While research on the symptoms and treatments of mental health abounds, studies on the stigma that prevents people from seeking care in the Arab world, though growing, are limited.   

In communities where mental illness is associated with shame, explained away or seen as best handled privately, individuals tend to delay professional support until daily life becomes harder to manage. For young adults, these developmental years can negatively impact their self-esteem, with repercussions on their education, careers, and relationships.   

To guide better outreach, improve services and reduce preventable suffering, a multidisciplinary team of LAU faculty investigated the correlation between stigma and real-world help-seeking in a study titled “Cultural stigma, psychological distress and help-seeking: Moderating role of self-esteem and self-stigma in Lebanon,” published in PLOS One.  

The research was led by Dr. Myriam El Khoury-Malhame, associate professor at the School of Arts and Sciences (SoAS),  Dr. Toni Sawma, assistant professor at SoAS,  and Dr. Rita Doumit, associate professor at the Alice Ramez Chagoury School of Nursing. The team also included two LAU student co-authors alongside collaborators from Lebanon and Saudi Arabia.   

Using an online survey shared between February 2023 and August 2024, the researchers collected responses from 245 participants aged 18–40 across Lebanon, all of whom reported a clinical mental health diagnosis. 

Data collection was a challenging part of the study, noted Dr. Khoury-Malhame and Dr. Sawma.  “Many participants already struggle with enough distress to fill scales,” they said, and reaching participants “who either do not have internet access or reside outside main districts of Beirut, Metn and Keserwan” was particularly difficult. 

The findings showed that openness to care is partly shaped by exposure, learning and life experience, not only need. Individuals who reported higher levels of stigma and distress were less likely to seek professional help, whereas those with higher self-esteem exhibited more positive attitudes toward seeking help. 

A parallel effect for self-stigma was also found.  Practically, this means that anti-stigma efforts, besides sharing information, may be more effective when they build self-worth and reduce internalized shame.   

When it comes to age and education, older participants and those with higher levels of education had significantly more positive help-seeking attitudes. By contrast, the difference by gender was not statistically significant.  Addressing the last finding, Dr. Khoury-Malhame and Dr. Sawma noted that the result, while seemingly surprising, may be explained by several factors. “Psychological variables may overshadow gender-based differences,” they observed, particularly in a sample where “both genders have similar exposure to mental health literacy, and shared sociocultural influences.”

Other possible explanations, they added, included higher self-esteem among men, which is a strong predictor of help-seeking, as well as the influence of collectivist environments, where shared social norms and a fear of stigmatization may shape help-seeking attitudes more strongly than gender-specific expectations. 

When asked, Dr. Khoury-Malhame and Dr. Sawma also pointed out several additional factors that could help build a more complete picture for policymaking. These include the structural availability of care, such as cost, insurance coverage, and geographical access to services; specific cultural and religious backgrounds, among which rural-versus-urban differences and the role of religious beliefs; family history of mental disorders and family-level stigma; and levels of mental health literacy. They also highlighted the importance of studying differences by diagnosis.

The study’s recommendations for policymaking entail interventions both at the individual level, where self-esteem and self-stigma shape willingness to seek care, and at the institutional level, where systems must ensure that support is available, affordable, and culturally responsive.  

What is needed are programs that strengthen self-esteem, normalize help-seeking and challenge harmful stereotypes to make professional support feel accessible and acceptable.   

To browse more scholarly output by the LAU community, visit our open-access digital archive, the Lebanese American University Repository (LAUR).