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Prevalence of mental disorders among patients attending primary health care centers in the capital of Saudi Arabia

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Objective: To assess the prevalence of common mental disorders at primary health care (PHC) centers in Saudi Arabia using the Self-Reporting Questionnaire. Methods: This was a cross-sectional study carried out at a single PHC center in Riyadh city, Kingdom of Saudi Arabia. A self-medication questionnaire was utilized to collect the data. The prevalence of mental disorders has assessed by the Self-Reporting Questionnaire that consists of 20 items with binary answers (Yes/No). Results: This study reports that the prevalence of mental disorders among patients attended primary health care center was 28.5%. Moreover, prevalence did not significant differ by sociodemographic (p>0.05). Conclusion: The prevalence of mental disorders was slight high. The rates of untreated mental disorders necessitate the healthcare makers in Kingdom of Saudi Arabia to implement efficient strategies to halt the progression of untreated mental disorders.
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Prevalence of mental disorders among patients attending
primary health care centers in the capital of Saudi Arabia
Sultan M. Alghadeer, PharmD, BCPS, Abdulaziz M. Alhossan, PharmD, MPH, BCPS, Mohamed N. Al-Arifi, PhD,
Zyad S. Alrabiah, PharmD, BCPS, Syed W. Ali, M.pharm, Salmeen D. Babelghaith, PhD, Mohammed A. Altamimi, B.pharm.
238
ABSTRACT



-SRQ

28.5% 

       
.)p>0.05(

 


Objectives: To assess the prevalence of common
mental disorders at primary health care )PHC(
centers in Saudi Arabia using the Self-Reporting
Questionnaire.
Methods: is was a cross-sectional study carried
out at a single PHC center in Riyadh city, Kingdom
of Saudi Arabia. A self-medication questionnaire
was utilized to collect the data. e prevalence of
mental disorders has assessed by the Self-Reporting
Questionnaire that consists of 20 items with binary
answers )Yes/No(.
Results: is study reports that the prevalence of
mental disorders among patients attended primary
health care center was 28.5%. Moreover, prevalence
did not significant differ by sociodemographic
)p>0.05(
Conclusion: e prevalence of mental disorders was
slight high. e rates of untreated mental disorders
necessitate the healthcare makers in Kingdom of
Saudi Arabia to implement efficient strategies to halt
the progression of untreated mental disorders.
Neurosciences 2018; Vol. 23 (3): 238-243
doi: 10.17712/nsj.2018.3.20180058
From the Department of Basic Sciences (Alghadeer), Prince Sultan
bin Abdulaziz College for Emergency Medical Services, from the
Department of Clinical Pharmacyy (Alghadeer, Alhossan, Al-
Arifi, Alrabiah, Ali, Babelghaith), College of Pharmacy, King Saud
University, and from the Department of Pharmacy (Altamimi),
Ministry of Interior, Riyadh, Kingdom of Saudi Arabia.
Received 31st January 2018. Accepted 11th April 2018.
Address correspondence and reprint request to: Dr. Sultan M.
Alghadeer, Department of Basic Sciences and Clinical Pharmacy,
Prince Sultan bin Abdulaziz College for Emergency Medical Services,
King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
salghadeer@ksu.edu.sa
Orcid id: https://orcid.org/0000-0003-3306-0387
Neurosciences 2018; Vol. 23 )3( OPEN ACCESS www.nsj.org.sa
There is growing concern about the mental
disorders among people around the world.1 Due
to its prevalence, depression and anxiety are considered
major public health issues and is ranked as the fourth
leading cause of the global diseases burden.2 However,
the World Health Organization )WHO( has estimated
that the impact of mental disorders will become the
second leading cause of disability among individuals.3-5
Previous studies have shown that mental disorders are
very common in almost every part of the world, with
a significant difference in their frequency.1,6 Mental
disorders refer to health conditions that are characterized
by alterations in thinking, mood, or behavior. Diagnoses
of mental disorders, also known as neuropsychiatric
disorders, are made when people become mentally
ill with the presence of somatic symptoms, such as
irritation, headache, fatigue, forgetfulness, decreased
concentration, anxiety, and mental retardation.7,8 It has
been documented that in the USA, mental disorders are
the third-most common cause of hospitalization of both
young people and adults aged between 18 and 44 years.
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ese include major depression, dysthymic disorders,
and bipolar disorders.9 Approximately 1 in 5 adults in
the USA, which can be expressed as 43.8 million or
18.5% of the individuals, suffer from mental disorders
that cost about 193.2 billion dollars.10 Previously
published studies have reported that 450 million
people in the world suffer from some form of mental
disorders.11 In the UK and the USA, about one-fourth
and almost half of the populations, respectively, have
a mental illness at some point during their life.12 In
contrast to any other chronic illness, mental disorders
are the highest reported illness.11 In Saudi Arabia, the
prevalence rate of psychiatric disorders at primary health
care )PHC( institutions is estimated to be 30-46%13
with the prevalence of depression of 20%.14 Chronic
illness such as diabetes and hypertension increase
the rate of the occurrence of mental disorders.15,16
Depression and anxiety are considered serious disorders
that have a negative effect on the quality of life,
medical comorbidity, and mortality.11,17-19 Despite the
availability of some studies, most of these studies used
specific screening tool for a particular disorder as the
Beck Depression Inventory-Short Form )BDI-SF( for
depression or the Rahim Anxiety-Depression Scale for
anxiety/depression. e evaluation of common mental
and psychiatric disorders at PHC centers using more
generalized tools or techniques needs further research.
