Treatment Adherence and Related Factors Among Children with Attention-Deficit/Hyperactivity Disorder in Saudi Arabia.

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. It frequently persists into adulthood and is a risk factor for other mental disorders and adverse outcomes, mainly if not managed optimally. This study aimed to assess ADHD treatment adherence and explore the underlying causes of non-adherence in ADHD children in Saudi Arabia. Methods: A cross-sectional study of a convenience sample of 221 participants. The survey included demographic characteristics of the child and parents, the child's medical history, quality of services evaluation, as well as medication adherence assessment by Medication Adherence Report Scale (MARS), the general beliefs about medicines questionnaire (General-BMQ), in addition to assessing the parents' beliefs about ADHD and provided/recommended treatment. Results: The sample was primarily 6 to 8-year-old children (32.81%) and males (78.52%). Most subjects were prescribed extended-release agents (45.7%), and overall, high-quality services were provided to the patients. The adherence rate of ADHD patients to their medication was 89.77%. The mother's education correlated significantly with patient adherence (p=0.029), and the mother's age correlated significantly with their beliefs (p=0.021), in addition to the family income (0.033). Children on Methylphenidate Immediate Release had good compliance with the medication (p=0.008). Moreover, Methylphenidate Extended Release has shown continuity results, increasing the adherence rates (p=0.035). Conclusion: ADHD medication adherence was high and associated with older age, educational status, and type of medication used. Physicians should consider these factors to improve adherence in their patients.

Validity and reliability of the Arabic version of the population postpartum depression literacy scale (PoDLiS): a web-based survey in Saudi Arabia.

BACKGROUND: Proper knowledge about postpartum depression (PPD) will help recognize symptoms and encourage women to seek the needed professional help. Until now, there has been a scarcity of research on the literacy level of PPD among the Saudi population and the factors affecting it. This study translated the Postpartum Depression Literacy Scale (PoDLiS) into Arabic and evaluated its psychometric properties. Furthermore, the Saudi population's mental health literacy for PPD and the factors associated with it were examined as a secondary objective. METHODS: This cross-sectional study involved 2,336 participants selected via convenience sampling from all over Saudi Arabia, all of whom willingly agreed to participate. Data collection was done through an online questionnaire using Google Forms, covering sociodemographic characteristics and the Arabic PoDLiS. RESULTS: The Arabic version of PoDLiS showed acceptable goodness-of-fit between the observed data and the resulting six-factor solution, RMSEA = 0.049, 90% confidence interval RMSEA (0.010-0.050), pCLOSE = 0.742, CFI = 0.962, TLI = 0.940, χ2(270) = 1576.12, p-value = 0.742. The total Cronbach's alpha (α) of the PoDLiS showed acceptable internal consistency, measuring at 0.742. High literacy was seen in married and young participants with a postgraduate degree and sufficient household income who have known someone with PPD. Significantly lower literacy was seen in male, non-Saudi participants and those residing in the central and northern regions of Saudi Arabia. CONCLUSIONS: The Arabic version of the PoDLiS showed good psychometric properties, and it can be used to assess PPD literacy among perinatal women and to examine the impact of PPD awareness programs. Despite reporting relatively good PPD literacy in the Saudi population, there is a persistent gap in participants' beliefs about available professional help and the attitudes that facilitate recognizing PPD. Our findings highlight the importance of implementing public education campaigns to improve overall knowledge about PPD and promote prevention, early recognition, and treatment of PPD.

The Arab COVID-19 Anxiety Syndrome Scale (C-19ASS): COVID-19 anxiety syndrome and psychological symptoms in the Saudi Arabian population.

INTRODUCTION: The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a validation of the Arabic version of the C-19ASS and to explore the association between the C-19ASS and psychological symptoms syndrome. METHOD: In Study 1, a community sample of 404 participants completed the Arabic version of the C-19ASS and results were subjected to an exploratory factor analysis. In Study 2, a community sample of 903 participants completed the Arabic version of the C-19ASS and a series of measures assessing depressed mood and anhedonia, generalized anxiety and health anxiety. Internal consistency, construct validity and incremental validity were assessed. Associations between C-19ASS and psychological symptoms were assessed. RESULTS: Factor analysis identified a two-factor solution (i.e., C-19ASS-Perseveration and C-19ASS-Avoidance), and confirmatory factor analysis suggested a two-factor model best fits the data. The Arabic version of the C-19ASS showed good internal consistency, good construct and incremental validity. COVID-19 anxiety syndrome was associated with more severe anxiety symptoms, depressive symptoms and health anxiety. Females had higher levels of COVID-19 anxiety syndrome than males. Participants diagnosed with COVID-19, and those who had experienced loss as a consequence of COVID-19, had higher levels of COVID-19 anxiety syndrome (Perseveration). CONCLUSIONS: The Arabic version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to improve psychological recovery during the COVID-19 pandemic among Arabs.

