to the deceased and the bereaved. Given the increasing focus on suicide-related topics such as euthanasia/ medical assistance in dying (MAID) and suicide contagion, Islam's ethical and legal position on suicide is discussed in the context of these contemporary moral issues.

Developing a Suicide Crisis Response Team in America: An Islamic Perspective

Suicide is a critical public health issue in the United States, recognized as the tenth leading cause of death across all age groups (Centers for Disease Control and Prevention, 2020). Despite the Islamic prohibition on suicide, suicidal ideation and suicide mortality persist among Muslim populations. Recent data suggest that U.S. Muslim adults are particularly vulnerable, with a higher attempt history compared to respondents from other faith traditions. While the underlying reasons for this vulnerability are unclear, it is evident that culturally and religiously congruent mental health services can be utilized to steer suicide prevention, intervention, and postvention in Muslim communities across the United States. However, the development of Suicide Response toolkits specific to Muslim populations is currently limited. As a result, Muslim communities lack a detailed framework to appropriately respond in the event of a suicide tragedy. This paper aims to fill this gap in the literature by providing structured guidelines for the formation of a Crisis Response Team (CRT) through an Islamic lens. The CRT comprises of a group of individuals who are strategically positioned to respond to a suicide tragedy. Ideally, the team will include religious leaders, mental health professionals, healthcare providers, social workers, and community leaders. The proposed guidelines are designed to be culturally and religiously congruent and take into account the unique cultural and religious factors that influence Muslim communities' responses to suicide. By equipping key personnel in Muslim communities with the resources to intervene in an emergent situation, provide support to those affected, and mobilize community members to assist in prevention efforts, this model can help save lives and prevent future suicide tragedies in Muslim communities across the United States.

Ethnic Differences in Muslim Women's Mental Health Beliefs, Rejection Attitudes, and Familiarity with Professional Mental Healthcare

Prior work on Muslims' mental health help-seeking factors has emphasized their rejection attitudes, religious and cultural beliefs, and familiarity with mental health (Aloud & Rathur, 2009; Ali et al., 2021). However, no research has examined differences in these factors across different Muslim ethnic groups, and particularly among Muslim women. 1214 Muslim women living in the USA completed online questionnaires. Data was stratified based on history of mental health visits to control for previous service utilization. MANOVAs assessed ethnic group differences in beliefs, familiarity, and rejection attitudes toward professional mental healthcare. Results revealed significant differences between ethnic groups in all three factors; these differences depended on the women's history of service utilization. Findings suggest that barriers to accessing professional mental healthcare differ among Muslim ethnic groups. Results are discussed in light of clinical implications and other contributing factors to the underutilization of professional mental healthcare among ethnically diverse American Muslim women.

Suicidality in the Arab World: Results from an Online Screener

Suicide in the Arab World is grossly understudied. This study sought to understand suicidality among Arabic-speaking individuals visiting an online depression screener. A large sample (N = 23,201) from the Arab World was recruited online. 78.9% (n = 17,042) reported suicidality (thoughts of death or suicide, or a suicide attempt) and 12.4% reported a suicide attempt in the past 2 weeks. Binary logistic regressions indicated that women tended to report more suicidality, and that suicidality tended to decline with age (all ps < 0.001), across all levels of suicidality. Comparing countries with n ≥ 1000 (Algeria, Egypt, Jordan, Morocco, and Saudi Arabia), several 3-way (gender * age * country) and 2-way interactions indicated that some countries departed from the usual pattern of responses. For instance, in Algeria, neither gender nor age differences were observed in reported attempts. Women and younger adults in the Arab World may be at higher risk of suicidality. Differences between and within countries warrant further exploration.

Predictors of depression among Syrian refugee women: A socio-culturally relevant analysis

OBJECTIVES

Syrian refugee women have faced myriad adversities as they have navigated the realities of war, increasing the risk for mental health concerns such as depressive symptomatology. This study explores the nuances of relevant sociocultural factors that can contribute to depressive symptomatology among widowed Syrian refugee women who live in an institutionalized care setting. We explored the impact of past trauma exposure, perceived independence, and a desire to leave the current place of displacement and the interplay between them.

