Psychiatric morbidity and its sociodemographic correlates among women in Irbid, Jordan.

The rate of psychiatric morbidity and its sociodemographic correlates was estimated in 2000 women attending 3 primary care centres in Irbid, Jordan. Women completed standardized diagnostic tools that yielded psychiatric diagnoses, a stress scale and sociodemographic details. The rate of psychiatric morbidity was 26.3% and psychological distress 39.0%. A significant association was found between the amount and severity of stress and psychiatric morbidity. Post-marital status (separated, divorced, widowed), woman's illiteracy, family violence, violent marital relationship, living independently, being in a non-cousin marriage, being a second wife, poor housing and absence of a social support system were significantly associated with psychiatric morbidity in this group of women.

Psychiatric morbidity and its sociodemographic correlates among women in Irbid, Jordan

The rate of psychiatric morbidity and its sociodemographic correlates was estimated in 2000 women attending 3 primary care centres in Irbid, Jordan. Women completed standardized diagnostic tools that yielded psychiatric diagnoses, a stress scale and sociodemographic details. The rate of psychiatric morbidity was 26.3% and psychological distress 39.0%. A significant association was found between the amount and severity of stress and psychiatric morbidity. Post-marital status [separated, divorced, widowed], woman's illiteracy, family violence, violent marital relationship, living independently, being in a non-cousin marriage, being a second wife, poor housing and absence of a social support system were significantly associated with psychiatric morbidity in this group of women

Quality of life of patients with schizophrenia 2.

We studied quality of life in 211 patients with schizophrenia from 2 outpatient clinics in Irbid, Jordan and Riyadh, Saudi Arabia, using the self-reporting questionnaire SRQ-24 and the modified version of the schizophrenia quality of life scale. Sex, marital status, employment, education, nonpsychotic symptoms and psychotic symptoms were examined. Approximately 27% had good quality of life, 19.4% thought their general health was excellent or very good and about 30% said they had achieved their expectations. There was no significant relationship between sex and marital status and quality of life but employment and education were significantly related. Patients with less severe psychotic and non-psychotic symptoms were also found to have better quality of life.

Quality of life of patients with schizophrenia 2

We studied quality of life in 211 patients with schizophrenia from 2 outpatient clinics in Irbid, Jordan and Riyadh, Saudi Arabia, using the self-reporting questionnaire SRQ-24 and the modified version of the schizophrenia quality of life scale. Sex, marital status, employment, education, nonpsychotic symptoms and psychotic symptoms were examined. Approximately 27% had good quality of life, 19.4% thought their general health was excellent or very good and about 30% said they had achieved their expectations. There was no significant relationship between sex and marital status and quality of life but employment and education were significantly related. Patients with less severe psychotic and non-psychotic symptoms were also found to have better quality of life

Reliability, validity, and factor structure of the Arabic version of the 12-item General Health Questionnaire.

The aim was to examine the psychometric properties of the Arabic 12-item General Health Questionnaire in a sample of university students. A sample of 157 university students was screened using this questionnaire and the Hopkins Symptom Checklist-90. A standardized clinical interview using SCID was conducted on a subset of screened students. Reliability, validity, and factor analysis of the questionnaire were evaluated. Using factor score discrimination between cases and noncases was also evaluated. The Arabic version of the GHQ-12 proved to be reliable as indicated by Cronbach alpha of .86. The best balance between sensitivity and specificity was found at the General Health Questionnaire cut-off point of 15/16: at this threshold, sensitivity was .88 and was paired with a specificity of .84. Principal component analysis with varimax rotation identified three factors, namely, Factor A (general dysphoria), Factor B (lack of enjoyment), and Factor C (social dysfunction). Factors A and C discriminated between clinically distressed and clinically nondistressed subjects. The General Health Questionnaire-12 as a whole is a reliable and valid screening tool in university settings.

A1 Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates.

BACKGROUND: Psychiatric community studies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. METHODS: A total of 1394 (n = 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. RESULTS: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7-9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8-19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5-25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. CONCLUSION: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used.

Al-Ain community psychiatric survey IV: socio-cultural changes (traditionality-liberalism) and prevalence of psychiatric disorders.

