ArticlePDF AvailableLiterature Review

Abstract

Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can result in high rates of morbidity and mortality from communicable and non-communicable diseases, 'accidents' and, over recent years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj annually, it has been described as, 'The largest and longest-standing mass gathering event on Earth'. Although Hajj is a spiritual experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims. This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with the mental health of pilgrims.
S290
Psychiatria Danubina, 2019; Vol. 31, Suppl. 3, pp 290-293 Conference paper
© Medicinska naklada - Zagreb, Croatia
HAJJ AND THE MENTAL HEALTH OF MUSLIM PILGRIMS:
A REVIEW
Ahmed Hankir1,2,3, Zavid Chariwala4, Usman Siddique5,
Frederick R. Carrick1,6,7,8 & Rashid Zaman1,9,10
1Centre for Mental Health Research in association with University of Cambridge (CMHR-CU), Cambridge, UK
2South London and Maudsley NHS Foundation Trust, London, UK
3Department of Psychiatry, Carrick Institute for Graduate Studies, Cape Canaveral, FL, USA
4British Hajj Delegation, UK
5South West Yorkshire Partnership NHS Foundation Trust, Halifax, UK
6Department of Neurology, Carrick Institute for Graduate Studies, Cape Canaveral, FL, USA
7Neurology, University of Central Florida College of Medicine, Orlando, FL, USA
8Medical Education, MGH Institute for Health Professions, Boston, MA, USA
9Hertfordshire Partnership University NHS Foundation Trust, UK
10Department of Psychiatry, University of Cambridge, Cambridge, UK
SUMMARY
Mass gatherings occur in different situations and settings around the world. A mass gathering can range in size from thousands
to millions and in nature from recreation (i.e. concerts) to religious festivals (i.e. the Hajj pilgrimage). Such mass gatherings can
result in high rates of morbidity and mortality from communicable and non-communicable diseases, ‘accidents’ and, over recent
years, terror attacks. Disproportionately lower consideration has been given to the mental health and wellbeing of people during
mass gatherings compared to that given to physical health during such events. Hajj is a religious pilgrimage to Mecca in Saudi
Arabia that all Muslims are Islamically obliged to fulfil at least once in their lifetime. With up to 3 million pilgrims attending Hajj
annually, it has been described as, ‘The largest and longest-standing mass gathering event on Earth’. Although Hajj is a spiritual
experience that is considered enlightening by many pilgrims, it can also be highly stressful which can have adverse effects on both
physical and mental health. Few studies have been published hitherto on the impact that Hajj has on the mental health of pilgrims.
This review article provides a narrative summary of studies conducted on Hajj and the relationship that this mass gathering has with
the mental health of pilgrims.
Key words: Hajj – mass gatherings – Muslim mental health – pilgrimage – mental illness
* * * * *
INTRODUCTION
Approximately 1.8 billion or 24.1% of the world po-
pulation are Muslims of which 62% live in Asian-Pacific
countries (e.g., Indonesia, Pakistan, India, Bangladesh,
Iran and Turkey), 20% in the Middle East or North Africa
(e.g., Egypt, Yemen, Sudan, Saudi Arabia, Algeria,
Syria), 15% in Sub-Saharan Africa (e.g., Nigeria, Rwan-
da, Kenya), 3% in Europe (e.g., France, Belgium, Aus-
tria, United Kingdom) and less than 1% in North Ame-
rica (e.g., United States, Canada) (Lipka et al. 2017).
Hajj is an annual Islamic pilgrimage to the holy city
of Mecca in Saudi Arabia involving approximately 3
million Muslim pilgrims for over 30 days including a 5-
day core period of intensive rituals and prayers. Hajj has
been described as, ‘The largest and longest-standing
mass gathering event on Earth’. Hajj is one of the Five
Pillars of Islam; it is a mandatory religious duty for
adherents of the Islamic faith that must be carried out at
least once in their lifetime. Pilgrims can also go to
Mecca to perform the rituals at other times of the year.
This is sometimes called the "lesser pilgrimage", or
Umrah. However, even if pilgrims choose to perform
the Umrah, they are still obliged to perform the Hajj at
some other point in their lifetime.
