SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted An Exploration of Occupational Therapists’ Understanding of Mental Health in Saudi Arabia: A Qualitative Investigation.(Saudi Digital Library, 2025-03-03) Alrashidi, Raiyad Abbad D Alrashidi; Whitcombe, SteveObjectives: This study explores the understanding of mental health among occupational therapists in Saudi Arabia. The objectives of the research were to examine the professional and cultural factors that influence occupational therapists’ perceptions of mental health, to assess opportunities and challenges faced by occupational therapists working in mental health settings and to explore the perceived value and role of occupational therapy in mental health care in Saudi Arabia. Methodology: This study used an exploratory- descriptive qualitative approach. Data was collected through semi-structured interviews from eight occupational therapists practising in Saudi Arabia. The data was analysed using reflexive thematic analysis, a framework that facilitated identification and development of key themes. Findings: The findings were categorised into four main themes. Firstly, occupational therapists’ perceptions of mental health. The study revealed varying levels of understanding and awareness of mental health which attributed to lack of professional training in this area. Secondly, inadequacies in training and education showed the need for improved professional development opportunities in mental health among occupational therapists in Saudi Arabia. The third theme examined current challenges and cultural influences in that occupational therapists in Saudi Arabia face systematic barriers since there are no policies to support their role in mental health. They are challenges related to stigma surrounding mental health and limited collaboration between OTs and other healthcare professionals. The final theme centred on future perspectives and recommendations, where participants advocated for increased awareness of their role - occupational therapy in mental health situations. There is a need for policy reforms and integration of occupational therapy into mental health services through professional training. Conclusion: This study provides information on whether mental health has been integrated into occupational therapy in Saudi Arabia and examines the opportunities and challenges facing OT professionals working in the mental health field. The study highlights the importance of addressing challenges such as cultural and systematic barriers limiting the integration of metal health in OT and a need to enhance education opportunities promoting the role of occupational therapy in mental health. The findings of this study will inform future policies and research that will support the integration of mental health into occupational therapy.8 0Item Restricted Mental Illness in Relation to Cardiovascular Disease Mortality and Out-of-Hospital Cardiac Arrest Characteristics and Survival(University of Edinburgh, 2024) Alotaibi, Raied; Jackson, CarolineAbstract Background People with mental illnesses have a 10–20 years shorter life expectancy than the general population. This mortality gap is primarily attributed to the increased risk and worse outcome of cardiovascular disease (CVD) among individuals with mental illnesses. Socioeconomic factors and healthcare accessibility, combined with systemic deficiencies in healthcare infrastructure and new policies aimed at reducing healthcare utilisation, may have exacerbated these disparities. Despite efforts to prioritise equitable care delivery, stigma and a lack of training among healthcare providers about mental health conditions persist, contributing to the ongoing challenges of addressing this issue. Although the link between mental illnesses and CVD is well established, the relationship between mental illnesses and out-of-hospital cardiac arrest (OHCA) characteristics and outcomes has been comparatively underresearched. The majority of OHCAs have an underlying cardiac aetiology, and hence, risk factors for CVD, such as depression, can influence the probability of experiencing OHCA and surviving it. A better understanding of how mental illnesses affect OHCA outcomes may help explain part of the overall observed lower life expectancy in patients with mental illnesses. Therefore, this thesis aims to explore the mortality gap between individuals with and without mental illnesses, with a specific focus on OHCA as a potential contributor to this gap. Methods In this thesis, I conducted a systematic literature review and three data analysis projects using different datasets and methods. In the first research project, I used data from the Scottish Mental Health Inpatient and Day Case Scottish Morbidity Record dataset to identify individuals who were 18 years of age or older and admitted with depression, as coded by the International Classification of Diseases (ICD)-10 F32– F33, between 2000 and 2019. I subsequently linked this dataset with death records to ascertain the causes of death. To estimate standardised mortality ratios (SMRs), I calculated the person-time at risk for people with severe depression by sex, 5-year age group, and calendar-year group. I estimated SMRs among individuals with severe depression using the whole Scottish population as the standard. To identify gaps in the current research on the relationship