Received: 21 February 2017 Revised: 6 June 2017 Accepted: 2 July 2017

DOI: 10.1111/ppc.12232

ORIGINAL ARTICLE

Cultural misconceptions and public stigma against mental

illness among Lebanese university students

Ahmad Rayan PhD1 Mirna Fawaz PhD2

1 Faculty of Nursing, Zarqa University, Zarqa,

Jordan
2 Faculty of Health Sciences, Beirut Arab
University, Beirut, Lebanon
Correspondence
Ahmad Rayan, Zarqa University, Faculty of
Nursing, Zarqa, Jordan.
Email: Ahmed_rayan87@yahoo.com, with a copy
to the Editor: e426@twc.com
Abstract
Purpose: The purpose of this study was to examine cultural misconceptions about mental illness
and how they are associated with the public stigma against mental illness among Lebanese univer-
sity students.
Methods: A sample of 203 participants completed the study. Data about cultural misconceptions,
attitudes about mental illness, and public stigma of mental illness were obtained. The researchers
examined the mean difference in public stigma according to cultural beliefs about mental illness.

Results: The majority of students believe that mental health professionals have inadequate knowl-
edge and expertise to treat mental disorders. Various cultural misconceptions about mental illness
were reported. Public stigma significantly differed based on these cultural misconceptions.

Conclusion: Psychiatric nurses should play a vital role in reshaping the inappropriate cultural view
about mental illness.

KEYWORDS
culture, Lebanon, mental illness, misconceptions, stigma, university students

1 INTRODUCTION
Stigma against mental illness involves labeling, stereotyping, and
rejecting people diagnosed with mental illness.1 The public stigma
against mental illness represents the discrimination directed at peo-
ple suffering from mental illness by the larger population or the
community.2 Self-stigma occurs when people diagnosed with mental
illness believe that they are less valued because of their mental illness.3
The stigma against mental illness may lead to social exclusion of peo-
ple with mental illness and affect patients’ willingness to seek mental
health care.4
Culture-specific perceptions were viewed as affecting both the
patients living with mental illness and people living in the community.5
Cultural factors often influence beliefs about the cause and treatment
of mental illness and shape the public attitudes toward people diag-
nosed with mental illness.6 Addressing the cultural beliefs associated
with stigma against mental illness is of special importance in the Arab
world, where most of the people diagnosed with mental illness suffer
from war-related mental health consequences and living in poverty.7
In addition, people diagnosed with mental illness living in the Arab
word might refuse seeking formal psychological help due to cultural
stigma.2,8 Identification of the cultural attitudes and beliefs associated
with stigma against mental illness has direct implications for culturally
tailored interventions for reducing public stigma against mental ill-
ness. In this study, the researchers examined the association between
cultural misconceptions about mental illness and public stigma against
mental illness among Lebanese university students.
2 BACKGROUND
Mental illnesses are widespread in Lebanon, with prevalence compa-
rable to that in Western Europe.9,10 The war-associated trauma, inter-
nal conflictions, and political insecurity in the Middle East Region have
augmented the emergence of some mental health problems.10–12 With
respect to research conducted by the American University of Beirut,
rates of posttraumatic stress disorder (PTSD) and depression have
reached 30% in some areas of southern Lebanon.12 Prevalence rates
of PTSD ranged from 8.5 to 14.7% for the civil war, 3.7% for teenagers
with sensory impairments, 21.6% for the Grapes of Wrath War, and
15.4 to 35.0% for the 2006 July War.13 Furthermore, it is estimated
that 152 people in Lebanon die annually due to suicide.14 These val-
ues are acknowledged as an underrepresentation of the breadth of the
problem in Lebanon as cultural factors restrict the declaration of sui-
cide cases.15 Beside these rates of mental disorders, there are still mis-
conceptions and stigma associated with mental illness in the Lebanese
community.