HISTORY OF THE HAJJ PILGRIMAGE
The present custom of Hajj was established by the
prophet Muhammed (PBUH). However, according to
the Quran, aspects of the present custom of Hajj trace
back to the time of the prophet Abraham (RA). Accor-
ding to Islamic tradition, Abraham (RA) was commanded
by God to leave his wife Hagar and his son Ishmael (RA)
alone in the barren desert of ancient Mecca. It is narra-
ted that Hagar succumbed to despair and ran seven
times between the two hills of Safa and Marwah in
search of water to quench her own thirst and that or her
son but to no avail. Returning in a state of resignation to
her baby son Ishmael, she saw that her child started
rubbing the ground with his leg and a fountain of water
gushed forth beneath his foot. Later, Abraham (RA) was
commanded to build the Kaaba and to invite people to
perform pilgrimage there. The Quran refers to these
events in chapter 2 (‘The Cow’) verses 124–127 and
chapter 22 (‘The Pilgrimage’) verses 27–30.
Ahmed Hankir, Zavid Chariwala, Usman Siddique, Frederick R. Carrick & Rashid Zaman: HAJJ AND THE MENTAL HEALTH
OF MUSLIM PILGRIMS: A REVIEW Psychiatria Danubina, 2019; Vol. 31, Suppl. 3, pp 290-293
S291
The pilgrimage occurs from the 8th to 12th (or in
some cases 13th) of Dhu al-Hijjah, the last month of the
Islamic calendar. Because the Islamic calendar is lunar
and the Islamic year is about eleven days shorter than
the Gregorian year, the Gregorian date of Hajj changes
from year to year.
HAJJ AND HEALTH
Most pilgrims take the necessary precautions when it
comes to their physical health before they travel to
Mecca. For example, they would make sure they take all
the injections and immunizations that their doctor re-
commends (Visser et al. 2011). It would be equally
important for pilgrims to look after their mental health
in the same way they do their physical health. This may
seem counterintuitive to many Muslims since Hajj is
considered a spiritual journey that is beneficial for a
Muslim’s mental health and ‘soul’.
Muslims consider Hajj and the performing of it to be
a blessing and pilgrims describe it as ‘enlightening’ and
a ‘life-changing experience’. However, there are factors
that contribute to Hajj being a highly stressful expe-
rience such as: unfamiliar environment, overcrowding,
heat, physical exertion, limited dietary intake, exhaus-
tion, sleep deprivation and being on a foreign land that
is far away from home (Masood et al. 2011). These
stressors can adversely affect the mental health and
wellbeing of pilgrims (Masood et al. 2011) as will be
discussed and described in the review below.
COMMON MISCONCEPTIONS ABOUT
MENTAL ILLNESS IN MUSLIMS
Muslims often attribute mental health difficulties to
supernatural causes like Jinn possession and/or the evil
eye (Hankir et al. 2017). Muslims with mental health
difficulties may think that Allah is punishing them for a
sin they committed or that they have week faith (Hankir
et al. 2015). Of course, this isn’t true; although Islam
can be a protective factor against mental illness there
are many Muslims who experience mental health
difficulties despite having strong faith (Hankir et al.
2015). Prayer can provide relief and comfort and is very
important, but since mental health problems are often
caused by a psychiatric disease, it is important to seek
help from a doctor for medical treatment in addition to
prayer. The Prophet (PBUH) said:
"Make use of medical treatment, for Allah has not
made a disease without appointing a remedy for it ..."
(Kitah Al-Tibb of Sunan Abu-Dawud).
THE EFFECTS OF HAJJ
ON MENTAL HEALTH
Previous studies have shown that most pilgrims who
developed mental health problems were not told about
the “actual” difficulties involved or the details of rituals
during Hajj. Muslims may have pre-existing mental
illness or may experience mental illness for the first-
time during Hajj. Pilgrims going to Hajj for the first
time and older people seem to be at increased risk of
experiencing a mental illness. Pilgrims who are from
rural backgrounds and who have low exposure to urban
life also seem to be at increased risk of certain mental
illnesses (Masood et al. 2011).
The first few weeks of arrival in Mecca and the core
Hajj period can be the most stressful and this is when
Muslims can feel most anxious. Fear of getting lost, being
on a foreign land and language barriers are all factors that
can cause stress. Anticipation of a mishap such as a
stampede or a terror attack are other factors that can
contribute to stress and confusion. Heat and dehydration
are some of the preventable causes of sudden confusion,
especially in older people (Masood et al. 2011).
Common mental illnesses seen in Hajj are:
Stress related;
Psychosis (experiencing unusual and frightening
beliefs and often hearing voices);
Insomnia (difficulty sleeping);
Mood disorders.
