The immediate psychological response of the general population in Saudi Arabia during COVID-19 pandemic: A cross-sectional study

Unmasking the psychological impact of the early COVID-19 pandemic in young adults: results from a cross-sectional online survey

Background

The COVID-19 pandemic emerged as an international public health emergency and threat to individual psychological resilience.

Objective

To examine the prevalence of psychological issues and identify key associations with mental health indicators in young adults (ages 18-28) worldwide during the initial phase of the pandemic.

Methods

Through a cross-sectional online survey utilizing convenience sampling, we collected data on demographics, COVID-19-related questions, depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), stress/trauma (Impact of Event Scale-Revised), and fear of COVID-19 (Fear of COVID-19 scale) between September 2020-January 2021. A total of 183 were eligible analysis. All statistical analyses were set at alpha = 0.05.

Results

Over 70% of participants reported mild anxiety (n=129), 80% mild depression (n=136), 40% pandemic-related trauma (n=61), and 50% high fear (n=88). Female respondents reported higher anxiety (t(173)=-3.352, <.001), depression (t(166)=-3.310, P=.001), and trauma from COVID-19 ((t(151)=-2.004, P=.047). Hispanic/Latino/a/x participants reported higher depression (F(2,156)=7.761, P<.001) and trauma scores (F(2,143)=3.999, P=.020). Age in 2020 was associated with trauma total scores (F(1,154)=4.230, P=0.041, R2 = 0.027). Individuals who were mandated a quarantine were linked to lower levels of anxiety (F(2,175)=3.442, P=.034) and depression (F(2,170)=3.092, P =.048) than those not mandated. Those quarantined with close contacts were linked to lower anxiety (t(162.184)=2.705, P =.008) and trauma (t(149)=2.169; P=.032). Close contacts' hospitalization from COVID-19 infections were linked to lower anxiety (t(127)=2.855, P=.005), depression(t(123)=3.111, P=.002), and trauma (t(152)=-1.975, P=.050).

Conclusion

The findings highlight the significant effect COVID-19 had on mental health in young adults worldwide.

Burnout Among Primary Healthcare Nurses: A Study of Association With Depression, Anxiety and Self-Efficacy

Burnout is a significant issue among healthcare professionals, particularly nurses, due to high workloads and emotional demands. However, limited research has explored burnout among primary healthcare nurses in Saudi Arabia, who play a vital role in healthcare delivery. This study aims to address this gap by investigating burnout levels and their association with anxiety, depression and self-efficacy among primary healthcare nurses. A cross-sectional survey design was employed, with 161 primary healthcare nurses from the Qassim region, Saudi Arabia. Data were collected using the Maslach Burnout Inventory, the Patient Health Questionnaire-4 and the General Self-Efficacy Scale. Pearson correlation and logistic regression were used to analyse the associations between study variables. A high prevalence of burnout risk (78.9%) was observed. Emotional exhaustion was detected in 35.4%, depersonalisation in 44.7% and low personal accomplishment in 57.8%. Anxiety (r = 0.707, p < 0.01) and depression (r = 0.564, p < 0.01) were positively correlated with emotional exhaustion, while self-efficacy was negatively correlated (r = -0.260, p < 0.05). Logistic regression analysis revealed that anxiety (OR = 5.784, 95% CI: 2.056-16.269) and low self-efficacy (OR = 6.625, 95% CI: 2.979-14.737) were significant predictors of burnout. Targeted interventions are essential to mitigate burnout among primary healthcare nurses. Specific measures could include mindfulness-based stress reduction programmes to address emotional exhaustion, peer support sessions to reduce depersonalisation and skill-building workshops to enhance self-efficacy. These interventions can improve nurse well-being and ensure sustainable healthcare delivery in primary care settings.

Assessing the prevalence of generalized anxiety disorder in a multicultural medical education setting in Saudi Arabia during the COVID-19 pandemic

Introduction

Mental health among medical students is an area that has been increasingly garnering world-wide attention. Yet, despite this increased attention, research related to anxiety disorders in Saudi Arabia remain limited. This study aims to address this gap by assessing the prevalence of generalized anxiety disorder (GAD) as well as explore its association with students' sociodemographic factors and academic performance among medical students in a Saudi Arabian institute that has a diverse, multicultural student body.

Methods

The study takes place in a unique educational environment: a privately funded institute in Riyadh, the capital of Saudi Arabia, with 32% of its student body comprising international students from over 40 countries, during the COVID-19 pandemic. The study deploys the use of a survey that was sent to the students at this institute via their institutional emails. A survey containing 33 items assessing demographics, GAD using GAD-7 questionnaire, stress-relief measures, online learning experience during the pandemic, mental disorders, anxiety associated with the pandemic, two open-ended questions, and one item assessing sleep difficulty.

Results

The results of the survey showed that a significant majority of the responders' scores in the GAD-7 assessment were in the range of moderate to severe anxiety. The results also suggest that low cGPA and the first academic years are significantly associated with higher GAD-7 scores. Students found severe time constraints, difficult educational content, and lack of psychological support to be major sources of stress. Furthermore, students suggested providing an in-house psychologist, personalized feedback, and guidance on study tactics as methods to reduce anxiety.

Conclusion

These findings, among others, suggest a need for further studies and research in this field to uncover broader patterns and inform targeted mental health support strategies.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Impact of COVID-19 related movement restrictions on the follow-up care visits of adults with chronic conditions: A Saudi arabian survey study

Aims

Lockdown measures implemented during the initial phase of the pandemic resulted in the delay and disruption of healthcare utilization for individuals with chronic conditions. We aimed to evaluate the impact of COVID-19 movement restrictions on the follow-up care visits of individuals with chronic illnesses. We also assessed the possible reasons patients missed their follow-ups and the potential barriers impeding follow-up during the pandemic.

