Saudi Cultural Missions Theses & Dissertations
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Item Restricted Three Essays in Mental Health Economics: Education and Labor Market Outcomes(Saudi Digital Library, 2025-06) Alarabim, Hosam; Koreshkova, TatyanaThis dissertation explores how mental and physical health influence key economic outcomes over the life course, focusing on education, occupational outcomes, and workplace productivity. Using longitudinal data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study employs advanced modeling techniques, including Generalized Structural Equation Modeling (GSEM) and mixed-effects regression, to construct latent health measures and quantify their economic consequences. The first chapter examines the impact of adolescent mental health on academic achievement, particularly high school completion and college enrollment. It addresses the limitations of using narrow diagnostic proxies for mental health by applying a factor-analytic approach to create latent constructs. The findings reveal that better mental health significantly improves educational attainment, with a stronger effect on college entry than on high school completion. The second chapter investigates how health status shapes occupational sorting across two major classifications: white-collar and full-time employment. It finds that individuals with poor mental health are disproportionately concentrated in low skill, physically demanding, blue-collar jobs, while those with better health are more likely to enter cognitively intensive, white-collar occupations. Physical health also influences job type, reinforcing disparities in labor market access and long-term mobility. The third chapter evaluates the effect of mental health on workplace productivity. By constructing a composite latent productivity score, based on job satisfaction, hours worked, and income, the study estimates the long-term effects of lagged health status. A one standard deviation increase in mental health is associated with a 0.0251 rise in latent productivity and a 0.0201 increase in wage measure of productivity, confirming the strong and persistent influence of psychological well-being. Together, these chapters show that mental health is a critical determinant of economic opportunity, shaping individual outcomes from adolescence through adulthood.5 0Item Restricted An Adapted Framework for the Interaction of Parenting Style in Shaping/Facilitating Attachment to God and Parents in Islamic, Middle Eastern Culture(Widener University, 2025-06-23) Alotaibi, Ohud; Boyer, BretThis study sought to further research regarding the relationship between parenting and interpersonal attachment styles, attachment to God, and life satisfaction, by extending the Western centric theoretical framework and data to cultural contexts and values of Islamic faith in the Middle East, specifically, Saudi Arabia. Data was collected from 474 participants. Multiple regression results indicate a strong positive relationship between authoritative parenting and life satisfaction, and a negative correlation with insecure interpersonal attachment. Conversely, individuals exposed to authoritarian parenting are at a higher risk of developing insecure attachment styles, which can manifest as difficulty forming secure interpersonal relationships, which further relate to attachment relationships to God (Allah), and life satisfaction.58 0Item Restricted Does Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review.(Cardiff University, 2025) Alqahtani, Ola; Gale, NicholaDoes Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review. Background & Rationale Cardiovascular disease (CVD) is the world’s leading cause of death and disability, placing significant clinical and economic burdens on healthcare systems. While cardiac rehabilitation (CR) encompassing exercise, education, and routine psychosocial support has been shown to improve clinical outcomes, up to thirty percent of cardiac patients experience clinically meaningful depressive symptoms which reduce CR adherence and long-term success. Cognitive behavioural therapy (CBT) offers a structured approach to modifying maladaptive thoughts and behaviours, potentially addressing psychological barriers more effectively than generic psychosocial support. However, many reviews have evaluated heterogeneous ‘psychological interventions’ rather than isolating CBT’s specific impact. This systematic review set out to determine whether CBT, when integrated into CR, alleviates depression and enhances health-related quality of life (HRQoL) more effectively than CR alone. Methods A systematic literature search was conducted across five major databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO) from inception to the most recent feasible date, adhering to PRISMA guidelines for study selection and reporting. Six randomised controlled trials, totalling 708 participants, satisfied the inclusion criteria by focusing on