Prevalence and factors associated with thyroid autoimmunity among children newly diagnosed with type 1 diabetes before and during the COVID-19 pandemic: Evidence from Kuwait.

AIMS: This study reports the prevalence and characteristics related to the development of thyroid autoimmunity among children newly diagnosed with type I diabetes (T1D) during the COVID-19 pandemic in Kuwait. MATERIALS AND METHODS: This is a prospective observational study of all children under age 14 years newly diagnosed with T1D in Kuwait. We define the duration of the COVID-19 pandemic from the official declaration of the first identified positive COVID-19 case on 24 February 2020 until 31 December 2022. For comparison, we use the time period directly before the COVID-19 pandemic, 1 January 2017 to 23 February 2020. RESULTS: One thousand twenty-four (1024) children newly diagnosed with T1D in Kuwait during the study period were included. Among newly diagnosed children, 20.3% tested positive for thyroid antibodies during the COVID-19 pandemic, compared with 14.5% during the pre-pandemic period (p = 0.015). Children with positive COVID-19 status were more likely to present with thyroid antibodies (p = 0.035). After adjusting for other characteristics, patients diagnosed with T1D during the COVID-19 pandemic had double the odds of testing positive for thyroid antibodies (Adjusted odds ratio = 2.173, 95%CI: 1.108, 4.261, p = 0.024). CONCLUSIONS: Incident cases of T1D during the COVID-19 pandemic may be different in aetiology or contextual factors leading to a higher risk of thyroid autoimmunity. Longitudinal studies are needed to understand the role of COVID-19 in the onset and progression of T1D and on thyroid autoimmunity and disease.

Health-related quality of life of children and adolescents with type 1 diabetes during the COVID-19 pandemic in Kuwait.

Background: With the rapid transmission of COVID-19 globally, countries have implemented strict governmental measures and social distancing rules that aimed to minimize the spread of the virus. School closures, quarantine orders, and social isolation, coupled with a surge in family stress and lack of peer interactions, are probable causes of mental health complications and psychological symptoms faced by children. This study aims at comparing the HRQoL of children and adolescents with type 1 diabetes (T1D) and affected by COVID-19 infection (personal or familial) and those who were not affected by COVID-19. Materials and methods: A random sample was selected from children and adolescents diagnosed with T1D at the six major governmental diabetes centers in Kuwait. To measure HRQoL, parent-proxy and self-reports from the Pediatric Quality of Life Inventory (PedsQLTM) 3.0 Diabetes Module were used. Results: A sample of 455 children and adolescents with T1D diabetes (44.6% male participants and 41.98% affected by COVID-19 infection) was studied. The total score of the HRQoL self-reports was significantly higher compared with parent-proxy reports (79.06 ± 15.19 vs. 73.79 ± 15.17, p < 0.01). Children reported significantly higher HRQoL scores in the "treatment I" domain and "worry" domain and lower scores in the "diabetes" symptoms domain, compared with their parents' reports (p < 0.01). In the COVID-19-affected group, a major difference was noticed between the total scores of children and parent-proxy reports (77.04 ± 15.81 vs. 72.80±14.90, p = 0.047). The affected children reported significantly lower scores in "diabetes" symptoms (59.50) (p < 0.01) and higher scores in the "treatment I" domain (81.43) than their parent-proxy reports (72.05) (p < 0.01). Conclusion: This is the first report on the health-related quality of life of children with T1D in Kuwait during the COVID-19 era. Parents' or caregivers' experience of caring for their children was negative, as they worried, and reported poorer HRQoL compared with their children's perceptions. There is a need to empower healthcare professionals to support parents and caregivers of children with chronic diseases such as T1D in promoting self-management, enhancing physical and psychological wellbeing, treatment adherence, and continuous health education during pandemics of any kind.

Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia.

OBJECTIVES: To determine the prevalence of attention deficit hyperactivity disorder (ADHD), subtypes of ADHD, and psychiatric, academic, and behavioral comorbidity in public primary school students in Jeddah, Saudi Arabia.  Methods: This is a cross-sectional study. A simple random sample of 6 primary government schools in Jeddah, Saudi Arabia, was identified (3 male, 3 female), and a random sample of classes in each of grades 1-6 were selected. Between July and November 2016, teachers in these classes were asked to complete the Vanderbilt ADHD scale on all students in their classes.  Results: A total of 929 students were screened. The overall prevalence of ADHD was 5% (5.3% in girls, 4.7% in boys). The most prevalent subtype of ADHD was combined type (2.7%), followed by hyperactive type (1.2%), and inattentive type (1.1%). The highest prevalence of ADHD overall was in grade 3 (7.1%) and the lowest prevalence in grade 6 (3.4%). Among students with ADHD, prevalence of comorbid psychiatric, academic, and behavioral problems was widespread (56.5% oppositional defiant disorder/conduct disorder, 54.4% impaired academic performance, 44.4% classroom behavioral problems, 41.3% depression/anxiety). Comorbid problems were especially prevalent in combined ADHD subtype and in boys. Conclusions: Attention deficit hyperactivity disorder is common in primary school children in Jeddah, and is associated with widespread psychiatric, academic, and behavioral problems, especially in boys. These findings have implications for the diagnosis and treatment of this serious neurobehavioral disorder.

