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.

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.

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.

Impact of the fear of Covid-19 infection on intent to breastfeed; a cross sectional survey of a perinatal population in Qatar.

OBJECTIVES: Infection control measures during the Covid-19 pandemic have focused on limiting physical contact and decontamination by observing cleaning and hygiene rituals. Breastfeeding requires close physical contact and observance of hygienic measures like handwashing. Worries around contamination increase during the perinatal period and can be expressed as increase in obsessive compulsive symptoms. These symptoms have shown to impact breastfeeding rates. This study attempts to explore any relationship between the Covid-19 pandemic and perinatal obsessive-compulsive symptomatology and whether the Covid-19 pandemic has any impact on intent to breastfeed. METHODS: A cross sectional survey of perinatal women attending largest maternity centre in Qatar was carried out during the months of October to December 2020. Socio-demographic information, intent to breastfeed and information around obsessive compulsive thoughts around Covid-19 pandemic were collected using validated tools. RESULTS: 15.7% respondents report intent to not breastfeed. 21.4% respondents reported obsessive-compulsive symptoms. 77.3% respondents believed the biggest source of infection was from others while as only 12% of the respondents believed that the source of infection was through breastfeeding and 15.7% believed the vertical transmission as the main source of risk of transmission. CONCLUSIONS: The rates of Obsessive-compulsive symptoms were increased and the rates of intent to breastfeed were decreased when compared with pre pandemic rates. The obsessive-compulsive symptoms and the intent to not breastfeed were significantly associated with fear of infection to the new-born. Obsessive-compulsive symptoms were not significantly correlated with intent to breastfeed and can be seen as adaptive strategies utilized by women to continue breastfeeding in the context of fear of infection.

Impact of COVID-19 on ECT Practice in Qatar.

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries.

Characteristics of 100 consecutive patients with COVID-19 referred to consultation-liaison psychiatry services in Qatar: A comparison of patients with delirium versus other psychiatric diagnoses.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can present with various neuropsychiatric manifestations. This study reports on patients with COVID-19 who were referred to the consultation-liaison (CL) psychiatry services in Qatar and compares the clinical and sociodemographic characteristics of those diagnosed with delirium versus other psychiatric diagnoses. METHODS: This is a retrospective review of the first 100 consecutive patients with COVID-19 who were referred to the CL services. RESULTS: Within the total cohort (n=100), most patients (92%) were male, and the mean age was 46 years. About 27% of patients had asymptomatic COVID-19, 35% had a past psychiatric history, and 48% reported pandemic related psychosocial stress. Delirium was the most common psychiatric diagnosis (n=29), followed by acute stress reaction/adjustment disorder, depression, mania, anxiety, non-affective psychosis, and dementia. Among patients with delirium, agitation was the most common symptom (76%), 86% were treated with psychotropic medications, and 17% died. Higher age, longer hospital stays, lower oxygen saturation, lower lymphocytic count, and higher C-reactive protein (CRP) values were significantly associated with delirium versus other psychiatric diagnoses. Higher age and lower oxygen saturations predicted delirium. CONCLUSION: Delirium was associated with a range of clinical variables and had significant mortality, despite the relatively young age of the patients. COVID-19 should be considered in patients presenting with delirium. Finally, early identification and management of delirium should be integral to COVID-19 protocols.

Suspected Agomelatine-induced restless legs syndrome: a case report.

BACKGROUND: Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by unpleasant and distressing sensations in the lower limbs that are more pronounced in the evening, commence or worsen at rest, and show partial or complete relief following movement. It can occur as a primary disorder, secondary to medical conditions or treatment with medications including but not limited to antidepressants or antipsychotics. CASE PRESENTATION: A 32-year old man with major depressive disorder showed partial response to Escitalopram 10 mg daily. Agomelatine 25 mg at night was added to Escitalopram to treat his residual depressive symptoms, namely insomnia and tiredness. Within two days he developed restlessness and unpleasant sensations in his legs which were worse at night. Symptom severity increased over the following days, prompting an urgent consultation a week later. The patient's presentation met the criteria for RLS. Agomelatine was discontinued leaving the patient on Escitalopram alone. The patient's symptoms improved within 24 h of stopping Agomelatine, with complete resolution four days later. There was no recurrence of RLS during follow-up. The patient scored 6 on Naranjo's adverse drug reaction probability scale, indicating a probable adverse drug reaction caused by Agomelatine. CONCLUSIONS: To the best of our knowledge, this is the first case report of suspected Agomelatine-induced RLS. Clinicians need to be aware of RLS to enable prompt diagnosis and management. We suggest adding Agomelatine to the list of agents that can potentially induce RLS.

