HELP-SEEKING BEHAVIOUR OF PATIENTS ATTENDING

THE PSYCHIATRIC SERVICE IN A SAMPLE OF

UNITED ARAB EMIRATES POPULATION

MOHAMED OMAR SALEM, BADER SALEH, SAID YOUSEF & SUFYAN SABRI

ABSTRACT
Background: Many patients suffering from psychiatric disorders seek non-
professional care before attending specialized services.
Aims: To study the help-seeking behaviour of patients referred to the psychiatric
department of Al-Ain Hospital, which is the main university teaching hospital
in UAE.
Methods: This study was a descriptive cross-sectional epidemiological survey.
All new patients attending the psychiatry out-patient clinic at Al-Ain Hospital were
screened for nine consecutive months from March to November 2003 inclusive.
Results: The sample consisted of 106 patients (52 male; 54 female). Prior to
presenting to the psychiatric service, 44.8% consulted faith healers, 31% of whom
had had a previous experience with them; 45% reported some improvement but their
symptoms recurred later, while 47% reported no improvement. In 8% their symptoms
worsened for the current episode. Treatments received were herbal (29.8%) and
prayer (70.2%). Of the sample, 43.4% consulted a primary care physician before
presenting to the secondary psychiatric care.
Conclusion: In this sample a sizable number of patients sought alternative methods
of treatment before attending the specialized psychiatric services.

Key words: help-seeking, faith healers, psychiatric illness, herbal treatment, prayer

INTRODUCTION

The pathways to psychiatric care are diverse, as a substantial number of patients suffering from
psychiatric disorders seek non-professional care. A wide range of agencies, including traditional
healers, faith healers, general practioners, psychologists and psychiatrists, cater to the needs of
mentally ill patients (Patel et al., 1997). Traditional and faith healers were found to be a major source
of care for people with mental health problems in Pakistan (Saeed et al., 2000). Also, a study in South
India revealed that 45% had sought between one and 15 sessions from healers, and a significantly
higher consultation rate was observed in those patients with schizophrenia and delusional dis-
orders. An average of 30% of patients claimed some benefits from healer consultation (Campion
& Bhugra, 1997). Ethiopians have important beliefs about health and medicine that necessarily
affect their help-seeking behaviour. They believe that excess sun exposure causes skin disease and

International Journal of Social Psychiatry. Copyright © 2009 SAGE Publications (Los Angeles, London, New Delhi,
Singapore and Washington DC) www.sagepublications.com Vol 55(2): 141–148 DOI: 10.1177/0020764008093373
142 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 55(2)

that blowing winds are thought to cause pain wherever they hit. Sexually transmitted diseases are
attributed to urinating under a full moon and people with ‘Buda’ (evil eye) are said to be able to
harm others by looking at them. Most Ethiopians have faith in traditional healers and procedures.
In children, uvulectomy (to prevent presumed suffocation during pharyngitis in babies), the extrac-
tion of lower incisors (to prevent diarrhoea), and the incision of eyelids (to prevent or cure
conjunctivitis) are common (Hodes, 1997). In Turkish communities, magic conceptions of the
pathogenesis of illness have a wide acceptance in some sectors of the population. Magic faith
healers, called ‘Hocas’, are authorities to be consulted for treatment. Their treatment includes ritual
acts intending to negate the harmful influences and to strengthen the healing power and sacred
formulas (Assion et al., 1999). The aim of this work was to study the help-seeking behaviour
of a sample of patients in the United Arab Emirates (UAE) before attending the local profes-
sional psychiatric service.

METHOD

This study was a descriptive cross-sectional epidemiological survey conducted at Al-Ain, which is
a large city in the UAE with a population of over 400,000. This population is of mixed ethnicity,
with the local citizens constituting about one third of the total population.

The sample
All new patients attending the psychiatry out-patient clinic at Al-Ain Hospital and all patients
admitted to the psychiatric ward of the same hospital were screened for nine consecutive months
from March to November 2003 inclusive. Patients aged 17–65 and who gave their consent to
participate in this research were included in the study.

Instrument
The data-collecting instrument used was a questionnaire devised for the purpose of this study,
aiming at exploring the different agencies attended before presenting to the psychiatric service and
its associates. It included socio-demographic data, total duration of illness, presenting symptoms,
precipitating factors, family history of psychiatric illness, pre-morbid personality (gross assess-
ment), the patient’s views towards mental illness and healing, the details of any previous contact
with similar agents (if any) and its outcome, and the psychiatric diagnosis of the patient’s condition.
The psychiatric diagnosis was made by the consultant psychiatrist in charge of the care of the
patient, and according to the ICD10 criteria, in line with the policy of Al Ain Hospital.

Procedure
After seeing the doctor, and when the patient was fit for the interview, the questionnaire was
administered by face-to-face interview in a quiet side room. Occasionally some information was
taken from the accompanying relatives with the patient’s consent.

