Traditional healing for physical and mental problems in the Arab region: past and current practices.

Exploring traditional healing practices in the Arab world unveils a diverse range of methods deeply rooted in ancient beliefs. Traditional healing practices encompass natural remedies, spiritual rituals and physical treatments. These historical practices persist today, reflecting their enduring relevance in Arab culture and their influence on healthcare approaches. Factors such as accessibility to traditional healing services, a lack of affordable medical treatment, cultural familiarity and a strong belief in the efficacy of traditional healing methods in treating mental problems contribute to their continued use. However, potential challenges arise when an exclusive reliance on traditional methods might hinder access to critical medical interventions. Thus, the need for further documentation and research into these deeply ingrained healing traditions is emphasised. Some research has focused on integrating these traditional approaches with the modern medical system, recognising their combined value in healthcare. This balanced approach holds the potential to bridge the gap between culturally informed traditional practices and contemporary medical treatments.

Transforming psychology education to include global mental health.

In recent years, the reality of global migration has brought the lack of understanding of mental health needs across different cultures into sharp focus. Psychology programs are not up to date on global issues and are often experienced as inadequate in preparing graduates to meet the challenges of society today. The field of education and training in psychology has hardly evolved since the last two decades. On the other hand, the mental health needs arising locally and globally require a knowledge base and a set of skills future psychologists need to have in order to be able to work and grow professionally. In addition, most psychologists in the western world are bound, at some point in their career, to be in contact with immigrants or refugees to offer them services and be a source of support for such a vulnerable population. Also, the field of psychology is witnessing more movement among psychologists than ever before, whereby many professionals move to another country, to work, volunteer, gain or provide training, consult and much more. This requires a certain level of preparation, which psychologists need to be aware of and ready to engage in before and after they move. This article highlights different psychology programs around the world that include global mental health in their programs. It discusses essential aspects and skills that psychologists need to learn to be prepared to work globally with various populations and to expand their skills beyond service providing to more management and policy work. Topics such as human rights and social justice, advocacy, health management and policymaking are addressed as important competencies to be gained during the education and training of future psychologists.

Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study.

BACKGROUND: Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. METHOD: A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms. RESULTS: On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time. CONCLUSIONS: This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.

Case-controlled field study of the ICD-11 clinical descriptions and diagnostic requirements for Bodily Distress Disorders.

AIMS: Mental disorders characterized by preoccupation with distressing bodily symptoms and associated functional impairment have been a target of major reconceptualization in the ICD-11, in which a single category of Bodily Distress Disorder (BDD) with different levels of severity replaces most of the Somatoform Disorders in ICD-10. This study compared the accuracy of clinicians' diagnosis of disorders of somatic symptoms using either the ICD-11 or ICD-10 diagnostic guidelines in an online study. METHODS: Clinically active members of the World Health Organization's Global Clinical Practice Network (N = 1065) participating in English, Spanish, or Japanese were randomly assigned to apply ICD-11 or ICD-10 diagnostic guidelines to one of nine pairs of standardized case vignettes. The accuracy of the clinicians' diagnoses as well as their ratings of the guidelines' clinical utility were assessed. RESULTS: Overall, clinicians were more accurate using ICD-11 compared to ICD-10 for every presentation of a vignette characterized primarily by bodily symptoms associated with distress and impairment. Clinicians who made a diagnosis of BDD using ICD-11 were generally correct in applying the severity specifiers for the condition. LIMITATIONS: This sample may represent some self-selection bias and thus may not generalize to all clinicians. Additionally, diagnostic decisions with live patients may lead to different results. CONCLUSIONS: The ICD-11 diagnostic guidelines for BDD represent an improvement over those for Somatoform Disorders in ICD-10 in regard to clinicians' diagnostic accuracy and perceived clinical utility.

The impact of forced displacement: trauma, increased levels of inflammation and early presentation of diabetes in women Syrian refugees.