COVID-19 vaccine hesitancy in perinatal women: a cross sectional survey.

OBJECTIVES: To explore attitudes to COVID-19 vaccination among perinatal women. METHODS: A nationwide online, cross-sectional survey was conducted in Qatar from 15th October 2020 to 15th November 2020 with voluntary participation open to all adult residents. Of the respondents, the population group for this study comprised the 341 pregnant and breastfeeding participants. The survey utilized a composite questionnaire incorporating a validated instrument to measure vaccine attitudes. The responses were recorded and analysed with statistical analysis being performed with SPSS software. Outcome measures included intentions towards vaccination and potential factors influencing vaccine hesitancy (contextual factors, vaccine specific concerns and group/individual influences). RESULTS: Perinatal women exhibited a vaccine hesitancy rate of 25% towards COVID-19 immunisation. The main concerns of the group were of infection risks and main factor determining vaccine hesitancy was of vaccine specific safety concerns. Previous vaccine "acceptors" showed vaccine hesitancy to COVID-19 immunisation. A third of the group cited non availability of the vaccine as a concern. CONCLUSIONS: COVID-19 vaccine trials amongst pregnant and lactating women have lagged behind those for general populations and this has compounded concerns around safety in this special group. Perinatal women constitute a vulnerable group and play an important role in vaccination of wider family members. This study highlights the need for trials and data for COVID-19 vaccine in this group to be able to achieve appreciable numbers needed for herd immunity and ultimately control of the pandemic.

Perceived stress and post-traumatic stress disorder symptoms among intensive care unit staff caring for severely ill coronavirus disease 2019 patients during the pandemic: a national study.

BACKGROUND: Intensive care unit (ICU) staff have faced unprecedented challenges during the coronavirus disease 2019 (COVID-19) pandemic, which could significantly affect their mental health and well-being. The present study aimed to investigate perceived stress and post-traumatic stress disorder (PTSD) symptoms reported by ICU staff working directly with COVID-19 patients. METHODS: The Perceived Stress Scale was used to assess perceived stress, the PTSD Diagnostic Scale for the Diagnostic and Statistical Manual of Mental Disorders (5th edition) was used to determine PTSD symptoms, and a sociodemographic questionnaire was used to record different sociodemographic variables. RESULTS: Altogether, 124 participants (57.2% of whom were men) were included in the analysis. The majority of participants perceived working in the ICU with COVID-19 patients as moderately to severely stressful. Moreover, 71.4% of doctors and 74.4% of nurses experienced moderate-to-severe perceived stress. The staff with previous ICU experience were less likely to have a probable diagnosis of PTSD than those without previous ICU experience. CONCLUSIONS: Assessing perceived stress levels and PTSD among ICU staff may enhance our understanding of COVID-19-induced mental health challenges. Specific strategies to enhance ICU staff's mental well-being during the COVID-19 pandemic should be employed and monitored regularly. Interventions aimed at alleviating sources of anxiety in a high-stress environment may reduce the likelihood of developing PTSD.

Redeployment of psychiatrist trainees during the COVID-19 pandemic: evaluation of attitude and preparedness.

