Table 1 Coding tree

T1: EFFECTS OF MENTAL DISORDER ON EVERYDAY LIFE

X

ST: Effects on family and social life

I didn’t leave the house much, malls bothered me, and crowds and noises had me feel disassociation – (P2).

“…not in the mood all the time…became careless” (P3)

“I used to isolate myself from people so no one will notice the symptoms that I have… when I had to, I would lie and fake laughs but inside of me I feel like there is a baby crying” – (P1)

x

ST: Effects on work/studies

“had to temporarily suspend my studies”– (P11)

“completely withdrew from college - (P10)

x

ST: Effects on physical health and wellbeing

“Sleeping was difficult… I was distracted…” - (P10)

“…my sister noticed the cuts on my arms…” – (P2)

x

T2: CHALLENGES

X

X

X

ST Public

 •Family and friends rejecting the idea of illness

 •People’s lack of knowledge about mental illnesses

 •Religious beliefs standing in a way of accepting the illness

“…didn’t actually believe [me]…” (P7)

“…thought I was just being spoiled and not actually suffering…” (P8).

x

x

“…they don’t understand and think it’s a false subject” (P1).

“people aren’t accepting it [because] they don’t have enough knowledge in this field to consider it just like any other disease”. – (P10)

“…less sensible, unable to make decisions and that they have done that to themselves in one way or another, not being religious enough and not being close to god is one of the reasons for their suffering. Society could never believe in patients with mental disorders and their abilities to take care of themselves…” - (P11).

x

“people blame you for feeling like this and assume it’s from how distant you are from God, and ask you to pray and read Quran [Muslim holy scripture]” (P8).

x

ST Personal

Being afraid of telling people/concealing the illness:

 > Worrying about public stigma and people’s reaction

 > Perceiving the illness as something personal, shameful and embarrassing

“[my] view [of the illness] was so negative…[I] didn’t take it as a normal illness”. (P3)

x

x

x

x

Isolation and not having anyone to talk to about the illness

“to isolate myself from people so no one would know” (P1)

x

Trivializing or rejecting the illness

“[this is] something normal for a human being…[something that] would pass” (P1)

x

x

Lack of knowledge about the illness

P3 did not seek treatment because she was convinced that only introverts may suffer from depression, and she was “the opposite of this”.

x

T3: OVERCOMING THE CHALLENGES

X

X

X

ST Public factors

 •Family and friends’ positive reaction

 •Family and friends’ ongoing support and understanding

 •Other people being aware and educated about the illness

“Their acceptance made me accept myself peacefully” (P6)

“…extremely positive and my family still is…‘so what if they diagnosed you? Let them diagnose you with whatever because, in the end, this is meant to happen, and it will happen, and it was written before you were even in this world and I’m sure it is for the best’”. (P12)

x

x

The brother tried supporting her by telling her “this disorder happens to intelligent people” (P12).

“…it’s the kindness of those around me…” (P8)

x

x

“they’ve got a background about mental health treatment”. (P2)

x

ST Personal factors & strategies

 •Doing their own research on the illness

 •Having knowledge about your illness

 •Talking about it openly and reaching out to other patients

 •Finding positive distractions and facing the triggers

 •Reverting to religion

 •Working on self-perceptions and self-positioning

“did a lot of search[ing] on the internet” (P1),

“searching and digging deeper” (P4)

x

x

“I now understand my disorder and I really understand how it makes me think” (P8)

“I was happy because there were a lot of unclear things to me…I thought it was normal to hear voices…it could be my imagination it could be anything, I didn’t have the insight but afterward I knew that’s not it, there was something wrong and it should stop and it should get treated.” (P5)

x

“I answer freely about it if I’m asked” (P2)

“was at peace with it and didn’t really mind the topic”. (P10)

x

x

“…would distract myself by exercising and spending time with my children” (P11)

I tried to avoid the things that possibly will make me angry, I started to do the things that I love, I did join volunteer teams, so I don’t stay alone and overthink - (P3).

x

“I reverted back to religion for peace and comfort” (P3)

x

“I started considering myself as a champion for getting over it, and indeed they have been better and I come out of them sooner instead of living two weeks of self-hate and blame…(P8)

“felt like I should have done that a long time ago”. (P9)

x

x

T4: TYPES OF STIGMA

X

X

X

ST: Public stigma

“people aren’t accepting of [mental health disorders]…people look at people with mental diseases in an inferior way or stay away from them…if you go to a Psychiatric clinic then you’re crazy” (P10).

“People’s beliefs about you doesn’t reflect who you truly are, it’s not a shame to ask for therapeutic help from a specialist or anyone in case of psychological distress. And we should be proud of ourselves because at some point even sleeping was a great achievement. You will get through it just like you got through a lot of stuff and still made it. Your health is above all.” (P2).

x

x

x

ST: Self-stigma

“…felt weak and stupid…used to really hate myself back then”. (P8)

“to explain and apologize” (P11)

x

x

x