What is mental health?

Mental health refers to the overall functioning of the mind including the emotional and psychological state of an individual. It is about the coping ability of a person i.e. how efficiently a person can deal with different situations in his/her life. I will clarify a common misconception about mental well-being that it is the mere absence of mental illnesses or disorders. Rather, it is extended to having the general feeling of satisfaction and contentment in one’s life. According to World Health Organisation (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”

Mental health conditions in the Middle East

According to a recent global study, the Middle Eastern region suffers from the highest rates of depression, anxiety disorders, PTSD (Post Traumatic Stress Disorder), and suicide. Furthermore, there is a lack of awareness about mental health, limited mental health services, and stigmatization which worsens the situation.

Depression

According to the American Psychological Association (APA), depression is the most common mood disorder, characterized by feelings of sadness and loss of interest. People may feel worried, low, worthless, and frequently sad. However, when this feeling consistently lasts over a certain length of time, it turns in to clinical depression.

According to DSM-V (Diagnostic and Statistical Manual for Mental Disorders), professionals diagnose depression when a person has been persistently experiencing the following conditions (at least five of them) for two or more than two weeks and is causing a significant and observable impairment in the daily functioning of the individual:

• Depressed mood (low feelings, sad, hopeless, irritated, or even teary) for most of the day
• The feeling of worthlessness and increased guilt
• Insomnia (sleeplessness) or hypersomnia (excessive sleep throughout the day)
• Loss of appetite or increased appetite
• Less interested in almost every activity
• Feeling of restlessness, agitation, or slowed down
• Lack of energy or feeling of tiredness and fatigue for most of the time
• Difficulty (or even inability) in concentrating, thinking, and making decisions almost every day
• Persistent thoughts about death or thinking/planning about suicide as well as suicidal attempts in most of the cases.

Note: The presence of the above symptoms cannot be explained by any other medical or psychological condition and are not attributable to use of drugs, alcohol, etc.

Factors involved in causing depression

Different factors that contribute to developing depression may include:

1. Biological causes: including the genetics, the biological makeup of an individual, hormonal and neuroendocrinological system. Twin studies provide the evidence that depression may run in families. Some individuals are biologically predisposed to depression. Different neurotransmitters do also play role in developing and regulating depression such as serotonin, norepinephrine, and adrenaline. Imbalance in the hormones may contribute to the feelings of depression. Furthermore, it can also be explained by gender, as women tend to experience depression more than men.

2. Environmental Factors: Different environmental conditions contribute to depression. Environmental stressors associated with depression include: exposure to stress over a long period of time; traumatic and stressful past experiences; family dynamics; loss of a loved one; childhood abuse or maltreatment; natural disasters or catastrophic events; physical stressors i.e. noise pollution, excessive workload, etc. The people you are surrounded by can also play a significant role, this is because being in pessimistic company can affect your own thinking patterns and you may develop depression over time. 

3. Personal Characteristics: Research suggests that several personality characteristics and temperament of an individual serve as a risk factor for developing depression. People who are shy, have low self-esteem, lack self-confidence, work as perfectionists, and are self-critical are more prone to developing depression. People who are self-focused may develop depression. In addition, faulty cognitive abilities and thinking patterns may also end up with depression.

Depression results in the combined interplay of the above-mentioned factors – they do not individually serve as a contributing factor. People who are biologically predisposed to depression are at a risk of developing it, depending on the conditions of the environment they are exposed to. Similarly, a person having no prior family history of depression, but is exposed to the stressful environment over a longer time may develop depression, in conjunction with a vulnerable personality type. So, the more risk factors combined for a person, the more they are vulnerable to depression.

Keeping in view the Middle East, environmental factors play a major role in developing depression and anxiety. As mentioned above, this region is experiencing the highest rates of depression. Let us have a look at the factors that are contributing towards depression in the Arab World.

Prevalence of depression in the Middle East and the contributing factors

According to a recent study, the Arab World is facing greater problems of depression, compared to the rest of the World. The unique challenges faced by this region makes it the most depressive region throughout the World, some of which are discussed as follows:

1. i) Stigmatization: Stigmatization of any mental health condition (in any region) worsens the problem. A society where mental health problem is associated with shame, disgrace, and disrespect and is considered as a taboo, people hesitate to talk about their mental health problems and are less likely to seek medical and psychological help. The internalization of the problems results in increasing mental stress, which ultimately leads towards clinical depression and even suicides in most of the cases.
2. ii) Lack of mental health awareness and psychological help: Despite increasing mental health awareness throughout the World, the Arab World is still lacking it. The Arab World has an Islamic culture, where mental health is mostly linked with religion. People are encouraged to deal with their mental health issues by maintaining a good relationship with God, involving in religious activities and not to discuss your problems with others, due to the influence of culture. A limited professional psychological help is provided, but due to the cultural and religious beliefs, most people keep their issues to themselves and do not seek professional help, resulting in higher levels of depression in the region (Pocock, 2017).

Apart from these factors, there are many others which contribute to the development of depression, including:

1. Increase usage of cell (mobile) phones and less social interaction

Today, teenagers and adults are increasingly using cell phone. This leads to a decline in social interaction which may lead to isolation. Excessive usage and late-night wakefulness cause insomnia, poor concentration, laziness, and fatigue. These all are contributing factors in depression.

2. Lack of physical activity

Due to increased technology, people spend much of their time in their homes and thus there is physical inactivity. Even in the work environment, many people conduct their work whilst seated. A lack of physical activity causes fatigue and this also contributes towards depression.

Treatment

Various types of treatment are used for the cure of depression including medical and psychological treatment.

The medications used for the treatment of depression do not cure it completely, instead, they help to manage it.  These may include antidepressants, mood stabilizers, and even antipsychotic drugs, for severe cases.

Psychological treatment involves different therapies including CBT (Cognitive Behavioural Therapy), IPT (Interpersonal Therapy) and MBCT (Mindfulness-based Cognitive Therapy). The main focus of all these therapies is to improve the thinking patterns and behaviours of the person towards life, that would help to keep him safe from being stressed. These are aimed to change your perspective of looking at problems, shifting negative patterns of thinking to rationalization, create a problem-solving attitude, improve relationships, and focus on the present to cope with various life problems.

Besides the professional treatment, one can get rid of depression through support groups, as well as maintaining a healthier lifestyle.

Prevention

Once you have suffered from depression, there is a high chance of experiencing a relapse despite having received treatment. So, it is important to know how to manage it and keep yourself safe from getting it again.

Here are some prevention strategies that can help to maintain good mental health:

• Having a healthy and good life style
• Practising positive thinking patterns
• Learn to cope with stress through exercise and other positive ways (including reading books, meditation, talking to a friend, etc.)
• Seeking out mental help when in trouble.

Conclusion

There is a dire need to increase mental health awareness in the Middle East, in order to overcome the growing rate of depression and other related mental health issues in the region. As there are many people suffering in the Arab World, including due to the political situation, people should be educated to have a better understanding of mental health and to stop stigmatization. Furthermore, governments should increase better medical and psychological help facilities to control this situation.