Literature Review: Mental Health Treatment in America and Saudi Arabia

This report is a literature review comparing mental health treatment approaches and prevalence rates in the United States and Saudi Arabia. It examines the prevalence of various mental illnesses like depression, OCD, and PTSD, drawing on studies conducted in both countries. The review highlights differences in access to care, treatment modalities (psychotherapy, pharmacotherapy), and the impact of cultural and religious beliefs on mental health perceptions and help-seeking behaviors. The report discusses barriers to treatment in Saudi Arabia, including social stigmas and the influence of traditional healers. The conclusion aims to provide a comparative analysis of mental health treatment, including the frequency of different mental illnesses and treatment approaches in both countries based on the reviewed data, and it emphasizes the importance of critical thinking to address the gaps in mental health services. The review also includes an analysis of the structure of mental health services, including the role of government and private healthcare providers, as well as training and staffing issues.

Running head: MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 1
Hi Dear,
You are still missing this part:
( Your conclusion does not provide :
1- how the Two countries compare in the frequency of occurrence of different types of
mental illness
2- and different types of treatment in the population based on the data you reported in
your literature review.
3- This is the one section I want you to add. At least 1 and 1/2 pages. ) you need to cite.
4-Critical thinking.
Also, and I highlight some words you need to fix the sentences.
I need it Today
Thank you,
Literature Review: Comparing Mental Health Treatment in America and Saudi Arabia
Bowl Al-Shaikh

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 2
Emporia State University
Introduction
Mental health illnesses Batowl, often illnesses is written as illness, and then there are
different types of mental health illness such as depression, etc-present serious medical conditions
that impact individual’s behavior, thoughts, feelings, and moods. A wide range of conditions is
associated with mental illnesses including Depression, Obsessive-Compulsive Disorder,
personality disorders, Posttraumatic Stress Disorder, schizophrenia, bipolar disorder, panic
disorder, posttraumatic stress disorder, eating disorders, and addictive behaviors. These illnesses
affect people of all ages, cultures, religion, incomes, and ethnicities. The World Health
Organization estimates that approximately a quarter of the world’s population suffers from
mental illnesses both in developed and developing worlds. The majority lives in major
industrialized countries such as US and Saudi Arabia. These illnesses are considered to be the
leading sources of disability across the world. As a result, there is a high financial cost linked to

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 3
mental illnesses in the form of mortality and lost productivity. Due to the impact the mental
illnesses have on patients, healthcare and the economy, it is important to study the topic and
provide important insights into the problem. An overview of the literature in relation to mental
health in the United States shows that mental healthcare is a multibillion-dollar industry that has
not yet achieved the goal to serve all those who require mental health treatment. For a long time,
the access to mental health was poor with cost being the largest barrier. An overview of the
literature focusing in Saudi Arabia demonstrates the lack of accurate estimates on the prevalence
of mental illnesses among the population. However, there are few studies on specific mental
illnesses. This literature review explores the treatment of mental illnesses in Saudi Arabia and
the United States with the aim of providing a comparison between the two. The report is
organized into sections, with each section discussing major themes relevant to the topic.
Theme A: Mental health treatment in Saudi Arabia
Prevalence of mental health illnesses
Few studies have been carried out in relation to the specific mental disorders affecting
different populations in Saudi Arabia. Al-Sughayr & Ferwana, (2012) measured the prevalence
of mental illness among 354 high school students who were selected from four schools. The
results indicated that the rate of mental illness stood at 48%. How the prevalence was measured
—a question on a survey? The prevalence was higher among females than in males. Female
adolescents accounted for 51% of the population with mental illnesses while male adolescents
accounted for 41% of the population. However, the study was limited in its relatively small size
and measures used. A cross-sectional study conducted by Alqahtani& Salmon (2008) showed
that depression screening is high, at a rate of 39%, among people in Saudi Arabia. Higher level
of education and gender were found to be significant predictor’s of depression screening with 57

