Cash transfers and mental health in Egypt

The relationship between poverty and mental health is complex. Conditional cash transfers are seen as an important policy tool in reducing poverty and fostering social protection. Evidence on the impact of cash transfers on mental health is mixed. In this study, we assess the causal impact of Egypt's conditional cash transfer (CCT) programme Takaful on the main recipients' mental health. Using a regression discontinuity design, we find that receiving the Takaful CCT does not have a significant impact on the anxiety levels of mothers in our sample. In addition, we do not find supporting evidence that the programme has heterogeneous impacts on anxiety levels. We discuss possible explanations behind these null results.

The effects of mindfulness-based techniques on self-rumination, cognitive reappraisal and expressive suppression among patients with major depression: a nursing perspective

Background

Patients with major depressive disorder (MDD) often struggle with adaptive strategies like self-reflection and cognitive reappraisal, relying instead on maladaptive ones like self-rumination and emotional suppression. Mindfulness-based techniques (MBTs) have been identified as a promising complementary psychological intervention for this population.

Aims

To evaluate the effects of MBTs on mindful attention awareness, self-rumination, self-reflection, cognitive reappraisal and expressive suppression in patients with MDD between patients who receive MBTs and those who do not.

Methods

This quasi-experimental research was carried out at the Psychiatric Outpatient Clinics. A representative sample of 120 patients with MDD were randomly recruited to either a study group (n = 60) or a control group (n = 60). The Mindful Attention Awareness Scale (MAAS), The Rumination-Reflection Questionnaire (RRQ) and The Emotion Regulation Questionnaire (ERQ) were utilised to collect data.

Results

After participation in MBTs, the study group had significantly greater improvements in the mean scores of MAAS, RRQ, Cognitive Reappraisal and Expressive Suppression compared to the control group (p < 0.001 each).

Recommendations

The study recommends developing and implementing training programmes for nurses to equip them with the skills and knowledge to effectively deliver MBTs as part of patient care. Conducting longitudinal studies is necessary to assess the sustainability of these improvements.

Comorbidity of depression and type 2 diabetes in Egypt results from the International Prevalence and Treatment of Diabetes and Depression (INTERPRET-DD) study

BACKGROUND

Diabetes mellitus and depression are serious common diseases, and the number of people with both conditions is rising steadily. Depression in people with diabetes mellitus results in poorer prognosis through different mechanisms. On the other hand, the presence of diabetes in individuals with depression increases functional impairment that is associated with depression.

AIMS

The study aimed to assess the prevalence and factors associated with depression among adults with type 2 diabetes mellitus attending a diabetes clinic in Cairo, Egypt.

METHODS

A cross-sectional study was conducted among adult patients with diabetes type 2 attending a diabetes clinic in the endocrinology department in Ain Shams University Teaching Hospital, Cairo, Egypt. Data were collected through face-to-face interviews by trained psychiatrists and from patients' records.

RESULTS

The prevalence of depression among diabetic patients was 21.8% (95% CI [15.6%, 29.1%]). Depression was more common among younger age groups and those with a higher level of education. There was no significant difference between those with lifetime depression compared to those without depression regarding physical health complications.

CONCLUSIONS

The prevalence of depression among patients with type 2 diabetes is high. Given the impact of co-morbid diabetes and depression, diabetic patients should be routinely screened for the latter condition.

The epidemiology of obsessive-compulsive disorder in the Kingdom of Saudi Arabia: Data from the Saudi National Mental Health Survey

AIMS

There is ongoing debate about the extent to which the epidemiology of OCD is similar across the world, given the lack of nationally representative data from key regions like the Middle East and North Africa. Using the nationally representative dataset from the Saudi National Mental Health Survey (SNMHS), we aimed to delineate the epidemiological profile of OCD in the Saudi population.

METHODS

A subsample of 1981 participants from the SNMHS was assessed. Prevalence estimates and correlates of OCD were determined using logistic regressions and cross tabulations.

RESULTS

The lifetime, 12-month, and 30-day prevalence estimates for OCD were 4.2%, 1.8%, and 1.6%, respectively, with hoarding being the most common symptom dimension. The mean age-of-onset of OCD was 16.8 years. In over two-thirds of respondents with lifetime (72.2%) or 12-month (71.2%), OCD was accompanied by comorbid mental disorder, particularly impulse control, anxiety, and mood disorders. Among individuals with 12-month OCD, 77.5% reported severe impairment, and only 9.2% received treatment.

CONCLUSIONS

In Saudi Arabia, OCD is a prevalent and persistent condition, characterized by early onset, high odds of mental comorbidity, and significant associated impairment. These findings emphasize the universality of OCD epidemiology and the need for improved diagnosis and treatment globally.

Decoding and reconstructing disease relations between dry eye and depression: a multimodal investigation comprising meta-analysis, genetic pathways and Mendelian randomization

INTRODUCTION

The clinical presentations of dry eye disease (DED) and depression (DEP) often comanifest. However, the robustness and the mechanisms underlying this association were undetermined.

OBJECTIVES

To this end, we set up a three-segment study that employed multimodality results (meta-analysis, genome-wide association study [GWAS] and Mendelian randomization [MR]) to elucidate the association, common pathways and causality between DED and DEP.

METHODS

A meta-analysis comprising 26 case-control studies was first conducted to confirm the DED-DEP association. Next, we performed a linkage disequilibrium (LD)-adjusted GWAS and targeted phenotype association study (PheWAS) in East Asian TW Biobank (TWB) and European UK Biobank (UKB) populations. Single-nucleotide polymorphisms (SNPs) were further screened for molecular interactions and common pathways at the functional gene level. To further elucidate the activated pathways in DED and DEP, a systemic transcriptome review was conducted on RNA sequencing samples from the Gene Expression Omnibus. Finally, 48 MR experiments were implemented to examine the bidirectional causation between DED and DEP.

RESULTS

Our meta-analysis showed that DED patients are associated with an increased DEP prevalence (OR = 1.83), while DEP patients have a concurrent higher risk of DED (OR = 2.34). Notably, cross-disease GWAS analysis revealed that similar genetic architecture (rG = 0.19) and pleiotropic functional genes contributed to phenotypes in both diseases. Through protein-protein interaction and ontology convergence, we summarized the pleiotropic functional genes under the ontology of immune activation, which was further validated by a transcriptome systemic review. Importantly, the inverse variance-weighted (IVW)-MR experiments in both TWB and UKB populations (p value <0.001) supported the bidirectional exposure-outcome causation for DED-to-DEP and DEP-to-DED. Despite stringent LD-corrected instrumental variable re-selection, the bidirectional causation between DED and DEP remained.

CONCLUSION

With the multi-modal evidence combined, we consolidated the association and causation between DED and DEP.

Association between genetic variants of GRM7 (rs1396409 and rs9883258) and treatment outcomes in Schizophrenic Egyptian patients

BACKGROUND AND AIM

This study evaluated the association between rs1396409 and rs9883258 and the risk of schizophrenia (SCZ) and treatment outcomes in Egyptian patients.

METHODS

This study included 88 patients with SCZ and 88 healthy controls. Lipid profile was assayed. Genotyping of rs1396409 and rs9883258 polymorphisms was analyzed using real-time PCR.

