Table 1 Characteristics of included studies
Author(s) (Year) | Study Country | Study Design | Sample Size (N) | Age and Participants | Aim/Outcome(s) | Key Findings | |
|---|---|---|---|---|---|---|---|
Aarethun et al. (2021) [31] | Norway | Qualitative | 31 | > 18 year old Syrian Refugees | Help-seeking preferences for PTSD and depression | Social network preferred help-seeking source Cultural stigma barrier to formal help Barriers to help-seeking in Norway: miscommunication, language, trust Help-seeking affected by migration process and is contextual | |
Abubotain (2020) [32] | USA | Quantitative | 102 | > 18 year old first and second generation Arab Americans | Factors involved in attitudes toward seeking professional mental health services Differences between the way first and second generation Arab Americans seek and perceive professional help | Acculturation, stigma, gender involved in help seeking Second generation more likely to utilize mental health services First generation more likely to use culturally accepted means (Friends, family) Societal stigma towards seeking mental health support in both groups | |
Abuhammad & Hamaideh (2022) [33] | Jordan | Quantitative | 205 | > 20 year old Jordanian nursing students | Attitudes toward seeking professional psychological help, before and after taking part in a mental health course | Positive effect of mental health course on attitudes toward seeking professional psychological help | |
Ahmed et al. (2017) [34] | Canada | Mixed Methods | 12 | > 20 year old Syrian refugee pregnant or postpartum women | Barriers to access maternal mental health services and seek help | Stigma, privacy concerns, language | |
Alajlan (2016) [35] | USA | Mixed Methods | 197 | > 19 year old Saudi Arabian international students | Relationship between psychological attitudes toward mental health services and gender, age, education, marital status, counselor type Barriers to seeking counseling or psychotherapy | Counseling or psychotherapy experience described as positive Enthusiasm about seeking mental health services Barriers: counselor’s cultural insensitivity, discrimination and fear of being incriminated for being from the Middle East | |
Al Ali et al. (2017) [36] | Jordan | Quantitative | 428 | > 18 year old Jordanians attending primary health care centers | Factors influencing attitudes and preferences toward seeking formal mental health services | Tendency to seek informal mental health resources and less favorable attitude to seeking formal help Stigma, cultural beliefs about mental health problem, institutional barriers | |
Al-Busaidi (2010) [37] | Oman | Qualitative | 30 | > 21 year old Omani women attending primary health care > 31 year old Omani GPs | Attitudes and beliefs regarding help seeking behavior for emotional distress | Informal source of help preferred (faith, family, traditional healer) Quality of doctor patient relationship influences likelihood of seeking/continuing treatment Stigma, time restraints | |
Al-Darmaki et al. (2016) [38] | UAE | Qualitative | 70 | > 18 year old Emirati female college students | Help seeking attitudes/barriers | Willingness among majority to seek help for psychological problems Barriers: social stigma, misconception of role of psychologists or services, lack of awareness or knowledge of psychological disorders, mistrust, and lack of confidence in professionals, financial difficulties | |
Al-Dousari & Prior (2020) [39] | Kuwait | Qualitative | 3 | > 28 year old Kuwaiti women receiving counselling | Perspectives on decisions to seek help/experiences of help-seeking | Faith facilitated and supported formal help-seeking | |
Alhomaizi et al. (2018) [40] | USA | Qualitative | 17 | Lay informants: M = 26 years, Key informants: M = 42, Arab Muslims | Factors influencing decision to seek formal MH treatment | Stigma Family/community role and support Mental health literacy, beliefs about causes of mental health problems, gender | |
Ali & Agyapong (2016) [41] | Sudan | Mixed Methods | 109 | > 20 year old carers of mentally ill patients and psychiatrists | Barriers to mental health services utilization | Barriers: beliefs around mental illness, resorting to alternative treatments (religious and traditional healers), centralization of mental health services, inadequate number of mental health staff, and mental health not being a priority by policy makers Psychiatric consultants identified stigma, cost of medications, and worries about medication’s side effects | |
Alissa (2021) [42] | Saudi Arabia | Quantitative | 1632 | > 18 year old Saudi Arabians (3% non-Saudi) | Impact of social barriers on mental health help-seeking | Majority of the participants agreed that social barriers could prevent them from seeking mental health help Stigma chosen as the most common social barrier, followed by culture and negative perceptions of mental illness | |
