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Limited studies have been conducted in the Kingdom of Saudi Arabia on eating disorders (EDs). This study presents national epidemiological survey data on the prevalence and correlates of anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) and their association with other mental health disorders, impairment in role functioning, and individual help-seeking behaviors in the Saudi National Mental Health Survey (SNMHS).A face-to-face survey was conducted in a nationally representative household sample of Saudi citizens aged 15-65 (n = 4004). The Composite International Diagnostic Interview (CIDI 3.0) was used to produce estimates of lifetime and 12-month prevalence and treatment of common DSM-IV mental disorders.Twelve-month prevalence of any of the three EDs was 3.2%; the overall lifetime prevalence was 6.1%. Education and marital status were significantly associated with both 12-month and lifetime EDs prevalence. Significant mental health comorbidities associated with 12-month EDs were anxiety, mood, and impulse-control disorders, while lifetime EDs were significantly related to all disorders. A similar percentage of respondents that reported having ED-related treatment at some point in their lifetime utilized healthcare and nonhealthcare sector. There was a significant relationship between body mass index category, and lifetime BED and BN.The 12-month prevalence of EDs in the Saudi population was higher than the EDs rates reported worldwide. These findings can help healthcare experts, and policymakers in the implementation of initiatives for raising awareness of EDs among the Saudi population, and the development of a country-wide plan for the prevention of EDs.The study presents data on the prevalence, correlates, and help-seeking behaviors of AN, BN, and BED, in the Saudi National Mental Health Survey (SNMHS). Obtaining information on this underrepresented region is essential due to the large differences in cross-national data in addition to cultural beliefs about mental illness and treatment seeking to exert an important influence on eating disorders. Such knowledge could provide a better understand of mechanisms underlying the development of eating disorders and thereby improve prediction, prevention, and treatment.

To evaluate the patterns and potential risk factors associated with mental health treatment dropout in the Saudi National Mental Health Survey (SNMHS).The SNMHS is a face-to-face community-based ep...

Previous studies suggest that refusals form the largest proportion of nonresponse for household surveys. As face-to-face household health surveys are uncommon in several countries, it might be advantageous for prospective surveys to preemptively tackle respondents’ refusal to survey participation. Using contact history data from the Saudi National Mental Health Survey, we examined the relationship between social environmental factors, respondent characteristics, survey request concerns recorded by interviewers, and respondents’ propensity to refuse to participate in the survey. Content analysis and logistic regressions were conducted. Our findings suggest that urbanicity, region, socioeconomic status, age, and gender are associated with refusal. Patriarchal gatekeepers and specific survey-related concerns are more likely to lead to temporary refusals compared to final refusals. These results have implications for survey researchers employing similar recruitment and data collection methods, for example in tailoring refusal conversion strategies for interviewers to address concerns expressed by Saudi and/or culturally similar respondents.

Background: While global studies demonstrated that features of urban living are associated with the risk of developing mental disorders, there remains a significant knowledge gap surrounding this topic in the Middle East and North Africa region. Aims: This study aims to assess the prevalence, severity, correlates, and treatment of mental disorders in Riyadh City by examining certain aspects of urban living such as exposure to traumatic events, early exposure to urbanization, and seeking treatment. Methods: The Saudi National Mental Health Survey is a community epidemiological survey in a nationally representative sample of citizens aged 15 to 65 in KSA. The World Health Organization Composite International Diagnostic Interview (CIDI 3·0) was used to estimate the 12-month prevalence of common mental disorders. Results: The prevalence of any mental disorder in Riyadh City was 29.2%. The most common disorders were anxiety disorders and mood disorders. Female, young, and previously married respondents were at higher risk for developing mental disorders. Exposure to traumatic events was associated with all types of mental disorders. Only 2.9% of those with any mental disorder sought mental health treatments. Conclusions: We found a high prevalence of mental disorders in Riyadh City that could be attributed to certain features of urban living. These results may point to potential interventions in urban areas that can mitigate the adverse consequences of urban living and promote the salutogenic aspects of cities.

Introduction Few studies have considered the impact of COVID-19 on the mental health of healthcare workers (HCWs) in the Kingdom of Saudi Arabia (KSA). We estimated the prevalence and severity of psychological distress and characterized predisposing risk factors among HCWs in KSA during the COVID-19 pandemic. Methods We conducted a cross-sectional online survey of 1,985 HCWs from 6 hospitals across the country designated with caring for COVID-19 patients between April 16 and June 21, 2020. Our data analysis was performed using logistic regressions. Ordered logistic regressions were also performed using forward stepwise model selection to explore the effects of risk factors on psychological distress. Results The prevalence of psychological distress reported by HCWs in KSA was high, ranging from mild-moderate to severe in severity. Younger HCWs, women, those in contact with COVID-19 patients, and those who either had loved ones affected or who were themselves affected by COVID-19 were the most at-risk of psychological distress. Risk factors such as insomnia, loneliness, fear of transmission, and separation from loved ones most significantly predicted elevated levels of distress among HCWs. Conclusions Increasing psychological distress was commonly reported by HCWs during the early months of COVID-19 pandemic in KSA. Public health policy makers and mental health professionals must give special attention to risk factors that predispose HCWs in KSA to psychological distress.

