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Background and Hypothesis While literature indicates that culture modulates phenomenological characteristics of hallucinations in schizophrenia-spectrum disorders, little is known about the extent culture modulates these characteristics in nonclinical samples. Study Design We compared lifetime prevalence, age of onset, and phenomenology of hallucinations as assessed with the Questionnaire for Psychotic Experiences between samples of nonclinical participants used from the Netherlands (N = 2999) and Qatar (N = 2999). While participant recruitment differed between the 2 countries, the samples were relatively equal in terms of demographic factors. Study Results Our findings indicate that the lifetime prevalence of tactile and olfactory hallucinations are the same across countries. However, the prevalence of auditory hallucinations (AH) and visual hallucinations (VH) were twice as high in the Dutch sample. The reported age of onset for auditory and tactile hallucinations was younger for the Dutch sample. Findings from the measurement invariance supported cross-cultural comparisons with exception for duration, distress, and insight. Qatar’s and Dutch participants reported similar valence and extent of interaction with AH and VH. However, compared to those in the Netherlands, participants from Qatar reported significantly more impact on daily functioning and a higher prevalence of receiving commands from hallucinations in the past week. Conclusions While AH and VH were more often reported in the Dutch sample, participants in Qatar generally had higher mean factor scores for past week AH and VH than in the Netherlands. The phenomenology of hallucinations in the Qatar sample was of greater clinical relevance, with potentially important implications for early screening and prevention.

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

Background\ud \ud Prevalence trends from Arabic speaking countries on psychiatric symptoms before and after COVID-19 pandemic is lacking. We estimated the point prevalence and change in depression and anxiety symptoms scores in relation to sociodemographic variables following the resolution of the first wave in Qatar compared with before the pandemic.\ud \ud \ud \ud Methods\ud \ud We conducted a trend analysis using repeated nationally representative cross-sectional surveys spanning 2017, 2018, 2020/2021 and using the Physician Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to assess depressive and anxiety symptoms. Negative binomial regression modelled changes in these symptoms in relation sociodemographics and survey year.\ud \ud \ud \ud Results\ud \ud The two-week prevalence of depressive symptoms (≥10 on the PHQ-9) was 6.6% in 2017 and 6.5% in 2020/2021 (p = 0.986). The two-week prevalence of anxiety symptoms (≥10 or higher on the GAD-7) was 3.6% in 2018 and 5.1% in 2020/2021 (p = 0.062). The data for 2020/21 showed a 35.1% and 29.2% decrease in depression and anxiety symptoms scores compared to pre-pandemic years (2017/2018) after adjusting for sociodemographic factors.\ud \ud \ud \ud Limitations\ud \ud Screening tools rather than structured interviews were to assess depressive and anxiety symptoms.\ud \ud \ud \ud Conclusions\ud \ud Prevalence for depression and anxiety post the first COVID wave did not differ significantly to pre-pandemic estimates. The end of the first wave of the pandemic had a ‘levelling’ effect on these symptoms and their associations with traditional sociodemographic risk factors. The 2020/21 depression and anxiety symptoms scores remained high for Qataris and Arabs, suggesting that these cultural groups may benefit most from public mental health interventions.

There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, and COVID-19 infection and mortality rates. The main purpose of the study is to identify the factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey in Qatar between July and December 2020 after Qatar’s first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the Patient Health Questionnaire-Anxiety Depression Scale (PHQ-ADS). Of 1138 participants, 71.0% were female, 69.0% Arabs, 70.0% Non-Qataris, and 77.0% were

Adolescents in Qatar have some of the highest levels of inactivity and gender inequality in physical activity (PA) among all adolescents in the world. Contextual psychosocial influences remain unknown to date. The current study is a secondary analysis of 1,157 Qatari students (13 to 20 years of age) who completed a national cross-sectional survey. Males reported significantly higher daily PA than females (p < 0.0001) and increasing daily PA with personal importance for PA (p = 0.0140). However, compared to females, significantly higher proportion of daily active males were in the lowest level of self-efficacy (p = 0.0096), body shape satisfaction (p = 0.0003), likeness of body in pictures (p = 0.0011), and highest levels of psychological distress (p = 0.0313). Our results support positive association between adverse psychosocial constructs and daily PA in both genders; poor psychosocial profile was more pronounced among adolescent males. Future strategies aiming to increase PA should take into consideration these differences.