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 4
percent of cases being mild to moderate. Females with low education were more likely to
experience depression compared to those with higher education. The study was conducted
through a survey analysis of 477 patients who utilized services from the general government
hospitals, of whom 33.8% were males, 77.4% were married, and approximately 20% were
illiterate. 49.9% showed signs of depression on the basis of PHQ9 measurement tool, of which
1.0% severe cases, 4.4% moderate-severe, 13.4% moderate, and 31% were mild.
Al-Dabal, Koura, & Al-Sowielem, (2015) found that moderate to severe depression
among primary healthcare consumers was 16%. Depression occurred significantly more among
men than women with common manifestations being eating and sleeping problems as well as
suicidal thoughts. The major predictors of depression were personal history of chronic diseases,
family history of depression or psychiatric diseases, female gender, being unemployed or
unmarried, cardiovascular and skin diseases while predictors of suicidal ideation were low level
of education, female gender, and severe depression. Al-Khathami & Ogbeide (2002) found high
prevalence in mental illnesses among primary health care clinic attendants. To determine the
prevalence, a sample of 609 Saudi adult patients was selected from Al-Kharj, Kingdom of Saudi
Arabia. The cross-sectional epidemiological study involved patients from ages 15-65 years who
attended Family and Community Medicine Clinic from July 2000 to November 2000. The
researcher used the Rahim Anxiety-Depression Scale to screen the patients. The findings showed
that the prevalence of minor mental illnesses stood at 18.2%. Additionally, the prevalence was
significantly higher in women at 22.2% than in men at 13.7%. For the participants aged 15 to 29
years, the prevalence was higher at 23.2% women; compared to 17.8% men among those aged
between 30 and 44 years 8%. Those between ages 45 to 65 recorded a prevalence rate of 7.1%.
Additionally, the rate was high among widows and divorcees at 40% and 43.8%, respectively.

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 5
Patients with Diabetes Mellitus, hypertension and bronchial asthma had a prevalence rate of
16%, 22.2%, and 28.3% respectively. The overall findings showed that a third of all primary
healthcare patients had mental illness. While there is individual initiative to document mental
illnesses in Saudi Arabia, the area of study is still underdeveloped.
Treatment of different mental health illnesses
Depression
Al-Dabal et al. (2015) noted that depression in Saudi Arabia often goes unrecognized.
Additionally, Becker (2004) established that physicians overlook depressive disorders and lack
the necessary skills to identify, respond, diagnose and treat depressive disorders. While
depressive symptoms can be reliably diagnosed and treated by healthcare professionals , fewer
people have access to effective treatment in Saudi Arabia (Al-Shehri, Sabra, Taha, Khamis, &
Hafez, (2012) The study shows that physicians understood psychiatric disorders but had poor
diagnostic skills for depression and somatization. Abdelwahid & Al-Shahrani (2011)
recommend that patients with moderate depression be treated with psychotherapy or
pharmacotherapy. Combined cognitive behavior therapy and antidepressants may be useful in
patients with psychosocial problems, such as marital conflicts, which were linked to depression
in the studies. Patients with severe depression require combined pharmacotherapy and
psychotherapy or pharmacotherapy.
Obsessive-compulsive disorder (OCD)
Mahgoub and Abdel-Hafeiz (1991) established that 97% of subjects in the study
developed OCD before the age of 30 years in Saudi Arabia. The subjects were married and
unmarried women.Tek and Ulug (2001) also establishes that Religious themes were predominant
in these patients. According to Al-Sughayir (2000), most OCD patients in Saudi Arabia are

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 6
treated with medication. However, the pharmacotherapy combined with behavior therapy for
persons with mental illnesses is regarded as an effective treatment. Therefore, ineffective
treatments lower the quality of life of most patients with OCD (Alghamdi & Awadalla, 2016).
Post Traumatic Stress Disorder
Alghamdi, Hunt, and Thomas, (2016) showed that little support is provided to people
suffering from posttraumatic stress disorder in Saudi Arabia. The study assessed firefighters who
were exposed to a range of traumatic events. 57% of firefighters met DSM-IV criteria for PTSD
symptoms. The symptoms were positively correlated with active coping such as religion,
planning and positive reframing and passive coping including substance abuse, behavioral
disengagement, and self‐blame.
Anxiety
Tanios, Abou-Saleh, Karam, Salamoun, Mneimneh, and Karam (2009) shows that
anxiety disorders are common in the Arab world including Saudi Arabia. According to,
cognitive- behavioral therapy (CBT), Pharmacotherapy and other psychological treatment
modalities are necessary in managing panic disorder. Uncomplicated panic disorder is treated at
outpatient care. Patients may also be hospitalized when they are not in capacity to obtain regular
outpatient care.
Personality Disorders
Al-Kawi (1998) recommended an average of three drugs for concomitant use. The author
also recommends an individual focused approach in the treatment of personality disorder and the
use of available psychotropic medication. The study by Hafizi, Tabatabaei, and Koenig, (2014)

