Public knowledge, stigma, and social acceptance toward mental illness in the Gulf region: a cross-sectional survey

Mental illness stigma undermines help-seeking, treatment engagement, and social inclusion globally. Although the Gulf Cooperation Council (GCC) region has undergone rapid social and health-system modernization, few studies have simultaneously assessed public knowledge, attitudes, and intended behaviour toward people with mental illness using validated instruments.

To examine mental-health knowledge, public stigma, and social acceptance among adults in GCC countries using the Mental Health Knowledge Schedule (MAKS), the Reported and Intended Behaviour Scale (RIBS), and the 40-item Community Attitudes toward the Mentally Ill (CAMI) scale.

An Arabic-language online survey was completed by 1, 557 adults (84.1% female; mean age = 26.2 years, SD = 10.6; 80.5% from Kuwait). Descriptive statistics, bivariate analyses, and simultaneous-entry multiple linear regression were conducted. Internal consistency was evaluated using Cronbach's α and McDonald's ω, supplemented by item-total correlations and confirmatory factor analysis (CFA) of the CAMI.

Participants reported moderate mental-health knowledge (MAKS M = 41.6, SD = 5.9), moderately positive attitudes (CAMI M = 135.2, SD = 16.2), and moderate behavioural willingness (RIBS M = 13.1, SD = 3.2). Knowledge and attitudes were moderately correlated (r = .341, p <.001), but the association between attitudes and intended behaviour was weaker (r = .209, p <.001). In regression, social restrictiveness was the strongest predictor of behavioural engagement (β = .374, p <.001), followed by male sex (β = .098) and MAKS total (β = -.103). A confirmatory factor analysis indicated poor fit of the original four-factor CAMI structure (CFI = .673, RMSEA = .141), supporting cautious subscale-level interpretation. A supplementary regression using the more reliable CAMI total score confirmed the primary pattern. Sensitivity analyses following removal of implausible age entries and restricting to Kuwait-only participants produced substantively identical findings.

These findings, drawn from a predominantly Kuwaiti, female, and university-educated convenience sample, indicate that respondents endorsed sympathetic and recovery-oriented principles yet showed substantial hesitation regarding close social contact. The disconnect between attitudes and behavioural willingness highlights the need for culturally grounded, contact-based anti-stigma interventions that target social distance specifically, while requiring replication in more representative GCC populations.