Methods

A total of 397 adults with pre-existing medical conditions participated in an online cross-sectional survey from October to December 2022. The study sample comprised 57 % females and 43 % males, with a mean age of 43 years. A 36-item online self-report survey was used for data collection.Results: Fifty-five percent of participants reported missing their follow-up during COVID-19 pandemic, and 14 % made emergency department visits due to their missed follow-up appointments. In addition, 24 % experienced complications due to their missed appointments. The mean score on the fear of COVID-19 scale was 17.8 ± 6.5 (SD). For the majority of participants (60 %), pandemic-related restrictions were the predominant barrier to their follow-up visits. Additionally, we found that as individuals' COVID-19 fear scores increased, the likelihood of missing a follow-up care visit also increased (AOR: 1.067; p-value = 0.001). However, participants who did not perceive COVID-19 pandemic-related restrictions as a barrier were less likely to miss their follow-up visits (AOR: 0.581; p-value = 0.031). Furthermore, those who understood the significance of follow-up care were less likely to miss any of their follow-up visits (AOR: 0.224; p-value < 0.001) than those who had limited understanding of its importance.

Conclusion

The results showed that pandemic-related movement restrictions negatively affected attendance at follow-up visits for people with pre-existing health conditions. Initiatives should therefore be undertaken during global public health emergencies to provide medical and psychological support to vulnerable and high-risk groups.

COVID-19 exposure and depression-anxiety levels among Saudi adults in the Jazan region: a study with a predominantly female and undergraduate sample

Background

The COVID-19 pandemic has caused significant mental health challenges worldwide, as evidenced by numerous studies indicating high levels of depression and anxiety among individuals. However, the extent of mental health disorders following the pandemic and the association between anxiety and depression and COVID-19 exposure levels in the Jazan region of the Kingdom of Saudi Arabia have received little research attention.

Methods

A convenience sample of 377 participants, predominantly female (85.4%) with undergraduate education (74.5%) and Saudi nationality (92.8%), was included in the study. The study utilized a self-administered questionnaire to collect data from participants between 1st August and 8th September 2022. The questionnaire consisted of four parts, including demographic characteristics, COVID-19 exposure, the Patient Health Questionnaire-9 (PHQ-9) for depression assessment, and the Generalized Anxiety Disorders-7 (GAD-7) for anxiety evaluation. Statistical techniques such as descriptive statistics, independent t-tests, ANOVA (Analysis of Variance), and regression analysis were employed to analyze the collected data.

Results

The mean age of the study participants was 30.97 years (SD = 9.072). The mean score for COVID-19 exposure was 2.98 (SD = 1.48). The mean level of depression was 7.83 (SD = 6.43), with 20% of participants experiencing moderate to severe depression. Additionally, the study found that the mean score of anxiety level among participants was 6.75 (SD = 6.57), with 26% of the participants experiencing moderate to severe anxiety. Independent t-test revealed significant differences in mean depression and anxiety scores between participants with varying COVID-19 exposure levels (p = 0.001). The regression analysis demonstrated that anxiety levels were significant predictors of depression (p < 0.001). There is a significant difference in the depression mean between participants with high levels of anxiety (≥10) compared to others with levels <10. Furthermore, significant predictors of anxiety levels included either student or unemployment status (p < 0.001), increased age (≥35) (p = 0.049), female gender (p = 0.009), marital status of not being married, divorced, or widowed (p = 0.004), low monthly income (p = 0.019), and increased depression level (p < 0.001).

Conclusion

This study provides evidence of significant depression and anxiety levels among participants, with higher COVID-19 infection exposure correlating with increased scores for both. Anxiety was identified as a significant predictor of depression. Demographic factors, such as employment status, age, gender, and marital status, played a role in influencing anxiety levels. The findings highlight the need for targeted mental health interventions to address the psychological impact of COVID-19 infection exposure and support affected individuals effectively.

Depression, Anxiety, and Stress During COVID-19 Pandemic Among Females Who Live in Kuwait

Health regulations to constrain the progress of the pandemic such as lockdowns, curfews, and quarantines made radical alterations in every aspect of individuals' lives, causing significant impact on their mental health and well-being. The current study aimed to examine whether there are significant differences in participants' sociodemographic variables in reported cases of depression, anxiety, and stress among women who lived in Kuwait during the curfew and lockdown caused by COVID-19 pandemic. This study used a cross-sectional method. A nonrandom sample of 596 participants was recruited. The current study found that women at higher risk of reporting more incidents of depression, anxiety, and stress during the lockdown and curfew were from the older age group above 50 years old, hold higher educational certificates, and own private businesses. High rates of reported depression and anxiety were detected significantly among Kuwaiti women. The findings of this study reveal the significant impact of an uncomfortable and distressful environment during the COVID-19 pandemic, which may negatively affected individuals' mental health and generated diverse forms of psychosocial illness.

COVID-19-Related Stressors and Clinical Mental Health Symptoms in a Northeast US Sample

Research has linked specific COVID-19-related stressors to the mental health burden, yet most previous studies have examined only a limited number of stressors and have paid little attention to their clinical significance. This study tested the hypothesis that individuals who reported greater COVID-19-related stressors would be more likely to have elevated levels of anxiety, posttraumatic stress symptoms, and serious psychological distress.

METHODS

An online survey was administered to a convenience sample from 18 June to 19 July 2020, in US states that were most affected by COVID-19 infections and deaths at the time. Individuals who were 18 or older and residents of five Northeast US states were eligible to participate (N = 1079). In preregistered analyses, we used logistic regression models to test the associations of COVID-19 stressors with symptoms on the Generalized Anxiety Disorder-7 (GAD-7), Impact of Event Scale-Revised, and K6, adjusting for sociodemographic covariates.

