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.

Prevalence of Undiagnosed Attention Deficit Hyperactivity Disorder (ADHD) Symptoms in the Young Adult Population of the United Arab Emirates: A National Cross-Sectional Study.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD), a globally prevalent behavioural disorder, remains underdiagnosed, particularly among adults. This issue is exacerbated in the Arab region due to stigma and insufficient healthcare facilities and professionals. Despite the United Arab Emirates (UAE) efforts to improve mental healthcare, shortcomings persist. No studies in the UAE currently assesses the appropriateness of the screening system for ADHD and other behavioural issues. Furthermore, prevalence rates of ADHD, particularly within the young adult population, are absent. AIM: To estimate the prevalence of ADHD amongst young adults attending university in UAE and examine its relationship with gender and academic outcomes. METHODS: A cross-sectional, correlational design was used. Young adults in their first year at university were recruited from different academic institutions across the UAE. The study utilized the Adult ADHD Self-Report Scale (ASRS) for data collection. RESULTS: A sample of 406 young adults, aged between 18 and 20 years of age were recruited. Approximately, 34.7% (n = 141) reported symptoms suggestive of probable ADHD. Significantly lower grade point average marks were observed in participants with ADHD symptoms (M = 3.15) compared to those without (M = 3.35). Females reported symptoms of probable ADHD at higher rates than males, indicating possibly a potential screening deficiency and a potential stigma consequence. CONCLUSIONS: The study demonstrates a high prevalence of probable ADHD in young adults, particularly among females attending university in the United Arab Emirates. Implications for early screening, service provision, and greater professional health training on this disorder are required.

A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants.

BACKGROUND: Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations. METHODS: English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456). RESULTS: Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions. CONCLUSION: Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.

Trajectories of psychological distress and social integration in newly resettled refugees: findings from the Building a New Life in Australia longitudinal study.

PURPOSE: Refugees are at greater risk of mental illness due to stressors encountered post-resettlement. However, few longitudinal studies have examined the within-person effects of these stressors, especially with respect to social integration. This study aims to examine what factors are associated with psychological distress in a longitudinal sample of refugees resettled in Australia. METHODS: This study used data from three Waves of the Building a New Life in Australia study, collected between 2013 and 2018. The eligible sample included 1881 adult respondents, clustered in 1175 households. We conducted multilevel mixed-effects growth modelling incorporating time-variant and time-invariant covariates with psychological distress, using the Kessler Psychological Distress Scale (K6). RESULTS: Rates of high psychological distress increased across the 5-year follow-up period. Social integration stressors (e.g. discrimination, lower sense of belonging, loneliness, lower English proficiency) were associated with higher levels of psychological distress over time. Refugees reporting loneliness not only had a greater risk of elevated psychological distress at each time point, but the difference in risk increased over each time point. Refugees who were exposed to traumatic events, older, female and of Middle Eastern background were also more likely to report higher levels of psychological distress over time. CONCLUSIONS: These findings highlight the importance of identifying refugees who may encounter difficulties with social integration in the early years of resettlement. Newly arrived refugees may benefit from longer-term resettlement programmes that address post-migratory stressors, particularly with regards to loneliness, to reduce the prevalence of elevated psychological distress during the early years of resettlement.

Depression and Generalized Anxiety as Long-Term Mental Health Consequences of COVID-19 in Iraqi Kurdistan.

Coronavirus disease 2019 (COVID-19) has been associated with a variety of psychiatric symptoms. However, COVID-19's association with psychiatric symptoms after the acute illness phase is not fully understood. Thus, this study sought to examine symptoms of depression and generalized anxiety and associated factors in the period following COVID-19 infection. A cross-sectional study design was conducted in three governorates of the Iraqi Kurdistan region. Face-to-face interviews were held between the period of 15 September and 20 December 2021 with both those who had been infected with COVID-19 and those who had not. Depression symptomology was assessed using the 9-item Patient Health Questionnaire and levels of anxiety were measured using the 7-item Generalized Anxiety Disorder scale. A total of 727 participants were recruited. The bulk of the respondents (n = 454) reported having a past COVID-19 infection, of whom a considerable proportion (82%) had mild-moderate symptoms. More than half of the infected respondents (53.3%) stated they were treated at home. The mean score of generalized anxiety was higher among the infected group compared to the non-infected group t(725) = 2.538, p = 0.011. Factors such as older age, female gender, unemployment, previous psychological problems, and diabetes mellitus were strongly associated with symptoms of depression and anxiety post-COVID-19 infection. Additionally, anxiety was associated with a longer duration of post-COVID symptoms. The majority of the study population had mild to moderate levels of post-COVID-19 depression and anxiety. Psychological education and interventions are required to reduce the psychological burden of post-COVID-19 symptoms among the general population.