RESULTS

The rs1396409 AG genotype frequency was significantly associated with SCZ risk (p = 0.002). Also, significant increased risk of SCZ was observed under allelic (p = 0.001), dominant (p = 0.001) and overdominant (p = 0.001) genetic model of rs1396409. However, rs9883258 AA genotype revealed nonsignificant association with SCZ. Cases with the rs1396409AG genotype exhibited hypertriglyceridemia (p < 0.001) and hypercholesterolemia (p = 0.001). In total, 72.3% and 74.5% of the cases presented with rs1396409 AG have negative symptoms (p = 0.022) and exhibited poor drug response (p = 0.023), respectively; all cases with rs1396409 GG genotype attempted suicide (p = 0.002) and are drug-free (p = 0.003). SCZ patients with negative symptoms had hypercholesterolemia (p = 0.008) mainly low-density lipoproteins (LDLc) (p = 0.016), and those with cognitive symptoms presented with low level of high-density lipoprotein (HDLc) (p = 0.023). Moreover, the multivariate regression analysis revealed that both rs1396409 G allele and HDLc were predictors of SCZ (p = 0.003 and 0.001, resp.).

CONCLUSION

The current study concluded that metabotropic glutamate receptor 7 (GRM7) rs1396409 AG could be a potential biomarker for SCZ diagnosis. It also revealed an independent association between the GRM7 rs1396409 G allele, HDLc and SCZ development.

Projecting the Potential Budget Impact Analysis of Paliperidone Palmitate in Egyptian Adult Patients with Schizophrenia

Background: Schizophrenia is a serious mental disorder that has greater negative consequences on role functioning than many other severe chronic diseases. Objective: We evaluated the economic impact of long-acting injections of paliperidone palmitate (PP) vs daily oral antipsychotics to treat chronic schizophrenia from a societal perspective over a 2-year period. Methods: A static budget impact model was developed to compare PP with daily oral antipsychotics (risperidone, olanzapine, and aripiprazole) in the treatment of patients with chronic schizophrenia. Our study included treatments used during relapse and hospitalization, validated by an expert panel. The clinical parameters were extracted from the PRIDE trial. Direct medical costs and indirect costs were measured. The unit cost of drug acquisition for all medications was extracted from the public sector. One-way sensitivity analyses were conducted. Results: The target population in our model was estimated to be 142 incident patients. In the first year, the total drug costs in Egyptian pounds (EGP) for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5.6 million, respectively. In the second year, the total drug costs for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5 million, respectively. The total costs for PP (£11.6 million) over 2 years were less than those of oral antipsychotics without PP (£12.7 million). PP produced an estimated budget savings of £1 046 561 (budget savings per patient per year, £3667). In addition, PP resulted in the avoidance of 18 hospitalizations per year compared with the without-PP arm. Sensitivity analyses showed that the percent of hospitalizations for both oral antipsychotics and PP had the greatest impact on the results. Conclusion: The lower hospitalization rates associated with PP offset the increase in drug costs. PP may potentially be cost-saving compared with the standard of care in chronic schizophrenia in Egyptian representative healthcare settings. Policy makers may consider this approach to improve patient outcomes and budget sustainability.

Suicide Risk among Patients with Substance Use Disorders, A Cross Sectional Study In Suez Canal Area Hospitals.. [DOI: 10.21203/rs.3.rs-3076857/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Substance Use Disorders are serious health issues that have been linked to numerous clinical correlations and mental health comorbidities. One of the most important health dangers linked to substance addiction was suicide. The current study aims to investigate the phenomena using a bio-psycho-social framework. The aim was to investigate the risk of suicide in a sample of substance use disorders patients. A case control comparison was performed between 190 substance abusers versus 30 controls. Addiction Severity Index, Beck Suicidal Ideation Scale, Arab Religiosity Scale, Socioeconomic Status Scale, as well as multiple historical variables, have been investigated. Results: Suicidality was prevalent among alcohol and opioids abusers, poly substance abusers, those with a family history of suicide, and those with a history of a previous attempt. Having a positive family history of suicide could predict an 8.3 point rise in Beck Suicidal Ideation Scale score, while having any previous attempt of suicide could predict 9.04 point rise in Beck Suicidal Ideation Scale score. Suicidality scores correlated with Addiction Severity Index scores, and indirectly with socioeconomic status and Religiosity. Combinations of drugs with other mental illness showed a significant predictive effect on suicidality score. Conclusion: Suicidality is expected among substance abusers, and is affected by multiple bio-psycho-social variables.

Clinical characteristics of bipolar 1 disorder in relation to interleukin-6: a cross-sectional study among Egyptian patients

Background

Strong evidence in the literature points to the role of pro-inflammatory cytokines in bipolar disorder (BD) pathophysiology. Interleukin-6 (IL-6) is a pro and anti-inflammatory cytokine that was repeatedly found higher in bipolar patients than in healthy controls. However, studies on the phasic differences of IL-6 in bipolar type I (BP-I) were limited. This study aims to explore the phasic differences of serum IL-6 levels in BP-I during euthymia, depression, and mania and their association with the disease’s clinical characteristics in a sample of Egyptian BP-I patients. Thirty currently euthymic, 24 currently depressed, 29 currently manic BP-I patients, and 20 healthy subjects were recruited. Serum IL-6 levels were compared among BP-I groups and then between each group and a group of 20 healthy controls. Serum IL-6 levels (pg/ml) were measured with a sandwich enzyme-linked immunosorbent assay (ELISA). Depression and mania symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and the Young Mania Rating Scale (YMRS), respectively. Clinical characteristics were evaluated through a semi-structured clinical psychiatric interview, and cognitive status was tested using the Montreal Cognitive Assessment (MoCA).

Results

Serum IL-6 levels were significantly higher in each bipolar phase than in healthy subjects. In the BP-I patients, IL-6 levels were lower in patients with a current manic episode than in patients with a current depressive episode (P < 0.05) or who were currently euthymic (P < 0.001). Moreover, IL-6 levels correlated inversely with the YMRS score (rs =  − 0.29; P < 0.05). Compared to patients without psychotic features, patients with psychotic features had decreased serum IL-6. Moreover, IL-6 levels were lower in inpatients compared to outpatients.

Conclusions

BP-I disorder is associated with an inflammatory state. The decreased levels of IL-6 during manic episodes, affective episodes with psychotic features, and their inverse correlation with the severity of mania symptoms indicate a possible anti-inflammatory role of IL-6 in mania and psychotic symptoms pathogenesis.

Prevalence and economic burden of depression and anxiety symptoms among Singaporean adults: results from a 2022 web panel

BACKGROUND

Major depressive disorder (MDD) and generalized anxiety disorder (GAD) are leading causes of disability and premature mortality. At a global level, over 300 million people are estimated to suffer from major depressive disorders, equivalent to 4·4% of the world's population. Pandemic era stressors have increased rates for depression and anxiety by upwards of 25%. The goal of this study is to estimate the prevalence and economic burden of depression and anxiety symptoms in Singapore after the peak of the COVID-19 pandemic.

METHODS

An existing web panel was queried between April 2022 and June 2022. Adult participants aged > 21 years old who screened positive for depression and anxiety symptoms based on the Patient Health Questionnaire-4 (PHQ-4) Screener were eligible for participation. Prevalence estimates were quantified by dividing the number of respondents who screened positive for these symptoms by the total number of respondents. Participants who screened positive were asked about healthcare utilization, days missed from work, and reduced productivity due to these symptoms. These values were then monetized and scaled based on prevalence and population counts to generate per capita and total annual costs.