RESULTS

COVID-19-related stressors (i.e., essential worker status, worry about COVID-19 infection, knowing someone hospitalized by COVID-19, having children under 14 at home, loneliness, barriers to environmental rewards, food insecurity, loss of employment) were associated with meeting thresholds (i.e., positive screening) for anxiety, posttraumatic stress, and/or serious psychological distress. Loneliness and barriers to environmental rewards were associated with all mental health outcomes.

LIMITATIONS

We used a non-probability sample and cannot assume temporal precedence of stressors with regard to development of mental health symptoms.

CONCLUSIONS

These findings link specific stressors to the mental health burden of the COVID-19 pandemic.

Public Knowledge, Attitudes, and Practices Toward COVID-19 Pandemic: A Cross-Sectional Study in Delhi and National Capital Region (NCR), India

To assess knowledge, attitudes, and practices of people toward coronavirus disease 2019 (COVID-19) pandemic in National Capital Territory of Delhi and National Capital Region (NCR), India. Various nations, including India, devised strategies to impose lockdowns and movement restrictions on their citizens in order to mitigate the effects of COVID-19. Cooperation and compliance by the populace are crucial to the effectiveness of such measures. People's knowledge, attitudes, and behavior toward such diseases are crucial in determining the adaptability of a society to such changes. Using Google Forms, a self-designed semi-structured questionnaire was created. This study is cross-sectional. Participants were eligible to participate if they were over the age of 18 and presently resided in the study area. The questionnaire included demographic variables such as gender, age, location, occupation, and income level. A total of 1,002 people completed the survey. A 48.80% of the respondents in the study group were females. The mean knowledge score was 13.14 (Maximum Score = 17), while the mean attitude score was 27.24 (Maximum Score = 30). Most of the respondents (96%) had adequate knowledge about the disease's symptoms. A 91% of the respondents had an average attitude score. A 74.85% of respondents accepted that they had avoided large social events. Gender had a negligible impact on the average knowledge score, while the score differed significantly across education levels and occupation categories. Consistent dissemination of messages regarding the virus, its spread, control measures implemented, and precautions expected from the public aids in reassuring the public and reducing their anxiety regarding the virus.

The Relationship Between Social Interaction and Anxiety Regarding COVID-19 in Japanese Older Adults

While previous studies suggest that women have higher anxiety than men regarding COVID-19, underlying mechanisms remain unclear. This study tries to explain the mechanisms by gender difference in social interaction based on a theory of social amplification of risk framework (SARF). We surveyed older adults in Japan regarding their anxiety regarding COVID-19, as well as the frequencies of their direct and indirect social interaction in July 2020 (N = 1,587, aged 78-99 years). To explore the way in which gender and anxiety regarding COVID-19 were mediated by these two types of social interactions, MODEL4 of SPSS's Process MACRO was applied to the data. We found that older women interacted more directly and indirectly with others than did older men. And, direct social interaction was negatively and related, but indirect social interaction was positively related to older adults' anxiety regarding COVID-19. Furthermore, direct social interaction was related to older women's low anxiety regarding COVID-19, whereas indirect social interaction was related to older women's high anxiety regarding COVID-19. The findings of our study suggest that the degree of anxiety regarding COVID-19 among older women may be dependent upon the types of social interaction they have with others.

Logistic regression analysis for studying the impact of home quarantine on psychological health during COVID-19 in Saudi Arabia

During the Coronavirus disease (COVID-19) period, the world witnessed a complete closure of all aspects of social life, and people must go for home quarantine to limit the spread of Corona virus disease. This study aims to use multiple logistic regression model (MLR) to identify the impact of home quarantine on psychological stability of individuals and its relationship to various factors. Maximum likelihood is used to estimate the parameters of MLR. Hosmer-Lemeshow method and Wald statistic are calculated to assess the significance of MLR. Cross sectional study was carried out and MLR was fitted to the collected data. This study applied to 846 residents of Makkah region during the COVID-19 period. High percentage of respondents felt psychological stability during the period of home quarantine. Logistic regression model showed that education level and psychological disorders during home quarantine were the significant risk factors for psychological stability during COVID-19. In addition, the positive impact of the home quarantine that people became more attention to their health, more interested to self-development and the families become close to each other. On the other hand, people on private employee or unemployed had psychological disorders more than others due to home quarantine and decrease their income.

Emotional Contagion Scale and Mental Health Status during the First Wave of COVID-19 Pandemic, National Assessment

Background

This great pandemic of COVID-19 has been a unique stressor that affected all communities in 2020. This study aims to examine the prevalence of anxiety and depression due to the COVID-19 pandemic in Saudi Arabia and to study the emotional cognition scale in the Kingdom of Saudi Arabia (KSA) in relation to the COVID-19 pandemic.

Methodology

A descriptive cross-sectional study was conducted on 857 inhabitants randomly selected from the 13 administrative regions of Saudi Arabia, using a validated self-administrated questionnaire comprising six sections. The collected data were summarized and analyzed.

Results

Among the majority of the studied participants, 377 (44.0%) were aged from 35 to less than 50 y. There were 489 (57.1%) females and 368 (42.9%) males, 616 (71.9%) Saudi nationals, 715 (83.4%) university-educated or postgraduate, 619 (72.2%) unmarried and 238 (27.8%) married, and 663 (77.4%) living in areas under partial lockdown. The resultant elevated total depression score was statistically significant (p<0.05) for the following: participants younger than 35y, females, Saudis, those with lower education levels, those who were married, students, those with work suspension during the COVID-19 pandemic, and amongst those who experienced complete lockdown. Among the majority of the studied participants, 355 (41.2%) showed mild depression, and 281(32.6) showed moderate anxiety, and were in the growth zone. In addition, the elevated total anxiety score was statistically significant (p<0.05) amongst the following; younger participants, females, Saudi nationals, those with lower educational levels, those who were unmarried, students, those with telework, and those with no curfew.