Psychotic expression is influenced by unique contexts, including the individual’s culture. The majority of research on psychotic experiences is quantitative and from Western, democratic societies. This article explores the explanatory models used by Saudis to describe psychotic experiences (i.e., hallucinations and delusions). Using open-ended responses to a structured psychosis screener embedded within a comprehensive mental health survey instrument, we conducted thematic analysis on data representing the psychotic experiences of 59 individuals. We found that Saudis report religious (e.g., Jinns) and cultural (e.g., modest clothing) frameworks alongside biological, psychological, and social mechanisms which potentially trigger an alternative reality for the affected individual. Our findings suggest it may be helpful for health care professionals to consider individual differences and work with religious leaders (e.g., Shaykhs) to prevent misdiagnosis and mistreatment. In-depth qualitative studies are needed to examine trajectories of psychotic symptomatology among Saudis and the specific language used to describe such occurrences.

Objective There is limited evidence on how workplace health promotion is implemented and evaluated in the Arab countries of the Gulf Cooperation Council (GCC). The present study aimed to improve the overall well-being of employees at a departmental level in a hospital setting in Riyadh, Saudi Arabia. Methods Using a pre-post longitudinal design, a wellness program was implemented, assessing physical activity, diet, work productivity, absenteeism, workplace satisfaction, and stress. Results Significant improvement was observed in physical functioning of the employees; with a significant increase in average intake of water/d and fruit consumption, significant decrease in average number of soft drinks consumed/wk, and significant decrease in the days of absence in the last 3 months. Conclusions There were trends in improvement overall on the wellness measures with significant impact on the physical functioning and dietary habits of the employees.

Objectives: To present an overview of the survey and field procedures developed for the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a face-to-face community epidemiological survey of DSM-IV mental disorders in a nationally representative sample of the household population in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The SNMHS was implemented as part of the WHO World Mental Health (WMH) Survey Initiative. WMH carries out coordinated psychiatric epidemiological surveys in countries throughout the world using standardized procedures designed to provide valid cross-national comparative data on prevalence and correlates of common mental disorders. However, these procedures need to be adapted to the unique experiences in each country. We focus here on the adaptations made for the SNMHS. Results: Modifications were needed to several interview sections and expansions were needed to address issues of special policy importance in KSA. Several special field implementation challenges also had to be addressed because of the need for female interviewers to travel with male escorts and for respondents to be interviewed by interviewers of the same gender. Conclusions: Thoughtful revisions led to a high-quality field implementation in the SNMHS.

Objectives To estimate 12‐month prevalence and severity of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens aged 15 to 65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate 12‐month prevalence of common DSM‐IV mental disorders. Results Twelve‐month prevalence of any DSM‐IV/CIDI disorder is 20.2%. Most common are anxiety disorders (12.3%) followed by mood (6.8%), disruptive behavior (5.4%), eating (3.2%), and substance use (1.9%) disorders. The proportion of 12‐month cases rated serious (39.0% of all cases) is high across virtually all disorders relative to the proportions found in CIDI surveys in other high‐income countries. Younger people have significantly elevated odds of mood and disruptive behavior disorders and serious disorders. Women have significantly elevated odds of anxiety and mood disorders and serious disorders. Previously married people have significantly elevated odds of most disorder classes and serious disorders. Conclusions Both 12‐month prevalence and severity of DSM‐IV/CIDI disorders are high in Saudi Arabia compared to other high‐income countries that carried out comparable surveys.

Objectives The DSM‐IV diagnoses generated by the fully structured lay‐administered Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) in the Saudi National Mental Health Survey (SNMHS) were compared to diagnoses based on blinded clinical reappraisal interviews. Methods Telephone follow‐up interviews were administered using the clinician‐administered non‐patient edition of the Structured Clinical Interview for DSM‐IV (SCID) in separate sub‐samples of SNMHS respondents who screened positive for four disorders that are of special importance in Arab countries: obsessive–compulsive disorder, separation anxiety disorder, social phobia, and major depressive episode. Results Initial diagnoses based on the CIDI were found to have higher prevalence than those based on the SCID for all four disorders. For reasons having to do with respondent denial of symptoms in the SCID reported in the CIDI, we interpreted these differences as due more to under‐diagnoses in the SCID than over‐diagnoses in the CIDI. Nonetheless, CIDI diagnostic thresholds for three of the four disorders were increased to make sure prevalence estimates based on the CIDI were conservative. The procedures used to implement these recalibrations are described in this paper. Conclusions The CIDI interviews used in the SNMHS generated valid but conservative diagnoses of common mental disorders in the Saudi population.

