Suicide is one of the leading causes of death and has steadily increased throughout the past 2 decades. 1 Religious affiliation may be associated with a lower risk for both suicide attempt and death through multiple mechanisms, including the promotion of social support, personal empowerment, healthy lifestyle, and commitment to religious life-preserving morals. 2 In the US, Muslim individuals represent a religious minority group who are vulnerable to religious discrimination but may access mental health services more infrequently than other groups. We compare the prevalence of suicide attempts among Muslim adults compared with adults of other faith communities in the US. Methods | Participants completed the 2019 Institute for SocialPolicy and Understanding national community-based survey 3 conducted over landline, cell phone, and online by Social Science Research Solutions during January 2019. Muslim and Jewish participants were oversampled, and other religious groups were weighted to provide nationally representative and projectable estimates of the US adult population 18 years and older. The eMethods in the Supplement include a description of sample design, survey administration, and weighting procedures. The Stanford University institutional review board exempted the study from ethical review because it was an analysis of deidentified poll data.Participant demographics were collected using selfreported items. Participants were asked to self-identify their religion from the following categories: agnostic, atheist, Buddhist, Catholic, Christian, do not know, Hindu, Jewish, Mormon, Muslim, no religion, Orthodox, Protestant, something else, or Unitarian (Universalist). Participants were also asked to self-identify their race and ethnicity using the following categories: African American, Arab, Asian/Chinese/ Japanese/Indian/Pakistani, Native American/American Indian/ Alaska Native, Native Hawaiian/Pacific Islander, mixed, Hispanic, White, or other. Lifetime suicide attempt was assessed with a question adapted from the Columbia-Suicide Severity Rating Scale: "Have you ever tried to do anything to try to kill yourself or make yourself not alive anymore?" 4 Descriptive statistics and cross-tabulations were used to categorize and compare the frequency of the chosen study characteristics of participants. Univariate and multivariate logistic regression analyses were performed using Stata version 15 (StataCorp) to calculate unadjusted and adjusted odds ratios. Demographic factors were coded as categorical variables in the adjusted analyses. Individuals who refused to identify with a religious group or other demographic variable were coded as missing and excluded. Two-sided P values were statistically significant at .05. Analysis took place from March to December 2020.

Muslims living in Western countries appear to utilize mental health services at lower rates than the general population despite facing significant mental health challenges. Stigma toward help-seeking may be a barrier to treatment. One model suggests that public stigma, internalized as self-stigma, leads to negative attitudes and less favorable intentions toward seeking psychological help. Cross-cultural differences in this model challenge its applicability for Western Muslims and suggest that it may be moderated by acculturation and enculturation. The first objective of this study is to investigate the applicability of the internalized stigma model (Vogel et al., 2007) in a sample of Muslims. The second objective is to explore whether acculturation and enculturation moderate this model. An online survey that included measures of public and self-stigma of help-seeking, attitudes toward help-seeking, intentions to seek help, and acculturation/enculturation was completed by 238 Canadian Muslim participants. Serial mediation analyses investigated whether public stigma predicts (a) attitudes through self-stigma and (b) intentions toward help-seeking through self-stigma and attitudes. Conditional process modeling examined whether acculturation and enculturation moderated the serial mediation models. Both mediation models were significant. Public stigma was positively associated with self-stigma, self-stigma was negatively associated with attitudes toward help-seeking, and attitudes were positively related to intentions to seek services. Acculturation and enculturation did not moderate the models. The internalized stigma model is applicable to Canadian Muslims. Previous assertions that acculturation or enculturation influence this model were not supported.

Background: The underutilization of mental health services is a recognized problem for the growing number of Muslims living in the West. Despite their unique mental health risk factors and the pivotal role they play in determining mental health discourse in their families and in society, Muslim women in particular have not received sufficient study. Aim: To help remedy this research gap, we examined factors that may impact the rejection attitudes of Muslim women toward professional mental health care using the first psychometrically validated scale of its kind; the M-PAMH (Muslims’ Perceptions and Attitudes to Mental Health). Methods: A total of 1,222 Muslim women responded to questions about their cultural and religious beliefs about mental health, stigma associated with mental health, and familiarity with formal mental health services in an anonymous online survey. Results: Hierarchical multiple regression analysis revealed that higher religious and cultural beliefs, higher societal stigma, and lower familiarity with professional mental health services were associated with greater rejection attitudes toward professional mental healthcare. The final model was statistically significant, F (5, 1,216) = 73.778; p < .001, and explained 23% of the variance in rejection attitudes with stigma accounting for the most (12.3%) variance, followed by cultural and religious mental health beliefs (6%), and familiarity with mental health services (2.7%). Conclusions: Findings suggest that although the examined factors contributed significantly to the model, they may not be sufficient in the explanation of Muslim women's rejection attitudes toward mental health services. Future research may explore additional variables, as well as predictive profiles for Muslim women’s perceptions and attitudes of mental health based on a combination of these factors.

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Muslims in Canada may have unmet psychological service needs, but little is known about their past use of, and future preferences for, mental health services. We addressed this gap with an online survey of 238 Canadian Muslims. Analyses investigated differences in intentions to seek support from various informal and formal sources. A majority (65%) of the sample reported at least moderate levels of current distress but only 48.7% sought professional treatment in their lifetimes. Participants preferred dealing with future psychological concerns themselves or with friends/family, closely followed by professional help. Imams were the least preferred source of support.