Highlights

Abstract

Keywords

1. Background

2. Gender and mental health in the Arab world

3. Women’s mental health services in Qatar

4. Developments following the steering committee report submission

5. Future directions

Declarations of conflict of interest

Author contributions

Financial disclosure

Acknowledgements

Data Availability

References

Abstract

Investigations into gender differences in the epidemiology of common mental disorders have highlighted the fundamental role of socio-economic factors as the key determinants in experiencing mental ill health and access to treatment. Women are almost always at a socio-economic disadvantage across cultures throughout the world and as a result experience mental health inequality. This disparity in control over their socio-economic determinants is even more stark in the Middle Eastern and North African region. This region has additionally also cultural and legal conditions that make women empowerment and access to health difficult. Qatar launched an ambitious National Health Strategic program and identified women’s mental health as a priority. This paper describes the development of a gender aware mental health service in Qatar, first of its kind in the region. It describes the challenges that exist in the region when attempting to develop such a service and some challenges that are unique to Qatar. This paper sets out a template of important principles that will be valuable for countries in the MENA region and beyond to develop evidence-based gender aware service that focuses on female empowerment and better mental health outcomes.

1. Background

Epidemiological data from across the world have reiterated that there exists a gender-based difference in mental health morbidity between men and women (Kessler et al., 1995; Leibenluft, 1999). From a summary of evidence in an epidemiological review by, Weissman and Klerman (1977) showing higher prevalence of mood and anxiety disorders among women, these findings have been replicated by subsequent community based epidemiological studies over the subsequent decades (Weissman et al., 1996, Kessler et al., 2005; Piccinelli and Gomez Homen, 1997).

However, studies conducted in societies or groups with socially homogenous gender roles and empowerment did not always support these findings (Egeland and Hostetter, 1983; Jenkins, 1985; Loewenthal et al., 1995). More specifically, these studies underlined the role of social factors underpinning these differences rather than the traditionally understood genetic basis (Parker and Brotchie, 2010). Over time, accumulating evidence for a social model as the variable that explains gender differences came to be seen as the only viable framework within which the evidence could be properly examined (Pan American Health Organization, 1995; World Health Organization, 1998).

It has been increasingly recognized that gender determines how the individual will interact with, have access to and have control over the socio-environmental determinants of mental health with the women universally having less control and access (WHO, 2000). The social position of women and their economic condition tends to be different from men and varies across the countries and has been shown to impact mental health (WHO, 2000). States economic policies and access to resources including those of health vary according to gender and most countries have their Gender Development Indices (GDI) lower for women than men (United Nations Women white paper 2018).

1- Introduction

2- Method

3- Results

4- Discussion

References

Abstract

Intrasexual competition supports the acquisition of new mates and the maintenance of existing relationships. We investigated intrasexual competition in relation to Dark Triad traits (narcissism, Machiavellianism, and psychopathy) and intensity of Facebook use. Men (n = 61) and women (n = 164) completed measures assessing intrasexual competition (Buunk & Fisher, 2009), Dark Triad traits (Jones & Paulhus, 2014), and intensity of Facebook use (Ellison, Steinfield, & Lampe, 2007). Machiavellianism and psychopathy were positive predictors for endorsement of intrasexual competition. Narcissism and Facebook intensity did not predict intrasexual competition. Findings are discussed in relation to personality and mate competition.