Perspect Psychiatr Care. 2017;1–8. wileyonlinelibrary.com/journal/ppc 

c 2017 Wiley Periodicals, Inc 1
2 RAYAN AND FAWAZ
Although all individuals do encounter psychological difficulties dur-
ing their life, university students are apt to have serious health bur-
dens that are usually underdiagnosed, and these may relate to high-risk
behaviors such as drug and alcohol abuse, smoking, and mental health
issues such as depression and suicidal thoughts and attempts.16–19 In
addition, literature suggests that most of those affected by mental dis-
orders will experience their first episode during or before university
age of 22.20,21 University students are usually hesitant to disclose men-
tal health concerns because of the issues of confidentiality and embar-
rassment, lack of medical insurance, lack of awareness about available
services, absence of trust in healthcare workers, and stigma associated
with mental illness.2,22,23
Literature revealed various beliefs and practices associated with
mental illness such as deciding to manage the problem by oneself and
assuming that the conflict will subside.24–26 In addition, some factors
might influence practices associated with mental illness such as the
perception of the effectiveness of service providers,27 the concept of
certain risk factors and causative factors of psychological problems,
and attitudes toward mental illnesses.28 Furthermore, studies have
also proven the existence of subcultural beliefs associated with men-
tal illness.29,30 Arabs share a mutual selection of beliefs, values, and
traditions associated with mental illness that are considerably differ-
ent from those of Westerners.31 According to Fakhr El-Islam,32 Arab
Muslims profoundly believe in the reality of paranormal entities such
as Jinn (the devil or the Shaytaan), Sehr (Black Magic), and the evil
eye (Hasad). It is widespread among Arabs to associate the symp-
toms of psychiatric disorders to the workings of these paranormal
entities.33–35 Arabs might hold that Sehr (black magic) is designated
into a group of knots (oqad), conjurations, and phrases uttered, written,
or executed in a technique as to influence the body or mind of the tar-
get without touching him/her. A lot of Arabs hold that mental illnesses
are an experiment from God, God’s will, or comes as a consequence of
a sin or a wrongdoing.36 In general, the Arab World has its distinctive
sociocultural, religious, and political milieu that is impossible to disre-
gard when providing psychiatric care.
When university students living in the Arab world are confronted
with psychiatric health problems, they usually pursue medical atten-
tion informally; as they try to avoid stigma associated with mental ill-
ness. Instead, they are more likely to seek help from people close to
them: parents, friends, or others they trust. Healthcare-seeking behav-
ior among young individuals is also partly influenced by their financial
and social standing and the expenses attributed to health services.37,38
From the viewpoint of healthcare delivery, nowadays, the sole
approach to mental health services in the public sector is through
psychiatric institutions,39 which might not pay attention to the cul-
tural factors associated with mental illness. One factor that appears
to be remarkably disadvantageous to pursuing professional attention
is associated with stigma or the cultural shame related to having emo-
tional conflictions. The concept deeming patients to be stigmatized by
community persists to be a common finding among the public.40,41
So far, there has been a limited literature regarding the associa-
tion of cultural beliefs and practices associated with mental illness in
the Arab culture with the mental illness stigma.42,43 The researchers
in this study are enthusiastic to obtain baseline data that are of aid
to help mental health nurses create specific and relevant antistigma
programs to challenge the misconceptions about mental illness and
reduce the stigma associated with psychiatric illness among Lebanese
population. This might aid the development of intervention programs
that encourage university students to pursue professional psycholog-
ical attention. Moreover, in the recent years, the percentage of ethnic
Arab populations has sharply increased in various Western countries.
Awareness regarding psychological disorders and associated stigma
in an Arab sample may facilitate the development of culturally ori-
ented care for this population in particular. Therefore, the purpose of
this study was to examine cultural misconceptions about mental illness
and how they are associated with public stigma against mental illness
among Lebanese university students.
3 METHODOLOGY
3.1 Research design
A descriptive correlational design was used. Prior to data collection,
the ethical approval for conducting the study was obtained (Pro-
tocol number 84/1/21/7). The researchers created an online self-
administered questionnaire and sent the students an online link allow-
ing them to access the consent form and the study questionnaires to
complete the study.
3.2 Subjects
A total of 203 undergraduate students from the Beirut Arab Univer-
sity in Beirut, the capital city of Lebanon, participated in this study.
The Beirut Arab University was selected because it provides a multi-
cultural environment in which about 15,000 students are involved. For
the purpose of this study, students were invited to participate in the
study if they were Lebanese and if they were currently undergradu-
ate students in the Beirut Arab University. All postgraduate students
were excluded from the study. Using G power program, for indepen-
dent samples t-test, with medium effect size, the needed sample size
is 102. However, the sample was increased to 203 to increase the rep-
resentativeness and obtain greater statistical power in detecting the
relationships.
3.3 Data collection and ethical considerations
After obtaining the ethical approval, the researchers accessed the
potential participants and invited them to participate in the study. Uni-
versity students were invited to complete the study using the offi-
cial online social network of the university in which thousands of stu-
dents are involved. To assure that students meet all of the inclusion