Statistical analysis
Data was tabulated and expressed in proportions, and statistical analysis was done using SPSS
software (Statistical Package for the Social Sciences, version 15.0) for Windows. The χ2 test was
 SALEM ET AL.: HELP-SEEKING BEHAVIOUR OF PATIENTS 143

used to assess the correlates of faith-healer contact versus socio-economic and socio-demographic
factors and for comparison of frequencies between psychotic and non-psychotic patients and the
frequency of other associated demographic variables like gender, view of the patient towards their
problem (the cause of psychiatric illness), education and marital status. The level p < 0.05 was the
cut-off value for significance.
There are no known conflicts of interest in this study. This study was approved by the Research
Ethics Committee of the Faculty of Medicine and Health Sciences, United Arab Emirates University,
and all authors certify responsibility for the manuscript.

RESULTS

The sample consisted of 106 patients: 52 males and 54 females. The overall response rate for
completion of the study was 89.8%. The mean and standard deviation (SD) of the age of the participant
was 31.3 ± 12.2. Table 1 shows the socio-demographic characteristics of the participants.
Regarding the diagnosis, 22.6% of the patients were diagnosed as suffering from psychotic
disorders, while 77.4% were suffering from a variety of non-psychotic disorders. Nearly half of the

Table 1
Socio-demographic characteristics

n = 106 %
Gender
Male 52 49.1
Female 54 50.9
Age groups
Less than 20 years 21 20.4
20–40 years 58 56.3
More than 40 years 24 23.3
Education
Uneducated (up to ninth grade) 61 57.5
Educated (high school and above) 45 42.5
Nationality
UAE 44 41.5
GCC 23 21.7
Other Arab nationality 25 23.6
Others 14 13.2
Occupation
Skilled, professional and managerial 18 17
Unskilled 10 9.4
Student 24 22.6
Unemployed 31 29.3
Others 23 21.7
Marital status
Currently married 59 55.7
Currently single 47 44.3
144 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 55(2)

Table 2
Diagnosis of psychotic and non-psychotic distribution

Psychotic n = 24 %
Acute psychotic disorder 6 25
Schizophrenia 7 29.2
Bipolar affective disorder 5 20.8
Delusional disorder 4 16.7
Organic psychotic disorder 2 8.3
Total 24 100
Non-psychotic n = 82
Depression 26 31.7
Anxiety 28 34.1
Obsessive compulsive disorder 5 6.1
Personality disorder 5 6.1
Substance misuse 5 6.1
Other 13 15.9
Total 82 100

psychotic group (54.2%) was diagnosed as suffering from acute psychotic disorder or schizophrenia,
while those suffering from bipolar affective disorder, delusional disorder and organic psychotic
disorders comprised 45.8% of the cases. The majority of the non-psychotic group was suffering
from anxiety disorders (34.6%) and depression (30.9%) (Table 2).

Help-seeking behaviour
Of the total sample, 44.8% consulted faith healers before presenting to the psychiatric service, 31%
of whom had had a previous experience with them; 33.3% continued to see the faith healer besides
the psychiatrist. Of the sample, 43.4% consulted a primary care physician before presenting to the
secondary psychiatric care and 82% believed that God acts through doctors or faith healers.

Primary care physicians

Nearly half of the non-psychotic group (49%) consulted the primary care doctor before attending
the psychiatric service. On the other hand, one quarter of the psychotic group (25%) made this
contact (p < 0.034).

Faith healers
Of those who visited faith healers, 64.4% were aged between 20 and 40 years, 53.2% were female
and 31.9% were unemployed.

Outcome of faith-healer intervention

Of those who consulted faith healers, 45% reported some improvement but their symptoms recurred
later, while 47% reported no improvement. In 8% their symptoms worsened for the current episode.
Table 3 shows the association and correlates of faith-healer contact versus socio-economic and
socio-demographic factors.
 SALEM ET AL.: HELP-SEEKING BEHAVIOUR OF PATIENTS 145

Table 3
Association and correlates of faith healer contact versus socio-economic and socio-demographic factors

Faith healer contact

Yes No
n % n % p-value
Age group
Less than 20 years 5 11.2 16 28 0.108
20–40 years 29 64.4 29 50.9
More than 40 years 11 24.4 12 21.1
Gender
Male 22 46.8 29 50 0.745
Female 25 53.2 29 50
Total 47 100 58 100
Education
Uneducated (up to ninth grade) 27 57.4 33 56.9 0.995
Educated (high school and above) 20 42.6 25 43.1
Occupation
Skilled, professional and managerial 8 17 10 17.2 0.217
Unskilled 3 6.4 7 12.1
Student 7 14.9 17 29.3
Unemployed 15 31.9 15 25.9
Others 14 29.8 9 15.5
Nationality
UAE 25 56.8 19 43.2 0.134
GCC 9 40.9 13 59.1
Other Arab nationality 7 28 18 72
Others 6 42.9 8 57.1
Marital status
Currently married 16 34 31 53.4 0.047
Currently single 31 66 27 46.6

