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Mental Health Among Young Women in Saudi Arabia: a Mixed Methods

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Mental Health Among Young Women in Saudi Arabia: a Mixed Methods Mental Health Among Young Women In Saudi Arabia: A mixed Methods Approach Hissah Alzahrani A thesis submitted in partial fulfilment for the requirements for the award of Doctor of Philosophy University of Central Lancashire May, 2019 i Declaration I declare that while registered as a candidate for the research degree, I have not been a registered candidate or enrolled student for another award of the University or other academic or professional institution. I declare that that no material contained in the thesis has been used in any other submission for an academic award and is solely my own work. Signature of Candidate: Type of Award: Doctor of Philosophy School: School of Psychology ii Abstract This thesis aims to gain an understanding of the mental health of young women in Saudi Arabia. To achieve this broad aim, this thesis, which encompasses two studies, employs a mixed methods approach. Study 1 is a longitudinal quantitative study that aims to examine the trajectories of university students ’ mental health—via the change in their mental health and their ability to adjust—by assessing them over three time points during their first year at university. This study also examined whether theoretically relevant determinants, such as trait emotional intelligence (EI), emotional self-efficacy (ESE), social support and loneliness, affected the students’ mental health trajectories and adjustment to university life. The results show that the mean level of mental health problems was low and did not change significantly over time, while the adjustment level decreased over the first year of university. The results indicated that even in students with a high adjustment level in the beginning of their university year, the level decreased over time. These results also showed that all the students in the current study face difficulties in adjusting to university. University counselling centres must provide more support to students through programs aimed at identifying the types of issues faced by students throughout their studies and understanding why they are not able to adapt well. This can be achieved by investigating the reasons behind poor adjustment, followed by programs designed to address their needs. In addition, the results show there are distinct classes within the trajectories of mental health and adjustment to university. These different classes are likely to be determined by the range of variables such as trait EI, ESE, perceived social support and loneliness. The results demonstrate that these theoretically and empirically associated variables are important determinants of the trajectories of mental health and adjustment within the Saudi sample. Furthermore, these variables are operate in the same way in terms of being a potential protective factor for mental health in a non-Westernised population. Study 2 is a qualitative study that builds on, and extends the findings of, the longitudinal research to fulfil the overall objective. This study aims to 1) explore the difficulties that students face during university life which may contribute to the decline in their adjustment level; 2) explore the coping strategies students employ when trying to alleviate the problems and challenges they face; 3) identify the barriers faced by students when attempting to access mental health services; and 4) explore students’ perceptions of university counselling centres. Utilising a iii sub-sample of the longitudinal study results, the results indicated that students face a range of difficulties at university which may affect their mental health, including issues relating to their studies and university staff. The results show that students use different coping strategies to face their challenges, including both emotionally focused and problem-focused responses, as well as more specific strategies such as turning to religion. In terms of accessing support services when required, either from inside or outside the university, this study highlights some of the issues. Students demonstrated a distinct lack of knowledge about the counselling centre at the university and the services it offers. The study also found that female's students, avoid seeking mental health support from outside resources because of the associated stigma from both their family and society. These results extend our knowledge and comprehension of university students’ mental health and adjustment to university by identifying the academic challenges they face during their university lives, strengthening our knowledge of their coping strategies, and improving our understanding of the barriers that Saudi female students may face when accessing mental health services. A major