adults (≥18 years) undergoing CR for various cardiac conditions (such as myocardial infarction, heart failure, or post-cardiac surgery). Studies which integrated structured CBT sessions into standard CR were compared to CR alone or other forms of standard care. The primary outcome was the reduction in depressive symptoms, measured by validated scales (e.g., the Hamilton Rating Scale for Depression or the Hospital Anxiety and Depression Scale (HADS)). Secondary outcomes involved changes in HRQoL, assessed by either generic or cardiac-specific instruments (such as the Minnesota Living with Heart Failure Questionnaire). Quality appraisal followed the Joanna Briggs Institute guidelines and due to heterogeneity in intervention formats, population characteristics, and outcome measures, a narrative synthesis approach was applied rather than a meta-analysis. Key Findings and Discussion Although the six trials varied in terms of sample size, intervention intensity, and follow-up duration, they shared an overarching conclusion that integrating CBT within CR can lead to notable reductions in depressive symptoms and meaningful improvements in HRQoL. The degree of benefit was generally greater in patients presenting with moderate-to-severe baseline depression. Face-to-face CBT delivery typically achieved better adherence (often exceeding 75%) and larger effect sizes, whereas fully digital CBT programmes suffered from low engagement (approximately 15% module completion). These findings suggest that the personal interaction and therapeutic alliance inherent in face-to-face sessions remain critical for maximising CBT’s clinical impact in cardiac populations, particularly those facing multiple stressors related to their disease. CBT combined with exercise, in several trials, appeared to deliver synergistic benefits for depression and HRQoL, possibly through complementary behavioural (cognitive restructuring and skill-building) and physiological (improved cardiovascular function) mechanisms. The interplay between exercise encouragement and cognitive-behavioural strategies against fear-avoidance thinking also emerged as an important determinant of enhanced functional capacity and sustained improvements in mood. Limitations Several limitations may constrain the generalisability of these results. First, the overall sample predominantly comprised of male participants (approximately two-thirds were male), leaving questions regarding whether women, who often exhibit different depressive symptom profiles and a greater prevalence of depression post-myocardial infarction, would experience similar outcomes. Second, varied measures of depression and HRQoL, along with wide differences in the intervention ‘dose’ (ranging from five-session brief interventions to twelve-week combined programmes), precluded direct quantitative comparisons across studies. Some trials were also underpowered and only a few extended follow-up beyond six to twelve months. Digital CBT approaches did not yield strong results in this review but that may reflect poor adherence rather than intrinsic ineffectiveness, highlighting a need for more engaging and personalised technological platforms. Finally, these RCTs spanned multiple healthcare settings in Europe and the United States where infrastructural and cultural factors might influence both the feasibility of CBT delivery and participant engagement. Conclusions and Recommendations This review provides evidence that structured CBT, when delivered in tandem with cardiac rehabilitation, can significantly alleviate depressive symptoms and promote better quality of life. The most robust outcomes were observed in trials that targeted moderate-to-severe depression, employed face-to-face group or individual CBT sessions, and ensured consistent patient follow-up. These findings strengthen the case for systematically screening CR entrants for depressive symptoms and offering a dedicated CBT component to those above a certain severity threshold. Practical feasibility can be enhanced by training nurses, physiotherapists, or other allied professionals in CBT skills, as illustrated in studies where task shifting maintained strong outcomes. Policy-making bodies, such as national cardiac societies and health agencies, may wish to recommend CBT as a priority psychological intervention in CR programmes, particularly for patients with moderate or severe depression. Future research should further refine the optimal ‘dose’ of CBT, compare blended or stepped-care digital and in-person models, and evaluate the cost-effectiveness to guide broader adoption. By focusing on cognitive restructuring and behaviour change within the supportive framework of CR, healthcare systems can potentially improve both the mental health and functional recovery of individuals with CVD.7 0Item Restricted Mental Health on Social Media: AI-Driven Detection and Response(Arizona State University, 2025) Alghamdi, Zeyad; Liu, HuanMental health issues