Introduction

Intrasexual competition is a common sexual strategy, which functions to increase access to new partners and supports the maintenance of existing relationships. In humans, there is considerable within-sex variation in how competitive individuals are and the way in which people engage in competition. For example, gossip through social networks (Davis, Dufort, Desrochers, Vaillancourt, & Arnocky, 2017), or in online social media (Hendrickse, Arpan, Clayton, & Ridgway, 2017) are strategies that can be useful in intrasexual competition. Personality is another one important factor associated with competitive behaviour (Buunk, Bucksath, & Cordero, 2017; Goncalves & Campbell, 2014). In this brief report, we investigated intrasexual competition in relation to the Dark Triad personality traits (i.e., narcissism, Machiavellianism, and psychopathy) and intensity of Facebook use. The Dark Triad (Paulhus & Williams, 2002) is a widely researched personality constellation. The traits share a common core of manipulation and callousness (Jones & Figueredo, 2013) and influence a range of relationship types (Lyons, 2019). In particular, individuals at the higher end of the continuum have increased motivations for sexual partners (Lee et al., 2013), which appear to impact intrasexual competition (Carter, Montanaro, Linney, & Campbell, 2015). Each trait has been associated with a unique style of same-sex competition. For example, psychopathy is related to the use of deception (e.g., trying to impress a same-sex competitor by greeting an attractive member of the opposite sex; Jonason, Lyons, Baughman, & Vernon, 2014), as well as employing gossiping tactics that are aimed at damaging the reputation of the rival (Goncalves & Campbell, 2014). Narcissism has been connected to trying to outshine a competitor, and Machiavellianism to rude derogation of the competitor (Goncalves & Campbell, 2014). It is possible that social networking sites such as Facebook are also used as a forum for intrasexual competition (Wyckoff, Buss, & Markman, 2018). Social comparison and self-promotion are important features of social networking sites, especially amongst those who are younger or more intense users of these sites (Lee, 2014; Ozimek & Bierhoff, 2016). Aggressive behaviour such as cyberbullying and relational aggression are also commonplace online (Abell & Brewer, 2014; Slonje & Smith, 2008). Previous research demonstrates that relationship status influences men’s behaviour on such sites (McAndrew & Jeong, 2012), and attractiveness appears to influence the responses of other users (Wang, Moon, Kwon, Evans, & Stefanone, 2010). It is therefore possible that exposure to online promotion, comparison, and aggression encourages intrasexual competition. It is also plausible that those with an elevated drive for competition spend more time using these sites. Previous research has established sex differences in the intensity of Facebook use, indicating that women use it more than men do (Mcandrew & Jeong, 2012). Yet, it is not clear whether the sexes use social media differently as a tool in intrasexual competition, which is something that we will explore in this research. Furthermore, men tend to score higher than women on the Dark Triad instruments (Paulhus & Williams, 2002). However, rather than the sex of the individual, it is possible that the Dark Triad traits are more influential in intrasexual competition (Jonason et al., 2014). Therefore, we predict that irrespective of the sex of the participant, those high in the Dark Triad traits display greater levels of intrasexual competition.

The Big Five personality traits are powerful predictors of health and longevity. However, few studies have addressed partner effects of personality on health, whereby the personalities of people close to us affect our health. The current study examined the partner effects of Big Five traits on health behaviours, mood, and quality of life in romantic couples. Here, 182 romantic couples (N = 364 participants; Mage = 35.7 years) completed self-report measures of the Big Five (TIPI), health behaviours (GPHB), mood (DASS-21) and quality of life (WHOQOL-BREF). Data were analysed using the Actor-Partner Interdependence Model and showed significant partner effects of conscientiousness on quality of life. No other partner effects of the Big Five were found. These findings suggest that there are specific, focussed associations between health and a romantic partner’s personality.

A recent meta-synthesis indicates that the Big Five traits are moderately associated with overall health, with larger effects for agreeableness, conscientiousness, and neuroticism than either extraversion or openness to experience (Strickhouser, Zell, & Krizan, 2017). Conscientiousness has been consistently shown to have a positive impact on health, predicting positive health behaviours (Bogg & Roberts, 2004), physical health (Sutin, Stephan, & Terracciano, 2018), and increased longevity (Kern & Friedman, 2008). In contrast, neuroticism is associated with poor health outcomes, including all-cause mortality (Ó Súilleabháin, & Hughes, 2018). These intrapersonal effects of the Big Five on health are well established but less research has examined the interpersonal effects of personality on health, whereby the personalities of people close to us affect our health (Zayas, Shoda, & Ayduk, 2002). Zayas et al. outline a personality-in-context framework, which suggests that our thoughts, emotions, and behaviours are the product of the interpersonal system that we are part of, rather than solely the result of our own personality. Roberts, Smith, Jackson, and Edmonds (2009) conducted one of the first studies to demonstrate partner effects of conscientiousness. Nickel, Iveniuk, and Roberts (2017) replicated these results. They found that those with partners with higher levels of conscientiousness reported better subjective health and fewer physical limitations. The authors referred to this effect as compensatory conscientiousness, as partner conscientiousness predicted health outcomes above and beyond the individual’s own level of conscientiousness.

