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

Impact of COVID-19 pandemic on the mental health of university students in the United Arab Emirates: a cross-sectional study

BACKGROUND

The COVID-19 pandemic had a significant impact on the mental well-being of students worldwide. There is a scarcity of information on the mental health impact of the COVID-19 pandemic on university students in the United Arab Emirates (UAE). This study aimed to investigate the mental health impact of the COVID-19, including depression, anxiety and resilience among a sample of university students in the UAE.

METHODS

A cross-sectional study using an online survey was conducted from September to November 2021. The patient health questionnaire (PHQ-9), generalized anxiety disorder-7 (GAD-7) and Connor-Davidson Resilience Scale (CD-RISC-10) were used to assess depression, anxiety, and resilience. The COVID-19 impact was assessed using a list of questions.

RESULTS

Only, 798 students completed the survey and were analyzed for this study. Overall, 74.8% of the students were females, 91.2% were never married, and 66.3% were UAE-nationals. Based on PHQ-9 and GAD-7 cut-off scores (≥ 10), four out of ten of the students self-reported moderate to severe depression (40.9%) and anxiety (39.1%). Significantly higher mean PHQ-9 and GAD-7 scores were found among students who were impacted by COVID-19 than those non-impacted (mean PHQ-9 = 9.51 ± 6.39 and 6.80 ± 6.34; p = 0.001, respectively) and (mean GAD-7 = 9.03 ± 6.00 and 8.54 ± 6.02; respectively, p < 0.001). Female students who were impacted by COVID-19 had statistically significant higher depression and anxiety scores (mean PHQ-9 of 9.14 ± 5.86 vs. 6.83 ± 6.25, respectively; p < 0.001) than the non-impacted females (mean GAD-7 of 9.57 ± 6.32 vs. 5.15 ± 3.88, respectively; p = 0.005). Never married students had significantly higher PHQ-9 and GAD-7 scores than ever-married (9.31 ± 6.37 vs. 6.93 ± 5.47, P = 0.003) and (8.89 ± 6.11 vs. 7.13 ± 5.49, respectively; p = 0.017).

CONCLUSIONS

The results of this study demonstrate that the COVID-19 pandemic has negatively impacted the mental health of this sample of university students in terms of depression and anxiety. The results highlight the need to adopt culturally appropriate interventions for university students and focus on vulnerable groups.

Correlates of eating disorder pathology in Saudi Arabia: BMI and body dissatisfaction

BACKGROUND

Saudi Arabia is undergoing rapid sociocultural changes, which may have led to an increase of body mass index and eating disorder pathology. The aim of this study is to investigate whether body dissatisfaction, self-esteem, having lived abroad, cultural orientation, perceived stress, media use, and socioeconomic status are correlates of eating disorder pathology with body mass index as a covariate. Additional aims are to investigate if cultural orientation is associated with symptomatology and if stress is a covariate in the association between eating disorder pathology and Western orientation.

METHOD

Self-report measures were administered in a convenience Saudi community sample (N = 1225) between April 2017 and May 2018. Hierarchical multiple linear regression analyses with eating disorder pathology as dependent variable were performed to establish the associations among the variables.

RESULTS

After adjusting for the effect of BMI, only body dissatisfaction and eating disorder pathology were moderately associated. Eating disorder pathology and body dissatisfaction were more severe among Saudi citizens with a higher BMI.

DISCUSSION

Several explanations for the lack of associations of westernization, self-esteem, and stress with eating disorder pathology are reviewed and discussed. The majority of this convenience sample existed of young unmarried Saudi females of high socioeconomic status. Of the total sample, 35% displayed eating disorder pathology which may be a reflection of the high rates of excess weight.

Spouses of Student Mothers in the United Arab Emirates: Enablers or Constraints to Their Pursuit of Higher Education?

The educational status of Emirati women in the United Arab Emirates has developed rapidly over the last five decades, with females now outnumbering males in higher education institutions. Marriage and motherhood often take place during the years of undergraduate study for women, particularly for those from families who retain Emirati cultural traditions of relatively early marriage and childbearing. This study analyses the role which spouses play in their wives’ pursuit of education, using the theoretical gender and development lens to explore whether a transformation of power relations within the marriage takes place for the growth in female participation in higher education to occur. Spousal behaviours are identified and categorised through the gender and development lens as either enablers or constraints to women’s empowerment and participation in higher education, and potential reasons for these behaviours surrounding gender relations are discussed.