Conclusion

The adverse mental health effects were more prevalent among particular groups of the population, such as females, adults under 35 years old, students, those with lower educational attainments, and those suffering from chronic illnesses. Anxiety was significantly correlated with depression. The practice of preventive measures, e.g., wearing masks, and social distancing to prevent the spread of COVID-19, may have had psychological benefits during the pandemic.

Summary

We assessed the mental health status in Saudi Arabia during the first wave of the COVID-19 pandemic. Mild depression and moderate anxiety were prevalent problems, with many determinants and interrelations. Fear was the most infectious emotion, while happiness was the highest.

The mental health of healthcare workers in GCC countries during the COVID-19 pandemic: A systematic review and meta-analysis

Objectives

The aim of this study was to summarize the available evidence on the prevalence of stress, burnout, anxiety and depression among healthcare providers in the Gulf Cooperation Council (GCC) countries (KSA, Bahrain, Kuwait, Oman, Qatar, and the United Arab Emirates) during the COVID-19 pandemic.

Methods

We searched PubMed, PsycINFO, Scopus, and Google scholar for related studies published between January 2020 and April 2021 and conducted a systematic review and meta-analysis.

Results

Of the 1815 identified studies, 29 met the inclusion criteria, and 19 studies were included in the meta-analysis. The pooled estimate of prevalence for moderate to severe anxiety as reported using GAD-7 was 34.57% (95% CI = 19.73%, 51.12%), that for moderate to severe depression using PHQ-9 was 53.12% (95% CI = 32.76%, 72.96%), and that for moderate to severe stress using the 10-item Perceived Stress Scales was 81.12% (95% CI = 72.15%, 88.70%). Meta-analysis was not performed for burnout due to the small number of identified studies and the different tools used; however, the highest prevalence was reported at 76% (95% CI = 64%, 85%). Overall, a positive trend was observed over time for moderate to severe anxiety and depression, p = 0.0059 and 0.0762, respectively. Of note, the heterogeneity was significant among the studies, and many studies were of poor quality.

Conclusion

The prevalence of mental health disorders during the current pandemic among healthcare workers in GCC countries is high. However, the results could be affected by the high heterogeneity and low quality studies.

Trends in emergency department visits for mental health disorder diagnoses before and during the COVID-19 pandemic: a retrospective cohort study 2018-2021

BACKGROUND

As the pandemic started, Saudi Arabia applied extreme measures in responses to the pandemic crises, which have adversely affected individuals' mental health. Therefore, the aim of this study is to describe trends in mental health disorder ED visit before and after the pandemic in two medical centers in Saudi Arabia.

METHODS

A retrospective cohort study using data from electronic health records in the Ministry of National Guard Health Affairs' (MNG-HA) in Saudi Arabia. Multiple logistic regression model was used to examine the age and sex differences in mental health disorder ED visits before and during the COVID19 pandemic.

RESULTS

A total of 1117 ED psychiatric visits, a sharp increase in the number of psychiatric ED visits during the pandemic with an average increase of 25.66% was observed. During the pandemic, psychiatric ED visits were significantly higher in females (adjusted AOR 1.41, 95% CI 1.08, 1.83) than males. During the COVID19 pandemic, generalized anxiety disorder was the most common psychiatric ED disorder with reported increase of visits by 53.34% (p-value 0.005).

CONCLUSION

ED psychiatric visits have consistently increased before and during the COVID19 pandemic. Interventions for mental health related disorders are urgently needed for preventing mental health problems among females.

[Incidence and predictors of peri-traumatic reactions in an Algerian population faced with COVID-19]

Objectives

This study explored two related questions: (1) the incidence of peri-traumatic distress and dissociation in a general Algerian population during the initial stages of the COVID-19 epidemic; (2) sociodemographic predictors of peri-traumatic reaction. The objective is to better understand the peri-traumatic experience in order to identify vulnerable people to whom psychological care could be offered.

Materials and methods

An online descriptive survey containing three questionnaires, a demographic questionnaire, the questionnaire for peri-traumatic distress and the questionnaire for peri-traumatic dissociation experiences, was conducted using the snowball sampling technique to select 1374 Algerians.

Results

The results of this survey indicate that 32.7 % of the participants present a peri-traumatic distress and 61.8 % of the participants present a significant level of peri-traumatic dissociation during the initial phases of the COVID-19 pandemic. In addition to confinement, stress, female gender, the origin of a particularly affected department, the average economic situation and a history of psychological problems are predictors of peri-traumatic distress.

Conclusion

This study provides the first empirical data on the incidence of peri-traumatic reactions (distress and dissociation), as well as their predictors in an Algerian population during the initial phases of the COVID-19 epidemic. The Algerian population has experienced levels of distress in the low range of what has been described in the literature, while the dissociation shows that the majority of the population is affected. This result demonstrates the importance of measuring the peri-traumatic reactions according to the two dimensions of distress and dissociation, and offering psychological care for the most vulnerable people, in order to prevent the risk of their possible chronicisation, and developing post-traumatic stress disorder in later periods.