Dysmenorrhea and depressive symptoms among female university students: a descriptive study from Saudi Arabia.

Background: Dysmenorrhea has significantly increased in prevalence. There is also evidence of the coexistence of dysmenorrhea and psychological disorders. This study aims to explore the prevalence of dysmenorrhea and investigate its correlation with depressive symptoms among Princess Nourah bint Abdulrahman University (PNU) students. All participants (N = 487) in this cross-sectional study provided sociodemographic data, menstrual and medical history, and completed the Patient Health Questionnaire (PHQ-9) scale and (working ability, location, intensity, days of pain, dysmenorrhea [WaLIDD]) scale on a self-administered online questionnaire. Results: The mean age of the females was 20.64 ± 2.38 years, and 40.7% were from health colleges. Severe dysmenorrhea requiring medical attention and pain killers or herbs was reported by 30.8% of the students. Significant predictors of severe dysmenorrhea were: younger age, earlier menarche, pain killers and herbs used for menstrual pain, a doctor visit for menstrual pain, and depression. In addition, significant protective factors of depression were: later menarche age, having a regular menstrual cycle, and longer duration. Conclusions: Students with severe dysmenorrhea have a higher risk of depression than other students. The findings stress the importance of awareness, education, a multidisciplinary approach to women's health, and early detection to prevent future complications.

Loneliness and Depression Among Female University Students During the COVID-19 Pandemic: A Cross-Sectional Study in Riyadh, Saudi Arabia, 2020.

Objectives: Quarantine-related loneliness has impacted university students during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to evaluate loneliness among female university students in Riyadh, Saudi Arabia during the pandemic and to investigate its correlation with depression. Methods: A sample of 753 female students was collected during the first COVID-19 summer vacation outbreak through a cross-sectional survey that consisted of two parts: 1) Sociodemographic characteristics and COVID-19 related questions; 2) The eight-item UCLA Loneliness Scale (ULS-8) and the Patient Health Questionnaire-9 (PHQ-9). Results: Most participants were between 18 and 22 years old (75.2%) and were studying at humanities college (61.50%). Loneliness and depression were reported among 63.3% and 41.1% of female students, respectively, and the correlation between them was significantly positive (beta = 0.419, p < 0.001). Having a previous history of a psychiatric condition and families with insufficient monthly income were the main associated factors with high levels of loneliness and depression. Conclusion: Female university students experienced loneliness and depression under quarantine during the first COVID-19 summer vacation outbreak. Psychosocial intervention for the vulnerable groups is essential, as are longitudinal studies.

The use of dietary supplements for mental health among the Saudi population: A cross-sectional survey.

Introduction: Despite limited evidence about the efficacy and safety of dietary supplements (DSs) for improving mental health, people with or without mental disorders often tend to use them, especially during the ongoing COVID-19 pandemic. Previous studies focused on DS use for maintaining or improving overall health; Therefore, this study aimed to assess the prevalence of DSs for mental health among the SA population and to determine the factors that affect their use. Methods: This cross-sectional study was based on an online survey of Saudi Arabian participants between July and August 2021 with an anonymous, self-completed questionnaire distributed using convenience sampling. The questionnaire included queries related to demographic information, DS use assessment, and mental health evaluation using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7), questionnaire, and the Insomnia Severity Index (ISI). Results: In total, 443 participants from various regions of Saudi Arabia completed the questionnaire. The prevalence of DS use in the Saudi population was 44%. Vitamin D (28%) and melatonin (20%) were the most commonly reported DSs used for mental health. The odds of DS use were three times higher in responders with previous mental health diagnoses (OR: 2.972; 95% CI: 1.602-5.515). Furthermore, the chances of using DSs almost doubled in patients with sub-threshold and moderate to severe insomnia (OR: 1.930; 95% CI: 1.191-3.126 and OR: 2.485; 95% CI: 1.247-4.954, respectively). Conclusion: Responders diagnosed by a specialist with psychiatric disorders or current insomnia had a higher chance of using DSs. Thus, healthcare providers must provide evidence-based information regarding DSs for mental health improvement and encourage the public to consult healthcare professionals before self-medicating for mental health problems.

The impact of the coronavirus (COVID-19) pandemic on the development of obsessive-compulsive symptoms in Saudi Arabia.