We describe a method assessing inattentive responding in internet-based studies and explore factors associated with this problem. We inserted ‘bogus’ items into an online questionnaire completed by 210 participants and looked at associations between items and possible predictors. We found evidence of inattentive responding despite all participants being willing volunteers. Inattentive responding was related to being male and lower scores on conscientiousness, openness to experience and agreeableness. Researchers carrying out internet-based research should use methods, such as inserting ‘bogus’ items, to detect inattentive responders with a view to excluding their data.

Introduction

Although using the internet to overcome recruitment barriers is common in mental health research, the practice is criticised due to the lack of environmental control compared to face-to-face methods (Roivainen, Veijola, & Miettunen, 2016). Inattentive responding has been identified as a particular problem and is defined as responding without regard to item content (Huang, Bowling, Liu, & Li, 2015). People may randomly choose from all response options on a scale, or employ a non-random pattern (e.g. scoring all items the same). Estimated rates of inattention have varied widely, from 3% to 46% of respondents due to lack of clarity on how to define and measure it (Meade & Craig, 2012). Inattentive responding constitutes error variance, which attenuates correlations, reduces internal consistency reliability estimates and leads to erroneous factor analytic results. Common recommendations for cleaning problematic responses, such as univariate outlier analysis rest on the assumption that careless or inattentive responses are rare or extreme in magnitude (Meade & Craig, 2012). Meade and Craig (2012) assessed the utility of different measures and recommended the use of ‘bogus items’, which are improbable statements that only have one correct response. Incorrect answers therefore indicate inattentive responding. Such statements might include, “I drive in reverse on the motorway”. Such items are easy to create and provide an obvious metric for scoring as correct or incorrect. Unlike other approaches that can be cumbersome to implement (e.g. psychometric antonym) or are format-dependent (e.g. long strings), the bogus item approach is a simple method that can be used across different surveys (Huang, Bowling, Liu, & Li, 2015).

1- Introduction

2- Materials and methods

3- Results

4- Discussion

References

Abstract

Family history of tobacco use and use of e-cigarettes have both been associated with increased tobacco use among young adults. However, to our knowledge, these variables have not been considered simultaneously. This study was designed to evaluate the hypothesis that family history of tobacco use would predict tobacco product use over time among young adult e-cigarette users with limited combustible tobacco use experience. A sample of 124 participants were recruited online from across the United States, completed five surveys over 12 months, and reported use of nicotine and tobacco products over the previous two weeks at each survey. Family history of nicotine and tobacco use was reported at the 6-month assessment, and data were collected in 2017 and 2018. Regression models indicated that family history was associated with likelihood of cigarette use (odds ratio = 1.02 [95% confidence interval = [1.00, 1.04]). Significant interactions between family history and linear (OR = 1.05 [1.01, 1.10]) and quadratic (OR = 0.99 (0.98, 1.00)] time terms indicated that the association between family history and likelihood of combustible product use shifted over time. In both cases, more extensive family histories predicted greater use frequency, and follow-up analyses showed that more extensive family history was associated with greater combustible tobacco product use 3, 6, and 9 months following baseline. Family history of nicotine/tobacco use may promote initiation of tobacco use among e-cigarette users. These results suggest family history of tobacco use may comprise a risk factor for combustible tobacco use within the evolving tobacco product landscape.

Introduction

Recent research has indicated that e-cigarette use is becoming increasingly common among young adults (Ramo et al., 2015). Although long-term health consequences of using e-cigarettes remain uncertain, some studies suggest that using e-cigarettes is associated with respiratory disorders and exposure to chemicals that can promote respiratory disease (Farsalinos et al., 2015; Wills et al., 2019). Although some data characterize e-cigarettes as a healthier alternative to tobacco cigarettes (Choi and Forster, 2013; Sutfin et al., 2013), other findings suggest that e-cigarette use could promote tobacco use, especially within younger populations (Leventhal et al., 2015; Primack et al., 2015). Research has also shown that individuals with a family history of smoking tobacco cigarettes are more likely to smoke cigarettes themselves (Peterson et al., 2006). However, little is known about whether family history of nicotine and tobacco product use is associated with subsequent combustible tobacco use among young adults. It is possible that e-cigarette use and family history of combustible tobacco use might work synergistically to promote transitions to use of combustible tobacco products. This analysis was intended to evaluate the hypothesis of an association between family history of using nicotine/tobacco products and transitions to use of combustible tobacco products among young adult e-cigarette users. More specifically, we expected that participants with more family members with histories of nicotine/tobacco use would be more likely to begin using cigarettes and other combustible tobacco products.