RESULTS

Two thousand three hundred forty-eight respondents filled out the PHQ-4 depression/anxiety screener on behalf of the 5,725 adults living in their households (including respondents themselves). Prevalence estimates were calculated based on the responses recorded for these 5,725 adults. 14.1% adults had symptoms consistent with depression and 15.2% had symptoms consistent with anxiety. In total, 20.0% may experience symptoms consistent with at least one of these two conditions, yet approximately half reported never being formally diagnosed. 350 respondents screened positive for depression or anxiety symptoms and thus were eligible to fill out the healthcare utilization, presenteeism, and absenteeism survey. Direct annual healthcare costs due to depression and anxiety symptoms averaged Singapore dollar (SGD) $1,050 for these respondents. The employed subset (n = 304) missed an extra 17.7 days of work on average per year, which translates to SGD $4,980 per worker. These workers also reported being ~ 40% less productive at work, which equates to SGD $28,720 in economic losses annually. In total, these symptoms caused SGD $15.7 billion in increased costs. Presenteeism accounts for 81.6% of this total (SGD $12.8 billion), absenteeism for 14.2% (SGD $2.3 billion) and healthcare accounts for 4.2% (SGD $0.7 billion).

CONCLUSIONS

The health and economic burden associated with depression and anxiety symptoms is large in Singapore, representing 2.9% of Singapore's gross domestic product (GDP). Employers and governments should look to identify effective remediation strategies, including strategies to address the high rates of undiagnosed cases. Increasing psychiatric resources, general practitioner mental health competency, access to peer support, and increased efforts to reduce mental health stigma should be considered to address this growing public health crisis.

Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals

BACKGROUND

There is evidence that culture deeply affects beliefs about mental illnesses' causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking.

METHODS

We carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public.

RESULTS

More than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p < .001), knowledge (F = 88.7, p < .001), and help-seeking attitudes (F = 32.4, p < .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants.

CONCLUSION

Interventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations.

Mood regulation, alexithymia, and personality disorders in female patients with opioid use disorders

Background

Opioid use disorders are rising among females. So, there is a need for more recognition of the various factors contributing to this trend in women, to help us to plan effective interventions to this group of patients. Hence, we conducted this research to identify risk factors associated with opioid use in females including mood regulation, alexithymia, and personality disorders. The study included 60 females ranging from 18 to 45 years [30 females diagnosed with opioid use disorder according DSM-IV (case group), and 30 females with no mental illness diagnosis according to general health questionnaire (control group)]. The subjects were recruited from inpatients and outpatient clinic of Al-Abbassia Hospital, Cairo, Egypt. Both groups were assessed by the Structured Clinical Interview for DSM-IV axis II disorders (SCID II) for personality, Trait Meta-Mood Scale (TMMS) for emotional regulation and Toronto Alexithymia Scale-20 (TAS-20) for alexithymia.

Results

Regarding sociodemographic data, cases were significantly different from controls as they are less educated (P < 0.001), more 73% (22) unemployed (P <0.001) and 56.7% (17) of cases had positive family history of first degree relatives with drug use (P = 0.001).

SCID II showed more significant personality disorders diagnosis among cases as (borderline, antisocial, paranoid, schizotypal, and schizoid personality disorder) (P < 0.001, < 0.001, 0.01, 0.003, and 0.005, respectively) and also multiple personality disorders (P < 0.001) diagnosis. As regards alexithymia all cases were classified as having alexithymia 100% versus 56.7% among controls. Meanwhile, cases showed more difficulty in identifying (P < 0.001) and describing feelings (P = 0.001) and more externally oriented thinking (P = 0.010). Results of TMMS showed cases had lower total score on TMMS (p = 0.016). Signifying their inability to regulate their emotions in comparison to controls. There was no significant association between alexithymia, sociodemographic data, TMMS, and SCID II among cases group.

Conclusions

The present study found that females with opioid use disorders tend to be less educated, unemployed with positive family history of substance abuse, and diagnosed mainly with cluster A and B personality disorders. Moreover, had difficulty in identifying, describing, and regulating their emotions.

Depression and anxiety among people with hypertension on follow-up in Eastern Ethiopia: A multi-center cross-sectional study

Background

People with hypertension have a high risk of developing mental disorders, such as depression and/or anxiety. However, there is a paucity of data regarding comorbid depression and anxiety symptoms among people with hypertension in study settings.

Objective

The study determined the prevalence and associated factors of depression, and anxiety symptoms among people with hypertension on follow-up at public hospitals, in Eastern Ethiopia.

Materials and methods

A cross-sectional study was carried out among 471 people with hypertension who were randomly chosen from four public hospitals in Harar town and the Dire Dawa Administration. The data were collected by interviewer-administered structured questionnaires. A validated nine-item Patient Health Questionnaire and Generalized Anxiety Disorder scales were used to assess depression and anxiety symptoms, respectively. A logistic regression model was used to identify the association among depression, anxiety, and their predictors. An adjusted odds ratio and a 95% confidence interval were used to report the association. The statistical significance was set at a p-value of < 0.05.

Results

Depression and anxiety symptoms were present in 27.2 and 32.7% of people with hypertension, respectively. Being women (AOR = 1.74, 1.09-2.78), having no formal education (AOR = 2.19, 1.19-4.81), presence of other medical illnesses (AOR = 2.23, 1.39-3.56), having a family history of depression (AOR = 2.01, 1.25-3.19), and poor social support (AOR = 2.80, 1.60-5.22) were statistically associated with depressive symptoms, whereas being women (AOR = 1.54, 1.01-2.35), widowed and divorced (AOR = 2.22, 1.41-3.52), presence of other medical illnesses (AOR = 1.64, 1.06-2.53), and poor social support (AOR = 3.54, 2.09-6.01) were statistically associated with anxiety symptoms.

Conclusion

More than a quarter of people with hypertension reported symptoms of depression and anxiety. Findings demonstrated that being a woman, having an additional medical illness and having poor social support were statistically associated with depressive and anxiety symptoms. Regular screening, early detection, and offering the proper intervention should be on top priorities for healthcare professionals.

Depression in Public Servants of Upper Egypt: Gender-specific Prevalence and Determining Factors

Mental health disorders, including depression, cause more than half of worldwide disabilities. We aimed to estimate the prevalence of depression and determine its associated factors among Egyptian public servants. We collected data from 3134 subjects (1619 females and 1515 males) via a self-administered questionnaire, including the Center of Epidemiological Studies-Depression (CES-D) scale, medical history, sociodemographic, familial, occupational, and behavioral characteristics of the recruited Egyptian Public servants. We used logistic and linear regression models to assess the determinants of depression. The prevalence of depression was 43.5% (52.9% in females and 33.4% in males) among public servants. The past history of depression was a significant determining factor of depression; adjusted odds ratio (aOR): 95% confidence interval (CI) was 2.58 (1.87, 3.57) in females and 3.28 (2.20, 4.87) in males. Other determinants were daily working hours: aOR = 1.11 (1.02, 1.19) and high job demands: aOR = 2.19 (1.40–3.41) in males, and the high job control in females: aOR = 0.51 (0.36, 0.73). With the past history of depression, job demands, job control, family structure, education level, and working status of the spouse predicted 41% of the total variance in the CES-D score in females; R² = 0.41; whereas job demands, family structure, job hours per day predicted 40% of in males; R² = 0.40. In conclusion, the determinants of depression varied by gender. Governmental interventions aiming to improve the work environment (job demands, control, and working hours) and individual responsibilities to improve the living arrangement and education level could help to curb the emerging risk of depression.

Community Mental Health Services in Egypt

As far back as the 14th Century, Egypt had already developed mental health care in a community-based sense in Kalaoon Hospital in Cairo, 600 years before similar institutions were founded across the globe. By 2001, an Egyptian-Finnish bilateral comprehensive reform program was incorporated. A few years later, in 2007, the Minister of Health and Population initiated a proper appraisal of the mental health services in Egypt, which was aimed at achieving better integration and coordination in the mental health sector, as well as supervision and training on the national, governmental, and primary care levels. By 2009, the Mental Health Act of 2009 (Law 71) brought basic conceptual changes to the care of people with a mental illness in Egyptian institutions, replacing the outdated 1944 law that had been used in Egypt for decades. However, despite all of the important steps Egypt is taking to move toward more integrated mental health services, more effort and resources are still needed to fight against stigma and to develop a comprehensive multidisciplinary approach that is approachable and effective to all those who need it.

