Stigma-Related Survey Responses and Anticipated Help-Seeking Deterrence in Al-Ahsa, Saudi Arabia: An Area-Standardized Secondary Analysis and Measurement Appraisal

Abstract

Background: Stigma may affect mental health help-seeking, but a common survey outcome and an unvalidated composite can be difficult to interpret. We examined openly deposited Al-Ahsa survey data using area-standardized estimates, prevalence ratios and an appraisal of the stigma and deterrence measures.

Methods: We reanalysed 1,085 adult respondents to an October–November 2024 community survey in Al-Ahsa, Saudi Arabia. We constructed area-calibration weights using the three administrative-area population shares reported by the source investigators. We estimated composite-defined outcome proportions and covariate-adjusted prevalence ratios (PRs), examined item-level associations, and conducted exploratory latent class and psychometric analyses. Confidence intervals assume independent observations within the reported areas because original cluster identifiers were unavailable.

Results: Under the original questionnaire cut-offs, the area-standardized proportion meeting the deterrence criterion was 59.7% (model-based 95% CI 56.5–62.9), and the proportion meeting the stigma criterion was 22.6% (20.0–25.4). Overall, 70.9% endorsed the statement that community stigma prevents help-seeking. The adjusted association between the two composite indicators was PR 1.21 (1.08–1.36), versus an adjusted odds ratio of 1.72. The five stigma items had poor internal consistency (Cronbach's alpha 0.28); the four deterrence items had alpha 0.60. Witnessing harsh treatment was associated with the composite deterrence indicator (exploratory adjusted PR 1.37 [1.20–1.55]). A three-class model was selected exploratorily (classification entropy 0.57).

Conclusions: Approximately six in ten survey respondents met the original composite definition of stigma-related help-seeking deterrence; this is not a measured rate of actual care avoidance or a proven population prevalence. The adjusted stigma–deterrence association was modest, and the heterogeneous stigma items should not be interpreted as a validated single construct. Future studies should validate their scales, record recruitment and clustering information, and distinguish anticipated barriers from actual service use.

Keywords

• mental health stigma
• anticipated help-seeking deterrence
• Saudi Arabia
• area-standardization
• secondary data analysis
• prevalence ratios
• psychometrics