METHODS

The PCRF Traumatic Events Questionnaire and Patient Health Questionnaire (PHQ-9) were administered to 57 Syrian refugee women in Lebanon (Mage = 37; M number of children = 3) to measure levels of trauma exposure and depressive symptoms, respectively. Perceived independence and a desire to leave their current place of residence were measured using 1-item measures.

RESULTS

Using hierarchical regression models, past trauma exposure (B = 1.51, p = .002) and perceived independence (B = 0.33, p = .04) significantly predicted depressive symptoms. A desire to travel (B = 0.84, p = .07) marginally predicted depressive symptoms. Past trauma exposure attenuated the impact of perceived independence on depressive symptoms such that at lower levels of past trauma exposure, higher perceptions of independence predicted higher depression (simple slope = 0.29, t = 2.13, p = .05), while at higher levels of past trauma higher perceptions of independence predicted lower depressive symptoms (simple slope = -0.16, t = -2.21, p = .04). Trauma exposure did not moderate the impact of a desire to leave on depression, but age did.

CONCLUSION

These findings suggest that sociocultural factors may influence women's experiences with depressive symptoms differently, and this heterogeneity must be accounted for when treatment programs are proposed. Further, Syrian refugee women who have lost primary family members may pose different profiles of depressive symptoms than other groups of women.

Islamic Civilizations and Plagues: The Role of Religion, Faith and Psychology During Pandemics

The current study seeks to analyze Muslim experiences of communicative diseases with a focus on the psychosocial impacts and public, communal, and personal responses of Muslim populations throughout history. By examining a selection of plague outbreaks between the 8-19th centuries across the lands broadly defined as the Islamic Mediterranean (Varlık, 2017), the guidelines and coping mechanisms that Muslims extracted from their traditional sources are highlighted. This historical perspective contributes to a better understanding of the psychological and social aspects of pandemics for the Muslim community, specifically for the role played by faith and spirituality as determinants of psychological well-being in Muslims' perceptions and responses. We suggest that such an understanding is especially useful for contemporary mental health practitioners working with Muslim patients through the global COVID-19 pandemic.

Addressing Mental Health Through Community Partnerships in a Muslim Community

The mental health of American Muslims remains significantly understudied and unaddressed, despite known obstacles to Muslims' utilization of mental health services, such as stigma and institutional mistrust. Since the inception of the Stanford Muslim Mental Health and Islamic Psychology Lab in 2014, partnerships across the Bay Area were formed among key Muslim community establishments to address obstacles to good mental health. Through a community-centered approach, diverse stakeholders engaged to identify and address the community's most pressing mental health challenges. Successful outcomes of this approach include facilitated research and mental health initiatives to support the Bay Area Muslim community.

Role of Mosque Communities in Supporting Muslims with Mental Illness: Results of CBPR-oriented Focus Groups in the Bay Area, California

Objective The purpose of this study was to explore perspectives of Muslims residing in the Bay Area, California on the role of the mosque community in supporting community members' mental health needs and barriers to mental health care for members who experience mental health challenges. Methods This study employed a CBPR-focused qualitative approach in the form of content analysis of three focus group discussions organized and conducted with the help of a Community Advisory Board made up of members of the Muslim Community Association. Results Two major themes were identified upon examination of the data: services needed in the mosque community and barriers to addressing mental health issues in the mosque community. Specifically, participants reported wanting support groups within the mosque space, mosque-based activities, virtual support, community social workers, and family-oriented services. Barriers reported included community stigma, lack of cultural awareness of race-ethnic minorities within the community, attribution of mental illness to lack of faith or supernatural causes, and specific barriers unique to vulnerable/special subgroups within the community. Conclusion These findings highlight the need for developing mental health-related services and social support initiatives within the mosque space, specifically for those Muslim Americans living in the Bay Area in California. Furthermore, special attention needs to be placed on the barriers to accessing these services as identified by the community members.

Predicting rejection attitudes toward utilizing formal mental health services in Muslim women in the US: Results from the Muslims' perceptions and attitudes to mental health study

BACKGROUND

The underutilization of mental health services is a recognized problem for the growing number of Muslims living in the West. Despite their unique mental health risk factors and the pivotal role they play in determining mental health discourse in their families and in society, Muslim women in particular have not received sufficient study.