Cases of psychosis were often due to the discontinua-
tion of anti-psychotic medication without medical ad-
vice. It is therefore crucial that Muslims with pre-exis-
ting mental illness such as psychosis continue adhering
with their psychotropic medication. Simple measures
such as going to an isolated place, physical comforting,
nearness to family members, repeated reassurance,
fluids and repeated verbalization of sequence of events
as well as reorientation and deep breathing all help
(Masood et al. 2011).
Narrative Review of Published Research on
Hajj and the mental health of Muslim Pilgrims
Below is a narrative summary of studies conducted
on Hajj and the relationship that this religious mass
gathering has with the mental health of pilgrims.
Bakhtiari and colleagues at the Sharif University of
Technology investigated the relationship between the
Hajj pilgrimage and mental health among university
students in Iran (n=350). The General Health
Questionnaire (GHQ) and the Meaning in Life
Questionnaire were administered on participants before
and after the Hajj pilgrimage. The authors of the study
report that pilgrimage to Mecca lowered anxiety,
depression, and stress levels in their sample and that
there were improvements in social functioning and
meaning in life (Bakhtiari et al. 2017).
However, Fateh and colleagues conducted a
longitudinal study on the psychological effects of Hajj
using the same instrument as Bakhtiari and colleagues
did (the General Health Questionnaire (GHQ)). The
findings of Fateh’s study revealed that there was no
statistically significant difference in the GHQ scores of
pilgrims before and after the Hajj (Fateh et al. 2019).
Ahmed Hankir, Zavid Chariwala, Usman Siddique, Frederick R. Carrick & Rashid Zaman: HAJJ AND THE MENTAL HEALTH
OF MUSLIM PILGRIMS: A REVIEW Psychiatria Danubina, 2019; Vol. 31, Suppl. 3, pp 290-293
S292
Clingingsmith and colleagues estimated the impact
of Hajj on 1,605 pilgrims from Pakistan. They reveal
that female pilgrims were more likely to report negative
feelings that suggest distress, and are less likely to
report positive feelings of well-being (higher levels of
distress were detected in female pilgrims, as measured
by a version of the K6 screening scale). This could po-
tentially be due to the impact of the Hajj on physical
health. Indeed, the negative physical health effects were
stronger for women than they were for men suggesting
that part of the negative effect of the Hajj on women’s
feelings of well-being could be explained by poorer
physical health. The findings could also potentially be
due to the changes in pilgrim’s beliefs and frame of
reference discussed below (which the psychology litera-
ture suggests can lead to stress). Increased distress in
female pilgrims might be due to the stark contrast bet-
ween the typical Pakistani woman’s daily life and the
relatively greater equality and integration experienced
during the Hajj. The impact of the Hajj on gender atti-
tudes suggests an increased realization that the con-
straints and restrictions women are accustomed to in
Pakistan may not be part of global Islam. It is important
to note that this study revealed that while the Hajj has a
negative impact on a female pilgrim’s emotional state, it
does not affect overall life satisfaction (Clingingsmith et
al. 2009).
Khan and colleagues conducted a study on 136,000
Indian Hajj pilgrims in 2016 (Indian Medical Mission).
They revealed that 182 patients developed psychologi-
cal problems (1.3%) of which 45.7% were stress related
issues, 9.8% psychosis, 7.3% insomnia and 5.6% mood
disorders. The most common symptoms recorded in this
sample were apprehension (45%), poor sleep (55%), an-
xiety (41%), and fear of being lost (27%). All cases of
psychological problems were on their first Hajj, 60%
were male and a majority were from rural areas. 22
patients (12%) required admission to hospital and only
12 pilgrims (6.8%) reported a past history of a mental
illness (Khan et al. 2016).
Ozen and colleagues carried out a study on 130,000
Turkish Hajj pilgrims in 2008 (Turkish Mecca Hos-
pital). 294 participants (0.2%) in their sample presented
to psychiatric services, of which 38.4% reported an-
xiety, 22.1% mood disorders and 11.2% sleep disorders.
The most common symptoms recorded were discomfort
(70%), poor sleep (55%), anorexia (35%), ‘whining’
(30%) and fatigue (28%). 60% of those who presented
to psychiatric services had a previous psychiatric
history, 40% were male, 77% had low education and
71% had not been abroad before (Ozen et al. 2009).
