Most people suffering from mental illness do not obtain treatment. Mental health illiteracy and stigma are common barriers to seeking help. In this study, we investigate the barriers to mental health treatment in Lebanon, a low-to-middle income country (LMIC) in the Middle East that has low levels of help-seeking. We employed a cross-sectional research design, using quantitative and qualitative methods, to assess knowledge, stigma and help-seeking attitudes in a representative sample of Lebanese adults (n=1600) through the Computer Assisted Telephone Interview technique. We found that, while Lebanese scored on the higher end of the knowledge instrument, they exhibited a negative attitude towards mental illness. Social desirability bias and extreme responding style influenced participants’ reported stigma levels. Fear of social stigma was the highest identified barrier for seeking treatment. We discuss how the Lebanese compare to other populations, the factors that were found to predict knowledge, stigma and help-seeking attitudes, and the relation of honor-related beliefs to social stigma in the Lebanese culture. Our findings have implications for culturally similar LMICs. They also hold implications about how we measure attitudes and knowledge in these populations. To our knowledge, this has been the first study primarily intended to assess knowledge and attitudes towards mental illness in Lebanon using a nationally representative sample. Future studies should investigate the impact of knowledge and stigma on important facets of patients’ lives, including treatment compliance, continuation of care and long term clinical outcomes in our population, as it has been reported to impact negatively in Western countries.
Arabic or English speaking Lebanese adults (18-65 years old) with a mobile or landline phone connection.
Computer-assisted telephone interviews were conducted after stratified random sampling of registered phone numbers.
The sample will consist of the general adult Lebanese
population, between the ages 18 and 65, and who are English or Arabic speaking.
Individuals under the age of 18 or over the age of 65 will be excluded because they are considered vulnerable groups; children’s participation may require parental permission which will not be feasible via telephone interview, and the elderly are not within the targeted adult population for this study.