Alkhayat-Hatahet (2021) [43] | USA | Quantitative | 63 | > 18 year old Syrian Refugees in Southeast Michigan | Barriers to receiving or seeking MH services Association between perceived needs for mental health services and utilized services | Barriers: lack of information about services available, judgement of the community and shame, language, lack of previous experience in these services Perceived need for services but low utilization | |
Al-Krenawi (2002) [44] | Israel | Quantitative | 15,698 | Age not specified- National hospital records of Arabs | Mental health service utilization patterns | Arab women utilize psychiatric services less than Arab men Arabs underutilize mental health services | |
Al-Krenawi et al. (2009) [45] | Egypt Kuwait Palestine | Quantitative | 716 | M = 22 year old Israeli-Arab, Egyptian, Kuwaiti, and Palestinian students | Perceptions and attitudes towards help-seeking | Higher intention to consult professional MH services among woman Differences in perceptions and attitudes between Palestinians and Arab-Israelis compared to Kuwaitis and Egyptians | |
Al-Krenawi & Graham, (2011) [46] | Israel | Quantitative | 195 | > 18 year old Arab university students | Attitudes and mental health-seeking patterns in 3 major religious minorities | Higher interpersonal openness, less stigmata towards services, less likely to use traditional healing systems in Christians compared to Druze and Muslims | |
Al-Krenawi et al. (2004) [47] | Israël | Quantitative | 262 | > 19 year old undergraduate female university students from Jordan, UAE, Israel | Attitudes to mental health treatment | Age, educational attainment, marital status predictors of attitudes to help-seeking Faith common help-seeking behavior in times of distress Nationally not a predictor to attitudes of MH treatment | |
AlLaham et al. (2020) [48] | Lebanon | Qualitative | 46 | > 18 year old Syrian Refugees and Lebanese community members | Factors that influence help-seeking behaviors | Lack of knowledge about mental health symptoms and available services, stigma, financial barriers Less stigma to seeking help from religious leaders | |
Aloud & Rathur (2009) [49] | USA | Quantitative | 286 | > 18 year old Arab Muslims in Ohio USA | Attitudes toward seeking and using formal mental health and psychological services | Attitudes towards seeking and formal MH services influenced by cultural and traditional beliefs about MH problems, knowledge and familiarity of services, perceived societal stigma, use of informal services | |
Al-Roubaiy et al. (2017) [50] | Sweden | Qualitative | 10 | > 21 year old Male Iraqi refugees | Attitudes and experiences of counselling | Positive and negative views/experiences to counselling Social support valued Reluctance to disclose issues to therapists Barriers: transparency and competence of therapists | |
Al-Soleiti et al. (2021) [51] | Jordan | Qualitative | 20 | > 24 year old Jordanian and Syrian Mental health professionals working with refugees | Barriers to seeking mental health treatment and ability of local systems to provide services | Barriers: Financial, stigma, systemic/organizational (distrust in the system, accessibility, misdiagnosis, and lack of screening in primary settings, shortage of mental health professionals, communication and language, legal/immigration barriers), stigma, awareness and education, limited accessibility | |
Ayalon et al. (2015) [52] | Israel | Qualitative | 45 | > 20 year old Israeli Arab women, primary care patients, primary care providers | Attitudes/use of alternative services and informal help-seeking behaviors for depression and anxiety | 3 informal help-seeking behaviors identified: social support (extended family and neighbors versus nuclear family and close friends) religiosity, self-help techniques Primary care providers did not endorse religion and self-help | |
Balesh et al. (2018) [53] | USA | Quantitative | 298 | > 18 year old Arab Americans | Effects of acculturation, ethnic identity, and spirituality on mental health service utilization attitudes | Greater levels of identity and heritage and mainstream acculturation predictors of higher levels and willingness to seek help | |
Bashir et al. (2020) [54] | Sudan | Quantitative | 644 | M = 20 year old Medical students | Mental health care seeking behaviors and barriers | Barriers: Fear of stigmatization, preference for dealing with the problem alone, fear of the unknown, and failure to recognize symptoms | |
