Saudi Arabia Mental Health Surveillance System (MHSS): mental health trends amid COVID-19 and comparison with pre-COVID-19 trends.

Background: The impact of the COVID-19 pandemic on populations' mental health has started to emerge. Objectives: To describe the mental health trends of the risk of major depressive disorder (MDD) and generalized anxiety disorder (GAD) between May and August 2020. It also compares the results with pre-COVID-19 results and identifies risk factors associated with increased likelihood of being at risk of MDD and GAD. Method: This study utilizes repeated cross-sectional design, at national-level coverage of mental health screenings via computer-assisted phone interviews conducted in four waves monthly (between May and August 2020). Arabic-speaking adults from Saudi Arabia were recruited via a random phone list. The questionnaire includes the Arabic version of the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Pre-COVID-19 comparison was done using the PHQ-2 score to allow for comparison with a previous and similar national study conducted in 2018. Results: Across the four waves, 16,513 participants completed the interviews, with an overall response rate of 81.3%. The weighted national prevalence of people at risk of MDD was 14.9% overall, and 13.8%, 13.6%, 16.8%, and 15.3% in Waves 1, 2, 3, and 4, respectively. The weighted national prevalence of people at risk of GAD was 11.4%, overall, and 10.9%, 10.7%, 12.4%, and 11.7% in Waves 1, 2, 3, and 4, respectively. The weighted national proportion of individuals who were at risk of MDD and GAD at the same time was 7.4% overall. The risk of MDD on PHQ-2 increased by 71.2%, from 12.5% in 2018 to 21.4% in 2020. Conclusions: The risks of MDD and GAD in this study are relatively high. These results can help decision makers to understand the impact of the COVID-19 pandemic on the population's mental health and the most-impacted subgroups.

Antecedentes: El impacto de la pandemia COVID-19 en la salud mental de la población ha comenzado a emerger.Objetivos: Describir las tendencias en salud mental del riesgo de tener un trastorno depresivo mayor (MDD por sus siglas en inglés) y un trastorno de ansiedad generalizado (GAD por sus siglas en inglés) entre Mayo y Agosto de 2020. También compara los resultados con los resultados pre COVID-19 e identifica factores de riesgo asociados con el aumento de la probabilidad de estar en riesgo de sufrir MDD y GADMétodo: Este estudio utiliza un diseño transversal repetido, a un nivel de cobertura nacional de tamizaje sobre salud mental vía entrevistas telefónicas asistidas por computador, conducidas en 4 olas mensualmente (entre Mayo y agosto de 2020). Adultos que hablasen árabe de Arabia Saudita fueron reclutados mediante una lista aleatoria de teléfonos. El cuestionario incluía la versión árabe del Cuestionario de Salud del Paciente (PHQ-9) y de La Escala del Trastorno de Ansiedad Generalizada (GAD-7). Se hicieron comparaciones pre-COVID 19 usando el puntaje del PHQ-2 para permitir la comparación con un estudio previo nacional de características similares que fue realizado el 2018.Resultados: A través de las cuatro olas, 16.513 participantes completaron las entrevistas, con una tasa de respuesta promedio de 81.3%. La prevalencia nacional calculada de personas en riesgo para MDD fue de 14.9% en general y de 13.8%, 13.6%, 16.8% y 15.3% en Olas 1, 2, 3 y 4 respectivamente. La prevalencia nacional calculada de personas en riesgo para GAD fue 11.4% en general y 10.9%, 10.7%, 12.4% y 11.7% en Olas 1, 2, 3 y 4 respectivamente. La proporción nacional calculada de individuos que estaban en riesgo para MDD y GAD al mismo tiempo fue de 7.4% en general. El riesgo de MDD según el PHQ-2 aumentó en un 71.2%, de 12.5% en 2018 a 21.4% en 2020.Conclusiones: El riesgo de MDD y GAD encontrado en este estudio es relativamente alto. Estos resultados pueden ayudar a entender a las personas que toman decisiones del impacto de la pandemia COVID-19 en la salud mental de la población y en los subgrupos más impactados.

A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study.

BACKGROUND: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. OBJECTIVE: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. METHODS: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. RESULTS: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. CONCLUSIONS: Monitoring the population's mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23748.

Time for an Adolescent Health Surveillance System in Saudi Arabia: Findings From "Jeeluna".

PURPOSE: With the increasing burden of noncommunicable disease, adolescence is viewed as an opportune time to prevent the onset of certain behaviors and promote healthy states. Although adolescents comprise a considerable portion of Saudi Arabia's population, they have received insufficient attention and indicators of their health status, as a first step in a prevention cycle are unavailable. This study was carried out with the aim of identifying the health risk behaviors and health status of adolescents in Saudi Arabia. METHODS: This cross-sectional, school-based study was carried out in all 13 regions of Saudi Arabia. Through multistage, cluster, random sampling, intermediate, and secondary school students were invited to participate. Data were collected by means of a self-administered questionnaire addressing health risk behaviors and health status, clinical anthropometric measurements, and laboratory investigations. RESULTS: A total of 12,575 adolescents participated. Various health risk behaviors, including dietary and sedentary behaviors, lack of safety measures, tobacco use, bullying, and violence were highly prevalent. Twenty-eight percent of adolescents reported having a chronic health condition, 14.3% reported having symptoms suggestive of depression, 30.0% were overweight/obese, and 95.6% were vitamin D deficient. CONCLUSION: Behaviors and conditions known to persist into adulthood and result in morbidity and premature mortality are prevalent among adolescents in Saudi Arabia. Preventive measures and local health policies are urgently needed and can impact adolescents and future adults. Establishing adolescent health surveillance is necessary to monitor trends and impacts of such measures.

Toward an objective assessment of technical skills: a national survey of surgical program directors in Saudi Arabia.

BACKGROUND: After almost a decade of implementing competency-based programs in postgraduate training programs, the assessment of technical skills remains more subjective than objective. National data on the assessment of technical skills during surgical training are lacking. We conducted this study to document the assessment tools for technical skills currently used in different surgical specialties, their relationship with remediation, the recommended tools from the program directors' perspective, and program directors' attitudes toward the available objective tools to assess technical skills. METHODS: This study was a cross-sectional survey of surgical program directors (PDs). The survey was initially developed using a focus group and was then sent to 116 PDs. The survey contains demographic information about the program, the objective assessment tools used, and the reason for not using assessment tools. The last section discusses the recommended tools to be used from the PDs' perspective and the PDs' attitude and motivation to apply these tools in each program. The associations between the responses to the assessment questions and remediation were statistically evaluated. RESULTS: Seventy-one (61%) participants responded. Of the respondents, 59% mentioned using only nonstandardized, subjective, direct observation for technical skills assessment. Sixty percent use only summative evaluation, whereas 15% perform only formative evaluations of their residents, and the remaining 22% conduct both summative and formative evaluations of their residents' technical skills. Operative portfolios are kept by 53% of programs. The percentage of programs with mechanisms for remediation is 29% (19 of 65). CONCLUSION: The survey showed that surgical training programs use different tools to assess surgical skills competency. Having a clear remediation mechanism was highly associated with reporting remediation, which reflects the capability to detect struggling residents. Surgical training leadership should invest more in standardizing the assessment of surgical skills.