AIM

To help remedy this research gap, we examined factors that may impact the rejection attitudes of Muslim women toward professional mental health care using the first psychometrically validated scale of its kind; the M-PAMH (Muslims' Perceptions and Attitudes to Mental Health).

METHODS

A total of 1,222 Muslim women responded to questions about their cultural and religious beliefs about mental health, stigma associated with mental health, and familiarity with formal mental health services in an anonymous online survey.

RESULTS

Hierarchical multiple regression analysis revealed that higher religious and cultural beliefs, higher societal stigma, and lower familiarity with professional mental health services were associated with greater rejection attitudes toward professional mental healthcare. The final model was statistically significant, F (5, 1,216) = 73.778; p < .001, and explained 23% of the variance in rejection attitudes with stigma accounting for the most (12.3%) variance, followed by cultural and religious mental health beliefs (6%), and familiarity with mental health services (2.7%).

CONCLUSIONS

Findings suggest that although the examined factors contributed significantly to the model, they may not be sufficient in the explanation of Muslim women's rejection attitudes toward mental health services. Future research may explore additional variables, as well as predictive profiles for Muslim women's perceptions and attitudes of mental health based on a combination of these factors.

Improving Recruitment for Mental Health Research in Muslim American Women : Research Recruitment in Muslim American Women

This study determines the methods for improving recruitment of Muslim American women in mental health research. Studying this minority population in more depth will reduce their suffering from mental illness. A 40-item survey, along with cover letter, was hosted on the Stanford University website and sent via email to organizations known to have large Muslim American women populations. Although approximately 200-300 responses were hoped for, an unexpected total of 1279 women completed the survey within days. The effectiveness of this survey was attributed to multiple factors: ease of an online survey, privacy afforded through an anonymous survey, trust in the PI, the survey being hosted by a reputable university and understanding the importance of mental health research. It is important to continue improving methods to recruit the minority Muslim American women population for studies.

Suicide Attempts of Muslims Compared With Other Religious Groups in the US

This study compares the prevalence of suicide attempts among Muslims compared with other faith communities in the US.

Common and Country-Specific Characteristics Associated With Suicidality in the Arab Region

OBJECTIVE

To explore the prevalence of recent (previous 2 weeks) suicide attempts and estimates of likelihood of future suicide attempts as well as demographic characteristics associated with such attempts among residents of the Arab region looking for depression information online.

METHODS

Google Ads were used to recruit 1,003 Arabic-speaking adults mostly from February 2014 to June 2014 to take part in a depression and suicidality screening study using a self-report questionnaire based on DSM-IV diagnostic criteria.

RESULTS

Of the eligible participants (N = 900), 10.6% reported a suicide attempt in the previous 2 weeks, and 16.1% indicated a likelihood of making a suicide attempt in the following month. Men, those declining to state their sexual orientation, those from lower subjective social status (SSS), and unemployed individuals had higher odds of reporting a past suicide attempt (P = .001, P = .002, P < .001, P = .023, respectively). Younger individuals, those less religious, those with past suicide attempt, and those with lower SSS had higher odds of a likelihood of a future suicide attempt (P = .03, P = .02, P < .001, P = .001, respectively). Comparing the 4 countries with highest number of participants (Algeria, n = 148, Egypt, n = 260, Morocco, n = 118, and Saudi Arabia, n = 99), lower SSS was associated with higher odds of an attempt for Algeria, Morocco, and Saudi Arabia, but not for Egypt (P = .002). Lower religiosity was related to higher odds of estimates of future suicide for Algeria, Egypt, and Saudi Arabia, but not for Morocco (P = .014).

CONCLUSIONS

Suicidality among residents of Arab-speaking countries warrants further exploration. Common predictors of risk may be less relevant for some populations.​.

Facilitating mental health screening of war-torn populations using mobile applications

BACKGROUND

War-torn populations are often hard to screen for mental health disorders. Classical data collection approaches, such as paper-based, online, or SMS-operated, are either infeasible or lack accuracy due to a variety of challenges associated with dynamics and consequences of war.

METHODS

In this paper, we introduce a novel approach for accurate and fast screening using free open-source software, Open Data Kit (ODK) mobile application. This approach was developed by the Palestine Children's Relief Fund (PCRF) to assess the mental health symptoms of 986 Palestinian children (age 6-18) in the aftermath of Israel's Operation Protective Edge (OPE) in 2014. The organization developed assessment questionnaires and trained local field workers on the use of the mobile application, and on recruiting and interviewing war victims.

