Evaluating the pictorial warnings on tobacco products in Arabian Gulf countries against other international pictorial warnings.

BACKGROUND: Few assessments of pictorial warnings (PWs) on cigarette packs implemented in Gulf Cooperation Council (GCC) countries have been done. METHODS: This article includes two cross-sectional studies. In Study 1, convenience samples of adults from the Kingdom of Saudi Arabia (n=111) and USA (n=115) participated in a consumer survey to rate a total of nine PWs from the GCC, Australia and the UK. Outcome measures were affective responses to PWs and concerns about smoking. In Study 2, tobacco control experts (n=14) from multiple countries rated the same PWs on a potential efficacy scale and completed one open-ended question about each. The PWs were altered to mask their country of origin. Analyses compared ranking on multiple outcomes and examined ratings by country of origin and by smoking status. RESULTS: In the consumer survey, participants from both countries rated the PWs from GCC lower than PWs from other countries on the two measures. The mixed-model analysis showed significant differences between the PWs from Australia and those from the GCC and between the PWs from the UK and those from the GCC (p<0.001) in the consumer and expert samples. The experts' comments about the PWs implemented in the GCC were negative overall and confirmed previously identified themes about effective PWs. CONCLUSION: This study shows PWs originating from the GCC had significantly lower ratings than those implemented in Australia and the UK. The GCC countries may need to re-evaluate the currently implemented PWs and update them periodically.

Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional's Help?

BACKGROUND: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. METHOD: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple's App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app's download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. RESULTS: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). CONCLUSIONS: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps.

Consistency and Sensitivity Evaluation of the Saudi Arabia Mental Health Surveillance System (MHSS): Hypothesis Generation and Testing.

BACKGROUND: Public health surveillance systems should be evaluated periodically, and the evaluation should include recommendations for improving the system's quality and efficiency. Each surveillance system may have a unique situation in which evaluating its quality depends on its methodology, aims, and other factors, such as the frequency of repeating the survey in the case of survey-based surveillance. OBJECTIVE: As the consistency of the surveillance system to capture demographic data and its sensitivity to monitor the intended health-related event are important indicators of the quality of the surveillance system, the aim of this article is to evaluate the Saudi Arabia Mental Health Surveillance System (MHSS) in terms of consistency and sensitivity via the scientific hypothesis testing process. METHODS: The quality of the MHSS was assessed by examining (1) the consistency of the main demographic variables and (2) the sensitivity to changes in score between the 2 mental health screening tools used in the MHSS and between the 3 waves collected in 3 consecutive months. The assessment uses all data collected via the MHSS between May 2020 and July 2020. The first null hypothesis predicted there were differences between the distributions of the demographic variables between the 3 waves. The second predicted there were no differences between the scores of the Patient Health Questionnaire 9 (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7) between the 3 waves. RESULTS: In terms of sampling variables (age, gender, and region), there were no significant differences between the 3 waves in age, using one-way ANOVA, nor in gender and region, using the chi-square test. In addition, there were no significant differences between the 3 waves in all other demographic variables, except in the income variable. However, in terms of the PHQ-9 score, the one-way ANOVA (F2,12334=8.05; P<.001) showed significant differences between waves. Similarly, significant differences between waves were found in the GAD-7 score (F2,12334=7.09; P=.001). CONCLUSIONS: The MHSS showed a consistent distribution of the sample demographic variables, while being sensitive to the changes in mental health scores across waves. The MHSS can generate an acceptable level of consistency and sensitivity to monitor mental health trends. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/23748.

Exploring the Association Between Physical Activity and Risk of Mental Health Disorders in Saudi Arabian Adults: Cross-sectional Study.