Symptoms of psychological distress amongst women during the COVID-19 pandemic in Saudi Arabia

BACKGROUND

Since the emergence of the COVID-19 pandemic in early 2020, several countries are still struggling to contain its spread. Apart from economic challenges, the pandemic has had a negative impact on the mental health and psychological well-being of millions of people worldwide. The effects of COVID-19 are disproportionate depending on sociodemographic characteristics. The aim of this study was to investigate the impact of COVID-19 on psychological distress among women in Saudi Arabia.

METHODS

Data were extracted from an online cross-sectional self-reported questionnaire conducted to measure symptoms of psychological distress during the COVID-19 pandemic in Saudi Arabia from 3 May to 8 May 2020. The study included a sample of 1527 women. The questionnaire was based on the COVID-19 Peritraumatic Distress Index (CPDI) tool to categorise women who responded to the questionnaire as experiencing normal, mild, or severe levels of distress. Sociodemographic factors related to different levels of psychological distress among women were examined using descriptive analysis and multinomial logistic regression models.

RESULTS

Overall, 44% of the respondents indicated symptoms of psychological distress due to the COVID-19 pandemic. Approximately 36% of women showed symptoms of mild psychological distress, with 8% of women experiencing a severe distress level. The results also revealed particularly high levels of psychological distress among younger women and female healthcare workers.

CONCLUSION

The COVID-19 pandemic highly contributes to psychological distress among women in Saudi Arabia. Therefore, it is essential to establish medium- and long-term strategies that target the most vulnerable women affected by the COVID-19 pandemic.

Contrasting Association Between COVID-19 Vaccine Hesitancy and Mental Health Status in India and Saudi Arabia-A Preliminary Evidence Collected During the Second Wave of COVID-19 Pandemic

Background

Vaccine hesitancy is a global public health threat. Understanding the role of psychological factors in vaccine hesitancy is often neglected and relatively less explored.

Aim and Objectives

To analyze the relationship between mental health and COVID-19 vaccine hesitancy before and after the advent of COVID-19 vaccines (AC19V) in the general population of India and Saudi Arabia (KSA) which vary in severity of the pandemic and vaccine mandates.

Materials and Methods

A total of 677 adult participants from India and KSA participated in this cross-sectional online web-based survey. Sociodemographic details and current COVID-19 status pertaining to infection and vaccination were collected. Depression, anxiety, post-traumatic stress disorder (PTSD) symptoms, and perceptive need for mental health support (MHS) were assessed before and after AC19V. A newly constructed and validated COVID19 vaccine hesitancy scale-12 (COVID19-VHS12) scale was used to evaluate the COVID-19 vaccine hesitancy.

Results

Prevalence and levels of depression and anxiety symptoms decreased significantly in Saudis but not in Indians after AC19V. PTSD symptoms showed a significant reduction in both India and KSA. Anxiety symptoms were higher in KSA than India before AC19V while PTSD was higher in India before and after AC19V. Except for the place of residence and employment status, the subgroups of sociodemographic variables which were at higher risk of negative mental health before AC19V showed improvement in their mental health after AC19V. The prevalence of COVID-19 vaccine hesitancy in India and KSA was 50.8% (95% CI 45.73–55.89%) and 55.7% (95% CI 50.16–61.31%), respectively. A bidirectional association between vaccine hesitancy and mental health was observed in KSA but not in India. Higher vaccine hesitancy favored higher levels of depression, anxiety, and perceptive need for MHS and vice versa in KSA. None of the mental health parameters predicted vaccine hesitancy in India, while higher vaccine hesitancy increased the risk of anxiety.

Conclusion

Vaccine hesitancy has a negative impact on mental health and vice versa over and above the impact of sociodemographic factors and COVID-19 vaccination and infection status which shows variations between India and KSA.

Associations of Depression and Anxiety with Stigma in a Sample of Patients in Saudi Arabia Who Recovered from COVID-19

Purpose

The coronavirus disease (COVID-19) outbreak combined with social distancing, isolation, and movement restrictions has had a profound impact on individuals’ physical and psychological well-being. The aim of this study was to examine the associations of depression and anxiety with feelings of stigma among patients in Saudi Arabia who have recovered from COVID-19.

Materials and Methods

A cross-sectional survey was conducted between July and December 2020. Trained healthcare providers contacted and interviewed participants by phone. Depression, anxiety, and stigma were assessed using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7) questionnaire, and the Explanatory Model Interview Catalogue stigma scale (EMIC). Data on sociodemographic characteristics, comorbidities, and family history of mental illness were also collected. Multiple linear regression models were performed to explore factors associated with depression and anxiety.

Results

A total of 174 adult participants (≥18 years old) who had recently recovered from COVID-19 were interviewed. The mean PHQ-9 and GAD-7 scores were 7.53 (±5.04) and 3.77 (±4.47), respectively. About 68% of the participants had at least mild depression (PHQ-9 score of 5–9), whereas only 29.89% had at least mild anxiety (GAD-7 score of 5–9) during their infections with COVID-19. Multiple linear regression showed that females were more vulnerable to depression and anxiety disorders than their male counterparts were (β=3.071 and β=1.86, respectively). Notably, participants’ stigma scores were significantly associated with higher scores on depression and anxiety.

Conclusion

These findings highlight the negative consequences of COVID-19 infection on the mental health of recovered patients. Therefore, considerable attention from local and international health authorities is needed to improve the mental well-being of recovered COVID-19 patients.

Increased psychological distress after the lifting of COVID-19 lockdown in the Saudi population: a cross-sectional study

Background

Amid the ongoing COVID-19 pandemic and its global health and socioeconomic aftereffects, the enduring state of crisis is increasingly impacting the coping capacity of the populations. In this study, we aimed to characterize the levels of psychological distress after the lifting of COVID-19 lockdown.

