Social cognitive elements of mental illness stigma among healthcare professionals currently working in general hospitals: A cross-sectional study from Jordan.

AIM: To assess the social cognitive elements of the stigma of mental illness (knowledge, attitudes and behaviours) among healthcare professionals (HCPs) in Jordan. DESIGN: A cross-sectional descriptive design. METHODS: A total of 206 HCPs were conveniently recruited from general hospitals in Jordan. The mental attitude, knowledge and intended behaviours scales were used to measure stigma elements. RESULTS: Participants reported a moderate level of knowledge, a moderate negative attitude and a moderate or not greater interest to deal with people with mental health illnesses. The bivariate correlation revealed a negative significant correlation between HCPs' knowledge and attitude, indicating that HCPs with more knowledge significantly have more positive attitude (lower average score) towards those suffering from the illness. A more significant correlation was found between HCPs' knowledge and behaviour. The HCPs who had more knowledge were holding more interest and willingness towards dealing with persons with mental illness. PATIENT OR PUBLIC CONTRIBUTION: Negative attitudes among HCPs demand awareness programmes pertaining to the stigma of mental illness to afford higher standards of practice for patients with mental problems.

Determinants of breastfeeding attitudes of mothers in Jordan: A cross-sectional study.

Breastfeeding provides the optimal nutrition for an infant. However, breastfeeding practice is on decline globally. Attitude toward breastfeeding may determine the practice. This study aimed to examine postnatal mothers' attitude to breastfeeding and its determinants. A cross-sectional study was conducted, and data on attitude were collected using the Iowa Infant Feeding Attitude Scale (IIFAS). A convenience sample of 301 postnatal women were recruited from a major referral hospital in Jordan. Data on sociodemographic characteristics, pregnancy and delivery outcomes were collected. SPSS was used to analyze the data and identify the determinants of attitudes to breastfeeding. The mean total attitude score for participants was 65.0 ±7.15, which is close to the upper limit of the neutral attitude range. Factors associated with attitude that is positive to breastfeeding were high income (p = 0.048), pregnancy complications (p = 0.049), delivery complications (p = 0.008), prematurity (p = 0.042), intention to breastfeed (p = 0.002) and willingness to breastfeed (p = 0.005). With binary logistic regression modelling, determinants of attitude positive to breastfeeding were highest income level and willingness to breastfeed exclusively (OR = 14.77, 95%CI = 2.25-99.64 and OR = 3.41, 95%CI = 1.35-8.63 respectively). We conclude that mothers in Jordan have neutral attitude to breastfeeding. Breastfeeding promotion programs and initiatives should target low-income mothers and the general population. Policymakers and health care professionals can use the results of this study to encourage breastfeeding and improve breastfeeding rate in Jordan.

Assessment and Evaluation of Psychological Status of Undergraduate College Students during COVID-19 Pandemic: A Cross-Sectional Study in the United Arab Emirates.

The COVID-19 pandemic caused by the novel coronavirus instigated a worldwide lockdown that affected students mitigating various psychological issues including depression, stress, and anxiety. This study aimed to assess the impact of COVID-19 pandemic on undergraduate university students' psychological status in terms of depression, anxiety, and stress. A total of 206 students from the Higher College of Technology (HCT), Sharjah Campuses participated in this descriptive cross-sectional study. Data were collected between March and May 2021. Participants completed an online survey including a demographic data questionnaire and the depression, anxiety, stress scale (DASS-21). The mean depression, stress, and anxiety scores were 15.56 (±11.573), 17.13 (±10.946), and 14.90 (±10.523) respectively. Categorically, most students (33.3%) reported no depression, while 26.1% of students reported moderate depression. For stress, the majority (44.4%) experienced no stress, while 19.8% reported moderate stress. Strikingly, 36.7% of students reported extreme severe anxiety, with 28% reporting no anxiety. Students with history of depression, stress, and anxiety symptoms reported a statistically significant mean difference in depression, stress, and anxiety compared with those with no previous history of those symptoms. We conclude with a recommendation to expand mental health screening among undergraduate university students and design appropriate therapeutic modalities.