UNLABELLED: BACKGROUND This study was set to explore the relationship between socio-cultural change and psychopathology. METHOD: A representative sample (n = 1,394) of Al-Ain adult population had their psychopathology assessed with the Composite International Diagnostic Interview and other self-reported questionnaires, while the socio-cultural change was assessed with the modified version of the Socio-cultural Change Questionnaire (ScCQ). The reliability and construct validity of the modified ScCQ were assessed. The overall Tradition Index, attitudinal and behavioural indices of the sample were estimated. Association between socio-cultural change and psychopathology was also evaluated. RESULT: The reliability of the modified ScCQ was found to be moderate (alpha Cronbach 0.66) and the hypothesis regarding its construct validity was confirmed. Mean traditional index was found to be 0.61 +/- 0.14.Young, highly educated, skilled, and female subjects were found to be significantly less conservative and their scores on traditional index deviated significantly from overall mean. Less traditional people were also found to have a significantly increased rate of ICD-10 psychiatric disorder and higher scores on psychopathology measures especially among females. Although females showed significantly more modern attitude, there were no significant sex differences in the expressed behaviour as measured by the behavioural Tradition Index. CONCLUSION: The findings of this study suggest that the prevalence of psychiatric disorder varies significantly according to the extent to which subjects adhere to traditional values.

The performance of the Center for Epidemiologic Study Depression Scale (CES-D) in an Arab female community.

BACKGROUND: The purpose of this study was to investigate the psychometric properties of the Arabic version of the CES-D. METHODS: Three samples of young Arab females were chosen from different young female populations (n =450). The translated version of the CES-D, sociodemographic and risk factors questionnaires were applied to the above three samples. A subsample was selected (n = 30) to re-rate the scale items and the same sample was interviewed by the SCID. The internal consistency and test-re-test reliability were estimated as well as the factor structure of the Arabic CES-D. The discriminative and criterion validity of the scale was also investigated using the ROC analysis. RESULTS: Seventy five percent (n = 350) of the subjects completed the scale. Alpha coefficient was found to be 0.88 and the split-half reliability was 0.83. The average re-test reliability (ICC = 0.59). Factor analysis yielded three factors: interpersonal problems, mixed affective/somatic factor and the positive affect factor. There was significant differences in mean total score between depressed and non-depressed subjects as classified by SCID as well as by self-perception of depression and the need for treatment. ROC analysis revealed that a cut-off point of 21 discriminated best between depressed and non-depressed subjects (sensitivity= 82%, specificity = 83% with AUC of 84%). CONCLUSION: The Arabic CES-D was found to possess reasonable reliability and reasonable discriminative and criterion validity.

Al Ain Community Survey of Psychiatric Morbidity III. The natural history of psychopathology and the utilization rate of psychiatric services in Al Ain.

BACKGROUND: We evaluated the natural history of psychopathology in a stratified sample (n = 245) comprising subjects with no DSM-III-R psychiatric disorder, subthreshold disorder and threshold (DSM-III-R) psychiatric disorder, respectively, over a 12-months period, using the Structured Clinical Interview for DSM-III-R mental disorders (SCID) as an assessment tool. METHODS: A representative sample categorized 1 year earlier into DSM-III-R psychiatric disorder, subthreshold disorder and no DSM-III-R psychiatric disorder were reassessed with SCID 1 year on. The incidence, recovery rates and the percentage of subthreshold disorders which become DSM-III-R disorders were calculated. The utilization rate of psychiatric services was also assessed. RESULTS: The incidence rate of new cases was 10.4%. The recovery (remission) rate was 41.5%, and approximately 20% of subthreshold disorders became definitive disorders (DSM-III-R) after 1 year. Anxiety disorders tend to have a higher magnitude of temporal stability in comparison with depressive disorders. Male sex and contact with psychiatric services were found to affect the recovery rate. Approximately 13% of the sample had made contact with psychiatric services with no gender differences, but men were significantly more often hospitalized than women. CONCLUSION: Our findings indicate that mental disorders are relatively common. The high incidence rate found in this study is attributed in part to the high negative rate at baseline assessment. Approximately 60% of psychiatric disorders in the community are persistent, and patients with emotional disorder under-utilize existing services.

The rationale, development and reliability of a new screening psychiatric instrument.

BACKGROUND: This paper describes the rationale, development, reliability and validity of a new screening psychiatric instrument. METHOD: The instrument comprises 26 items that tap the cardinal features of main psychiatric categories as defined by ICD-10 and DSM-IV. These items were adapted from various structured and semi-structured diagnostic interviews that yield ICD-10 and DSM-IV psychiatric diagnoses. After a training course, 12 trainees and the trainer rated blindly the 26 items on 45 subjects (22 with psychopathology and 23 without). Inter-rater reliability coefficient (Kappa) was estimated between trainees and the trainer on each item of the instrument. The total score on the new instrument was then correlated with the total score on the Arabic Self Reporting Questionnaire (SRQ-20) and the Arabic version of the General Health Questionnaire (GHQ) in a random sample from the general population (n = 365). Logistic regression was utilised to estimate the power of the total score on the new instrument in discriminating between cases and non-cases as classified by the SRQ-20. RESULTS: Excellent levels of agreement (Kappa > 0.80) were found for all items except for obsession (Kappa = 0.65) and for depressed mood (Kappa = 0.70). Moderate correlations were found between the total score on the new instrument and total score on SRQ-20 (r = 0.69) and the total score on the Arabic GHQ (r = 0.7). The new instrument correctly classified 89% of subjects into cases and non-cases. CONCLUSIONS: The results of this study indicate that the new instrument is a highly reliable and valid screening instrument. The authors are now investigating its test-retest reliability and its procedural validity.