Psychological impact of mass gatherings
The traditional view (which has now largely been
discredited) is that people in crowds tend to:
Lose their sense of self;
Lose their sense of judgement;
Become capable of the most extreme actions.
However, in social identity theory, people perceive a
common group membership and assume a shared social
identity in a ‘psychological crowd’. This leads to:
A cognitive transformation - People stop behaving in
terms of their idiosyncratic beliefs and start be-
having on the basis of shared norms, values, and
understandings.
A relational transformation - The crowd is part of an
extended group rather than ‘‘others’’. This leads to a
shift towards greater intimacy and trust, respect,
cooperation, mutual influence, helping, and also
expectations of help from others.
An emotional transformation - The crowd can dis-
play intense positive effect, termed ‘effervescence’.
Close and supportive relationships can contribute
positively to feelings of wellbeing.
A study of 1,194 pilgrims attending Mecca in 2012
found that people felt safer and perceived the crowds to
be less dangerous when they strongly identified with
others in the crowd. Social identity theory helps to ex-
plain the perception that others in the crowd were suppor-
tive. The survey of pilgrims attending the 2012 Hajj sho-
wed that, although increasing levels of crowd density
reduced feelings of safety, this effect was moderated by
identification with the crowd and perceptions that others
identified as Muslim. Specifically, those who were high
in identification with the crowd actually felt safer as den-
sity increased. Mediation analysis was consistent with the
idea that this moderation effect was because of the per-
ception that others in the crowd were supportive, which
was higher the more that people identified with the
crowd. This same relationship was found for those pil-
grims from Arab countries and Iran compared with those
from other countries, whose greater reported safety was
explicable in terms of their crowd identification and
perceptions of support (Alnabulsi et al. 2014).
CONCLUSION
Although Hajj is a spiritual experience that has been
described as enlightening, it can also be highly stressful
which can have adverse effects on both physical and men-
tal health. Few studies have been published hitherto on
the impact that Hajj has on the mental health of pilgrims.
Currently the literature in relation to the mental health of
Muslims during Hajj is conflicting and the conclusions
from these studies must be interpreted with caution.
Protective factors against developing mental health
difficulties during the Hajj pilgrimage include:
Preparation for Hajj (i.e. being aware of the chal-
lenge and exertion of performing the Hajj (a detailed
understanding of what is involved)) and physical
fitness and healthy diet in months before Hajj.
Support while on Hajj (i.e. family/close friends com-
petent tour staff, realistic itinerary for visit,
professional health services during Hajj, asking for
help during Hajj from fellow pilgrims, consideration
for less crowded times and areas).
Ahmed Hankir, Zavid Chariwala, Usman Siddique, Frederick R. Carrick & Rashid Zaman: HAJJ AND THE MENTAL HEALTH
OF MUSLIM PILGRIMS: A REVIEW Psychiatria Danubina, 2019; Vol. 31, Suppl. 3, pp 290-293
S293
Future research investigating the impact of Hajj on
the mental health and wellbeing of pilgrims is urgently
needed.
Acknowledgements:
We would like to thank Dr Ian Walker Consultant in
Global Public Health for his permission to use
information from his presentation on mass gatherings
and mental health. We would also like to thank the
British Hajj Delegation for their support and help in
formulating this manuscript.
Conflict of interest: None to declare.
Contribution of individual authors:
Ahmed Hankir & Zavid Chariwala conceived the idea
for the paper and contributed to the literature review
and revised the manuscript.
Usman Siddique, Frederick R. Carrick, Ian Walker &
Rashid Zaman contributed to the literature review
and revised the manuscript.
References
1. Alnabulsi H & Drury J: Social identification moderates
the effect of crowd density on safety at the Hajj. Proc Natl
Acad Sci 2014; 111:9091–9096.