Religiosity and Telomere Length in Colorectal Cancer Patients in Saudi Arabia.

Numerous studies have reported a significant relationship between psychological stress, depression, and telomere length (TL), an indicator of cellular lifespan. Religious involvement, which is associated with lower levels of stress and depression, has also recently been related to TL. To our knowledge, this relationship has not yet been examined in Muslims, colorectal cancer patients, cancer patients more generally, or any population outside the USA. A convenience sample of 50 colorectal patients was recruited from hospital-based oncology clinics in Jeddah, Saudi Arabia. Religious involvement was assessed with the 13-item Muslim Religiosity Scale. Social and psychological mediators were measured using established scales. TL was determined from whole-blood leukocytes using quantitative PCR technology. Bivariate analyses indicated a positive but nonsignificant relationship between religiosity and TL (r = 0.13, p = 0.35). Controlling for age, did not affect the relationship (B = 15.6, SE = 17.3, p = 0.37), nor did controlling for other demographic, social or psychological factors. Religious involvement was unrelated to TL in this small sample of colorectal patients. Future cross-sectional and prospective studies in different populations with larger samples are needed.

Religious beliefs, practices, and health in colorectal cancer patients in Saudi Arabia.

OBJECTIVE: Colorectal cancer (CRC) patients experience considerable psychological stress because of changes brought on by their illness. Religion may be a resource for such patients. We examined the prevalence of religious beliefs and practices in CRC patients and correlation with demographic, social, psychological, and physical health characteristics. METHODS: Seventy CRC patients (all Muslim) in Jeddah, Saudi Arabia, were surveyed using a 13-item Muslim religiosity scale. Standard measures were used to assess depressive symptoms, depressive disorder, and social support; demographic and social factors, psychiatric history, and disease factors were also measured. RESULTS: All 70 participants (100%) engaged in group worship and prayer (Fard) five times/day, and 75.7% never skipped or combined two or more obligatory prayers; 71.4% read or recited the Qur'an several times/week or daily; 80.0% gave money to the poor each year (Zakat); 71.4% fasted throughout the month of Ramadan (Sawm) and other times as well; 91.4% said they 'definitely' experienced the presence of Allah; and 74.3% said their entire approach to life was definitely based on their religious beliefs. Overall religiosity was inversely related to depressive symptoms (B = -0.58, SE = 0.30, p = 0.026) and suicidal ideation (B = -0.07, SE = 0.03, p = 0.025), after controlling for financial status and social factors. CONCLUSIONS: Religious involvement was widespread in this sample of CRC patients in Saudi Arabia and was related to fewer depressive symptoms and less suicidal ideation. No relationship was found with stage of disease or duration of treatment.

Prospective study of depression among dialysis patients in Saudi Arabia.

OBJECTIVES: The purpose was to determine the short-term course of depression among dialysis patients in Saudi Arabia and identify baseline characteristics that may influence course. METHODS: Thirty-nine dialysis patients in Jeddah, SA, were identified with subthreshold, minor, or major depressive disorders using the Structured Clinical Interview for Depression (SCID) and followed up at 6 and 12 weeks using the Longitudinal Interview and Follow-up Evaluation (LIFE) schedule. Depressive symptoms were tracked using the Hamilton Depression Rating Scale (HDRS). Patient characteristics measured at baseline included demographic, psychosocial, physical health, and treatment factors. RESULTS: Of the 20 patients with major or minor depressive disorder, eight (40 %) fully remitted by 6 weeks and an additional three patients remitted over the next 6 weeks, leaving 45 % with significant depressive symptoms persisting beyond 12 weeks. Subthreshold disorders followed a similar course (42 % with persistent symptoms). Few patients received treatment for depression. Those with more education, severe health problems, poorer psychological function, more severe depressive symptoms, or a family psychiatric history were less likely to remit. Similar factors predicted change in depressive symptoms assessed by HDRS, especially high medical co-morbidity, severe illness, and overall poor psychological functioning. CONCLUSIONS: Nearly one-half of depressed dialysis patients in Saudi Arabia continue to have significant symptoms beyond 12 weeks of follow-up, few of whom were treated. Specific characteristics at baseline identify depressed dialysis patients at greater risk of persistent symptoms who need treatment.

Test-retest reliability of the Muslim Religiosity Scale: follow-up to "Religious involvement and health among dialysis patients in Saudi Arabia".

The intra-class correlation coefficient for the scale was 0.961, 95 % CI 0.912-0.983. We conclude that the MRS is a highly reliable measure of Muslim religiosity over time.

Depression in patients with colorectal cancer in Saudi Arabia.