Mental illness stigma and associated factors among Arabic-speaking refugee and migrant populations in Australia.

BACKGROUND: Arabic-speaking refugee and migrant populations form a significant proportion of Australia's population. Despite high levels of psychological distress among Arabic-speaking populations, low uptake of mental health services has been demonstrated. Evidence suggests poor levels of mental health literacy (MHL) and high levels of stigmatising attitudes among Arabic-speaking populations, which may act as barriers to help-seeking behaviours. This study aimed to explore the relationships between measures of mental illness stigma, socio-demographic factors and psychological distress, as well as to determine the factors associated with MHL (i.e., correct recognition of mental illness and knowledge of causes) among Arabic-speaking refugee and migrant populations in Australia. METHODS: Participants were recruited from non-government organisations in Greater Western Sydney that provided support services to Arabic-speaking migrants and/or refugees. As this study is nested within an interventional pilot study evaluating a culturally tailored MHL program, only the pre-intervention survey responses for 53 participants were utilised. The survey measured key aspects of MHL (i.e., recognition of mental illness, knowledge of causes), levels of psychological distress (using K10 scale), and stigmatising attitudes towards mental illness (using Personal Stigma Subscales and Social Distance Scale). RESULTS: The Personal Stigma subscale of 'Dangerous/unpredictable' was strongly positively correlated with participants' K10 psychological distress scores and strongly negatively correlated with years of education completed. There were moderate negative correlations between two Personal Stigma subscales ('Dangerous/unpredictable' and 'I-would-not-tell-anyone') and the length of stay in Australia. Being female was associated with an increase in personal stigma demonstrated by higher scores for 'I-would-not-tell-anyone' subscale than males. Similarly, increase in age was associated with a decrease on scores of the personal stigma 'Dangerous/unpredictable'. CONCLUSIONS: While future research with larger sample size are needed, the study findings can be considered as adding to the evidence base on mental illness related stigma in Arabic-speaking populations. Further, this study provides a starting point in developing the rationale for why population sub-group specific interventions are required to address mental illness stigma and improve MHL among Arabic-speaking refugee and migrant populations in Australia.

A Qualitative Exploration of Sources of Help for Mental Illness in Arabic-, Mandarin-, and Swahili-Speaking Communities in Sydney, Australia.

Despite being disproportionately affected by poor mental health, culturally and linguistically diverse (CaLD) individuals seek help from mental health services at lower rates than others in the Australian population. The preferred sources of help for mental illness amongst CaLD individuals remain poorly understood. The aim of this study was to explore sources of help in Arabic-, Mandarin-, and Swahili-speaking communities in Sydney, Australia. Eight focus-group discussions (n = 51) and twenty-six key informant interviews were undertaken online using Zoom. Two major themes were identified: informal sources of help and formal sources of help. Under the informal sources of help theme, three sub-themes were identified: social, religious, and self-help sources. All three communities strongly recognised the role of social sources of help, with more nuanced roles held by religion and self-help activities. Formal sources of help were described by all communities, although to a lesser extent than informal sources. Our findings suggest that interventions to support help-seeking for all three communities should involve building the capacity of informal sources of help, utilising culturally appropriate environments, and the collaboration between informal and formal sources of help. We also discuss differences between the three communities and offer service providers insights into unique issues that require attention when working with these groups.

Experiences of a mental health promotion, prevention, and early-intervention training program targeted to school nurses in the United Arab Emirates.