BACKGROUND: Forced displacement and war trauma cause high rates of post-traumatic stress, anxiety disorders and depression in refugee populations. We investigated the impact of forced displacement on mental health status, gender, presentation of type 2 diabetes (T2D) and associated inflammatory markers among Syrian refugees in Lebanon. METHODS: Mental health status was assessed using the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist-25 (HSCL-25). Additional metabolic and inflammatory markers were analyzed. RESULTS: Although symptomatic stress scores were observed in both men and women, women consistently displayed higher symptomatic anxiety/depression scores with the HSCL-25 (2.13 ± 0.58 versus 1.95 ± 0.63). With the HTQ, however, only women aged 35-55 years displayed symptomatic post-traumatic stress disorder (PTSD) scores (2.18 ± 0.43). Furthermore, a significantly higher prevalence of obesity, prediabetes and undiagnosed T2D were observed in women participants (23.43, 14.91 and 15.18%, respectively). Significantly high levels of the inflammatory marker serum amyloid A were observed in women (11.90 ± 11.27 versus 9.28 ± 6.93, P = 0.036). CONCLUSIONS: Symptomatic PTSD, anxiety/depression coupled with higher levels of inflammatory marker and T2D were found in refugee women aged between 35 and 55 years favoring the strong need for psychosocial therapeutic interventions in moderating stress-related immune dysfunction and development of diabetes in this subset of female Syrian refugees.

Mental Health of LGBTQ Individuals Who are Arab or of an Arab Descent: A Systematic Review.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at a higher risk of mental illness when compared to their heterosexual and cisgender counterparts. Most research emanates from Western countries, with a paucity of studies in the Arab world. We systematically reviewed studies assessing the mental health of LGBTQ individuals who live in the Arab world or are of Arab descent. Of 261 articles, seven were eligible for analysis. Depression was the most common psychiatric disorder. Suicidal ideations and attempts were frequent in trans women. Post-traumatic stress disorder was also common, with the majority of precipitating traumatic events being related to sexual orientation and/or gender identity. Societal and familial stressors in the Arab culture are major contributors to the increased vulnerability of the LGBTQ community to mental health challenges. Further research is of utmost need while taking into consideration the Arab socio-cultural context.

Complex post-traumatic stress disorder.

Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents. Studies recommend multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration, and treatment components that include self-regulatory strategies and trauma-focused interventions.

An international survey examining the impact of the COVID-19 pandemic on telehealth use among mental health professionals.

BACKGROUND: COVID-19 has profoundly affected the work of mental health professionals with many transitioning to telehealth to comply with public health measures. This large international study examined the impact of the pandemic on mental health clinicians' telehealth use. METHODS: This survey study was conducted with mental health professionals, primarily psychiatrists and psychologists, registered with WHO's Global Clinical Practice Network (GCPN). 1206 clinicians from 100 countries completed the telehealth section of the online survey in one of six languages between June 4 and July 7, 2020. Participants were asked about their use, training (i.e., aspects of telehealth addressed), perceptions, and concerns. OUTCOMES: Since the pandemic onset, 1092 (90.5%) clinicians reported to have started or increased their telehealth services. Telephone and videoconferencing were the most common modalities. 592 (49.1%) participants indicated that they had not received any training. Clinicians with no training or training that only addressed a single aspect of telehealth practice were more likely to perceive their services as somewhat ineffective than those with training that addressed two or more aspects. Most clinicians indicated positive perceptions of effectiveness and patient satisfaction. Quality of care compared to in-person services and technical issues were the most common concerns. Findings varied by WHO region, country income level, and profession. INTERPRETATION: Findings suggest a global practice change with providers perceiving telehealth as a viable option for mental health care. Increasing local training opportunities and efforts to address clinical and technological concerns is important for meeting ongoing demands.

Anxiety, depression and PTSD in children and adolescents following the Beirut port explosion.