criteria, researchers have asked them to self-identify their national-
ity before sending them the survey link. Non-Lebanese students were
excluded from the study. To assure obtaining 203 completed question-
naires, the researchers decided to keep inviting participants to take
part in the study until 203 questionnaires were filled. The total num-
ber of students who were invited to participate in the study was 247,
RAYAN AND FAWAZ
representing a response rate of 82.19%. The purpose of the study
was explained to all students, and they were assured that their par-
ticipation is voluntary and they could withdraw from the study at any
time. Students were informed that there is no any direct harm or ben-
efit to them because of taking a part in the study. All students who
agreed to participate in the study completed an anonymous online self-
administered questionnaire in which confidentiality of the participants
was ensured, as they were not requested to mention their names.
3.4 Instruments
The instruments used in the study included a demographic survey, cul-
tural attitudes toward mental illness and professional psychological
services, cultural misconceptions about causes and treatment of men-
tal illness, and a measure of the public stigma of mental illness.
3.5 The demographic survey
The demographic survey was used to obtain demographic information
including age, gender, specialty, and marital status. In addition, partic-
ipants were asked to indicate ‘‘yes’’ or ‘‘no’’ to the prompt ‘‘Have you
ever visited a psychiatric clinic or a psychiatric ward to seek psycho-
logical help?’’ and the prompt “Do you feel you receive adequate emo-
tional support from your family members and friends?”
3.6 The cultural attitudes toward mental illness and
professional psychological services
In order to assess cultural attitudes toward mental illness and profes-
sional psychological services, a measure was specifically developed uti-
lizing various aspects reported in literature. Since this measure was
developed for the purpose of this study, three experts in psychiatric
nursing reviewed the measure to assure its content validity. The three
content experts were asked to provide feedback on the clarity and
relevance of the items included in the scale for Lebanese students.
The researchers addressed the comments made by the experts before
the pilot testing of the measure. The measure was pilot tested on
20 Lebanese university students who found the measure clear and
did not suggest a need for further modifications. For this question-
naire, participants were asked to indicate ‘‘yes’’ or ‘‘no’’ to six ques-
tions inquiring about cultural attitudes toward mental illness and pro-
fessional psychological services (e.g., “Do you think that mental health
services are adequately available in your country?”). For items 3, 5, and
6, the answer “yes” indicates a positive attitude toward mental illness
and professional psychological services. Items 1, 2, and 4 are reverse-
scored before computing the reliability coefficient. The Cronbach’s 𝛼
reliability coefficient of the measure was .72.
3.7 Cultural misconceptions about causes and
treatment of mental illness
To assess cultural misconceptions about mental illness in Lebanon, this
eight-item questionnaire was used. The questionnaire focuses on eight
cultural misconceptions common in the Arab world as reported in lit-
3
erature. These eight cultural misconceptions were determined using
the literature review. For this questionnaire, participants were asked
to indicate ‘‘yes’’ or ‘‘no’’ to four questions regarding cultural miscon-
ceptions about causes of mental illness (e.g., “Do you think that evil
eye (Hasad) might cause mental illness?”) and four questions regard-
ing cultural misconceptions about treatment of mental illness (e.g., “Do
you think that Pray might treat mental illness?”). The content validity of
the measure was confirmed by three experts in psychiatric nursing who
assured its relevance for Lebanese students and the clarity of its items.
The measure was pilot-tested on 20 Lebanese students. The feedback
of the content experts and the students were addressed and the tool
was modified accordingly. For items 1–4, 6–8, the answer “yes” indi-
cates cultural misconception about causes and treatment of mental ill-
ness. Item 5 is reverse-scored. The Cronbach’s 𝛼 reliability coefficient
of the measure was .81.
3.8 Devaluation–discrimination scale
This 12-item scale assesses public stigma toward mental illness by ask-
ing participants to rate on a six-point Likert scale what they believe
about individuals with a mental illness.44 Each item is rated on a Likert
scale ranging from 1 (Strongly Agree) to 6 (Strongly Disagree), yield-
ing a total score ranging from 12 to 72, with higher scores indicat-
ing greater perceived public stigma and discrimination related to men-
tal illness. The devaluation–discrimination scale (DDS) had adequate
internal consistency (Cronbach’s 𝛼 = .78) (Link, 1987). The DDS has
six reverse-coded items. For this study, an updated version of the DDS
was used.45 In this version, Eisenberg et al. changed the phrase “former
mental health patient” to “a person who has received mental health
treatment.”45 The Arabic version of updated version of the DDS was
previously used in clinical and nonclinical samples in the Jordanian
population.2,46,47
3.9 Data analysis
Data were analyzed using the SPSS Program, version 21. Descrip-
tive statistics including frequencies, percentages, means, and standard
deviations were used to summarize and present the study variables.
In addition, frequency and percentage statistics were used to describe
the number and percent of participants who report each cultural atti-
tude toward mental illness and professional psychological services.
Similarly, the frequency and percent responses to each item regarding
cultural misconceptions about causes and treatment of mental illness
were reported. Finally, independent samples t-test was used to assess
if there was a significant mean difference in the public stigma according
to cultural beliefs associated with mental illness.
4 RESULTS
4.1 Sample characteristics
A total of 203 students participated in this study. Of the 203 stu-
dents, 116 (57.1%) were females. The mean age (SD) of the stu-
4 RAYAN AND FAWAZ

