Adaptation, Validity, and Reliability of the Patient Health Questionnaire (PHQ-9) in the Kurdistan Region of Iraq.

AIM: The Patient Health Questionnaire (PHQ-9) is widely used for detecting and screening depression in Iraq. However, no psychometric assessment has been performed on any Iraqi version. This study aims at studying the reliability and validity of the Iraqi Kurdish version of the PHQ-9 as tool for identifying depression. METHODS: A cross-sectional study design was used; data were collected from 872 participants (49.3% female and 51.7% male) at Primary Health Care Centers (PHCCs) in the host community as well as from Internal Displaced Persons (IDPs) and refugee camps. Sociodemographic information was obtained; PHQ-9 for the diagnosis and screening of depression and Self Reporting Questionnaire 20 items (SRQ-20) for the screening of common mental illnesses were administered. Validity and reliability analyses were performed. RESULTS: In total, 19% of the participants had a PHQ-9 total score equal to or higher than the clinical cut-off of 10 for diagnosing depressive disorder. The internal consistency of the PHQ-9 was good (Cronbach's alpha coefficient was 0.89). Good concurrent validity for PHQ-9 compared with SRQ-20 (71%, p < 0.001) was found. CONCLUSIONS: The PHQ-9 demonstrates good psychometric properties and proves to be a good tool for detecting and screening depression.

Workload assessment of medical doctors at primary health care centers in the Duhok governorate.

BACKGROUND: A shortage in human resources, particularly physicians, has become a challenge confronting health authorities in the Duhok governorate, as these resources are the key input for delivering health care. It has become necessary to identify the most appropriate scientifically sound method for having adequate staffing levels. This study aimed to forecast the required number of physicians to cope with the current workload at the main primary health care centers in the Duhok governorate. METHODS: A cross-sectional study was adopted to collect data for 1 full year. Data collection included both primary and secondary data sources. A semi-structured questionnaire was developed to obtain information every month from health centers on activities related to training and leaves. Data analysis was performed using Workload Indicators of Staffing Need software. RESULTS: Sixty-one primary health care centers met the final criteria for analysis. The study revealed physician shortages and inequity in the distribution of staffing. In these centers, 145 physicians lacked an adequate delivery of health services based on the workload imposed on them. The 'workload indicators of staffing need' ratio was 0.33, indicating high work pressure on medical doctors. Some centers offered more health care than others, but had fewer doctors based on the current staffing practices. CONCLUSIONS: This study pointed out the importance for the public health sector and academic medical institutions to use Workload Indicators of Staffing Needs software in health policy administration to restructure their efforts to address the physician shortages and distribution imbalances at primary health care facilities.

Clinical and epidemiological characteristics and outcomes of Coronavirus disease-19 patients in a large longitudinal study.

OBJECTIVE: This study aimed to determine the clinical and epidemiological characteristics and outcomes of Coronavirus disease (COVID)-19 patients. METHODS: In this large cohort study, 15,409 confirmed patients with the COVID-19 of different severities were followed-up from three specialized COVID-19 hospitals between March 18 and October 11, 2020 in Iraqi Kurdistan. The predictors of mortality and severity were examined in binary logistic regression analysis. RESULTS: The incidence rate of severe/critical status was 12.3% with a median age of 36.0 and case fatality rate (CFR) of 1.98%. The incidence rate of severe/critical conditions and CFR rose with increased age groups; except for 0-14 years (11.9%). The incidence rate of severe/critical patients and CFR was 8.3% and 0.5%, 21.1% and 4.0%, and 23.7% and 8.7% in 15-49 years, 50-64 years, and 65 and older age groups, respectively. The severity of the disease and CFR was associated with coexisting chronic diseases such as cardiovascular diseases (18.2% and 3.1%) and diabetes mellitus (19.8% and 3.4%). The asymptomatic patients (8400 and 54.5%) had statistically higher CFR; 2.3% versus 1.6% (P = 0.006). The most common symptoms on diagnosis were fever (31.9%), cough (23.5%), loss of smell/taste (16.3%), sore throat (15.7%), shortness of breath (9.8%), and headache (9.5%). The results showed that being older was the only predictor of mortality and severity in COVID-19 patients. CONCLUSIONS: This region has a low incidence of severe-critic status and CFR. The patients with coexisting medical conditions are more likely to have severe conditions and die of COVID-19. The older age predicts severe/critic status and higher CFR.

Posttraumatic stress disorder correlates among internally displaced Yazidi population following Islamic state of Iraq and Syria attacks in Iraq.

BACKGROUND: In 2014, the so-called Islamic State of Iraq and Syria (ISIS) took over one-third of Iraq. This study measured the rate of posttraumatic stress disorder (PTSD) among Iraqi Yazidi internally displaced persons (IDPs) and examined associated demographic and traumatic risk factors. METHODS: A cross-sectional survey was carried out in April-June 2015 at the Khanke camp, northern Iraq. Trauma exposure and PTSD were measured by the Harvard Trauma Questionnaire (Iraqi version). RESULTS: Of 814 adult Yazidi IDPs, 34% screened positive for PTSD. Avoidance and intrusion symptoms had the highest means (M = 3.16, SD = 0.86 and M = 2.63, SD = 0.59 respectively). Associated factors of PTSD included exposure to a high number of traumatic events, unmet basic needs and having witnessed the destruction of residential or religious areas (OR = 1.39, 95% CI: 1.02-1.9 and OR = 1.25, 95% CI: 1.01-1.53 respectively). Being a widow was the only linked demographic factor (OR = 15.39, 95% CI: 3.02-78.39). CONCLUSIONS: High traumatic exposure, specifically unmet basic needs and having witnessed destruction, was an important predictor of PTSD among Yazidi IDPs. These findings are important for mental health planning for IDPs in camps.