Ziad Kronfol

Pathways to postoperative hostility in cardiac patients: mediation of coping, spiritual struggle and interleukin-6.

Using structural equation modeling, we estimated major pathways from preoperative distress, indicated by anxiety and other factors, to postoperative hostility in cardiac patients. Sequential interviews were conducted before and after surgery. Standardized medical and surgical indices were selected from a national database. Results showed that preoperative spiritual struggle mediated indirect effects of anxiety and anger coping on Interleukin-6 (IL-6) immediately before surgery. The link between spiritual struggle and IL-6 further mediated the indirect effects of anxiety and anger coping on postoperative hostility. Anger coping mediated the harmful influence of anxiety and counteracted the protection of positive religious coping on adjustment.

Depression following open-heart surgery: a path model involving interleukin-6, spiritual struggle, and hope under preoperative distress.

Faith factors (i.e., factors pertaining to religion/spirituality) have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle. Based on the multidisciplinary literature and on previous findings, the studys analysis estimated parallel psychophysiological pathways from preoperative distress to postoperative depression in patients undergoing open heart surgery. Plasma samples for interleukin(IL)-6 were obtained before surgery. The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of preoperative anxiety on postoperative depression. Avoidant coping also mediated the influence of anxiety on postoperative maladjustment. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on postoperative mental health attributes.

Country in focus: Qatar

Qatar is a small country of 11,571 km located in the Arabain (Persian) Gulf, off the eastern coast of Saudi Arabia. Originally a semi-autonomous Ottoman and later British protectorate, the country was officially formed in 1971 when the British withdrew their political and military presence from the Gulf, forcing the United States to fill the security vacuum (Smith, 2004; Al-Shelek, 2009). The U.S. still maintains large military bases in the country. Qatar has traditionally supported two groups of inhabitants: pastoral nomadic Bedouin tribes and settled coastal Arabs who relied on pearling, trade, and piracy. The country is run by a hereditary Emir, Sheikh Hamad bin Khalifa Al-Thani, and members of the Al-Thani family occupy numerous top government posts. The Majlis al Shura (Advisory Council) appointed by the Emir advises on legislation, and elected members will be added to the Council in 2013. The new constitution adopted in 2003 guarantees freedom of speech, freedom of worship, freedom of economic activity, and freedom of assembly, although political parties are not allowed (RosmanStollman, 2009; Fromherz, 2012). According to the latest statistics, Qatar has a population of 1.7 million inhabitants (QSA, 2012). This population is however quite unique in several ways: over 86% of the population consists of foreigners, mostly expatriate workers from India, Pakistan, Nepal and the Philippines on short term contracts. Since much of the workforce consists of young males working in the oil and construction industries, there is a skewed male: female ratio of 3:1. Almost all Qataris work in the government sector because of the higher wages, shorter working hours and lengthy vacation. The government offers free education, healthcare, electricity, water, and house and land upon marriage to all Qatari citizens (Weber, 2011). The majority of Qataris are Sunni Muslim. Gulf Arabic (khaliji) is the main traditional language of Qatar, but English is becoming dominant because of the many expatriates. Many traditional customs have largely been unaffected by modernization: large family size, first cousin marriage, arranged marriage, and public segregation of males and females. K-12 education in Qatar is compulsory and free and the national university Qatar University also provides free tuition. Education

Mental health issues among migrant workers in Gulf Cooperation Council countries: Literature review and case illustrations

More than 15 million non-nationals are currently living and working in Gulf Cooperation Council (GCC) states. The majority are blue-collar or domestic workers coming from the Indian Subcontinent or South East Asia. They often work under very harsh conditions. There are reports of a high rate of psychosis and suicide among these people but no reliable data are available. To address this issue we conducted a literature search both in English and in Arabic to review the available articles on the psychological well-being of this population. Very few articles were found. We hereby review the available literature and contribute by presenting several brief vignettes to illustrate the various clinical aspects of this at risk population. We also discuss possible reasons for underreporting and underscore the need for more research in this area.

A graph based method for depicting population characteristics using Genome Wide Data

Abstract Genome Wide Association (GWA) studies associate genetic variants to clinical phenotypes using statistical tests which are based on assumption of random mating. Populations having history of consanguineous marriages, especially from Middle East, can violate this assumption. Here we present, use of averaged weighted clustering coefficient of undirected graphs to quantify cryptic relatedness between individuals from a random cohort. This measure can be used to understand pattern of relatedness in populations to choose between removing related samples and using mixed linear models correcting for relatedness while performing GWA studies.

Teaching Psychiatry on the Global Scene: The Cornell University Experience

Qatar is a small country located on the eastern coast of the Arabian Peninsula inWestern Asia. With a surface area barely exceeding 10,000 km and a population of about two million people, it is currently one of the largest exporters of liquid natural gas globally. Because of the sudden rise in revenues from energy resources, Qatar has the highest per capita income in the world. Rather than depending on a fuel-based economy alone, however, the political leadership plans to transform Qatar into a “knowledge-based economy” by investing in people and services. To that end, Qatar Foundation for Education, Science and Community Development (QF) partnered with several renowned universities to establish branches in Qatar. In collaboration with QF, Cornell University in New York established the first medical school in Qatar in 2002. Like the main campus in NewYork, theWeill Cornell Medical College in Qatar (WCMC-Q) has a tripartite mission of fostering excellence in medical education, research, and clinical care [1]. Students are admitted with the same admission criteria and follow the same curriculum as students at Weill Cornell Medical College (WCMC) in New York City. They also take the same exams and adhere to the same criteria for evaluation, promotion, and graduation. The inaugural class, graduating in 2008, had 15 students (nine women and six men) representing seven different nationalities. In 2015, the number rose to 43, and the trend of diversity in gender, nationality, religion, and native languages continues. Stakeholders in Qatar hope that many of the alumni will train in the USA but eventually return to practice in Qatar. Because psychiatry relates more to culture than most other medical specialties, teaching psychiatry has been somewhat of a challenge. We have earlier reported on the state of psychiatry in Qatar [2]. Here we describe our experience teaching psychiatry at WCMC-Q since its inception several years ago. Although there is much written about psychiatric education internationally, teaching at WCMC-Q offers the additional challenge of transferring a US curriculum to the Middle East.