In addition, the integration of mental health practices
at PHC centers is one of the challenges faced by them,
and investigating various psychiatric disorders using
generalized assessment tools such as the Self-Reporting
Questionnaire would help provide the real picture of
mental disorder burden at PHC centers in Saudi Arabia.
e objective of this study was to assess the prevalence
of common mental disorders at PHC centers in Saudi
Arabia using the Self-Reporting Questionnaire.
Methods. Participants. A survey study was carried
out at a center of PHC for a period of three months
from June to August 2017. Participants were enrolled
by convenience sampling. e convenience sampling
was utilized due to the difficulty of getting a list of
all patients who will visit the PHC during the study
period. erefore, any adult patient aged 18 years or
older who attended the Security Forces PHC clinic at
Western Riyadh during the study period, agreed to be
interviewed, and was able to interact effectively with
interviewers was included in our study. Any patient who
is poor historian or refused to participate was excluded.
Approximately 600 patients visited a primary care clinic
during the study period. Around 250 subjects who are
over 18 years old were approached for the interview, and
210 subjects agreed to be interviewed )approximately
84%(. During the interview, 15 subjects either refused
to complete the interview or refused to answer some
questions; and thus excluded from the study. In
addition, 2 more subjects were excluded from the study
because they were poor historian patients.
Questionnaire tool. Data were collected by a
questionnaire which was developed to explore some
sociodemographic factors including gender, age,
educational level, income, and employment status
or occupation. Following this, the Self-Reporting
Questionnaire-20 )SRQ-20( was used to investigate the
presence of mental disorders. e SRQ-20 was initially
developed by a team of psychiatrists, public health
workers, and others coordinated by WHO to investigate
the prevalence of mental illness in developed countries
and areas that lack mental healthcare services. e aim
of developing SRQ-20 was to find a cost-effective tool
for mental illness screening. Subsequent studies from
different regions translated and validated SRQ-20 in
different languages for mental illness screening.20-22
It is composed of 20 items with binary answers )Yes/
No( that underlie in one of 4 domains; decreased
energy )such as being tired(, somatic symptoms )such
as headache or stomach upset(, depressive mood )such
as being nervous or worried(, and depressive thoughts
)such as feeling worthless person(. Each positive answer
is scored as 1 and a negative answer is scored as 0. e
total scores indicated the probability of the prevalence of
mental disorder, and it ranged from 0 )no probability(
to 20 )high probability(. e original SRQ test has been
validated, and the Cronbach’s alpha was 0.86 and the
cutoff point was ≥7.23 e SRQ test was translated into
Arabic language using standard forward and backward
translation procedure. After translation, the reliability
was tested, and Cronbachs Alpha was 0.73.
Data analysis. Descriptive statistics were used to
determine the frequencies, percentages, and means. e
chi-square test was used to compare low probability
and high probability of mental disorder based on
sociodemographic factors including gender, age group,
marital status, educational level, and financial status.
Results. A total of 193 participants were interviewed
and enrolled in this study. Most of the participants
Disclosure. Authors have no conflict of interests, and the
work was not supported or funded by any drug company.
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were males )60.6%(. e age of about 46% of the
participants ranged from 36 to 55 years. Approximately
48% of the participants were married. Almost half of
the participants were employed, and about 44% of the
participants had high school level education. For more
details on the sociodemographic characteristics of the
participants )Table 1).
Table 2 summarizes the frequencies of the symptoms
of mental disorders assessed by the SRQ-20. e most
prevalent symptoms were headache )66.8%(, followed
by poor sleep )39.4%(, discomfort in the stomach
)39.4%(, fatigue )33.7%(, feeling of nervousness
)34.2%(, and daily work burden )30.6%(. In addition,
about 29% of the participants contemplated suicide,
while 26.9% were easily frightened, and 22.3% of
the participants did not enjoy daily activities. More
affirmative symptoms of mental disorders are listed in
Table 2.
Table 1 - Demographic data of participants )n=193(.
Characteristics n (%)
Gender
Male 117 )60.6(
Female 76 )39.4(
*Material status
Single 82 )42.5(
Married 92 )47.7(
Divorced 18 )9.3(
*Age group
15-35 49 )25.4(
36-55 89 )46.1(
56-75 42 )21.8(
More than 75 2 )1.0(
*Occupation
Employed 102 )52.8(
Unemployed 73 )37.8(
*Education level
University 79 )40.9(
High school 86 )44.6(
Below high
school
18 )9.3(
None 6 )3.1(
*Insurance status
None 37 )19.2(
Governmental 127 )65.8(
Private 28 )14.5(
*Income
Comfortable 41 )21.2(
Manageable 119 )61.7(
Difficult 28 )14.5(
*Percentages do not add up to total )100%(
because of missing data
Table 2 - Frequency of positive and negative answers of participants
)n=193(.