BACKGROUND: The relationship between physical activity and mental health, especially the symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), has received increasing attention in recent years. OBJECTIVE: The aim of this study was to explore the association between fulfilling the World Health Organization (WHO) global recommendations on physical activity and the risk and symptoms of MDD and GAD in the Saudi population. METHODS: This study was a secondary analysis of data from a large nationwide cross-sectional survey conducted via phone interviews in June and July 2020. In this study, a proportional quota sampling technique was used to obtain an equal distribution of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. The main mental health screening tool used for the risk of MDD was the Patient Health Questionnaire-9 (PHQ-9). Risk of GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Participants self-reported whether they fulfill the WHO global recommendations on (1) moderate-intensity aerobic physical activity (MIPA) and (2) vigorous-intensity aerobic physical activity (VIPA). The results were then analyzed based on the following two categories: fulfilling the WHO global recommendations or not. RESULTS: The data analysis included 8333 participants recruited in the main study between June and July 2020. The response rate was 81.45% (8333/10,231). Of them, 50.3% (4192/8333) were female, and the mean age was 36.5 years, with a median age of 36 years and a range from 18 to 90 years. The average total PHQ-9 score was 5.61, and the average total GAD-7 score was 4.18. For men, the average total PHQ-9 and GAD-7 scores were associated with fulfilling recommendations for MIPA; however, there were no associations for VIPA in both sexes. Fulfilling the WHO's recommendations for MIPA was associated with considerably fewer depressive symptoms in six of the nine items in the PHQ-9. Moreover, fulfilling recommendations for MIPA was associated with considerably fewer anxiety symptoms in six of the seven items in the GAD-7. However, fulfilling recommendations for VIPA was significantly associated with more depressive symptoms in one of the PHQ-9 items ("Thoughts that you would be better off dead or thoughts of hurting yourself in some way;" P<.001). CONCLUSIONS: This study has shown that fulfilling guidelines on MIPA is associated with less overall risk of MDD and GAD in males and fewer depressive and anxiety symptoms generally in a nonclinical population. In the general population, an increase in MIPA may improve well-being and general mental health.

Food Taste, Dietary Consumption, and Food Preference Perception of Changes Following Bariatric Surgery in the Saudi Population: A Cross-Sectional Study.

BACKGROUND: Bariatric surgery is known as the most effective treatment resulting in long-term weight loss for obesity. However, behavioral changes, including food preference, food allergies, and consumption, between groups of patients who underwent bariatric surgery in comparison with people who did not have bariatric surgery have not been fully discussed in the literature. OBJECTIVE: The aim of this article is to describe patient-reported changes of perception related to food preferences, consumption, and food allergies in participants who underwent bariatric surgery and to compare their food consumption with participants who did not have bariatric surgery in Saudi Arabia. METHODOLOGY: This study is a secondary analysis of the Sharik Diet and Health National Survey (SDHNS) conducted in July 2021. Quota sampling was utilized to generate balanced distributions of participants by age and gender across all administrative regions of Saudi Arabia. Data collection included sociodemographic information (age, gender, and educational level), as well as food habits and the consumption of various food categories. RESULTS: Of the 6267 potential participants contacted in 2021 from the 13 administrative regions of Saudi Arabia, 5228 successfully completed the interview, with a response rate of 83.4%. Gender was distributed equally among the total participants in the sample. The prevalence of bariatric surgeries in Saudi Arabia was estimated at around 4.1% of the total sample. More than 36% of people who had bariatric surgery experienced food taste changes, and around 15% reported a decrease in allergic reactions to food. Moreover, 68.1% had food preference changes, either starting to favor a new food or no longer favoring one. There was a significant association between consuming more red meat, chicken, and energy drinks and a decreased consumption of grains and rice among those who had the bariatric surgery compared with those who did not. CONCLUSIONS: This study found that more than two-thirds of people who had bariatric surgery self-reported food taste and food preference changes. More studies should be performed on the Saudi population, including clinical follow-up, to better understand these changes.

Levels and Associations of Weight Misperception with Healthy Lifestyle among Adults in Saudi Arabia.