OBJECTIVES: To explore the impact of the COVID-19 pandemic on the development of obsessive-compulsive disorder (OCD) symptoms and its correlation with the level of perceived stress among the Saudi population. METHODS: In July 2020, a cross-sectional survey of 2909 participants in Saudi Arabia during the outbreak was conducted to collect data related to sociodemographic characteristics and scores on the Brief Obsessive-Compulsive Scale (BOCS) and Perceived Stress Scale (PSS). RESULTS: Most participants were female (73.9%) with a university level of education or higher (81%). The prevalence of new-onset obsessions was 57.8%, compulsions 45.9%, and moderate/high perceived stress 72.4%. New-onset dirt, germs, and virus obsessions were significantly higher among 40-49 age group, employees, housewives, students, quarantine discipliners, and those who spent 20 or more days in quarantine. New-onset hand-washing compulsions were significantly higher among the 30-49 age group. A significantly higher level of perceived stress was reported among those in the 18-29 age group, females, singles, participants with no children, students, non-smokers, those who were unemployed, living with families, diagnosed with a psychiatric disorder, living in the northern region, quarantine discipliners, and those who spent 60 or more days in quarantine. CONCLUSION: This study revealed a significantly higher prevalence of high perceived stress in respondents with new-onset OCD contamination symptoms during the COVID-19 pandemic. This implies that a biodisaster is associated with high psychological morbidity.

Mental health among healthcare providers during coronavirus disease (COVID-19) outbreak in Saudi Arabia.

BACKGROUND: The novel coronavirus (COVID-19) was recently declared a pandemic by the World Health Organization (WHO). The first confirmed case in Saudi Arabia was announced on March 2, 2020. Several psychiatric manifestations may appear during pandemics, especially among frontline healthcare providers. OBJECTIVES: This study sought to explore depression and anxiety levels among healthcare providers during the COVID-19 outbreak in Saudi Arabia. METHODS: This was a cross-sectional study of a convenience sample of 502 healthcare providers in the Ministry of Health. Depression and anxiety were assessed via the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires, respectively. RESULTS: The respondents represented various healthcare occupations: administrators (28.49%), nurses (26.29%), physicians (22.11%), non-physician specialists (13.94%), technicians (6.77%), and pharmacists (2.30%). The majority of them were male (68.1%). More than half of them had depressive disorder (55.2%), which ranged from mild (24.9%), moderate (14.5%), and moderately severe (10%) to severe (5.8%). Half of the sample had generalized anxiety disorder (51.4%), which ranged from mild (25.1%) and moderate (11%) to severe (15.3%). Multivariate analysis showed that males were significantly less predicted to have anxiety (Beta=-0.22, P-value <0.04), 30-39 years age group were significantly more predicted to have depression and anxiety group (Beta=0.204, P-value <0.001 and beta=0.521, P-value <0.003 respectively), and nurses had significantly higher mean score of anxiety (Beta=0.445, P-value <0.026). CONCLUSIONS: This study revealed that depression and anxiety are prevailing conditions among healthcare providers. Although efforts were accelerated to support their psychological well-being, more attention should be paid to the mental health of female, 30-39 age group and nursing staff. Promoting healthcare service as a humanitarian and national duty may contribute to making it a more meaningful experience in addition to advocating for solidarity, altruism, and social inclusion. Longitudinal research studies need to be conducted to follow up on healthcare providers' mental health symptoms and develop evidence-based interventions.

Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA.

OBJECTIVES: COVID-19 is a newly discovered infectious Coronavirus that became pandemic. Since disease outbreaks can have mental health consequences, this study explored the perceived stress level among students during the Coronavirus Disease Outbreak and suspension of in-person teaching in Saudi Arabia. METHODS: A cross-sectional survey of a sample consisting of 367 students living in Saudi Arabia assessed socio-demographic characteristics, Perceived Stress Scale (PSS) and their emotions and concerns during the outbreak. RESULTS: Most participants were female (74.7%) and secondary school (79.8%) students. More than half of the participants showed moderate levels of stress (55%), while 30.2% registered high levels. Females and university students showed a significant association with stress level (p-value = 0.003 and 0.049, respectively). CONCLUSIONS: There was a moderate to high level of stress among students in KSA at the start of the COVID-19 outbreak. This study found a significant correlation between a high level of stress and female university students. The integration of online counselling and stress management programs would help mitigate the stress of students during distance learning.

Public Awareness, Beliefs, And Attitudes Toward Bipolar Disorder In Saudi Arabia.