AIM: To report participants' and facilitators' experiences of mental health promotion, prevention, and early-intervention training program targeted at school nurses in the United Arab Emirates (UAE). BACKGROUND: The UAE school healthcare service is staffed by full-time nurses and part-time doctors and linked to primary healthcare centers. This service supports children's physical and mental well-being. However, school nurses' capacity to realize the potential of this service, particularly regarding mental health, has not yet been explored. METHODS: We used an exploratory qualitative approach with data triangulation. Data were drawn from school nurses that participated in a targeted mental health promotion, prevention, and early-intervention training program. Data were gathered through focus group interviews with participating school nurses, written reflections, and notes recorded by the program designers and trainers. All school nurses who participated in the training program (N = 15) were included in this study. This study adhered to the consolidated criteria for reporting qualitative research. RESULTS: Nurses' narratives encompassed three main themes, which indicated the program was an enjoyable professional and personal journey that allowed professional discovery/development and personal growth. Program organizers/facilitators indicated the training program was important, but challenging to implement. Four themes emerged from their reflections that covered the structure of school nursing services, participants' competency and education, the UAE context, and teaching style. CONCLUSION: A well-structured professional development program can contribute to improving mental healthcare in schools. Improved service structure and regulations to support this goal are essential. IMPLICATIONS FOR NURSING PRACTICE, RESEARCH, AND POLICY: School nurses benefit professionally and personally from targeted mental health training, which also improves the care students receive. School healthcare service managers should consider increasing such training opportunities for nurses and focus on measuring service outcomes and evaluating effectiveness. It is also necessary to reassess the minimum qualification requirement for school nurses. Specific professional development programs for school nurses will improve their clinical practice and support the recruitment of competent and prepared staff.

Conceptualisations of mental illness and stigma in Congolese, Arabic-speaking and Mandarin-speaking communities: a qualitative study.

BACKGROUND: Australia is an ethnically diverse nation. Research has demonstrated an elevated risk of developing a mental illness in culturally and linguistically diverse (CaLD) communities yet uptake of mental health services is low. To improve mental health treatment seeking and outcomes for CaLD individuals in Australia there is an urgent need to deeply understand barriers to treatment such as stigma. Using an exploratory qualitative approach, the aim of the study was to explore how CaLD communities' conceptualise and interpret mental illness and associated beliefs and experiences of stigma. METHODS: The study focused on three key CaLD groups: the Congolese, Arabic-speaking and Mandarin-speaking communities residing in Sydney, Australia. A series of eight focus group discussions (n = 51) and 26 key informant interviews were undertaken online using Zoom during the period of November to December 2021. Focus group discussions and key informant interviews were digitally recorded, transcribed, and analysed using NVivo software. RESULTS: Three major themes were identified. The first theme related to mental illness terminology used in the three communities. Despite variation in the terms used to refer to 'mental illness' all three communities generally distinguished between 'mental illness', a more severe condition and 'mental health problems', considered to arise due to stressors. The second theme centred on beliefs about mental illness; with all three communities identifying migration-related stressors as contributing to mental illness. Culturally related beliefs were noted for the Congolese participants with the perception of a link between mental illness and supernatural factors, whereas Mandarin-speaking participants highlighted lack of inter and intrapersonal harmony and failure to adhere to values such as filial piety as contributing to mental illness. The final theme related to mental illness related stigma and the various ways it manifested in the three communities including presence of collectivist public stigma felt across all three groups and affiliate (family) stigma reported by the Arabic and Mandarin-speaking groups. CONCLUSIONS: We found rich diversity in how these communities view and respond to mental illness. Our findings provide some possible insights on both service provision and the mental health system with a view to building effective engagement and pathways to care.

A qualitative exploration of mental health knowledge among pediatric health professionals in the United Arab Emirates.

BACKGROUND: Mental health literacy (MHL) is an essential competency for all healthcare professionals. In the United Arab Emirates, previous studies reported a low level of MHL among healthcare professionals working with vulnerable populations such as children and adolescents with chronic illnesses. Further in-depth exploration is necessary to build understanding of beliefs and knowledge about mental illness among pediatric health professionals. METHODS: Written narratives exploring mental health knowledge were collected from pediatric nurses and analyzed using content analysis. These written narratives were extracted from responses to open-ended questions embedded in a questionnaire completed as part of previous studies. The Standards for Reporting Qualitative Research were followed in reporting this study. RESULTS: The overarching theme that emerged from the data was that nurses struggled to negotiate the complexities of psychological distress and mental illness. Two overlapping sub-themes were identified: (1) professional knowledge was incomplete, confused, and lacking in clarity and (2) professional knowledge was impacted by cultural beliefs and stigma. A third sub-theme reflected how participants identified with others' suffering and felt powerless to help themselves or others. Participants described stress and mental exhaustion. CONCLUSIONS: Participants' narratives were characterized by struggles arising from insufficient knowledge, confusion, and deeply-held cultural and religious beliefs. Therefore, they were unable to resolve the conflict between professional knowledge, attitudes, and beliefs about mental illness and stigma arising from cultural and religious beliefs/attitudes. Culturally-specific education is needed for healthcare professionals that addresses contextual, cultural, and religious factors impacting on stigma while actively supporting the healthcare workforce and enabling access to mental health services.

Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement.

The current longitudinal study sought to identify predictors of professional help seeking for mental health problems amongst Afghan and Iraqi refugees five years post-settlement utilising the Building a New Life in Australia dataset (BNLA). Data were collected via face-to-face or phone interviews across five waves from October 2013 to March 2018. Afghan and Iraqi born refugees numbering 1180 and over 18 years of age with a permanent humanitarian visa were included in this study. The results suggest differences in help-seeking behaviors amongst the two ethnic groups. Amongst the Afghan sample, older adults with high psychological distress were more likely to seek help, while living in regional Australia, not requiring interpreters, and knowing how to find out information about government services were related to lower likelihood of help-seeking. Within the Iraqi sample, poor overall health and knowing how to find out about services were related to a greater likelihood of help-seeking, while fewer financial hardships decreased the likelihood of help-seeking. Amongst those with probable PTSD, disability was associated with an increased likelihood of help-seeking while experiencing fewer financial hardships and living in regional Australia resulted in a lower likelihood of help-seeking in this group. These results have implications for promotional material and mental health interventions, suggesting that more integrated services tailored to specific characteristics of ethnic groups are needed.

Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis.

BACKGROUND: The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. METHODS: Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. RESULTS: Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. CONCLUSIONS: Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.

Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis.

BACKGROUND: Stigma refers to the discrediting, devaluing, and shaming of a person because of characteristics or attributes that they possess. Generally, stigma leads to negative social experiences such as isolation, rejection, marginalization, and discrimination. If related to a health condition such as mental illness, stigma may affect a person's illness and treatment course, including access to appropriate and professional medical treatment. Stigma has also been reported to affect patients' families or relatives, along with professionals who work in mental healthcare settings. Stigma is strongly influenced by cultural and contextual value systems that differ over time and across contexts. However, limited information is available on how types of stigma are experienced by patients with mental illness and mental health nurses in Indonesia. METHOD: We explored the stigma-related experiences of 15 nurses and 15 patients in Indonesia. The study design and analysis of interview data were guided by deductive (directed) content analysis. RESULTS: Five themes emerged. Four themes were patient-related: personal/patients' stigma, public/social stigma, family stigma, and employment stigma. The fifth theme related to stigma toward healthcare professionals working with patients with mental illnesses, which we categorized as professional stigma. CONCLUSIONS: This study has achieved a deep understanding of the concept of stigma in the Indonesian context. This understanding is a prerequisite for developing appropriate interventions that address this phenomenon and thereby for the development of mental health services in Indonesia. This study may also be transferable to other countries that share similar cultural backgrounds and adhere to traditional and religious value systems.

Mental Illness Stigma and Associated Factors among Arabic-Speaking Religious and Community Leaders.

Evidence suggests that Arabic-speaking refugees in Australia seek help from informal sources, including religious and community leaders, when experiencing mental health issues. Despite their significant influence, there is scarce research exploring attitudes of Arabic-speaking leaders toward mental illness. The current exploratory study explored mental illness stigma and various factors among Arabic-speaking religious and community leaders. This study uses a subset of data from an evaluation trial of mental health literacy training for Arabic-speaking religious and community leaders. Our dataset contains the pre-intervention survey responses for 52 Arabic-speaking leaders (69.2% female; mean age = 47.1, SD = 15.3) on the ability to recognise a mental disorder, beliefs about causes for developing mental illness, and two stigma measures, personal stigma, and social distance. Being female was associated with a decrease in personal stigma. An increase in age was associated with an increase in personal stigma. Correct recognition of a mental disorder was associated with decreased personal stigma, and after adjusting for age and gender, significance was retained for the I-would-not-tell-anyone subscale. Endorsing the cause "being a person of weak character" was associated with an increase in personal stigma. There is an urgent need for future research to elucidate stigma to develop effective educational initiatives for stigma reduction among Arabic-speaking leaders.

Resilience and Hope Among Yazidi Women Released From ISIS Enslavement.