between mental illnesses and OHCA, I conducted a systematic review search of studies that looked into this topic, starting from the inception of relevant databases and ending on December 11, 2021, with an update on February 9, 2024. The search objective was to identify observational studies reporting on OHCA incidence, characteristics, or outcomes among individuals with mental illnesses. I and a second reviewer (another PhD student) independently screened titles and abstracts for eligibility. Both reviewers then independently assessed the full texts of potentially eligible articles against the eligibility criteria and independently conducted the data extraction. Following these initial investigations, I conducted two retrospective cohort studies using OHCA event data to further explore the survival and characteristics of OHCA in individuals with depression in one study and with unscheduled hospital admissions where a mental illness was recorded in the other study. In the first study, I used data from the ARREST (Amsterdam Resuscitation Studies) registry, spanning the period from 2008 to 2018. I extracted relevant comorbidity information, including depression, from patients' general practitioner records. OHCA survival was defined as survival 30 days after the OHCA or hospital discharge. To estimate the association between history of depression and OHCA survival, I used logistic regression modelling. Additionally, I explored the mediating effects of initial heart rhythm and bystander cardiopulmonary resuscitation (bCPR) provision. In the second study, I linked the Scottish Ambulance Services (SAS) OHCA dataset with the Unscheduled Care Data Mart (UCD). The UCD includes patient demographics, mortality data, emergency and urgent care service use across Scotland, and unscheduled hospital admission records to acute and psychiatric hospitals from January 1, 2011 onward. The analysis excluded individuals below 18 years of age, those with traumatic OHCA incidents, and those without community health index numbers. I classified exposed patients based on whether they had a documented history of an unscheduled hospital admission where a mental health illness was recorded (ICD-10 codes F00–F99) or had previously experienced unscheduled psychiatric hospital admissions before the OHCA event. I assessed the association between unscheduled hospital admission record of mental illness and 30-day survival following OHCA using both unadjusted and adjusted logistic regression models. I performed subgroup analyses to examine this association across some demographic and clinical strata, including age groups, sex, socioeconomic status, year of arrest, and prevalent types of mental illnesses in the study population. Results In the initial study, I found that among 28,808 individuals with severe depression, 27.4% died over a median follow-up of 8.7 years, with all-cause relative mortality being over three times higher than expected. Circulatory diseases were the leading causes of death, with excess mortality particularly pronounced for cerebrovascular disease. Both males and females with severe depression experienced higher all -cause and cause-specific mortality compared to the general population, with deaths from suicide having the highest SMR. For the literature review, the full search yielded 11,380 studies, with 10 meeting inclusion criteria (eight retrospective cohort studies and two nested case-control studies). Three of the included studies focused on depression, while seven encompassed various psychiatric conditions. People with mental illnesses were more likely to have arrests in private residences, unwitnessed arrests, more comorbidities, less bCPR, and non-shockable initial heart rhythms. The few studies that were identified also reported a higher OHCA incidence risk and lower survival rates in people with mental illnesses compared to people without mental illnesses. The analysis of the ARREST dataset included 5,594 OHCA cases, of which 582 individuals had pre-existing depression. These patients exhibited less favourable patient and resuscitation characteristics and lower odds of survival, even after adjusting for age, sex, and comorbidities. Initial heart rhythm and bCPR partially mediated the observed association, but they did not fully account for it. The final study, which used national Scottish data, initially identified 36,775 OHCA patients that were attended by SAS. After excluding those who were not eligible, the study included 30,523 patients with OHCA. Among the included cases, 12.8% had a history of an unscheduled hospital admission where a mental health illness was recorded. Those with a record of a mental illness had substantially lower 30-day survival odds compared to those without. This association persisted across various demographic and clinical subgroups. Conclusion This thesis addresses shortcomings in our understanding of the mortality gap between individuals with and without mental illnesses, particularly focussing on OHCA as a contributing factor. The findings show that patients with depression have higher mortality rates, mainly due to circulatory diseases. A systematic review highlighted the scarcity of research on OHCA among people with mental illnesses. Subsequent studies showed that patients with depression in the Netherlands and those with an unscheduled hospital admission record of