TA B L E 1 The sociodemographic characteristics

Variable Frequency Percent

Gender Male 87 42.9
Female 116 57.1
Marital status Married 31 15.3
Single 172 84.7
Specialty nursing 60 29.6
medicine 30 14.8
engineering 24 11.8
Trade 18 8.9
Physical therapy 21 10.3
Nutrition 10 4.9
Other specialty 40 19.7
Have you ever visited a psychiatric clinic or a psychiatric ward to seek for a psychological help? No 181 89.2
Yes 22 10.8
Do you feel you receive adequate emotional support from your family members and friends? No 52 25.6
Yes 151 74.4

dents was 22.11 (3.4) years. A total of 31 (15.3%) were married and
172 (84.7%) were single. The major specialty of students was nursing
(n = 60, 29.6%), followed by medicine (n = 30, 14.8%), and the major-
ity of the participants were Muslims (n = 171, 84.2%), followed by
Christians (n = 17, 8.4%), and other religious groups (n = 17, 7.4%).
Regarding the history of seeking professional psychological help, 181
(89.2%) had never visited a psychiatric clinic or a psychiatric ward,
while 22 (10.8%) had a history of seeking professional psychological
help. However, the majority feel that they do receive adequate emo-
tional support from their family members and friends (n = 151, 74.4%)
(Table 1).
conceptions about the causes of mental illness. For example, 192
(94.6%) think that Seher might cause mental illness, 158 (77.8 %)
think that evil eye (Hasad) might cause mental illness, 144 (70.9%)
think that Jinn might cause mental illness, and 95 (46.8%) think that
mental illness is a punishment from God. Additionally, misconcep-
tions about treatment of mental illness were reported. For example,
157 (77.3%) think that Shehk (the religious leader or Imam) might
treat mental illness using the Holy Quran or another holy book, 181
(89.2%) think that pray might treat mental illness, and 160 (78.8%)
think that Rukia (a religious healing and Jinn catching method by
which the magic accompanied by Jinn is removed) might treat mental
illness.