Analysis of selected polymorphisms in FOXP3 gene in a cohort of Egyptian patients with schizophrenia

BACKGROUND

Schizophrenia is a chronic mental disorder with different symptoms. The environmental and genetic factors are suggested to be the etiology of schizophrenia. However, the exact cause and pathogenesis of schizophrenia are still unclear. Different studies suggested that the immune system may have a role in schizophrenia. A genetic study found a relation between the disease and the HLA region on the sixth chromosome. Regulatory T cells (Treg) have a role in the regulation of immune response, especially the balance between TH1 and TH2 cells. The FOXP3 protein is a key regulator for Treg cell's functions. FOXP3 is a transcriptional factor, and its gene is present on the short arm of the X chromosome. The selected SNPs present in the promoter region which act as binding sites for transcriptional factors. This study investigated FOXP3 gene polymorphisms (rs3761548, rs3761549, and rs2232365) in Egyptian patients with schizophrenia. There are no previous studies about the association of FOXP3 gene polymorphisms with schizophrenia. The three selected single-nucleotide polymorphisms (SNPs) were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for 125 schizophrenia patients and 160 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate patients with schizophrenia.

RESULTS

No significant associations were found between schizophrenia patients and healthy controls for the alleles and genotypes of the selected SNPs (P-value > 0.05). However, a significant association with ACC and ATC haplotypes was detected (P-value 0.001). No significant association was detected between the PANSS score and any of the studied SNPs.

CONCLUSION

The ATC haplotype of rs2232365, rs3761549, and rs3761548 could be considered a risk factor for schizophrenia in Egyptian patients.

Posttraumatic growth and recovery among a sample of Egyptian mental health service users: a phenomenological study

BACKGROUND

Delivery of recovery-oriented mental health practice is fundamental to personal recovery. Yet, there is lack of service users' accounts on what constitutes mental health recovery in Egypt.

OBJECTIVES

The aim of this study was to explore mental health recovery meaning informed by people with personal experience of recovery.

METHODS

A phenomenological research design was used. Semi-structured qualitative interviews were conducted with 17 adult community-dwelling individuals who identified as recovered/recovering from mental health issues. An inductive thematic analysis approach was used to analyses participants' responses.

RESULTS

Participants predominately reported personal and functional definitions of mental health recovery. Posttraumatic growth was the strongest theme comprising: relation to others, spirituality, new possibilities, identity & strengths, and appreciation of life. Themes of acceptance and forgiveness, functional and clinical recovery, and finding hope were also identified.

CONCLUSIONS

This is the first study to explore mental health recovery meaning among a sample of people with lived experience of mental health issues in Egypt. Findings suggest that developing and implementing psychosocial interventions to support posttraumatic growth among people with mental health issues is a priority.

University students under lockdown, the psychosocial effects and coping strategies during COVID-19 pandemic: A cross sectional study in Egypt

Objective: This study aimed to assess the psychosocial effects and coping strategies of university students during COVID-19 pandemic. Methods: Between 30 May and 6 June 2020, an online cross-sectional survey was fulfilled by 612 university students. The University of California Los Angeles (UCLA) Loneliness Scale, version 3, the Depression Anxiety Stress Scale (DASS-21), and the Brief COPE scale were used. Results: Different degrees of depression, anxiety, and stress were reported by 74.5%, 47.1%, and 40.5% of the surveyed students, respectively. Dysfunctional coping strategies including venting, denial, and substance use had the lowest scores on Brief COPE while problem-focused coping strategies including planning and active coping strategies had the highest scores on Brief COPE. Conclusion: Undergraduate university students are very prone to experience psychosocial problems during the current pandemic. Educational institutions should work together with the authorities to promote measures to improve mental health and academic performance of their students.

Impact of spirituality and religiosity on suicidal risk among a sample of lebanese psychiatric in-patients

OBJECTIVES

To evaluate the prevalence of suicidality among the psychiatric inpatients community in Lebanon, and to elucidate the effect of religiosity and spirituality on suicidal thoughts or behaviours.

METHODS

A total sample of 159 patient consecutively admitted to a psychiatric hospital was interviewed. The Ask Suicide-screening Questionnaire (ASQ) was used to assess suicidal risk; the Mature Religiosity Scale (MRS) and the Spirituality Index for Well Being (SIWB) scales were used to assess religiosity and spirituality.

RESULTS

We found that 45.6% of the participants screened positively on the ASQ, including 37.5% with acute suicidal ideation. A backward logistic regression, taking the negative/positive screening ASQ as the dependent variable, showed that a positive family history of suicide and depression were significantly associated with higher positive suicidal screening, whereas higher spirituality was significantly associated with lower positive suicidal screening. When forcing the mature religiosity scale as an independent variable, the results remained the same.

CONCLUSION

Spiritual well-being might be considered an important factor to explore among psychiatric patients. Psychiatric inpatients have a high risk for suicide; the challenge remains for clinicians to identify upon admission patients that are most likely to die from suicide.Key pointsA positive family history of suicide and depression was significantly associated with higher suicidality.Higher spirituality, but not religiosity, was significantly associated with lower suicidality.Spiritual well-being might be considered an important factor to explore among psychiatric patients.The challenge remains for clinicians to identify patients that are most likely to die from suicide upon admission.

Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis

We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.

Mental Health during the COVID-19 Crisis in Africa: A Systematic Review and Meta-Analysis

We aim to provide a systematic review and meta-analysis of the prevalence rates of mental health symptoms among major African populations during the COVID-19 pandemic. We include articles from PubMed, Embase, Web of Science, PsycINFO, and medRxiv between 1 February 2020 and 6 February 2021, and pooled data using random-effects meta-analyses. We identify 28 studies and 32 independent samples from 12 African countries with a total of 15,071 participants. The pooled prevalence of anxiety was 37% in 27 studies, of depression was 45% in 24 studies, and of insomnia was 28% in 9 studies. The pooled prevalence rates of anxiety, depression, and insomnia in North Africa (44%, 55%, and 31%, respectively) are higher than those in Sub-Saharan Africa (31%, 30%, and 24%, respectively). We find (a) a scarcity of studies in several African countries with a high number of COVID-19 cases; (b) high heterogeneity among the studies; (c) the extent and pattern of prevalence of mental health symptoms in Africa is high and differs from elsewhere-more African adults suffer from depression rather than anxiety and insomnia during COVID 19 compared to adult populations in other countries/regions. Hence, our findings carry crucial implications and impact future research to enable evidence-based medicine in Africa.

The epidemiology of psychiatric disorders in Africa: a scoping review

This scoping review of population-based epidemiological studies was done to provide background information on the prevalences and distribution of psychiatric disorders in Africa for calls to broaden diversity in psychiatric genetic studies. We searched PubMed, EMBASE, and Web of Science to retrieve relevant literature in English, French, and Portuguese from Jan 1, 1984, to Aug 18, 2020. In 36 studies from 12 African countries, the lifetime prevalence ranged from 3·3% to 9·8% for mood disorders, from 5·7% to 15·8% for anxiety disorders, from 3·7% to 13·3% for substance use disorders, and from 1·0% to 4·4% for psychotic disorders. Although the prevalence of mood and anxiety disorders appears to be lower than that observed in research outside the continent, we identified similar distributions by gender, although not by age or urbanicity. This review reveals gaps in epidemiological research on psychiatric disorders and opportunities to leverage existing epidemiological and genetic research within Africa to advance our understanding of psychiatric disorders. Studies that are methodologically comparable but diverse in geographical context are needed to advance psychiatric epidemiology and provide a foundation for understanding environmental risk in genetic studies of diverse populations globally.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

Knowledge, attitude and health-seeking behavior among family caregivers of mentally ill patients at Assiut University Hospitals: a cross-sectional study

Background

Mental illness is associated with misunderstanding and unfavorable attitude worldwide. The belief in its spiritual nature made traditional healers the main service consultants for mentally ill patients. The present study is a cross-sectional study conducted among 425 main family caregivers of mentally ill patients at Assiut University Hospital. The objective of the study was to assess the caregivers’ knowledge and attitude towards mental illness as well as their health-seeking behavior for their mentally ill relatives.