INTRODUCTION: Obesity affects more than one-quarter of adults in Saudi Arabia and is on the rise. A significant proportion of overweight and obese individuals misperceive their weight, and this misperception can affect their likelihood to exercise, consume healthy foods, or change unhealthy dietary habits. This study examines the prevalence of weight misperceptions in a national sample of Saudi adults and explores weight misperception association with sociodemographic factors, behavioral factors, and health status. METHODS: This study was a nationwide cross-sectional survey conducted via phone interviews. A proportional quota sampling technique was used to obtain equal distributions of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. Weight and height were self-reported, and obesity was determined as a BMI ≥30. Participants were asked to describe their current weight as ideal, underweight, overweight, or obese. Misclassification was then compared across groups according to a range of sociodemographic factors, behavioral risk factors, and health indicators. RESULTS: Of the 6,239 participants contacted, 4,709 (75.5%) responded and completed the interview. Of them, 50.1% were female, and the mean age was 36.4 (SD ± 13.55) years. The majority (70.1%) of participants indicated having weighed themselves within the past 30 days. The prevalence of weight misperception in general was 42.0%, and in obese participants, it was 67.6%. In addition, a significant association was observed between weight misperception and obesity, age-group, educational level, diagnosed chronic condition, self-rated health, and sedentary lifestyle. There was no significant association between weight misperception and gender, physical activity, or a nutritional knowledge. CONCLUSIONS: Weight misperception could be used as an indicator of a poor health routine that may lead to negative health outcomes.

Prevalence of Self-Reported Food Allergies and Their Association with Other Health Conditions among Adults in Saudi Arabia.

Food allergies are a potentially life-threatening health issue, and few studies have determined their prevalence throughout Saudi Arabia. The main objective of our study was to estimate the prevalence and distribution of self-reported food allergies, and explore their association with other health conditions among adults in Saudi Arabia. This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was used to obtain equal distributions of participants by age and gender across the 13 regions of Saudi Arabia. Self-reported food allergy, height, weight, health conditions, mental health status, and demographic variables were collected. Of the 6239 participants contacted, 4709 (75.48%) participants responded and completed the interview. Furthermore, 50.1% of the participants were female, with a mean age of 36.4 ± 13.5 years (18-90 years). The prevalence of food allergies was 19.7%. The most self-reported food allergies were egg, shellfish and shrimp, and peanuts, with a prevalence of 3.7%, 3.1%, and 3.0%, respectively. There was an association between the presence of food allergies and reported bariatric surgery, asthma, colon disease, and being at risk of depression. Bariatric surgery was significantly associated with lower likelihood of self-reported allergy (OR 1.69, 95% CI 1.22-2.34, p = 0.002). This study revealed, for the first time, a high prevalence of self-reported food allergies among adults in Saudi Arabia in a large nationwide sample, and food allergy association with bariatric surgery, asthma, colon disease, and being at risk of depression. This information is valuable for clinicians and policymakers, particularly in terms of food allergen labeling.

Understanding Food Waste, Food Insecurity, and the Gap between the Two: A Nationwide Cross-Sectional Study in Saudi Arabia.

BACKGROUND: Food waste and food insecurity may co-exist in various balances in developing and developed countries. This study aimed to explore the levels of food waste and food insecurity, the factors associated with them, and their relationships at the household and individual levels in Saudi Arabia. METHODS: This study was a nationwide cross-sectional survey conducted via computer-assisted phone interviews in January 2021. Quota sampling was utilized to generate balanced distributions of participants by gender across all the administrative regions of Saudi Arabia. Data collection included household demographics, food waste and disposal, the Food Insecurity Experience Scale (FIES), and the Household Food Insecurity Access Scale (HFIAS). RESULTS: Out of the 2807 potential participants contacted, 2454 (87.4%) completed the interview. The mean age was 31.4 (SD = 11.7; range = 18-99) and 50.1% were female. The weighted prevalence of uncooked food waste in the last four weeks was 63.6% and the cooked food waste was 74.4%. However, the food insecurity weighted prevalence at the individual level (FIES) was 6.8%. In terms of food insecurity at the household level (HFIAS), 13.3% were in the "severely food insecure" category. Moreover, this study found that "moderately food insecure" households were associated with an increased likelihood to waste uncooked food (relative risk (RR) = 1.25), and the "mildly food insecure" (RR = 1.21) and "moderately food insecure" (RR = 1.17) households were associated with an increased likelihood to waste cooked food. However, "food secure" households were associated with a decreased likelihood to waste cooked food (RR = 0.56). Finally, this study identified four household factors associated with food waste and three household factors that were associated with "severe food insecurity." CONCLUSIONS: This first national coverage study to explore food waste and food insecurity at the individual level and household level, identified household factors associated with food waste and food insecurity and identified new associations between food waste and food insecurity in Saudi Arabia. The associations found between food waste and food insecurity are potential areas of intervention to reduce both food waste and food insecurity at the same time, toward achieving the Sustainable Development Goal (SDG) targets related to food waste and food security.