https://doi.org/10.1073/pnas.1404953111
2. Bakhtiari M, Masjedi Arani A, Karamkhani M, Shokri
Khubestani M, Mohammadi H: Investigating the Relation
ship between Hajj Pilgrimage and Mental Health among
Sharif University of Technology Students. J Res Relig
Health 2017; 3:78- 87
3. Clingingsmith D, Asim IK & Kremer MR: Estimating the
impact of the Hajj: Religion and tolerance in Islam's global
gathering. Quarterly Journal of Economics 2009; 124
4. Fateh M, Mousavi SA, Sohrabi MB et al.: J Relig Health
2019. https://doi.org/10.1007/s10943-019-00825-7
5. Hankir A, Khalil S, Wadood Q, Madarbukus D, Yunus HA,
Bibi S, Carrick FR, Zaman R: The Federation of Student
Islamic Societies programme to challenge mental health Stig-
ma in Muslim communities in England: The FOSIS Birming-
ham study. Psychiatr Danub 2017; 29(Suppl 3):512-520
6. Hankir A, Carrick FR, Zaman R: Islam, mental health and
being a Muslim in the West. Psychiatr Danub 2015;
27(Suppl 1):S53-9
7. Khan SA, Chauhan VS, Timothy A, Kalpana S & Khanam
S: Mental health in mass gatherings. Industrial psychiatry
journal 2016; 25:216
8. Masood K, Gazzaz ZJ, Ismail K, Dhafar KO, Kamal A:
Pattern of psychiatry morbidity during Hajj period at Al-
Noor Specialist Hospital. Int J Psychiatry Med 2007;
37:163-172
9. Michael Lipka & Conrad Hackett: Why Muslims are the
world's fastest-growing religious group. Pew Research
Centre, 2017. Archived from the original on 23 August 2017
10. Özen ù: Sociodemographic characteristics and frequency
of psychiatric disorders in Turkish pilgrims attending
psychiatric outpatient clinics during Hajj. Dicle Med J
Cilt 2009;. 37:8-15
11. Visser H, Lettinga KD, Siegert CE: Health risks and
advice for Hajj pilgrims. Ned Tijdschr Geneeskd 2011;
155:A3962
Correspondence:
Ahmed Hankir, MBChB
South London and Maudsley NHS Foundation Trust
London, UK
E-mail: Ahmed.hankir@nhs.net
... It is one of the benefits tourists enjoy when they fulfill the need for personal growth through goal-driven journeys (Sirgy, 2010). Engaging in social, activity-based, and spiritual tourism provides opportunities to enhance wellbeing, mainly by calming anxiety and distress and meeting participants' mental needs (Hankir et al., 2019;McCabe & Johnson, 2013). Through symbolic value-seeking journeys, pilgrims take their faith out of their homes (Morinis, 1992) and follow the Divine. ...
... Hence, tourism studies incorporating negative contextual variables can reveal different levels of intuition (e.g., adaptivity) and the benefits of SWB for tourists (Nawijn, 2016). There is also great demand for empirical attempts to understand how wellbeing can be obtained from mass religious gatherings (Hankir et al., 2019). Consequently, academic attempts to consider ways to achieve restoration during a pandemic should bring enlightening insights. ...
... Tewari et al. (2012) revealed that pilgrims celebrating the Hindu month of Magh experienced psychological wellbeing. Hankir et al. (2019) suggested that Hajj pilgrims manifested cognitive, relational, and emotional transformations. In post-COVID times, Di Giovine (2020) proposed Pio as a "pandemic saint" for Catholics seeking to alleviate their physical, emotional, and spiritual suffering. ...
Article
In response to the overwhelming global turbulence seen in 2020, humankind has renewed their pursuit of resiliency and ways to maintain wellbeing. There is limited work on COVID's effects on wellbeing of pilgrims in important pilgrimages, such as the Hajj. The current study offers a timely collection of data obtained from pious worshippers attending the 2020 Matsu pilgrimage. The goal of this work was to understand how to ensure religious tourists' wellbeing during a pandemic through an analysis of the perceptions of pilgrims persevering in their faith, even during this extremely negative world event. The resilience developed and restoration perceived from attending the pilgrimage were found to have significant direct effects on attendees' wellbeing. Thus, this research provides useful references to ways of caring for people's wellbeing that were developed during the pilgrimage, as well as vital information about the psychological resiliency derived from spiritual tourism in hard times.
... Ibadah solat mampu membantu individu menjalani kehidupan harian dengan lebih baik kerana amalan ini terbukti boleh meningkatkan tahap fokus dan menguruskan tekanan diri. (Örneklemler, Bilişsel, İlişkili, & Türleri, 2021) Jemaah yang mengerjakan haji juga membuktikan bahawa ibadah haji membentuk fizikal yang lebih bertenaga sekali gus pemikiran yang lebih baik dan seterusnya membawa kepada kesihatan fizikal dan mental mereka (Hankir et al., 2019). Dalam satu Hadith riwayat Muslim, Rasulullah SAW bersabda yang bermaksud, "Mukmin yang kuat lebih disukai oleh Allah SWT berbanding mukmin yang lemah." ...
