Assessment of stress level and depression among orthopaedic surgeons in Saudi Arabia.

PURPOSE: The aim of this study was to assess the stress level and depression among orthopaedic surgeons in Saudi Arabia. In addition, to evaluate orthopedic training programs related factors that might have a critical role in the development of depression among orthopaedic surgeons. METHODS: The study adopted a cross-sectional study design. Two validated questionnaires were utilized, the Patient Health Questionnaire 9 (PHQ-9) and the Perceived Stress Scale (PSS-10) for assessing depressive symptoms and stress levels. Data was collected by sending the survey to the Saudi Commission for Health Specialties so they could be distributed throughout all registered orthopaedic surgeons. RESULTS: The study sample consisted of 325 participants. The results revealed that the severity of depression varied across the different groups. As per the PHQ-9 criteria, 74 (22.8%) were initially diagnosed with major depression. Among assistant consultants, 39.5% reported severe depression, while 34.9% reported mild depression. Consultants predominantly reported moderate perceived stress (82.9%) with a notable proportion experiencing high perceived stress (12.4%). Assistant consultants showed a balanced distribution, with 93.0% reporting moderate perceived stress and 4.7% reporting high perceived stress. Demographic variables gender, relationship status and having children revealed statistically significant relationship with PHQ-9 scores (p-value < 0.05) but not with PSS-10 scores. CONCLUSION: The study highlights pressing need to address mental health concerns within orthopaedic surgeons. To address these challenges, healthcare institutions should implement comprehensive mental health support programs offering resources for stress management, counseling services, and peer support groups.

The Impact of COVID-19 on Suicidal Behavior in King Abdulaziz Medical City in Saudi Arabia.

INTRODUCTION:  During the COVID-19 pandemic, there has been a global increase in mental health issues, including suicidal behaviors. This study focuses on assessing the impact of the pandemic on the prevalence and characteristics of suicidal behavior at King Abdulaziz Medical City in Riyadh, Saudi Arabia. METHODS: A retrospective cohort study was conducted on 580 patients from January 2017 to December 2022, focusing on those aged 18 and above referred for suicide evaluation. Data were collected via chart reviews and analyzed using Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY). RESULTS: Our study reviewed 580 patient charts, with 555 (95.7%) meeting the inclusion criteria. The majority of participants were in the 18-29 age group (66.7%). We observed an increase in the number of cases undergoing suicide attempt assessment post COVID-19, with 296 incidents (53.3%) from March 2020 to December 2022 (about a year and eight months), compared to 259 incidents (46.7%) from January 2017 to March 2020 (over three years). A significant post-pandemic increase was noted in individuals with secondary education or higher (p = 0.004). No significant changes were found in other demographic variables or in the profiles of individuals with an intention to end life before and after the pandemic. CONCLUSION: The study highlights the nuanced impact of the COVID-19 pandemic on suicidal behavior in Saudi Arabia, revealing an increased demand for suicide assessments, particularly among educated individuals. However, no corresponding increase was observed in the rate of high-intent suicidal cases or other significant variables. The findings underscore the complexity of factors influencing suicidal behavior during the pandemic and the need for targeted mental health interventions. Future research, ideally supported by a national database, is essential for a comprehensive understanding of suicidal behavior in Saudi Arabia.

Determining patterns and types of violence against the elderly in the Kingdom of Saudi Arabia.

Reports indicate an increase in the incidence of violence against the elderly in the Kingdom of Saudi Arabia (KSA). This study aimed to determine the types and risk factors of elder abuse in KSA. A cross-sectional observational study was conducted of abuse among the elderly (65 years and older; n = 128) reported in the National Family Safety Registry (NFSR) between April 2017 and December 2021. Most cases involved women (65.6%) and married individuals (54.7%). Physical abuse was the most common type (44.5%), followed by neglect (34.4%). Men, married individuals, people without family support, and people with physical disabilities were more likely to experience physical abuse. Elderly people, single individuals, women, and those lacking family support showed an increased likelihood of neglect. Preventive strategies should be implemented through awareness raising, capacity building, resource allocation, and the exchange of multidisciplinary good practices across sectors.