4.2 The cultural attitudes toward mental illness and

professional psychological services
The majority think that the cost of mental health treatment is high
(n = 176 (86.7%)). However, a large number of students do not
think that mental health professionals in Lebanon have adequate
knowledge and expertise to treat mental disorders, while 180 (88.7%)
mentioned that the media in Lebanon discourage seeking professional
psychological help for psychiatric problems. Consistent with the
Arab cultural beliefs, a total of 142 students (70%) think that mental
illness in Lebanon is considered a secret that should be hidden by
family members. Furthermore, the majority think that mental health
services are not adequately available in Lebanon (n = 132, 65%), while
most of the students do not have adequate time to seek professional
psychological counseling (n = 132, 65%) (Table 2).
4.3 Cultural misconceptions about causes and
treatment of mental illness
As presented in Table 3, the majority think that mental illness is
treatable (n = 132, 65%). However, it was noted that there are mis-
4.4 Differences in public stigma according to
cultural beliefs associated with mental illness
Using an independent samples t-test, Table 4 presents the differences
in public stigma according to cultural beliefs about mental illness. Stu-
dents who think that evil eye (Hasad), Seher, Jinn, and punishment from
God might cause mental illness had lower scores on public stigma than
students who do not believe in these causes, though not all of these
differences were significant. Students who feel they receive adequate
emotional support from family members and friends reported lower
public stigma than those who do not. Students who think that mental
illness is a secret which should be hidden by family members reported
a higher level of public stigma than those who do not. Students who
think that mental health services are adequately available in the coun-
try and those who think that mental health professionals in the coun-
try have adequate knowledge and expertise to treat mental disorders
reported lower levels of public stigma. Finally, students who think that
Shehk, Pray, and Rukia might treat mental illness reported lower levels
of public stigma.
RAYAN AND FAWAZ 5

TA B L E 2 Cultural attitudes toward mental illness and professional psychological services in the Lebanese culture

Variable Category Frequency Percent

1. Do you think that cost of mental health treatment in your country is No 27 13.3
high?
Yes 176 86.7
2. Do you think that mental health professionals in your country have No 132 65.0
adequate knowledge and expertise to treat mental disorders?
Yes 71 35.0
3. Do you think that mental illness in your society is a secret which should No 61 30.0
be hidden by family members?
Yes 142 70.0
4. Do media in your country discourage seeking professional No 23 11.3
psychological help?
Yes 180 88.7
5. Do you think that mental health services are adequately available in No 132 65
your country?
Yes 71 35
6. Do you have adequate time to seek professional psychological No 132 65
counseling when needed?
Yes 71 35

TA B L E 3 Cultural misconceptions about causes and treatment of mental illness

Variable Frequency Percent

1. Do you think that evil eye (Hasad) might cause mental illness? No 45 22.2
Yes 158 77.8
2. Do you think that “Seher” might cause mental illness? No 11 5.4
Yes 192 94.6
3. Do you think that “Jinn” might cause mental illness? No 59 29.1
Yes 144 70.9
4. Do you think that mental illness is a punishment from God? No 108 53.2
Yes 95 46.8
5. Is mental illness treatable? No 6 3.0
Yes 197 97.0
6. Do you think that “Shehk” might treat mental illness using the Holy Quran or another holy book? No 46 22.7
Yes 157 77.3
7. Do you think that Pray might treat mental illness? No 22 10.8
Yes 181 89.2
8. Do you think that “Rukia” might treat mental illness? No 43 21.2
Yes 160 78.8