Eating disorders in the Arab world: a literature review

BACKGROUND

The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders.

METHOD

Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale.

RESULTS

Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically.

DISCUSSION

In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy.

Psychosocial Correlates of Depression and Anxiety in the United Arab Emirates During the COVID-19 Pandemic

The impact of the COVID-19 pandemic on mental health is likely to be significant. Identifying vulnerable groups during the pandemic is essential for targeting psychological support, and in preparation for any second wave or future pandemic. Vulnerable groups are likely to vary across different societies; therefore, research needs to be conducted at a national and international level. This online survey explored generalized anxiety and depression symptoms in a community sample of adults (N = 1,039) in the United Arab Emirates (UAE) between April 8th and April 22nd, 2020. Respondents completed symptom measures of depression (PHQ8) and generalized anxiety (GAD7), along with psychosocial and demographic variables that might potentially influence such symptoms. Bivariate and multivariate associations were calculated for the main study variables. Levels of anxiety and depression were notably higher than those reported in previous (pre-pandemic) national studies. Similar variables were statistically significantly associated with both depression and anxiety, most notably younger age, being female, having a history of mental health problems, self or loved ones testing positive for COVID-19, and having high levels of COVID-related anxiety and economic threat. Sections of the UAE population experienced relatively high levels of depression and anxiety symptoms during the early stages of the pandemic. Several COVID-related and psychosocial variables were associated with heightened symptomatology. Identifying such vulnerable groups can help inform the public mental health response to the current and future pandemics.

National Identity, Implicit In-Group Evaluation, and Psychological Well-Being Among Emirati Women

A sense of connectedness, and belonging to a valued social group (social identity processes), has been found to promote psychological well-being. This study, using implicit and explicit assessments, extends the exploration of social identity and well-being to citizens of the United Arab Emirates (Emiratis). In this cross-sectional correlational study, Emirati college women ( N = 210), all of them bilingual (English/Arabic), performed an affective priming task designed to assess, implicitly, in-group (Emirati) preference (a positive bias toward the in-group relative to an out-group). Participants also completed the Multicomponent In-Group Identification Scale (MIIS), a measure of in-group identification and self-report measures of English/Arabic language proficiency. Participants also reported their psychological well-being using the World Health Organization’s well-being index. Implicit in-group preference and self-reported Arabic language dominance were independently predictive of higher levels of psychological well-being. The implicit measure was the strongest, most robust, predictor. Interventions aimed at maintaining or increasing a positive sense of a shared social identity may be a useful objective of public mental health strategy.

Culture, Cultural Competency and Psychosocial Occupational Therapy: A Middle Eastern Perspective

A Western occupational therapist appointed to mental health services for Emirati nationals in Al Ain in the United Arab Emirates is faced with many questions regarding competent practice in what is, to the therapist, a largely alien culture. In an effort to develop a culturally sensitive approach to a new service development, an extensive review was undertaken of the cultural competency and related occupational therapy literature and a framework for culturally competent practice was proposed (Awaad 2003a).

One of the key themes identified was the importance of attaining, and the skilful use in therapy, of specific cultural knowledge. This paper attempts to apply this principle through an exploration of the literature concerned with social, occupational and mental health practices in Middle Eastern Islamic societies and their relationship to psychosocial occupational therapy.

Implicit out-group preference is associated with eating disorders symptoms amongst Emirati females

Studies exploring the relationship between acculturation and eating disorders symptoms have proven equivocal. Socially desirable responding associated with the use of explicit measures may account for these mixed findings. This study explores the relationship between in-group identity, acculturation and eating disorders symptoms using both implicit and explicit assessments. Emirati female college students (N=94) completed an affective priming task (APT) designed to implicitly assess Emirati in-group evaluations. Participants also completed explicit measures, including the Westernization Survey and the Multicomponent In-group Identification Scale. Eating disorders symptoms were assessed using the Eating Attitudes Test. Only implicit in-group evaluations were correlated with eating disorders symptoms. Specifically, increases in in-group preference were associated with lower levels of eating disorders symptomatology. Furthermore, participants with an actual out-group preference had significantly higher levels of eating disorders symptomatology compared with those demonstrating an in-group preference. These findings support the acculturative stress hypothesis, and suggest that the relationship between eating disorders and acculturation may be better understood with reference to implicit rather than explicit in-group evaluations.