Results

The Impact of Event Scale (IES-R) and Depression, Anxiety, and Stress Scales-21 items (DASS-21) were used to screen for post-traumatic stress syndrome (PTSD), depression, anxiety, and stress. The prevalence of PTSD was 41.6% and was associated with severe or extremely severe stress (27.8%), anxiety (31.4%), and depression (39.0%). All disorders were strongly correlated with one another. The risk of developing PTSD was independently associated with residence in high COVID-19 prevalence region (OR = 2.25, p = 0.004), poor (OR = 3.98, p = 0.002), or moderate (OR = 1.63, p = 0.048) self-assessed overall physical health, psychiatric comorbidity (OR = 1.87, p = 0.036), number of COVID-19-like symptoms (OR = 1.94, p = 0.039), and severe COVID-19 morbidity in the acquaintances (OR = 1.54, p = 0.026). Four theories were proposed to explain these high figures, with a discussion of their practical implications.

Conclusions

The lifting of lockdown measures was associated with a substantial increase in psychological distress among the Saudi population, referring to figures reported during the lockdown. This may indicate a decline in the overall population’s coping capacity with the enduring crisis.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.

PURPOSE

To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.

PATIENTS AND METHODS

This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.

RESULTS

Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.

CONCLUSION

The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

Factors associated with depression and anxiety in the adult population of Qatar after the first COVID-19 wave: a cross-sectional study

There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, and COVID-19 infection and mortality rates. The main purpose of the study is to identify the factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey in Qatar between July and December 2020 after Qatar’s first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the Patient Health Questionnaire-Anxiety Depression Scale (PHQ-ADS). Of 1138 participants, 71.0% were female, 69.0% Arabs, 70.0% Non-Qataris, and 77.0% were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with moderate-to-severe levels of depression or anxiety on the PHQ-ADS; Arab ethnicity (OR = 1.67, p = 0.026), never married versus married (OR = 1.69, p = 0.015), prior history of psychiatric disorder versus no history (OR = 1.80, p = 0.009), increased worries due to social media use for COVID-related news/updates (OR = 1.72, p = 0.003), a history of COVID-19 (OR = 1.76, p = 0.039), loneliness (OR = 1.91, p < 0.001), and lower levels of religiosity (OR = 0.96, p = 0.039). These associations also pertained in the reduced model, with the exception of religiosity which was only marginally statistically significant (OR = 0.97, p = 0.055). The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, and similar national events, and assist with early intervention to treat sufferers.

The psychological and emotional impact of coronavirus disease on COVID-19 patients in Najran Province, Saudi Arabia: An exploratory study

BACKGROUND

The COVID-19 pandemic contributes to a significant mental health crisis. This pandemic caused a widening economic crisis, growing financial loss, and numerous uncertainties. This pandemic brought alarming implications and overall increased risk for psychiatric illness. This study explores the psychological impact experienced by patients who tested positive from coronavirus disease in the Najran region, Saudi Arabia.

DESIGN AND METHODS

This exploratory analysis included 210 COVID-19 positive patients. The study was conducted during a six month period starting from March to September 2020, in two tertiary government hospitals in Najran, Saudi Arabia. Samples were selected using purposive sampling. The researches utilized survey questionnaire and face-to-face interview to collect the data. The statistical data were calculated using IBM Statistical Package for Social Sciences version 2.0 to compute the following statistical formulas: percentage distribution, mean, standard deviation, and Chi-square test of independence.

RESULTS

The findings of this study revealed that the majority of COVID-19 positive patients were middle-aged adults (n=98 or 46.7%), male (n=178 or 84.8%), and were non-Saudi nationals (n=132 or 62.9%). It was found out that COVID-19 patients experienced bothersome behaviour at a very high level (x̅=2.63 ± 0.6734). Meanwhile, depression (x̅=2.51 ± 0.7070), worry (x̅=2.23 ± 0.8811), and anxiety (x̅=2.21 ± 0.8719) was only at a high level.

CONCLUSIONS

The study findings revealed that the majority of participants had high levels of depression, anxiety and bothersome behaviours. However, demographic characteristics like age, sex, and nationality were not significantly related to coronavirus patients' psychological health problems during the pandemic. Assessment and interventions for psychosocial concerns, integration of mental health considerations, consultation with specialists, and treatment for severe psychosocial consequences must be administered in COVID-19 care facilities.

Mediating Effect of Chronic Illnesses in the Relationship Between Psychological Distress and COVID-19 Vaccine Acceptance

The impact of the COVID-19 pandemic on mental health is an emerging problem globally. This study aimed to examine the mediating effect of chronic illnesses in the relationship between psychological health and the acceptance of the COVID-19 vaccine, prior to the national vaccine rollout in Malaysia. An online cross-sectional study was conducted in Malaysia between December 10, 2020, and February 9, 2021. In addition to the descriptive analyses, a mediation analysis was performed to examine the mediating effect of chronic illnesses in the relationship between psychological distress and the willingness to accept the vaccine. A total of 1738 participants completed the survey. The psychological distress levels were found to be significantly different across demographic factors such as age, gender, and social economic status. This study demonstrated a partial mediating effect of chronic illnesses in the relationship between psychological distress and vaccine acceptance.

Pattern of dental needs and advice on Twitter during the COVID-19 pandemic in Saudi Arabia

Aim

To compare and evaluate the influence of the COVID-19 outbreak on tweets related to dental treatment needs and advice of Saudi Twitter users in 2020 by comparing them to the same time-period in 2019.