The validity of the Arabic Edinburgh Postnatal Depression Scale.

For the purpose of this study, a consecutive sample of 95 postpartum women were assessed at 1 week postpartum with the (EPDS) and at 8 +/- 2 weeks postpartum using the Present State Examination (PSE). A moderate correlation between PSE total score and EPDS score was found (r = 0.57). A moderate agreement between EPDS and Catego diagnosis of depression was also found (Kappa = 0.52). Using a cut-off score of 12 on EPDS and Catego diagnosis as a criterion variable, the sensitivity and specificity of the scale were 73% and 90%, respectively. However, using a cut-off score of 10, the sensitivity of the scale rose to 91% without much fall in its specificity (84%). The internal reliability of the scale was 0.84 (alpha Cronbach). We conclude that the Arabic version of the EPDS is a reliable and valid screening tool for depression in postpartum women.

Validation of the Arabic versions of the thirty- and twelve-item General Health Questionnaires in primary care patients.

BACKGROUND: The aim of this study was to investigate the validity of the Arabic versions of the GHQ-30 and GHQ-12 in a sample of primary health care (PHC) patients in Al Ain, United Arab Emirates. METHOD: A randomly selected sample (n = 157) of patients attending a PHC centre in Al Ain was screened using the Arabic version of the GHQ-30, the first 12 items of which constitute the GHQ-12. Then a standardised clinical interview using the Clinical Interview Schedule (CIS) was conducted with all screened patients. The receiver operating characteristic analyses of the Arabic versions of both GHQ-30 and GHQ-12 were compared and their correlation coefficients with the weighted total score of the CIS and the overall severity rate were estimated. Discriminant functional analysis was also performed to assess the discriminatory powers of both the GHQ-30 and GHQ-12. RESULTS: Using the simple Likert scoring method, the best cut-off point of the GHQ-30, that balances between sensitivity and specificity, was 31/32 with a sensitivity of 0.83 and specificity of 0.83, and that of the GHQ-12 was 12/13 with a sensitivity of 0.83 and specificity 0.80. The total discriminatory powers of the GHQ-30 and GHQ-12 were approximately 93 and 86%, respectively. Both versions of the GHQ were found to have a significant concurrent validity. CONCLUSION: The Arabic versions of both GHQ-30 and GHQ-12 are valid psychiatric screening instruments, with almost similar performance, for Arabic-speaking PHC patients.

Efficacy and safety of risperidone in psychotic patients: an open study.

This open prospective study was undertaken to determine the efficacy and safety of a fixed dose (6 mg) of risperidone in psychotic patients. Hospital in-patients who fulfilled DSM-111-R criteria for schizophrenia, schizoaffective and bipolar disorders were eligible for entry into the study (n = 15). Patients who were on other antipsychotics had a washout period of 1 week before they were started on the drug. A fixed dose of risperidone was administered (6 mg). The Brief Psychiatric Rating Scale (BPRS), Negative Symptom Rating Scale (NSRS) and Abnormal Involuntary Movement Scale were used to measure psychopathology and extrapyramidal side-effects. Five patients dropped out of the study. Two patients became very agitated and potentially aggressive, one patient became very restless and did not respond to benzodiazepines, and one dropped out because of restlessness that did not respond to clonazepam. Of the 10 patients who completed the study, 50 per cent reduction on BPRS and NSRS was achieved by five and six patients respectively. There was a marginally significant trend towards a greater reduction in the magnitude of negative symptoms. Four patients required treatment with anticholinergic drugs. Risperidone was effective in resistent psychotic patients, but agitated and impulsive psychotic patients with positive symptoms may not be best candidates for treatment with risperidone. On average, negative symptoms respond better than positive symptoms.

Stability of psychiatric diagnoses in clinical practice.