Bipolar disorders in the Arab world: a critical review

Bipolar disorders are common psychiatric disorders that affect 1–5% of the population worldwide. Major advances in the epidemiology, pathophysiology, and treatment of the disorders have recently occurred. The majority of published reports, however, originate from the Western hemisphere, mostly Europe and the United States. There is a shortage of data from the Arab world on bipolar disorders. In an era of globalization and rapid communication, it is not clear to what extent research findings pertaining to one part of the world are by necessity applicable to other parts. Psychiatric disorders are known to be affected by the culture in which they occur, and knowledge of variations in illness presentation in different ethnic groups is also increasing. However, knowledge of variations affecting Arab populations remains quite limited. This paper provides a critical review of the literature on bipolar affective disorders in the Arab world, pointing to major gaps in knowledge and future opportunities to fill these gaps.

Psychiatry Residency Education in Countries with Low- and Middle-Income Economies

Utilizing scarce resources creatively becomes challenging for psychiatrists in impoverished countries. Balancing academic duties with public health needs compounds economic hardship, having to face concomitant problems of low wages, personnel shortages, large-volume practices, societal stigma, and discrimination. This chapter reviews how economic disparities in most of Asia, Africa, and Latin America, combined with psychiatric workforce inequities, create resource deficiencies having to culturally adapt educational initiatives. We recommend a learning inclusive approach that incorporates meeting public health needs and highest standards of care educational models. Specific examples will be given of collaborative didactic programs that connect mentors and institutions from high-income countries with trainees and faculty in underserved areas.

Selected psychiatric problems among college students in two Arab countries: comparison with the USA

BackgroundPsychiatric problems among college students on USA campuses are common. Little is known about similar problems in developing countries, particularly the Arab region. The goal of this study was to assess the frequency of selected psychiatric problems among college students in two Arab countries: Qatar and Lebanon, and to compare them to the USA.MethodsThe Healthy Minds Study, an online confidential survey of common psychiatric symptoms designed for college campuses was used. We used the Patient Health Questionnaire-9 (PHQ-9) to screen for major depression, the Generalized Anxiety Disorder-7 (GAD-7) to screen for generalized anxiety and the SCOFF questionnaire to screen for eating disorders. Comparisons were made using ANOVA, Chi-Square tests and logistic regressions.ResultsA total of 1841 students participated in the study. The rates of depression (PHQ-9u2009≥u200912), generalized anxiety (GAD-7u2009≥u200910) and eating disorders (SCOFF≥3) at the combined Arab universities were 34.6, 36.1 and 20.4% respectively. The corresponding rates in the USA were: 12.8, 15.9 and 6.8% (pu2009<u20090.001 for all measures). The impact of psychiatric problems on functioning in general and academic performance in particular was more severe in the Arab countries compared to the USA (pu2009<u20090.001). Independent predictors of psychiatric problems in general included location, female gender, financial difficulties and poor grades. Being religious had a protective association with mental health.ConclusionThe rates of depression, anxiety and eating disorders were significantly higher among college students in Qatar and Lebanon compared to the USA. Additional research is needed to determine whether these results reflect methodological limitations or true differences in psychopathology across these populations. If replicated, the results indicate that the psychiatric problems on college campuses in the USA are a microcosm of a global problem that needs global solutions.

P02-03 - Depression and anxiety following open heart surgery: Mediation of coping, spiritual struggle and interleukin-6

Introduction Factors pertaining to religion and spirituality have been linked with well-being and adequate coping. Few studies have investigated negative aspects of religious coping, such as spiritual struggle. Objectives Based on multidisciplinary literature and previous findings, our studys objectives are to estimate the parallel psychophysiological pathways from pre-operative distress to post-operative depression in patients undergoing open heart surgery. Aims The studys aims are to examine the association in depression, anxiety, and how coping, spiritual struggle and interleukin-6 play a role in patients following open heart surgery. Methods Plasma samples for interleukin-6 (IL-6) were obtained before open heart surgery. Patients’ history and demographic information obtained through interviews 2 days before surgery. Follow up interview for mental health and religious were conducted before and after surgery. Results The results showed that a link between spiritual struggle and IL-6 mediated the indirect effects of pre-operative anxiety on post-operative depression. Anxiety had positive indirect effects on post-operative hostility. Further, hope played a protective mediating role to moderate the undesirable influences of the spiritual struggle-IL-6 link and maladaptive coping on post-operative mental health attributes. Conclusions Our study estimated important psychophysiological pathways from pre-operative distress to post-operative maladjustment. To our knowledge, this model is the first analysis to demonstrate the significant mediating effect of the spiritual-IL-6 link, alongside that of positive religious copping and other maladaptive coping, in this population.