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 7
involved 429 medical students schooling at Tehran University of Medical Sciences. The study
results a negative correlation between Borderline Personality Disorder and Religion.
Access to mental health treatment
In the past three decades, the Kingdom of Saudi Arabia has developed a comprehensive
hospital-based mental health system that culminated in the passing of a mental health law in
2014. However, the country has not yet sufficiently implemented the mechanism for protecting
human rights of psychiatrists. The Ministry of Health along with other government agencies is
the main providers of mental health services. In the early 1980s, only two psychiatric hospitals
operated in the country. Psychiatric training was also underdeveloped with practitioners reaching
the highest possible level of Diploma (Koenig, Al Zaben, Sehlo, Khalifa, Al Ahwal, Qureshi, and
Al-Habeeb, (2014). Professionals who wished to pursue psychiatric consultancy studied their
undergraduate studies abroad. A large number of consultant psychiatrist and nursing staff were
non-Saudis. Psychiatric treatment was largely focused on medication and physical restraint was
commonplace. The Ministry of health began decentralizing psychiatric services in 1983 and
established dozens of regional psychiatric hospitals. By 2014, there were numerous psychiatric
clinics, free-standing private and psychiatric clinics based in different areas of the country and
more than 125 private general hospitals offering mental health services. Another improvement in
the mental health service provision is the implementation of the national mental health policy in
2006 that included special programs for individuals with addiction adolescents, children, the
elderly, as well as consultation-liaison services in medical settings. However, hospitals are the
main specialist providers, with community mental health services provided by primary care
physicians (Koenig et al., 2014).

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 8
Mental health training has become increasingly available with more than 1126
psychologists, occupational therapists and social workers, and 700 psychiatrists working in
mental health in 2010 (Koenig et al., 2014). According to Aldeham, (2009), there is a large
number of senior staff members who are Saudi Nationals although some staffs are still non-
Saudis (Aldeham, 2009). The demography of staff offering mental health services is relevant due
to culture and religion of Saudi psychiatric patients. There is evidence that mental health
illnesses often go underdiagnosed, with people often understanding their experiences from
religious perspectives (Alqahtani & Salmon, 2008) and choosing to use the services of traditional
healers (Al-Habeeb, 2003).
Barriers to mental health treatment
There are a number of individual, social and economic elements that act as barriers to
mental health treatment in Saudi Arabia. These include religious ideologies, social beliefs, and
superstitions. These factors influence people’s perception of mental health illness causes and
treatment. The doctrines and attitudes are significantly impacted by culture and can affect how
populations perceive and seek help for mental health illnesses. Koenig et al. (2014) established
that patients attributed their mental illnesses to spiritual causes such as demons.
As a result, the beliefs lead patients to religious advisors, faith healers and other agencies
that provide non-medical treatments. However, the non-medical practitioners may prove to be
helpful in some circumstances as they may offer counseling to patients on how to go about their
lives. On the other hand, they can also derail recovery as they do not provide any form of
medical intervention. A significant number of patients who seek help from healthcare
organizations are likely to have visited non-medical practitioners. However, the majority reports

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 9
no change in their situations or their conditions may worsen. Therefore, belief that supernatural
forces are the main causes of illnesses drives people to seek spiritual forms of non-medical help.
Culture plays a role in acerbating these barriers. Saudi Arabia is a conservative country
with a large Muslim population that maintains a considerable part of its traditional beliefs. The
supernatural spirits called “Jinn” and supernatural powers such as “the evil eye” are often
attributed to mental healthcare problem. Therefore, the beliefs stem from a mixture of cultural
and Islamic ideologies. Alahmed, Anjum, & Masuadi, (2018) looks at mental illness stigma
among 870 staff members working at a large healthcare organization in Al-Ahsa. They report
that a majority of the participants perceived mentally ill patients to be dangerous, thus leading to
discriminatory behavior towards them. The aim of the researchers was to identify how Saudi
healthcare students perceived mental illness and its etiology, help-seeking behavior and
treatment interventions. The data did not show any difference between Shia and Sunni?
Mental health treatment in the United States
Prevalence of mental health illnesses
According to a report by Mental Health America (2017), 18.29% of adults struggle with a
mental health problems every year. The percentage is equivalent to 43.7 million Americans. The
longitudinal study aimed at determining the prevalence of mental health in different states in the
United States. The prevalence ranges from 22.66% in Oregon to 16.03% in Florida. The
percentage of people that reported thoughts of suicide amounted to 3.94%, equivalent to 9.4
million people. The figures vary from state to state. Mental illness has a significant impact on
health outcomes such as healthcare spending, patient satisfaction, length of stay and quality of
life of individuals with patients suffering from severe mental illnesses such as bipolar disorder,
major depressive disorder, or schizophrenia living approximately 25 years lesser than others. A