Items Yes No
n (%)
Do you have often headache? 64 )33.2( 129 )66.8(
Is your appetite poor? 63 )32.6( 130 )67.4(
Do you sleep badly? 76 )39.4( 117 )60.6(
Are you easily frightened? 52 )26.9( 141 )73.1(
Do you hand shake? 31 )16.1( 162 )83.9(
Do you feel nervous, tense or worried? 66 )34.2( 127 )65.8(
Is your digestion poor? 56 )29( 137 )71(
Do you have trouble thinking clearly? 43 )22.3( 150 )77.7(
Do you feel unhappy? 32 )16.6( 161 )83.4(
Do you cry more than usual? 41 )21.2( 152 )78.8(
Do you find it difficult to enjoy daily
activities?
43 )22.3( 150 )77.7(
Do you find it difficult to make decisions? 52 )26.9( 141 )73.1(
Is your daily work suffering? 59 )30.6( 134 )69.4(
Are you unable to play a useful role in life? 39 )20.2( 154 )79.8(
Have you lost interest in things? 37 )19.2( 156 )80.8(
Do you feel that you are a worthless person? 37 )19.2( 156 )80.8(
Has the thought of ending your life been on
your mind?
55 )28.5( 138 )71.5(
Do you feel tired all the time? 56 )29( 137 )71(
Are you easily tired? 65 )33.7( 128 )66.3(
Do you have uncomfortable feelings in your
stomach?
76 )39.4( 117 )60.6(
It was found that 28.5% of the participants had
mental disorders. Additionally, the results of this study
revealed that there were no significant associations
between mental disorders and sociodemographic
characteristics )p>0.05( as shown in Table 3.
Discussion. Approximately 28.5% of our
participants were seen to have mental disorders. is
is very comparable to 2 local studies which found that
the prevalence of mental disorders such as depression,
anxiety, somatization, or panic disorders among 431
outpatients )using Patient Health Questionnaire, PHQ(
and the prevalence of minor mental illness among 609
outpatients )using e Rahim Anxiety-Depression
Scale( in primary care settings were 33.4% and 30.5%,
respectively.14,24 ese rates seem to be lower than older
studies conducted by Al-Fares et al13,25 in 1992 and
1995 which reported the incidence of mental disorders
to be 46% and 39%, respectively.e relative decline in
identifying undiagnosed or untreated mental disorders
resulted from the awareness of healthcare authorities in
Saudi Arabia regarding these conditions by adapting the
WHO recommendations for managing and referring
patients with mental illness.26 In 2001, the WHO
established a global project known as “Mental Health
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Atlas” that assists health planners to improve or identify
areas for the best health of mental illness.27 According to
the 2014 Mental health Atlas country profile of Saudi
Arabia, some basic information was missing, which was
likely due to the absence of country-wide surveillance.28
Although regional studies were conducted at a
primary care setting or a region and used different
assessment methods, these studies estimated that almost
28.5-46% of our population had untreated mental
disorders, and females comprised the vast majority
of untreated participants.17,18,24,25 Some literature
suggests that Arab or Saudi population may avoid
seeking psychiatric treatment either because of their
supernatural interpretation of mental illness as due to
“jinn,” “evil eye,” or “magic/seher, or because of the
stigma associated with reporting embarrassing problems
particularly from men to a psychiatrist.29 However,
these claims have diminished recently due to observable
education of mental illness through TV or the Internet.
us, the society, in general, is becoming more aware of
such illnesses.
In order to raise awareness in the society and develop
a country-wide plan to reduce the progression of
mental disorders, healthcare planners in Saudi Arabia
have begun to take essential steps effectively. In 2007,
the Saudi Arabian Mental and Social Health Atlas
)SAMSHA( was developed which aimed to develop,
improve, and expand mental health services through
conducting research studies, carrying out continuous
educational sessions, building modern centers, and
graduating specialty providers.30 Further, in 2010, a
national project named “e Saudi National Mental
Health Survey )SNMHS(” was established aiming to
determine the prevalence, risk factors, comorbidities,
treatment services, and outcomes of mental disorders
in Saudi Arabia.31
Our study used self–reported measures which may
increase the likelihood of response bias. Furthermore,
the participants were recruited in the study without
any clear inclusion or exclusion criteria, and the study
was conducted at a single center. Although our study
was conducted at a regional primary care center similar
to other published local studies, it used a different
assessment tool, the SRQ-20. e SRQ-20 is neither
a specific screening tool for a particular disorder as the
Beck Depression Inventory-Short Form )BDI-SF( for
depression or the Rahim Anxiety-Depression Scale
for anxiety/depression nor is an indicator of illness
severity as the PHQ.32-33 e SRQ-20 is composed of
20 items with yes or no answer choice. e generality
and simplicity of the SRQ-20 make it a preferable tool
to be used in a primary care setting. Although our study
used different assessment tools, the results are consistent
with those of other studies. A study was carried out in
Qatar among adult patients who attending primary
health care center to assess the presence of common
mental disorders )n=1660(. is study was used
different tool compared to our study. However it
found the overall incidence of mental disorders was
36.6%.11 A similar study was carried out in Brazil to
assess the incidence of common mental disorder and its
associated factors in primary health care. It found slight
higher than our finding, )31.47%(.23 Another study
was carried out in Ethiopia used same tool. e result
of this study revealed that the prevalence of common
mental disorders was 32.4%.34 e prevalence rate of
untreated mental disorders necessitates the need for
healthcare policy makers in Saudi Arabia to accelerate
the implementation of their plans.