BACKGROUND: On August 4, 2020, Beirut's port experienced one of the strongest non-nuclear explosions in history, killing approximately 200 people, displacing 300,000 persons, and injuring more than 1000 children. METHODS: An online anonymous survey assessed the prevalence of probable mental health disorders (MHDs) and impact of blast-related and other factors controlling for sociodemographics in 801 children aged 8 to 17 years old. RESULTS: About two thirds (64%) were screened positive for probable anxiety using the Screen for Childhood Anxiety Related Disorder, 52% for probable PTSD using CRIES-13, and 33% for probable depression using the Mood and Feelings Questionnaire (MFQ). Children who resided farthest way from the explosion site or were not in Beirut during blast had a significantly lower odds of anxiety and PTSD. Children who sustained any physical injury (vs. none) or witnessed casualties (vs. not) were at higher odds for PTSD. Children of parents who reported that their homes sustained minor damages (vs. no damages at all) were at higher odds for anxiety and PTSD, and temporary displacement (vs. none) increased odds of PTSD only. Poorer perceived economic status, poorer academic performance, having a family member injured in the blast, and prior mental health care seeking were associated with higher odds for all MHDs. CONCLUSION: Our study, the only one to document the mental health impact of the Beirut Port explosion on children, highlights the critical need for an emergency mental health response, prioritizing disadvantaged communities and children with prior mental health problems.

Validity of Categories Related to Gender Identity in ICD-11 and DSM-5 Among Transgender Individuals who Seek Gender-Affirming Medical Procedures.

BACKGROUND/OBJECTIVE: The most recent versions of the two main mental disorders classifications-the World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5-differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is explicitly not a mental disorder; neither distress nor dysfunction is a required feature. The objective was compared ICD-11 and DSM-5 diagnostic requirements in terms of their sensitivity, specificity, discriminability and ability to predict the use of gender-affirming medical procedures. METHOD: A total of 649 of transgender adults in six countries completed a retrospective structured interview. RESULTS: Using ROC analysis, sensitivity of the diagnostic requirements was equivalent for both systems, but ICD-11 showed greater specificity than DSM-5. Regression analyses indicated that history of hormones and/or surgery was predicted by variables that are an intrinsic aspect of GI/GD more than by distress and dysfunction. IRT analyses showed that the ICD-11 diagnostic formulation was more parsimonious and contained more information about caseness than the DSM-5 model. CONCLUSIONS: This study supports the ICD-11 position that GI/GD is not a mental disorder; additional diagnostic requirements of distress and/or dysfunction in DSM-5 reduce the predictive power of the diagnostic model.

ANTECEDENTES/OBJETIVO: Las versiones más recientes de las clasificaciones de trastornos mentales ­CIE-11 de la Organización Mundial de la Salud y DSM­5 de la Asociación Psiquiátrica Americana­ difieren en sus categorías diagnósticas relacionadas con la identidad transgénero. La discordancia de género (DiscG) de la CIE-11, en contraste con la disforia de género (DisfG) del DSM-5, no es considerada un trastorno mental; el distrés y la disfunción no son características requeridas para el diagnóstico. El objetivo fue comparar los requisitos diagnósticos de la CIE-11 y el DSM-5 en términos de sensibilidad, especificidad y capacidad para discriminar casos y predecir el uso de procedimientos médicos de afirmación de género. MÉTODO: 649 adultos transgénero de seis países completaron una entrevista estructurada retrospectiva. RESULTADOS: De acuerdo con el análisis ROC, la sensibilidad de ambos sistemas fue equivalente, aunque la CIE-11 mostró mayor especificidad que el DSM-5. Los análisis de regresión indicaron que la historia de uso de hormonas o cirugía se predijo por variables intrínsecas a la DiscG/DisfG y no por el distrés o disfunción. Según los análisis de respuesta al ítem (TRi) la formación CIE-11 resulta más parsimoniosa y contiene mayor información sobre los casos. CONCLUSIONES: Se aporta evidencia a favor de que la DiscG/DisfG no es un trastorno mental; los criterios diagnósticos adicionales de distrés y/o disfunción del DSM-5 reducen su poder predictivo.

A global field study of the international classification of diseases (ICD-11) mood disorders clinical descriptions and diagnostic guidelines.