Impulse control disorders in patients with dopamine agonist-treated pituitary adenomas: a cross-sectional multicenter study.

BACKGROUND: Impulse control disorders (ICDs) have been described as underrecognized side effects of dopamine agonists (DAs) in neurological disorders but are not sufficiently understood in endocrine conditions. OBJECTIVE: To identify the prevalence of DAs induced ICDs and determine potential risk factors related to these disorders in patients with prolactinoma and non-function pituitary adenomas (NFPAs). METHODS: This is a cross-sectional multicenter study involving 200 patients with prolactinoma and NFPAs, who received follow-ups in tertiary referral centers. DA-induced ICDs were assessed using ICD questionnaires modified from prior studies. RESULT: At least one ICD was reported by 52% of participants, among whom 28.5% mentioned compulsive shopping, 24.5% punding, and 24.5% hypersexuality. Furthermore, 33% of the patients reported the presence of one type of ICD behavior, while 12% specified two and 7% had three types of such behavior. The multivariable logistic regression showed that the significant risk factors of ICD were younger age (adjusted odds ratio [AOR]: 0.92, 95% confidence interval [CI]: 0.88-0.97, p 0.001), being single (AOR: 0.15, 95%CI: 0.03-0.84, p 0.03), and a positive history of psychiatric illness (AOR: 7.67, 95% CI: 1.37-42.97, p 0.021). CONCLUSION: ICDs with a broad range of psychiatric symptoms are common in individuals with DA-treated prolactinoma and NFPAs. Endocrinologists should be aware of this potential side effect, particularly in patients with a personal history of psychiatric disorder.

Monkeypox stigma and risk communication; Understanding the dilemma.

Monkeypox (MPX) is a viral zoonotic disease that is endemic in Central and West African countries had affected countries in Asia, Europe, Africa, Australia, and South and North America. Some globally reported cases were linked to history of recent travel to endemic regions, however, official reports revealed homosexual practices among the majority of reported cases. In response to global increase MPX burden and number of cases, the WHO declared MPX a Public Health Emergency with International Concern (PHEIC) on July 23, 2022. The first MPX case in Saudi Arabia was a returning traveler from Europe to Riyadh on July 14, 2022. It is essential for policy makers to maintain neutral tone for health education messages and inform the public that MPX transmits via physical contact.

Distribution of perceived weight stigma and its psychological impact on obese people in Saudi Arabia.

Background: Worldwide, obesity prevalence has nearly tripled since 1975, with about 13% of adults being obese and about 39% overweight. Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight, an issue that is barely discussed in the medical literature. In Saudi Arabia, the prevalence of obesity is 36%. However, there is no available data on the prevalence of perceived weight stigma among obese people. Therefore, this study aims to (a) determine the Distribution of perceived weight stigma among obese people, (b) identify the major sources of stigma, and (c) determine the psychological impact of perceived weight-based stigma on obese people in Saudi Arabia. Methods: This is a cross-sectional study conducted in Saudi Arabia using an online questionnaire that includes Stigmatizing Situations Inventory Scale (SSI) and Perceived Stress Scale (PSS). Results: 1341 people participated in the study, of which 819 (61%) were females and 522 (39%) were male. Of all, 62 (5%) were underweight, 357 (27%) were normal weight, and 922 (69%) were overweight or obese. Participants in the overweight/obese category scored higher on average in every SSI item than did their counterparts in the underweight and normal weight categories, indicating higher levels of stigma among overweight and obese participants. The major sources of stigma for overweight and obese participants were identified based on the mean of participant responses to each item. These were: assumption about overeating or binge eating (mean response ± SD 2.80 ± 3.01), children's comments (2.22 ± 2.58), being stared at in public (2.18 ± 2.83) and being singled out as a child (2.05 ± 2.67). Conclusion: Parallel with the literature, our findings indicate a high prevalence of weight stigma in Saudi Arabia which can have negative psychological implications on obese people.