... Mereka merupakan individu penting yang boleh memberi teguran serta membantu untuk menambahbaik perkembangan kehidupan seharian di samping memberi pengalaman serta pengajaran dalam kehidupan. (Hankir et al., 2019) Kedua ialah sentiasa aktif dalam aktiviti fizikal atau aktiviti lain agar dapat berhubung dengan alam dan menyihatkan tubuh badan. Ketiga ialah dengan memerhatikan dunia di sekitar dan merenung kehebatan dan mengambil pengajaran daripada pengalaman tersebut. ...
Conference Paper
Full-text available
Psikospiritual Islam merupakan antara salah satu konsep pendekatan Islam secara holistik yang kini semakin berkembang diaplikasikan dalam pelbagai rawatan sama ada melibatkan spiritual, psikologi, mental, emosi, sosial dan juga fizikal. Hal ini berikutan konsep Psikospiritual Islam itu seiring dengan ajaran agama Islam yang bersifat syumul. Oleh itu, kajian ini adalah untuk melihat kaedah dan keberkesanan pendekatan Psikospiritual Islam dalam merawat masalah keresahan spiritual secara holistik. Metodologi kajian ini melibatkan pengumpulan data secara sorotan literatur. Manakala penganalisisan data menggunakan kaedah analisis tematik melalui perisian ATLAS.ti versi 9. Dapatan kajian menunjukkan Psikospiritual Islam mampu merawat pelbagai masalah terutamanya keresahan spiritual dalam mendepani Cabaran COVID-19.
Article
The Hajj is a pilgrimage conducted yearly in Mecca, a city located in the western province of Saudi Arabia where over 2.5 million Muslims gather from over 160 countries at the same place and time. This mass gathering is considered one of the largest mass gatherings worldwide. Performance of the Hajj is physically and emotionally demanding, therefore pilgrims could undergo great physical and emotional strain. As a consequence, morbidity and mortality rates rise as the demands arise. It is important to identify the common causes of death and injury to help prevent them and reduce their incidence. This study aims to identify the most common causes of mortality during Hajj. This is a review article that has been conducted by reviewing articles discussing the causes of death in Hajj. We found that the majority of the studies concludedthat cardiovascular diseases were the most common causes of death followed by respiratory, specifically pneumonia, which is most commonly caused by Mycobacterium tuberculosis. Also, cerebrovascular accidentswere reported in some studies to be the 3rd most common cause of death. Furthermore, old age was identified to be the most significant risk factor for dying in hajj.
Article
Full-text available
Hajj is a spiritual journey and religious ritual which is performed every year. Here, we evaluate the psychological effect of the Hajj. Using General Health Questionnaire (GHQ) questionnaire with 28 questions, the mental health of the pilgrims was assessed before and after the journey. A total of 154 people were questioned, 72 pilgrims (47%) were male. The mean GHQ score of participants before the journey was 50.1 and after the journey was 49.5 (P = 0.248). The results of analysis of variance and generalized estimating equation indicated that the GHQ scores had no significant difference before and after the journey.
Article
Full-text available
Background: 1 in 4 people experience mental health problems at some point during their lives and Muslims are no exception. Exacerbating the morbidity and mortality associated with mental health problems in Muslims is Islamophobia. Stigma and shame are major barriers to accessing and using mental health services and many Muslims with mental health problems do not receive the treatment they need. The Federation of Student Islamic Societies (FOSIS) United Kingdom branch organized a mental health conference to challenge the stigma attached to psychological problems in Muslims and to encourage care seeking in this group. Design: We conducted a single arm, pre-post comparison study on Muslims who attended the FOSIS mental health conference in Birmingham Medical School, England. Validated stigma scales measuring knowledge, attitudes and behavior were administered on participants before and immediately after exposure to the programme. Participants were also asked to respond to statements, the items of which were on a 5-point Likert scale, about the role that Islam plays in Muslim mental health, stigma as a barrier for Muslims with mental health problems to accessing and using mental health services and if they felt inspired to challenge stigma. Results: 50/250 (20%) of participants completed the study. There were statistically significant improvements in the 'Reported and Intended Behavior' score (p=0.0036), the 'Inspired to Take Action' Score (p=0.0202) and the 'Incorporating Islamic Principles into Mental Health Treatment for Muslims is Beneficial' score (p=0.0187). Discussion: The findings of our study suggest that a 'bespoke' Muslim mental health conference comprised of talks delivered by experts in Islam and mental health and a Muslim who has first-hand experience of psychological distress might be effective at reducing mental health stigma in the Muslim community. Our results should help to inform the design, development and delivery of future Muslim mental health conferences however more robust research in this area is needed.