Methods

Eight independent searches based on dentistry related keywords: “teeth, mouth and gingiva” were carried out within the timeframe between the 23rd of March and the 21st of June for the years 2020 and 2019. Extracted tweets were analyzed by two calibrated examiners as tweets containing expressed dental needs and tweets for dental advice, while spam tweets were excluded. Descriptive analysis was performed to present the overview of the findings using SPSS. Bivariate analysis was performed with Pearson’s Chi Square, Fisher’s Exact test and Mann–Whitney U test. Statistical significance was set at p ≤ 0.05.

Results

A total of 595 tweets from the year 2019 and 714 tweets from the year 2020 were obtained. Overall, combined dental needs and advice tweets, retweets, likes, and replies were higher in 2020 compared to 2019. Dental needs tweets were higher in 2020 compared to 2019, while dental advice tweets were lower in 2020 compared to 2019. Statistically significant differences were found between 2020 and 2019 with regards to dental needs well as with dental advice (p < 0.05). In addition, statistically significant differences were found between 2019 and 2020 with presence of pain, urgency of the dental need and type of advisor (p < 0.05).

Conclusion

An obvious impact of the pandemic can be seen in the form of increased self-reported dental needs, pain and urgency among the public in Saudi Arabia. This study highlights the importance of social media, specifically Twitter, in expressing the public needs and utilizing it as a platform for education and advice.

The Economic and Psychological Impacts of COVID-19 Pandemic on Indian Migrant Workers in the Kingdom of Saudi Arabia

The ongoing Coronavirus disease 2019 (COVID-19) pandemic has changed the working environment, occupation, and living style of billions of people around the world. The severest impact of the coronavirus is on migrant communities; hence, it is relevant to assess the economic impact and mental status of the Indian migrants. This study is quantitative in nature and based on a sample survey of 180 migrant workers. Descriptive statistics, chi-square test, dependent sample t-test, and Pearson’s correlation coefficient were utilized to analyze the surveyed data. The findings of the study reveal, through the working experience of the migrants, that new international migration has reduced due to lockdown and international travel restrictions. It was also reported that the majority of the migrants worked less than the normal working hours during the lockdown, causing a reduction of salary and remittances. Chi-square test confirms that the perceptions of migrants towards the COVID-19 management by the government were significantly different in opinion by different occupation/profession. Majority of the sampled migrants reported the problem of nervousness, anxiety, and depression; however, they were also hopeful about the future. The psychological problem was severe for the migrants above the age of 40, not educated, and with a higher number of family members. Subsequently, the policy implications from the findings of the research can draw attention of the policy makers towards protective measures which need to be implemented to support migrants during the ongoing pandemic. The government should take some necessary steps, such as a financial benefit scheme, to overcome the problems in the reduction of migrant earnings and remittances. The government should not focus only on vaccination and physical fitness of the migrants but also need to find out the cure of the psychological impact arising during the pandemic.

Parental psychological distress and attitudes towards COVID-19 vaccination: A cross-sectional survey in Shenzhen, China

BACKGROUND

Parental attitudes towards the vaccines play a key role in the success of the herd immunity for the COVID-19. Psychological health seems to be a controversial determinant of vaccine hesitancy and remains to be investigated. This study attempted to measure parental psychological distress, attitudes towards the COVID-19 vaccine, and to explore the potential associations.

METHODS

An online survey using convenience sampling method was conducted among parents within the school public health network of Shenzhen. Demographic information and attitudes towards COVID-19 vaccination were collected. The Patient Health Questionnaire (PHQ-4) was applied to measure psychological distress.

RESULTS

Overall, 4,748 parents were included (average age: 40.28, standard deviation: 5.08). More than one fifth of them demonstrated psychological distress, in which only 3.3% were moderate to severe symptom. The proportions of COVID-19 vaccine hesitancy for themselves, their spouses, and their children were 25.2%, 26.1%, and 27.3%, respectively. Parents with psychological distress were more likely to suffer vaccine hesitancy for themselves (OR: 1.277, 95%CI: 1.091~1.494), for their spouses (OR:1.276, 95%CI: 1.088~1.496) and children (OR:1.274, 95%CI: 1.092~1.486). These associations tended to be more significant among parents with mild or severe psychological distress.

LIMITATION

Non-random sampling limited the generalization of our findings to all parents.

CONCLUSION

Parents had a low level of psychological distress but relatively high willingness of COVID-19 vaccination when there was no local epidemic but persistent risk of imported cases. Targeted health education and intervention strategies should be provided to people with vaccine hesitancy, especially for those who are susceptible to psychological distress.

COVID-19 related psychological distress and fears among mothers and pregnant women in Saudi Arabia

OBJECTIVES

This study objectives were to investigate maternal psychological distress, mothers' fear of their children contracting COVID-19, mothers' perceptions of the information available regarding children and COVID-19, changes in children's behavior during lockdown, and concerns of pregnant women in Saudi Arabia.

METHODS

This cross-sectional study surveyed women aged 18 years and older who either had children under 10 years of age or were pregnant at the time of the survey. The outcomes included psychological distress, mothers' fear of their children contracting COVID-19, change in children's behaviors during COVID-19 lockdown and pregnant women's concerns. Multivariable ordinary least squares regression models were employed to examine the adjusted associations between sociodemographic factors and psychological distress, as well as fear of COVID-19.

RESULTS

Of 628 women, 11.8% (n = 74) were pregnant at the time of survey. Most of the pregnant women (89.2%, n = 66) had some degree of concerns about their unborn babies getting infected during delivery in the hospital. Among mothers of children under 10 years of age (n = 564), half (n = 282) reported change in their children's behavior during the lockdown. Most mothers and pregnant women (94.9%, n = 569) had some degree of psychological distress. Mothers and pregnant women with a college degree had significantly lower psychological distress (β = -1.346; p = 0.014) than women with a high school education or less. Similarly, mothers and pregnant women with monthly family income ≥ US$ 1,333 had lower psychological distress than those with < US$ 1,333. Women with pre-existing chronic physical (β = 2.424; p < 0.001) or mental (β = 4.733; p < 0.001) conditions had higher psychological distress than those without these conditions. Having children in the house was a contributory factor for higher psychological distress. For example, mothers with one child (β = 2.602; p = 0.007) had significantly higher psychological distress compared to expectant mothers without children in the house.