Table 3 - Prevalence of mental disorders according to sociodemographic
variables.*
Variables
Mental disorder
P-value
Yes No
n (%)
Gender
Male 83 )70.9( 34 )29.1( 0.87
Female 55 )72.4( 21 )27.6(
Material status
Single 62 )75.6( 20 )27.4(
0.56Married 63 )68.6( 29 )31.5(
Divorced 12 )66.7( 6 )33.3(
Age group
15-35 37 )75.5( 12 )23.5(
0.7736-55 63 )70.8( 26 )29.2(
56-75 29 )69.0( 13 )31.0(
More than 75 2 )100(
Occupation
Employed 68 )66.7( 34 )33.3( 0.18
Unemployed 57 )76.0( 18 )24(
Education level
University 58 )73.4( 21 )26.6(
0.6
High school 61 )70.9( 25 )29.1(
Below high school 14 )77.8( 4 )22.2(
None 3 )50.0( 3 )50.0(
Insurance status
None 23 )62.2( 14 )37.8(
0.13Governmental 97 )76.7( 30 )23.6(
Private 17 )60.7( 11 )39.3(
Income
Comfortable 30 )73.2( 12 )28.6(
0.19Manageable 81 )68.1( 38 )31.9(
Difficult 24 )58.7( 4 )14.3(
*e table was calculated based on the available collected data
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is study suggests the prevalence of general mental
disorders was slightly high with no significant association
between mental disorders and other sociodemographic
variables. However, these findings which suggest
untreated mental disorders seem consistent with
other local published studies that used different tools.
erefore, the local healthcare policy makers should
implement effective strategies to stop the progression of
untreated mental disorders.
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... These results suggest that possibly two-thirds of primary health care patients need a more in-depth assessment of their symptoms to identify possible hidden mental health disorders. This study's high prevalence is comparatively higher than that reported by other neighboring counties (Alghadeer et al., 2018;Ghuloum et al., 2011;E. G. Karam et al., 2019). ...
... Females are more likely to have high and very high psychological morbidity scores than males, as noted in the univariable analysis. Others have reported similar findings, indicating that women have a higher rate of psychological morbidity among PHC attendees in the Arab World (Alghadeer et al., 2018;Ghanem et al., 2009;Sundquist et al., 2017). Away from the biological differences between males and females, women bear many stressors more than males. ...
... Away from the biological differences between males and females, women bear many stressors more than males. Like the responsibilities of house and children, less access to educations, being abused by their husbands, fewer opportunities to jobs, and limitations in activities outside the home (Alghadeer et al., 2018;Ghanem et al., 2009). ...
Article
Full-text available
Mental morbidities have been widely investigated at Primary Health Care (PHC) worldwide, but no data available in Palestine have discussed these diseases’ burden. This study aimed to assess the prevalence of psychological morbidity among primary health care attendees and related factors. A cross-sectional design was adopted in this research. We collected data from primary healthcare center attendees from Sept 2019 to Jan 2020, using an interviewer-administered questionnaire called the Four-Dimensional Symptom Questionnaire. It is a valid tool that can be used in a primary healthcare setting. The Chi-square test explored psychological morbidity risk factors, and the multivariable logistic regression model was used to adjust for confounders. The study included four hundred clients >18 years of age; 287 (71.8%) were females, and 209 (52.3%) were > 50 years of age. The prevalence for high psychological morbidity of any type was 63.9% (95% CI: 58.8%–68.7%), while 24.9% (99 clients) reported very high psychological morbidity. Very high psychological morbidity was significantly higher among unmarried [adjusted OR = 2.7 (95%CI = 1.4–5.4)], lower educational level (less than 12 years schooling) [adjusted OR = 4.0, 95%CI (1.8–4.8)], and clients with high distress [adjusted OR = 15.6, 95%CI (7.9–30.9)]. In conclusion, the high prevalence of psychological morbidity identified in this study highlights the importance of early detection and management, especially among unmarried, less educated, and distressed primary health care attendants. Early interventions are of high value to reduce patient suffering, decrease the financial strain on the health system, and improve the quality of care.
... The World Health Organization has reported that approximately 25% of the world's population suffers from some form of mental illness, with depression and anxiety being the most common conditions [1]. At primary healthcare centers (PHCs), the prevalence rate of psychiatric disorders is estimated to be 30-46%, with depression accounting for 20% of the total in the KSA [2]. Saudi women and elderly individuals with any form of disability recorded a higher prevalence rate [3][4][5]. ...