ABSTRACT: This study aimed to explore the levels of resilience and hope among Yazidi women who survived captivity by Islamic State of Iraq and Syria (ISIS) and to examine its relationship with posttraumatic stress disorder (PTSD), generalized anxiety, and depressive symptoms. In this cross-sectional study, 139 formerly enslaved Yazidi women were assessed. The mean scores of resilience and hope were below the suggested cutoff means (M = 2.47, SD = 0.48, R = 1-5) and (M = 31.6, SD = 11.7, R = 8-64), respectively. Sociodemographic variables were not related to resilience and hope, other than those women who stayed in captivity for more than a 3-year period who reported significantly lower levels of hope (M = 28.36, SD = 11.69). Formerly enslaved Yazidi women who display higher levels of PTSD, generalized anxiety, and depression exhibit significantly lower levels of resilience and hope. Resilience and hope are therefore important concepts to explore in traumatized populations.

Self-recognition of trauma-related psychopathology and help-seeking among resettled Iraqi refugees in Australia.

The current study sought to examine resettled Iraqi refugees' recognition of trauma-related psychopathology and the association between recognition and help-seeking. Participants were 66 men and women aged 18 to 70 years with clinically significant symptoms of posttraumatic stress disorder (PTSD) recruited from a larger, community-based sample in Western Sydney, Australia. Participants were presented with a vignette of a fictional character who had been exposed to trauma prior to leaving Iraq and who was suffering from symptoms of PTSD. Participants were then asked if they believed that they might currently have a problem such as the one described in the vignette. Approximately half (50.8%) of participants believed that they might currently have a problem such as the one described in the vignette and one third (33.3%) of participants had ever sought help for such a problem. Participants who believed that they might currently have a problem like the one described were 13 times more likely to have sought help for such a problem, controlling for demographic characteristics, trauma-related symptomatology, and levels of general psychological distress. Poor self-recognition level of trauma-related psychopathology among resettled Iraqi refugees may be a barrier to help-seeking and may therefore be an important target for health promotion and early intervention initiatives.

Measures of depression, generalized anxiety, and posttraumatic stress disorders amongst Yazidi female survivors of ISIS slavery and violence.

BACKGROUND: In 2014 the Islamic State of Iraq and Syria (ISIS) undertook a systematic and deliberate campaign against minority groups and non-Sunni Muslim communities. Amongst some of the greatest atrocities were those targeted towards Yazidi communities and in particular their women. The mental health outcomes of those women held in captivity requires investigation. This study sought to examine and compare levels of general psychological distress, depression, generalized anxiety, posttraumatic stress disorder (PTSD) and self-reported suicidal thoughts and behaviors amongst Yazidi women held in captivity compared with those without such experiences. METHOD: Between January to May 2019, a total 348 Yazidi women located in internal displaced person (IDP) camps were interviewed. Of these 348, 139 females were survivors of ISIS captivity. Measures used included Kessler Psychological Distress Scale (K10), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and Harvard Trauma Questionnaire part IV (HTQ part IV). RESULTS: Formerly enslaved Yazidi females showed a significantly higher prevalence of severe mental distress (97.1%; P < 0.001), more severe levels of depression (36.7%; P < 0.001) and general anxiety symptoms (37.4%; P < 0.001), greater rates of PTSD (90.6%; P < 0.001) and higher reported rates of suicidal ideation (38.1%; P < 0.001). Logistic regression analysis undertaken to examine the role of sociodemographic factors as predictors of the assessed mental health conditions. Amongst the formerly enslaved group, no such significance was found, however amongst the non-enslaved group, unemployment was found to statistically determine depression, generalized anxiety and PTSD. Specifically, women from the non-enslaved group who were unemployed were 2.5 times more likely to have depression, 3 times more likely to have generalized anxiety and 3.3 times more likely to have PTSD. Finally, amongst the non-enslaved group, those women with between 5 to 8 siblings were significantly less likely to have depression than those with fewer siblings. CONCLUSION: Rates of distress and trauma related symptomology were significantly higher amongst those with history of enslavement. Sociodemographic factors and duration of enslavement do not seem to predict mental disorders among enslaved females.

An evaluation of a mental health literacy course for Arabic speaking religious and community leaders in Australia: effects on posttraumatic stress disorder related knowledge, attitudes and help-seeking.

