Arab Men and Women’s Conceptualization of Mental Health and Depression: A Qualitative Study from the Middle East
Cardiovascular diseases are the leading cause of death worldwide. Among cardiovascular patients, depression is associated with an increased morbidity and mortality. Understanding how depression is conceptualized from cardiovascular patients’ perspective can help with prevention, early detection, and treatment for depression. This might reduce cardiovascular morbidity and mortality, and save health care costs. To the best of our knowledge, there is no study in the Gulf region exploring depression among Arab cardiovascular patients. The purpose of this exploratory ethnographic qualitative research is to investigate how Arab male and female patients with cardiovascular disease conceptualize mental health and depression. Two theoretical frameworks guided this research: (1) The Ecological Perspective, and (2) Kleinman’s Explanatory Model of Health and Illness. Using maximum variation purposive sampling, thirty (30) male and twenty-five (25) female, self-identified, Arab cardiovascular patients were recruited as research participants. Individual in-depth interviews were conducted using a semi-structured questionnaire. Thematic analysis was performed to generate themes. Nvivo 10, a qualitative data analysis software, was used to organize the narrative data. The participants in this study placed great emphasis on the manifestations of mental illness and their impact on both themselves and their families. Four major themes were identified from their narratives: psychological and physical disturbances; unfavorable personal characteristics; work issues and financial constraints; lack of family and social support. The knowledge generated in this study might help increase awareness, prevention of and treatment for depression among cardiovascular patients in Qatar. The findings from this study can also be used to inform a multi-disciplinary and multi-sectoral intervention approach that is contextualized to meet the mental health care needs of Arab cardiovascular patients, thus reducing cardiovascular diseases morbidity and mortality in Qatar and the Gulf region.
KeywordsDepression in cardiovascular patients Mental health in the Gulf region Arab mental health Mental health in the Middle East Arab cardiovascular patients Qualitative research
This publication was made possible by a grant from Qatar National Research Fund under its National Priority Research Programme (NPRP 5-106-3-025). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of Qatar National Research Fund. The authors are grateful to all the patients who participated in this research, as well as to the Qatar National Research Fund which provided us with funding to conduct this study. The authors give their special thanks to staff at the Hamad Medical Corporation (Hamad General Hospital) who helped us recruit research participants. The authors thank our project manager IremMueed and research assistants Shima Sharara, Sarah Omar, Noha El Banna and Tamara Marji.
Compliance with Ethical Standards
Conflict of interest
None of the authors have any competing interests.
Ethics approvals were obtained from: the Hamad Medical Corporation Research Committee (Reference NO: RC/59412/2012), Qatar Supreme Council of Health (SCH-A-UCQ-050), and the University of Calgary’s Conjoint Health Research Ethics Board (E-24738).
- 1.Dovzhenko TV, Vasiuk IA, Semiglazova MV, Krasnov VN, Lebedev AV, Tarasova KV. The clinical picture and treatment of depression spectrum disorders in patients with cardiovascular disease. Ter Arkh. 2009;8(12):30–4.Google Scholar
- 5.Bener A, Al-Suwaidi J, El-Menyar A, Al-Binali H. Effect of hypertension on acute myocardial infarction: a cross-cultural comparison. Med Hypotheses Res. 2006;3(1):637–42.Google Scholar
- 6.Chanpong GF. Qatar world health survey overview. Doha: Department of Public Health National Health Authority; 2008Google Scholar
- 7.Hamad Medical Corporation. Inpatient discharge diagnosis of the Hamad Medical Corporation. Doha: Hamad Medical Corporation; 2009Google Scholar
- 8.MedicineNet.com. Depression. 2010. From: http://www.medicinenet.com/depression/article.htm.