Bawadi et al. (2022) [55] | Jordan | Qualitative | 24 | > 18 year old Syrian refugees and community leaders | Barriers and facilitators to the use of mental health services | Barriers: Lack of awareness of mental illness and available services Availability, accessibility, and affordability of mental health services Stigma and social discrimination | |
Castaneda et al. (2020) [56] | Finland | Quantitative | 512 | > 18 year old Somali migrants in Finland | Mental health-related use of health services and the correspondence between the need and use of services | High need for services but low use of mental health services Lack of awareness/familiarity with services | |
Dogan et al. (2019) [57] | Turkey | Qualitative | 24 | > 18 year old Syrian Refugees | Experiences and difficulties regarding mental health services | Difficulties making appointments, obtaining medicine, personal rights, lack of information, language, discrimination, | |
Elghoroury (2017) [58] | USA | Quantitative | 131 | > 18 year old Muslim Arab Americans | Relationship of acculturation and religiosity on help-seeking attitudes | No relationship between acculturation and religiosity on help-seeking attitudes Gender and age predictors of help-seeking attitudes | |
Fassaert et al. (2009) [59] | Netherlands | Quantitative | 127 | > 18 year old Moroccan migrants in Netherlands | Uptake of mental health services | Moroccan migrants did not differ in uptake of specialized mental health services compared to other non-Arab ethnicities in presence of a common mental disorder Difference in uptake for psychological distress. Moroccan migrants less likely to report uptake of primary care for mental health problems | |
Fekih-Romdhane et al.(2021) [60] | Tunis | Quantitative | 714 | > 18 year old Tunisian students | Association between stigma levels and help-seeking intentions and comfort with disclosing mental illness | Better knowledge of mental illness predicted favorable help-seeking intentions Favorable help seeking intentions associated with lower stigma Gender predictor of help seeking intentions: females higher in help-seeking intentions and knowledge of mental illness Comfort with disclosing significantly and negatively correlated with attitudes to help seeking | |
Fuhr et al. (2020) [61] | Turkey | Quantitative | 1678 | > 18 year old Syrian Refugees | Mental health care utilisation and barriers to seeking and continuing care | Structural and attitudinal barriers for not seeking care: cost of mental health care, the belief that time would improve symptoms, fear of being stigmatized and lack of knowledge on where and how to get help | |
Gundel et al. (2016) [62] | USA | Qualitative | 9 | > 27 year old Sudanese refugees | Factors promoting seeking mental health care and beliefs about counselling | Religion, education, age Use of help from community members Distrust and Ambivalence for Western Mental Health Care Barriers to Western Mental Health Care: confidentiality and stigmatization of mental health, experiences as refugees and as a cultural minority in dominant culture, assumed lack of multicultural competence ascribed to mental health practitioners | |
Habhab (2018) [63] | USA | Qualitative | 11 | > 25 year old Arab American psychotherapists | Barriers and facilitators of providing mental health services | Barriers: acculturation, gender, family support, stigma and community | |
Hamid & Furnham (2013) [64] | UK | Quantitative | 259 | > 18 year old Arabs living in UK | Factors affecting attitude towards seeking professional psychological help | Less positive attitudes towards seeking professional psychological help Education, age, years in host country and confidentiality concerns predictors of attitudes to help seeking Shame and Gender not predictors | |
Harris et al. (2021) [65] | Norway | Quantitative | 92 | > 18 year old Syrian refugees | Help-seeking preferences and perceived barriers in accessing help from the GP | Preference to seek help from informal sources mostly family, partner, and God, followed by seeking help from GP Barriers: language, perceiving services as unhelpful, long wait times, not feeling understood Feelings of connectedness with host country and social integration promote help-seeking from GP | |
Hasan & Musleh (2017) [66] | Jordan | Qualitative | 27 | > 37 year old family members of patients with psychosis | Barriers to seeking early psychiatric treatment | Barriers: perceived stigma, role of extended family members, financial reasons, misattribution of the cause and symptoms of mental illness | |