Beliefs and Attitudes of Health Care Professionals Toward Mental Health Services Users' Rights: A Cross-Sectional Study from the United Arab Emirates.

Purpose: The beliefs and attitudes of healthcare professionals (HCPs) towards service user's rights in mental healthcare are critical to understanding as it impacts the quality of care and treatment, leading to social discrimination and possible coercive professional practices. This study aimed to investigate the association between the HCPs' beliefs and attitudes towards service users' rights in seeking treatment in the UAE and to identify or may predict the stigmatized attitudes and behaviors among HCPs. Patients and Methods: Data was collected from HCPs participants working at three healthcare entities (n=307) allocated at selected primary and tertiary healthcare settings that specifically treat mental disorders. The Health Professionals Beliefs and Attitudes towards Mental Health Users' Rights Scale (BAMHS) questionnaire was used to assess the beliefs and attitudes. Unconditional associations using regression models included whether HCPs provide care to specific mental health patients, whether treating mental health patients is part of their jobs, whether HCPs receive professional training for mental healthcare, nationality of HCPs, and the number of years of professional experience. Results: Our findings demonstrate that HPCs understand mental disorders and feel that individuals' rights should be equal to those who do not have mental disorders while believing in autonomy and freedom, but there is a level of discrimination and a high level of social distance. HCPs are less tolerant when interacting with those with mental disorders outside their professional lives. Conclusion: Interventions with long-term follow-up activities must be implemented and assessed using assessment systems that measure acquired knowledge and actual behavioral change to ensure anti-stigma impact in practice and policy.

Mental health, learning behaviour and perceived fatigue among university students during the COVID-19 outbreak: a cross-sectional multicentric study in the UAE.

BACKGROUND: The rapid shift to online education due to COVID-19 quarantine challenged students' ability to accept pure online learning without negative consequences for their physical, emotional and mental health. Some educational institutions introduced new strategies to reduce the psychosocial burden associated with online learning during home confinement. Thus, the primary aims were to determine the consequences of COVID-19 for the psychological well-being and fatigue levels of higher education students and to explore the effects of a new academic assessment approach in reducing home confinement stress. METHOD: A cross-sectional online survey was conducted among students, from 30 August to 30 September 2020, of 7 disciplines in all 16 higher colleges of technology in the United Arab Emirates (UAE). The Mental Well-being and Learning Behaviours Scale and the modified Copenhagen Burnout Inventory were used to evaluate students' psychological well-being and fatigue levels. A Welch t-test and Welch ANOVA were performed to determine the differences in perceived psychological well-being associated with students' characteristics. Second, Kruskal_Wallis and Mann_Whitney were performed to determine the differences in fatigue level based on students' characteristics. RESULTS: One thousand four hundred students participated. The majority were female (78.5%) and aged from 21-25 years (58.1%). Around 14% of respondents were married with children. Nearly 40% were satisfied with the new assessment approach introduced during the COVID pandemic and 45.5% perceived it as having reduced their home confinement stress. The mean psychological distress score of 3.00 (SD ± 0.71) indicates a moderate impact of COVID-19 on psychological well-being. Students' psychological distress was positively correlated with fatigue level (0.256, p < 0.001) and negatively correlated with the perceived impact of the new assessment approach on student lifestyle (- 0.133, p < 0.001), physical health (- 0.149, p < 0.001) and coping with stress (- 0.125, p < 0.001). Male students experienced significantly lower fatigue and better psychological well-being than female students. CONCLUSION: The study reveals that new assessment approaches which emerged during home confinement reduced students' perception of stress and of impaired lifestyle. However, students still had a considerable burden of psychological distress, requiring further preventive measures to maintain their psychological well-being during future outbreak events. Educational institutions should consider additional strategies to improve students' preparedness for online teaching, which could help maintain their psychological well-being.

Assessment of the Awareness, Perception, Attitudes, and Preparedness of Health-care Professionals Potentially Exposed to COVID-19 in the United Arab Emirates.

