Bridging the gap: culturally sensitive approaches to Middle Eastern mental health

Mental health has no borders, yet the methodologies employed to understand and address it must be as diverse and personalized as the individuals it affects, since it is intricately interwoven with the sociocultural determinants that shape our lives. In the context of Middle Eastern mental health, a call for culturally sensitive approaches is not a mere suggestion; it is a requirement and an ethical prerequisite. As we explore the critical importance of cultural sensitivity in mental health research and practice across regions, we try to uncover the challenges and opportunities that lie ahead.

The Middle Eastern region is a tapestry of cultures, each with its own traditions, beliefs, and languages.¹ In this context, implementation of culturally sensitive methodologies encounters many challenges. Understanding and addressing these determinants is crucial for providing effective, culturally sensitive mental health care. Otherwise, there is a risk of conducting biased studies and implementing interventions that will not accurately measure what they are intended to,² resulting in unreliable and untrustworthy data. For example, a research conducted in a Palestinian refugee camp on behalf of the NGO Handicap International in Lebanon evaluated the prevalence of mental disorders among children and adolescents using an internationally validated scale; results indicated a high prevalence (exceeding 80%). However, this rate cannot be taken to represent the actual prevalence of mental disorders accurately in these young individuals. The scale lacked cultural validation and overlooked the specific historical context of the population (El Husseini M., personal communication, February 2010). Other studies by transcultural teams³,⁴ working with migrant populations have emphasized diagnostic errors due to cultural biases inherent in European and North American psychiatric categories. These errors confine patients within their psychopathology because the psychiatric perspective does not align with their own etiological theory of their distress.

Some important sociocultural determinants to consider are, first, stigma and stereotypes. One of the pervasive and prevalent sociocultural determinants affecting mental health care in this region is stigma, which inhibits individuals from seeking help. Sociocultural norms and attitudes toward mental health issues can vary widely, and understanding these dynamics is essential for implementing effective interventions. Moreover, outdated stereotypes and misinformed perspectives on mental health are still pervasive, making it difficult to initiate conversations about these topics.

A second fundamental point is religion and spirituality. Religion plays a profound, significant role in the lives of many if not most individuals in the Middle Eastern region, shaping their mental health experiences. It is not uncommon for individuals to seek solace, support, and strength in their faith. However, these same faith traditions can also exert psychological pressure on individuals, creating expectations and taboos that surround mental health issues, and some may face challenges related to religious and cultural expectations. In Lebanon, for instance, there are 18 separate religious communities, each of which expresses its faith in a myriad of distinct ways.⁵ Acknowledging the interplay between religion and mental health is essential to providing culturally sensitive care.

Another salient point involves gender roles and expectations. These are very rigid in some Middle Eastern cultures and may affect how mental health issues are perceived and addressed. Notions of masculinity, for instance, can deter men from openly acknowledging their mental health challenges.

Language is also an essential aspect of culture. Ensuring effective communication in a person’s native language is crucial for accurate diagnosis and treatment. Language barriers can impede access to care and create misunderstandings, consequently yielding unreliable tools and data in the realm of mental health research.¹ Language leads to another fundamental point: migration and acculturation. Many individuals in the Middle Eastern region have experienced migration or have been part of multicultural societies. The challenges of acculturation and the balancing of multiple cultural identities are important determinants. This region has seen conflict and displacement, leading to unique mental health challenges such as trauma, loss, and adjustment difficulties for affected individuals and communities.

Finally, access to mental help should be added to this list. Socioeconomic factors affect access to mental health resources. Addressing disparities in health care services within culturally sensitive methodologies is vital. Sociocultural pressures may lead to silence. The importance of culturally competent mental health care providers cannot be overstated; it is a key determinant in providing effective care. Professionals and researchers need to understand and respect the cultural context of their patients. Such cultural competence is not merely an option, but a necessity in delivering mental health support. To bridge the gap in access to mental health services, addressing these challenges demands a nuanced understanding of the region’s sociocultural determinants and a commitment to culturally sensitive methodologies. By comprehensively considering these determinants and acknowledging the challenges they pose in each Middle Eastern culture or subculture, practitioners can provide effective reliable mental health care and research to the whole region.

In conclusion, the landscape of mental health in the Middle Eastern region is shaped significantly by sociocultural determinants, from religion and stigma to gender roles and language barriers. Recognizing these determinants is a crucial step towards providing effective and culturally sensitive mental health care. It is essential that mental health professionals, policymakers, and communities collaborate in establishing a supportive environment where individuals can seek help without fear of shame. Culturally sensitive mental health approaches, rooted in a profound comprehension of their sociocultural milieu, are the only way forward. By embracing diversity and acknowledging the complexities of this specific region, we can ensure that mental health care is accessible and effective for all, irrespective of their cultural backgrounds.

Acknowledgments

SZ would like to acknowledge the Bolsa Doutorado Nota 10 scholarship awarded by Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), for the financial support which made this research possible.

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Edited by

Handling Editor: Andre Brunoni

Publication Dates

• Publication in this collection
  07 Oct 2024
• Date of issue
  2024

History

• Received
  27 Nov 2023
• Accepted
  31 Jan 2024