... Our study was guided by the research question that stigma, attitudes and stress play a significant role in hindering the process of seeking psychological help. Based on the findings of previous studies [2,7], we hypothesized that (1) participants who received previous psychological treatment would display more positive attitudes toward psychological help-seeking, (2) participants' attitudes toward psychological help-seeking would negatively relate to the stigma of help-seeking and positively to psychological stressors (3) women would report higher perceived stigma than men as measured by SSRPH-Arabic, and (4) psychological distress would positively relate to help-seeking attitudes. ...
... Our study was guided by the research question that stigma, attitudes and stress play a significant role in hindering the process of seeking psychological help. Based on the findings of previous studies [2,7], we hypothesized that (1) participants who received previous psychological treatment would display more positive attitudes toward psychological help-seeking, (2) participants' attitudes toward psychological help-seeking would negatively relate to the stigma of help-seeking and positively to psychological stressors (3) women would report higher perceived stigma than men as measured by SSRPH-Arabic, and (4) psychological distress would positively relate to help-seeking attitudes. ...
Article
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Background In the Kingdom of Saudi Arabia (KSA), public attitudes and stigma toward mental health illness seem to prevent people from seeking psychological help, which negatively impacts an individual's life. The primary objective of this study was to investigate people's attitudes toward seeking psychological help and identify the extent to which the associated stigma is responsible for preventing them from seeking psychological help. Methods Two hundred eighteen adults recruited from the community living in the Eastern Province of the KSA completed the questionnaires, customized to create the Arabic version of Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF-A), the Arabic version of Stigma Scale for Receiving Psychological Help (SSRPH-A), and the Arabic version of Hopkins Symptom Checklist-25 (HSCL-25-A). Results Both stigma and psychological distress significantly affected attitudes toward seeking professional help. Furthermore, it indicated that attitudes were negatively correlated with stigma while positively correlated with psychological distress. No significant difference in attitudes toward psychological help-seeking was identified between male and female participants. However, males displayed higher levels of stigma, while females showed greater psychological distress. Furthermore, the groups who received psychological treatment demonstrated more favorable attitudes toward seeking psychological help. Conclusion Stigma and psychological stress influence attitudes toward treatment-seeking behavior for mental illness, making them two major predictors responsible for the underutilization of mental health services. More research is needed to assess specific sociodemographic disparities across more data sources and the factors that further contribute to stigma and psychological distress.
... ]. In 2018 a cross sectional study conducted in the capital city of Riyadh found that 28% of individuals visiting primary healthcare were diagnosed with a mental health disorder [7]. Despite the huge impact on the health of the population, its well-known that mental health services have been always under-resourced, and least invested in comparison to other health conditions [5][6][7]. ...
... In 2018 a cross sectional study conducted in the capital city of Riyadh found that 28% of individuals visiting primary healthcare were diagnosed with a mental health disorder [7]. Despite the huge impact on the health of the population, its well-known that mental health services have been always under-resourced, and least invested in comparison to other health conditions [5][6][7]. ...
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Background As the pandemic started, Saudi Arabia applied extreme measures in responses to the pandemic crises, which have adversely affected individuals’ mental health. Therefore, the aim of this study is to describe trends in mental health disorder ED visit before and after the pandemic in two medical centers in Saudi Arabia. Methods A retrospective cohort study using data from electronic health records in the Ministry of National Guard Health Affairs’ (MNG-HA) in Saudi Arabia. Multiple logistic regression model was used to examine the age and sex differences in mental health disorder ED visits before and during the COVID19 pandemic. Results A total of 1117 ED psychiatric visits, a sharp increase in the number of psychiatric ED visits during the pandemic with an average increase of 25.66% was observed. During the pandemic, psychiatric ED visits were significantly higher in females (adjusted AOR 1.41, 95% CI 1.08, 1.83) than males. During the COVID19 pandemic, generalized anxiety disorder was the most common psychiatric ED disorder with reported increase of visits by 53.34% ( p- value 0.005). Conclusion ED psychiatric visits have consistently increased before and during the COVID19 pandemic. Interventions for mental health related disorders are urgently needed for preventing mental health problems among females.
... [7] A self-medication questionnaire found that 28.5% of patients who attended primary health care had underlying mental disorders. [8] Using the Rahim Anxiety-Depression Scale, Al-Khathami found that one in three primary health care patients suffered from some form of mental illness. [9] Using the General Health Questionnaire-28, Al-Sughayr found mental illness in 48% of high schoolers, with a greater proportion among female students. ...
... [11] e majority of Saudi Arabian studies. [7][8][9] on the prevalence of mental disorders have used self-reporting questionnaires rather than a certified psychiatrist following standardized diagnostic criteria. e Rahim Anxiety-Depression Scale and self-reporting questionnaires used in these studies are simply instruments for mental health screening. ...
