Quality of life, disability, health behaviours and recovery among women living with mental illness in Saudi Arabia: A mixed methods study

Abstract

Background Research on women with mental illness in Saudi Arabia is limited with the voices of these women not heard. Quality of life, disability and recovery are critical concerns for these women. Healthy lifestyle behaviours and their life experiences are not known. Aim To explore the experiences of women hospitalised with mental illness and to examine the quality of life, level of disability, health behaviours and personal recovery of women living with mental illness in Saudi Arabia. Methods A convergent mixed methods research design was conducted in two Saudi government-funded mental health hospitals in the cities of Taif and Jeddah in the Kingdom of Saudi Arabia. Face-to-face in-depth semi-structured interviews were used to collect qualitative data. For quantitative data, a cross-sectional survey administered three standardised and validated instruments to measure quality of life, disability and recovery: the World Health Organization Quality of Life Brief Version questionnaire, the World Health Organization Disability Assessment Schedule 2.0, and a Questionnaire about the Process of Recovery. Demographic characteristics, clinical information and health behaviours were collected from medical records and by self-report. Data were collected simultaneously and analysed separately. Qualitative data were analysed thematically. Quantitative data were summarised descriptively, and linear and logistic regression techniques were used to determine factors associated with quality of life, disability and recovery. Results from both methods were integrated and discussed to gain a comprehensive understanding of the research phenomenon with researcher reflexivity. Findings and results Individual interviews were undertaken with 19 women hospitalised with mental illness. Four major themes emerged: lived experiences with mental illnesses, the voice of recovery, lifestyle and wellness, and knowledge and understanding. The cross-sectional survey was administered to 201 women. There was a higher proportion of married women and women who were housekeepers from Taif, while there was a high proportion of single women and more highly educated women from Jeddah. Health behaviour characteristics indicated that many women were either overweight or obese and did not engage in physical activity. Final adjusted regression models revealed several key findings. Recent diagnoses with mental illness and unemployment status resulted in lower quality of life scores. Lack of exercise resulted in lower physical health and psychological health. Being single resulted in lower social relationships and environment domains, while being married resulted in lower scores for physical and psychological health domains. Married or widowed women who were recently diagnosed with a mental illness, unemployed women, women with no formal education, or who never exercised were more likely to have higher disability levels. Recent diagnosis, being younger, married or widowed, unemployed, not engaging in activity and having poor sleep resulted in lower recovery levels. This integrated approach demonstrates that face-to-face interviews can reveal deeper, context-specific factors influencing the quality of life and recovery and underscores the necessity of a holistic approach to the mental health care of women with mental illness. The interviews revealed significant challenges related to stigma, social isolation and the impact of educational background on participants’ lives, which were less apparent in the quantitative component. The survey data provided a better understanding of potentially modifiable factors to impact quality of life, disability and recovery. Both data sources aligned with the Connectedness, Hope, Identity, Meaning and Empowerment framework revealing a shared emphasis on the five key aspects of personal recovery. Conclusion This thesis uniquely explores the experiences of women with mental illness in Saudi Arabia focusing on their quality of life, disability, health behaviours and recovery providing valuable insights and implications for enhancing support and care for women. This study provides new insights into their experiences and significantly advances the understanding of women’s challenges and perspectives. Delivering recovery-based practices and advocacy programs for community and mental health professionals is recommended. Incorporating counselling services into healthcare policies, enhancing community-based support, and improving nursing practices are critical. Advancing mental health education and addressing stigma through public awareness are crucial to building a more inclusive and supportive society. Future research should focus on understanding the mental health needs of women with mental illness, addressing socio-cultural barriers to help seeking, and reducing stigmatisation and discrimination. Including more women from this vulnerable group in research allows their voices to be heard.