Mental health in Kuwaiti and American College Students

In samples of 154 Kuwaiti and 154 American college students (81.8% women), the Arabic Scale of Mental Health had good reliability (Cronbach α=.95 and .96 for both samples, respectively). The American students obtained slightly higher mean score than did their Kuwaiti counterparts. This difference may result from the different levels of freedom, individualism, and collectivism between the students in the two countries.


Summary
In samples of 154 Kuwaiti and 154 American college students (81.8% women), the Arabic Scale of Mental Health had good reliability (Cronbach α=.95 and .96 for both samples, respectively). The American students obtained slightly higher mean score than did their Kuwaiti counterparts. This difference may result from the different levels of freedom, individualism, and collectivism between the students in the two countries.
One of the main principles in health psychology is that health is not complete without mental health. Moreover, physical and mental health is not simply the absence of negative symptoms and signs. A meaningful measure of health must include positive aspects and indicators. Satcher [1] stated that mental health refers to the successful performance of mental functions, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity (p. 6).
Influenced by positive psychology, Wang et al. [2] proposed a dual-factor model of mental health. They suggested that subjective well-being should be included into a mental health evaluation as a positive indicator. Their model sought to solve the deficiency in traditional mental health models based on psychopathology. For example, the entire definition and application of all the versions of the Diagnostic and Statistical Manuals is essentially a definition of mental health as the absence of illness, and there are many critics of this approach.
Most existing scales of mental health reflect a "disease model" Rush et al. [3]. The Arabic Scale of Mental Health Abdel-Khalek [4] is based on positive indicators of mental health. Based on a back translation technique, it has two equivalent versions (Arabic and English) and, therefore, cross-cultural comparisons become feasible. The aim of the present study was to compare college students from two different cultures and background on mental health.
There are many differences between the American and Kuwaiti participants including religion, urbanization, sociopolitical factors, family structure, and family size. Furthermore, the cultural framework of the American population is individualism, where the cultural framework is collectivism for many Asian, African, and Hispanic nations, including Kuwait Triantis [5]. Individualism is positively correlated with high self-esteem Heine and Lehman [6], and self-esteem is strongly and positively correlated with mental health Abdel-Khalek [7]. Therefore, it could be predicted that Americans would have the higher scores than Kuwaitis on measures of mental health.
Furthermore, American college students obtained significantly higher scores than did their Kuwaiti counterparts on a single-item self-rating scale of mental health Abdel-Khalek, Lester [12]. Based on the limitations of single-item rating scales, and previous research indicating higher mean scores on psychopathology measures and the lower mean scores on positive psychology variables in Kuwaiti students relative to American students, we hypothesized American students would obtain higher mean scores on a multi-item Arabic Scale of Mental Health than would Kuwaiti students. The Scale: The Arabic Scale of Mental Health is a unidimensional trait measure for adults and adolescents. It is comprised of 40 brief statements plus 10 filler items answered on a 5-point scale anchored by 1: No and 5: Very much (e.g., "I feel safe", "My morale is high", and "I get along well with others"). In previous research, the Cronbach alphas and test-retest reliabilities ranged from .84 to .96. Concurrent validity was high with measures of happiness, satisfaction with life, hope, optimism, love of life, and self-actualization. Scores on the scale were significantly and negatively correlated with measures of anxiety, neuroticism, insomnia, somatization, and depression Abdel-Khalek [4,7,17,18].

Results and Discussion
The Arabic Scale of Mental Health had high internal consistency reliability in both of the present samples, with Cronbach's alphas of .95 and .96 for the Kuwaiti and American samples respectively. The mean scores for the scale were 147.1 (SD=26.1) and 153.3 (SD=23.9) for the Kuwaiti and American samples, respectively (t306= 2.17, p= .03, Cohen's d = 0.25) indicating slightly higher mental health in the American students.
The present result is consistent with previous findings reviewed in the introduction which reported that Kuwaiti students had a significantly lower mean score on measures of positive psychology variables than did their American counterparts, whereas American students had significantly lower mean scores on measures of psychopathology than did their Kuwaiti peers.
Veenhoven [19] compared 43 nations in the early 1990's. He found that the quality of life of citizens was associated with greater individualization in the nations and the more that the citizens reported enjoying their life. The costs of individualism appear to be outweighed by the benefits. In line with this, the quality of life was significantly and positively correlated with mental health in an Arabic sample [20].

Limitations
The findings from the current study must be viewed within the limitations imposed by the data. Foremost among them is the special properties of undergraduates (educated and highly intelligent) compared to the general population. Moreover, the age range of the present samples was limited. Thus, an important next step in this endeavor would be to replicate and extend the present investigation using older age groups and other measures of psychopathology and mental health. Further research appears warranted.

Conclusion
As far as the present research is concerned, its salient implication is that the internal consistency of the Arabic Scale of Mental Health is high in its both versions: Arabic and English. American students obtained higher mean scores on the Arabic Scale of Mental Health than did their Kuwaiti counterparts. In addition, because the present finding confirmed a previous result using a single-item self-rating scale of mental health, this supports the validity of the single-item self-rating scale of mental health.