Results

The studied caregivers had low scores of knowledge and attitude towards mental illness. Age of the caregivers, their education, and the type of first consulted care and aggressive behavior of the mentally ill relatives were the significant predictors of caregivers’ knowledge and attitude towards mental illness. The majority of caregivers (80.2%) sought advice for the first time from traditional healers. Traditional healers referred only 16.4% of caregivers’ mentally ill relatives to psychiatric care.

Conclusion

The studied caregivers had poor knowledge and a negative attitude towards mental illness. Traditional healers were the main consulted care. So, increasing awareness of mental illness is highly recommended.

Pharmaceutical Care in Depression: A Survey of Stigma, Confidence, Attitudes, and Barriers

Purpose

Patients with depression are in high need of optimal pharmaceutical care as they have poor quality of life and functioning. However, little is known about the delivery of pharmaceutical care to patients with depression in Egypt. This study aimed to detect pharmacists' stigma of patients with depression, assess attitudes toward providing depression care, evaluate pharmacists' confidence with depression medication consultation, and identify barriers in providing pharmaceutical care to patients with depression.

Methods

A cross-sectional survey was posted on the social media websites of Egyptian pharmacists' groups and associations. The survey collected pharmacists' demographic information, then measured their confidence in medication consultation through the Pharmacists' Confidence scale about Medication Consultation for Depressive Patients (PCMCD), with items to assess stigma of patients with depression and attitudes toward providing care to patients with depression compared with other physical conditions. The pharmacists were also asked about the barriers to providing pharmaceutical care to patients with depression.

Results

Totally, 86 pharmacists completed the survey: 56 (65.1%) were aged 30 years or older, and 64 (74.6%) had more than five years of experience. The stigma of patients with depression was generally low. The mean (SD) PCMCD score was 51.4 (6.6), reflecting that most pharmacists were confident about medication consultation for patients with depression. Attitudes toward providing pharmaceutical care to patients with depression were generally positive but significantly lower than those reported for patients with other conditions. Lack of education on mental health was the most commonly reported barrier (81.2%) to providing pharmaceutical care to patients with depression.

Conclusion

Participants were confident about medication consultation with a positive attitude toward providing pharmaceutical care. Frequent mental health educational courses, tools, and other methods of consistent engagement that enhance practice, behaviors, and outcomes should be considered for Egyptian pharmacists to improve pharmaceutical care provided to patients with depression.

A systematic review of the prevalence of mental and neurocognitive disorders amongst older adults’ populace in Egypt

Background

Mental and neurocognitive disorders are the leading cause of disabilities amongst the older adult populace worldwide. The population of the older adult in Egypt is fast growing. The national census in 2017 revealed a 2.56% increase in the older adult population from the 2006 census, and these figures are expected to double by year 2031. This study aims to review current evidence about the prevalence of mental and neurocognitive disorders amongst older adult population in Egypt.

Results

A systematic review was carried out, and 16 studies met the inclusion criteria outlined in this study. Four main mental and neurocognitive disorders were identified: depression, anxiety, cognitive impairment and dementia. The reported prevalence of depression, anxiety, dementia and cognitive impairment are 23.7–74.5%, 14.2–72%, 3.66–39.2% and 1.74–51.4%, respectively. Anxiety and depression were positively correlated with the female gender, increasing age and lower educational status. Also, cognitive impairment and dementia were positively correlated with age, illiteracy or low education. However, there appears to be inconsistencies in the diagnostic tools used.

Conclusion

Egypt aging population is growing, and this research brings to forefront the scale of mental and neurocognitive disorders amongst the older adult population. This may help ensure evidence-based initiatives are put in place and priority is given to resource allocation for geriatric mental and neurocognitive disorders in Egypt.

Systematic review registration

PROSPERO CRD42018114831

Stigma and burden of mental illness and their correlates among family caregivers of mentally ill patients

Background and objectives

Family caregivers play a curial role in supporting and caring for their mentally ill relatives. Their struggle for facing stigma and shouldering caregiving burden is marginalized, undervalued, and invisible to medical services. This study assessed the stigma and burden of mental illnesses, and their correlates among family caregivers of mentally ill patients.

Methods

A cross-sectional study design was used to collect data from 425 main family caregivers of mentally ill patients at Assiut University Hospital. A structured interview questionnaire was designed to collect socio-demographic data of both patients and their caregivers. Stigma scale for caregivers of people with mental illness (CPMI) was used to assess the affiliate stigma, while the associative stigma was assessed by the explanatory model interview catalogue stigma scale (EMIC-Stigma scale). The caregivers’ burden was assessed using Zarit burden Interview, and Modified Attitude toward Mental Illness Questionnaire was used to assess caregivers’ knowledge and attitude towards mental illness.

Results

Bipolar disorder (48%) and schizophrenia/other related psychotic disorders (42.8%) were the most common mental illnesses among the study patients. The mean scores of CPMI total scale, EMIC-Stigma scale, and Zarit Burden scale were 56.80 ± 7.99, 13.81 ± 5.42, and 55.20 ± 9.82, respectively. The significant correlates for affiliate stigma were being parents of patients (ß = 4.529, p < 0.001), having higher associate stigma (ß = 0.793, p < 0.001), and aggressive behavior of mentally ill patients (ß = 1.343, p = 0.038). The significant correlates for associate stigma of the study caregivers were being caregivers’ relatives other than parents (ß = 1.815, p = 0.006), having high affiliate stigma (ß = 0.431, p < 0.001), having poor knowledge and negative attitude towards mental illness (ß = − 0.158, p = 0.002), and aggressive behavior of mentally ill relatives (ß = 1.332, p = 0.005). The correlates for the high burden were being male (ß = 3.638, p = 0.006), non-educated caregiver (ß = 1.864, p = 0.045), having high affiliate stigma (ß = 0.467, p < 0.001), having high associative stigma (ß = 0.409, p < 0.001), having poor knowledge and negative attitude toward mental illness (ß = − 0.221, p = 0.021), seeking traditional healers and non-psychiatrist’s care from the start (ß = 2.378, p = 0.018), and caring after young mentally ill relatives (ß = − 0.136, p = 0.003).

Conclusion

The studied caregivers suffered from stigma and a high level of burden. Psycho-educational programs directed toward family caregivers are highly recommended.

Electronic Mental Health as an Option for Egyptian Psychiatry: Cross-Sectional Study

BACKGROUND

Egypt is a country of nearly 100 million citizens, and there are less than 1000 registered psychiatrists. The mental health care system is under resourced and nearly inaccessible for the majority of the population. In addition, youth under the age of 25 years represent 50% of Egyptian citizens; however, there are no specific services addressing their unique needs. How can the needs of the largest population in the Middle East be effectively addressed? Is a web-based framework an option for Egyptian psychiatrists to serve the population?