Kamel et al. (2021) [67] | Egypt | Quantitative | 707 | M = 20 year old Egyptian medical students | Help-seeking behaviours and barriers to accessing care | Preferred sources of help in order: self-help, family/friends, professional services last Barriers: preferred to handle problem alone, did not know where to go, stigma/infrastructural barriers (wait times, travel distance, not having needs met) | |
Karadag et al. (2021) [68] | Turkey | Mixed-Methods | 440 | Age not specified- Syrian refugees in Turkey | Challenges and experiences in assessing mental health problems and barriers to accessing mental health care | Barriers: language, lack of knowledge about existing services Health provider's mentioned barriers: higher prioritization of daily life challenges, physical health problems and their low level of awareness on available services | |
Karam et al. (2018) [69] | Lebanon | Quantitative | 2857 | > 18 year old Arab adults | Determinants and barriers of seeking help for mental disorders | Barriers: perceived severity of problem and perceived need, financial, uncertainty about where to go and who to see, logistic (transportation/appointments), dissatisfied with previous treatment Female gender, higher education, and income predictors of positive attitudes to help seeking | |
Kayrouz et al. (2018) [70] | Online | Quantitative | 503 | > 18 year old Arabs | Acceptability of traditional face-to-face and internet delivered mental health services Barriers to services | Moderate to high acceptability rates for mental health services Differences in acceptability of mental health services by country Females more likely to try internet delivered treatment compared to males | |
Kayrouz et al. (2015) [71] | Australia | Quantitative | 252 | > 18 year old Arab Australians | Help-seeking behaviors and barriers to accessing psychological treatments | Barriers: shame, trust, mental health literacy, practical barriers (time, cost, transport) No differences by country of birth, gender, or religion Preference for non-medical support Low rates of service use | |
Khatib & Abo-Rass (2021) [72] | Israel | Qualitative | 28 | > 18 year old Arab students | Mental health literacy | High levels of mental health literacy among students and knowledge of available services Preference for self-treatment and religious therapies Pessimistic attitudes to help seeking Barriers: language and stigma | |
Kiselev et al. (2020) [73] | Switzerland | Qualitative | 5 | > 18 year old Syrian Refugees | Structural and socio-cultural barriers to accessing mental healthcare | Basic needs prioritized, gender, mismatch between western system of diagnosis and needs perceived by refugees, stigma, lack of awareness of services, lack of resources, language, lack of awareness of the health system | |
Levav et al. (2007) [74] | Israel | Quantitative | 632 | > 21 year old Arab-Israelis | Rate of help-seeking | Lower rates of help-seeking compared to Jewish Israeli’s and no perception of need for it | |
Linney et al. (2020) [75] | UK | Qualitative | 23 | > 18 year old Somali's living in UK | Views on accessing appropriate healthcare and ideas to improve access and reduce barriers | Religious healing, medication, community support and services expressed as potentially helpful treatments Barriers: unsure where to access services, language barriers, long waiting times and a lack of continuity with seeing different medical professionals, mistrust of perceived authority figures and fear of going to the doctor or getting treated due to potential economic repercussions | |
Loewenthal et al. (2012) [76] | UK | Qualitative | 24 | > 40 year old Somali's living in the UK | Understanding of mental health issues and available services Barriers to accessing of psychological therapies services | Lack of understanding of Western conceptualizations of depression/anxiety Lack of appropriate knowledge of services and fear of repercussions if accessed services Barriers: confidentiality (interpreters), stigma, needs not addressed (language and cultural barriers) Religion as method to deal with mental health issue | |
Mahajan et al. (2022) [77] | Canada | Qualitative | 12 | > 19 year old Syrian refugee women | Roles of social networks in resource seeking behaviors | Family role in providing information about Canada’s health system Social networks influence assumptions about mental health services Women feel more welcomed into social networks in Canada than in countries of first asylum. Social networks as alternatives to seeking formal help | |
Mahmoud (2018) [78] | Saudi Arabia | Quantitative | 5644 | > 20 year old Saudi Arabian adults | Knowledge, attitudes and perceptions towards health services and barriers that affect willingness to seek psychiatric help | Many unaware about psychiatric services available in the kingdom Reports of not seeking help when needed psychiatric help when needed Shame felt in relation to help-seeking Male gender, > 20 years old, not knowing whether a relative is suffering from mental illness and not knowing about the services provided by psychiatric health services associated with unwillingness to seek psychiatrist consultation Gaps in knowledge of mental illness | |