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 10
third of people with serious mental health illnesses do not receive adequate treatment necessary
to reduce the impairments caused by the mental health condition suffered. Additionally, this
population is likely to be more likely to experience violent crimes, as opposed to being
perpetrators of violence. Approximately 4% of violent crimes are tied to a perpetrator’s mental
illness and individuals suffering from different mental illnesses are ten times likely to be the
victims of violence compared to the general public. The relationship between mental diseases
and poverty in the United States is complicated; however, those with severe mental illnesses are
likely to live in poverty.
According to MHA, (2017) estimates 25% of homeless Americans suffer from serious
mental illnesses. From depression to schizophrenia, the United States has experienced a rise in
mental illnesses, especially among teens and women. Accordingly, suicide rates have gradually
increased in the past one and half decades as 90% of people who commit suicide are diagnosed
with an underlying mental illness (MHA, 2017). The steady increase in mental illnesses has
been attributed to economic stagnation, social changes including rising divorce rates, feeling
hopeless, poor job prospects, chronic disease, no or limited health insurance, and low income
(Bagalman & Napili, 2014).
Treatment of different mental illnesses
Depression
Olfson et al. (2016) established that treatment of depression from 46,417 responses to the
Medical Expenditure Panel Surveys. The participants were US households by participants aged
18 years and older. The study outcomes showed that a 47 percent of adults with screen-positive
depression stratified by serious psychological distress. The evidence showed that majority of
patients had treatment disparities in their treatments based on factors such as age, ethnicity, race

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 11
or any type of insurance. The aim of the study was to assess whether disparities in treatment
were due to differences in initiation or to differences in the quality of treatment once treatment
had began. A logistic regression model showed that depression treatment for participants with
self-reported depression were higher. However, African Americans and Latinos were less likely
to take antidepressant prescription compared to Caucasians. African Americans received
inadequate course of psychotherapy than Latinos and Caucasians Are you sure about this? Need
Citation .ِ Participants without insurance cover were less likely to initiate any depression
treatment compared with participants who did not have insurance. Additionally, elderly persons
were less likely to receive an adequate counseling and course of psychotherapy compared to
younger persons. Therefore, disparities in depression treatment are attributed to differences in
rates of initiation of depression treatment.
Obsessive-compulsive disorder (OCD)
Blanco, Olfson, Stein, Simpson, Gameroff and Narrow (2006) established that OCD
continues to be an area with substantial opportunity for quality improvement continues to be an
important area of advances despite important advances in the efficacy of psychological and
pharmacologic. To examine the treatment of OCD, the researcher obtained a nationally
representative sample of psychiatrists and analyzed physician-reported data recorded between the
years 1997 and 1999. The results showed that 65% of patients received serotonin reuptake
inhibitors (SRI) 39.4% of sample patients who received SRI had their dose titrated. “thought
titrated”—what does this mean> ?? 7.5% of participants received cognitive-behavioral therapy
with or without medical treatment. The most common prescription was antipsychotics or
benzodiazepines, often in the absence of an SRI. Do not clearly understand this paragraph

MENTAL HEALTH TREATMENT IN AMERICA VS. SAUDI ARABIA 12
Roberts, Gilman, Breslau, Breslau and Koenen (2011) aimed at establishing the race and ethnic
differences related to post-traumatic stress disorder based on risk for PTSD and trauma exposure
among those exposed to trauma, and seeking treatment among Hispanics, Blacks, Whites, and
Asians in the US general population. 34,653 adults were interviewed between 2004 and 2005.
The results show that PTSD affects US race or ethnic minorities is this result a surprise and, if
so, why? Explean . It is often untreated. The study shows the need to focus treatment on specific
populations that have been underserved in the United States. In Saudi Arabia, mental health
issues remain prevalent. While there have been significant improvements in the past, more
efforts are required. Saudi Arabia is a conservative country with a large Muslim population that
maintains a considerable part of its traditional beliefs. The supernatural spirits called “Jinn” and
supernatural powers such as “the evil eye” are often attributed to mental healthcare problem.
Therefore, the beliefs stem from a mixture of cultural and Islamic ideologies.
Anxiety and personality disorder
Anxiety and personality disorder often goes unrecognized in public healthcare settings
(Olfson, Blanco, & Marcus (2016). A number of earlier studies such as Angold, Costello,
Farmer,Burns, and Erkanli (1999) and Davis, Ressler, Schwartz, Stephens and Bradley 2008),
have shown that physicians often overlook anxiety and personality disorder symptoms and lack
the needed skills for recognizing, responding, diagnosing, and treating the problem.
Treatment of different mental health illnesses
A number of strategies have been previously adapted to solve the mental health problem
among patients. These strategies can be categorized into five general interventions. They
include improving the accessibility of healthcare services, counseling, building skills, providing
information and providing a safe and supportive external environment. Improving accessibility to