are increasingly prevalent, with stress playing a critical role in the development of severe mental and physical health conditions. Early detection and effective intervention are essential for mitigating these challenges. In an increasingly digital world, social media serves as a valuable repository of large-scale data on how individuals vent and express stress. This data source captures two critical dimensions or perspectives: the individual and the social. The individual dimension is revealed through direct expressions of stress in users’ posts, where emotional states and linguistic patterns provide important indicators. In a synergistic manner, the social dimension is discerned from the reactions of others, offering contextual cues that reflect the broader environment’s influence on the user’s mental state. My dissertation builds on this dual perspective by integrating social science and psychological theories to inform a methodologies,that strengthens AI’s capacity to recognize stress-related cues and also to engage with mental health discourse in a refined and contextaware manner. To achieve this, I propose three innovative detection strategies that capture the individual and social dimensions. The first strategy focuses on analyzing the finegrained linguistic and emotional features to identify stress within individual posts, directly addressing the individual perspective. The second strategy extends this analysis by examining the broader contextual nuances embedded in these posts, thereby deepening the understanding of individual stress expressions. The third strategy shifts attention to the social perspective by incorporating emotional cues from community responses as auxiliary signals to enhance the stress classification. Finally, drawing on the insights from these works, I established a data-supported refinement process that improves AI’s ability to produce more supportive responses that are both contextually aware and socially attuned. This research exemplifies how interdisciplinary innovation can redefine AI’s role in addressing complex challenges in mental health.25 0Item Restricted The Efficacy of Cognitive Behavioural Therapy for Schizophrenia(QUEEN’S UNIVERSITY, BELFAST, 2025-01-21) Dabsh, Munirah; Ownes, MarkThis dissertation evaluates the efficacy of cognitive behavioural therapy (CBT) in treating schizophrenia, focusing on symptom reduction, social functioning improvement, and cultural adaptations. A systematic review of ten studies was conducted using rigorous inclusion criteria, resulting in a synthesis of evidence spanning diverse settings and methodologies. Findings highlighted CBT's significant impact on positive symptoms, moderate effect on negative symptoms, and the necessity for culturally sensitive approaches. However, barriers such as methodological limitations, cultural barriers, and limited therapist training were evident. Future research is essential to refine interventions and expand access to evidence-based care7 0Item Restricted Unveiling Maternal Mental Health: Exploring the Perceptions and Practices of Mental Health Care for Pregnant and Postnatal Women in Kingdom of Saudi Arabia: A Mixed Methods Study(University of East Anglia, 2024) Alshammari, Athar; Crozier, Kenda; Wadnerkar, MeghanaBackground: Mental health during pregnancy and the postpartum period is critical yet often overlooked. In Saudi Arabia, cultural and societal norms significantly influence perceptions and practices related to mental health and these are compounded in the context of maternal mental health. Objective: This thesis aimed to explore the knowledge, perceptions, and challenges faced by women and healthcare providers (HCPs) regarding mental health during pregnancy and postpartum in Hail, Saudi Arabia. Methods: An embedded mixed-method design was used. Semi-structured interviews with ten pregnant and postpartum women and ten HCPs. An online cross-sectional survey was conducted with 349 HCPs to evaluate their knowledge of depression symptoms, risk factors, and treatment options. Results: Qualitative interviews revealed four major themes: Awareness and Education on Maternal Mental Health, Stigma and Shame, Barriers to Accessibility, and Enhancing Maternal Mental Health Care. Women's misconceptions and fears of stigma led to reluctance to seek help. HCPs highlighted gaps in training and guidelines, with barriers including limited time and inadequate mental health education. Quantitative results showed insufficient knowledge among HCPs, with an average score of 8.62 out of 20 (44.86% correct). Knowledge was higher in treatment (53%) compared to assessment (45.88%) and education (35.71%) domains. Discussion: The integrated findings reveal gaps in knowledge and perceptions of maternal mental health among both women and HCP. This study offers novel insights by combining perspectives from both groups, uncovering underexplored cultural barriers and care gaps. It highlights how cultural stigma, HCP