Objectives To estimate lifetime prevalence of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens ages 15–65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate lifetime prevalence of common DSM‐IV mental disorders. Results Estimated lifetime prevalence of any DSM‐IV/CIDI disorder is 34.2% and lifetime morbid risk is 38.0%. Anxiety disorders are by far the most prevalent (23.2%) followed by disruptive behavior (11.2%), mood (9.3%), eating (6.1%), and substance use (4.0%) disorders. Synthetic estimates of cohort effects suggest that prevalence of many disorders has increased in recent cohorts. Onsets typically occur in childhood for a number of anxiety and disruptive behavior disorders and in adolescence or early adulthood for most other disorders, although age‐of‐onset distributions for drug abuse is much later (median age of 31) than in CIDI surveys carried out in other high‐income countries. Conclusions Lifetime mental disorders are highly prevalent in Saudi Arabia and typically have early ages‐of‐onset.

Objectives To estimate lifetime treatment rates of mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens ages 15–65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to produce estimates of lifetime prevalence and treatment of common DSM‐IV mental disorders. Results Lifetime treatment ranged from 52.2% for generalized anxiety disorder to 20.3% for attention deficit/hyperactivity disorder, had a median (interquartile range) of 35.5% (30.6–39.5%) across disorders, and was 28.3% for people with any lifetime DSM‐IV/CIDI disorder. Half (49.0%) of patients received treatment in the mental health specialty sector, 35.9% in the general medical sector, 35.2% in the human services sector, and 15.7% in the complementary‐alternative medical sector. Median (interquartile range) delays in help‐seeking after disorder onset among respondents who already sought treatment were 8 (3–15) years. Odds of seeking treatment are positively related to age‐of‐onset and comorbidity. Conclusions Unmet need for treatment of lifetime mental disorders is a major problem in KSA. Interventions to ensure prompt help‐seeking are needed to reduce the burdens and hazards of untreated mental disorders.

Objectives To estimate treatment rates of 12‐month mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods The SNMHS is a face‐to‐face community epidemiological survey in a nationally representative household sample of citizens ages 15–65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization Composite International Diagnostic Interview (CIDI) was used to produce estimates of 12‐month prevalence and treatment of common DSM‐IV mental disorders. Results About one eighth (13.7%) of respondents with a 12‐month DSM‐IV/CIDI disorder received 12‐month treatment. The highest proportion of treatment occurred in the general medical sector (53.0%). Close to half (45.2%) of patients received treatment rated at least minimally adequate using standard treatment guidelines. Although serious disorders were significantly more likely to be treated (20.2%) than mild or moderate disorders (8.5–10.7%), no association was found between disorder severity and probability of receiving adequate treatment. Sociodemographic correlates were for the most part nonsignificant. Conclusions A high level of unmet need for treatment of mental disorders exists in KSA. Further analyses of the SNMHS data might provide insights into modifiable barriers to treatment and policy options to address the problem of unmet need for treatment.

One of the core components of the TRAPD (Translation, Review, Adjudication, Pretesting and Documentation) team approach to translation in survey research is pretesting. Cognitive interviewing is increasingly being used for pretesting survey questionnaires adapted to different populations. Exploring the issue of question sensitivity is particularly relevant when adapting a questionnaire to a population different than the one for which it was designed. However, little guidance exists on the use of cognitive interviewing, and specifically, the types of verbal probes, to elicit respondent feedback on question sensitivity. In preparation for the Saudi National Mental Health Survey, cognitive interviewing was carried out to pretest the Arabic version of the World Mental Health survey instrument (CIDI 3.0). Different types of cognitive probes: proactive direct, proactive indirect and general probes were randomly assigned to survey questions to investigate differences in the feedback elicited by each type of probe. Findings suggest that different types of cognitive probes that are designed to explore perceived sensitivity of the survey questions elicit different amounts and types of feedback. An indirect cognitive probe identified a topic to be sensitive in more instances than a direct probe or a general probe. A general probe, on the other hand, elicited more non-codable feedback especially when paired with a survey question that asks about a more abstract concept such as the respondent’s feelings.