BACKGROUND: We report results of an internet-based field study evaluating the diagnostic guidelines for ICD-11 mood disorders. Accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 guidelines to standardized case vignettes was assessed as well as perceived clinical utility. METHODS: 1357 clinician members of the World Health Organization's Global Clinical Practice Network completed the study in English, Spanish, Japanese or Russian. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of eleven pairs of case vignettes. RESULTS: Clinicians using the ICD-11 and ICD-10 guidelines achieved similar levels of accuracy in diagnosing mood disorders depicted in vignettes. Those using the ICD-11 were more accurate in identifying depressive episode in recurrent depressive disorder. There were no statistically significant differences detected across classifications in the accuracy of identifying dysthymic or cyclothymic disorder. Circumscribed problems with the proposed ICD-11 guidelines were identified including difficulties differentiating bipolar type I from bipolar type II disorder and applying revised severity ratings to depressive episodes. Clinical utility of ICD-11 bipolar disorders was found to be significantly lower than for ICD-10 equivalent categories. LIMITATIONS: Standardized case vignettes were manipulated to evaluate specific changes. The degree of accuracy of clinicians' diagnostic judgments may not reflect clinical decision-making with patients. CONCLUSIONS: Alignment of the ICD-11 with current research appears to have been achieved without sacrificing diagnostic accuracy or clinical utility though specific training may be necessary as ICD-11 is implemented worldwide. Areas in which the ICD-11 guidelines did not perform as intended resulted in further revisions.

Psychological science and COVID-19: An agenda for social action.

This report summarizes what is known about the psychological impact of the COVID-19 pandemic and proposes ways for psychology organizations to engage in addressing pandemic-related challenges. A stress and coping framework is used to describe key factors that account for mental health difficulties resulting from the stress of pandemics including the pandemic course, political leadership and public response, cumulative stressors, risk and protective factors, and coping strategies. Psychology organizations could do much to provide help particularly to vulnerable healthcare and frontline workers, the elderly, and the socially isolated. They could offer clinical services and design prevention programs, train non-professional community workers to provide mental health first aid, assist NGO's and political leaders, and translate basic research on psychological factors that influence acceptance of public health measures. The pandemic occurs at a time of advanced connectivity that provides an opportunity for (a) scientific information exchange, (b) alleviation of distress of social isolation, but also (c) infodemic, unprecedented spread of hoaxes and online incitements to non-compliance with preventative measures. Psychology's role is not limited to addressing mental health needs but also includes promoting adjustment to changes in the economy, education and employment, and developing effective communication strategies that encourage acceptance of public health measures. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The ICD-11 classification of gender incongruence of adolescence and adulthood: adequacy among transgender people in Lebanon.

The aim of this study was to evaluate the adequacy of the then proposed International Classification of Diseases version 11 (ICD-11) diagnostic guidelines for Gender Incongruence of Adolescence and Adulthood in a sample of transgender people accessing multi-disciplinary health care services at specialised organisations in Lebanon. The cross-sectional study reported here was part of the ICD-11 field test studies that took place in several countries. Twenty-eight Arab transgender adults residing in Lebanon were recruited after giving consent to participate in a structured interview with a mental health professional. The questions asked of them consisted of the following: socio-demographic data; medical history related to gender identity; experiences of gender incongruence; psychological distress; rejection; violence; and functional impairment. Results showed that Arab transgender individuals living in Lebanon report being the victims of violence, abuse, discrimination and rejection from family, peers and society in general. As a result, they develop psychological distress that is better explained by the social context in which they live, rather than by their transgender identity. Reformulating ICD-10 Transsexualism as Gender Incongruence of Adolescence and Adulthood in ICD-11 and moving this diagnosis out of the chapter on mental disorders chapter would be favourable to the Lebanese sample.

Diagnostic classification of irritability and oppositionality in youth: a global field study comparing ICD-11 with ICD-10 and DSM-5.

BACKGROUND: Severe irritability has become an important topic in child and adolescent mental health. Based on the available evidence and on public health considerations, WHO classified chronic irritability within oppositional defiant disorder (ODD) in ICD-11, a solution markedly different from DSM-5's (i.e. the new childhood mood diagnosis, disruptive mood dysregulation disorder [DMDD]) and from ICD-10's (i.e. ODD as one of several conduct disorders without attention to irritability). In this study, we tested the accuracy with which a global, multilingual, multidisciplinary sample of clinicians were able to use the ICD-11 classification of chronic irritability and oppositionality as compared to the ICD-10 and DSM-5 approaches. METHODS: Clinicians (N = 196) from 48 countries participated in an Internet-based field study in English, Spanish, or Japanese and were randomized to review and use one of the three diagnostic systems. Through experimental manipulation of validated clinical vignettes, we evaluated how well clinicians in each condition could identify chronic irritability versus nonirritable oppositionality, episodic bipolar disorder, dysthymic depression, and normative irritability. RESULTS: Compared to ICD-10 and DSM-5, ICD-11 led to more accurate identification of severe irritability and better differentiation from boundary presentations. Participants using DSM-5 largely failed to apply the DMDD diagnosis when it was appropriate, and they more often applied psychopathological diagnoses to developmentally normative irritability. CONCLUSIONS: The formulation of irritability and oppositionality put forth in ICD-11 shows evidence of clinical utility, supporting accurate diagnosis. Global mental health clinicians can readily identify ODD both with and without chronic irritability.

