Twelve-month prevalence, persistence, severity, and treatment of mood and anxiety disorders in Qatar's national mental health study.

OBJECTIVES: To estimate 12-month prevalence, persistence, severity, and treatment of mental disorders and socio-demographic correlates in Qatar. METHODS: We conducted the first national population-based telephone survey of Arab adults between 2019 and 2022 using the Composite International Diagnostic Interview and estimated 12-month DSM-5 mood and anxiety disorders and their persistence (the proportion of lifetime cases who continue to meet 12-month criteria). RESULTS: The 12-month prevalence of any disorder was 21.1% (10.4% mild, 38.7% moderate, and 50.9% severe) and was associated with: younger age, female, previously married, and with persistence of any disorder. Persistence was 74.7% (64.0% mood and 75.6% anxiety) and was significantly associated with secondary education or lower. Minimally adequate treatment received among those with any 12-month mental disorder was 10.6% (74.6% in healthcare and 64.6% non-healthcare sectors). Severity and the number of disorders significantly associated with each other and with treatment received (χ2 = 7.24, p = 0.027) including adequate treatment within the mental health specialty sector (χ2 = 21.42, p < 0.001). CONCLUSIONS: Multimorbidity and sociodemographics were associated with 12-month mental disorder. Treatment adequacy in Qatar are comparable to high-income countries. Low treatment contact indicate need for population-wide mental health literacy programes in addition to more accessible and effective mental health services.

Lifetime prevalence, risk, and treatment of mood and anxiety disorders in Qatar's national mental health study.

OBJECTIVES: To estimate lifetime prevalence, risk, and treatment for mental disorders and their correlates in Qatar's general population for the first time. METHODS: We conducted a national phone survey of 5,195 Qatari and Arab residents in Qatar (2019-2022) using the Composite International Diagnostic Interview Version 3.3 and estimated lifetime mood and anxiety defined diagnoses. Survival-based discrete time models, lifetime morbid risk, and treatment projections were estimated. RESULTS: Lifetime prevalence of any disorder was 28.0% and was associated with younger cohorts, females, and migrants, but lower formal education. Treatment contact in the year of disorder onset were 13.5%. The median delay in receiving treatment was 5 years (IQR = 2-13). Lifetime treatment among those with a lifetime disorder were 59.9% for non-healthcare and 63.5% for healthcare; it was 68.1% for any anxiety and 80.1% for any mood disorder after 50 years of onset. Younger cohorts and later age of onset were significantly predictors of treatment. CONCLUSIONS: Lifetime prevalence of mental disorders in Qatar is comparable to other countries. Treatment is significantly delayed and delivered largely in non-healthcare sectors thus the need for increased literacy of mental illness to reduce stigma and improve earlier help-seeking in healthcare settings.

Clinical reappraisal of the composite international diagnostic interview version 3.3 in Qatar's National Mental Health Study.

OBJECTIVES: Lifetime DSM-5 diagnoses generated by the lay-administered Composite International Diagnostic Interview for DSM-5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to diagnoses based on blinded clinician-administered reappraisal interviews. METHODS: Telephone follow-up interviews used the non-patient edition of the Structured Clinician Interview for DSM-5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Concordance was also examined for a diagnoses of post-traumatic stress disorder based on a short-form versus full version of the PTSD Checklist for DSM-5 (PCL-5). RESULTS: Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses ( χ 1 2 ${\chi }_{1}^{2}$  = 6.6-31.4, p = 0.010 < 0.001), but recalibration reduced most of these differences and led to consistent increases in individual-level concordance (AU-ROC) from 0.53-0.76 to 0.67-0.81. Recalibration of the short-form PCL-5 removed an initially significant difference in PTSD prevalence with the full PCL-5 (from χ 1 2 ${\chi }_{1}^{2}$  = 610.5, p < 0.001 to χ 1 2 ${\chi }_{1}^{2}$  = 2.5, p = 0.110) while also increasing AU-ROC from 0.76 to 0.81. CONCLUSIONS: Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.

The psychological impact of the Turkey-Syria earthquake on children: addressing the need for ongoing mental health support and global humanitarian response.