mental illness in Scotland had lower OHCA survival rates, regardless of event characteristics or comorbidities. This thesis also discusses common barriers to pre-hospital and mental health research, emphasising the necessity for improved data linkage and comprehensive national datasets. The association between mental illness and lower OHCA survival persisted after adjusting for key OHCA characteristics that could potentially explain the link, suggesting that this association may be independent of these factors. Future research should further investigate the underlying mechanisms to help reduce premature mortality in people with mental illness, including factors not discussed in this thesis, such as the potential impact of psychotropic medications on OHCA incidence and outcomes.12 0Item Restricted The therapeutic role of Non-invasive Temporal Interference (TI) stimulation in Traumatic Brain Injury(Imperial College London, 2024) Alkhawajah, Batool; Sastre, Magdalena; Hervas, Laura AbelleiraThe therapeutic role of Non-invasive Temporal Interference (TI) stimulation in Traumatic Brain Injury Traumatic Brain Injury (TBI), characterized by cranial compression leading to neural loss and white matter damage. IT is associated with the development of severe neurological disorders such as Alzheimer's and dementia. Temporal interference (TI) stimulation has emerged as a recent therapeutic modality for severe neurological and psychiatric disorders, such as Alzheimer's disease (AD) and dementia. TI stimulation delivers two frequencies to the brain, generating an electrical field with nuanced frequency differentials, thereby non-invasively targeting specific brain regions. Experimental validation on animal models and healthy subjects has revealed significant improvements in cognitive function following TI stimulation. Recognizing shared pathological mechanisms between TBI and AD, our laboratory has initiated investigations into the potential anti-inflammatory effects of TI stimulation in the context of TBI. A conducted experiment applied TI stimulation targeting the ipsilateral hippocampus in a mild Closed head injury (CHI) model, with a single impact, resulting in observed memory enhancement. However, the cellular and molecular consequences of TI stimulation on the brain remain an unexplored realm. This research project seeks to delineate these changes through various staining techniques targeting Glial Fibrillary Acidic Protein (GFAP), microglia, and neurogenesis. Floating brain sections from three distinct groups: CHI-TI, CHI control, and sham were subjected to staining, enabling the quantification of alterations in the hippocampal region and cortex. Our findings unveil that TI stimulation augments activated microglial populations, diminishes astrocyte presence, and exerts no apparent impact on neural proliferation. This scientific endeavour contributes to the elucidation of the neurobiological effects of TI stimulation, paving the way for a deeper understanding of its therapeutic potential in TBIs.17 0Item Restricted The use of social media and its impact on the mental health of the Saudi Arabian community.(Queen’s University Belfast, 2024-09-08) Almabdi, Adel; McLaughlin, DerekAbstract Background: The Kingdom of Saudi Arabia (KSA) is a nation with unique cultural, geographical, and economic features, predominantly characterized by a young Muslim population. In recent years, significant modernization and urbanization have influenced Saudis' lifestyles and mental health. Cultural attitudes and economic factors shape these mental health issues, with social media playing a pivotal role in societal interactions and mental well-being. Objectives: This study systematically reviewed the current peer-reviewed literature on the impact of social media on the mental health of the Saudi Arabian community. The goal was to synthesize key findings on both the positive and negative effects of social media use, offering insights for individuals, educators, policymakers, and healthcare systems to encourage healthier technology usage and enhance mental healthcare access. Search Strategy: A systematic search was conducted using keywords and Boolean operators across MEDLINE, PubMed, CINAHL, and PsycINFO databases to identify relevant peer-reviewed literature. The inclusion criteria focused on articles published between 2018 and 2024, written in English, and conducted in Saudi Arabia, specifically cross-sectional studies. Results: Thirteen articles met the inclusion criteria and were critically assessed using the appraisal tool for cross-sectional studies (AXIS). The studies were generally of acceptable quality, with well-defined research questions and appropriate methodologies. The findings were categorized into seven themes: prevalence of mental health issues, social media addiction and psychological distress, gender disparities, impact on adolescents, misinformation, the complex relationship with well-being, and family dynamics within the cultural context. Conclusion: This review highlighted that while social media fosters communication and information sharing, it also correlates with addiction, psychological distress, and misinformation. High rates of mental health issues, particularly among healthcare professionals and adolescents, underscore the need for targeted interventions and policies. Future research should focus on longitudinal