Role of Psychosomatic Medicine in Complex Medical Cases: A Case Study of a Patient With Breast Cancer Who Refused Mastectomy.

Psychosomatic medicine has been known to play a pivotal role in the management of complex medical cases by providing a bridge between the physical disease and psychological distress. This case study focuses on a 42-year-old Saudi female diagnosed with breast cancer and generalized anxiety disorder. In addition to anxiety, the patient had a history of obsessive-compulsive personality traits, which contributed to her reluctance to undergo mastectomy. Significant challenges and noncompliance with treatment were caused by her unwillingness and inadequate interaction with the medical team. An integrated multidisciplinary strategy including psycho-oncological interventions was necessary because of the complexity of this case. Communication issues were addressed through the concerted efforts of the specialist teams. A comprehensive patient-practitioner understanding was established, which enabled the teams to persuade the patient to undergo surgical intervention. Overcoming her initial resistance, the patient eventually complied with the treatment plan, leading to a successful surgery. Postsurgical evaluations using the Hamilton Anxiety Scale indicated a significant reduction in anxiety levels. This case underscores the critical contribution of psychosomatic medicine to healthcare, especially in challenging situations that demand additional resource allocation, further highlighting the importance of an interdisciplinary approach, efficient communication, and patient-practitioner rapport in healthcare outcomes.

Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia: A 6-month follow-up questionnaire study.

BACKGROUND: Psychological assessment after intensive care unit (ICU) discharge is increasingly used to assess patients' cognitive and psychological well-being. However, few studies have examined those who recovered from coronavirus disease 2019 (COVID-19). There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19. AIM: To evaluate anxiety and depression among patients who had severe COVID-19. METHODS: This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for > 24 h for COVID-19. Eligible patients were contacted via telephone. The patient's anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the mean HADS score. The secondary outcomes were risk factors of anxiety and/or depression. RESULTS: Patients who were admitted to the ICU because of COVID-19 were screened (n = 518). Of these, 48 completed the questionnaires. The mean age was 56.3 ± 17.2 years. Thirty patients (62.5%) were male. The main comorbidities were endocrine (n = 24, 50%) and cardiovascular (n = 21, 43.8%) diseases. The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4 (SD ± 8.5). A HADS score of > 7 for anxiety and depression was detected in 15 patients (30%) and 18 patients (36%), respectively. Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression [odds ratio (OR) 39.06, 95% confidence interval: 1.309-1165.8; P < 0.05]. CONCLUSION: Six months after ICU discharge, 30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression. To compare the psychological status of patients following an ICU admission (with vs without COVID-19), further studies are warranted.

Utility and Implementation of the Distress Thermometer for Cancer Patients: A Cross-Sectional Study From Saudi Arabia.

Background Cancer patients suffer from variable degrees of distress. The distress thermometer (DT) is a valuable tool for screening those patients for distress. Few studies have addressed the utility of DT in screening cancer patients in Saudi Arabia. We aimed to measure the distress level of adult cancer patients utilizing the DT and identify the appropriate measures and interventions required to improve this population's well-being. Methods This cross-sectional study was carried out at the oncology center of King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Enrollment criteria were Saudi adults (≥14 years old), with a diagnosis of cancer, who gave informed consent. They were screened for distress using the DT and its associated problem list (PL). A workflow for a psycho-oncology supportive program was suggested. Results Using DT at a cut-off score of ≥4, 22% of patients had significant distress. The most frequent problems reported were loss/change of physical activity, swelling/edema, change in eating, family health problems, and child care. The multivariable binary regression analysis showed that sadness, depression, worry/anxiety, fear, loss of interest, change in appearance, taking care of myself, swelling/edema, and memory/concentration problems were independent factors for significant distress in our cohort. The suggested workflow could effectively be implemented among cancer patients. Conclusion The current study's findings support previous reports concerning the utility of DT in screening cancer patients for distress. A considerable number of Saudi cancer patients suffered from significant distress, which was significantly related to the emotional, spiritual, social, and religious aspects of their problems. We suggested a workflow by which cancer centers can implement DT screening after developing a plan for timely distress evaluation, with further proper management and referrals accordingly. Additional studies are warranted.

