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BACKGROUND AND AIMS: COVID-19 survivors often experience significant and pervasive psychological distress. This study aimed to investigate the prevalence and demographic factors affecting anxiety, stress, and depression levels among COVID-19 survivors in the Kurdistan region of Iraq. METHOD: This online cross-sectional study was conducted from August 1, 2023 to December 17, 2023, in the Kurdistan region of Iraq, including Erbil, Sulaymaniyah, and Duhok. Purposive sampling was used to collect data using an online survey. The survey included demographic information and the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX), with frequency and percentage used for categorical variables and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess associations between demographic factors and mental health outcomes. A p-value of less than 0.05 was considered statistically significant. RESULTS: A total of 783 participants were enrolled in the study. The mean score for anxiety was 11.62 ± 4.71, indicating moderate levels. For depression, the mean score was 11.54 ± 5.21, indicating mild levels, and for stress, the mean score was 14.0 ± 5.78, indicating normal levels. Younger individuals (15-27) showed higher stress (Estimate: 18.96, P=0.001) and anxiety (Estimate: 2.79, P=0.001) levels compared to older age groups. Males reported significantly lower stress (Estimate: -1.01, P=0.001), anxiety (Estimate: -1.29, P=0.001), and depression (Estimate: -0.72, P=0.001) than females. Participants with a diploma had lower anxiety (Estimate: 0.65, P=0.004) and stress (Estimate: 0.77, P=0.002) levels compared to those with only elementary education. CONCLUSIONS: The study found moderate levels of anxiety among COVID-19 survivors, with mild depression and normal stress levels. To address these issues, it is recommended that policymakers develop targeted mental health interventions. Healthcare providers should focus on early identification and treatment, providing personalized counseling and support to enhance coping mechanisms and overall psychological well-being. By implementing these measures, mental health outcomes for COVID-19 survivors in Iraq can be significantly improved.
RESUMEN
BACKGROUND AND AIM: In Erbil, Iraq, the reluctance of young adults to engage with psychiatric services is influenced by a complex array of barriers, including stigma-related, attitudinal, and instrumental factors that hinder effective mental healthcare access. This study aimed to identify these specific barriers to accessing psychiatric care among young adults in Erbil. MATERIALS AND METHODS: The study utilized a cross-sectional online survey conducted between April 5th and May 1st, 2024. Data collection was carried out through purposive sampling and involved a comprehensive questionnaire. Electronic informed consent was obtained from all participants before they started the survey, which collected demographic data and utilized the Barriers to Access to Care Evaluation (BACE v3) tool. Statistical analysis was conducted using SPSS version 27 (IBM Corp., Armonk, NY). Descriptive statistics (frequency and percentage) were used for categorical data, while the mean and standard deviation characterized continuous variables. Chi-square tests, including Fisher's exact test and odds ratio (OR), were used to analyze categorical data, with a significance level set at p < 0.05. RESULTS: A total of 407 participants were enrolled in the study. The study highlighted several barriers to mental health care. Stigma-related barriers were significant, with participants fearing being seen as weak (mean score = 2.14, SD = 0.96) and concerns about being labeled "crazy" (mean score = 1.80, SD = 1.19). Regarding attitudinal barriers, there was a notable preference for dealing with issues independently (mean score = 2.04, SD = 0.98) and a tendency toward resolving problems without professional help (mean score = 1.88, SD = 0.98). Additionally, instrumental barriers were identified, including the rare availability of culturally diverse mental health professionals (mean score = 1.78, SD = 1.09) and practical difficulties such as arranging transportation to appointments (mean score = 0.61, SD = 0.87). CONCLUSION: The study demonstrated that young adults in Erbil face significant stigma and attitudinal and instrumental barriers to accessing psychiatric care. In response to these findings, it is recommended for the government to prioritize mental health awareness, actively destigmatize mental health issues, and improve service accessibility to foster a supportive care environment. Additionally, mental health professionals and educational institutions should collaborate to provide targeted support programs and resources for young adults.
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Several individual social determinants of health have been identified as significant factors contributing to achieving glycemic targets (glycated hemoglobin < 7). However, it remains unclear how these social variables individually or collectively contribute to glycemic targets among adults with type 2 diabetes (T2D) in the United States (U.S.) The purpose of the current integrative review (IR) was to describe and synthesize findings from studies on social determinants of glycemic target achievement in adults with T2D in the U.S. and integrate them into the United States Department of Health and Human Services Conceptual Framework. The databases searched included PubMed, CINAHL Plus with Full Text, Medline with Full Text [EBSCO], Google Scholar, bibliography, and hand searching. A total of 948 records were identified. After excluding duplicates and irrelevant studies based on inclusion and exclusion criteria through title, abstract, and full-text screening, 13 studies were finally included in this IR. The results revealed that race/ethnicity, economic access and stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context contribute to glycemic target achievement among adult patients with T2D in the U.S. Integrating findings from key studies on social determinants of glycemic health may contribute to developing interventions aimed at reducing and eventually eradicating health disparities for individuals with and at risk for T2D in the U.S.