IntroductionQatar is a small but high-income Middle Eastern country with a large influx of migrants each year. However, the impact of changing population structure and urbanization on prevalence of generalized anxiety symptoms remains unexplored to date. Materials & MethodsA total of 2,640 participants interviewed by phone using the Generalized Anxiety Disorder (GAD-7) and the Patient Health Questionnaire (PHQ-2). Bivariate and multinomial logistic regression analyses were conducted to explore the associations of ethnicity (Arab versus Non-Arab) with severity and symptom profile of GAD and overlap with depressive symptoms. ResultsThe point prevalence of mild, moderate, and severe symptoms were 13.4% (95% CI: 11.9 – 15.0), 2.7% (95% CI: 2.0 – 3.5), and 0.9% (95% CI: 0.6– 1.4), respectively. Arab ethnicity was associated with mild GAD (OR=1.78, p=0.009) and moderate-to-severe GAD (OR=2.36, p=0.044). Relative to non-migrants, migrant types were not significantly associated with mild or with moderate-to- severe GAD. Interactions between depressive symptoms and ethnicity were evident and statistically significant for the association with mild GAD versus no GAD (OR=0.34, p=0.003). ConclusionsEthnicity moderated the association of depression symptoms and GAD severity, with potential implications for early screening and community intervention.

Background: There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, COVID-19 infection and mortality rates.Aim: To identify factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic.Method: We conducted a cross-sectional online survey in Qatar between July and December 2020 after the first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the PHQ-ADS scale. Results: Of 1138 participants, 71.05% were female, 69.0% Arabs, and 70.0% Non-Qataris. 77% were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with PHQ-ADS; Arab ethnicity (OR=1.67, p=0.026), never married (OR=2.04, p < 0.001 (versus married), prior history of psychiatric disorder (versus no history) (OR=1.76, p=0.039), increased worries due to social media use for COVID-related news/updates (OR=1.72, p=0.003), those with a history of COVID-19 (OR=1.76, p=0.039), loneliness (OR=1.91, p < 0.001), and lower levels of religiosity (OR=0.96, p=0.039). These associations also pertained in the reduced model, with exception of religiosity which was only marginally statistically significant (OR=0.97, p=0.055).Conclusions: The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, and similar crises, and assist with early intervention to treat sufferers.

Background: Effective public health measures in tackling the global COVID-19 pandemic necessitate understanding risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lacks vital representative vaccine hesitancy data. Methods: We conducted the first representative national phone survey using probability sampling among the adult population of Qatar, between December 2020 and January 2021, to identify the prevalence and potential determinants of vaccine willingness. This was categorized into: vaccine acceptance (strongly agree), vaccine resistance (strongly disagree) and vaccine hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between vaccine willingness and fifteen sociodemographic, work-, and health-related variables. Findings: In the total sample, 42.7% (95%CI: 39.5-46.1) were classified as accepting, 45.2% (95%CI: 41.9-48.4) hesitant, and 12.1% (95%CI: 10.1-14.4) resistant. Those in the vaccine resistance group reported no source of endorsement will increase their confidence in accepting the vaccine (58.9% vs. 5.6% vs. 0.2%, respectively). Hesitancy and resistance were explained by female gender, Arab ethnicity, migrant status/type, and concerns about vaccine side-effects. COVID-19 related bereavement, personal infection, and quarantine status were not significantly associated with any group. Absence of or lack of concern about contracting the virus was solely associated with resistance. Interpretation: COVID-19 vaccine resistance, hesitance, and concern about side-effects is high in Qatar’s population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants) and those of Arab ethnicity. Funding: This study was funded by the Emergency Response Grant at Qatar University (QUERG-CAS-2020-1). Declaration of Interests: P.M.H. reports personal fees from Janssen, Lundbeck, Otsuka, New Bridge Pharmaceuticals and Sunovion, outside the submitted work. All other authors report no conflicts of interest. Ethics Approval Statement: The study was reviewed and approved by the Institutional Review Boards at Qatar University (QU-IRB 1338-EA/20) and Hamad Medical Corporation (MRC-05-089).