studies and interdisciplinary collaborations to effectively understand and address these impacts.20 0Item Restricted Test Anxiety: A Comparative Study of Post-Graduate Taught Students in the UK and Saudi Arabia(University of Glasgow, 2024) Alshammari, Wafa; Swingler, Maxine; Biello, Stephany; Elliot, DelyTest anxiety (TA) is a multifaceted concept that has led to the development of numerous micro-level theories to elucidate its nature. However, only a handful have employed mid-level theories to comprehend TA in cross-cultural scenarios. This research endeavours to adapt the bioecological and biopsychosocial theories in a framework to discern the variations in TA experiences among students across different cultures and educational settings. To realize this aim, the study outlines three objectives: (i) to define, differentiate, and categorize TA, (ii) to examine the factors influencing TA, and (iii) to investigate the coping mechanisms that might mitigate the effects of TA across diverse cultural settings. These objectives are addressed through a series of three complementary studies: a systematic review, seeking to incorporate multiple cultural perspectives and encompassing 81 papers from 2000 to 2019 based on the PRISMA method, a quantitative survey (N = 429), and qualitative interviews (N = 15). The latter two phases focused on four distinct groups, comprising local Saudi students, local British students and European and Eastern international students studying in the UK. The research yielded several key findings. First, TA is more prevalent among all studied groups in the UK than in Saudi Arabia . Second, exosystem and mesosystem factors make the British education system more conducive to TA, while macrosystem and microsystem factors result in a more nuanced experience for Saudi and Eastern students . Third, contrary to popular belief and the existing literature, holding that coursework induces less TA than conventional examinations, this study demonstrates that the characteristics of coursework, such as the number of deadlines, uncertainty about the requirements, lack of familiarity with assessment type, perceived inability to secure full marks, and long duration of stress, can intensify TA. Responses to these factors are heavily influenced by cultural norms and students’ individual backgrounds . There is an interplay between coping mechanisms, cultural values (which might encourage procrastination), and the education system (coursework vs conventional examinations). Coping strategies vary across cultures, influenced by distinct cultural values and the education system. In addition, seeking psychological counselling for TA can be hindered by perceived barriers, namely cultural factors and lack of awareness. The academic implications drawn from this study are twofold: (i) while bioecological/biopsychosocial theory aptly describes TA across varied cultural contexts, it is crucial to recognize the proactive roles of individuals and the variance in cultural values, which can shape reactions and attitudes to TA; (ii) TA, coping strategies, and academic factors are intricately connected and are complex, warranting exploration from multi-level perspectives . From a professional standpoint, this research offers several insights. First, stakeholders, including universities, employers, and the public, should reconsider the values underpinning the nexus between students' social standing, career trajectories, and their evaluations. Second, UK academic institutions should implement policies ensuring that assessments prioritize mental well-being. Third, Saudi and Eastern universities need to expand their awareness campaigns, targeting not only their student body but also families and the broader community to combat competitiveness and the culture of high expectations.14 0Item Restricted Prevalence of Depression among University Students in Saudi Arabia An Adopted Systematic Review(University of Manchester, 2024-03-27) Alzahrani, Raghad; Shields, GemmaThe prevalence of depression is one of the critical mental disorders that affect a large population. The symptoms of the disorders include sad mood, anhedonia, low self-esteem insomnia, general fatigue, lack of appetite, and decreased concentration. The global prevalence rate is estimated at 4.4% across the populations, and a 49% prevalence of depression and anxiety symptoms among university students in Saudi Arabia. Studies on the prevalence of depression have confirmed that various factors such as sociocultural, biological, and psychological are the main contributors to depression and affect people of all ages. Depression disorders affect the level of quality of life for individuals, which leads to changes in physical activities, emotional functions, and behavioral changes. This study focuses on the prevalence of depression among university students in Saudi Arabia. This group of the population encounters a critical transition from one level of education to another, which requires them to be self-reliant and responsible individuals for them to survive, and from a transition from adolescence to adulthood, which turns out to be stressful at times. The stress mostly emanates from trying to blend into a new lifestyle, maintaining the pressure to excel academically, being away from home, and uncertainty about the future. The prevalence of depressive disorders is the