contribution of this study is to show that context is important when attempting to understand students’ mental health, and it offers an explanation of the different factors affecting students’ mental health. Mental health services need to take context into account in regard to students, and further research is required to deepen our understanding of the key surrounding issues. Overall, the thesis establishes a new foundation of knowledge regarding the mental health of young women in Saudi Arabia. This thesis also shows that the mixed method approach is useful in understanding students’ mental health because it helps to obtain a deeper understanding of the issues and looks at students’ mental health from different perspectives. This knowledge will facilitate the development of future research and support programmes to promote the mental health of young Saudi women. iv Table of content CHAPTER 1: INTRODUCTION AND OVERVIEW 1.1 Introduction and overview of thesis……………………………………………1 1.2 -Thesis approach………………………………………………………….….....5 1.2.1 Mixed Methods Approach…………………………………………………....5 1.2.2. Philosophical Position of mixed methods……………………………….…...7 1.2.3 Mixed Methods Research Design.................................................................8 1.3. Thesis objectives……………………………………………………..…… ....10 1.3.1study one..………………………………………………………….……...10 1.3.2Study two……………………………………………………………..…... 12 1.4. Structure of thesis ……………………………………………………………..13 CHAPTER 2: LITERATURE REVIEW (1) 2.1. Background of the study sample……………………………………………....15 1.2.1Overview of context Kingdom of Saudi Arabia…………………………….15 2.1.2 Women’s mental health in Saudi Arabia…………………………………....16 2.1.3 The position of women in education in Saudi Arabia………………………19 2.2 Conception of mental health of SA female university students……………… 21 2.2.1 Mental health problems……………………………………………….......21 2.2.2 Adjustment to university………………………………………………….24 2.3 The theoretical framework of SA female university students………………...26 2.3.1 Theoretical framework of metal health problems………………………....26 2.3.2 Theoretical framework of adjustment to university………………………..28 2.4 Prevalence and common mental health problems among university students….32 2.5 The impact of mental health issues on University campus……………………...35 2.6 Factors found to be linked to the mental health of university students………….36 2.6.1 Social support……………………………………………………………..36 2.6.2 Trait Emotion Intelligence………………………………………………...40 v 2.6.3 Emotional self-efficacy………………………………………………..…45 2.6.4 Loneliness……………………………………………………………….48 2.7 Gaps in the current literature review…………………………………………...52 CHAPTER 3: TRAJECTORIES OF MENTAL HEALTH AND ADJUSTMENT TO UNIVERSITY: EXAMINATION IN A SAMPLE OF YOUNG WOMEN FROM SAUDI 3.1 Current Study………………………………………………………………….55 3.2 Method………………………………………………………………………...55 2.2.1 .Participants and Procedure………………………………………………...55 2.2.3 Measures…………………………………………………………………..57 2.2.4 Data Analysis Plan………………………………………………………..63 3.3. Results……………………………………………………………………...…64 3.4.Discussion……………………………………………………………….….…84 CHAPTER 4: LITERATURE REVIEW (2) 4.1 Introduction……………………………………………………………………94 4.2 Difficulties during life…………………………………………………………97 4.3 Coping strategies……………………………………………………………..100 4.4 Barries to mental health services…………………………………………… 103 4.4 Students’ perceptions of university counselling centres……………………...106 4.5 Gaps in the current literature………………………………………………….110 CHAPTER 5: QUALITATIVE EXPLORATION OF MENTAL HEALTH ISSUES IN SAMPLE OF YOUNG WOMEN IN SAUDI ARABIA 5.1 Research questions…………………………………………………………….112 5.2. Methodological approach …………………………………………………….112 5.3. Method ……………………………………………………………..................115 5.3.1 Participants ………………………………………………………...............115 5.3.2. Data collection…………………………………………………………......116 5.3.3 Analytic procedure…………………………………………………………119 vi 5.3.4 Ensuring Data Quality: Trustworthiness and Ethical Considerations...............................................................................................................121 5.4 Result………………………………………………………………………………121 5.5 Discussion section………………………………………………………………...131 5.5.1 What difficulties face Saudi female university students during university life?................................................................................................................................131 5.5.2 What are the coping Strategies That Students Use to Face Their Challenges?....................................................................................................................134 5.5.3 What are the barriers to accessing mental services among Saudi female students? ………………………………………………………………………………………....139 5.5.4 What is the student’s perception of the university counselling centre? ………………………………………………………………………………..….142 5.6 Conclusion …………………………………..……………………………144 CHAPTER 6:
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