Background: The coronavirus disease-2019 (COVID-19) pandemic has imposed an unprecedented strain on healthcare systems worldwide. In response, psychiatrist trainees were redeployed from their training sites to help manage patients with COVID-19. This study aimed to examine the attitude of psychiatrist trainees toward redeployment to COVID-19 sites and their perceived preparedness for managing physical health conditions during redeployment. Methods: A cross-sectional researcher-developed online survey was administered among psychiatrist trainees in May 2020 at the Department of Psychiatry, Hamad Medical Corporation, Qatar. Results: Of the 45 psychiatrist trainees, 40 (88.9%) responded to the survey. Most trainees reported being comfortable dealing with chronic medical conditions, but less so with acute life-threatening medical conditions. Half reported feeling anxious about redeployment, and most felt the need for additional training. We found that trainees' perceived redeployment preparedness was significantly associated with their level of postgraduate training and the time since and duration of their last medical or surgical training. Conclusion: Adequate preparation and training of psychiatrist trainees is important before redeployment to COVID-19 sites to ensure that they can effectively and safely manage patients with COVID-19.

Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar.

BACKGROUND: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. METHODS: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. RESULTS: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. CONCLUSION: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.

Cardiovascular risk assessment for patients with serious mental illnesses: An internal review.

Cardiovascular diseases (CVD) are the leading cause of excess premature mortality among patients with serious mental illness (SMI), mainly because of higher cardiovascular risk and metabolic syndrome compared to the general population.1,2 A pertinent contributing factor is second-generation antipsychotics, which further negatively impact the cardiovascular risk burden, amounting to a significant clinical and public health challenge among patients with SMI.3 Qatar has a high metabolic syndrome prevalence of 26%, and the blood pressure of patients with SMI receiving antipsychotics is significantly higher.4 In 2019, the Pharmacy Department of Mental Health Services at Hamad Medical Corporation (HMC) in Doha, Qatar flagged four moderately and one mildly severe cases of adverse drug reaction secondary to antipsychotics. In response to above mentioned incidents, this quality improvement (QI) project was conducted in an acute inpatient male ward from November 2019 to June 2020 in the Psychiatry Hospital of Hamad Medical Corporation to implement a cardiovascular risk assessment for inpatients with SMI. The atherosclerotic cardiovascular disease (ASCVD) risk estimator was used to estimate the 10-year risk of CVD, and inpatients were categorized into low-risk ( < 5%), borderline risk (5%-7.4%), intermediate-risk (7.5%-19.9%), and high risk ( ≥ 20%).5 Patients with SMI above 40 years of age were included. Within 72 hours of admission, the admitting inpatient nurse filled a cardiovascular risk assessment (CVRA) questionnaire, including basic demographics, past and present cardiology and smoking history, laboratory test results such as lipid panel, and renal function tests. This study used an in-depth, semi-structured face-to-face interview as a primary data collection technique. An interview guide was developed to address the purpose. At the end of each assessment, the QI nurse approached the participants again to educate them about the cardiovascular risk result accordingly and explained the required referrals (Cardiology and/or Smoking Cessation). The QI team member calculated the cardiovascular risk by utilizing the ASCVD plus application to determine inpatient cardiovascular risk. Out of 26 inpatients with SMI who underwent CVRA, nine (35%) scored moderate to high risk, and were referred to Cardiology for further intervention. Among these nine patients, two (22%) were started on statin therapy, three (33%) started on aspirin, and the remaining four (44%) received lifestyle modifications advice and counseling. Ten (38%) were referred to a smoking cessation clinic for nicotine replacement therapy and counseling. Table 1 shows the clinical characteristics of patients included in this study. Three inpatient consultations to cardiology were rejected, which shows how health professionals underestimate and stigmatize effective interventions for patient with SMI. In case of comorbidities of two diseases, one of them is known overlooked and this is particularly true for mental illness.6 A cohort study on medical comorbidities in patients with SMIs in Qatar concluded that an evidence of individuals with SMI is less likely to receive standard levels of care for their medical comorbidities.7 Mental health training could help medical health professionals from other specialties improve their understanding on the impact of both psychotropic medications and mental illness in the physical health of people with SMI and address the fear and stigma. Communication improvement between professionals by meaningful discussion of objectives of referral with the patient and contacting the consultant referred to might improve coordination among the referring psychiatrist, physician referred to, and patient.8 Patients who scored high on (ASCVD) assessment and are asymptomatic might benefit from referral to primary health care centers for further assessment by a generalist from whom a referral to other specialty like cardiology might be more easily accepted. From the patients' perspective, physical health education, and most importantly, cardiovascular risk assessment are now significantly invested. All patients above 40 years old with SMI will undergo a CVRA. Besides, their assigned nurse will work jointly with allied health professionals to educate them about the importance of healthy lifestyle, including healthy diet and staying fit. Tailor-made recommendations will be established, taking into consideration the cardiovascular risk status and antipsychotic medications. Close participation with the clinical pharmacist and dietician will ensure constant psychoeducation about the metabolic side effects of antipsychotic medications. Physiotherapists will identify barriers, if any, for patients to participate in physical activities offered by the ward. Simultaneously, facilitators will include one-to-one contact with staff and work on increasing awareness of the positive impact of physical activity at the departmental level. Leadership involvement is crucial to ensure joint agreement with different specialties, particularly those based in other HMC facilities, such as cardiology and smoking cessation clinics, to accept referrals when required.