most typical disease affecting many different factors of humanity. University students in Saudi Arabia may be at increased risk of depression owing to the pressure and stress they encounter. Therefore, the purpose of this study is to focus on the level of prevalence of depression among undergraduate university students in Saudi Arabia. A total of 460 journal sources were screened, which resulted in 3 appropriate journal sources for the final inclusion in the study on the prevalence of depression. A systematic review was used to evaluate several kinds of literature on the prevalence of depression among undergraduate university students.42 0Item Restricted Gender and intersectionality: Understanding and Addressing Women's Mental Health and Mental Health Policy within the Cultural Context of Saudi Arabia(University Of Glasgow, 2024-02-06) Alghamdi, NadiaAhmed Alhamd; Melville, CraigBackground: Intersectionality concerns the interconnected nature of social categories (e.g., race, gender, age, education) and how these ‘intersect’ to produce privilege and oppression. In the current context, this helps to understand women's mental health in socially disadvantaged positions, especially how intersections among gender inequality and factors such as socioeconomic status contribute to women’s mental health inequalities and experiences. Yet this remains an under researched area. This study’s overarching aim concerns understanding Saudi Arabian women’s mental health disorders, risks, challenges, and issues. For this, it has three objectives: to review the effects of intersectionality on this group within extant quantitative literature; to identify and explore the significant interactions among variables relating to this population’s social disadvantage and mental ill-health (e.g., gender and the risk of depression); and to analyse Saudi Arabia’s current mental health policy and gender equality. This study’s more specific aims involve furthering understanding of the effects of content, context, and actors behind mental health policies and programmes on Saudi women to help address their mental health needs. It takes the form of three studies. Study 1. This systematic review investigated quantitative methods used to study the intersectionality of multiple social disadvantages in women with common mental disorders. It reviewed studies on the intersectional effects of gender with multiple social disadvantages from the PROGRESS-Plus inequity framework and examined the quantitative methods these studies employ. The most common and means of studying intersectionality in mental health studies in the included studies was statistical interaction analysis. Other methods such as multilevel modelling and mediation decomposition analysis were also used. These robust statistical methods facilitate research on intersectional effects on mental health and improve understanding of the complex intersection of gender and other social disadvantages concerning women’s risk of common mental disorders. Study 2: This study analysed the National Survey of Saudi Food and Drug Authority dataset, a nationally representative sample of individuals aged 18–88 in Saudi Arabia (3,408 participants: 1,753 males and 1,655 females). Evaluating variable risks of depression using the PHQ-2 screening questionnaire, it found significant correlations between depression risk and the variables of gender, education, family income, and employment status. Although a subsequent multivariate analysis found the only significant predictors of depression risk to be female gender and education below the bachelor level. No interaction effects were observed, implying an additive effect of gender and education on the risk of depression. Study 3: This study analysed Saudi Arabia's mental health policies and gender equality. Using Walt and Gilson's health policy analysis framework, it highlights the need to address gender inequalities in the country's mental health policies. It provides evidence-based mental health policy recommendations relating to women in Saudi Arabia about enhancing their mental health and well-being and establishing an equal health system. Conclusions: Examining women’s mental health through an intersectionality lens can help policymakers address Saudi Arabian women’s mental health issue . To reduce inequalities, advances must be made in women’s education, training, employment, socioeconomic status, access and participation, equality, and overall independence. However, this must take place within a wider targeted and tailored reform agenda (legal, policy, political, PR, cultural, religious, economic, careers, educational) within which women must actively participate. Urgent inclusive, deep, and far-reaching intersectional initiatives, adjustments, research and reforms are needed to elevate Saudi women’s circumstances, experiences, and mental health and thereby address the current issue and ultimately improve society overall.42 0Item Restricted THE INTRICATE RELATIONSHIP BETWEEN TOURISM AND HEALTH: A SYSTEMATIC REVIEW(University of Surrey, 2024-02-26) Alqahtani, Saad; Chen, JasonBackground: There exists a direct relationship between tourism, travel and health. According to the United Nations World Tourism Organization (2015), tourism can directly promote health and wellness through the provision of strategically reinvented health-related services. It is