Depression and Muslims in Britain

Depression is one of the most common mental illnesses worldwide, affecting approximately 280 million people globally (WHO 2021). Research suggests that Muslims are more likely to experience depression, and over a longer period, than other religious groups in Britain (Meer and Mir 2014).

It is difficult to gauge the precise extent to which depression affects Muslims in Britain because statistics on mental health are most often collected using ethnic rather than religious categories. However, as covered in Week 1 (Step 1.4d), ethnicity can be used as a proxy for religious identity among religiously homogenous groups: in the case of Muslim mental health, this is most often Pakistani and Bangladeshi groups. In Britain, Pakistani and Bangladeshi communities have higher level of depression and experience it over a longer period of time when compared to the general population (Sproston and Nazroo 2002).

Researchers working on the COVID-19 Social Study at University College London reported that people from ethnic minority backgrounds experienced more negative effects of ‘lockdown’ during the pandemic than those from white backgrounds (Fancourt et al. 2020). People from ethnic minority groups had higher levels of depression and anxiety during the Covid-19 pandemic, and lower levels of happiness and life satisfaction; they also reported being more worried about unemployment and financial stress than those from white ethnic groups (Fancourt et al. 2020).

Depression affects many adults in the UK: one in six adults in England reported some form of depression during the COVID-19 pandemic (ONS 2021). Poverty increases the likelihood of depression: one in four adults living in the most deprived areas experienced some form of depression during the pandemic (ONS 2021). As covered in Week 1, Muslim households are more likely to be in poverty than those of other religious groups. Muslims in Britain, therefore, are likely to be disproportionately affected by depression.

Addressing depression in Muslim communities

As we have covered previously in the course, aspects of faith identity for Muslims – such as religious practices and beliefs – can be a resource for good mental health, but they can also have a negative impact (see Activity 5, Week 2). In addition, the contextual circumstances of Muslims in Britain can include risk factors for common mental health problems like depression (Mental Health Foundation 2021). The contextual circumstances of Muslim include:

• racism, and, for Muslims, Islamophobia
• social and economic inequalities such as poverty and unemployment
• mental health stigma, when mental health problems are seen as shameful or embarrassing.

Literature on religion and mental health distinguishes between ‘negative religious coping’ and ‘positive religious coping’. Negative religious coping, for example when mental health problems are seen as a test from God or as punishment for sins, can increase depression and anxiety. Positive religious coping is associated with reduced levels of depression, religious practices and beliefs can provide strategies that promote hope and resilience (Mir et al. 2019). Muslims are more likely to use religious coping techniques and are least likely to seek professional for help with depression than individuals from other religious groups (Meer and Mir 2014).

Studies have shown that mental health support services that draw on faith as a resource can help to reduce or prevent long-term depression and improve quality of life (Koenig et al. 2010). Research evidence suggests that adapted therapies that incorporate religious elements into mainstream therapies for depression can be at least as effective as existing secular therapies (Mir et al. 2019).

Dr Ghazala Mir and colleagues at Leeds University have developed a therapy for Muslims who choose positive religious coping as a resource for health. This ongoing project is called ‘Addressing depression in Muslim communities’ and is funded by the National Institute for Health Research. The therapy is based on behavioural activation, an established and evidence-based psychosocial treatment, and it incorporates Islamic practices and beliefs (Mir et al 2019). The adapted therapy is being delivered in several primary care mental health services across England with additional training for the teams delivering the therapy.

You can find out more about this work by following up the references to Dr Mir’s work in the bibliography, and by looking at the project website – a link is included in the signposting section below.

Improving Access to Psychological Therapies (IAPT) – mainstream support for common mental health problems such as depression

The Improving Access to Psychological Therapies (IAPT) programme in England began in 2008, with the aim of providing equitable access to evidence-based psychological interventions for people experiencing common mental health disorders such as depression and anxiety (NHS website, no date). Recent research on ethnic variations in the take-up of IAPT services shows that:

• Black African, Asian, and Mixed groups are less likely to self-refer to IAPT services, than the White British group
• all ethnic minority groups are less likely to receive an assessment compared to the White British group after being referred
• all ethnic minority groups are less likely to receive treatment after assessment.

(Harwood et al. 2021)

Harwood and colleagues (2021) suggest that more can be done to ensure mental health services and psychometric measures are adapted to a culturally diverse population. Potential bias can arise when psychometric scales, based on Western understandings of mental health, are used to assess and diagnose mental health problems for ethnic minority groups. Lower rates of self-referral among the South Asian group may be as a result of this group being less likely to perceive mental health problems as medical disorders that can be treated by mental health professionals, for example because they attribute them to the will of God (Harwood et al. 2021).

Academic researchers recommend that IAPT services make the process of self-referral easier for ethnic minatory service users, and that the service provided by IAPT practitioners is culturally sensitive and anti-racist (Rhead 2021). Specifically, IAPT services should address how depression symptoms among ethnic minority groups are perceived by health professionals and how this influences clinical decision-making (Rhead 2021).

National healthcare policies state that professionals should take account of cultural identity and provide appropriate healthcare for minority ethnic and religious groups (NICE 2009; Department of Health 2005). However, professionals may get little practical support on how to do this, furthermore, there is little research evidence on how to meet the needs of minority faith groups (Meer and Mir 2014).

Signposting

Dr Ghazala Mir profile, Leeds University

Project website for Addressing Depression in Muslim Communities. Leeds University

Behavioural activation for Muslims manual

BBC. 2017. Mental health therapy for Muslims embraces religion

Find out more about self-referral to IAPT services:

NHS talking therapies website

MIND website

Over to you

Dr Ghazala Mir and colleagues have developed a manual for practitioners supporting Muslim people who are experiencing depression (the manual is available using the link below). In the manual, they make suggestions for how to talk to clients about drawing on religion in therapy. Here is an example:

Do you ever feel guilty or sinful or angry because of your religious beliefs? Do you know of any Islamic teachings that might help you think about your experience in a way that is more helpful to you? How could you find out more about positive Islamic teachings?

Would you feel comfortable asking someone you support these questions, and why? Share your response in the comments below.