Elnour E. Dafeeah

Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients

Aim To determine the prevalence of low back pain (LBP), investigate the sociodemographic characteristics of patients with LBP, and examine its association with psychological distress such as anxiety, depression, and somatization. Subjects and methods Of the 2742 patients approached, 2180 agreed to participate in this cross-sectional study (79.5% response rate). The survey was conducted among primary health care visitors from March to October 2012 and collected sociodemographic details and LBP characteristics. General Health Questionnaire-12 was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder-7, depression was assessed with Patient Health Questionnaire-9, and somatization was measured with Patient Health Questionnaire-15. Results The study sample consisted of 52.9% males and 47.1% females. The prevalence of LBP was 59.2%, comprising 46.1% men and 53.9% women. LBP was significantly higher in Qataris (57.9%), women (53.9%), housewives (40.1%), and individuals with higher monthly income (53.9%). Somatization (14.9%) was observed more in LBP patients, followed by depression (13.7%) and anxiety disorders (9.5%). The most frequently reported symptoms were “headaches” (41.1%) and “pain in your arms, legs, or joints” (38.5%) in LBP patients with somatization. The most frequent symptoms among depressed LBP patients were “thinking of suicide or wanting to hurt yourself” (51.4%) and “feeling down, depressed, or hopeless” (49.2%). “Not being able to stop or control worrying” (40.2%), “worrying too much about different things” (40.2%), and “feeling afraid as if something awful might happen” (40.2%) were the most common anxiety symptoms in LBP patients. Psychological distress such as anxiety (9.5% versus 6.2%), depression (13.7% versus 8.5%), and somatization (14.9% versus 8.3%) were significantly higher in LBP patients. Conclusion The prevalence of LBP in this study sample was comparable with other studies. Furthermore, psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP.

High Prevalence of Depression, Anxiety and Stress Symptoms Among Diabetes Mellitus Patients

Background: Few studies have documented the rates of psychiatric symptoms in patients with Diabetes Mellitus (DM) patients and compared them with healthy controls. Aim: To determine whether there is a relationship between high depression, anxiety, and stress symptoms in Diabetes Mellitus (DM) patients in comparison to a group of controls. Design: This was a matched case-control study. Setting: Primary Health Care (PHC) Centres of the Supreme Council of Health, State of Qatar. Subjects: 889 DM patients and 889 healthy subjects matched for age, gender and ethnicity, from September 2009 to August 2010 were included in this study. Methods: Face to face interviews were conducted with DM patients and controls using a questionnaire which captured the socio-demographic characteristics of subjects and the short version of the Depression Anxiety Stress Scales (DASS)-21 questionnaire. Furthermore, we used the questionnaire based on the Hospital Anxiety and Depression Scale (HADS) to assess the validity of DASS-21. Results: The study findings revealed that most of the studied diabetic cases (33.6%) and healthy controls (30.9%) were in the 40-49 years age group. Significantly larger proportion of DM subjects had severe depression scores (13.6% vs 5.9%; p<0.001); severe anxiety scores (35.3% vs 16.3%; p<0.001); and severe stress scores (23.4% vs 10%; p<0.001) compared to healthy controls. The major predictors for high depression scores among diabetic cases were systolic blood pressure (OR 3.91; p=0.001), duration of diabetes (OR 2.68; p=0.011) and obesity (OR 2.50; p=0.001). The major predictors for high anxiety scores among diabetic cases were systolic blood pressure (OR 2.8; p=0.001), obesity (OR 2.27; p=0.001), and smoking (OR 1.78; p=0.04). The leading predictors for high stress scores were systolic blood pressure (OR 3.57; P=0.001), diastolic blood pressure (OR 2.80; P=0.001) and physical activity (OR 2.11, P=0.025). Diabetic women had higher depression (63.3% vs 50.4%), anxiety (70.1% vs 61.6%) and stress (73.3% vs 61.4%) scores than men. No significant association was observed between the diabetic complications and depression, anxiety or stress scores. Conclusion: The present findings revealed that diabetic cases had significantly higher depression, anxiety and stress scores compared to healthy controls. In particular anxiety scores were higher more frequently among diabetic patients in comparison to depression and stress scores.

Prevalence and correlates of low back pain in primary care: what are the contributing factors in a rapidly developing country.