from this perspective that the rise of medical tourism became apparent. Medical tourism is the practice of travelling abroad for medical services. Under normal circumstances, wellness tourism is aimed at advancing the motivation of relaxation, mental therapies, and an improved quality of life for the tourists. There is a direct link between travel/tourism and health as the former directly impact an individual’s state of health in association with social, physical and mental wellbeing (Alipour et al., 2020: Lee et al., 2020). Moreover, according to Hartwell et al. (2018), tourism presents a direct influence on psychological, emotional, spiritual and cognitive dimensions of a normal person’s wellbeing. The above arguments by Alipour et al. (2020) and Lee et al. (2020) support a previous finding indicating that there is a causal relationship between tourism and health based on the observation that older tourists tend to be healthier and active as compared to non-tourists (Ferrer et al., 2016). Research aim: To identify, evaluate, and synthesise evidence from the published research on the relationship between tourism and health to set precedence for the future research on the identified gaps. Research objectives: 1) To summarise and synthesise the existing evidence on the relationship between tourism and health 2) To identify knowledge gaps in the extant literature in relation to the nexus between tourism and health 3) Establish precedence and set a background for the future research on the relationship between tourism and health 4) To make relevant recommendations that will inform decision-making practices by companies operating within the tourism sector on the provision of health-oriented services 5) To make recommendations that will influence the perceptions and decisions made by tourists in visiting destinations solely for meeting their health and wellness needs Methods: Philosophy: The interpretivist-constructivist was preferred because it tends to focus on plausibility, authenticity, justifiability, coherence, criticality, comprehensibility, compulsion, and assessability of a certain topic of interest. The interpretivism-constructivism approach is justified because the researcher is aiming to derive meaning from the existing secondary sources on the relationship between tourism and health. Design: The systematic review design was used to determine the extent and nature of evidence published on the aspects of tourism and health. Search process: The online databases from which the evidence was retrieved include MEDLINE (PubMed) and Google Scholar. The combined keywords were [Tourism OR travel OR vacation] AND [health OR well-being OR medical OR mental health OR physical health OR wellness] AND [impact OR effect OR association] AND [population OR community OR individual]. The PRISMA 2020 flow diagram was used as a guide to the evidence search process. Quality appraisal: The mixed methods appraisal tool (MMAT) was adopted in the appraisal of methodological quality of the included studies. Results: The initial search retrieved 534 reports that were evaluated based on the inclusion/exclusion and eligibility criteria leading to the final list of 15 articles (2 qualitative and 13 quantitative). Evidence was then retrieved from the 15 articles. The intricate relationship between tourism and health was revealed in four perspectives. First, medical tourism positively impacts tourists’ physical and psychological health, wellness in the form of positive emotions and life satisfaction due to the tourist’s autonomy, experience, and intrinsic motivation. Second, higher perceptions of community well-being arose from greater economic performance of medical tourism. Given the perceived positive impacts of tourism, the community’s attitudes toward medical tourism influenced the overall satisfaction with the practice and eventually, the community’s willingness to pay higher taxes and participate in the promotion of medical tourism. Third, the negative health impacts of tourism include increased crime rates, overcrowding and congestion that heighten the residents’ stress levels leading to ill health. Finally, medical tourists’ require to be motivated, and the factors that influence their intentions to visit a destination include follow-up care, advanced and affordable medical technology, tourism activities for companions, strong government support, extra support for patients, price, variety of treatments, accessibility and service, and infrastructure at the destination, perceived risks, and medical facilities associated with the destinations. The factors that influence revisit intentions are health evaluation, international certified doctors, doctors’ expertise, quality of medical treatment, advanced medical treatment, high healthcare quality, hospital contact information, waiting time until treatment, and availability of medication. Limitations: The scope of the review was limited as only 15 articles were included. There was inadequate theoretical development in the studies due to failure to incorporate key elements pertaining to this relationship such as public awareness and tourism campaigns in cementing medical tourism, responding to health crises such as pandemics, the dynamics of medical tourists’ behaviours during pandemics, the role of policy, regulation, technology, ethics and sustainability as fundamental pillars