Psychosocial correlates of using faith healing services in Riyadh, Saudi Arabia: a comparative cross-sectional study

Traditional healers represent an undeniable source of care for people with psychiatric disorders in developing countries [1]. Those who most utilize traditional healers are thought to be uneducated, poor, and lacking access to the health care system [2]. However, there is a large number of overlapping social, economic, and cultural factors that determine patient help-seeking behavior from traditional and faith healers (FHs) [3]. The prevailing belief system plays important roles in shaping the use of faith healing from people with psychiatric disorders [4].

Religion plays an important role in the lives of people in Saudi Arabia where Islam is the state religion. Many patients seek the help of FHs for a wide variety of physical and psychiatric problems before turning to modern medicine [5]. The FHs operate in harmony with a shared world view of the society that includes beliefs in magic, evil eye, and possession [6]. The FHs typically perform religious-based practices, such as reading the Holy Quran, as a source of healing. Also, they claim to follow the prophetic traditions of the prophet Mohammad with regard to the health, sickness, and treatment [7].

Psychiatric patients within the faith healing system have not been widely studied. In this study, we compared the prevalence of psychiatric disorders and characteristics of both those who use and do not use FHs. We also assessed the independent factors of study subjects associated with visiting FHs.

Of the total 807 study subjects, 383 (47.4%) from faith healing settings and shopping malls settings have used FHs services. The remaining 424 (52.6%) were those from the shopping malls who had not used FHs services (the control group). The mean (standard deviation) age of these study subjects is 31.5 (10.7). The mean age is statistically significantly higher in users of FHs (34.2 years) than the control group (29.1 years).

Higher proportions of FHs using were found in males (63.2%) and singles (46.2%). The association between these sociodemographic characteristics of those using the FHs in comparison to the control group shows a high statistically significant association. For example, the odds of male study subjects using FHs for their health problems is 3.9 times more than female using FHs. Also, the odds of married and who were either divorced or widowed using FHs is 2.4 times and 3.7 times more compared to study subjects who were single.

About 48.3% of the participants had intermediate or secondary levels of education, and about 40.1% had university degrees. A small percentage had lower educational levels or was illiterate (6.1%). Those who were illiterateor had only a primary level of education, and those who had intermediate or secondary levels of education were more likely to use FHs for their health problems. Their odds ratios of 18.8 and 3.0, respectively, indicate that there is a statistically significant association between these levels of education and using FHs compared to those who held Master's or Ph.D. degrees.

The stepwise multivariate binary logistic regression analysis of our data provides the independent factors of the participants and their associations with using FHs. The analysis shows that males were 4.8 times more likely than females to use FHs; those who were divorced or widowed were 3.5 and 4.8 times more likely, respectively, than singles to use FHs; those who were illiterate or held only primary levels of education were13.9 times more likely than those who held Masters or PhD degrees to use FHs; and those with lower incomes (<10,000SR) were 1.8 times more likely than others to use FHs.

As in the Saudi population [11], the participants were mostly young adults with at least an intermediate level of education. However, those with lower levels of education and lower incomes were more likely to use FHs. This fact indicates that people with more education and higher economic status may seek medical help instead of faith healing treatment. Al-Rowais et al. [12] completed a household survey in search of the reasons and health problems associated with seeking help from traditional healers. They reported the same inverse relationship between education and the likelihood of visiting a traditional healer; however, there was no association with income. Sorketti et al. [8] also reported that most of the visitors to the faith healing centers in Sudan were illiterate or held only basic primary education.

This may support the notion that users of FHs in developing countries generally have low educational and socioeconomic status. However, this is not the case in western communities where studies of sociodemographic correlates of the use of such type of healing in western communities resulted in inconsistent findings depending on the sample characteristics, type of healing intervention assessed, and time frame of the utilization question [2]. Considering epilepsy as a neurological disorder with major neuropsychiatric manifestations, we found that in some developing countries, such as Saudi Arabia and Pakistan and some minority ethnic communities in United Kingdom, epilepsy was frequently attributed to supernatural causes, and people with epilepsy sought treatment from FHs [13–15]. However, not only poor, less educated people, or those who cannot access the health care system,will seek treatment from FHs; well educated people and those with higher socioeconomic class may also seek help from FHs [16].