The Barriers to Seeking Mental Health Services at King Saud Bin Abdulaziz University for Health Sciences.

BACKGROUND: The mental health of college students, especially medical students, is a major issue worldwide. Depression and anxiety are among the top causes of death among people aged 15-29 years old. Mental health disorders, especially mood disorders such as depression and anxiety, are common among university students. Psychological problems can negatively impact academic performance and life satisfaction. The earlier mental illness is detected, the better the treatment and outcome. The aim of this study is to determine the barriers among students to seeking mental health services. METHODS: This cross-sectional questionnaire-based study was carried out at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia The cross-sectional questionnaire-based study involved 434 students: 72.1% men and 27.9% women. This study had a response rate of 28.5% and responses were gathered in May 2023. RESULTS: The top three barriers identified in this study were "Feeling that my problems are not important," "Concern that no one will understand my problems," and "Difficulty with access to care." The majority of students reported feeling "I feel reluctance a little" to use mental health services; 31.4% chose "I need it a little" when asked whether they needed to use mental health services. Furthermore, 34.8% of students reported having mild anxiety, and 34.1% reported having mild depression. CONCLUSION: Mental illness is a serious issue, which is why medical students should be aware of it to improve their quality of life and reduce the stress and obstacles they face. Medical schools should address awareness of mental illness and how to approach a clinic. This is important for students to succeed and overcome the psychological difficulties that might affect academic performance. In addition, recognizing the barriers will help achieve better outcomes in seeking help and utilizing existing services.

Cushing's Syndrome With Acute Psychosis: A Case Report.

Cushing syndrome is a rare disease that rarely presents as acute psychosis. In this case, the patient presented with acute psychosis and agitation as the first manifestations of the disease which led to the admission of the patient to a psychiatry hospital for one month, as it was difficult to restrain her sufficiently for performing appropriate diagnostic tests due to disturbing behavior. She responded well to treatment with olanzapine and lorazepam to treat the patient's agitation, and successfully complete her evaluation. Thereafter, she was diagnosed with a pituitary tumor and underwent pituitary lesion resection via a microscopic transsphenoidal as needed. Two months after surgery, her cortisol levels returned to baseline, and she became calmer and decreased the tensity of her psychosis; however, it was only five months after surgery that her psychotic symptoms and disturbed behavior ceased.

Depression and Quality of Life Among Caregivers of Pediatric Cancer Patients.

Background This study aimed to assess the prevalence of depression, depressive symptoms, and quality of life among caregivers of pediatric cancer patients and the associated risk factors. Methodology In total, 73 participants were recruited for this cross-sectional study in King Abdullah Specialist Children Hospital. Two self-administered questionnaires were used, the Patient Health Questionnaire 9 (PHQ9) and World Health Organization Quality of Life (WHOQOL), to assess the depressive symptoms as well as the prevalence of clinical depression and quality of life, respectively. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA) to assess the level of depression and quality of life and the associated factors using Fisher's exact and Mann-Whitney tests. Results It was found that 90.4% were females and 9.6% were males, with 49.3% being between the ages of 31 and 40. Regarding the level of depression, 47.80% had mild depression. There were no significant associations between the baseline characteristics and the level of depression. Gender was significantly associated with all four domains of quality of life, age was significant in physical health and environmental domains, duration of illness was significant only in the physical health domain, while education level was found to be not significantly associated with any of the domains. Conclusions This study found that nearly half of the participants had mild levels of depression, and the four domains of the WHOQOL were significantly affected by several risk factors. We recommend further research into this topic with larger sample sizes, as well as a follow-up assessment of caregivers for a more accurate representation of caregivers' depression and quality of life. We recommend that in addition to the assessment of pediatric cancer patients, caregivers must also be assessed due to the burden associated with the task of being a caregiver.

Domestic Violence Against Married Women During the COVID-19 Quarantine in Saudi Arabia.