The impact of the COVID-19 pandemic on the perinatal mental health of women.

Objectives The physical health impact of the coronavirus disease infection (COVID-19) has received attention worldwide; however, data around the psychological impact of the pandemic is still emerging and little has been reported on psychological effects among vulnerable groups. This study was undertaken with the aim of studying the impact of the COVID-19 pandemic and related restrictions on perinatal mental health among women in Qatar. Methods A cross- sectional survey of women accessing maternity services in Qatar was carried out during the months of June and July 2020 at the local peak of the pandemic. Background data including relevant demographic details, pregnancy and mental health history, concerns, as well as helpful stress-reducing factors reported by women was collected. Depression and anxiety symptomatology was studied using the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results The survey results revealed a high prevalence of anxiety and Depressive symptomatology (34.4 and 39.2% respectively), based on PHQ-ADS scoring. These rates appeared much higher than the reported pre-pandemic prevalence and were not affected by occupation, previous mental health problems or pregnancy complications. Women's most commonly reported concerns as well as coping factors are discussed. Conclusions Results indicate a marked increase in anxiety and depressive symptoms during the COVID-19 pandemic, among pregnant and puerperal individuals, who constitute a vulnerable group with respect to mental health morbidity. These findings can be used to inform public health interventions, among which, consideration should be given to routine mental health screening of vulnerable groups during major health crises.

Mental wellbeing of healthcare workers working in quarantine centers during the COVID-19 pandemic in Qatar.

BACKGROUND: Healthcare workers managing Coronavirus 19 (COVID-19) patients are at increased risk of poor mental wellbeing. The available literature on the psychological impact in the Arabian Gulf region is limited, and a more in-depth analysis of factors affecting frontline healthcare workers' mental wellbeing is warranted. The aim of this study was to evaluate and explore healthcare workers' wellbeing working in quarantine centers in Qatar. METHODS: This study was a cross-sectional, web-based survey conducted on healthcare workers managing patients in designated quarantine centers. Healthcare workers associated with 51 COVID-19 quarantine centers were eligible to participate in this survey from April 19 to May 3, 2020. The primary outcome of interest was mental wellbeing as measured by the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). RESULTS: A total of 127 of 169 contacted staff members completed the survey, with a participation rate of 75%. Approximately 17.4% of participants had well-being scores of less than 45, indicating suboptimal wellbeing and a high risk of psychological distress and depression. The multivariable logistic regression analysis showed that nurses are associated with increased risk (more than the fivefold higher risk of having WEMWBS score < 45) of adverse mental wellbeing (adjusted OR 5.65; 95% CI 0.57, 56.4; p = 0.140). CONCLUSION: The psychological impact of working in quarantine centers on healthcare workers was less than what has been reported globally. Nurses are the most vulnerable group. It is essential that health services monitor the psychological impact on its workforce and puts appropriate mitigation strategies in place.

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.

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.

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.

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.