Obesity in Saudi Arabia in 2020: Prevalence, Distribution, and Its Current Association with Various Health Conditions.

The global prevalence of obesity is increasing. Obesity is associated with many chronic diseases and health conditions. This study aims to estimate the current prevalence of obesity in Saudi Arabia and described the current national-level status of the association between obesity and various health conditions. This study is a nationwide cross-sectional survey conducted over phone-interviews in June 2020. In this study, a proportional quota-sampling technique was used to obtain equal distributions of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. Weight and height were self-reported, and the obesity was determined as BMI ≥ 30. Logistic regression adjusted for age and gender was used for exploring current associations between obesity and health conditions. Of the 6239 participants contacted, 4709 participants responded and completed the interview with a response rate of 75.48%. Of them, 50.1% were female, the mean age was 36.4 ± 13.5 (Range: 18-90), and the median age was 36. The national weighted prevalence of obesity (BMI ≥ 30) was 24.7%, and the prevalence in the sample (unweighted) was 21.7%. Obesity was significantly associated with type 2 diabetes [Odd ratio, (OR) = 1.52], hypercholesterolemia (OR = 1.69), hypertension (OR = 1.61), lung diseases (OR = 1.69), rheumatoid arthritis (OR = 1.57), sleep apnea (OR = 1.82), colon diseases (OR = 1.31), and thyroid disorders (OR = 1.8). This study provides an update on the recent prevalence of obesity in Saudi Arabia. It also shows the variation in prevalence rates between different regions, which might be explored further. Although obesity shows a decreasing trend, almost one-quarter of this study sample were obese. Obesity is currently associated with many health conditions that can affect the individuals' quality of life, impose stress on the healthcare system and impose an economic burden on the country. This evidence highlights the need for action to focus more on obesity in Saudi Arabia.

Reporting of Differences in Taste Between Branded and Unbranded Cigarettes by Smokers Blinded to Cigarette Branding: Within-Person, Randomized Crossover Study.

BACKGROUND: Saudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization's recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization. OBJECTIVE: The main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath. METHODS: This study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation. RESULTS: This study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=-0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=-0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette. CONCLUSIONS: After controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand.

Exploring the Impact of COVID-19 Response on Population Health in Saudi Arabia: Results from the "Sharik" Health Indicators Surveillance System during 2020.