Article
Full-text available
Objectives Mental disorders manifest as social, occupational, or emotional dysfunctions. Many countries struggle to recognize mental disorders and their effects on communities. Mental health awareness in Saudi Arabia has improved in recent years as psychiatric treatment has become more acceptable in Saudi society. The aim of this study was to determine the percentages of mental disorders among a hospital population at Hera General Hospital, Makkah, Saudi Arabia, using the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the tenth revision of the International Classification of Diseases. We aimed to determine sex differences and to identify the five most common disorders. Material and Methods We identified clusters of mental disorders seen at Hera General Hospital psychiatric clinic using the diagnostic criteria of the DSM-IV and ICD-10 and it was a cross-sectional study of patients at a psychiatric outpatient department from July 2009 to June 2019 in Hera General Hospital, Makkah, Saudi Arabia. Results The most common mental disorders in patients attending the psychiatric clinic of Hera General Hospital were found to be major depressive disorder (41.3%), followed by anxiety disorders (22.1%), substance-induced psychotic disorder (11.4%), schizophrenia (8.9%), and Mental retardation (7.0%). Females were observed to have a higher risk for mood and anxiety disorders, whereas males had a higher risk for substance-induced psychotic disorder and schizophrenia. Conclusion Major depressive disorder was the most prevalent mental disorder at Hera General Hospital. Most patients with depressive disorder were female.
... In the case of Saudi Arabia, the prevalence of mental disorders is not well documented. As reported in a previous study [2], mental health disorders accounted for 28.5% of adult patients visiting primary health care centres in Saudi Arabia. Although most mental illnesses can be treated in low-and middle-income countries, between 76% and 85% of patients with mental disorders do not receive treatment [3]. ...
... [15] Moreover, mental disorders such as depression, anxiety, somatization, or panic disorders were generally found in 28.9% out of 431 outpatients in primary care clinics in central Saudi Arabia. [16] 90% of family medicine physicians support the need for collaboration between primary care physicians and psychiatrists to provide optimal care due to the rising numbers of mental disorders. [17] Despite previous studies looking at the nonmedical use of specific psychiatric medications or all types of drugs, no study was conducted in Saudi Arabia that specifically focuses on the medical use and nonmedical use of psychiatric medications. ...
Article
Full-text available
Introduction: Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self‑administered without medical supervision. Objectives: To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use. Methods: A cross‑sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia. Results: A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for “relax or relieve tension” 12 (29%), followed by “relieve pain caused by other health problems” 8 (20%), and “medication to get through the day” 6 (15%). Conclusion: Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross‑cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.
... [15] Moreover, mental disorders such as depression, anxiety, somatization, or panic disorders were generally found in 28.9% out of 431 outpatients in primary care clinics in central Saudi Arabia. [16] 90% of family medicine physicians support the need for collaboration between primary care physicians and psychiatrists to provide optimal care due to the rising numbers of mental disorders. [17] Despite previous studies looking at the nonmedical use of specific psychiatric medications or all types of drugs, no study was conducted in Saudi Arabia that specifically focuses on the medical use and nonmedical use of psychiatric medications. ...
Article
Introduction: Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self-administered without medical supervision. Objectives: To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use. Methods: A cross-sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia. Results: A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for “relax or relieve tension” 12 (29%), followed by “relieve pain caused by other health problems” 8 (20%), and “medication to get through the day” 6 (15%). Conclusion: Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross-cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.
... Mental health is one of the core priorities, alongside maternal care, malnutrition, and non-communicable diseases [5] . Providing mental health services in primary health care involves diagnosing and treating people with mental disorders; putting in place strategies to promote and prevent mental disorders; and ensuring that primary health care workers are able to apply key psychosocial and behavioral science skills, such as interviewing, counseling and interpersonal skills, in their day to day work [6] . There is growing concern about the mental disorders among people around the world. ...
Article
Full-text available
Background: In most health care systems, primary care doctors are the cornerstone of recognition, diagnosis, treatment, and specialist referral for all types of disorders, whether they are somatic, psychological, or both. The past two decades have witnessed a further emphasis of this role, particularly with regard to the treatment of mental disorders in primary care. (1)
... The descriptive findings show a low rate of school and university students who were diagnosed with mental illness although about one in ten had a family member or a friend diagnosed with a mental illness. Contradictive findings were reported in different Arab countries with both low prevalence (4%-8% in Egypt, Sudan, and Kuwait) (Dardas et al., 2016), and other higher prevalence in a similar context and neighboring countries such as Saudi Arabia, 28.5% (Alghadeer et al., 2018), and Jordan, 34% (Dardas et al., 2017). The healthseeking behavior influenced by the existing stigmatization towards persons with mental illness might explain the low rate of diagnosed persons with mental illness in our sample, meaning that this low prevalence does not necessarily reflect the actual number of persons with mental illness. ...
Article
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Purpose This study aimed to explore the associated factors of stigma towards people with mental illness among Omani school and university students. Design and Method A cross-sectional study among 371 school and university students with a multivariable linear regression model to identify the associated factors of personal and perceptions of stigma. Results Male students, those with highly educated mothers, have high monthly income, higher mental health knowledge, employed fathers, and received focused education on mental illness showed fewer stigmatizing attitudes. Implications for Practice Enhancing the knowledge about mental illness among school and university students and their families can play a significant role in reversing stigma.