BACKGROUND: Since COVID-19 surfaced in December 2019, health-care organizations across the globe have struggled to maintain the safety and well-being of health-care professionals (HCPs). PURPOSE: This study investigates the HCPs' general understanding of the health risks of COVID-19 and to what extent they are equipped with the knowledge to protect themselves and others against this contagion. METHODS: This cross-sectional study used a web-based structured questionnaire posted on the UAE government electronic survey portal. A collection of 941 HCPs from diverse general and specialty hospitals in the UAE responded to an electronic participation invite. RESULTS: Our analysis showed that the majority of HCPs (97.6%) had updated information about COVID-19 modes of transmission, risks of contamination, high-risk groups, and the potential consequences of testing positive. Furthermore, the results of the chi-squared testing revealed that the HCPs' confidence and vigilance of the COVID-19 threats were significantly increased (p< 0.01) by being experienced, having had infection control training, or/and having undergone COVID-19 education. CONCLUSION: We conclude that HCPs have an evidence-based understanding of the ways their own health is at risk while they are performing their duties in hospital setups. Further, the study found that HCPs who undergo special infection control training and who are kept posted on the official updates on COVID-19 are more likely to remain vigilant at all times to minimize the risks to themselves and their patients. Although the generalizability of the study findings should be considered with caution, the results could be generalizable to health-care professionals who received similar COVID-19 related training in the UAE or other regional countries.

Assessment of Mental Health Stigma Components of Mental Health Knowledge, Attitudes and Behaviors Among Jordanian Healthcare Providers.

Health care providers (HCPs)' stigma perception can determine their behaviors and attitudes toward providing mental health services. This study aimed to assess stigma components of knowledge, attitude, and behavior among HCPs in Jordan. A cross sectional descriptive study using a convenience sample of 541 HCPs utilized. The Mental Health Knowledge Schedule (MAKS), the Mental Illness: Clinicians' Attitudes Scale (MICA) and the Reported and Intended Behavior Scale (RIBS) were used to evaluate HCPs' perceived stigma. Mean scores on RIBS were lowest and at mid-point for MAKS and MICA. Results revealed significantly that HCPs perceived stigma demonstrated in greater negative attitudes correlated with less knowledge (r = .18, .17; p = .01, .009) for both physicians and nurses. And between attitudes and reported intended behavior (r = .13, p = .025) among nurses. This make them less likely to deal with mental health problems in primary healthcare centers. The reported stigma in this context is possibly due to lack of training, inadequate experience, and cultural dynamics. Indeed, awareness programs are important to prepare those HCPs to provide mental health care in these settings shall they are asked to.

Psychosocial Burden and Stigma Perception of Jordanian Patients With Epilepsy.

Epilepsy requires long-term treatment that interferes with individuals' social relationships. Because the effects of psychosocial burden and stigma perception on patients with epilepsy in Jordan have not been explored, the study assessed the relationship among psychosocial burden, stigma of epilepsy, and demographic variables. Subjects were adult patients with epilepsy ( N = 200) registered at hospital clinics. Two published instruments were used to measure outcomes. The participants in the study perceived the burden and stigma of epilepsy as moderate. A strong, positive correlation between psychosocial burden and stigma perception among participants was found. Stigma perception, employment, and education variables explained 31.6% of variation of the level of psychosocial burden. The results showed a relationship between stigma perception and psychosocial level, and this provides information that may assist health care providers in formulating strategic plans to improve the care, safety, and quality of life of patients with epilepsy in Jordan.

Depression, anxiety, and stress among college students in Jordan and their need for mental health services.

INTRODUCTION: Psychological distress (in the form of depression, anxiety, and stress) among college students is prevalent and increasing. In most instances, college students with mental health issues are not seeking treatment. Although not a new phenomenon, little progress has been made toward promoting students' use of mental health services in Jordan. AIM: To measure depression, anxiety, and stress among college students in Jordan and explore their awareness of available mental health services. METHODS: A convenience sample (n = 600) was tested using the Depression, Anxiety, and Stress Scale. Students answered questions concerning the use of campus mental health services. RESULTS: Findings showed college students have a moderate level of depression, severe level of anxiety, and a moderate level of stress. Half were not aware that psychological support services were available, although 54.4% indicated they experienced problems. CONCLUSION: Similar results have been reported in non-Arab countries. Anxiety appears to be high in college students worldwide. Strategies are needed to promote awareness of resources and encourage access. Nurses are ideally suited for promoting awareness among students on seeking help. They are also needed to screen students for mental health problems and provide counseling as needed.