training, and systemic issues impact Saudi women’s perinatal and postnatal experiences. Conclusion: This thesis provides new insights into maternal mental health issues in Saudi Arabia, highlighting the need for targeted education, reduce stigma, and improved support systems. Future research should explore socio-cultural interventions to address these gaps and enhance care delivery21 0Item Restricted Influence of Culture and Stigma on Help-Seeking for Mental Health: A Cross-Sectional Study of Saudi University Students in the US(Kent State University, 2024-09) Alshehri, Amer Ali; Ding, Kelemental health help-seeking intentions and acculturation, stigma tolerance, expertness, and self-efficacy among Saudi international students in the United States. Additionally, it sought to explore the impact of anxiety, depression, and the COVID-19 experience on the intention. A cross-sectional survey research design was used to collect data from Saudi students enrolled in American universities. A sample size of 377 was pursued based on sample size estimation for a confidence interval of 95% and a margin of error of 5%. A total of 198 respondents completed the survey covering demographic variables, acculturation, stigma tolerance, expertness, intent, self-efficacy, anxiety and depression assessment, and COVID-19 impact and experience. Data were analyzed by using Statistical Package for the Social Sciences (SPSS)Statistical significance was set at p≤.05. The findings highlighted the importance of considering cultural and individual factors in understanding mental health help-seeking behaviors among Saudi international students. The Theory of Planned Behavior provides a valuable framework for conceptualizing these behaviors. Implications of the findings for mental health interventions and support services for Saudi students in the United States are discussed.12 0Item Restricted The Relationship of Dispositional Optimism and Religiosity to Mental and Physical Health in Saudi Arabian Students Studying in The United States.(Barry University, 2023-02) Albattah, Majidah; Koncsol, StephenThe relationship between different forms of faith as belief systems and universal concepts of quality of life, health, well-being, etc., has attracted huge research attention. Data from Islamic samples support the positive link between religious belief, mental, and physical health. Little research has been done to examine the multiple dimensions of optimism and how it relates to religion and health. The aim of this study was to investigate the relationship of dispositional optimism and religiosity to the mental and physical health of Saudi Arabian students studying in the United States. Understanding the relationship between optimism and religiosity may allow the creation of different strategies and therapy plans that help to maintain good mental and physical health for students studying aboard. A sample of 316 Saudi Arabian college students studying in United State were recruited. The sample was collected through an anonymous online survey through online sources e.g. WhatsApp, Facebook, Twitter, and Snapchat that reach Saudi communities in United States. Participants were asked to complete five questionnaires anonymously including: A Demographic questionnaire, Physical Health questionnaire, The Revised Life Orientation Test (LOT-R; Scheier, Carver, & Bridges, 1994), The Muslim Daily Religiosity Assessment Scale (MUDRAS; Olufadi, Y., 2016), and the Warwick–Edinburgh Mental Well-being Scale (WEMWBS, Stewart-Brown & Janmohamed, 2008). For the first hypothesis, a correlational analysis was performed to assess the relationship between the scores for The Revised Life Orientation scale and The Muslim Daily Religiosity Assessment Scale. Results showed a significant positive relationship between dispositional optimism and Muslim religiosity. For second hypothesis, a correlational analysis was performed to assess the relationship between dispositional optimism and mental health. Results reveled that there was a significant positive relationship between dispositional optimism and mental health. Results for the third hypothesis showed a significant positive relationship between dispositional optimism and better mental health. In a fourth hypothesis a hierarchical regression was conducted to test that optimism (LOT-R Scores), Mental Health (WEMWBS Scores) and Physical health (Phy Scores) would predict religiosity (MUDRAS Scores). Mental health, physical health and disposition optimism were not found to have a significant impact on Muslim religiosity. As the fourth hypothesis was rejected it was decided to investigate the relationship of optimism as a mediator of religiosity, mental and physical health. Therefore, a hierarchical regression was conducted to test that religiosity, mental and physical health would predict dispositional optimism. Results showed that optimism significantly predicts mental health. There was a trend toward optimism predicting