Study Design Cross-sectional. Purpose The purpose of the study was to determine the prevalence of low back pain (LBP) in the primary care setting with emphasis on the socio-demographic contributing factors and impact of LBP on lifestyle habits. Overview of Literature LBP is one of the most common medical conditions seen in the Primary Health Care Clinic. Methods A representative sample of 2,600 patients were approached and 1,829 subjects agreed to participate in this study (70.0%). Data on socio-demographic characteristics, life style habits and type of treatment were collected through a questionnaire. Results The prevalence of LBP in the study sample was 56.5% (95% confidence interval, 54.2-58.8). LBP was more prevalent among women (53.9%) compared to men (46.1%). There was significant difference between male and female patients of LBP in terms of ethnicity (p<0.001), marital status (p=0.010), occupation (p<0.001), monthly household income (p=0.004), and cigarette/sheesha smokers (p<0.001). The percentages of different aspects of functional disabilities were statistically significantly higher among females compared to male patients with LBP. Almost a quarter of female patients with LBP (26%) and 18% male patients with LBP reported pain in the arms and legs (p=0.002). In addition, gastrointestinal complaints such as abdominal pain and food intolerance were significantly higher among female patients with LBP as compared to males (31% vs. 24.6%, p=0.018; and 25% vs. 18%, p=0.008, respectively). Complaints about headache and fainting were also significantly higher among female patients as compared to male LBP patients (43% vs. 36%, p=0.029; and 26% vs. 20%, p=0.016, respectively). The multivariate logistic regression revealed that being female, prolonged standing, prolonged sitting, heavy weight lifting, weakness in the legs, regular exercise, and cigarette/sheesh a smoking had a significant effect on the presence of LBP. Conclusions LBP is highly prevalent among both genders and in older age. Also, weakness in the legs, smoking, prolonged standing and sitting had a significant effect on LBP. Furthermore, the current study findings support the fact that LBP continues to be an important clinical, social and economic, burden and a public health problem affecting the population of the entire world.

Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care

The aim of the present study was to determine the prevalence of somatization, anxiety, depression and stress in a primary care population, explore their association to psychosocial stressors and determine the diagnostic overlap of these four mental disorders.

A Cross “Ethnical” Comparison of the Driver Behaviour Questionnaire (DBQ) in an Economically Fast Developing Country

Aim: The aim of this study was to compare the driving behaviours of four ethnic groups and to investigate the relationship between violations, errors and lapses of DBQ and accident involvement in Qatar. Subjects and Methods: The Driver Behaviour Questionnaire (DBQ) was used to measure the aberrant driving behaviours leading to accidents. Of 2400 drivers approached, 1824 drivers agreed to participate (76%) and completed the driver behaviour questionnaire and background information. Results: The study revealed that the majority of the Qatari (35.9%) and Jordanian drivers (37.5%) were below 30 years of age, whereas Filipino (42.3%) and Indian subcontinent (34.1%) drivers were in the age group of 30-39 years. Qatari drivers (52%) were involved in most accidents, followed by Jordanians (48.3%). The most common type of collision was a head on collision, which was similar in all four ethnic groups. The Qatari drivers scored higher on almost all items of violations, errors and lapses compared to other ethnic groups, while Filipino drivers were lower on all the items. The most common violation was the same in all four ethnic groups “Disregard the speed limits on a motorway”. The most common error item observed was “Queing to turn right/left on to a main road”. “Forget where you left your car” and “Hit something when reversing” were the two lapses identified in factor analysis. Conclusion: The present study identified that Qatari drivers scored higher on most of the items of violations, errors and lapses of DBQ compared to other countries, whereas Filipino drivers scored lower in DBQ items.

Association between psychological distress and gastrointestinal symptoms in diabetes mellitus