This letter aims to explore the potential impact of the Turkey-Syria earthquake on the psychological well-being of the affected children and adolescents. It emphasises the crucial importance of prompt identification and management of emerging mental health disorders in this vulnerable population. The letter draws on existing research evidence to highlight the need for suitable mental health interventions to mitigate the anticipated suffering of many children and adolescents affected by the earthquake. A comprehensive overview of the mediating factors which may play a role in the extent of the impact of an earthquake on the mental health of children is discussed. A range of appropriate strategies and interventions are recommended and the call for continued global support is renewed. We have concluded that major earthquakes can potentially contribute to the development of mental health disorders among children and adolescents. However, by providing timely and effective support, it is possible to prevent long-term psychological consequences and facilitate early recovery. We propose the urgent implementation of effective mental health interventions in the aftermath of the Turkey-Syria earthquake to foster the recovery and resilience of the affected young population.

Mental health disorders are more prevalent in children affected by earthquakes.Prompt identification of emerging mental health disorders among this population is crucial.Management of the psychological impact in this context must be practical and needs-based.A focused and continued global support response is needed to manage the long-term challenges.

Death by suicide during COVID-19 infection: Two case reports.

A range of psychiatric disorders has been recognized with coronavirus disease 2019 (COVID-19) infection, including acute stress, anxiety, depression, suicidal behavior, and post-traumatic stress disorder. Among those, the most worrying is death by suicide, which has been associated with COVID-19-related psychiatric disorders and psychosocial stressors. We report the first two cases of death by suicide, unlikely due to any current psychiatric disorders, while undergoing treatment in two inpatient facilities designated for COVID-19 patients. Case 1 was a 40-year-old man who presented to the emergency department with symptoms of a viral infection. This led to the diagnosis of COVID-19. While undergoing treatment in an inpatient facility, 3 weeks later, he died by hanging. Case 2 was a 25-year-old man with COVID-19-related upper respiratory tract symptoms and a possible undiagnosed pre-existing anxiety disorder. While undergoing treatment in a medical unit of a COVID-19-designated hospital, a week after the diagnosis of COVID-19, the patient died after jumping off the multistory hospital building. In both cases, there had been a diagnosis of COVID-19, and treatment was provided within an inpatient facility. Both patients were unvaccinated and had no evidence of a current psychiatric disorder or any warning signs of suicidal intent. Death by suicide can occur in COVID-19 patients without any warning signs of a psychiatric disorder or evidence of any apparent distress. Therefore, even without a diagnosable mental disorder, clinicians should still be vigilant about potential suicidal risk in patients with COVID-19 infection.

Burnout among healthcare professionals in Qatar: A systematic review.

This systematic review aims to cover studies addressing the topic of burnout among the various types of healthcare professionals in Qatar. PubMed, Scopus and Google Scholar were searched with no filters. All studies using the Maslach Burnout Inventory (MBI) were included. The Newcastle-Ottawa Scale was used for quality assessment of the studies included. The reporting of the study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The results indicate that the pooled prevalence rate of burnout among healthcare professionals in Qatar are, 17% and 20% based on fixed effect and random effect models, respectively.

Management of suicide and self-harm risk by the National Mental Health Helpline in the State of Qatar.

BACKGROUND: Suicide is a serious public health problem. AIMS: To investigate the sociodemographic and clinical features of callers (patients) classed by the Qatar National Mental Health Helpline (NMHH) as moderate to high priority based on the risk of self-harm or suicide during the COVID-19 pandemic. METHOD: The study design was a retrospective chart review of patients who contacted the helpline in the first 12 months, starting 1 April 2020. Data of those classed as moderate to high priority based on risk to self were collected using a specifically designed form. Absolute and relative frequencies for each of the studied categorical variables were determined. RESULTS: Four hundred and ninety-eight patients were included. More than half were female. The mean age was 32 years (range 8-85 years). Two-thirds of patients were from Arab countries and more than half of all patients had contacted mental health services for the first time. The most common symptoms elicited included suicidal thoughts, depressed mood and disturbed sleep. The most common psychiatric disorders were depression and generalised anxiety disorder. Most patients were seen within 4 h and received psychiatric interventions. Virtually all patients received non-pharmacological interventions; only 38.5% received pharmacological interventions. The majority had follow-up appointments arranged with mental health services. CONCLUSIONS: People from the Indian subcontinent and males proportionally approached services less, which may reflect stigma. The NMHH improved access to care for patients considered at risk to self and prevented hospital admissions. The NMHH offers a valuable additional choice to patients and assists in prevention and management of suicidal behaviour and other mental health difficulties.