Coping strategies of psychiatrists and psychiatry trainees following patient suicide and suicide attempt: A national cross-sectional study in Saudi Arabia.

A patient's suicide or suicide attempt is a challenging experience for psychiatrists. This study aimed to explore the common coping strategies and habits developed by psychiatrists/trainees following such incidents. A self-administered questionnaire was distributed among participants in Saudi Arabia. The study enrolled 178 participants, of whom 38.8% experienced a patient's suicide, 12.9% experienced a patient's severe suicide attempt, and 48.3% did not encounter any suicidal events. The most frequently utilized sources of support were colleagues (48.9%), team discussions (41.3%), and supervisors (29.3%). Only 21.4% received formal education in coping with a patient's suicide. Approximately 94.9% reported a lack of support systems within their institution. The study highlighted the coping strategies most commonly employed by psychiatrists/trainees and revealed that the majority of participants reported no changes in their daily habits. The findings underscore the need for a structured support system and formal educational resources to address the existing deficit. Mental health organizations must take action to ensure adequate resources for healthcare providers.

Pattern of dietary supplement use and its psychosocial predictors among females visiting fitness centers in Saudi Arabia: Findings from a cross-sectional study.

Background: Establishing a balanced diet is necessary for obtaining the required daily micronutrients and macronutrients. However, the importance of using dietary supplements to complement one's diet is a significant aspect to consider. While studies have reported the prevalence and patterns of dietary supplements in Saudi Arabia, most focused on university students, women in their reproductive life-particularly during pregnancy-or male athletes. Hence, the objective of this study is to estimate the prevalence and patterns of dietary supplement usage, along with the associated sociodemographic and psychiatric predictors among women attending fitness centers in Saudi Arabia. Methods: A cross-sectional design was utilized using a structured questionnaire to collect data on dietary intakes such as consumption, nutrition supplements, type of nutrition supplements, and reason for consuming dietary supplements. Data collection occurred in female fitness centers, with participants accessing the questionnaires through QR codes linked to online Google forms. The dietary usage was assessed using a structured questionnaire developed by the study authors, and depressive and anxiety symptoms were assessed using the PHQ-9 and the GAD-7 scales, respectively. SPSS 23.0 was utilized to analyze the data, and a multivariable logistic regression analysis was performed to determine the association between sociodemographic and psychiatric predictors and patterns of dietary supplement usage. The results were presented by reporting an unadjusted and adjusted odds ratio (AOR) with 95 % Confidence Intervals (CIs). Results: The total number of participants in this study was 453 women. Half of the 453 women (46.1 %) consumed dietary supplements, and (84.0 %) reported taking proteins, caffeine, creatinine, mineral salts, fish oil, and/or amino acids or a combination of these dietary supplements. A considerable number of women (41.0 %) reported that a doctor, dietitian, or trainer motivated them to take the dietary supplement, and (38.0 %) of women self-prescribed dietary supplements. More than half (51 %) of the women consumed dietary supplements to compensate for nutrient deficiency, and 48 % used them to improve their health. Women who did not work to earn were 53 % less likely to consume dietary supplements (AOR = 0.47; [95 % CI: 0.30-0.72]) than women who reported working to earn either in the private or government sector. Depressed women were (42 %) less likely to consume dietary supplements than non-depressed women (AOR = 0.58; [95 % CI: 0.33-0.99]) after adjusting for sociodemographic variables and other medical conditions. Conclusion: It has been evident that a large proportion of women enrolled in the fitness center report consuming dietary supplements, mostly to compensate for energy and to improve overall health. The findings highlight that non-working and depressed women were less likely to use dietary supplements than their counterparts. By understanding these patterns, the community can tailor health interventions and policies to ensure equitable access to proper dietary support, especially for those facing challenges like depression and unemployment. Future research on a larger sample of women outside fitness centers is encouraged to explore further dietary supplement consumption and patterns among diverse population groups, and to ultimately develop health guidelines for the appropriate use of supplements.

Is There an Association between Increased Stress and Smartphone Addiction? Insights from a Study on Medical Students from Saudi Arabia during the COVID-19 Pandemic.