There is limited data from Arabic-speaking countries on risk factors for depression and anxiety during the COVID-19 pandemic. Country-specific data is necessary given differences in culture, demographics, and COVID-19 infection and mortality rates. This study intended to identify the factors associated with symptoms of depression-anxiety in the adult population of Qatar during the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey in Qatar between July and December 2020 after Qatar’s first COVID-19 wave and before the beginning of the second wave. Depression-anxiety was defined as a cut-off of 20 or higher on the PHQ-ADS scale. Of 1138 participants, 71.05% were female, 69.0% Arabs, and 70.0% Non-Qataris. 77 % were < 40 years (the median age in Qatar is 32 years). In a fully-adjusted model, six variables were significantly associated with PHQ-ADS; Arab ethnicity (OR=1.67, p=0.026), never married (OR=1.69, p < 0.015), prior psychiatric history (OR=1.80, p=0.009), Social Media induced worries (OR=1.72, p=0.003), history of COVID-19 (OR=1.76, p=0.039), loneliness (OR=1.91, p < 0.001), and lower levels of religiosity (OR=0.96, p=0.039). The potential risk factors identified may assist with anxiety and depression prevention in future COVID-19 waves, similar national events and assist with early intervention to treat sufferers.

Global COVID-19 pandemic containment necessitates understanding the risk of hesitance or resistance to vaccine uptake in different populations. The Middle East and North Africa currently lack vital representative vaccine hesitancy data. We conducted the first representative national phone survey among the adult population of Qatar, between December 2020 and January 2021, to estimate the prevalence and identify potential determinants of vaccine willingness: acceptance (strongly agree), resistance (strongly disagree), and hesitance (somewhat agree, neutral, somewhat disagree). Bivariate and multinomial logistic regression models estimated associations between willingness groups and fifteen variables. In the total sample, 42.7% (95% CI: 39.5–46.1) were accepting, 45.2% (95% CI: 41.9–48.4) hesitant, and 12.1% (95% CI: 10.1–14.4) resistant. Vaccine resistant compared with hesistant and accepting groups reported no endorsement source will increase vaccine confidence (58.9% vs. 5.6% vs. 0.2%, respectively). Female gender, Arab ethnicity, migrant status/type, and vaccine side-effects concerns were associated with hesitancy and resistance. COVID-19 related bereavement, infection, and quarantine status were not significantly associated with any willingness group. Absence of or lack of concern about contracting the virus was solely associated with resistance. COVID-19 vaccine resistance, hesitance, and side-effects concerns are high in Qatar’s population compared with those globally. Urgent public health engagement should focus on women, Qataris (non-migrants), and Arab ethnicity.