5 DISCUSSION
The purpose the current study was to assess cultural misconceptions
about mental illness and how public stigma against mental illness dif-
fers based on these cultural misconceptions among Lebanese univer-
sity students. Despite the high prevalence of mental illness in Lebanon,
a large percent of students (n = 181, 89.2%) have never visited a psychi-
atric clinic (Table 1), which might suggest that this age group is one of
the least likely to ask for professional psychological help. Subsequently,
for this age group, who might suffer from depression or PTSD related
to decades of wars and violence in Lebanon, mental health facilities are
inaccessible.
The current study suggests that high cost of psychiatric care, the
public view of mental illness, the negative role of media, and lack of
trust in qualifications and expertise of mental health professionals
are among the most important barriers to seeking mental health
treatment. On the other hand, many students mentioned that mental
health services are not adequately available in Lebanon and seeking
psychological help is time-consuming. In the light of these drawbacks,
the prevalence rates of mental disorders are high enough to rank
mental illness among the most prevalent health issues in the Lebanese
community.13
Misconceptions about the causes of mental illness might determine
the way in which individuals might treat it. The Seher, evil eye (Hasad),
6 RAYAN AND FAWAZ

Jinn, and God’s punishment were common suggested causes of mental

<.0001
P value
illness in the Lebanese culture. Subsequently, common misconceptions

.010
.004
.000

.000

.014
.002

.000
.82
.30

.03
.09
about treatment of mental illness suggested various methods used in
Lebanon to treat mental illness including going to Shehk, praying, and
using the Rukia.

201
201

201

201
201

201

201
201

201

201
201

201
df

Public stigma against mental illness significantly differed according

to cultural beliefs associated with mental illness. Lower scores on pub-

10.30
lic stigma against mental illness were associated with the belief that
0.22
1.03

2.16

2.58
1.68

4.55

2.92
5.39

2.47
3.13

6.43
evil eye (Hasad), Seher, Jinn, and punishment from God might cause
t

mental illness. Students might think that the patient who was subjected
to evil eye (Hasad), Seher, and Jinn is a victim who needs to be helped
36. 77 (15.00)

37. 24 (13.88)
33. 66 (16.17)

35. 25 (13.45)

27. 18 (12.21)

36.66 (14. 37)

33. 32 (13.62)
38.05 (13.82)
36.36 (14.25)
37.70 (13.77)

36.82 (14.37)
42.57 (10.67) rather than stigmatized, while punishment from God in the worldly life
might afflict the individual for his or her sin to forgive him or her in the
M (SD)
Yes

Day of Judgment (Yawm Al-Qiyamah). Consistently, those who think

that Shehk, Pray, and Rukia might treat mental illness reported lower
levels of public stigma against mental illness. Emotional support from
44. 71 (10.60)
46.34 (10.53)

43.96 (10.39)
36.16 (14.34)
41. 99 (9.41)

family members and friends, ability to disclose mental illness outside

39.33 (4.54)
44.20 (8.95)
44.81 (9.09)

41.30 (8.84)

45.09 (8.96)
43.39 (8.70)
42.41 (9.72)

the family, availability of mental health services, and trust in mental

M (SD)

health professionals are all important factors associated with public

No

stigma against mental illness.

Mental health problems must be perceived in relation to cultural
Do you think that mental health professionals in your country have adequate knowledge and expertise to treat mental disorders?

background in order to guarantee availability of access to mental

health facilities and employment of resources by all populations.48
Transcultural mental health nurses should be aware that people from
different cultures perceive mental disorders in unique ways.49–51 Iden-
tifying the current cultural view of causes, treatment, and stigma
against mental illness among Lebanese population might aid in high-
lighting their readiness to seek professional psychological help for
Do you think that mental illness in your society is a secret which should be hidden by family members?