Purpose: Smartphone addiction is prevalent among medical students, and there is a concern that the coronavirus disease 2019 (COVID-19) pandemic fueled a rise in smartphone addiction. Earlier studies suggest a link between excessive smartphone usage and negative outcomes such as depression, stress, and reduced academic achievement. However, there is a dearth of both local studies in Saudi Arabia and studies conducted during the COVID-19 pandemic exploring the prevalence of smartphone addiction and its association with academic performance, depression, and perceived stress, which is the purpose of the current study. Methods: In 2021, a cross-sectional research project took place among medical students at King Saud University and the Vision Colleges located in Riyadh, Saudi Arabia. An online self-administered questionnaire consisting of demographic variables, grade point average (GPA), the Patient Health Questionnaire-9 (PHQ-9), the Perceived Stress Scale-4 (PSS-4), and the Smartphone Addiction Scale-Short Version (SAS-SV) was deployed. Results: Three hundred and fifteen students participated. Around 47.9% of students reported smartphone addiction, and the mean SAS-SV score was 32.31 ± 12.01 points. Both PHQ-9 and PSS-4 scores showed a significant positive correlation with the SAS-SV score (r = 0.216, p < 0.001 and r = 247, p < 0.001, respectively), while GPA did not (r = -0.027, p = 0.639). An adjusted analysis showed that the PSS-4 score was positively associated with the SAS-SV score (odds ratio (OR) = 1.206, p < 0.001), while the PHQ-9 score was not (OR = 102, p = 0.285). Conclusions: Smartphone addiction is prevalent among medical students and associated with perceived stress. Additional research is required to gain a deeper comprehension of this issue and to assess the success of intervention initiatives aimed at encouraging healthy smartphone usage, particularly in times of crisis like the COVID-19 pandemic.

Perceived impact of patients' suicide and serious suicidal attempts on their treating psychiatrists and trainees: a national cross-sectional study in Saudi Arabia.

BACKGROUND: Patient suicides are significant events that tremendously affect psychiatrists- personally and professionally. Very few studies have focused on studying the impact of both serious suicidal attempts and completed suicide on psychiatrists and psychiatry trainees. AIM: This study assessed the prevalence and impact of patient suicide and serious suicidal attempts on psychiatrists and psychiatry trainees in Saudi Arabia. METHODS: This national cross-sectional study of psychiatrists and psychiatry trainees was conducted in Saudi Arabia. Participants completed an online self-administered questionnaire to assess emotional and professional impacts and the traumatic impact of patient suicide using the Impact of Event Scale-Revised (IES-R). RESULTS: 178 psychiatrists were enrolled in this study. The prevalence rate of patient suicide among participants was 38.8%, and they experienced adverse emotional reactions. Additionally, among those who were not exposed to patient suicide, 12.9% reported exposure to serious suicide attempts, and almost all of them experienced related negative emotions. The most frequently reported emotions were sadness (61.95%), shock (48.91%), and guilt (25%), and these emotions lasted longer in completed patient suicide cases than attempted suicide. Nearly 84% of participants who experienced suicide reported its impact on their profession. The most reported professional impacts were increased focus on suicide cues, attention to legal aspects, and a tendency to hospitalize. Of participants who experienced suicide, 75.4% reported that the overall impact of suicidal events on their professional practice had improved. Of the total number of respondents who experienced either suicide or serious suicidal attempts, 10.9% reported symptoms of PTSD. CONCLUSIONS: The study highlighted the emotional and professional burden that psychiatrists and psychiatry trainees experience due to patient's completed suicides and serious suicidal attempts. Additionally, it emphasized the need for further research to study the benefits of implementing preparatory and training programs to help trainees and psychiatrists in such instances.

Determinants of quality of life of cancer patients at a tertiary care medical city in Riyadh, Saudi Arabia.