Mahsoon et al. (2020) [79] | Saudi Arabia | Quantitative | 236 | > 18 year old Saudi Arabians | Attitudes to MH help seeking Relationships between parental support, beliefs toward mental illness, and mental help-seeking attitude | Highly positive attitude toward mental help-seeking No relationship between parental support, beliefs towards mental illness and mental-help seeking | |
Mamdouh et al. (2022) [80] | Egypt | Quantitative | 707 | M = 20 year old Egyptian students | Attitudes, interest, and perceived barriers to electronic mental services | Little knowledge about electronic MH Barriers: privacy and confidentiality, unfamiliarity, technical issues | |
Markova & Sandal (2016) [81] | Norway | Mixed Methods | 105 | > 18 year old Somali refugees | Understand preferred coping strategies (in this paper refers to the way in which people prefer to react to or deal with depression, including help seeking behavior and preferred treatment) | Strong preference for coping with depression by religious practices and reliance on family, friends, and religious community, rather than by seeking professional treatment from public health services | |
Markova et al. (2020) [82] | Norway | Quantitative | 100 | M = 30 year old Somali immigrants in Norway | Preferred help-seeking sources for depression | Endorsement of traditional help sources and informal help Acculturation and education influenced help-seeking preferences | |
McKell et al. (2017) [83] | Jordan | Qualitative | 16 | Age not specified- Palestinian refugees | Barriers to accessing and consuming mental health services | Barriers: resource and financial deficits, sex, stigma, religion, culture, and discrimination | |
Molsa et al. (2010) [84] | Finland | Qualitative | 27 | > 50 year old Somali migrants in Finland | Change in help-seeking practices and use of services | Importance of trust in help-seeking Religious figures primary source of help Cultural barriers to treatment include not feeling understood by healthcare professionals | |
Molsa et al. (2019) [85] | Finland | Quantitative | 128 | > 50 year old Somali migrants | Healthcare services utilization patterns and preferences for mental healthcare | Low use and access to services Preference of traditional care and religious healing High level of symptoms not associated with use of services | |
Mond et al. (2021) [86] | Australia | Quantitative | 66 | > 18 year old Iraqi refugees | Association between trauma-related psychopathology recognition and help-seeking | Self-recognition of symptomology associated with help seeking Poor self-recognition level of trauma-related psychopathology barrier to help seeking | |
Nazzal (2015) [87] | USA | Quantitative | 166 | > 18 year old Arab Americans | Impact of biculturalism on well- being, race-related stress, and perceptions of a racist environment on attitudes towards help-seeking | No significant effect of biculturalism, well- being, race-related stress, and perceptions of a racist environment on attitudes towards seeking professional psychological help | |
Noorwali et al. (2022) [88] | Saudi Arabia | Qualitative | 12 | > 21 year old Saudi Arabians | Barriers and facilitators of seeking mental health support | Barriers: public stigma and lack of awareness, unprofessional practitioners, lack of accessibility to services and information, unsupportive families, intrapersonal dilemmas, and misconceptions based on religious beliefs Facilitators: increasing societal and family awareness, promoting the accessibility of services, enhancing sources of external support, personal motivation to change, and online therapy | |
Noubani et al. (2020) [89] | Lebanon | Qualitative | 36 | > 18 year old Lebanese hosts and Syrian refugee community members | Health seeking behaviors and barriers to health access | Women more likely to seek support Informal help sources first choice of support Barriers: significant delays in seeking help from formal services, social stigma, service costs, lack of health coverage, limited awareness of service availability, limited trust in the quality of services available | |
Palgi et al. (2011) [90] | Israel | Quantitative | 1068 | > 20 year old Arabs in Israel after war with Lebanon | Association between demographic variables, war-related factors, and psychosocial factors and mental health utilization | Injury of a relative during the war associated with increased probability of mental health service utilization No effect of gender, marital status, distress symptoms on service use | |