Psychological needs and response during the COVID-19 pandemic in Lebanon.

Lebanon was 1 of the countries to be affected early by the COVID-19 pandemic while in the midst of political upheaval. The stress implicated by this dual challenge allowed for mental health to take a center stage, prompting a nationwide official and informal response. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version.

INTRODUCTION: The World Health Organization's general assembly, in its last meeting of May 2019, has approved the suggested changes to the International Classification of Diseases manual, 11th version (ICD-11). Some of the proposed recommendations include the revision of "Disorders of Sexual Preference", now called Paraphilic Disorders, currently listed under the International Classification of Diseases-10 Mental and Behavioural Disorders. AIM: This article presents findings on the analysis of the existing laws and policies that are relevant to paraphilic disorders in Lebanon. METHODS: A literature review of all official and unofficial documents, reports, and articles published on laws and health policies relevant to paraphilic disorders in Lebanon was conducted, including a thorough review on Lebanese laws on that matter. Moreover, interviews with government representatives, including the Ministry of Public Health, the Ministry of Justice, the Ministry of Social Affairs, representatives of Non-Governmental Organizations working in child protection, and mental health professionals from the private and public sector, were conducted. MAIN OUTCOME MEASURE: Covered are (i) the health system in Lebanon including policies and laws related to mental health care provision and relevance to paraphilic disorders, (ii) the legal framework and the mental health evaluation and treatment in the Lebanese criminal justice system: the case of paraphilic disorders, (iii) adjudication of sex offenders in Lebanon, (iv) criminal responsibility relevant to paraphilic disorders, and (v) the relationship between legal and clinical issues for non-forensic health professionals. RESULTS: The treatment of paraphilic disorders would follow the treatment of all mental health conditions in Lebanon as no specific services for paraphilic disorders are available within these health-care systems. Legally, sexual crimes in Lebanon are not judged according to the individual's urges, fantasies, or state of mind, rather are assessed according to the acts committed by the individual. Therefore, an individual diagnosed with a paraphilic disorder is not culpable of any crime should he not act on this disorder by committing acts that fall under the scope of the penal code. An analysis of sexual acts that qualify as crimes reveals that the element of consent is rarely taken into consideration as most sexual crimes are defined as such with reference to violation of social norms, primarily "morals and public morality." Therefore, a change in the diagnostic classification of mental and behavioral disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) should not be a factor in their definition. Furthermore, in the course of enforcing criminal sanctions on individuals diagnosed with a mental disorder, the determining factor will be the individual's state of awareness at the time of the act. Psychiatric expertise initiated in that context lacks standardized criteria for diagnosis and is not bound by law to rely on international classifications; it is usually based on nonstructured interviews. Should it be assessed that the individual was fully aware of the consequences of his or her act, the paraphilic disorder diagnosis should not play any role in the sentencing. CLINICAL IMPLICATIONS: Clinicians in Lebanon can now be aware of the legal sanctions that patients with paraphilic disorders may fall under, should criminal acts be committed. Clinicians can also be familiar with the role of mental health disorders in the legal system, specifically with relevance to "awareness" at the time of the criminal act. Moreover, clinicians can freely use the updated diagnoses of paraphilic disorders in the ICD-11, as they form no legal detriments in Lebanon. STRENGTH & LIMITATIONS: The interviewing technique used in this study ensured that participants spoke about issues pertinent to their experience and expertise and helped achieve data saturation. Nonetheless, although this is a review, a quality and bias screening tool was not used because of the search mostly pertaining to legal laws and cases instead of research articles. furthermore, no software was used to analyze the qualitative data from the interviews. In addition, some of the documents reviewed were in Arabic, and therefore, some nuances, while translating the essential findings to English, might have been lost in translation. CONCLUSION: Compared with the ICD-10, the categories and definitions in ICD-11 should not create any additional obstacles nor offer any direct positive consideration, as the diagnostic classifications of mental disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) are not relevant to the definition of criminal sexual acts in Lebanon. Makhlouf Y, Kerbage H, Khauli N, et al. Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version. J Sex Med 2020;17:491-504.