CONCLUSIONS

Most mothers and expectant mothers in our study had moderate to high levels of psychological distress during the COVID-19 pandemic outbreak in Saudi Arabia. Education, family income and chronic mental and physical conditions were associated with high psychological distress in Saudi Arabia during COVID-19.

International survey of audiologists during the COVID-19 pandemic: effects on mental well-being of audiologists

OBJECTIVE

The aim of the study was to examine the mental well-being of audiologists in the midst of the COVID-19 pandemic.

DESIGN

A cross-sectional online survey was conducted during the COVID-19 pandemic, between 23 June and 13 August 2020. A self-report survey included screening measures for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3).

STUDY SAMPLE

239 audiologists from around the world.

RESULTS

The prevalence of psychological distress was 12.1% (subscales for anxiety 16.3% and depression 10.4%), and loneliness 32.2%. Depression and loneliness were higher in those participants self-reporting perceived job insecurity, with psychological distress (anxiety and depression) higher in those from South Africa. Accessibility to Employee Assistance Programs (EAPs) appears to be a protective factor.

CONCLUSIONS

Well-being interventions, such as EAPS, are needed to support audiologists during challenging times like the COVID-19 pandemic.

Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis

To provide a contemporary global prevalence of mental health issues among the general population amid the coronavirus disease-2019 (COVID-19) pandemic. We searched electronic databases, preprint databases, grey literature, and unpublished studies from January 1, 2020, to June 16, 2020 (updated on July 11, 2020), with no language restrictions. Observational studies using validated measurement tools and reporting data on mental health issues among the general population were screened to identify all relevant studies. We have included information from 32 different countries and 398,771 participants. The pooled prevalence of mental health issues amid the COVID-19 pandemic varied widely across countries and regions and was higher than previous reports before the COVID-19 outbreak began. The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress; and 27.6% for sleep problems. Data are limited for other aspects of mental health issues. Our findings highlight the disparities between countries in terms of the poverty impacts of COVID-19, preparedness of countries to respond, and economic vulnerabilities that impact the prevalence of mental health problems. Research on the social and economic burden is needed to better manage mental health problems during and after epidemics or pandemics. Systematic review registration: PROSPERO CRD 42020177120.

Drugs behind the veil of Islam: a view of Saudi youth

Insufficient research exists on drug trafficking and abuse in Saudi Arabia. This paper aims to uncover how drugs are trafficked to Saudi Arabia, what factors contribute to an ever-growing drug use in the Kingdom, and what the life of illegal drug use looks like in such an Islamic environment. Documentary methods and in-depth interviews were adopted to associate drug problems with social environments. It is discovered that drug trafficking is correlated to economic disparity among regions and social strata in the Kingdom, methods of drug purchase differ regionally, and drug use is an unintended consequence of social changes. The study concludes that drug offenses, countering traditional associations of Saudi society, creates a double life in the Kingdom.

Depression and Obsessive-Compulsive Disorders Amid the COVID-19 Pandemic in Saudi Arabia

Introduction: Coronavirus disease 2019 (COVID-19) is a global pandemic with significant morbidity and mortality. The Saudi government adopted mandatory home quarantine and curfew hours for all residents, excluding essential service workers. During the lockdown, the public's fear of infection can adversely impact mental health, causing psychological distress. The objective of this research is to assess frequency of depression and obsessive-compulsive disorder (OCD) among the general population during COVID-19 pandemic in Saudi Arabia.

Methodology: This was a cross-sectional study using the Patient Health Questionnaire (PHQ-9) and Obsessive-Compulsive Inventory-Revised assessment test (OCI-R) in Arabic and English languages distributed via social media platforms. Chi-square test was used with significance determined at p<0.005.

Results: We received a total of 2187 responses. Our results showed that being female, single, and unemployed had a higher frequency of suffering from depression whereas higher income levels and higher education was associated with less depression frequency. Increasing age, males, married individuals, higher income groups, higher levels of education and employed individuals were more likely to have OCD during COVID-19 pandemic. 

Conclusion: The COVID-19 pandemic period is associated with significant mental health risks among the Saudi population. The results can provide further scientific support to better understand the impact of quarantine on psychological distress and mental health during emergency and disaster situations. 

Research on Posttraumatic Stress Disorder in the Context of the COVID-19 Pandemic: A Review of Methods and Implications in General Population Samples

Increasing concern about the mental health sequelae to the COVID-19 pandemic has prompted a surge in research and publications on the prevalence of posttraumatic stress disorder in general population samples in relation to the pandemic. We examined how posttraumatic stress disorder in the context of the COVID-19 pandemic has been studied to date and found three general themes: (1) assessment of posttraumatic stress disorder and posttraumatic stress disorder symptoms relied on self-report measures and often did not determine direct trauma exposure as required by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criterion A to diagnose posttraumatic stress disorder; (2) inadequate assessment of pre-existing mental disorders and co-occurring stress; and (3) the use of cross-sectional designs in most studies, often relying on snowball sampling strategies to conduct online surveys. Notwithstanding these methodological limitations, these studies have reported moderate to severe posttraumatic symptoms in 25.8% of the general population on average in relation to the pandemic (ranging from 4.6% to 55.3%). Opportunities for advancing future research that will inform public health planning are discussed.