Background: Incidences of cancer are increasing at an unprecedented rate in Saudi Arabia, making it a major public health concern. Cancer patients are faced with physical, psychological, social, and economic challenges, all of which can impact quality of life (QoL). Objectives: This study aims to explore the sociodemographic, psychological, clinical, cultural, and personal factors that could affect the overall QoL of cancer patients. Methods: A total of 276 cancer patients who attended the King Saud University Medical City's oncology outpatient clinics between January 2018 to December 2019 were included. QoL was assessed with the Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Psychosocial factors were assessed with several validated scales. Results: QoL was poorer among patients who were female (p = 0.001), have visited a psychiatrist (p = 0.028); were taking psychiatric medications (p = 0.022); and had experienced anxiety (p < 0.001), depression (p < 0.001), and distress (p < 0.001). The most used method to self-treat was Islamic Ruqya (spiritual healing; 48.6%), and the most often perceived cause for developing cancer was evil eye or magic (28.6%). Good QoL outcomes were associated with biological treatment (p = 0.034) and satisfaction with health care (p = 0.001). A regression analysis showed that female sex, depression, and dissatisfaction with health care were independently associated with poor QoL. Conclusions: This study demonstrates that several factors could influence cancer patients' QoL. For instance, female sex, depression, and dissatisfaction with health care were all predictors of poor QoL. Our findings support the need for more programs and interventions to improve the social services for cancer patients, along with the need to explore the social difficulties oncology patients face and address such obstacles through improving social services by expanding the scope of social workers' contribution. Larger multicenter longitudinal studies are warranted to examine the generalizability of the results.

Does professionalism change with different sociodemographic variables? A survey of Arab medical residents.

BACKGROUND: Medical professionalism reflects the commitment of physicians to their patients, society, themselves, and the profession. The study examined residents' attitudes towards professionalism and how these attitudes vary among the different demographic groups, namely gender, specialty, and year of residency. METHODS: A proportionate random sampling strategy was used to select the study sample. Medical residents from six specialties at a large tertiary care teaching facility were invited to participate in an online survey. The survey used the modified Learners Attitude of Medical Professionalism Scale (LAMPS), which consists of five domains: respect, excellence, altruism, duty/accountability, and integrity. Chi-square, Student t-test, one-way ANOVA, factorial ANOVA, and post hoc analysis were used to examine the attitudinal differences towards professionalism among the different demographic factors. RESULTS: The overall response rate was 82.7%. Overall, the residents' self-reported attitudes towards professionalism was positive. The highest score was for the "respect" domain (4.61), and the lowest was for "altruism" (3.67). No significant association was found between the mean scores and the three studied variables, namely, gender, specialty (surgical/nonsurgical), and level (senior/junior). CONCLUSIONS: No significant differences were observed in the overall attitude towards professionalism among the residents regarding their year of residency, gender, and specialty. The low altruism score and absence of improvement of the total score regarding the residents' increasing experience in the profession are concerns that need remedial action. Therefore, we suggest that future research look for possible explanations by using multi-institutional surveys that explore not only the residents' attitudes, but also the trainers' attitudes and practice, work situations, the hidden curriculum, and culture. Key messagesAttitudes towards professionalism among different demographic groups of residents do not show similar variations as has been reported in the literature, albeit in different sociocultural contexts.The low altruism score and absence of improvement of the total score as the residents gained more experience in the profession are concerns that need remedial action.A longitudinal study involving more than one institution for both residents and their faculty members to compare faculty scores with those of residents, while controlling for specialty and gender, may help elucidate the factors affecting attitudes towards professionalism and suggest possible means of addressing unfavourable attitudes.

Psychosocial and clinical predictors of patient satisfaction with cancer care.

Purpose: Patient satisfaction with healthcare was recognized as an indispensable component of healthcare quality assurance programs for decades. Limited research has explored psychosocial variables impacting patient satisfaction with cancer care. The objective of our study was to identify the level of patient satisfaction with cancer care in Riyadh, Saudi Arabia and determine the psychosocial and clinical predictors of patient satisfaction. Methods: A cross-sectional observational study was carried out in 2018-2019 with patients with cancer at the Outpatient Oncology Clinic at King Saud University Medical City in Riyadh, Saudi Arabia. The questionnaire contained a visual analog scale (VAS) of satisfaction with cancer care, a VAS of satisfaction with social support, the Patient Health Questionnaire-9 Depression scale, and the Generalized Anxiety Disorder 7-item scale. Results: Out of the 400 patients approached, 280 agreed to participate in the study. Of the 280 patients participating in the study, 65% were satisfied with cancer care. Higher satisfaction was associated with being non-Saudi, being employed, having fewer household residents (≤4), being satisfied with social support, not receiving radiotherapy, and receiving hormonal or biological therapy. Having anxiety or depression was also associated with lower satisfaction. After adjustment for sociodemographic and clinical characteristics, being satisfied with social support, having ≤ 4 household residents, receiving hormonal therapy, and receiving biological therapy rather than radiotherapy were all independent predictors of higher satisfaction with cancer care. Conclusion: This study found an inadequate level of patient satisfaction with cancer care. Higher levels of satisfaction were associated with being satisfied with social support, using biological and hormonal therapy, while lower satisfaction was associated with a larger number of household residents (>4), depression, anxiety and using radiotherapy.