BACKGROUND: Australia is an ethnically diverse nation with one of the largest refugee resettlement programs worldwide, including high numbers of refugees with an Arabic speaking background. Evidence suggests that refugees can demonstrate high levels of psychological distress and are at a higher risk of developing mental illness such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Notwithstanding, research has also shown Arabic speaking refugees have lower levels of professional help-seeking behaviours, postulated to be related to mental health literacy levels. METHODS: A culturally sensitive mental health literacy (MHL) training program was developed and delivered in Arabic to Arabic speaking religious and community leaders using a 1-day training workshop format. An uncontrolled pre-, and post study design was used to provide a preliminary evaluation of improvement in PTSD-related knowledge, attitudes and help-seeking measures. RESULTS: A total of 54 adults were trained, with 52 completing the pre- and post-intervention questionnaire. Significant differences were found post-training in measures such as the ability to recognise mental health problems (p = 0.035) and an increased recognition of the role that medication can play in the treatment of PTSD (p = 0.00). Further, an improvement in negative attitudes such as a desire for social distance (p = 0.042) was noted and participants reported more helpful strategies in line with promoting professional help-seeking following training (p = 0.032). CONCLUSION: Our findings indicated the training led to an improvement of some measures of MHL. To the best of our knowledge, this is the first time that the MHL program has been tailored for Arabic speaking religious and community leaders; who assist refugees with an Arabic background. By equipping community leaders with the knowledge to better respond to mental health problems, the overall goal of improving the mental health outcomes of Arabic speaking refugee communities is closer to being realised.

Causes and risk factors for common mental illnesses: the beliefs of paediatric hospital staff in the United Arab Emirates.

BACKGROUND: Children and adolescents with chronic physical health conditions are vulnerable to poor mental health outcomes. The measurement of mental health literacy of health professionals working with such populations is important because of their role in promoting early and appropriate help-seeking. This study sought to determine the beliefs regarding the causes of and risks factors for three types of mental illnesses amongst health professionals in United Arab Emirates. METHOD: A culturally validated mental health literacy survey presenting three vignettes of fictional characters meeting diagnostic criteria for posttraumatic stress disorder, depression with suicidal thoughts and psychosis was distributed. The survey measured health care professionals' beliefs regarding the causes of and risk factors for these disorders. RESULTS: A total of 317 health care professional (> 90% nurses) were surveyed from across the UAE. Although 43.8% correctly endorsed exposure to a 'traumatic event' as the most likely cause for developing posttraumatic stress disorder, there was a more limited understanding of the contribution of biopsychosocial factors to the development of the mental illness, particularly for psychosis. Participant socio-demographic variables were associated with attributions of religious or spiritual beliefs and personal weakness as causal and/or vulnerability factors in the development of depression with suicidal thoughts and psychosis. CONCLUSIONS: Efforts to improve mental health systems and health care providers in UAE and other similar Middle Eastern countries requires targeted mental health literacy programs that seek to integrate biopsychosocial models of mental illness and their treatment with the positive aspects of religious and cultural beliefs that are dominant in this region.

Improving the mental wellbeing of Arabic speaking refugees: an evaluation of a mental health promotion program.

BACKGROUND: Refugee populations have particularly high rates of mental health problems, including Posttraumatic Stress Disorder (PTSD) and depression. However, uptake of mental health care may be low even when severe depression and PTSD symptoms are present in individuals following resettlement. This is likely due, at least in part, to cultural influences on refugees' knowledge and beliefs about mental health problems and their treatment. We sought to provide preliminary evidence for the effectiveness of a culturally tailored mental health promotion program for Arabic-speaking refugees. METHODS: A total of 33 Arabic-speaking refugees resettled in South Western Sydney were recruited and completed intervention which consisted of weekly three-hour sessions for 4 weeks delivered in Arabic. Key aspects of mental health literacy, help-seeking intentions and levels of general psychological distress were assessed, by means of a self-report survey, pre-intervention, (immediately) post-intervention and 3 months following intervention. RESULTS: Of the 33 participants that completed the intervention, 31 completed the immediate post-intervention survey and 29 completed the 3 months follow-up survey. Improvements in most aspects of mental health literacy assessed were found immediately post-intervention and at follow-up, although only changes relating to stigmatising attitudes were statistically significant. Additionally, a statistically significant decrease in participants' levels of general psychological distress was observed immediately following the intervention, and this decrease was sustained at follow-up. CONCLUSION: While further research employing a more rigorous study design and larger sample size will be needed, results of this initial trial suggest that a culturally tailored mental health promotion program targeting key aspects of mental health literacy can improve the mental health of Arabic-speaking refugees resettled in a Western nation.