OBJECTIVE

The aims of this study were to better understand the opinions of psychiatrists on the current state of mental health care services in Egypt and their current knowledge on electronic mental health (EMH); assess the attitudes of Egyptian psychiatrists toward web-based interventions and telemedicine for mental health; and identify perceived advantages and barriers of EMH development in Egypt.

METHODS

A cross-sectional survey was conducted online among 640 Egyptian psychiatrists. It included a total of 36 items within a set of 16 questions asking about EMH literacy, integrating EMH into the mental health care system, and the perceived priorities and barriers of EMH. The sampling was supported by Tanta University, a large academic institution close to Cairo. Statistical analysis was performed using SPSS 25 (IBM Corp). Descriptive statistics, the chi-square test, the independent sample t test, and analysis of variance were applied.

RESULTS

A total of 188 participants responded (response rate of 29.4%), of which 54.2% (102/188) were female and 54.3% (102/188) were between 30 and 45 years old. Less than half of the participants thought that the current health care system was efficient for adults (69/155, 44.4%), and even less thought it was efficient for youth (44/155, 28.3%). Almost all participants agreed that EMH would be beneficial for patient care (147/155, 94.8%) and that integrating EMH into the current health care system would be a good idea (118/155, 76.2%). The highest rated utility of web-based solutions was documentation, followed by psychoeducation and communication with professionals. The main advantages were to improve access to care in rural areas of the country and its convenience.

CONCLUSIONS

There is scarcity of mental health resources in Egypt. Egyptian psychiatrists are interested in EMH and believe web-based platforms can become part of the solution for the Egyptian mental health care system.

Self-Reported Sleep and Exercise Patterns in Patients with Schizophrenia: a Cross-Sectional Comparative Study

BACKGROUND

Adequate sleep and physical activity have been linked to the overall well-being of both medical and psychiatric patients. Patients with schizophrenia have shown abnormal sleep patterns and decreased physical activity that were linked to their psychopathology and physical health. These phenomena are not studied yet in Arab patients with schizophrenia. The purpose of this study is to study the sleep and exercise patterns in Arab patients with schizophrenia compared with those of healthy controls.

METHOD

A total of 99 patients with schizophrenia and 101 controls were recruited. Arabic versions of sleep, exercise, socio-demographic, and clinical questionnaires were administered as well as the validated scales to measure psychopathology, depression, and suicidality in these participants.

RESULTS

The majority of patients with schizophrenia slept more than 8 h per day and exercised less when compared with controls. Sleep quality was worse in those with higher depression score and higher suicidality scores were seen in patients with lower sleep duration. Multinomial regression showed that patients with schizophrenia have higher odds of sleeping more than 8 h even after controlling for the intake of antipsychotics, age, gender, smoking status, and other confounding factors.

CONCLUSION

Our results showed that Arab patients with schizophrenia are at increased risk of having longer sleep duration with inadequate physical activity, which are correlating with worsening of depressive symptoms and suicidality. Thus, more attention should be paid to the changes in sleep patterns and level of exercise when treating Arab patients with schizophrenia.

Prevalence of Mental Disorders, Cognitive Impairment, and Dementia Among Older Adults in Egypt: Protocol for a Systematic Review

Background

In Egypt, the population of older adults is rapidly growing. The last census in 2017 indicated that older adults numbered 94.8 million, which is a 2.56% increase from the 2006 census. There is growing evidence that the older population is at greater risk for some forms of mental disorders such as depression, dementia, and many more.

Objective

This study aims to review the current evidence regarding the prevalence of mental disorders among older adults in Egypt. This will be achieved by estimating the current prevalence of mental disorders and identifying any sociodemographic correlations with mental disorders.

Methods

An electronic search of 5 key databases (MEDLINE, PsycINFO, EMBASE, AMED, and PubMed) from their date of inception was conducted. In addition, scans of reference lists and searches of key journals, citations, and relevant internet resources were conducted. Studies were included if they were published in English, point prevalence studies, conducted with older Egyptians aged ≥60 years, and conducted using a validated diagnostic tool to ascertain mental disorders. Studies that did not meet any of these criteria were excluded.

Results

This systematic review started in November 2018. The literature search of the 5 databases revealed 343 papers. After screening titles and abstracts, scanning citations and reference lists, and searching internet sources, a total of 38 full-text articles were accessed, of which 16 studies met the eligibility criteria and were included. We are currently in the process of data extraction and synthesis.

Conclusions

This research will help bring the scale of mental disorders among older adults in Egypt to the forefront. This may help ensure evidence-based initiatives are established and that priority is given to resource allocation for geriatric mental health in Egypt.

Trial Registration

PROSPERO International Prospective Register of Systematic Review CRD42018114831; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=114831

International Registered Report Identifier (IRRID)

DERR1-10.2196/14637

The practice and research of cognitive behavioural therapy in Egypt: a review of the current status

Cognitive behavioural therapy (CBT) is generally defined as a short-term, problem-oriented psychotherapy that focuses on modifying dysfunctional emotions, thoughts and actions. In clinical practice, CBT consists of a number of cognitive and behavioural techniques that aim to help patients suffering from psychological disorders. The practice of CBT is well established in Western countries. In non-Western countries, CBT is still in the process of being established as the evidence-based psychotherapy. Despite being the heart of the Arab world, the development and practice of psychotherapy in Egypt in general, and CBT specifically, is still emerging. The training and practice of CBT has received a mixed response in Egypt. In practical settings, evidence-based CBT is subject to individual and cultural variations and adaptations. Many local studies examining the efficacy of CBT in psychiatric disorders among different population groups in Egypt have been conducted. Unfortunately, many of these studies have not been published and therefore have missed the opportunity for international recognition. The current review aims to explore the practice of CBT with a specific focus on national research of efficacy and adaptability of CBT for different populations in Egypt.

Key learning aims

(1)

Design, synthesis, molecular modelling and in vitro screening of monoamine oxidase inhibitory activities of novel quinazolyl hydrazine derivatives

A new series of N'-substituted benzylidene-2-(4-oxo-2-phenyl-1,4-dihydroquinazolin-3(2H)-yl)acetohydrazide (5a-5h) has been synthesized, characterized by FT-IR, NMR spectroscopy and mass spectrometry and tested against human monoamine oxidase (MAO) A and B. Only (4-hydroxy-3-methoxybenzylidene) substituted compounds gave submicromolar inhibition of MAO-A and MAO-B. Changing the phenyl substituent to methyl on the unsaturated quinazoline ring (12a-12d) decreased inhibition, but a less flexible linker (14a-14d) resulted in selective micromolar inhibition of hMAO-B providing insight for ongoing design.

Suicide Prevention in the Eastern Mediterranean Region

Abstract. The WHO Eastern Mediterranean Region (EMR) consists of 22 countries including Afghanistan, Bahrain, Djibouti, Egypt, Iraq, Islamic Republic of Iran, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates (UAE), and Yemen. According to Global Burden of Disease (GBD) data, death from self-harm has increased by 100% between 1990 and 2015 in this region. Although this increase is substantial, it appears trivial in comparison to the 1027% increase in deaths due to war and legal interventions. This might partly explain why suicide prevention does not have a high priority in these countries and why there are currently no suicide prevention strategies in place. Despite the above, some important activities in the area of suicide prevention have been carried out in the region. And while peace and stability may take time to come to the region, it should not prevent suicide prevention programs from being developed and implemented.

Polysomnographic Correlates for the Risk of Relapse in Detoxified Opiate-Misuse Patients

INTRODUCTION

Substance abuse is a complex issue requiring multi-disciplinary management. Protracted abstinence syndrome leads to persistent discomfort even after detoxification lasting months, resulting in poor sleep duration and quality. Despite being a major contributor to relapse and sleep disturbances, no objective assessment procedures to monitor sleep after the detoxification have been reported. The study aims to assess sleep structure after detoxification via polysomnography and psychometrically assess sleep over the next 6 months in abstinent and relapsing patients.