Nurse managers' perception of night-shift napping: A cross-sectional survey.

BACKGROUND: Night-shift work often results in sleep deprivation, and this in turn results in fatigue that jeopardizes both nurse and patient safety. Napping is considered a viable deterrent to fatigue, yet hospital administration has been slow to adopt napping. OBJECTIVES: To identify nurse managers' knowledge and approval of napping practices for nurses on night shifts. METHODOLOGY: Nurse managers at nine Jordanian hospitals (n = 129) were surveyed using an Arabic version of a questionnaire previously used in a Canadian study. Descriptive statistics were used to describe results, and a one-way ANOVA was used to determine if relationships existed among nurse manager's approval of napping and nurse demographic characteristics. RESULTS: The majority of nurse managers (61%) knew nurses were napping during breaks. However, the managers reported there was no written policy for napping. A majority thought there were more benefits to napping than drawbacks. Some 55% of nurse managers recognized fatigue as a cause of errors or incidents regarding patient safety, and 40% perceived fatigue to be a factor in staff injuries. CONCLUSION: This study supports an urgent need for shared responsibility among nursing administration, and bedside nurses to develop evidence-based programs to counteract the effects of nurse fatigue.

The Reliability and Validity of the Arabic World Health Organization Quality of Life-BREF Instrument Among Family Caregivers of Relatives With Psychiatric Illnesses in Jordan.

BACKGROUND: The concept of quality of life (QOL) has increasingly attracted the interest of healthcare providers and is considered a valid end point for assessing the overall mental health of patients and their caregivers. Instruments with psychometric and cross-cultural validity are recommended for making accurate QOL assessments. PURPOSE: The aim of this study was to provide further validation of the Arabic World Health Organization (WHO)QOL-BREF for use among family caregivers of relatives with psychiatric illnesses in Jordan. Of the 26 items that constitute the scale, 24 are in the domains of physical health, psychological health, social interactions, and environment. METHOD: Of the 328 family caregivers approached, data for 266 respondents were kept for analysis. The Arabic WHOQOL-BREF internal consistency, item internal consistency, item discriminant validity, and construct validity were evaluated. RESULTS: The Cronbach's alpha coefficient was ≥0.7. The 24 items constituting the evaluated domains reported an item internal consistency of ≥0.4 and met the item discriminant validity criterion of having a higher correlation with its corresponding domain than with other domains. Factor analysis revealed four strong factors that constituted the same constructs as in the WHO report. CONCLUSIONS: This study ascertains further validity of the Arabic WHOQOL-BREF scale for use among family caregivers of relatives with psychiatric illnesses in Jordan.

Quality of Life, Stigma and Burden Perception Among Family Caregivers and Patients with Psychiatric Illnesses in Jordan.

The literature reported several factors which could impact the quality of life of caregivers and patients with psychiatric illnesses. This study aimed to determine the level of quality of life among a sample of 532 of caregivers and patients with psychiatric illness at two out-patient mental health clinics in Northern Jordan, and to examine the relationships of sociodemographic characteristics, stigma and caregiver perceptions of burden with quality of life. A correlational descriptive design was utilized. Three self-administered questionnaires were used. Results indicated that patients had low to moderate QOL, and they suffered moderate to high stigma. Also, family caregivers perceived low to moderate QOL. Patients' and family caregivers' stigma perception correlated negatively and significantly with WHOQOL-BREF. Family caregivers' burden correlated negatively and significantly with all domains of WHOQOL-BREF, total QOL-100, and self-reported general health. Health care providers should assure the importance of focusing more toward minimizing stigma and promoting physical and general health to maintain a good quality of life of caregivers and patients with mental illnesses.