BACKGROUND: Although some studies have explored the effects of responses to COVID-19 on mortality, there are limited data on their effects on more immediate health risk factors and the trends of chronic diseases. OBJECTIVE: To explore the prevalence of some behavioral health risk factors, intermediate risk factors, and chronic diseases at different timepoints during 2020 using the data available from a currently used surveillance system in Saudi Arabia. METHODS: This study undertook a secondary analysis of data from the Sharik Health Indicators Surveillance System (SHISS). The SHISS employs short cross-sectional phone interviews, conducted in all 13 administrative regions of Saudi Arabia on a quarterly basis. Each interview lasts approximately 4 min and is conducted by a trained data collector. The SHISS collects demographic data, as well as data on the major behavioral and intermediate chronic disease risk factors and the major chronic diseases, including diabetes, heart disease, stroke, cancer, and chronic respiratory diseases. RESULTS: Of the 44,782 potential participants contacted in 2020, 30,134 completed the interview, with a response rate of 67.29%. Out of the total participants, 51.2% were female. The mean age was 36.5. The behavioral risk factors in this period exhibited significant changes compared to those in the first quarter (Q1) of 2020, when there were no significant restrictions on daily activities. These significant changes are related to reductions in fruit and vegetable intake (adjusted odds ratio (AOR), 0.23) and physical activity (AOR, 0.483), and a significant increase in e-cigarette use (AOR 1.531). In terms of the intermediate risk factors observed in the SHISS, significant increases in hypercholesterolemia (AOR, 1.225) and hypertension (AOR, 1.190) were observed. Finally, heart disease (AOR, 1.279) and diabetes (AOR, 1.138) displayed significant increases compared to Q1. CONCLUSIONS: This study shows some evidence of the impact of responses to COVID-19 on the health of the population in Saudi Arabia. Significant reductions in fruit and vegetable intake and physical activity, and significant increases in e-cigarette use, hypertension, and hypercholesterolemia may increase the burden of chronic diseases in Saudi Arabia in the near future. Thus, continuous monitoring of the health risk factors within the population, and early interventions, are recommended to prevent future increases in chronic diseases.

Exploring Weight Stigma in Saudi Arabia: A Nationwide Cross-Sectional Study.

BACKGROUND: Weight stigma (WS) in the Middle East, especially in Saudi Arabia, is widely ignored. People with obesity are blamed for their weight, and there is a common perception that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. The authors of this study aimed to explore WS prevalence and factors associated with WS in a large nationwide study of Saudi Arabian adults. METHODS: This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was adopted to obtain equal distributions of participants by age and sex across the 13 regions of Saudi Arabia. In total, 6239 people were contacted, and 4709 (75.48%) responded and completed the interview. The authors of the study collected data about WS using the Arabic Weight Self-Stigma Questionnaire (WSSQ), BMI, smoking, nutritional knowledge, bariatric surgery, risk of depression, and demographic variables. RESULTS: Participants had a mean age of 36.4 ± 13.5 (18-90), and 50.1% were female. The prevalence of higher WS was 46.4%. Among other risk factors, there was a significant association between WS and obesity (odds ratio (OR): 3.93; 95% CI: 2.83-5.44; p < 0.001), waterpipe smoking (OR: 1.80; 95% CI: 1.20-2.69; p < 0.001), bariatric surgery (OR: 2.07; 95% CI: 1.53-2.81; p < 0.001), and risk of depression (OR: 1.68; 95% CI: 1.36-2.09; p < 0.001). CONCLUSION: This was the first study to explore WS and its associated factors among adults in a community setting in Saudi Arabia. This study revealed some risk factors associated with WS that may help to identify people at risk of WS and to develop interventions to reduce WS, such as improving nutritional knowledge, correcting the ideas about bariatric surgery and obesity in general, and ceasing waterpipe smoking.

Saudi Arabia Mental Health Surveillance System (MHSS): mental health trends amid COVID-19 and comparison with pre-COVID-19 trends.

Background: The impact of the COVID-19 pandemic on populations' mental health has started to emerge. Objectives: To describe the mental health trends of the risk of major depressive disorder (MDD) and generalized anxiety disorder (GAD) between May and August 2020. It also compares the results with pre-COVID-19 results and identifies risk factors associated with increased likelihood of being at risk of MDD and GAD. Method: This study utilizes repeated cross-sectional design, at national-level coverage of mental health screenings via computer-assisted phone interviews conducted in four waves monthly (between May and August 2020). Arabic-speaking adults from Saudi Arabia were recruited via a random phone list. The questionnaire includes the Arabic version of the Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder-7 (GAD-7). Pre-COVID-19 comparison was done using the PHQ-2 score to allow for comparison with a previous and similar national study conducted in 2018. Results: Across the four waves, 16,513 participants completed the interviews, with an overall response rate of 81.3%. The weighted national prevalence of people at risk of MDD was 14.9% overall, and 13.8%, 13.6%, 16.8%, and 15.3% in Waves 1, 2, 3, and 4, respectively. The weighted national prevalence of people at risk of GAD was 11.4%, overall, and 10.9%, 10.7%, 12.4%, and 11.7% in Waves 1, 2, 3, and 4, respectively. The weighted national proportion of individuals who were at risk of MDD and GAD at the same time was 7.4% overall. The risk of MDD on PHQ-2 increased by 71.2%, from 12.5% in 2018 to 21.4% in 2020. Conclusions: The risks of MDD and GAD in this study are relatively high. These results can help decision makers to understand the impact of the COVID-19 pandemic on the population's mental health and the most-impacted subgroups.