Article
Full-text available
Background Hajj pilgrimage, in Saudi Arabia, is one of the world's largest religious mass gatherings. We have similar mass gathering scenarios in India such as the Amarnath Yatra and Kumbh. A unique combination of physical, physiological, and psychological factors makes this pilgrimage a very stressful milieu. We studied the emergence of psychopathology and its determinants, in this adverse environment in mass gathering situation, in Indian pilgrims on Hajj 2016. Materials and Methods This is a descriptive study analyzing the mental morbidity in 1.36 lakh Indian pilgrims during Hajj 2016, using SPSS software version 19. Results Totally 182 patients reported psychological problems. Twenty-two patients (12%) required admission. Twelve (6.8%) pilgrims reported a past history of a mental illness. One hundred and sixty-five (93.2%) patients never had any mental symptoms earlier in life. The most common illnesses seen were stress related (45.7%) followed by psychosis (9.8%), insomnia (7.3%), and mood disorders (5.6%). The most common symptoms recorded were apprehension (45%), sleep (55%), anxiety (41%), and fear of being lost (27%). Psychotropics were prescribed for 46% of pilgrims. All patients completed their Hajj successfully and returned to India. Conclusions Cumulative stress causes full spectrum of mental decompensation, and prompt healing is aided by simple nonpharmacological measures including social support and counseling in compatible sociolinguistic milieu.
Article
Full-text available
The allegation that, 'Being Muslim means that you cannot be British' is often made. In view of this, we conducted a small survey (n=75) utilising purposive sampling on Muslims residing in the United Kingdom. Participants were recruited in a King's College London Islamic Society event in November 2014 in Guy's Hospital, London. 75/75 (100%) of the participants recruited responded. 69/75 (94%) of respondents either disagreed or strongly disagreed that, 'Being Muslim means that you cannot be British' (75/75 (100%) Muslim participants, 43/75 (57.3%) female participants, 32/75 (42.7%) male participants, mean Age 20.5 years, (Std. Dev. ±2.5)). This paper broadly seeks to answer two related questions. Firstly, 'What is the relationship between Islam and the West?' and secondly, 'What is the relationship between Islam and mental health?' In relation to the former, the rise of radicalization over recent years and the Islamophobia that has ensued have brought Islam and Muslims under intense scrutiny. Hence we feel it is both timely and important to offer a brief background of Islam and its relevance to the Western world. In relation to the latter, for many people religion and mental health are deeply and intimately intertwined. For example, religion can enable a person to develop mental health resilience and Islam has been reported to be a protective factor against suicidal behaviour. We conclude our paper by illustrating how the two questions are interrelated. We do so by offering an autobiographical narrative from a Muslim healthcare professional residing in the UK who developed a mental health problem precipitated by war in the country of his origin. His narrative includes descriptions of the role Islam that played in his recovery as well as his attempts to reconcile seemingly disparate aspects of his identity.
Article
Full-text available
Significance A large-scale survey of pilgrims on the Hajj to Mecca (also called Makkah) showed that where there is identification with the crowd the negative effect of crowd density on safety is diminished or even reversed: a new finding. The reason that identification with the crowd moderates the effect of density on safety is because crowd identification increases the perception that others will be supportive. This process also helps to explain national differences among pilgrims in feelings of safety during the event. In contrast both to engineering approaches, which neglect crowd psychology, and traditional crowd psychology, which assumes that the crowd is inherently a “problem,” this study shows how the crowd can be part of the solution in crowd safety management.
Article
The Hajj, the pilgrimage to Mecca, is the largest mass migration in the world. Each year, 2.5 million Muslims from over 160 countries travel to the same place, 5000-6000 of these being from the Netherlands. During the Hajj, the pilgrims undergo great physical and emotional strain. Good medical preparation including vaccinations is very important for pilgrims who undertake the Hajj, in particular for those who are older and have chronic disease. The chance of transmission of infective disease is also high and rapid contagion of Hajj pilgrims could cause a pandemic. It is therefore important that the responsible doctor is aware of the health risks to the Hajj pilgrim and his environment.