Human rights as the key driver for development of Learning Disability services in Qatar.

Growing international consensus in recognising rights of individuals with disability to enabling environments has spurred on provision of services for support for these individuals. The provision of this support has however been variable across the globe, often depending upon the economic development and social stigma associated with disability within individual countries. Individuals with Mental health learning disability have experienced even more stigma and limitations to access care. Qatar, a young and economically prosperous country, has adopted this rights-based approach to developing services for individuals with learning disability. This has led to the development of a specialist mental health learning disability services which is taking its initial steps within the country. This specialist service places the individual and their family at the centre of developing and delivering care and aims at reducing stigma and improving access to specialist evidence-based care.

Patients' and primary carers' views on clozapine treatment for schizophrenia: A cross-sectional study in Qatar.

Subjective views of clozapine treatment among patients with schizophrenia in the Middle East and North African MENA Region have not previously been assessed. Globally, few studies have assessed the views of carers to clozapine treatment. We conducted a cross-sectional survey, using a clinician administered structured interview, of patients with schizophrenia/schizoaffective disorder prescribed clozapine in Qatar, and their primary carers. Participants were asked to rate clozapine against prior their antipsychotic treatment in terms of specific benefits and side effects. Forty-two patients and 33 carers participated in the study. Of the patients, two thirds were male, approximately half were Qatari and the mean age was 33.9 years. Patients and carers rated clozapine as superior to prior antipsychotic treatment on all 7 potential benefits inquired about. The greatest perceived benefit was improved mood. Patients rated clozapine as less likely to cause extrapyramidal side effects but more likely to cause 18 other potential side effects compared to prior antipsychotic treatment, with the greatest difference being for nocturnal salivation, increased appetite, and constipation. Nearly half of patients (48 %) and two thirds of carers (64 %) stated that they would have preferred to start clozapine earlier in their illness. Sixty percent of patients and 37 % of carers regarded the information that they had received from health professionals on clozapine as inadequate. Less than half of patients and approximately-two thirds of carers had adequate knowledge of haematological monitoring for clozapine. Generally, there were significantly positive correlation between patients and carers regarding the overall side effects of clozapine treatment. Likewise, improvement in hearing voices paranoid thoughts correlated with improved quality of life. In summary, the results show that patients and carers appreciate the benefits of clozapine despite its side effects being problematic. The results support clozapine being offered earlier in treatment and services providing more information on clozapine to patients and carers.

Cross-cultural Differences in Hallucinations: A Comparison Between Middle Eastern and European Community-Based Samples.

BACKGROUND AND HYPOTHESIS: While literature indicates that culture modulates phenomenological characteristics of hallucinations in schizophrenia-spectrum disorders, little is known about the extent culture modulates these characteristics in nonclinical samples. STUDY DESIGN: We compared lifetime prevalence, age of onset, and phenomenology of hallucinations as assessed with the Questionnaire for Psychotic Experiences between samples of nonclinical participants used from the Netherlands (N = 2999) and Qatar (N = 2999). While participant recruitment differed between the 2 countries, the samples were relatively equal in terms of demographic factors. STUDY RESULTS: Our findings indicate that the lifetime prevalence of tactile and olfactory hallucinations are the same across countries. However, the prevalence of auditory hallucinations (AH) and visual hallucinations (VH) were twice as high in the Dutch sample. The reported age of onset for auditory and tactile hallucinations was younger for the Dutch sample. Findings from the measurement invariance supported cross-cultural comparisons with exception for duration, distress, and insight. Qatar's and Dutch participants reported similar valence and extent of interaction with AH and VH. However, compared to those in the Netherlands, participants from Qatar reported significantly more impact on daily functioning and a higher prevalence of receiving commands from hallucinations in the past week. CONCLUSIONS: While AH and VH were more often reported in the Dutch sample, participants in Qatar generally had higher mean factor scores for past week AH and VH than in the Netherlands. The phenomenology of hallucinations in the Qatar sample was of greater clinical relevance, with potentially important implications for early screening and prevention.

Design and field procedures for the clinical reappraisal of the Composite International Diagnostic Interview version 3.3 in Qatar's national mental health study.