AIM To examine the possible association between gastrointestinal symptoms and anxiety and depression in type 2 diabetes mellitus (T2DM). METHODS The study was a matched case-control study based on a face to face interview with designed diagnostic screening questionnaires for gastrointestinal (GI) symptoms and T2DM, Patient Health Questionnaire (PHQ-9) for depression and General Anxiety Disorders (GAD-7) for anxiety. The questionnaire consisted of questions about symptoms and signs of anxiety and depression disorders. Also, socio-demographic characteristics, life style habits and the family history of patients were collected. It was carried out from June 2010 to May 2011 among Qatari and other Arab nationals over 20 years of age at Primary Health Care Centers of the Supreme Council of Health, Qatar, including patients with diabetes mellitus and healthy subjects over 20 years of age. RESULTS In the studied sample, most of the studied T2DM patients with GI symptoms (39.3%) and healthy subjects (33.3%) were in the age group 45-54 years (P < 0.001). The prevalence of severe depression (9.5% vs 4.4%, P < 0.001) and anxiety (26.3% vs 13.7%, P < 0.001) was significantly higher in T2DM patients with GI symptoms than in general population. Obesity (35.7% vs 31.2%) and being overweight (47.9% vs 42.8%) were significantly higher in T2DM patients with GI symptoms than in healthy subjects (P = 0.001). Mental health severity score was higher in T2DM patients with GI symptoms than in healthy subjects; depression (8.2 ± 3.7 vs 6.0 ± 3.6) and anxiety (7.6 ± 3.3 vs 6.0 ± 3.7). The most significant GI symptom which was considerably different from controls was early satiety [odds ratio (OR) = 10.8, P = 0.009] in depressed T2DM patients and loose/watery stools (OR = 2.79, P = 0.029) for severe anxiety. Anxiety was observed more than depression in T2DM patients with GI symptoms. CONCLUSION Gastrointestinal symptoms were significantly associated with depression and anxiety in T2DM patients, especially anxiety disorders.

The prevalence and burden of psychiatric disorders in primary health care visits in Qatar: Too little time?

Background: Psychiatric disorders including anxiety, depression, somatization, obsessive compulsive, and bipolar disorders are recognized as causing the biggest burden of disease worldwide. Aim: In this study, we aimed to assess the prevalence and burden of common mental disorders at Primary Health Care Centers (PHCC) using the World Health Organization Composite International Diagnostic Interview (WHO-CIDI) in the Qatari population, aged 18–65 who attended Primary Health Care (PHC) settings. Design: A prospective cross-sectional study conducted during November 2011 to October 2012. Setting: Primary Health Care Centers of the Supreme Council of Health, Qatar. Subjects: A total of 2,000 Qatari subjects aged 18–65 years were approached; 1475 (73.3%) agreed to participate. Methods: Prevalence and severity of International Classification of Disease-10 disorders were assessed with the WHO-CIDI (Version 3.0). Results: Of the 1475 participants, 830 (56.3%) were females and 645 (43.7%) was males. One-third were aged 35–49 years 558 (37.8%). The three most common disorders were major depression disorders (18.31%), any anxiety disorders (17.3%), any mood disorders (16.95%), followed by separation anxiety disorders (15.25%), personality disorder (14.1%). In the present study, prevalence in women was significantly higher than men for the most common psychiatric disorders, specifically generalized anxiety disorder, panic disorder, social phobia, specific phobias, obsessive compulsive disorders, posttraumatic disorder, somatization, major depressive disorder, bipolar disorder, dysthymia, and oppositional defiant disorder. Of the total 20% had only one psychiatric diagnosis and 12% had two disorders, 9.7% respondents with three diagnoses, and finally 4.3% of respondents had four or more diagnoses. Conclusion: One-fifth of all adults who attended the PHCC (20%) had at least one psychiatric diagnosis. The CIDI is a useful instrument for psychiatric diagnosis in community settings such as PHC clinics, clinical research and intervention studies. There is an urgent need to not only assess prevalence, but also risk factors, burden, treatment gaps and outcomes to obtain evidence for policy making.

The Impact of Consanguinity on Risk of Schizophrenia

The cross-sectional study was based on the Primary Health Care Centers among Arab patients aged 18–55 years from January 2009 to December 2010. Of the sample size of 1,491 subjects, 1,184 patients agreed to participate in this study (79.4%). Institutional review board approval was obtained from the Hamad Medical Corporation for conducting this research. The subjects who did not agree to participate (20.6%) were demographically similar to those who had agreed to participate. A validated self-administered questionnaire was designed to collect the data based on face-to-face interviews by physicians and qualified nurses. Following completion of this questionnaire by the patient, the provisional diagnosis score was calculated from the responses, which was then confirmed by psychiatrists through a clinical questioning using DSM-IV criteria. The general diagnostic screening questionnaire was not designed to make a definitive diagnosis but rather to identify people at high risk. Content validity, face validity and reliability of the questionnaire were tested using 50 paSchizophrenia (Sz) occurs worldwide and is one of the severest mental disorders [1] . The World Health Organization documented that Sz has been recognized as a major public health problem in the fourth position among the global burden of diseases [2] . It has been generally accepted that Sz, like all other complex diseases, is caused by genetic and environmental factors. Bener et al. [3] reported that consanguinity (inbreeding) may be associated with an increased risk for a wide range of genetically complex disorders. Marriages between relatives are common worldwide and lead to human consanguinity. It was found that consanguineous marriages increase the risk for Sz in offspring [4] . Since consanguinity is widely practiced in the Eastern Mediterranean region, it was considered worthwhile to study this aspect in this population. Moreover, an elevated parental consanguinity rate of 52% was reported in the State of Qatar [3] . The aim of the study was to examine the impact of consanguinity on the risk for Sz disorders and investigate the inbreeding characteristics of the Sz patients. Received: May 25, 2011 Accepted after revision: April 8, 2012 Published online: August 7, 2012