Patients’ view towards the cause of their illness

Just over one third of the sample (36.1%) attributed the cause of their symptoms to paranormal
phenomena: mainly black magic, Jinn and evil eye. One third (33%) considered their problems as
a psychiatric illness and the remainder (30.9%) were not sure about the cause of their troubles.
Of the non-psychotic group, nearly half of the depressed patients (48%) and just over one third
of the patients with anxiety disorders (35.7%) made contact with faith healers. On the other hand,
one fifth (20%) of the patients with personality disorders and drug misuse problems made this
contact. A higher proportion of patients with obsessive compulsive disorder (60%) consulted faith
healers before attending the psychiatric service.
More of the psychotic group made contact with faith healers (62.5%), than the non-psychotic
group (39.4%), which was statistically significant (p < 0.047).
Nearly two thirds (64.1%) of the psychotic patients believed that paranormal (culturally accepted)
phenomena (e.g. Jinn, black magic, evil eye) caused their disorders, while only (27.0%) of the
non-psychotic patients had the same beliefs (p < 0.004). The majority of schizophrenic patients
146 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 55(2)

Table 4
Association and correlates of faith healer contact versus diagnosis

Contact with faith healer before hospital p-value

Yes No
Non-psychotic disorder Count % Count % Count %
Depression 12 48 13 52 25 30.9
Anxiety 10 35.7 18 64.3 28 34.6
OCD 3 60 2 40 5 6.2
Personality disorder 1 20 4 80 5 6.2
Substance misuse 1 20 4 80 5 6.2
Other 5 38.5 8 61.5 13 16
Total 32 39.4 49 60.4 81 100
Psychotic disorder
Acute psychotic disorder 2 33.3 4 66.7 6 25
Schizophrenia 6 85.7 1 14.3 7 29.2
Bipolar affective disorder 3 60 2 40 5 20.8
Delusional disorder 3 75 1 25 4 16.7
Organic psychotic disorder 1 50 1 50 2 8.3
Total 15 62.5 9 37.6 24 100
Psychotic disorder 15 62.5 9 37.5 24 22.9 0.047
Non-psychotic disorder 32 39.5 49 60.5 81 77.1
Total 47 44.8 58 55.2 105 100

(85.7%), patients with delusional disorders (75%) and patients with bipolar affective disorders
(60%) made contact with faith healers, more than the organic psychotic conditions (50%) and the
acute psychotic group (33.3%).
Treatments received were in the form of herbal ingredients (29.8%) or prayer, which was the
most common method used by the faith healers (70.2%).
Table 4 shows the association and correlates of faith-healer contact versus the patients’
diagnosis.

DISCUSSION

The findings in this study are consistent with previous studies in other countries. In one study on
a US population, it was concluded that religious faith in healing is prevalent and that most people
believe that God acts through doctors (Mansfield et al., 2002). This is actually the view of most
of our patients according to the doctrine of Islamic faith, which is the religion of most people in
the region. In our study those who sought help from faith healers believed that their illness was
due to one or more of the following: black magic, evil eye or possession by Jinni. Hence, the main
treatment adopted by local faith healers was payer, herbal ingredients or a combination of both.
Also, the findings of our study are in agreement with the study of Campion and Bhugra (1997)
who found a significantly higher consultation rate with healers in those patients with schizophrenia
and delusional disorders.
 SALEM ET AL.: HELP-SEEKING BEHAVIOUR OF PATIENTS 147

It was also reported in a previous study that many patients combine traditional healing practices
with conventional medicine therapies and rarely perceive conflict between them (Kim & Kwok,
1998). Also, Zapata and Shippee-Rice (1999) came to the same conclusion when they studied six
Latinos living in New England. This is an important finding because some traditional and faith
healers’ practices can be of some help in some circumstances. Within African cultures, traditional
and faith healers play an important role in counselling (Semela, 2001), while in southeast Asia,
traditional healers treat drug dependence (Spencer et al., 1980). Again in our study most patients
combined traditional healing practices with conventional medicine therapies and did not perceive
conflict between them. It is apparent that psychiatrists are preferred the least because of stigma.
Psychiatric illness is often accompanied by social stigma, leading to a tendency by the sufferer
and his family to hide the problem and avoid psychiatric treatment. Instead they might prefer to
approach the alternative therapy provider. Also, non-medical causes are attributed to the aetiology
of mental illness in some cultures, making it more logical for them to seek help from other
non-medical facilities (Chadda et al., 2001). So, different factors operate in the decision-
making process in choosing the preferred agency consulted. Physicians need to be sensitive to
patients’ beliefs about faith, and must know why patients sometimes reject medical treatment
(King et al., 1988).

NOTE

This paper was presented orally on the 7th Annual Research Conference of the UAE University on 23 April 2006.

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148 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 55(2)

Mohamed Omar Salem, DPM, FRCPsych, Assistant Professor, Department of Psychiatry, Faculty of Medicine, UAE
University, UAE.
Bader Saleh, CABPsych, Arab Board in Psychiatry, Psychiatric Specialist, Al-Ain Hospital, Al Ain, UAE.
Said Yousef, BSc, Research Specialist, Department of Psychiatry, Faculty of Medicine, UAE University, UAE.
Sufyan Sabri, PhD, Research Specialist, Department of Psychiatry, Faculty of Medicine, UAE University, UAE.
Correspondence to: mohamed.salem@uaeu.ac.ae