Compulsive buying and depressive symptoms among female citizens of the United Arab Emirates

Compulsive buying is particularly relevant in nations with high levels of consumer spending. Most previous studies have focused on European and North America populations. This study explores compulsive buying amongst citizens of the United Arab Emirates, an Arab nation with high retail outlet density, and high levels of consumer spending. Female college students (N=100) completed an English/Arabic version of the compulsive buying scale along with a measure of depression. Rates of compulsive buying were higher than those reported in any previously published study. Furthermore, in line with previous findings from other nations, compulsive buying was associated with elevated depressive symptomatology.

Suicidal behavior and attitudes among medical students in the United Arab Emirates

BACKGROUND

Few studies have investigated suicidal behavior and attitudes of medical students. We are not aware of any previous reports emerging from the Arab world.

AIMS

To investigate suicidal behavior and attitudes among medical students in the United Arab Emirates (UAE).

METHOD

The prevalence of suicidal ideation and attempts as well as attitudes toward suicide and reactions to a hypothetical suicidal friend were assessed using a self-report survey. Furthermore, the survey included the self-assessment of the current mood and religiosity, and socio-demographic information.

RESULTS

A group of 115 medical students (mean age 20.7 years, 59.1% female) participated in the survey. The prevalence of lifetime suicidal ideation was 17.5% and of suicide attempts 1.8%. In general, students showed very low acceptability of suicide, strong beliefs in the punishment after death, and highly endorsed communicating problems with parents. Moreover, high acceptance of and support for a suicidal friend were found. Sadness was associated with higher acceptability of suicide and fewer beliefs in punishment after death. Religiosity was associated with less acceptability of suicide, seeing suicide in context of mental illness, communicating problems with parents, and greater support for a suicidal friend.

CONCLUSIONS

The prevalence of suicidal ideation and attempts among medical students in the UAE was in the lower range in international comparison. Negative attitudes toward suicide were accompanied by a strong support for a suicidal friend, and both were related to religiosity.

Predictors of Counseling Center Use Among College Students in the United Arab Emirates

College students’ decision to seek counseling is impacted by many factors such as demographic and psychological variables. This study investigated the differences between counseled (40 men and 120 women) and noncounseled (98 men and 111 women) college students from the United Arab Emirates using 3 measures of distress and a number of demographic variables (i.e., gender, marital status, residence, nationality, area of study, and grade point average). The counseled group reported more health concerns, symptoms of anxiety and depression, and psychological distress when compared with the noncounseled. Women reported more psychological distress than men. Discriminant analysis revealed that the most important predictors of whether a student would seek counseling were measures of general health, psychological distress, depression and anxiety, area of study, and gender, in that order. Of the noncounseled students, the majority claimed to be in need of counseling. Findings were discussed within the context of Emirati culture. Findings suggested that seeking psychological help may be stigmatized in Arab culture.

Disordered eating attitudes and symptomatology among adolescent girls in the United Arab Emirates

OBJECTIVE

To ascertain the prevalence and correlates of disordered eating attitudes and symptomatology in a school-based Arab population.

METHODS

A representative stratified random sample of 495 adolescent girls completed the Eating Attitudes Test (EAT-40) in the United Arab Emirates (UAE). A randomly selected subgroup from the those who scored above the recommended cut-off of 30 on the EAT-40 and an equal number of those who scored below 30 were interviewed in stage 2 by a psychiatrist, blind to the EAT scores, using the Schedule for Affective Disorders and Schizophrenia (KSADS) and DSM-IV criteria for the presence of eating disorders.

RESULTS

116 girls (23.4%) scored above the recommended cut-off on EAT. High EAT score was associated with age, BMI, internalization of thin ideal and drive for thinness, knowing someone on a weight loss strategy, having a family member with weight-related or mental health problem and watching western TV programs. Using clinical interview of 100 girls in stage 2, half of those who scored above the cut-off on EAT were found to have a propensity for anorexic behavior, while 2% met the criteria for the full clinical syndrome.

CONCLUSIONS

Thin body preoccupation as well as family and social factors are important in the development of abnormal eating attitudes among adolescents in this Arabian Gulf country.