Prevalence and biopsychosocial factors associated with treatment adherence among people with epilepsy in a tertiary care hospital in Riyadh, Saudi Arabia.

OBJECTIVES: To identify the magnitude of treatment adherence among people with epilepsy (PWE) and the impact of sociodemographic, medical and psychosocial factors on treatment adherence. METHODS: A quantitative cross-sectional observational study was performed based on data collected from adult patients attending the epilepsy clinic, King Saud University Medical City, Riyadh, Saudi Arabia. Patients completed paper-based questionnaires including a sociodemographic, cultural, psychiatric history and medical history sections. In addition to that we evaluated treatment adherence by visual-analogue scale (VAS), depressive symptoms by PHQ-9, anxiety symptoms by GAD7, physical symptoms by PHQ-15, attachment style by ECR16 and cognitive impairment by MOCA. RESULTS: A total of 207 patients participated, with a mean age of 34 years;.53.6% were female. The mean patient-reported adherence to their treatment regimen was 81.6%±18.4%. Univariate analysis revealed statistically significant negative associations between depression, anxiety and physical symptoms and treatment adherence. However, multiple linear regression analysis only showed physical symptoms to be a significant predictor for epilepsy medication adherence. CONCLUSION: Somatic (physical) complaints could be important predictors of treatment adherence in (PWE). This study is one of the first to suggest the importance of targeting physical symptoms in screening and intervention approaches to improve Antiepileptic drugs (AEDs) adherence.

Androgen deprivation therapy and depression in the prostate cancer patients: review of risk and pharmacological management.

Purpose: Despite the effectiveness of androgen deprivation therapy in advanced prostate cancer, serious neuropsychiatric consequences in androgen deprivation therapy (ADT)-treated patients, mainly depression, have been concerning and gained more attention recently. This narrative review aims to shed light on the risk and pharmacological management of ADT-induced depression in PCa patients.Methods: We searched PubMed, Scopus and Google Scholar databases using MESH keywords "Prostate cancer OR prostate neoplasm" AND "Depression" AND "Androgen Deprivation Therapy" AND "antidepressants". Search was limited to English and studies conducted on humans. Studies' titles and abstracts were screened, and further information were obtained from the text, if necessary, to decide whether studies are to be included in this review.Results: Our review revealed 23 studies confirming the occurrence and worsening of depressive symptoms in ADT-treated patients, which frequently require pharmacological interventions; whereas 10 studies indicated otherwise. All studies were prospective, retrospective, cross-sectional or case reports. Based on the incidence of depression provided by the observational studies, the average among ADT-treated patients was 18.23% (range: 2.1-46.9%), while it was 8.42% (range: 1.4-23.3%) in the non-ADT patients. Although several treatments have been used for depression in cancer patients, current knowledge lacks observational and controlled studies as well as clinical guidelines that demonstrate efficacy and safety of antidepressants and guide clinicians to the appropriate treatment in these patients, respectively. On the other side, a few clinical studies have been published regarding the efficacy of selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors and/or saftey on other ADT associated adverse effects.Conclusions: Our work supports the recent attention towards mood issues as an adverse effect of ADT, and that greater awareness of this is warranted among clinicians. Clinical studies published regarding the use of antidepressants for other ADT associated adverse effects established the foundation that can be adopted to examine these therapies on ADT-induced depression.

Anxiety and depression symptoms among medical residents in KSA during the COVID-19 pandemic.