Article
We estimate the impact on pilgrims of performing the Hajj pilgrimage to Mecca. Our method compares successful and unsuccessful applicants in a lottery used by Pakistan to allocate Hajj visas. Pilgrim accounts stress that the Hajj leads to a feeling of unity with fellow Muslims, but outsiders have sometimes feared that this could be accompanied by antipathy toward non-Muslims. We find that participation in the Hajj increases observance of global Islamic practices, such as prayer and fasting, while decreasing participation in localized practices and beliefs, such as the use of amulets and dowry. It increases belief in equality and harmony among ethnic groups and Islamic sects and leads to more favorable attitudes toward women, including greater acceptance of female education and employment. Increased unity within the Islamic world is not accompanied by antipathy toward non-Muslims. Instead, Hajjis show increased belief in peace, and in equality and harmony among adherents of different religions. The evidence suggests that these changes are likely due to exposure to and interaction with Hajjis from around the world, rather than to a changed social role of pilgrims upon return.
Article
Objectives: The psychiatric problems of pilgrims fromnon-Arabic speaking countries have not been investigatedsufficiently. The aim of this study was to investigate thefrequency of psychiatric disorders and socio-demographiccharacteristics of Turkish pilgrims in psychiatry departmentof Turkish Mecca Hospital.Methods: A detailed psychiatric interview was performedon 294 Turkish Pilgrims who attended the outpatient clinicof the psychiatric unit at the Turkish hospital in Mecca,Saudi Arabia, during 2008 Hajj period. Information wascollected by using a semi-structured form and the patients’diagnoses were done according to the DSM-IV-TRcriteria.Results: The study group consisted of 175 women (59.5%) and 119 men (40.5 %) with the mean age of 53.0±13years. A total of 71 % patients had not traveled abroadpreviously, and 60% had received a former psychiatrictreatment. The commonest disorders were found asdepression (26.5%), adjustment disorder with anxiety(16.3%) and panic disorder (14%) in the patients. Anxietydisorders alone or co-morbid with any other psychiatricdisorder were found in 49% of the patients. Nine percentof the patients had symptoms of acute psychosis, schizophrenia,dementia or mania which could prevent pilgrimsfrom performing Hajj rituals. Suicide attempt, alcohol andillicit drug use were not detected.Conclusions: Previous psychiatric admission and absenceof any foreign travel experience were commonamong Turkish pilgrims who had sought psychiatric helpduring the Hajj. Psychiatric disorders seems to be relatedwith older age, low educational level, and having previousmedical and psychiatric problems.
Article
To study the pattern and extent of psychiatric morbidity in the Hajj period (pilgrimage to Mecca by a Muslim). Study was conducted by psychiatry department and Health Research Centre, Al-Noor Specialist Hospital. We recorded demographic and clinical characteristics of all patients presenting during first two weeks of Zulhajjah, 1425H (11th to 24th of January 2005). Detailed clinical interviews were conducted by qualified psychiatrists and findings were recorded in semi-structured form. Diagnoses were made following the guidelines in clinical version of chapter V (Mental and Behavioral Disorders) of International Classification of Diseases (ICD-10). In difficult cases diagnosis was assigned by consensus between three psychiatrists. During study period 92 patients presented. Males were dominant (54%). Mean age was 43 +/- 17. Highest proportion (52%) belonged to young adults followed by middle-aged (20%). Majority (48%) belonged to Saudi Arabia. Self-referrals were 66% and 52% presented as first episodes. Behavior, mood, and sleep were affected more commonly (65%, 63%, and 59% respectively). Physical symptoms were reported by 28% of patients. Highest number (34%) belonged to "Neurotic, stress-related and somatoform disorders" followed by "Mood disorders" (22%). Medical disorder was reported by 33% of patients. Medications were advised to 79% and psychiatric admission to 6.5% of patients. In our study, important findings are outlined and discussed. Replication of study with increased sample size and planning of psychiatric services according to established need of population served particularly during hajj period is needed.
Investigating the Relation ship between Hajj Pilgrimage and Mental Health among Sharif University of Technology Students
  • M Bakhtiari
  • Masjedi Arani
  • A Karamkhani
  • Shokri Khubestani
  • M Mohammadi
Bakhtiari M, Masjedi Arani A, Karamkhani M, Shokri Khubestani M, Mohammadi H: Investigating the Relation ship between Hajj Pilgrimage and Mental Health among Sharif University of Technology Students. J Res Relig Health 2017; 3:78-87