BACKGROUND: The Composite International Diagnostic Interview (CIDI) has been clinically reappraised in several studies conducted mainly in the US and Europe. This report describes the methodology used to conduct one of the Middle East's largest clinical reappraisal studies. The study was carried out in conjunction with the World Mental Health Qatar-the first national psychiatric epidemiological study of common mental disorders in the country. This study aimed to evaluate the diagnostic consistency of core modules of the newly translated and adapted Arabic version of the CIDI 5.0 against the independent clinical diagnoses based on the Structured Clinical Interview for DSM-5 (SCID-5). METHODS: Telephone follow-up interviews were administered by trained clinicians using the latest research edition of the SCID for DSM-5. Telephone administered interviews were key in the data collection, as the study took place during the COVID-19 pandemic. RESULTS: Overall, within 12 months, 485 interviews were completed. The response rate was 52%. Quality control monitoring documented excellent adherence of clinical interviews to the rating protocol. CONCLUSIONS: The overall methods used in this study proved to be efficient and effective. For future research, instrument cultural adaptation within the cultural context is highly recommended.

False Positive Tramadol Urine Testing in Patients Taking Fexofenadine: A Tale of Two Consecutive Cases.

Urine drug screen immunoassays have been widely used as point-of-care testing for detection of various drug classes in substance use disorders. However, these immunoassays frequently result in false positive results. We report two patients that used 180 mg daily dose of fexofenadine hydrochloride for treatment of skin allergy and, falsely, tested positive for use of tramadol during urine drug screening. We recommend caution when interpreting positive tramadol urine screening among patients on fexofenadine treatment.

COVID-19 Vaccine Hesitancy and Personality Traits; Results from a Large National Cross-Sectional Survey in Qatar.

Attitudes to vaccination arise from a complex interplay of personal and environmental factors. This has been true for the COVID-19 vaccination attitudes too and understanding personal factors would help design immunisation strategies that help in infectious disease control. The five-factor model of personality has been established as a valid construct in exploring individual attitudes and traits. This institutional review board approved study explores the relationship between these five domains of personality and attitudes to COVID-19 vaccination in Qatar which has a migrant majority population. A cross-sectional survey was conducted in Qatar using an online survey link containing validated tools to measure vaccine hesitancy and personality traits. People from diverse ethnic and sociodemographic backgrounds, amounting to 5340 individuals, completed the self-report survey. After controlling for social and demographic variables, individuals scoring significantly higher on Conscientiousness were more likely to refuse the COVID-19 vaccination, while those scoring significantly lower on Openness to experience and Neuroticism were also more likely to refuse COVID-19 vaccination. Both groups of individuals scoring significantly higher and lower on Conscientiousness and Neuroticism, respectively, were more likely to trust their own research than trust endorsement of the COVID-19 vaccine from their doctor or healthcare organisation. The study highlights the highly complex and sometimes contradictory relationship between vaccine hesitancy and personality traits and makes a case for understanding this relationship better in order to inform successful immunisation strategies.

Policy and legislation for the treatment of mental health and substance use disorders in Qatar.

There is a marked paucity of publications on the policy and legislation of mental health, and substance use disorders in the public domain in Qatar. Qatar National Vision provides a framework for national strategies and the State of Qatar has developed policies and legislation dedicated to mental health and substance use. In doing so, Qatar has adopted international guidance to shape its mental health services and relevant policy and legislation. This article is a narrative description of the evolution of the mental health and substance use policy and legislation in Qatar.

Stress Levels and Coping Strategies of Families of Adults With Intellectual Disability and Challenging Behaviours During the COVID-19 Pandemic in Qatar.

This study investigated the perceived stress levels and coping strategies of caregivers of adults with intellectual disability and challenging behaviours during the COVID-19 pandemic in Qatar. A cross-sectional survey was conducted from June 7 to September 7, 2020 for caregivers of adults diagnosed with intellectual disability and challenging behaviours. Perceived stress levels and coping strategies were assessed using the Perceived Stress Scale and Brief Coping Orientation to Problems Experienced inventory. Results showed moderate to high perceived stress levels in most caregivers (69%). The most frequent coping strategy was religion, followed by acceptance and active coping. Substance use and self-blame were less frequently used. The study revealed that emotional support, informational support and venting coping strategies were significant predictors of perceived stress levels. Restrictions on physical activity and social mobility caused by pandemic-related lockdowns have placed tremendous pressure on caregivers. Appropriate supportive measures should be implemented for the caregivers.