of medical tourism. Moreover, methodological limitations were evident in the sampling strategies and data collection methods used. Most of the studies adopted purposive and convenience sampling strategies, which are non-probabilistic. This introduced sampling bias that affected the credibility and generalisability of the results. Additionally, interviews are subjective while cross-sectional designs do not depict causal relationships. Implications for practice and future research: This review positively contributes to the tourism industry. Since the number of health-conscious visitors is on the rise, businesses with stake in tourism, hospitality, and travel sectors should position themselves to offer services that appeal to such tourists. They can segment their clients according to their needs and invest in the required services and products to generate more revenues. Furthermore, since the review outlines the factors that motivate medical tourists to either visit or revisit an attraction destination, it is beneficial to the destinations that offer health and wellness services. These destinations will adopt the factors that motivate medical tourists to visit, and as a result, improve their competitiveness in that sphere of service provision. This will open up innovation in the sector in relation to enhancing medical tourism. The future research should pursue additional variables including the role of the tourism sector in responding to health crises such as pandemic, the dynamics of medical tourists’ behaviours during pandemics, the role of policy, regulation, technology, ethics and sustainability as fundamental pillars of medical tourism. The future research should consider investigating this relationship from the lenses of multiple motivational theories including Maslow’s Hierarchy of Needs, Theory of Planned Behaviour (TPB), Self-Determination Theory (SDT), and Expectation Confirmation Theory (ECT). Mixed methods, experimental, and quasi-experimental designs are recommended for future research to establish causal relationships among variables developed from the relationship between tourism and health. Conclusions: The review posits that tourism is not only for leisure purposes but serves even more interesting purposes such as promotion of health and wellness. It is evident that medical tourism is on the rise and its social, wellness, cultural, and economic value is acknowledgeable. Therefore, more efforts should be invested in medical tourism for the benefit of businesses, visitors, healthcare systems, and communities and their economies. Nevertheless, research is underdeveloped in this area, and thus, justifies the need for continued research to fill the existing knowledge gaps.26 0Item Restricted “We’ll hang ourselves tomorrow”: A Psychotherapeutic Study of Samuel Beckett’s Waiting for Godot(University of Leeds, 2023-11-23) Alshalawi, Haya; Ray, NicholasThe objective of the paper is to explore Samuel Beckett’s Waiting for Godot from a psychotherapeutic perspective, suggesting that the characters perform some representations that indicate their familiarity with psychotherapy. Drawing on different studies in the field of psychotherapy and psychiatry, I will argue that the play examines the influence of some psychotherapeutic practices on the characters’ mental health. In this way, this dissertation seeks to suggest that the play is far from being absurd as it portrays the human condition with its all complexities to produce a work that can communicate before it is understood.66 0Item Restricted Dose Mental Health Have an Impact on The Number of minutes Exercising?(University of Strathclyde, 2023-09-07) Albogamy, Nourah; Stewart, RyanThis study aimed to explore the influence of physical activity on mental health, utilizing the Scottish Health Survey 2021 data to investigate the association between exercise duration and mental well-being, alongside various confounding factors. Employing Poisson regression initially, the research encountered analytical challenges due to violation of model assumptions, prompting the use of Negative Binomial Regression and Zero-Inflated Negative Binomial Regression models for a more accurate assessment. The findings illustrate a significant positive relationship between Moderate to Vigorous Physical Activity (MVPA) and mental health, as measured by the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), highlighting the benefits of increased physical activity. The study further identifies age, gender, alcohol consumption, and education level as important determinants of physical activity frequency, each contributing uniquely to the complex dynamics between physical exercise and mental health. Notably, the analysis reveals age-related declines in exercise, gender disparities favoring males in physical activity levels, intricate interactions between alcohol use and exercise, and an unexpected pattern of higher MVPA among those with lower educational attainment. These insights emphasize the need for targeted, age-appropriate exercise programs and challenge prevailing assumptions about the socio-demographic drivers of physical activity. The paper also suggests avenues for future research, including the exploration of interdependencies among the identified variables, to deepen understanding of the multifaceted relationship between physical activity and mental health.43 0