METHODS

Sixty successfully detoxified males (35.8 ± 7.3 years) with a history of heroin abuse (DSM-V) (mean composite scores (ASI): 1.3 ± 0.06, 3.48 ± 0.38, 5.45 ± 0.63, 1.2 ± 0.19, 3.93 ± 0.9, and 2.61 ± 0.8 for medical status, employment/support status, alcohol/drugs status, legal status, family/social relationships, and psychiatric status, respectively) were recruited immediately following their detoxification, without giving additional psychoactive substances or medications. Polysomnography was done in the second week following detoxification to allow washout of medications, followed by a monthly sleep assessment through sleep diary and daytime sleepiness using a visual analog scale. Relapse was proved by a urine test. Polysomnographic parameters and ASI subscales for relapsing and non-relapsing participants were compared using a 2-tailed Student's t-test (p<0.05).

RESULTS

Eighteen participants relapsed by 6 months (12 by 3 months). Only the ASI legal problems score was significantly different for the two groups (p=0.001). The differences were significant for NREM stages I (p=0.001) and II (p=0.002), bilateral limb movement (p=0.009), and arousal indices (p=0.001).

CONCLUSION

Measuring polysomnographic parameters (percentage of NREM I and II, arousal index, and limb movement index) for sleep disturbance in detoxified heroin-abuse patients can be potential predictors for relapse in a 6-month follow-up.

Prevalence and predictors of psychological distress among primary healthcare service users in Mansoura district, Egypt

The current study is a health facility-based cross-sectional study that aims to measure the prevalence of psychological distress and to determine its associated factors among primary healthcare (PHC) service users in Mansoura district, Egypt. The study included service users aged ≥18 years. A predesigned structured interviewer-administered questionnaire was used to collect data from participants during the period from January 2018 to November 2018. The questionnaire included four sections; sociodemographic characteristics, recent history of stressful life events, history of relevant health conditions and a validated Arabic version of General Health Questionnaire, that was used to screen for psychological distress. The total calculated sample size was 573. Data was analysed using SPSS V. 16. Results indicated that the prevalence of psychological distress among PHC service users was 72.2% (95% CI: 68.6%-75.9%). Being a female, non-working, or married increased the risk of high psychological distress [OR (95%CI): 1.6 (1.2-2.4), 1.8(1.2-2.8) and 1.7 (1.1-2.8) respectively], but these factors were insignificant in multiple regression. Exposure to domestic violence (DV) and being current smokers were the only independent significant predictors of psychological distress [adjusted OR (95%CI): 3.8 (1.7-8.1) and 0.7 (0.4-0.9) respectively]. Findings indicate that psychological distress is common among PHC service users. Exposure to DV significantly predicts psychological distress, while smoking is associated with lower stress. Screening of PHC service users for mental health problems should be integrated within the PHC system.

Cross-cultural adaptation of the Arabic Positive and Negative Syndrome Scale in schizophrenia: Qualitative analysis of a focus group

As part of a project to translate and validate scales used in the diagnosis and treatment of Arab patients with schizophrenia, this study aimed to explore the experience of clinical research coordinators (CRCs) while administering the Arabic version of the Positive and Negative Syndrome Scale (PANSS) on Arab schizophrenia patients. We previously reported that the Arabic version of PANSS is a valid and reliable tool to assess Arab patients with schizophrenia. Five CRCs and the principal investigator attended focus group discussions on cultural issues in administering the PANSS. A thematic analysis approach was utilized for data coding and analysis. The results identified issues related to the translation of the instrument, the structure of the interview, the cultural sensitivity of some questions, and the procedures for rating items of the PANSS. Qualitative analysis also identified four main themes relevant to clinical assessment of patients from Middle Eastern cultures: religion, beliefs and values, gender, and semantic expressions. In conclusion, researchers or clinicians administering the PANSS scale interview in Arabic should be trained to consider the roles of local dialects, familiarity with abstract thinking, religion, and social constructs when assessing psychosis.

Premenstrual dysphoric disorder in Arab women: Validation and cultural adaptation of the Arabic version of the premenstrual screening tool

Premenstrual dysphoric disorder (PMDD) is not well-studied in Arab populations. The goal of this study was to validate the Arabic version of the Premenstrual Symptoms Screening Tool (PSST) using the DSM diagnosis of PMDD as the gold standard. The PSST was translated and culturally adapted using back translation and the approval of the original author. We recruited 194 adult women (between October 2013 and March 2014) from two primary care centers in Doha, Qatar. A psychiatrist determined the diagnosis using the semi-structured Mini International Neuropsychiatric Interview, and another rater blinded to the diagnosis finalized the Arabic PSST and administered other clinical questionnaires. The data showed that premenstrual symptoms and PMDD were observed in about 37 percent and 15 percent, respectively, of the women enrolled. The mean age of the women with PMDD according to the PSST was about 30 years, and the majority had children. The Arabic PSST showed high specificity of 95.6 percent but low sensitivity of 26.7 percent. A factor analysis of the different items in Arabic PSST showed that the Arabic PSST could detect the cases with definite PMDD and thus can be a useful tool in primary care settings as this treatable disorder is underdiagnosed in the Arab populations.

Acceptability of Mental Health Services for Anxiety and Depression in an Arab Sample

The aim of this paper was to examine the acceptability and use of mental health services in an Arab sample. An Internet survey was made available to Arab people worldwide and enquired about the acceptability of traditional face-to-face and internet-delivered mental health services. Five hundred and three participants were recruited via media and Facebook promotions. Of those surveyed, 36% (183/503), 46% (233/503), and 73% (365/503) reported that they would be willing to consult a mental health professional, take prescription medication and try an internet-delivered psychological treatment, respectively. Moderate to high acceptability rates for mental health services were found in this sample of Arab people. High acceptability of internet-delivered treatments among the current Arab sample, provides the opportunity for directing resources to the development of internet-delivered interventions to help reduce the stigma and burden of mental disease in the Arab world.

Occupational stress, anxiety and depression among Egyptian teachers

Occupational stress (OS) among teachers predispose to depression and anxiety. No study was done to assess these problems among Egyptian teachers. This study aimed to assess the prevalence of OS, depression and anxiety among Egyptian teachers. A cross sectional study was done on 568 Egyptian teachers. The respondents filled a questionnaire on personal data, and the Arabic version of the Occupational Stress Index (OSI), the Arabic validated versions of Taylor manifest anxiety scale and the Beck Depression Inventory (BDI) were used to assess OS, anxiety and depression respectively. The prevalence of OS, anxiety and depression among teachers was (100%, 67.5% and 23.2%) respectively. OS, anxiety and depression scores were significantly higher among teachers with an age more than 40 years, female teachers, primary school teachers, those with inadequate salary, higher teaching experience, higher qualifications and higher workload. A significant weak positive correlation was found between OS scores and anxiety and depression scores. This study indicated the need for future researches to address risk factors of OS and mental disorders among Egyptian teachers, and the need of periodical medical evaluation of teachers and medical and psychological support for the identified cases.

The mental health of youth and young adults during the transition to adulthood in Egypt

BACKGROUND

There has been growing interest in the stalled transition to adulthood in the Middle East and North Africa (MENA) and its consequences for young people’s socioeconomic outcomes. However, little is known about how important life transitions relate to youth psychosocial well-being in the region.

OBJECTIVE

Drawing on a life course framework, we estimate the associations between making transitions in education, employment, and marriage with changes in mental health among young people in Egypt.