Piwowarczyk et al. (2014) [91] | USA | Mixed Methods | 16 | > 18 year old Somali refugees or citizens in the US | Attitudes and beliefs about treatment Barriers to accessing mental health services | Turning to family or friends for support rather than acquiring formal services Traditional ways of healing and coping/ religion Negative attitudes toward medication Barriers: Western mental health services and mental health needs from a western perspective not understood, disclosure to strangers, stigma | |
Rae (2014) [92] | UK | Qualitative | 12 | > 20 year old Somali male refugees in UK | Views on Western-based professional help and barriers to treatment | Barriers: stigma, difficulty disclosing (fear of judgement, privacy, cultural norms of enduring difficulties), GP lack awareness of cultural backgrounds, fear of diagnosis and treatment, Traditional healing preferred method of treatment | |
Rakhawy (2010) [93] | Egypt | Quantitative | 5191 | > 18 year old Egyptian adults | Frequency and use of faith healing | Help-seeking tendency directed towards primary health care services first, followed by relatives, faith healers | |
Said et al. (2021) [94] | Australia | Qualitative | 31 | > 18 year old Somali-Australian women | Perceived barriers to help-seeking for mental health | Barriers: Influence of faith, stigma, mistrust of Western healthcare system and denial of mental illness | |
Schlechter et al. (2021) [95] | Germany | Quantitative | 384 | > 18 year old Syrian refugees | Attitudes toward seeking professional psychological help | More negative attitudes toward professional psychological help-seeking | |
Schubert et al. (2019) [96] | Finland | Quantitative | 351 | 18–64 year old Somali immigrants in Finland | Association of psychosocial factors (traumatic events, social network, acculturation indices, mental health, and trust in services) with help-seeking | Past traumatic events increase use of MH services Gender (men) utilized mental health services more | |
Shechtman et al. (2018) [97] | Israel | Quantitative | 196 | > 18 Clinical and non-clinical Arab adults | Mediation of help-seeking stigma towards group therapy | Higher public stigma linked to higher self-stigma, and in turn decreased intention to seek group therapy | |
Slewa-Younan et al. (2015) [98] | Australia | Quantitative | 225 | > 18 year old Iraqi refugees | Levels of psychological distress and help seeking behavior Associations between mental health and help seeking and demographic characteristics | High levels of distress yet low uptake of mental health treatment Association between help seeking behavior and PTSD symptomology No association between age, sex, religion, education, marital status, distress levels | |
Smith (2011) [99] | USA | Qualitative | 14 | > 18 year old Muslim Arab Americans | Beliefs and attitudes toward psychotherapy | Therapy described as useful and un-useful Preference for friends and family or spiritual healing Barriers: religion, stigma, and shame, mistrust of MH workers, lack of awareness, lack of access | |
Straiton et al. (2014) [100] | Norway | Quantitative | 15,053 | > 18 year old Iraqi immigrants | Rate of use of primary health care services for mental health problems | Rate of GP consultations with psychiatric consultations slightly higher among men | |
Tomasi et al. (2022) [101] | Australia | Quantitative | 1180 | > 18 year old Iraqi refugees | Predictors of professional help seeking for mental health problems | Age, psychological distress, presence of disability or long-term illness associated with increased help-seeking Lower financial issues associated with lower help-seeking | |
Vally et al. (2018) [102] | UAE | Quantitative | 114 | > 18 year old female undergraduate students | Relationship between both public and self-stigma, and help-seeking attitudes | High public stigma and self-stigma associated with less favorable attitudes to help-seeking | |
Youssef & Deane (2006) [103] | Australia | Qualitative | 35 | Age not specified- Arab individuals in Australia | Factors that influence utilization of mental-health services | Barriers: Stigma/shame, confidentiality and trust, family influence, lack of knowledge of services and role of professionals Religious leaders and family important source of help | |
Zalat et al. (2019) [104] | Egypt | Quantitative | 240 | M = 28 year working and non-working Egyptian Females | Stigma and attitudes toward seeking psychological help | Social support and personal stigma predict total self-stigma and attitude towards seeking mental health services Less stigmatized views in working females | |