2026 ECNP Congress

PS03-3120

Treatment adherence, stigma, and help-seeking among fasting and non-fasting psychiatric outpatients during ramadan

Yaren Babaoğlan — M. sancaktar, B. demir, G. elboğa, E. yalçın, F. bülbül, A. altındağ · Gaziantep Universty Hospital, Psychiatry, Gaziantep, Türkiye

2026 ECNP Congress

Background

Ramadan fasting, observed by approximately a quarter of the global population, alters medication intake, sleep, and meal timing [1]. Although religious practice has been linked with psychological well-being, fasting may compromise treatment regimens in psychiatric patients and intersect with stigma and help-seeking behaviour [2]. Studies simultaneously addressing these three dimensions in psychiatric outpatients remain scarce.

Aims

To compare treatment adherence, self- and social stigma, perceived social support, and attitudes toward seeking professional psychological help between fasting and non-fasting psychiatric outpatients during Ramadan.

Methods

In this cross-sectional, single-centre study, 180 outpatients aged 18 to 78 years with DSM-5-TR diagnoses of major depressive, anxiety, bipolar, obsessive-compulsive, or schizophrenia spectrum disorders, attending a university psychiatry clinic between 1 and 29 March 2025, were enrolled and self-classified as fasting (n=92) or non-fasting (n=88). Sample size was determined a priori with G*Power 3.9.1 (α=0.05, 1−β=0.80, expected d=0.74). Instruments included the Self-Stigma of Seeking Help Scale (SSOSH), Stigma Scale for Receiving Psychological Help (SSRPH), Multidimensional Scale of Perceived Social Support (MSPSS), 8-item Morisky Medication Adherence Scale (MMAS-8), and Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS). Analyses included t-tests, Mann–Whitney U, one-way ANOVA, chi-square, Pearson correlation, and multiple linear regression (SPSS 29.0; p<0.05).

Results

Mean age was 36.0±14.12 years; 69.4% were female. The most frequent diagnosis was major depressive disorder (50.0%), and 57.8% were receiving active antidepressant treatment [3]. Among sociodemographic variables, only educational level differed significantly between fasting and non-fasting groups (p=0.047). Fasting patients showed significantly more positive help-seeking attitudes (3.66±0.41 vs 3.53±0.50; p=0.029) but lower medication adherence on MMAS-8 (0.50±0.18 vs 0.55±0.21; p=0.029), higher social stigma (2.11±0.76 vs 1.85±0.68; p=0.009), and lower perceived social support (4.25±1.69 vs 5.06±1.51; p=0.001). Self-stigma did not differ between groups (p>0.05). Pearson correlation revealed a small negative association between social stigma and treatment adherence (r=−0.148, p=0.047) and a positive association between self-stigma and social stigma (r=0.237, p=0.001). Multiple linear regression explained 37% of the variance in help-seeking attitudes (R²=0.370, p<0.05): being married (β=0.151, p=0.047), fasting (β=0.153, p=0.047), and higher perceived social support (β=0.229, p=0.003) were positive predictors, whereas comorbid physical illness was a negative predictor (β=−0.128, p=0.044) [4].

Conclusions

Fasting psychiatric outpatients displayed a paradoxical help-seeking yet low-adherent profile, accompanied by elevated perceived social stigma and reduced social support. Although limited by cross-sectional design, single-centre sampling, self-report classification of fasting, and modest internal consistency of the adherence measure, these findings suggest that during Ramadan clinicians should consider simplified once- or twice-daily regimens, long-acting injectable antipsychotics where clinically appropriate, and proactive culturally sensitive discussion of fasting intentions to reduce stigma-related treatment barriers [5].

Table. Comparison of psychometric scores between fasting and non-fasting pyschiatric outpatients (mean +/- SD)

Scale Fasting (n=92) Non-fasting (n=88) p-value
Help-seeking attitudes (ATSPPHS) 3.66 +/- 0.41 3.53 +/- 0.50 0.029
Perceived social support (MSPSS) 4.25 +/- 1.69 5.06 +/- 1.51 0.001
Social stigma (SSRPH) 2.11 +/- 0.76 1.85 +/- 0.68 0.009
Self-stigma (SSOSH) 3.56 +/- 0.52 3.46 +/- 0.48 >0.05
Medication adherence (MMAS-8) 0.50 +/- 0.18 0.55 +/- 0.21 0.029

Independent samples t-test / Mann-Whitney U ; significance at p<0.05

References

  1. Furqan, Z., Awaad, R., Kurdyak, P., Husain, M.I., Husain, N., Zaheer, J., 2019. Considerations for clinicians treating Muslim patients with psychiatric disorders during Ramadan. The Lancet Psychiatry 6 (7), 556–557. https://doi.org/10.1016/S2215-0366(19)30161-0
  2. Mejri, I., Ouali, U., Gronholm, P.C., Zgueb, Y., Ouertani, A., Nacef, F., 2023. “To fast or not to fast?” Ramadan and religiosity through the eyes of people with bipolar disorder: an exploratory study. Frontiers in Psychiatry 14, 1270000. https://doi.org/10.3389/fpsyt.2023.1270000
  3. Mbarek, M.B., Amamou, B., Haouala, A.B., Mhalla, A., Gassab, L., Zaafrane, F., 2024. The impact of Ramadan fasting on sleep and treatment compliance in psychiatric patients: a survey study. Journal of Internal Medicine: Science & Art 5, 1–9. https://doi.org/10.36013/jimsa.v5i.133
  4. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J.S.L., Thornicroft, G., 2015. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 45 (1), 11–27. https://doi.org/10.1017/S0033291714000129
  5. Nazir, D., Wani, Z.A., Dar, M.M., Dar, S.A., 2023. Clinical profile of fasting and nonfasting psychiatric patients in Ramadan. Malaysian Journal of Psychiatry 32 (1). https://doi.org/10.4103/mjp.mjp_33_22