Antecedentes: El impacto de la pandemia COVID-19 en la salud mental de la población ha comenzado a emerger.Objetivos: Describir las tendencias en salud mental del riesgo de tener un trastorno depresivo mayor (MDD por sus siglas en inglés) y un trastorno de ansiedad generalizado (GAD por sus siglas en inglés) entre Mayo y Agosto de 2020. También compara los resultados con los resultados pre COVID-19 e identifica factores de riesgo asociados con el aumento de la probabilidad de estar en riesgo de sufrir MDD y GADMétodo: Este estudio utiliza un diseño transversal repetido, a un nivel de cobertura nacional de tamizaje sobre salud mental vía entrevistas telefónicas asistidas por computador, conducidas en 4 olas mensualmente (entre Mayo y agosto de 2020). Adultos que hablasen árabe de Arabia Saudita fueron reclutados mediante una lista aleatoria de teléfonos. El cuestionario incluía la versión árabe del Cuestionario de Salud del Paciente (PHQ-9) y de La Escala del Trastorno de Ansiedad Generalizada (GAD-7). Se hicieron comparaciones pre-COVID 19 usando el puntaje del PHQ-2 para permitir la comparación con un estudio previo nacional de características similares que fue realizado el 2018.Resultados: A través de las cuatro olas, 16.513 participantes completaron las entrevistas, con una tasa de respuesta promedio de 81.3%. La prevalencia nacional calculada de personas en riesgo para MDD fue de 14.9% en general y de 13.8%, 13.6%, 16.8% y 15.3% en Olas 1, 2, 3 y 4 respectivamente. La prevalencia nacional calculada de personas en riesgo para GAD fue 11.4% en general y 10.9%, 10.7%, 12.4% y 11.7% en Olas 1, 2, 3 y 4 respectivamente. La proporción nacional calculada de individuos que estaban en riesgo para MDD y GAD al mismo tiempo fue de 7.4% en general. El riesgo de MDD según el PHQ-2 aumentó en un 71.2%, de 12.5% en 2018 a 21.4% en 2020.Conclusiones: El riesgo de MDD y GAD encontrado en este estudio es relativamente alto. Estos resultados pueden ayudar a entender a las personas que toman decisiones del impacto de la pandemia COVID-19 en la salud mental de la población y en los subgrupos más impactados.

Arabic Translation of the Weight Self-Stigma Questionnaire: Instrument Validation Study of Factor Structure and Reliability.

BACKGROUND: While it is most often associated with its effects on physical health, obesity is also associated with serious self-stigmatization. The lack of a suitable, validated tool to measure weight-related self-stigma in Arabic countries may be partly responsible for the scarcity of literature about this problem. OBJECTIVE: This study investigated the reliability and validity of an Arabic version of the Weight Self-Stigma Questionnaire (WSSQ). METHODS: Data on the Arabic-translated version of the 12-item WSSQ were collected using two cross-sectional electronic questionnaires distributed among Saudi nationals through the Sharik Association for Health Research's database in June 2020. Internal consistency, test-retest reliability, and exploratory factor analysis of the Arabic WSSQ were assessed and compared with the original English version and other translations. RESULTS: For reliability analysis, 43 participants completed the Arabic WSSQ during two time periods. Internal consistency was α=.898 for the overall survey, α=.819 for the fear of enacted stigma subscale (factor 1), and α=.847 for the self-devaluation subscale (factor 2). The test-retest reliability of the intraclass correlation coefficient was α=.982. In the factor structure analysis, 295 participants completed the questionnaire. The Arabic WSSQ loading of the items was consistent with the original WSSQ, except for the loading of item 9, which was stronger in factor 2 than in factor 1. The two factors accounted for the observed variances of 47.7% and 10.6%. CONCLUSIONS: The Arabic version of the WSSQ has good internal consistency and reliability, and the factorial structure is similar to that of the original WSSQ. The Arabic WSSQ is adaptable for clinicians seeking to assess weight-related self-stigma in Arabic-speaking people.