OBJECTIVES: Medical residents' direct contact with patients with COVID-19 places them at high risk of psychological disturbance. This study aimed to estimate the prevalence of depression and anxiety symptoms, and their relationship with the COVID-19 pandemic among medical residents in KSA. METHODS: A cross-sectional study was conducted between January and March of 2021. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) were used to screen for depressive disorders and generalized anxiety disorder, respectively. RESULTS: A total of 533 medical residents participated in the study; 52% were men, and 58% were single. Most residents had direct contact with one or more patients with COVID-19. The prevalence of depression and anxiety symptoms was 65.8% and 58.3%, respectively. The study revealed that gender was a risk factor for diagnosis with COVID-19 among residents: male residents were diagnosed with COVID-19 to a greater extent than female residents. In addition, being a nonsmoker rather than a smoker was associated with a higher risk of COVID-19 diagnosis. A multivariate regression analysis revealed that gender (female) and residency level (R5) were independently associated with anxiety symptoms. Similarly, the independent correlates of depression symptoms were gender (female) and specialty (family medicine). CONCLUSION: A high prevalence of depression and anxiety symptoms was found among medical residents trained in KSA. The rates were significantly higher among female than male residents.

Prevalence and determinants of distress among oncology patients at a tertiary care medical city in Riyadh, Saudi Arabia.

OBJECTIVES: To estimate the prevalence of distress in patients with cancer in Saudi Arabia and to identify common psychosocial stressors in these patients. We also looked for associations between distress and psychological, sociodemographic, and medical factors. METHODS: This cross-sectional study was performed in the oncology outpatient clinic at King Saud University Medical City, Riyadh, Saudi Arabia, from January 2018 to December 2019. It included 280 patients with breast cancer, colorectal cancer, or lymphoma. Sociodemographic information was collected using questionnaire, along with information on medical history and any psychiatric history. Distress was assessed using the Distress Thermometer and Problem List. Satisfaction with social support was rated using the visual analog scale. All patients were screened for depression using the Patient Health Questionnaire 9-item depression scale and anxiety using the Generalized Anxiety Disorder 7-item scale. RESULTS: The prevalence of distress in our study population was found to be 46%. Distress was associated with several practical, family, emotional, and physical stressors in the problem list. Logistic regression identified predictors of distress to be anxiety (odds ratio [OR] 8.7, confidence interval [CI] 1.98-38.24, p=0.002) and receiving radiotherapy (OR 3.6, CI 1.33-9.99, p=0.009), while Saudi nationality (OR 0.22, CI 0.05-0.95, p=0.037) and stage I cancer (OR 0.18, CI 0.05-1.40, p=0.002) were associated with low distress. CONCLUSION: Approximately half of cancer patients were found to have distress. Anxiety, advanced cancer stage, and radiotherapy were independently associated with distress.

Translation, cultural adaptation, and evaluation of the psychometric properties of an Arabic diabetes distress scale: A cross sectional study from Saudi Arabia.

OBJECTIVES: To translate, validate, and adapt the diabetes distress scale (DDS)-17 to a Saudi Arabian (SA) DDS (SADDS-17). Also, to evaluate the psychometric properties of the newly adapted SADDS-17. METHODS: This was a cross-sectional study evaluating the psychometric properties of the DDS. The DDS was translated using the forward-backward translation from English to Arabic at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia, in January 2016. Statistical analyses included exploratory factor analysis, internal consistency, testretest reliability, and construct validity. Moreover, contingent validity was evaluated using hospital anxiety and depression scale, visual analogue scale, and the World Health Organization quality of life assessment instrument. RESULTS: A total of 109 participants were included in this study. The exploratory factor analysis of our Arabic scale supported the original DDS with 4 sub-scales. Correlations ranged from 0.376 to 0.718 for items in regimen-related distress, 0.327 to 0.533 for items in emotional burden, 0.413 to 0.722 for items in physician-related distress, and 0.492 to 0.556 for items in interpersonal distress. The Cronbach's alpha value of the SADDS was 0.848 for the total scale. The test-retest reliability value was 0.78. CONCLUSION: Our SADDS is a valid and reliable instrument for detecting diabetes distress among Saudi Arabian patients with type 2 diabetes.

Assessing the Prevalence of Diabetes Distress and Determining Its Psychosocial Predictors Among Saudi Adults With Type 2 Diabetes: A Cross-Sectional Study.