OBJECTIVE: Persons with colon cancer experience considerable psychological stress due to physical and social changes brought on by illness, increasing their risk of depressive disorder (DD). We examine the prevalence of DD and depressive symptoms and determine baseline demographic, social, psychological, and physical health correlates. METHODS: A convenience sample of 70 cancer patients in Jeddah, Saudi Arabia, was screened for DD using an abbreviated version of the Structured Clinical Interview for Depression (SCID) and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Demographic, psychosocial, psychiatric, and physical health characteristics were also assessed, along with past treatments for colon cancer. Bivariate and multivariate analyses identified predictors of DD and symptoms. RESULTS: The 1-month prevalence of DD was 30.0% (12.9% major depression, 5.7% minor depression, and 11.4% for dysthymia) and significant depressive symptoms were present in 57.1% (HDRS 8 or higher), including having persistent suicidal thoughts for 2 weeks or longer wthin the past month (14.3%) . Low social support and having a co-morbid psychiatric illness (particularly anxiety) independently predicted DD based on the SCID. Saudi nationality, poor financial situation, low social support, and co-morbid psychiatric illness independently predicted depressive symptoms on the HDRS. Surprisingly, stage of cancer, duration of cancer, and treatments for cancer were unrelated to DD or depressive symptoms. CONCLUSIONS: DD and significant depressive symptoms are common in patients with colon cancer in Saudi Arabia, and are predicted by a distinct set of demographic and psychosocial risk factors that may help with identification. Demographic and psychological risk factors were more likely to be associated with depression than cancer characteristics in this sample.

Religious involvement and health in dialysis patients in Saudi Arabia.

Patients on hemodialysis experience considerable psychological and physical stress due to the changes brought on by chronic kidney disease. Religion is often turned to in order to cope with illness and may buffer some of these stresses associated with illness. We describe here the religious activities of dialysis patients in Saudi Arabia and determined demographic, psychosocial, and physical health correlates. We administered an in-person questionnaire to 310 dialysis patients (99.4 % Muslim) in Jeddah, Saudi Arabia, that included the Muslim Religiosity Scale, Structured Clinical Interview for Depression, Hamilton Depression Rating Scale, Global Assessment of Functioning scale, and other established measures of psychosocial and physical health. Bivariate and multivariate analyses identified characteristics of patients who were more religiously involved. Religious practices and intrinsic religious beliefs were widespread. Religious involvement was more common among those who were older, better educated, had higher incomes, and were married. Overall psychological functioning was better and social support higher among those who were more religious. The religious also had better physical functioning, better cognitive functioning, and were less likely to smoke, despite having more severe overall illness and being on dialysis for longer than less religious patients. Religious involvement is correlated with better overall psychological functioning, greater social support, better physical and cognitive functioning, better health behavior, and longer duration of dialysis. Whether religion leads to or is a result of better mental and physical health will need to be determined by future longitudinal studies and clinical trials.

Depression in patients with chronic kidney disease on dialysis in Saudi Arabia.

OBJECTIVE: Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. METHODS: A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. RESULTS: The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. CONCLUSIONS: The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.

Current state of psychiatry in Saudi Arabia.

BACKGROUND: In 1983, an article and accompanying editorial was published on the state of psychiatry in the Kingdom of Saudi Arabia (KSA), which was described as "a mental health system in statu nascendi." METHODS: We provide a 30-year update on advances in mental health care in KSA. Data are reported from a wide range of sources, including the 2007 Saudi Arabian Mental and Social Health Atlas, which compares services in KSA with the rest of the world. RESULTS: We examine how the current mental health system operates in KSA, including recent changes in mental healthcare policy and development of a national mental healthcare plan. Discussed are current needs based on the prevalence and recognition of mental disorders; availability of services and providers (psychiatrists, psychiatric nurses, psychologists, and social workers); education and training in psychiatry; developments in consultation-liaison, addictions, child-adolescent, and geriatric psychiatry; and progress in mental health research. CONCLUSIONS: Mental healthcare in Saudi Arabia has come a long way in a very short time, despite cultural, religious, social, and political challenges, although there still remain areas where improvement is needed. The development of psychiatry in KSA serves as a model for countries in the Middle East and around the world.

Religion, spirituality and mental health in the West and the Middle East.

Research on religion, spirituality and mental health has been rapidly accumulating from Western countries and now increasingly from the Middle East. We review here the latest research on this topic from these two areas of the world, one largely Christian and the other largely Muslim, after discussing similarities and differences in these faith traditions. Contrary to popular thought, there is considerable overlap between these religious groups in beliefs, practices of worship, moral beliefs and values, and emphasis on family life (although also some distinct differences). Because of the similarity in belief and practice, it is not surprising that research on mental health and devout religious involvement in both these religious traditions has tended to produce similar results. Religious psychotherapies within these faith traditions have been developed and are now being refined and used in clinical trials to determine if integrating patients' religious resources into therapy is more or less effective than conventional therapies in relieving the symptoms of depression and anxiety.