Journal ofMuslim Mental Health

Background: The underutilization of mental health services is a very real problem, as many who might benefit from care do not receive it. In the United States, this trend has been documented in several studies with minorities such as African Americans (Alvidrez, 1999), Latinos (Alvidrez, 1999), Asian Americans (Kim & Omizo, 2003), and American Indians (Beals et al., 2005). This pattern of underutilization is not seen proportionally among diverse ethnicities, cultures, or religions. The Arab Muslim minority living in the United States has been found to significantly underutilize mental health services. Researchers have found that the beliefs, perceptions, and attitudes toward mental illness and mental health treatment may affect help-seeking behavior. An exploratory, qualitative study was conducted to understand the help-seeking behavior of the Arab Muslim minority in the US.

The study sought to uncover what attitudes Arab Muslims living in the US hold about seeking help when faced with stress or mental health issues; to understand the perception they hold about mental illness, its causes, and its treatments; and to identify some of the potential hindrances and facilitators of seeking formal mental health treatment.

Methods: An exploratory, qualitative study was conducted using 17 individual face-to-face semi-structured interviews. The semi-structured interview was written as a list of open-ended questions and topics. In addition, based on the participant’s responses during the interview, supplemental probes were added by the interviewer. The interviews were audio-recorded and were transcribed verbatim by the interviewer. Transcriptions were anonymous and assigned only a number.

Results: Ten laypersons (4 males; age = [M = 26.30, SD = 11.53]) and 7 key informants were recruited (5 males; age = [M = 42.14, SD = 10.63]). The key informants included 3 psychiatrists, 2 imams, one clinical social worker, and one licensed mental health counselor. Data analysis yielded major themes related to the factors that may influence an Arab Muslim’s decision to seek formal mental health services. We used a socio-ecological model to identify the multiple levels that may act as facilitators or hindrances of an individual’s help seeking behavior. The four levels that were identified included the individual level, the interpersonal level, the community level, and the larger environment level. At the individual level, the themes included self-stigma and intersectional. At the interpersonal level, the themes included associative stigma, family influence on seeking treatment, and receiving positive feedback from people for seeking treatment. At the community level, the themes included social stigma, the imam’s role in educating the community and encouraging treatment, and the community’s social support. At the larger environment level, the themes included institutional stigma.

In the model, we highlight the multi-level nature of the factors that may interact to influence a person to decide whether to seek formal mental health care or take a different course of action. This decision is made by the person as well as by the people around them, including their family, their community, and the larger environment in which they reside. In addition, we identified four crosscutting features that influence all levels of the model and thus, may influence the individual directly and/or influence one of the other levels that may in turn affect the individual. These crosscutting features include information, motivation, ability to act, and societal norms.

Discussion: The qualitative nature of this study provides an in-depth and holistic understanding of the attitudes and beliefs that Arab-Muslims living in the United States hold toward mental health as well as identifies potential facilitators and hindrances of seeking formal mental health services. This study provides a deeper understanding of this subgroup by elucidating the relationship between their attitudes, values, and cultural/religious beliefs and practices and as a result, their help-seeking behavior. In particular, important facilitators and barriers to help-seeking have been found. This study also adds to the current literature of Arab Muslims’ mental health help-seeking behavior in the United States by identifying novel themes not discussed in previous research and expanding on themes that have been identified.