In recent years, the global burden of diabetes distress has increased significantly worldwide, imposing mental health issues on patients and the healthcare system. Hence, this study aimed to estimate the prevalence of diabetes distress and determine its psychosocial predictors among Saudi adults with type 2 diabetes mellitus (T2DM). This cross-sectional, observational study was conducted at Diabetes Clinics, Tertiary Care Academic Medical Center, King Saud University Medical City, Riyadh, Saudi Arabia. The survey questionnaire was distributed to 423 participants. The sample size was 384, where the prevalence of diabetes distress was 48.5%. Based on 5% precision and a confidence interval of 95%, the response rate was 78.25% (334 respondents), among which 61.4% of respondents were females, the remaining 38.6% were males, and the mean age was 56.39 years. The mean scores for the Saudi Arabian Diabetes Distress Scale-17 (SADDS-17) subdomains including emotional burden, physician-related distress, regimen-related distress, and interpersonal distress were 2.63 ± 1.29, 2.31 ± 1.44, 2.48 ± 1.16, and 2.23 ± 1.24, respectively. Based on the World Health Organization Quality of Life Assessment Instrument, Short Version (WHOQOL-BREF) transformed scores, the quality of life was recorded as 62.7%. There was a statistically significant positive correlation between the Hospital Anxiety and Depression Scale (HADS) score (r = 0.287, p < 0.01) and the total SADDS-17 scores. The Patient Health Questionaire (PHQ) 15 scores showed significant positive correlations with the total SADDS-17 scores (r = 0.288, p < 0.01) and each of the four subdomains. Our present study revealed that diabetes distress prevalence is alarmingly high among patients in Saudi Arabia, Riyadh. Our findings provide evidence that physical symptoms, quality of life, depression, and anxiety are the notable predictors of diabetes distress.

People with diabetes need a lower cut-off than others for depression screening with PHQ-9.

AIMS: This study evaluated the psychometric characteristics of the Polish version of the PHQ-9 in detecting major depression (MDD) and 'MDD and/or dysthymia' in people with and without type 2 diabetes. METHODS: Participants were randomly selected from a diabetes outpatient facility (N = 216) and from among patients admitted to a medical center and psychiatric hospital (N = 99). The participants completed the PHQ-9. The Hamilton Depression Rating Scale and the Mini International Neuropsychiatric Interview were used to identify the presence of psychiatric symptoms. The optimal cut-offs for PHQ-9 in people with and without type 2 diabetes were investigated based on two methods: 1) Youden's index which identifies cut-off points useful in scientific research; 2) a second method of two-stage screening for depressive disorders to provide guidance for clinical practice. RESULTS: The Polish version of the PHQ-9 is a reliable and valid screening tool for depression in people with and without type 2 diabetes. An optimal cut-off of ≥ 7 was indicated by Youden's index and ≥ 5 by the two-stage method for screening for MDD and 'MDD and/or dysthymia' in the group with type 2 diabetes. A cut-off of ≥ 11 was optimal for screening for both MDD and 'MDD and/or dysthymia' among people without diabetes (Youden's index). The two-stage approach suggested a ≥ 10 score for screening for MDD and ≥ 9 for screening for 'MDD and/or dysthymia' in people without diabetes. CONCLUSIONS: A lower cut-off score of the PHQ-9 is recommended for people with type 2 diabetes as compared to the general population.

Psychosocial predictors of quality of life among chronic hemodialysis patients.