Background: With the growth of information technology, there is a need for the evaluation of cost-effective means of monitoring and support of field workers involved in large epidemiological surveys. Aim: The aim of this research was to measure the performance of a survey help desk that used knowledge management tools to improve its productivity and efficiency. Knowledge management tools are based on information technologies that improve the creation, sharing, and use of different types of knowledge that are critical for effective decision-making. Methods: The Saudi National Mental Health Survey's help desk developed and used specific knowledge management tools including a computer file system, feedback from experts and a call ticketing system. Results are based on the analyses of call records recorded by help desk agents in the call ticketing system using descriptive analysis, Wilcoxon rank-sum test (p < 0.01) and Goodman and Kruscal test (gamma). The call records were divided into two phases and included details such as types of calls, priority level and resolution time. Results: The average time to resolve a reported problem decreased overall, decreased at each priority level and led to increased first contact resolution. Conclusion: This study is the first of its kind to show how the use of knowledge management tools lead to a more efficient and productive help desk within a health survey environment in Saudi Arabia. Further research on help desk performance, particularly within health survey environments and the Middle Eastern region is needed to support this conclusion.

Objectives: To examine barriers to initiation and continuation of treatment among individuals with common mental disorders in the Saudi National Mental Health Survey (SNMHS). Methods: The SNMHS is a community-based epidemiological survey in a nationally representative household sample of respondents aged 15&ndash, 65 in the Kingdom of Saudi Arabia. The World Health Organization Composite International Diagnostic Interview (CIDI) 3.0 was used. Predictors of barriers to treatment were analyzed with multivariable logistic regression. Results: Among participants with a 12-month DSM-IV/CIDI disorder (n = 711), 86.1% reported no service use. Of those (n = 597), 50.7% did not think they needed any help (categorized as &ldquo, low perceived need&rdquo, ) and 49.3% did perceive need. Of those who perceived need (n = 309), the majority (98.9%) reported attitudinal barriers to initiation. In contrast, 10.3% of those with a perceived need reported structural barriers. Respondents who were previously married or indicated below-average income were more likely to believe they needed help. Conclusions: Among people with a diagnosed mental disorder, low perceived need and attitudinal barriers are the primary barriers to mental health treatment in the KSA. The results suggest that addressing poor mental health literacy may be essential factor in reducing the unmet need for mental health treatment in the KSA.

Background: The World Mental Health-Composite International Diagnostic Interview (CIDI) 3.0, originally in English, is a fully-structured interview designed for the assessment of mental disorders. Although Arabic translations of CIDI from countries like Lebanon and Iraq exist, a Modern Standard Arabic translation was developed to suit the Saudi population. While the translation model used in the present paper has been used to translate instruments in Asian and European languages, there is no study to the best of our knowledge which has used this specific model to translate a validated instrument from English to Arabic. Case presentation: This paper describes the Saudi adaptation of CIDI 3.0. The TRAPD team translation model - comprising of translation, review, adjudication, pretesting and documentation - was implemented to carry out the Saudi adaptation of CIDI 3.0. Pretests involving cognitive interviewing and pilot study led to translation revisions which consequently confirmed that Saudi respondents had a good understanding of various items of the instrument. The adaptation procedures for the Saudi CIDI 3.0 were well documented and the instrument was linguistically validated with the Saudi population. Conclusion: The TRAPD model was successfully implemented to adapt the CIDI 3.0 to be used as the main survey instrument for the Saudi National Mental Health Survey, findings of which will provide health policy makers mental health indicators for health decision making and planning.

Background: The World Mental Health surveys have been known to apply high standards of quality control, but few studies have been published to document this. Furthermore, the effectiveness of quality control has rarely been reported in the Middle East. Case presentation: The focus of this paper was to highlight the implementation of quality control procedures in the Saudi National Mental Health Survey under the World Mental Health Survey Consortium. The paper summarizes the guidelines implemented for the various phases of survey quality control-the quality assurance procedures, the quality control procedures and the quality control appraisal components-as per previously prescribed recommendations in literature. Conclusions: Survey quality management is a process and not reducible to a single event. Midstream corrections are warranted by detecting problems and intervening appropriately. The Saudi National Mental Health Survey implemented such procedures through continuous quality improvement.

Several challenges exist in carrying out nation-wide epidemiological surveys in the Kingdom of Saudi Arabia (KSA) due to the unique characteristics of its population. The objectives of this report are to review these challenges and the lessons learnt about best practices in meeting these challenges from the extensive piloting of the Saudi National Mental Health Survey (SNMHS), which is being carried out as part of the World Mental Health (WMH) Survey Initiative. We focus on challenges involving sample design, instrumentation, and data collection procedures. The SNMHS will ultimately provide crucial data for health policy-makers and mental health specialists in KSA.