Attitudes towards mental illness and psychological help seeking in Syria: an exploratory study

The overall aim of this thesis was to understand how mental health and seeking help for mental health problems were understood in Syria. The initial investigation began by examining whether or not Western mental health concepts and measures were applicable to the Syrian Arab culture.

Some earlier research had highlighted the important role of culture in conducting psychological research and identified the tension between taking an etic (universal approach) and an emic (indigenous) approach. In this thesis the initial approach is etic with Western measures, presumably universal, used to examine Syrian opinions on psychological help seeking and attitudes towards mental illness. In the light of the quantitative analysis an emic approach was adopted as the limitations of the etic concepts and measures became apparent. A further qualitative investigation was conducted to supplement the understanding of psychological help seeking in the Syrian context.

The thesis has three main aims. The first aim was to investigate the use of some of the most commonly used and validated scales related to psychological help seeking and investigate their applicability in a Syrian Arab context. Confirmatory Factor Analysis was used to investigate their validity. The second aim was to develop path analysis models to investigate the relationships between seeking psychological help, attitudes towards mental illness, coping styles, social support and mental well-being. The third ensuing aim was to qualitatively investigate real-life issues on mental health help seeking, attitudes towards mental illness and alternative sources of help.

To begin a cross-sectional survey design was employed with a stratified cluster sample of participants aged 15-29 years (N = 683) in Syria in 2011. Three scales developed in the USA and widely used in international research were used: Opinions on Seeking Psychological Help, Community Attitudes towards Mental Illness and Coping Style. CFA was used to assess the validity of these scales. Eight models were then constructed in order to investigate the relationship between variables of attitudes towards mental illness, psychological help seeking, coping styles, social support and mental well-being to the outcome variable recognition to seek psychological help using path analysis modelling. A final model was constructed to assess model fit when only significant pathways were included in the analysis.

The CFA findings showed that the adopted scales were of limited use in the Syrian context. Arguably the best option might have been to abandon these measures and design new measures from first principles. However, the Syrian war made further data collection impossible and the data set is relatively large and the measures have been used repeatedly in the literature so the decision was made to amend the measures for use in later analyses.

None of the hypothesized path analysis models were a good fit to the Syrian data. However, some variables of the models were found to significantly predict the outcome recognition of the need to seek psychological help. The main factors influencing cognitive psychological help seeking were: moral obligation to help those in need, community mental health ideology, fear of mental illness, the need for community help in order to cope, religious coping and mental health wellbeing. There were gender differences on tolerance to mental illness and on interpersonal openness to emotional problems.

The quantitative findings were used in the design of a qualitative investigation of mental health professionals understanding of psychological help seeking by Syrians during the time of war. This study used an online interviewing technique and provided an overview of experiences of mental health professionals working in the field. The relationship between the qualitative and quantitative research findings were further examined with the qualitative investigation showed that the quantitative findings of the thesis were still relevant to the current plight of Syrians seeking help today. These issues need further research and exploration in order to provide optimal mental health treatment and support to Syrians.