Background  Before the coronavirus disease 2019 (COVID-19) pandemic, cases of domestic abuse and aggressive behaviour between Saudi married couples were increasing annually, a topic of growing concern both socially and medically. With the forced indoor confinement enacted as a containment measure, international studies regarding domestic abuse indicated an almost unanimous increase in prevalence. This cross-sectional national study aimed to assess the change between the pre-and intra-pandemic prevalence of abuse in Saudi Arabia.  Material and methods  Anonymous data were gathered using a web-based Arabic version of the World Health Organization (WHO) multi-country instrument measuring violence against women residing in Saudi Arabia. The previously validated questionnaire included a series of multiple-choice questions related to demographic information, family infrastructure, experienced situations of abuse, and the severity and form of abuse during the quarantine period, from March 23, 2020, to June 21, 2020. Associations were tested using a two-tailed Pearson's Chi-square test and odds ratios. A binary multivariate logistic regression was used to identify the independent factors associated with domestic violence.  Results  In total, 2254 participants were included in the present study. The majority (n=2129, 94.7%) were Saudi nationals. The highest proportion (n=1022, 45.3%) was in the 30 to 40 years age group. The self-reported prevalence of domestic violence before COVID-19 pandemic and quarantine was 25.4% and 16.6% during the confinement, indicating an overall decrease of 8.8% in the reported cases. Regarding the type of violence, of the 315 (16.6%) women who endured violence since the confinement, the majority (n=301, 95.6%) experienced multiple forms of violent abuse, 264 (87.7%) suffered from psychological/emotional violence, 114 (37.9%) from physical violence, and 50 (16.6%) from sexual violence. Of the group who experienced multiple forms of violence, 120 (39.9%) reported an increase in the frequency and perceived intensity of the violence since the confinement. The only variable that directly increased the likelihood of suffering domestic violence had more than three children [OR = 1.59, P = 0.018]. Conclusions  Contrary to trends observed in other countries, the national prevalence of abusive conduct towards married women showed a marked decrease during the quarantine period-more children directly correlated with a higher reported frequency of being abused. Further studies in neighbouring countries with comparable societies and structures must be conducted to assess the validity of our findings in the context of the global trends of violence in the marital home.

The impact of the English medical curriculum on medical history taking from Arabic speaking patients by medical students.

INTRODUCTION: Medical education in Saudi medical colleges is delivered to students through a completely English language curriculum, whereas the practice that students face in the hospital is generally conducted in Arabic language settings. We suggest that the linguistic gap between the adopted medical curriculum and actual practice could influence students' confidence and level of difficulty in history taking in Arabic. The study aimed to identify the effects of learning history taking in the English language on applying it in the medical student's native language. METHODS: This cross-sectional design study was held in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS). The targeted sample size was 377 medical students from the fourth to the sixth year, and stratified random sampling was used. The questionnaire used was self-developed, validated, and pilot tested in other medical colleges. The questionnaire asked about students' confidence, the difficulty of Arabic history taking, and suggested strategies to improve the current curriculum. RESULTS: The response rate was 290 participants (76.9%), males were 205 (71%), and 136 (47%) were in the fourth year. Agreement on feeling confident while taking history taking in Arabic was 98 (33.8%), 102 (35.2%) were neutral, and 90 (31%) disagreed. Moreover, 138 (47.6%) of students preferred training for Objective Structured Clinical Examination (OSCE) in Arabic more than English, 86 (29.7%) were neutral, while 66 (22.8%) disagreed. The mean level of difficulty was 2.1 ± 0.7 (range 1- 5). Additionally, 198 (68%) of students suggested adding short Arabic history courses. CONCLUSION: Students considered history taking in Arabic as easy, even though they were not completely confident. Further efforts are needed to uplift students' of confidence to optimal levels. ADVANCES IN KNOWLEDGE: Communication is the cornerstone of medical education as well as clinical practice. The study explores the impact of instruction language on the physician-patient communication dynamic, providing better infrastructure for evidence-based educational practice. APPLICATION TO PATIENT CARE: This study gives insight into the students' level of preparation to practice in their local community and language. Furthermore, the study addresses strategies to enhance students communication skills and alleviate linguistic barriers in the physician-patient encounter.