A two fold risk of metabolic syndrome in a sample of patients with schizophrenia: Do consanguinity and family history increase risk?

BACKGROUND Patients with schizophrenia are at greater risk for metabolic syndrome (MetS) and other cardiovascular risk factors. OBJECTIVE The objective of the study was to examine the prevalence of metabolic syndrome (MetS) and its criteria among patients with schizophrenia (Sz) according to the revised criteria of NCEP ATP III and assess which component contributed to the increased risk of the MetS in schizophrenia patients. DESIGN This was a matched case-control study. SETTING Outpatient clinics of the Psychiatry department and Primary Health Care (PHC) Centers of the Supreme Council of Health, State of Qatar. SUBJECTS AND METHODS The study was carried out among patients with schizophrenia (SZ) and healthy subjects above 20 years old. The study based on matched by age and gender of 233 cases and 466 controls. The survey was conducted from June 2010 to May 2011. Face to face interviews were conducted using a structured questionnaire followed by laboratory tests. Metabolic syndrome was defined using the National Cholesterol Education Program - Third Adult Treatment Panel (ATP III). RESULTS The prevalence of metabolic syndrome among schizophrenic patients (36.5%) were significantly higher than healthy subjects (18.7%) (p<0.001). The prevalence of MetS in schizophrenic subjects was reported to be two times higher than in the general population. The MetS components were higher among schizophrenic patients than healthy subjects. Among the components of MetS, central obesity (63.9%) was the most common criteria among patients compared to healthy subjects (45.7%) (p<0.001). Schizophrenic patients (27%) were significantly obese than the healthy subjects (13.1%). Female schizophrenia patients were more likely to have three or more metabolic abnormalities compared to men. CONCLUSION The study indicated that metabolic syndrome was highly prevalent in patients with schizophrenia. The female gender was significantly associated with a higher prevalence of metabolic syndrome. The identification and clinical management of this high risk group is of great importance.

An epidemiologic analysis of low back pain in primary care: a hot humid country and global comparison.

Background: Low back pain is one of the most common conditions for which patients seek medical care. Aim: The aim of the study was to study the epidemiology of low back pain in primary care setting with emphasis on frequency, sociodemographic factors, and impact of low back pain on lifestyle habits. Subjects and Methods: This is a cross-sectional study. A representative sample of 2742 patients was approached and 2180 subjects agreed to participate in this study (79.5%). The survey was conducted among primary health care visitors during the period from March to October 2012. The questionnaire collected the sociodemographic characteristics, lifestyle habits, and type of treatment taken for relief from recruited subjects. Results: Of the subjects studied, 52.9% were males and 47.1% were females. The prevalence of low back pain in the study sample was 59.2%. Low back pain was more prevalent among women (67.7%) than among men (51.6%). The proportion of low back pain was highest in the age-group 45 to 55 years in both the genders (37.6% and 36.4%, respectively). Nearly half of the men (45.7%) and women (45.2%) with low back pain were overweight with a significant difference (P < .001). More than half of the women with low back pain were housewives (50.4%), whereas most of the men had clerical jobs (36.8%). There was a significant difference observed between men and women in terms of nationality (P < .001), body mass index (P < .001), and occupation (P < .001). Prolonged standing (41.2% vs 29.5%; P < .001) and use of sponge mattress (50.9% vs 45.8%; P .041) was significantly higher among male patients with low back pain compared with females. Coughing/sneezing/straining (9.7% vs 5.9%; P = .01) were more frequent triggering factors in male patients with low back pain as compared with females. Conclusion: The study findings revealed that the prevalence of low back pain was higher among women than among men. Low back pain was observed more frequently among older people and among those who were overweight.