RESULTS

War-affected children were found to suffer from several alarming symptoms associated with post-traumatic stress disorder (PTSD), depression, and somatic symptoms. Children with highest number of psychological symptoms were referred for further evaluation and treatment.

CONCLUSIONS

The use of ODK mobile technologies facilitated efficient screening of affected children in war zones. The offline data collection capability was crucial for handling the difficult conditions associated with war-torn areas, enabling timely intervention for urgent cases. Further applications of the novel mobile technology are to be explored.

A Process-Oriented Approach to Teaching Religion and Spirituality in Psychiatry Residency Training

OBJECTIVES

Although the importance of addressing issues of spirituality and religion is increasingly acknowledged within psychiatry training, many questions remain about how to best teach relevant knowledge, skills, and attitudes. Current literature on curricula highlights the importance of maintaining a clinical focus and the balance between didactic content and process issues. The authors present findings from a program evaluation study of a course on religion, spirituality, and psychiatry that deliberately takes a primarily process-oriented, clinically focused approach.

METHODS

Two six-session courses were offered. The first course targeted fourth-year psychiatry residents and the second targeted third-year psychiatry residents. Teaching sessions consisted of brief didactics combined with extensive process-oriented discussion. A two-person faculty team facilitated the courses. Clinical case discussions were integrated throughout the curriculum. A panel of chaplains was invited to participate in one session of each course to discuss the interface between spiritual counsel and psychiatry. A modified version of the Course Impact Questionnaire, a 20-item Likert scale utilized in previous studies of spirituality curricula in psychiatry, assessed residents' personal spiritual attitudes, competency, change in professional practice, and change in professional attitudes before and after the course (N = 20). Qualitative feedback was also elicited through written comments.

RESULTS

The results from this study showed a statistically significant difference between the pre- and post-test scale for residents' self-perceived competency and change in professional practice.

CONCLUSION

The findings suggest improvement in competency and professional practice scores in residents who participated in this course. This points toward the overall usefulness of the course and suggests that a process-oriented approach may be effective for discussing religion and spirituality in psychiatric training.

Obsessional Disorders in al-Balkhi's 9th century treatise: Sustenance of the Body and Soul

Some argue that the earliest case of Obsessive-Compulsive Disorder (OCD) was reported by Robert Burton in his compendium The Anatomy of Melancholy (1621) and that only in the 19th century did modern concepts of OCD evolve, differentiating it from other types of mental illness. In this paper, we aim to reveal an even earlier presentation of the malady we now call OCD based on the 9th century work, Sustenance of the Body and Soul, written by Abu Zayd al-Balkhi during the Islamic Golden Era. Discovery of this manuscript reveals that Abu Zayd al-Balkhi should be credited with differentiating OCD from other forms of mental illnesses nearly a millennium earlier than is currently claimed by anthologies documenting the history of mental illness. Particular attention is paid to al-Balkhi's classifications, symptom descriptions, predisposing factors, and the treatment modalities for obsessional disorders. Analysis of this manuscript in light of the DSM-5 and modern scientific discoveries reveals transcultural diagnostic consistency of OCD across many centuries. Theoretical and clinical implications of these findings are also discussed.

Functional assessment following intrathecal baclofen therapy in children with spastic cerebral palsy

The purpose of this article is to describe outcomes of intrathecal baclofen therapy for 29 patients with cerebral palsy, focusing on impairments, functional limitations, and disability. Patients received individualized rehabilitation and were followed up to 24 months. The primary outcome measures were the Ashworth Scale and the functional skills and caregiver assistance scales of the Pediatric Evaluation of Disability Inventory (PEDI). Ashworth Scale scores were significantly reduced (P < or = .0005). All areas of functional skills and caregiver assistance improved. Comparing groups of adults and patients less than 18 years, there were no significant differences, but there was a relationship between age and dose. Comparing groups of patients in high and low levels of independent functional mobility, no significant differences were found. These results provide suggestive evidence that the combination of intrathecal baclofen therapy and rehabilitation has positive effects across the dimensions of disablement. This study serves as a basis for high-level scientific studies of these effects.