Females and singles were less likely to visit FHs. This contrasts with the findings of Al-Rowais et al. [12] and of Sayed et al. [5], who studied sociodemographic and clinical characteristics of FH users among psychiatric outpatients in Saudi Arabia. Both reported that the elderly and females were more likely to visit traditional healers. This could be explained by the restriction made by FHs and the reluctance of females to being interviewed by male interviewers in our study.

The FH users were more likely to report past medical or psychiatric histories. Compared to the control group, those with diagnosable psychiatric disorders were more likely to visit FHs. Before adjusting for confounding variables, this was especially true for those with either psychotic or bipolar disorders; however, after adjusting for confounding variables, it was especially true for those with bipolar or depressive disorders.

The prevalence of psychiatric disorders was higher among FH users; depressive and anxiety disorders being the most prevalent. Where few studies have studied those with psychiatric disorders in traditional healing settings, our finding of a high prevalence of psychiatric disorders is consistent with what has been reported in the literature among those with various cultural and ethnic backgrounds. In spite of the consistency of association with psychiatric disorders, the most prevalent disorder varies between studies. The differences can be explained by use of different study procedures including diagnostic instruments and study settings. Two studies reported by Abbo et al. [17, 18] and Sorketti et al. [8] were conducted in facilities that provided overnight accommodations for the visitors. This may explain the high prevalence of severe psychiatric disorders, (i.e., psychotic and bipolar disorders) in their reports. Abbo et al. reported that 60.2% of those who used traditional healers in Uganda had a diagnosable psychiatric disorder. They also found that psychotic depression, mania, and schizophrenia were the most frequently observed disorders among their participants. Sorketti et al. reported that the most prevalent diagnosis for those under treatment in traditional healer centers in Sudan waspsychotic disorders (34.6%), manic episodes (27.4%), andmajor depressive disorders (15.8%).

As in our study, studies reported by Saeed et al. [19] and Ngoma et al. [20] recruited participants from facilities that did not allow patients to stay overnight; rather, they provided outpatient care. Both reported a high prevalence of depressive and anxiety disorders. Similar to our findings, Saeed et al. reported that, in rural Pakistan, 61% of FH users had psychiatric disorders, including a high proportion who had major depressive episodes (24%) or generalized anxiety disorders (15%). Ngoma et al. reported that the prevalence of psychiatric disorders among users of traditional healers in Tanzania was double (48%) that of primary care patients (24%). They also found that mixed anxiety-depressive disorder was the most prevalent (27.8%) among those who used traditional healers.

While our study has many advantages, we acknowledge a number of limitations. Because of the use of convenience sampling, our results should be cautiously generalized and should not be regarded as representative to all patients in Saudi Arabia. Also, the control group was recruited from visitors to shopping malls; therefore, they may not represent the general population. We chose this method because at this time, no epidemiological study has investigated the prevalence of psychiatric disorders in the general population of Saudi Arabia. Another limitation is our use of a self-report scale; therefore, recall bias cannot be excluded. Finally, the use of general questions about income may not precisely reflect the social class of the participants.

We showed that having a psychiatric history or a current psychiatric disorder are factors associated with FH use, and that a high percentage of FH users had a diagnosable psychiatric disorder. This study may complement other studies performed in Saudi Arabia that focused on studying the practices of FHs [6, 21] and the psychosocial characteristics of FH users [5, 12, 22]. We also investigated the psychiatric patients within the faith healing system. This study is likely to improve our understanding of the psychosocial correlates of visiting FHs and the types and prevalence of psychiatric disorders among those who use faith healing. Further research should assess how to facilitate access to the mental health care system for those who use FHs.