Authors: Ahmad M.Alridahie , Youmna M. Fallatah , Nuran H.JamalAllail , Ghala E.Alharbi , Arwa M.Alqadi , Mohammed A. Fatani , Tala J. Rummani , Manar S. Alharbi , Ayman A. Alharbi

Abstract

Background: The Hajj is one of the largest recurrent mass gatherings in the world, bringing millions of pilgrims into a confined setting under extreme heat, overcrowding, and physical exertion. Religiosity is generally protective for mental health, yet negative religious coping can worsen depressive symptoms, and the psychological consequences of Hajj remain fragmented across quantitative and qualitative studies. This review synthesised the evidence on how Hajj participation relates to psychological wellbeing.

Methods: This mixed-methods systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and was registered with the International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Embase, Scopus, and Web of Science were searched to June 2026 for quantitative and qualitative studies. Two reviewers independently screened records, extracted data, and appraised quality using the Mixed Methods Appraisal Tool (MMAT). Because of substantial heterogeneity, findings were combined through narrative synthesis rather than meta-analysis, with certainty assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and GRADE-CERQual.

Results: Eleven studies were included, most showing preserved or improved wellbeing, with gains in social cohesion, positive affect, and collective identity after pilgrimage. General-health outcomes diverged across studies using the same instrument, and a consistent minority, particularly women, unmarried or older attendees, and those on psychiatric medication, experienced elevated distress, including suicidal ideation in about six percent of one sample. Certainty was low for quantitative and moderate for qualitative findings.

Conclusion: Hajj participation was compatible with stable or improved psychological wellbeing for most pilgrims, while a consistent subgroup remained vulnerable under physical and social load. Targeted psychological screening within existing pre-travel and on-site services, alongside prospective multinational cohort research, would strengthen this fragmented evidence base.

Keywords: Hajj, mental health, psychological wellbeing, pilgrimage, psychological adaptation.