A Mental Health Surveillance System for the General Population During the COVID-19 Pandemic: Protocol for a Multiwave Cross-sectional Survey Study.

BACKGROUND: The COVID-19 outbreak can potentially be categorized as a traumatic event. Public health surveillance is one of the cornerstones of public health practice, and it empowers decision makers to lead and manage public health crises and programs more effectively by providing timely and useful evidence. OBJECTIVE: This paper presents the protocol for a study that aims to identify, track, and monitor trends in the population in Saudi Arabia at risk of major depressive disorders and anxiety during the COVID-19 pandemic. METHODS: This study utilizes continuous, cross-sectional, national-level mental health screening via computer-assisted phone interviews, conducted in four waves on a monthly basis (between May and August 2020). Arabic-speaking adults, aged ≥18 years, and living in Saudi Arabia were recruited via a random phone list. This surveillance system used the proportional quota sampling technique to achieve an equal distribution of participants, stratified by age and gender, and region, within and across the 13 administrative regions of Saudi Arabia. A sample size of 4056 participants per wave was calculated to achieve enough power to detect changes in mental health status. The questionnaire includes the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) to measure depressive symptoms and the General Anxiety Disorder-7 (GAD-7) to measure anxiety. In addition, it will collect data on sociodemographic variables and potential risk factors. RESULTS: Study recruitment began in May 2020. The data analysis was completed in October 2020, and the final report is expected to be published by the end of December 2020. CONCLUSIONS: Monitoring the population's mental health status during the COVID-19 pandemic will inform decision makers of any potential deterioration in mental health on a national level and among subgroups, including across regions, age groups, and gender groups. It will allow decision makers to recognize issues and intervene sooner. It will also provide valuable scientific data to help understand the effects of epidemics and pandemics on mental health. As far as we know, this is the only study that attempts to monitor the mental health status of the general population on a monthly basis. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23748.

Public response to MERS-CoV in the Middle East: iPhone survey in six countries.

Gulf Cooperation Council (GCC) countries bear the heaviest brunt of MERS-CoV. This study aims to compare public awareness and practice around MERS-CoV across GCC countries. A cross-sectional survey was conducted using the Gulf Indicators (GI) smartphone app among people in the six GCC countries, namely Saudi Arabia, Kuwait, the United Arab Emirates, Qatar, Bahrain, and Oman. A total of 1812 participants recruited. All were aware of MERS-CoV, yet the perception and practice around MERS-CoV varied widely between countries. Over two thirds were either "not concerned" or "slightly concerned" about contracting MERS-CoV; believing that they were under Allah's (God's) protection (40%) was the most cited reason. While 79% were aware that the disease can transmit through droplet from infected person, only 12% stated that MERS-CoV transmits via camels; people in Saudi Arabia were better aware of the transmission. Nevertheless, only 22% of respondents believed that camels are the zoonotic reservoir of MERS-CoV. Those who were concerned about contracting MERS-CoV (aOR: 1.6, 95% CI: 1.2-2.1, p<0.01) and those who thought MERS-CoV to be a severe disease only for those with high-risk conditions (aOR: 1.5, 95% CI: 1.1-2.1, p<0.01) were more likely to believe that camels are the zoonotic source. However, residents of KSA (aOR: 0.03, 95% CI: 0.01-0.07, p<0.01), UAE (aOR: 0.01, 95% CI: 0.004-0.02, p<0.01) and Kuwait (aOR: 0.03, 95% CI: 0.01-0.07, p<0.01) were less likely to believe that camels are the main zoonotic source compared to respondents from the other countries. Hygienic measures were more commonly adopted than avoidance of camels or their raw products, yet there was a discrepancy between the countries. This study highlights that despite being aware of the ongoing MERS-CoV epidemic; many people lack accurate understanding about MERS-CoV transmission, prevention, and are not fully compliant with preventive measures.