Sexual health services in the Arab region: Availability, access, and utilisation.

Sexual health is shaped by cultural, economic, and social norms in society. In the Arab region, cultural sensitivities and taboos surrounding sexuality are prominent and may prevent individuals from accessing and utilising sexual health services. It is important to map out available sexual health services to identify the challenges in availability, access, and treatment, and determine opportunities for improvement. We collected data on sexual health services through (1) relevant published and unpublished literature, (2) Arab media which included forums, websites, blogs and posts, and online surveys conducted in the Arab region, (3) a questionnaire emailed to sexual and reproductive health experts, organisations, clinics, and non-governmental organisations (NGOs), (4) phone and in-person formal and informal interviews with sexual health experts in the field, and (5) advice and recommendations from sexual health experts attending a World Health Organization (WHO) consultation meeting in Dubai related to sexual health in the Arab region. Although there is significant progress when it comes to the availability and provision of sexual health services in Arab countries, there is still a lot to be done to ensure that appropriate needs are met. This study discusses the implication of findings to inform programme and policy implementation in the region.

Mental health research in the Arab region: challenges and call for action.

Although mental disorders are a leading cause of disability in the Arab region, which includes 5·54% of the global population, Arab countries produce only 1·0% of the global output of peer-reviewed publications in mental health research. Various stakeholders, including Arab mental health researchers, institutional and funding agency officials, and international research collaborators, convened to identify challenges faced by Arab mental health researchers and propose an evidence-informed call for action. Challenges identified include prevalent stigma and low awareness, conflict and war, scarce institutional and funding resources, inadequate publishing opportunities, insufficient training in mental health research, and shortage of reliable and valid assessment tools. The proposed action plan includes ways of addressing stigma and spreading awareness, increasing collaborative efforts, building research infrastructure, strengthening the mental health workforce, and translating research findings into a call to action on societal and governmental levels. The proposed action plan could provide a roadmap for Arab mental health researchers and research institutions, which might ultimately increase research productivity in the Arab region and close the gap between Arab countries and the rest of the world.

Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders.

Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.

Field Testing of ICD-11 Proposals for Female Sexual Dysfunctions in India: Cognitive Interviews with Patients.

BACKGROUND: Women's experiences of female sexual difficulties are shaped by cultural expectations. AIM OF THE STUDY: To investigate the cultural validity and clinical utility of the classification of female sexual dysfunctions (FSD) in the International Classification of Diseases - 11th Revision (ICD-11) among Indian Women. METHODS: A purposive sample of 22 married women with probable sexual problems underwent cognitive interviews that were conducted using a semi-structured guide. The interviews were transcribed and analyzed qualitatively to help establish the content and cultural validity of the ICD-11 classification of FSD. RESULTS: Most participants had limited knowledge of the sexual act, felt unskilled in sex, and were led by their husbands in sexual matters. Many participants reported problems related to sexual dysfunction and sexual pain-penetration. Many participants with sexual pain-penetration issues and some with low sexual desire considered these symptoms to be problematic; however, this was rarely the case with the absence or lack of sexual arousal and orgasm. The application of the 'independent focus of clinical attention' requirement for diagnosis reduced cases by half for Hypoactive Sexual Desire Disorder (HSDD) and almost eliminated all cases of Female Sexual Arousal Dysfunction (FSAD) and Anorgasmia. Hence, this requirement was moved from essential (required) features to 'additional features' of the final ICD-11 sexual dysfunction guidelines. CONCLUSION: Advancement toward a more precise nomenclature and classification system of FSD will facilitate better diagnosis which will ultimately lead to improved care for women with sexual dysfunction.