METHODS

We descriptively analyze mental health scores, measured via the Self-Reporting Questionnaire-20 and disaggregated by gender, for a panel of young people first surveyed in 2009 at ages 13–29 and followed up in late 2013 and early 2014. We regress change in mental health scores against indicators of making different transitions.

RESULTS

Young women experience worse mental health than young men overall. Lower school achievement was associated with poorer mental health; being out of the labor force was an additional risk factor for young men. While average mental health scores improved over time, over a quarter of the sample experienced worsening mental health, related to failure to marry and find a job among older men, and failure to finish schooling among younger women.

CONCLUSIONS

Mental health is an important but often overlooked component of youth well-being during the transition to adulthood in MENA, and potentially other low- and middle-income countries.

CONTRIBUTION

This is the first paper to empirically examine the relationship between psychosocial well-being and achieving important socioeconomic milestones among a nationally representative cohort of young people in MENA.

The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990-2013

The Eastern Mediterranean Region (EMR) is witnessing an increase in chronic disorders, including mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the Global Burden of Disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost-YLLs) and nonfatal outcomes (years lived with disability-YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of the total disease burden in the EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years of age. The highest proportion of DALYs occurred in the 25-49 age group, with a peak in the 35-39 years age group (5344 DALYs/100,000). The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Within the mental disorders group in EMR, depressive disorders accounted for most DALYs, followed by anxiety disorders. Among EMR countries, Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to the global level. Our findings call for EMR ministries of health to increase provision of mental health services and to address the stigma of mental illness. Moreover, our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability. Indeed, mental health problems, if not properly addressed, will lead to an increased burden of diseases in the region.

The effects of the gender-culture interaction on self-reports of depressive symptoms: cross-cultural study among Egyptians and Canadians

PURPOSE

Research in depression has revealed differences in the way depressed individuals across cultures report their symptoms. This literature also points to possible differences in symptom reporting patterns between men and women. Using data from a larger dataset (Beshai et al. 2016), the current study examined whether non-depressed and depressed Egyptian and Canadian men and women differed in their self-report of the various domains of the Beck Depression Inventory -II (BDI-II).

METHOD

We recruited a total of 131 depressed and non-depressed participants from both Egypt (n = 29 depressed; n = 29 non-depressed) and Canada (n = 35 depressed; n = 38 non-depressed). Depression status was ascertained using a structured interview. All participants were asked to complete the BDI-II along with other self-report measures of depression. BDI-II items were divided into two subscales in accordance with Dozois, Dobson & Ahnberg (1998) factor analysis: cognitive-affective and somatic-vegetative subscales.

RESULTS

We found a significant three-way interaction effect on the cognitive-affective (F(1,121) = 9.51, p = .003) and main effect of depression status on somatic-vegetative subscales (F(1,121) = 42.80, p < .001). Post hoc analyses revealed that depressed Egyptian men reported lower scores on the cognitive-affective subscale of the BDI-II compared to their depressed Canadian male counterparts.

CONCLUSIONS

These results suggest that males across cultures may differentially report cognitive symptoms of depression. These results also suggest that clinicians and clinical scientists need to further examine the interaction effect of culture and gender when investigating self-reported symptoms of depression.

Reliability, validity and factorial structure of the Arabic version of the international suicide prevention trial (InterSePT) scale for suicidal thinking in schizophrenia patients in Doha, Qatar

BACKGROUND

Patients with schizophrenia are known to have higher rates of mortality and morbidity when compared to the general population. Suicidality is a major contributor to increased mortality. The International Suicide Prevention Trial (InterSePT) Scale for Suicidal Thinking (ISST) is a validated tool to assess current suicidal ideation in patients with schizophrenia. The aims of the study were to culturally adapt the Arabic translation of ISST and to examine the psychometric characteristics of the Arabic version of the ISST among patients with schizophrenia in Qatar.

METHODS

ISST was translated and adapted into formal Arabic using the back translation method. Patients diagnosed with schizophrenia were randomly recruited from the department of Psychiatry, Rumailah Hospital, Doha, Qatar. Healthy controls were randomly recruited from two primary health care centers in Doha, Qatar. The Arabic version of Module B for suicidality in Mini International Neuropsychiatric Interview was used as the gold standard to which the Arabic ISST was compared.

RESULTS

The study sample (n = 199) was composed of 100 patients diagnosed with schizophrenia (age 35.30 ± 10.04 years; M/F is 2/1) and 99 controls (age 33.98 ± 8.33 years; M/F is 2/3). The mean score on the ISST was 3.03 ± 4.75 vs. 0.47 ± 1.44 for the schizophrenia and control groups, respectively. Inter-rater reliability coefficient was 0.95, p > 0.001. The overall Cronbach's alpha was 0.92. Principal Component Analysis produced 3 factors explaining a total of 73.8% of variance.

CONCLUSIONS

This is the first study in the Arab countries to validate the Arabic version of the ISST. The psychometric properties indicate that the Arabic ISST is a valid tool to assess the severity of suicidal ideation in Arabic patients with schizophrenia.

A pilot study of self-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs

This pilot study examined the efficacy and acceptability of a self-guided and culturally modified internet-delivered Cognitive Behaviour Therapy (iCBT) treatment for Arab people, aged 18 and over, with symptoms of depression and anxiety. Thirty-six participants from seven countries, with at least mild symptoms of depression (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks and presented in the English language. Standard measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Thirty-six percent of participants completed the five lessons over eight weeks, with 61% and 36% providing post-treatment and 3-month follow-up data respectively. Participants reported significant improvements (within-group Cohen's d; avg. reduction) in depression (ds ≥ 1.20; avg. reduction ≥ 46%), anxiety (ds ≥ 1.15; avg. reduction ≥ 45%), disability (ds ≥ 0.81; avg. reduction ≥ 35%) and psychological distress (ds ≥ 0.91; avg. reduction ≥ 24%) immediately post-treatment, which were sustained at or further improved to 3-month follow-up. Participants rated the Arabic Wellbeing Course as acceptable. Notwithstanding the absence of a control group, low follow-up questionnaire completion rates and the Course not being translated in Arabic, these results are encouraging and contribute to a growing body of literature indicating that, with minor modifications, internet-delivered interventions have the potential of increasing access to treatment for immigrant groups.

Quality of life and human rights conditions in a public psychiatric hospital in Cairo

Purpose

– There is no documented evidence on service users’ perceptions of quality of care and observance of human rights in mental health residential facilities in Egypt after the new mental health law passed in 2009. The purpose of this paper is to investigate El-Abbassia Mental Health Hospital in Cairo. Special attention is paid as to the variety of human rights violations which are experienced by the users and the context in which these violations occur.

Design/methodology/approach

– A cross-sectional study was performed relying on 36 depth interviews with patients, 58 staff members and 15 family members, reviews of documents and observations by an independent assessment team consisting of the author, another psychiatrist, a nurse and a family member using the World Health Organization Quality Rights Tool Kit which uses the Convention on the Rights of Persons with Disabilities (CRPD) as its framework.

Findings

– The study reported empirical insights into how the steps taken by the hospital to address several of the themes drawn from the CRPD require either improvement or initiation to comply fully with the convention’s themes.

Research limitations/implications

– Respondents may have failed to disclose their true experiences due to fear of punishment.

Practical implications

– Users admitted to mental hospitals have often been forgotten, thus becoming victims of violence, neglect and other human rights violations.

Social implications

– An opportunity to promote public awareness of the rights of patients.

Originality/value

– The importance of this study came from being the first documented evidence on service users’ perceptions of quality of care and observance of human rights in mental health residential facilities in Egypt after the new mental health law passed in 2009.