Article
Background: To extend our knowledge of social barriers in relation to mental health, the present study was conducted to investigate the impact of social barriers on mental health help-seeking among Saudi Arabians aged 18 years and above. Materials and methods: This cross-sectional study was carried out on 1632 participants in 2018 during the months of October and November. The participants completed self-administered online surveys about the demographic characteristics, social barriers, and knowledge and attitudes about mental health. Results: The majority of the participants agreed that social barriers could prevent them from seeking mental health help. Stigma was chosen as the most common social barrier among the participants (76.3%), followed by culture (61.5%) and negative perceptions (56.2%). Conclusion: Social barriers are a challenge in seeking mental health. Increasing public awareness of available services and resources as well as developing programs to fight stigmatization should be initiated to create more positive attitudes toward people with mental illness and promote holistic well-being.
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Objective: The Self-Reporting Questionnaire and Rahim Anxiety-Depression Scale are instruments used for screening minor psychiatric morbidity. The aim of this study is to test and compare their validity and reliability in a sample of Saudi adult diabetic patients. Methods: A random sample of 226 adult diabetics and an equal number of matched normal subjects were interviewed using a structured questionnaire including socio-demographic and clinical characteristics, as well as the Self-Reporting Questionnaire and Rahim Anxiety-Depression Scale. A sub-sample of 49 patients were further clinically assessed according to DSM-IV diagnostic criteria. Results: Indices of inter-rater and test-retest reliability were in the range of 84% to 88%. Validity measures, reached by comparing the results of the screening tests with the blind clinical judgement of qualified psychiatrists, showed ranges of sensitivity between 70% and 94%, specificity between 72% and 84%, overall accuracy rate between 71% and 84%, and odds ratio between 6.3 to 48. Factor Analysis extracted 5 factors: one of predominantly depressive symptoms, 2 of somatic complaints, one of psychic anxiety, and one of neurasthenic manifestations. Compared to Self-Reporting Questionnaire, Rahim Anxiety-Depression Scale gave consistently higher values in all tested indices of validity. Conclusion: The 3 instruments seem reliable and valid in screening psychiatric morbidity in diabetic patients. Rahim Anxiety-Depression Scale, which incorporates all the items of Self-Reporting Questionnaire and Somatization Sub-scale, was found superior to Self-Reporting Questionnaire alone, and it allowed for probing the severity, as well as the frequency, of reported symptoms.
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Psychiatric disorders including anxiety, depression, somatization, obsessive compulsive, and bipolar disorders are recognized as causing the biggest burden of disease worldwide. In this study, we aimed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers (PHCC) using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) in the Qatari population, aged 18-65 who attended Primary Health Care (PHC) settings. A prospective cross-sectional study conducted during November 2011 to October 2012. Primary Health Care Centers of the Supreme Council of Health, Qatar. A total of 2,000 Qatari subjects aged 18-65 years were approached; 1475 (73.3%) agreed to participate. Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI (Version 3.0). Of the 1475 participants, 830 (56.3%) were females and 645 (43.7%) was males. One-third were aged 35-49 years 558 (37.8%). The three most common disorders were major depression disorders (18.31%), any anxiety disorders (17.3%), any mood disorders (16.95%), followed by separation anxiety disorders (15.25%), personality disorder (14.1%). In the present study, prevalence in women was significantly higher than men for the most common psychiatric disorders, specifically generalized anxiety disorder, panic disorder, social phobia, specific phobias, obsessive compulsive disorders, posttraumatic disorder, somatization, major depressive disorder, bipolar disorder, dysthymia, and oppositional defiant disorder. Of the total 20% had only one psychiatric diagnosis and 12% had two disorders, 9.7% respondents with three diagnoses, and finally 4.3% of respondents had four or more diagnoses. One-fifth of all adults who attended the PHCC (20%) had at least one psychiatric diagnosis. The CIDI is a useful instrument for psychiatric diagnosis in community settings such as PHC clinics, clinical research and intervention studies. There is an urgent need to not only assess prevalence, but also risk factors, burden, treatment gaps and outcomes to obtain evidence for policy making.
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Abstract: Background: Psychiatric disorders in Saudi Arabia, mainly depression and anxiety are estimated to have high prevalence. The aim of this study was to assess the magnitude of depression, and anxiety among Primary Health Care Centers (PHCCs) attendees in Dammam and Al-Qatif areas, Eastern Saudi Arabia and to identify possible predictors. Methods: This was a cross-sectional study conducted in ten randomly selected PHCCs. The study sample consisted of 822 adult male attendees. Data was collected using an interviewer-administered validated Arabic version of Patient Health Questionnaire (PHQ). The questionnaire consisted of socio-demographic characteristics and questions to assess depression and anxiety. The PHQ scoring system was used to derive severity scores for both conditions. Chi-square test and logistic regression were used for data analysis. Results: The overall prevalence of depression was 32.8% with mild depression accounting for 22.9%. The overall prevalence of anxiety was 22.3% with 17.0% of the attendees having mild degree of anxiety. Single marital status, younger age group, lower monthly income, and positive history of psychological and chronic disorders were statistically significantly associated with depression. Single marital status was statistically significantly associated with anxiety. Logistic regression analysis showed that, single marital status and positive history of psychological illness were significant predictors of depression; being single was the only predicting factor for the occurrence of anxiety. Conclusion: The prevalence rate of depression and anxiety among PHCCs male attendees was relatively high. Therefore, screening of mental illnesses, especially depression and anxiety should be implemented by PHC physicians during their routine activities.