physical health but it was not significant. However, optimism did not significantly predict religiosity. Future research should be focused on a Saudi Arabian population who study and live in Saudi Arabia instead of the USA.22 0Item Restricted A Grounded Theory Investigation of Self-Identified Female Students’ Mental Health Perception, Mental Health Factors, and Help Seeking Behaviours(Western University, 2024) Alzaidi, Laila; Forchuk, Cheryl; Babenko-Mould, Yolanda; Booth, RichardThe purpose of this integrated-article dissertation was to explore self-identified female students’ understanding of mental health, mental health factors, and help-seeking behaviours. Young adults often face multiple stressors in their daily lives and must find ways to prevent, address, or overcome stressors that can lead to emotional and physical distress. University life can be more stressful because of greater responsibilities and independence during this age period. Increasingly, post secondary school students are recognized as an at-risk population for poor mental health. It is worth noting that female students experienced greater levels of stress compared to other genders. Poor mental health can contribute to poor academic performance and excessive alcohol consumption. Transition-aged youth (17-29 years) of all genders are particularly at risk of developing mental health problems, yet they are one of the least likely demographic groups to seek help. In a state of mental health, individuals are more prepared to take healthy risks, actively contribute to society, and gain life satisfaction. The undertaking for mental well-being is a common desire for oneself, students, and loved ones. However, limited research has been conducted about perceptions and attitudes of young adults, especially among female students, regarding mental health and help-seeking behaviours. A constructivist grounded theory study was conducted, and semi-structured interviews were undertaken between January and March 2023 with 22 self- identified female students who were enrolled in post-secondary programs at a university in Ontario, Canada. Participants shared their insights during in-depth individual interviews. The following eighteen themes emerged from students data during data analysis: psychological well-being, socioeconomic factors, social and societal influences on students’ well-being, holistic well-being perspectives, academic perspectives, career and financial perspectives, life and future perspectives, coping mechanisms, healthcare engagement challenges, psychological barriers, relational barriers, personal challenges, seeking professional and non-professional support, integrated support, self-reliance and self-help. The findings demonstrated that students’ advocacy for the promotion of mental health practices has a strong impact on their overall well-being.18 0Item Restricted Introducing Stakeholder Perceptions of Refugee Children’s Wellbeing(University of Leicester, 2024-02-23) Alowaybil, Reem; Maltby, JohnThis thesis introduces a new approach of conceptualising refugee children’s wellbeing by incorporating insights of multiple stakeholders. This was achieved by five empirical studies using different qualitative and psychometric designs. The first study aimed to establish the challenges in addressing refugee children’s wellbeing using a sample of refugee children, parents, and professionals. Stakeholders highlighted the challenges in education wellbeing, indicating lack of understanding of refugee children’s mental health needs in the education system. The second study aimed to bridge this gap by introducing a new model of teachers’ perceptions of refugee children’s school wellbeing ‘The WELLS’, and developing a new scale. Study three aimed to test the underlying structure of the new developed scale using an independent sample of schoolteachers. Results suggested a three-dimensional model of teachers’ perception of refugee children’s school wellbeing; mental, academic, and social. The fourth study introduced a short form of the new scale, in order to provide schoolteachers with an efficient measure of refugee students’ mental health needs, and to support the multidimensional nature of the scale. To this end, two samples of schoolteachers were recruited in this study to confirm and test the replicability of the three-factor structure. Finally, a sample of schoolteachers was recruited in the fifth study to align the three dimensions against convergent and discriminant constructs. Overall, this thesis offers a comprehensive theoretical understanding of refugee children’s wellbeing as perceived by stakeholders. Furthermore, a novel measurement tool designed to assess refugee children's school wellbeing from the perspective of teachers was introduced. It contributes to improve our understanding of refugee children's mental health needs and offers a valuable resource for interventions that future research in this area can benefit from.13 0