Prevalence of physical, psychological, and sexual abuse among a nationwide sample of Arab high school students: association with family characteristics, anxiety, depression, self-esteem, and quality of life.

OBJECTIVES: The objectives were first, to assess the lifetime and 12-month prevalence of physical, psychological, and sexual abuse among a stratified random sample of Kuwaiti high school students and second, to explore the association of child abuse with parental characteristics, subjective quality of life (QOL), self-esteem, anxiety, and depression. METHOD: We assessed the students for experience of abuse by their mothers, fathers, and others, using standard scales on psychological, physical and sexual abuse. They also completed the short version of the World Health Organization's QOL Instrument; the Rosenberg self-esteem scale, and a scale for anxiety and depression. RESULTS: We obtained responses from 4,467 students (49% boys), mean age 16.9 years. About 18, 15, and 18%, indicated that for at least six times in the past 12 months, they experienced psychological abuse by their mothers, fathers and others, respectively. The corresponding figures for lifetime experience were similar. The respective figures for experience of physical abuse during the past 12 months were 4.3, 5.8, and 6.4%. For lifetime experience, the corresponding figures were 3.4, 5.3, and 5.8%. The girls had significantly higher physical/psychological abuse scores. There were no significant gender differences in the prevalence of sexual attacks (8.6%) and someone threatening the subjects with sex (5.9%). The prevalence of someone sexually exposing themselves to the students (15.3%) and unwanted touching of sexual parts (17.4%) was significantly higher among the boys. Over one-third of those abused had experienced multiple abuses. Child abuse was significantly associated with parental divorce, diminished QOL and self-esteem, high scores on anxiety/depression, and difficulty with studies, and social relationships. In the regression analysis involving only the abuse indices, psychological abuse by mothers was the most important predictor of depression, anxiety, and self-esteem (11.5-19.7% of variance). Good quality of parental relationship seemed protective. CONCLUSION: The findings support the impression that, despite the conservative culture, child abuse is being experienced by a significant number of children in the Arab world. Preventive education in this culture should include limits on child disciplinary measures, the vulnerable groups identified, the impact on psychosocial functioning, and the protective effect of parental harmony.

Relationship between symptoms of major depressive and generalized anxiety disorders in an Arab population using diagnostic criteria-based instruments.

BACKGROUND: The relationship between major depressive disorder (MDD) and generalized anxiety disorder (GAD) has been problematic in psychiatric nosology. We examined two research questions: First, using a data-driven approach, exploratory factor analysis (EFA), will symptoms that define MDD and GAD appear together in one factor, or are they separable into the hypothesized dimensions of the disorders? Second, using a theory-driven approach, confirmatory factor analysis (CFA), how will the structural integrity of the resulting factors compare with those of the various models that have been used to explain the relation between the symptoms? MATERIAL/METHODS: Participants (n=3303) were a general population sample of adult Kuwaitis who self-completed the DSM-IV-TR criteria-based questionnaires for MDD and GAD. Exploratory factor analysis was by principal axis factoring, with oblique rotation. Models were compared in CFA using 7 "fit" indices in AMOS-16 software. RESULTS: The questionnaires had adequate psychometrics. In the EFA, each questionnaire yielded 2 factors ("somatic-affective" and "cognitive"); but when the items were combined, 3 factors emerged ("somatic-affective"/"general distress: depressed"; "core anxiety"; and "cognitive-depression"). In CFA, only the (hierarchical) bifactor model and the (dimensional) model characterized by correlation of the 3 factors met the "fit" criteria. CONCLUSIONS: Our findings have widened the cross-cultural base of the evidence that while the symptoms of MDD and GAD form separate empiric clusters, there is an overlap of symptoms, which the disorders share. The relationship between the disorders' symptoms probably has hierarchical and dimensional elements.

Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument.

OBJECTIVES: The usefulness of quality of life (QOL) as an outcome measure in medicine has inspired general population studies to establish normative values. The objectives of the study were to: (1) highlight the pattern of satisfaction with aspects of life circumstances among a nationwide sample of Kuwaiti subjects, using the 26-item WHOQOL Instrument (WHOQOL-Bref); (2) establish the QOL domain normative values; (3) highlight the relationship of QOL with socio-demographic variables and scores on scales for anxiety and depression; and (4) assess the relationship between domains of QOL. METHOD: A one-in-three systematic random proportionate sample of consenting Kuwaiti nationals attending the large cooperative stores and municipal government offices in the six governorates, were requested to complete the questionnaires anonymously. RESULTS: There were 3,303 participants (44.8% m, 55.2% f, mean age 35.4, SD 11.9; range, 16-87). As a group, they were only moderately satisfied with their life circumstances. The domain scores for physical health (14.6 or 66.2%) and psychological health (14.2 or 63.9%) were at the middle of the range for the WHO 23-country report, while the social relations (15.0 or 68.8%) and environment (14.5 or 65.4%) domains were at the upper end of the WHO range. The general facet (GF) score (15.5 or 71.6%) was significantly higher than all domains. Diminished QOL was significantly associated with female gender, older age, social disadvantage, and high scores on anxiety/depression. Depression was the most important predictor of QOL, accounting for over 77% of total variance. CONCLUSION: QOL was sensitive to distressing and unfulfilled life circumstances. Hence, coupled with the difficulty of conducting house-to-house surveys in such a conservative society, a cost effective way of tracking societal distress is by including a brief and responsive measure of QOL during national census exercises. Clinicians need to be aware of QOL issues because QOL is associated with clinical and social variables. The differences between GF (representing subjective well-being) and the domains, has implications for QOL theory.