Date of Graduation


Document Type


Degree Type



School of Public Health



Committee Chair

Sarah S. Knox

Committee Member

Kim E. Innes

Committee Member

Alfgeir L. Kristjansson

Committee Member

Sijin Wen

Committee Member

Yasmin A. Altwaijri


Objectives: The goal of this project was to increase knowledge concerning the current prevalence, needs and barriers to mental health service use in the Kingdom of Saudi Arabia (KSA). It’s purpose was to gather data that would help to inform future policy decisions aimed at optimizing the use and availability of these services in the KSA. There were three specific aims: 1) Examine the barriers to initiation and continuation of mental health treatment in people with a disorder diagnosed during the previous 12-months. 2) Explore the prevalence and predictors of mental health treatment dropout. 3) Examine the prevalence and patterns of mental health service utilization during the previous 12 months based on gradients of need for treatment.

Methods: Data came from the Saudi National Mental Health Survey (SNMHS). The SNMHS is a face-to-face community based epidemiological survey in a nationally representative household sample of respondents aged 15-65 in the (KSA) (n = 4,004). The subsample analyzed in this study was limited to the participants in Part II of the survey (n=1981), which includes questions on mental health service use. The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) 3.0 was used to generate diagnoses. Logistic regression models were used to assess associations of predictors with service use.

Results: Study 1. Among participants with a 12-month DSM-IV/CIDI disorder (n= 711), 86.1% reported no service use. Of those, 50.7% (n= 597) did not think they needed any help (categorized as “low perceived need”) and 49.3% did perceive need. Of those who perceived need (n= 309), the majority (98.9%) reported attitudinal barriers to initiation, whereas 10.3% of those with a perceived need reported structural barriers. Respondents who were previously married or indicated below-average income were more likely than others with comparable disorders to believe they needed help. Study 2. Of survey participants who received some type of treatment during the previous 12 months (n= 168), treatment 42.1% dropped out of treatment, with dropout increasing steeply after the second visit. The most common source of mental health treatment were General Medical providers. Participants who were previously married or were diagnosed with a 12-month substance use disorder were significantly more likely to dropout than others. Conversely, those receiving care from more than 3 types of providers were significantly less likely than others to drop out of treatment. Study 3. Mental health service use varied significantly by indicators of need. Of respondents who had sought treatment during the previous 12 months (n= 168), 60.0% had a DSM-IV/CIDI diagnosis, 10.1% had a lifetime but not a 12-month diagnosis, 13.9% had some other indicator of possible need for treatment such as subthreshold 12-month disorder, a serious 12-month stressor, or lifetime mental health hospitalization, and 15.9% did not have any of the indicators of need considered here. Those without a previous 12-month disorder accounted for more than one-third of all services used. Respondents who were ever married were significantly more likely than others with comparable disorders to utilize mental health services, and those who reported lower income were less likely than others with comparable disorders to receive treatment.

Conclusions: Unmet need and drop out of mental health services are highly prevalent in the Kingdom of Saudi Arabia. In addition, marital status is associated with mental health service use. We identified that previously married people (separated, divorced, or widowed) are a specific high-risk group compared to other marital status categories. Improvements in early disorder detection, quality of services, public health education, and access might lead to reductions in these problems. Future studies should focus on social determinants of mental health service use.

Embargo Reason

Publication Pending

Available for download on Monday, July 12, 2021