Effect of 2019 Coronavirus Pandemic on Ophthalmologists Practicing in Saudi Arabia: A Psychological Health Assessment.

PURPOSE: To assess the psychological impact and mental health outcomes including depression, anxiety, and insomnia during COVID-19 crisis among ophthalmologists. METHODS: This was a simple random study in which ophthalmologists practicing in Saudi Arabia were asked to fill in a self-administered online survey during the period from March 28, 2020, to April 04, 2020. Four validated psychiatric assessment tools were used to detect symptoms of depression, anxiety, insomnia, and stress perception. RESULTS: One hundred and seven participants successfully completed the survey with a response rate of 30.6%. Males constituted 56.1% (n = 60). Ophthalmology residents constituted the majority (n = 66, 61.7%). About half of the physicians exhibited symptoms of depression (n = 56, 50.5%), anxiety (n = 50, 46.7%), and insomnia (n = 48, 44.9%). Symptoms of stress ranged between low (28%), moderate (68.2%), and high (3.7%). According to the cutoff values for severe symptoms, 29% were identified as having depression, 38.3% had anxiety, and 15% had insomnia.Depression was found to be more common among female ophthalmologists (P = 0.06), those living with an elderly (P = 0.003), and fellows (P = 0.006). Female ophthalmologists suffering from anxiety were significantly more than male ophthalmologists (P = 0.046). There was a trend toward suffering from anxiety in frontline health-care providers (P = 0.139) and in ophthalmologists who are living with an elderly (P = 0.149). Female participants exhibited significantly more moderate-to-high symptoms of stress (P = 0.018). CONCLUSIONS: Ophthalmologists' psychological needs, females in particular, should be addressed appropriately during the COVID-19 pandemic. Establishing psychological support units, especially for high-risk individuals, should be considered to minimize psychological adverse effects.

The level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences, towards mentally ill patients.

AIM: The study aimed to measure the level of the stigma of medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh campus, towards mentally ill patients. MATERIAL AND METHODS: A cross-sectional survey was conducted in King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh. The data collection was started in July 2017 till March 2018. The students completed a self-administered questionnaire consisting of sociodemographic data and the Community Attitudes toward the Mentally Ill (CAMI) Scale. RESULTS: The sample size was realized as 274 participants. There were no significant differences in all CAMI subscales for the different academic years except for Authoritarianism which showed a significant increase in the level of stigma (P-value = 0.04). Male gender, previous psychiatric treatment, and having a relative with psychiatric illness were associated with higher Authoritarianism and Social Restrictiveness scores and lower Benevolence and CMHI scores. DISCUSSION: More stigma was observed among the 4th year students and it might be due to insufficient academic preparation as well as more exposure to psychiatric rotations. CONCLUSION: The results support the importance of implementing anti-stigma programs throughout the medical program to improve the healthcare provided to mentally ill patients.

Depression Among Caregivers of Patients With Dementia.

We aimed to assess depressive symptoms in caregivers of patients with dementia, taking into account variables such as severity of dementia, sex, age, and financial state of the patient. We recruited 222 caregivers of patients with dementia from King Abdulaziz Medical City, Saudi Alzheimer's Disease Association, and online, from February to June 2017, and employed the Patient Health Questionnaire to assess depression, and the Blessed Dementia Scale to assess severity of dementia. The prevalence of clinical depression among the caregivers was 14.9%. Minimal symptoms of depression were experienced by 96 caregivers (43.2%), moderate by 45 (20.3%), moderate-severe by 15 (6.8%), and severe by 8 (3.6%). Forty-six patients had mild dementia (22%), 73 had moderate (34.9%), and 90 had severe (43.1%). Caregivers of patients with dementia experience considerable burden and lower level of health-related quality of life and may be predisposed to developing clinical depression.

The prevalence and association of stress with sleep quality among medical students.