Eating Habits and Associated Factors Among Adolescent Students in Jordan.

The study aimed to assess adolescent patterns of eating habits, determine factors influencing these patterns, and identify male and female differences related to eating habits. Using a cross-sectional study approach, a sample of adolescents ( N = 423) in randomly selected clusters chosen from government and private schools in the south of Jordan completed self-administered questionnaires relating to socio-demographic data and personal eating habits. Results showed that parents, peers, and mass media are contributing factors, with peer pressure likely outweighing parental guidance. Males were more likely to be influenced by peers than females, whereas females were more likely to be influenced by media-based advertising. Lower body mass indices correlate with eating breakfast, which a majority of adolescents reported they do not do. Interventions targeted toward improving eating and active behaviors should involve peers as well as parents.

Perception and coping with stigma of mental illness: Arab families' perspectives.

Family stigma is well documented in the research literature; however, it has only been recently that efforts have been undertaken to discuss the perception of stigma as reported by Arab families of relatives with mental illness. This clinical paper aims to identify families' perception of stigma related to mental illness, and to compare Arab families' approaches with various aspects of caring from different countries. Further, this paper discusses, in-depth, specific areas related to families' perceptions of stigma: What impacts does stigma perception have on those families and on their relatives' care outcomes and what are coping strategies are used to handle stigma and its impacts in such countries? This paper emphasizes that chronic mental illness contributes the most to families' perception of stigma. In this study, Arab families perceived the experience of caring for a family member with a mental illness with fear, loss, embarrassment, and disgrace of family reputations. Further, secrecy, isolation, despair, and helplessness were reported the most among different family groups in Jordan and Morocco. This paper reminds us that cultural norms and beliefs shape family members' perception of coping and their ability to manage caring for relatives with mental illnesses. Thus, more studies are needed concerning coping and management strategies that are culturally relevant. This could eventually guide the establishment of stigma reduction initiatives and expand understanding of stigma from different cultural perspectives.

Arabic translation and cultural adaptation of the stigma-devaluation scale in Jordan.

BACKGROUND: A review of the literature on measuring the concept of stigma related to caring for a relative with mental illness yielded no instrument appropriate for use in Jordan. AIMS: To translate and culturally modify the stigma-devaluation scale (SDS) into Arabic, and to test the reliability, content and construct validity of the Arabic version of the SDS. METHOD: The SDS was translated into the Arabic language, modified and culturally adapted by a translation model. Estimation of internal consistency was used to assess the reliability of the SDS. Construct validity was determined by confirmatory factor analysis (CFA). Measurements of content validity and reading level of the Arabic SDS were included. The Arabic SDS was evaluated in a sample of 164 family caregivers in Jordan. RESULTS: Content validity index was determined to be 1.0. Reading level of the Arabic SDS was deemed to be at a sixth grade level or higher. Cronbach's alpha coefficient of the Arabic SDS total scale was 0.87. The results of the CFA revealed that the factor structure of the SDS had a satisfactory fit. CONCLUSION: This study provided psychometric evidence that the modified Arabic SDS is valid and conceptually consistent with the content of the original English SDS.

Mental illness stigma reduction interventions: review of intervention trials.

This article reviews the literature evaluating the effectiveness of various stigma reduction interventions related to mental health illnesses. An integrated search of the English language literature from 1998 to May 2008 was done using CINAHL, Medline, PubMed, Scopus, and PsychINFO databases. The results of this review emphasize that experimental clinical trials hold promise for providing evidence-based data that can be used in mental health practice. Educational and contact-based strategies used in various stigma reduction programs resulted in the most durable gains in knowledge as well as positive attitudinal and behavioral changes needed to decrease the stigma associated with mental illness. Special stigma reduction programs are to be planned for adolescent and elderly targets. Future studies have yet to be designed to identify cost-effective stigma reduction programs. Moreover, interventional studies from different cultures are encouraged. Cross-cultural interventions need to be evaluated and modified to ensure providing culturally relevant interventions.