Vaccinations against respiratory infections in Arabian Gulf countries: Barriers and motivators.

AIM: To study the uptake, barriers and motivators of influenza, pneumococcal, meningococcal and pertussis vaccines among members of public in Arabian Gulf countries. METHODS: A cross-sectional survey among the Gulf Cooperation Council (GCC) countries' residents. Data collected electronically through a smartphone app. The survey variables aimed to investigate the respondents' awareness about vaccines against influenza, pneumococcal, meningococcal and pertussis infections. Collected data concerning the respondents' socio-demographic characteristics, their perception toward vaccine uptake and the factors that motivate or demotivate them from taking influenza vaccine. The data were analysed statistically using the SPSS v.23.0. Differences in the characteristics of users from different countries were quantified through bivariate analysis. Other important variables and controlling factors were studied using logistic regression. RESULTS: A total of 1812 respondents participated in the study. Their mean age was 27 years, 82% were male and 24% had ≥ 1 chronic diseases. The overall uptake of influenza vaccine was 17% (21% among "at risk" people) and ranged from 15% in Saudi Arabia to 24% in Qatar. Doctor's advice (23%) and a perception of having low body immunity (21%) were the main cited reasons for being vaccinated, whereas unawareness about the vaccine (43%) was the main barrier. The overall uptake of pneumococcal vaccine in the preceding three years was 22% (25% among "at risk" individuals) and ranged from 0% in Bahrain to 79% in Kuwait. The overall uptake of pertussis vaccine was 16% (31% among "vulnerable" people), and ranged from 7% in Saudi Arabia to 75% in Oman. The overall uptake of meningococcal vaccine was 20% (29% among the "at risk" people) and ranged from 3% in Oman to 50% in Bahrain. CONCLUSION: The vaccination uptake across GCC countries is suboptimal and varies widely across the countries. Further research is needed to unearth the reasons and formulate action plan.

Depression screening via a smartphone app: cross-country user characteristics and feasibility.

BACKGROUND AND OBJECTIVE: Smartphone applications (apps) have the potential to be valuable self-help interventions for depression screening. However, information about their feasibility and effectiveness and the characteristics of app users is limited. The aim of this study is to explore the uptake, utilization, and characteristics of voluntary users of an app for depression screening. METHODS: This was a cross-sectional study of a free depression screening smartphone app that contains the demographics, patient health questionnaire (PHQ-9), brief anxiety test, personalized recommendation based on the participant's results, and links to depression-relevant websites. The free app was released globally via Apple's App Store. Participants aged 18 and older downloaded the study app and were recruited passively between September 2012 and January 2013. FINDINGS: 8241 participants from 66 countries had downloaded the app, with a response rate of 73.9%. While one quarter of the participants had a previous diagnosis of depression, the prevalence of participants with a higher risk of depression was 82.5% and 66.8% at PHQ-9 cut-off 11 and cut-off 15, respectively. Many of the participants had one or more physical comorbid conditions and suicidal ideation. The cut-off 11 (OR: 1.4; 95% CI 1.2 to 1.6), previous depression diagnosis (OR: 1.3; 95% CI1.2 to 1.5), and postgraduate educational level (OR: 1.2; 95% CI 1.0 to 1.5) were associated with completing the PHQ-9 questionnaire more than once. CONCLUSIONS: Smartphone apps can be used to deliver a screening tool for depression across a large number of countries. Apps have the potential to play a significant role in disease screening, self-management, monitoring, and health education, particularly among younger adults.