- 9.American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR, 4th ed. Worcester: American Psychiatric Association; 2010.Google Scholar
- 23.Lichtman JH, Bigger JT Jr, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council onClinical Cardiology,Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 2008;118:1768–75.CrossRefPubMedGoogle Scholar
- 26.Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S. INTERHEART investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case–control study. Lancet 2004;364:953–62.CrossRefPubMedGoogle Scholar
- 32.Al-Krenawi A, Graham JR, Al-Bedah EA, Kadri HM, Sehwail MA. Cross-national comparison of Middle Eastern university students: help-seeking behaviors, attitudes toward helping professionals, and cultural beliefs about mental health problems. Community Ment Health J. 2009;45:26–36.CrossRefPubMedGoogle Scholar
- 39.Donnelly TT, Al Suwaidi J, Alqahtani A, Asaad N, Abdul Qader N, Byrne C, Singh R, Fung TS. Study exploring depression and cardiovascular diseases amongst Arabic speaking patients living in the State of Qatar: rationale and methodology. Glob Cardiol Sci Pract. 2012; http://www.qscience.com/doi/pdfplus/10.5339/gcsp.2012.24.
- 40.Donnelly TT, Al Suwaidi J, Alqahtani A, Asaad N, Fung TS, Singh R, Qader A, N (July. Mood disturbance and depression in Arab women following hospitalisation from acute cardiac conditions—a cross sectional study from Qatar. Br Med J. 2016;6(7):1–8. http://bmjopen.bmj.com/content/6/7/e011873.full.pdf+html.
- 41.Donnelly TT, Al Suwaidi J, Alqahtani A, Asaad N, Fung TS, Singh R, Qader NA. Association between socioeconomic factors and depression among cardiovascular patients living in rich resourced Middle Eastern Country. Int J Cardiol 2016;203:819–821. Published ahead online at http://authors.elsevier.com/a/1S3OIc5r~7e1V.
- 42.Epp J. (1986). Ottawa: health and welfare Canada. Achieving health for all: a framework for health promotion. Frcentre. Retrieved from http://www.frcentre.net/library/AchievingHealthForAll.pdf.
- 43.World Health Organization. Ottawa charter for health promotion. First International Conference on Health Promotion. Geneva: World Health Organization; 1986.Google Scholar
- 45.Sampson RJ, Morenoff JD. Public health and safety in context: lessons from community-level theory on social capital. In: Smedley BD, Syme SL, editors. Promoting health: intervention strategies from social and behavioural research. Washington, DC: National Academy Press; 2000. pp. 366–89.Google Scholar
- 46.Sallis JF, Owen N. Ecological models of health behavior. In: Glanz K editor. Health behavior and health education. New York: Jossey-Bass; 2002. pp. 462–84.Google Scholar
- 47.Lalonde M. A new perspective on the health of Canadians: a working document. Ottawa: Minister of National Health and Welfare; 1974.Google Scholar
- 48.Green LW, Kreuter MW. Health promotion planning: an educational and environmental approach (2nd ed.). Mountain View: Mayfield; 1991.Google Scholar
- 50.Hamilton N, Bhatti T. Population health promotion: an integrated model of population health and health promotion. Ottawa: Health Canada; 1996.Google Scholar
- 51.Vollman AR, Anderson ET, McFarlane J. Canadian community as partner: theory & multidisciplinary practice. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott, Williams & Wilkins; 2012.Google Scholar
- 52.Poland BD, Green LW, Rootman I. Settings for health promotion: linking theory and practice. Thousand Oaks: SAGE; 2000.Google Scholar
- 54.Kleinman A. Patients and the healer in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry. London: University of California Press; 1980.Google Scholar
- 56.Morse JM. Designing funded qualitative research. In: Denzin NK, Lincoln YS, editors. Handbook of qualitative research. Thousand Oaks: SAGE; 1994. pp. 220–35.Google Scholar
- 58.Schwandt TA. Constructivist, interpretivist approaches to human inquiry. In: Denzin NK, Lincoln, editors. Handbook of qualitative research. Thousand Oaks: SAGE; 1994. pp. 118–37.Google Scholar