INTRODUCTION: Medical students tend to reduce their sleep, in an effort to adjust and cope with their workload and stressful environment. This study estimated the prevalence of and the relationship between poor sleep quality and stress among medical students. METHODS: This cross-sectional study was conducted using a stratified random sample of male and female medical students in King Saud bin Abdulaziz University for Health Sciences in Riyadh, Saudi Arabia. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index, and the stress level by using the Kessler Psychological Distress Scale. RESULTS: A high prevalence of poor sleep quality (76%) and stress (53%) were found, with a statistically significant association (p<0.001). Logistic regression indicated that students who are not suffering from stress are less likely to have poor sleep quality (OR=0.28, p<0.001), and the risk of having poor sleep quality is almost four times higher in students whose cumulative grade point average (GPA) is less than 4.25 (OR=3.83, p=0.01). CONCLUSION: The study documents a statistically significant association between stress and poor sleep quality. A recommendation for the management of medical college is to establish academic counseling centers focusing in promoting good sleep hygiene and strengthening students' study skills and coping with their stressful environment.

Prevalence of Irritable Bowel Syndrome and its Association with Anxiety among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Riyadh.

OBJECTIVE: To quantify the prevalence of Irritable Bowel Syndrome (IBS) among medical students of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) and to observe the association between anxiety and IBS. METHODS: This cross-sectional observational study conducted during academic year 2015-2016 has used two self-administered, pre-validated questionnaires: Depression Anxiety Stress Scales-21 (DASS-21) and Rome III criteria. The sample size was 270, and proportional allocation was used to determine distribution of this sample across study population based on percentages of students in each academic year. Convenience sampling was used to select participants. RESULTS: The overall prevalence of IBS was 21% (n=57), with a higher prevalence among females (26%, n=23) than males (19%, n=34). IBS was most and least prevalent among first-year students (14%, n=5) and fifth-year students (29%, n=21) respectively. Anxiety levels were normal, mild, moderate, and severe or extremely severe in 39% (n=105), 7% (n=19), 26% (n=70), and 27%. A significant association was found between gender & IBS and anxiety levels & IBS. CONCLUSION: The prevalence of IBS in this study was 21% and higher among females than males but were highest among fifth-year students for both genders. More than 50% of students had moderate or high levels of anxiety for both genders. The prevalence of IBS was highest among students of 5th fifth year. The study provides evidence that, as medical students of higher year of their under graduation were having higher level of anxiety which leads to IBS.

Burnout and its association with extracurricular activities among medical students in Saudi Arabia.

OBJECTIVES: To assess levels of burnout in medical students, and to explore the influence of extracurricular activities on burnout at a medical school in Saudi Arabia. METHODS: This cross-sectional study was conducted with first to fourth year medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh, Saudi Arabia. Socio-demographic, burnout level (the Maslach Burnout Inventory-Student Survey, MBI-SS) and participation in extracurricular activities data were collected using a self-administered questionnaire. Statistical analyses were performed using the Pearson's chi-square test and binary logistic regression. RESULTS: From the 306 medical students approached, 249 (81.4%) completed the questionnaire. The level of high burnout was 67.1% (n=167). The study revealed that the majority (62.3%, n=155) of students had high levels of cynicism, 58.6% (n=146) had high levels of emotional exhaustion, and 60.2% (n=150) had low levels of professional efficacy. Most of the students (73.5%, n=183) participated in extracurricular activities, and 112 (45%) students were organizers of extracurricular activities. No significant association was found between burnout levels and the frequency of involvement in extracurricular activities (χ2=2.2, df=2, p=0.333). However, students who were organizing extracurricular activities were less likely to have low professional efficacy (OR=0.51, 95% CI: 0.27- 0.96). CONCLUSIONS: High levels of burnout were reported at this medical school. Although the burnout level is not significantly associated with the frequency of involvement in extracurricular activities, leading and organizing extracurricular activities might result in lower levels of burnout. Therefore, improving the students' leadership skills should be considered in curriculum planning, and greater emphasis should be placed on the quality of involvement in extracurricular activities rather than the quantity.