This is a retrospective study that aimed at studying the diagnostic stability of psychiatric diagnoses over a 4-year period. Three-hundred and twelve patients (n = 312) admitted more than once to Al Ain in-patient unit from January 1, 1990 to December 31, 1993, were the subjects for this study. The sample included patients with the following index diagnoses: acute psychoses (n = 37), alcohol abuse (n = 15), bipolar disorder (n = 27), depressive disorders (n = 63), drug abuse (n = 21), hysteria (n = 23), neurotic disorders (n = 50) and schizophrenia (n = 76). Diagnoses on discharge for first admissions were considered the index diagnoses. The shift from index diagnoses to subsequent diagnoses was counted. Diagnostic stability was calculated as the percentages of index diagnoses that did not change over time. In nearly half of the patients the index diagnoses changed over the 4-year period. Highest diagnostic stability was found in patients with index diagnoses of alcohol abuse, schizophrenia and drug abuse (92%, 74% and 71% respectively), while the lowest stability was found in patients with neurotic, hysterical, depressive disorders, acute psychoses and bipolar disorders (38%, 48% and 45%, 42%, 52% respectively). Two distinct patterns of shifts were noted. First shift occurred between functional psychoses and second shift between depressive and neurotic disorders. This study provides further support to the notion that diagnostic stability in clinical practice is still far from being satisfactory.

The reliability and validity of the proposed axis V (disabilities) of ICD-10.

BACKGROUND: The purpose of this study was to examine the reliability and validity of the newly proposed axis V (disabilities) of ICD-10. METHOD: Eighty-six acutely ill men and women were prospectively recruited from the Al Ain psychiatric units, UAE. Both versions of ICD-10, the Clinical Descriptions and Diagnostic Guidelines and the Diagnostic Criteria for Research (DCR) were used for coding axis I psychiatric diagnosis and its grade of severity; the WHO Disability Assessment Schedule was used to assess disabilities. RESULTS: Inter-rater reliability of the DAS items ranged from moderate to good, and axis V ratings correctly predicted 84% of the observed classification on axis I. CONCLUSION: Axis V is a valid measure of disabilities, but is limited by its modest reliability.

Predictors of employment status of treated patients with DSM-III-R diagnosis. Can logistic regression model find a solution?

To investigate the predictors of employment status of patients with DSM-III-R diagnosis, 55 patients were selected by a simple random technique from the main psychiatric clinic in Al Ain, United Arab Emirates. Structured and formal assessments were carried out to extract the potential predictors of outcome of schizophrenia. Logistic regression model revealed that being married, absence of schizoid personality, free or with minimum symptoms of the illness, later age of onset, and higher educational attainment were the most significant predictors of employment outcome. The implications of the results of this study are discussed in the text.

Parasuicide during Ramadan in Jordan.

To investigate the impact of national and religious events on the rate of parasuicide, a comparison was made between the number of reported parasuicides during the month of Ramadan and the month before and after Ramadan in Jordan, for the years from 1986 to 1991. Significantly fewer parasuicides were reported during Ramadan than the month preceding it and the month that follows Ramadan. The findings confirm previous observations that national events reduce the rate of parasuicide, but the protective effect does not persist into the month that follows Ramadan.

Suicide in Jordan 1980-1985.

In a study of suicide from 1980 through 1985 in Jordan, there were 219 suicides with an annual suicide rate of 2.1 per 100,000. The peak suicide rate was found to be among the age group 15-34 years. Nearly two-thirds of males that committed suicide were single, which was not the case with suicides among females. Over half of males that committed suicide were either unemployed and/or unskilled manual workers and over two-thirds of females that committed suicide were either housewives and/or students. Nearly two-thirds of the total population that committed suicide had previous psychiatric treatment. Violent methods of suicide were most frequently used. Some of the results were observed for the first time and the role of sociocultural factors is discussed. Suggestions are made to explore the role of religion in combatting suicide.

Parasuicide in an Arab industrial community: the Arabian-American Oil Company experience, Saudi Arabia.

The parasuicide phenomena was investigated for the first time in a retrospective and prospective way in an Arab industrial community in the Eastern Province of Saudi Arabia during 1985 and 1986. Though the parasuicide rate of 20.7 per 100,000 is substantially lower from the reported rates in the West, underreporting and misdiagnosing of the phenomena may explain the low rate. The results of this study confirm that the act is predominantly the activity of young females, and disordered interpersonal relationships with spouses and parents stand out as precipitating factors. Acute reaction to stress was the commonest diagnosis followed by depression. Deliberate self-poisoning by analgesics and psychotropic drugs was the commonest method used. The findings of this study refute the hypothesis that parasuicide is rare in this part of the world, and time probably has come to amend the law in order to give the opportunity for distressed people to receive help.