OBJECTIVES: To examine public's knowledge, beliefs, and attitudes toward bipolar disorder (BP) in Saudi Arabia (SA). METHODS: A cross-sectional survey was performed in 2016 in Riyadh, SA. The survey included sociodemographic characteristics and BP awareness scale. RESULTS: Of 416 participants, 49.5% had prior knowledge of BP, mainly from internet and social media, and 57% considered it to be common in SA. About half believed BP is caused by a neurophysiological or neurochemical imbalance and that it can be treated with psychiatric medications. Supernatural causes, weak faith, and weakness of character were considered causes of BP by 55%, 48%, and 40% of participants, respectively. Recreational activities and head bandaging by traditional therapists were considered viable treatment options by 55% and 41% of participants, respectively. Students and healthcare professionals scored significantly higher on awareness scale. Regarding attitude, a majority believed that persons with BP can work effectively (86%) , have to pull themselves together to get over it (47%), and consider it a shame to mention that someone in a family is affected by BP (32%). Regarding relationships, 22% were not willing to maintain a friendship and 39.3% were not willing to marry someone with BP. CONCLUSIONS: This study revealed suboptimal public awareness towards BP in SA. It identified several misconceptions and negative attitudes toward patients with BP. Further studies are needed to investigate potential public interventions to improve literacy of BP.

The experience and impact of stigma in Saudi people with a mood disorder.

BACKGROUND: Stigma plays a powerful role in an individual's attitude towards mental illness and in their seeking psychiatric and psychological services. Assessing stigma from the perspective of people with mood disorders is important as these disorders have been ranked as major causes of disability. OBJECTIVES: To determine the extent and impact of stigma experiences in Saudi patients with depression and bipolar disorder, and to examine stigma experiences across cultures. METHOD: Ninety-three individuals with a mood disorder were interviewed at King Saud University Medical City using the Inventory of Stigmatizing Experiences (ISE). RESULTS: We detected no significant differences in experiences of stigma or stigma impact in patients with bipolar vs. depressive disorder. However, over 50% of respondents reported trying to hide their mental illness from others to avoiding situations that might cause them to feel stigmatized. In comparison with a Canadian population, the Saudi participants in this study scored significantly lower on the ISE, which might be due to cultural differences. CONCLUSION: More than half of the Saudi participants with a mood disorder reported avoiding situations that might be potentially stigmatizing. There are higher levels of stigma in Canada and Korea than in Saudi Arabia. Our results suggest that cultural differences and family involvement in patient care can significantly impact self-stigmatization. The ISE is a highly reliable instrument across cultures.

An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample.

BACKGROUND: Psychological disorders including depression and anxiety are not rare in primary care clinics. The Patient Health Questionnaire (PHQ) is a clinical diagnostic tool that is widely utilized by primary health care physicians worldwide because it provides a practical in-clinic tool to screen for psychological disorders. This study evaluated the validity of the Arabic version of the PHQ in all six modules including depression, anxiety, somatic, panic, eating, and alcohol abuse disorders. METHODS: This is a quantitative observational cross-sectional study that was conducted by administrating the translated Arabic version of PHQ to a sample of King Saud University students in Riyadh, Saudi Arabia. RESULTS: The sample was 731 university students who participated in this study including 376 (51.6%) females and 354 (48.4%) males with a mean age of 21.30 years. Eight mental health experts carried out the face validation process of the PHQ Arabic version. The internal consistency reliability was measured using Cronbach's alpha for the PHQ9, GAD7, PHQ15, and panic disorder modules. The results were 0.857, 0.763, 0.826, and 0.696, respectively. In comparison, the eating disorders and alcohol abuse modules demonstrated poor internal consistency due to small number of participants in these modules. CONCLUSION: This study demonstrates that the Arabic version of the PHQ is a valid and reliable tool to screen for depression, anxiety, somatic, and panic disorders in a Saudi sample.

Childhood and adolescent obesity: Primary Health Care Physicians' perspectives from Riyadh, Saudi Arabia.

BACKGROUND & OBJECTIVES: Primary health care (PHC) physicians are foremost to confront childhood and adolescent obesity. Our objective was to evaluate PHC Physicians perspectives for managing overweight/obesity in children and adolescents. METHODS: PHC services from eight public hospitals in Riyadh participated. A self-administered tool maintaining anonymity evaluated facilitators and barriers for managing overweight/obese children and adolescent patients. Physicians who 'always' recommended weight management for an overweight / obese patient during past year, by involving patient, parents, and others were classified as having positive and appropriate practice. RESULTS: Of the 58 respondents, 51.7% had appropriate practices. Lack of patient motivation (82.2%), and parental involvement (70.7%) were the major barriers. Physicians with appropriate practices differed in perspectives from those with less appropriate practices by attending continued education forums (p<0.026), referring patients to sub-specialty (p< 0.041), clinical knowledge (p<0.039), convinced on interventions (p<0.017), low concern for precipitating eating disorders (p<0.019), comfortable in examining obese patients (p<0.020), and considered patient's readiness for weight change (p< 0.007). CONCLUSION: Efforts are needed to equip PHC physicians in managing overweight and obesity in Saudi children and adolescents.