OBJECTIVES: To examine the association of several psychosocial disorders with quality of life (QoL) among chronic hemodialysis patients. METHODS: A cross-sectional observational study was conducted in 2018 and recruited chronic hemodialysis patients from 3 major hemodialysis centers in Riyadh, Kingdom of Saudi Arabia (KSA). Quality of life was assessed using a previously validated Arabic version of the dialysis version-III of the QoL index. RESULTS: A total of 101 patients (56 males and 45 females) were included. The mean age was 54.0±12.3 years. The overall mean of QoL was 88.8/100 points (out of 100). The family (95.0%) and psychological/spiritual (94.7%) domains had the highest scores. The prevalence of psychosocial disorders was 24.8% for depressive symptoms, 15.8% for anxiety symptoms, 88.1% for cognitive impairment, 76.8% for insecure attachment style, and 38.6% for medium/high severity of somatic symptoms. All psychosocial disorders and higher cognition level were negatively correlated with QoL (Spearman correlation r ranged between -0.228- -0.468). After adjusting for sociodemographic and clinical characteristics, anxiety symptoms and higher cognition level were independent predictors of poor QoL, while marital status (married) was an independent predictor of good QoL. CONCLUSION: We report higher QoL and relatively better psychosocial profiles among current chronic hemodialysis patients than reported before. Psychosocial disorders specially anxiety can negatively impact QoL. Patients who were not cognitively impaired were more negatively affected in QOL. The findings re-emphasize the importance of the early detection and management of psychosocial disorders to improve QoL in chronic hemodialysis patients.

Comorbid psychiatric disorders among patients with narcolepsy.

PURPOSE: This case-control study assessed the prevalence of psychiatric disorders in Arab (Saudi) patients with narcolepsy using a structured clinical interview. METHODS: The study included 74 adult patients with narcolepsy and 265 controls matched for age and sex. Narcolepsy diagnosis was made according to the International Classification of Sleep Disorders-Third Edition. Psychiatric disorders were diagnosed via using a validated Arabic version of the Mini International Neuropsychiatric Interview DSM-IV (MINI version 6). A multivariate logistic regression model was used to assess the potential influence of narcolepsy on the comorbidity of psychiatric disorders. RESULTS: The mean age of the patients was 29.4 ± 10.2 years, and males accounted for 81% of the study sample. Forty-four patients (60%) were diagnosed with narcolepsy type-1 (NT1) and 30 (40%) with narcolepsy type-2 (NT2). Psychiatric disorders were diagnosed in 45% of patients with narcolepsy compared with 15% of the controls (p < 0.001). The multivariate logistic regression models demonstrated that compared with the controls, patients with narcolepsy were more likely to have major depressive disorders (OR, 4.3 [CI, 2.2-8.2]), and generalized anxiety disorders (OR, 9.5 [CI, 1.8-50.2]). No difference was detected between the prevalence of various psychiatric disorders in patients with NT1 and NT2. CONCLUSION: Comorbid psychiatric disorders are common among Arab (Saudi) patients with narcolepsy compared with the general population. Therefore, clinicians should be aware of the comorbidity of narcolepsy and psychiatric disorders, particularly depression.

Associations of foot ulceration with quality of life and psychosocial determinants among patients with diabetes; a case-control study.

BACKGROUND: Patients with diabetic foot ulcers may have a lower quality of life. The objective was to compare the quality of life and its psychosocial determinants among patients with and without diabetic foot ulcers. METHODS: A case-control study was conducted in 2017 among patients with (cases) and without (controls) diabetic foot ulcers. The study tools included the World Health Organization's Quality of Life scale (WHOQOL-BREF), the Hospital Anxiety and Depression (HAD) scale for anxiety and depression, the Patient Health Questionnaire Physical Symptoms (PHQ-15) for the severity of somatic symptoms, and the Summary of Diabetes Self-Care Activities (SDSCA) measure for self-management. RESULTS: A total of 209 patients (45 cases and 164 controls) were included. The average age was 56.2 ± 11.7 years, and 55.5% were female. The average scores of WHOQOL-BREF, PHQ-15, and SDSCA were 74.4% ± 12.1% and 8.1 ± 6.1, and 30.4 ± 21.8, respectively. The prevalence of anxiety and depression were 19.6 and 24.9%, respectively. SDSCA was the only psychosocial determinants higher in cases than controls (mean difference = 15.0, 95% CI = -8.0-22.0). The correlation coefficients of WHOQOL-BREF scores with anxiety, depression, and PHQ-15 scores in all patients were - 0.559 (p < 0.001), - 0.582 (p < 0.001), and - 0.532 (p < 0.001), respectively, with similar numbers in both groups. In multivariate analysis, only the association between quality of life and depression was maintained. CONCLUSION: Quality of life and psychosocial determinants with the exception of self-management were not associated with diabetic foot ulcers. Depressive symptoms were independent determinant of poor quality of life, irrespective of the status of diabetic foot ulcers.