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Background No study in Greece has assessed so far the full range of common mental disorders using a representative sample of the population from both mainland and insular regions of the country. The aim of the present paper was to present the results of the first such study. Methods The study was carried out between 2009–2010 in a nationally representative sample of 4894 individuals living in private households in Greece. Common mental disorders in the past week were assessed with the revised Clinical Interview Schedule (CIS-R). We also assessed alcohol use disorders (using AUDIT), smoking and cannabis use. Results 14% of the population (Male: 11%, Female: 17%) was found to have clinically significant psychiatric morbidity according to the scores on the CIS-R. The prevalence (past seven days) of specific common mental disorders was as follows: Generalized Anxiety Disorder: 4.10% (95% CI: 3.54, 4.65); Depression: 2.90% (2.43, 3.37); Panic Disorder: 1.88% (1.50, 2.26); Obsessive-Compulsive Disorder: 1.69% (1.33, 2.05); All Phobias: 2.79% (2.33, 3.26); Mixed anxiety-depression: 2.67% (2.22, 3.12). Harmful alcohol use was reported by 12.69% of the population (11.75, 13.62). Regular smoking was reported by 39.60% of the population (38.22, 40.97) while cannabis use (at least once during the past month) by 2.06% (1.66, 2.46). Clinically significant psychiatric morbidity was positively associated with the following variables: female gender, divorced or widowed family status, low educational status and unemployment. Use of all substances was more common in men compared to women. Common mental disorders were often comorbid, undertreated, and associated with a lower quality of life. Conclusions The findings of the present study can help in the better planning and development of mental health services in Greece, especially in a time of mental health budget restrictions.
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Background: Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. Method: Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. Results: Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9-38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0-2.9, p = 0.09-0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81-0.86, sensitivity 68.0-80.2%, specificity 90.1-98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR- is 0.1 or less at informative thresholds for all diagnoses. Conclusions: CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.
Article
The International Consortium in Psychiatric Epidemiology (ICPE) was established in 1998 by WHO to carry out cross-national comparative studies of the prevalences and correlates of mental disorders. This article describes the findings of ICPE surveys in seven countries in North America (Canada and USA), Latin America (Brazil and Mexico), and Europe (Germany, Netherlands, and Turkey), using a version of the WHO Composite International Diagnostic Interview (CIDI) to generate diagnoses. The results are reported using DSM- III-R and DSM-IV criteria without diagnostic hierarchy rules for mental disorders and with hierarchy rules for substance-use disorders. Prevalence estimates varied widely - from >40% lifetime prevalence of any mental disorder in Netherlands and the USA to levels of 12% in Turkey and 20% in Mexico. Comparisons of lifetime versus recent prevalence estimates show that mental disorders were often chronic, although chronicity was consistently higher for anxiety disorders than for mood or substance-use disorders. Retrospective reports suggest that mental disorders typically had early ages of onset, with estimated medians of 15 years for anxiety disorders, 26 years for mood disorders, and 21 years for substance-use disorders. All three classes of disorder were positively related to a number of socioeconomic measures of disadvantage (such as low income and education, unemployed, unmarried). Analysis of retrospective age-of-onset reports suggest that lifetime prevalences had increased in recent cohorts, but the increase was less for anxiety disorders than for mood or substance-use disorders. Delays in seeking professional treatment were widespread, especially among early- onset cases, and only a minority of people with prevailing disorders received any treatment. Mental disorders are among the most burdensome of all classes of disease because of their high prevalence and chronicity, early age of onset, and resulting serious impairment. There is a need for demonstration projects of early outreach and intervention programmes for people with early- onset mental disorders, as well as quality assurance programmes to look into the widespread problem of inadequate treatment.
Article
Objective: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. Measurements: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. Results: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. Conclusion: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
Article
In 1983, an article and accompanying editorial was published on the state of psychiatry in the Kingdom of Saudi Arabia (KSA), which was described as "a mental health system in statu nascendi." We provide a 30-year update on advances in mental health care in KSA. Data are reported from a wide range of sources, including the 2007 Saudi Arabian Mental and Social Health Atlas, which compares services in KSA with the rest of the world. We examine how the current mental health system operates in KSA, including recent changes in mental healthcare policy and development of a national mental healthcare plan. Discussed are current needs based on the prevalence and recognition of mental disorders; availability of services and providers (psychiatrists, psychiatric nurses, psychologists, and social workers); education and training in psychiatry; developments in consultation-liaison, addictions, child-adolescent, and geriatric psychiatry; and progress in mental health research. Mental healthcare in Saudi Arabia has come a long way in a very short time, despite cultural, religious, social, and political challenges, although there still remain areas where improvement is needed. The development of psychiatry in KSA serves as a model for countries in the Middle East and around the world.