mental health problems (Bermudez, Kirkpatrick, Hecker, & Torres-

Differences in stigma according to cultural beliefs associated with mental illness

Robles, 2010). Psychiatric and mental health nurses should acknowl-

Do you think that “Shehk” might treat mental illness using the Holy Quran or another holy book?

edge the role of cultural misconceptions about mental illness that

Do you feel you receive adequate emotional support from your family members and friends?

might affect patients’ willingness to seek or adhere to specific men-

tal health treatment. Evaluating Lebanese students’ misconceptions
Do you think that mental health services are adequately available in your country?

about mental illness in the current study provided valuable data spe-
cific to Lebanese culture, to be considered when implementing anti-
stigma programs for this population in particular.

5.1 Study implications

Do you think that evil eye (Hasad) might cause mental illness?

Do you think that mental illness is a punishment from God?

Mental health nurses should be involved in changing the public health

Do you think that “Seher” might cause mental illness?

Do you think that “Rukia” might treat mental illness?

policy. Health interventions targeting young adults are not a priority

Do you think that “Jinn” might cause mental illness?

Do you think that Pray might treat mental illness?

for health policies in Lebanon, hence services specifically provided for

young adults and their needs are very rare. Consistent with previous
research, the current study found that young people in Lebanon tend
to engage in informal healthcare-seeking behavior rather than resort
to formal health structures.52 The incorporation of mental health and
related services into the primary healthcare system is among the best
Is mental illness treatable?

solutions to overcome this challenge.53–55

From an economical viewpoint, psychiatric facilities in Lebanon are
poorly funded. Finance of psychiatric health services in Lebanon is
utterly poor as the essential source of funding for mental health is out-
TA B L E 4

of-pocket payment. The reliance of the contemporary system on out-

t-test

of-pocket expenses for mental health poses hindrance to access for

people of low socioeconomic status who are at the risk of development
RAYAN AND FAWAZ
of mental health illnesses.56 Future public health policy may want to
provide financial support to psychiatric facilities in Lebanon to facil-
itate access of people with low socioeconomic status to professional
mental health services.
Considering the outcomes of the current study, psychiatric nurses
can play a vital role in changing cultural misconceptions and myths
about causes, treatment, and stigma against mental illness. Research
on the interrelationships between culture and attitudes toward seek-
ing professional psychological help should be prioritized. In addition,
future research may want to examine the effectiveness of specific anti-
stigma programs implemented by psychiatric nurses, highlighting the
cultural misconceptions identified in the current study.
5.2 Limitations
There are some limitations that should be considered when trying to
generalize the study outcomes. The current study focused on Lebanese
university students. The researchers cannot assume that similar out-
comes would have been obtained in Lebanese populations from other
age groups or other educational backgrounds. Additionally, the con-
venience sample might limit the generalizability of the study. Further-
more, the cultural misconceptions identified in the current study were
determined utilizing an extensive literature review. Other cultural mis-
conceptions about mental illness might be underreported due to the
gaps in literature examining this area of investigation. Despite these
limitations, the current study is the first to examine specific cultural
misconceptions about mental illness and it has important implications
for psychiatric and mental health nursing practice and research.
5.3 Conclusions
The findings of this study indicate that professional mental health facil-
ities are inaccessible for most young people in Lebanon. Overall, there
were many barriers to seeking professional psychological help includ-
ing the high cost of psychiatric care, the public view of mental illness,
the negative role of media, lack of trust in qualifications and exper-
tise of mental health professionals, and difficulty to access mental
health services. In general, various misconceptions about the causes
and treatment of mental illness were very common in Lebanese cul-
ture. These misconceptions were associated with the public stigma
about mental illness. In situations like this, mental health nurses have
to play a great role in enhancing awareness about causes, treatment,
and stigma against mental illness.
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How to cite this article: Rayan A, Fawaz, M. Cultural
misconceptions and public stigma against mental illness
among Lebanese university students. Perspect Psychiatr Care.
2017;00:1–8. https://doi.org/10.1111/ppc.12232