Aims: Q-LAMP aims to identify risk factors and resilience factors for symptoms of psychiatric illness during the pandemic. Study strengths include the 1-year longitudinal design and the use of standardized instruments already available in English and Arabic. The results will increase understanding of the impact of the pandemic on mental health for better support of the population during the pandemic and in future epidemics. Until an effective vaccine is available or herd immunity is achieved, countries are likely to encounter repeated ‘waves’ of infection. The identification of at-risk groups for mental illness will inform the planning and delivery of individualized treatment including primary prevention. Methodology: Longitudinal online survey; SMS-based recruitment and social media platforms advertisements e.g. Facebook, Instagram; Online consent; Completion time for questionnaires: approx. 20 to 30 minute; Baseline questionnaire with follow up at 3, 6, 9 and 12 months; Study completion date: Sept. 2021. Inclusion criteria: Currently living in Qatar; Qatari residents: citizens and expatriates; Age 18 years; read Arabic or English (questionnaire and consent form available in both languages). Instruments: Sociodemographic questionnaire including personal and family experience of COVID-19 infection; Standard instruments to assess psychiatric morbidity including depression, anxiety and PTSD; research team-designed instruments to assess social impact of pandemic; standard questionnaires to assess resilience, personality, loneliness, religious beliefs and social networks. Results: The analysis was based on 181 observations. Approximately, 3.5% of the sample was from the sms-recruitment method. The sample of completed surveys consisted of 65.0% females and 35.0% males. Qatari respondents comprised 27.0% of the total sample, while 52% of the sample were married, 25% had Grade 12 or lower level of educational attainment, and 46.0% were unemployed. Covid-19 appears to have affected different aspects of people’s lives from personal health to living arrangements, employment, and health of family and friends. Approximately, 41% to 55% of those who responded to the survey perceived changes in their stress levels, mental health, and loneliness to be worse than before the pandemic. Additionally, the wide availability of information about the pandemic on the internet and social media was perceived as source of pandemic-related worries among members of the public. Conclusion: The continued provision of mental health service and educational campaigns about effective stress and mental health management is warranted.

Background: There is emerging evidence that supports a role for inflammatory processes and insomnia in the pathophysiology of depression. However, little is known about the role of inflammation in depression and insomnia in non-clinical populations. Aims: We aimed to estimate the association between inflammatory illness, depression and insomnia in the Qatari population. We hypothesized that inflammatory illness would be associated with sub-clinical depression and insomnia in the Qatari population. Methods: We used probability-based sampling on a representative sample (N= 1,611) of Qatar’s adult household population. Face-to-face interviews were conducted using computer-assisted technology as part of the SESRI’s annual omnibus survey in 2019. We used the Espie’s (2014) Sleep Condition Indicator, to assess insomnia symptoms, and PHQ-9 and GAD-2 for subthreshold depression (SUBD), major depressive disorder (MDD), and anxiety. Health information including personal and family history of inflammatory disease were also collected. Univariate, bivariate, and multivariate statistics were conducted. Results: Among those with no inflammatory disease, the 30-day prevalence of subthreshold and major depression in those with insomnia disorder compared to those without insomnia was (SUBD: 5.3% vs 2.9%; MDD: 7.2% vs 0.6%, P

BackgroundTo estimate the lifetime prevalence and potential determinants of psychotic experience(s) (PEs) in the general population of Qatar – a small non-war afflicted, conservative, high-income, middle-eastern country with recent rapid urbanization including an influx of migrants.MethodsA probability-based sample (n = 1353) of non-migrants and migrants were interviewed face-to-face and administered a 7-item psychosis screener adapted from the Composite International Diagnostic Interview, the Kessler 6-item psychological distress scale, and the 5 items assessing odd (paranormal) beliefs and magical thinking (OBMT) from the Schizotypal Personality Questionnaire. Using bivariate and logistic regression analyses, lifetime prevalence rates of PEs were estimated then compared before and after adjustment for socio-demographics, Arab ethnicity, psychological distress, and OBMT.ResultsPrevalence of PEs was 27.9%. Visual hallucinations were most common (12.8%), followed by persecutory delusions (6.7%) and auditory hallucinations (6.9%). Ideas of reference (3.6%) were least prevalent. PEs were significantly higher in Arabs (34.7%) compared with non-Arabs (16.4%, p < 0.001) with the exception of ideas of reference and paranoid delusions. Female gender was associated with a higher prevalence of PEs in the Arab group only (p < 0.001). Prevalence of PEs was significantly higher among Arabs (48.8% v. 15.8%, p < 0.001) and non-Arabs (35.2% v. 7.3%, p < 0.001) with OBMT. Arab ethnicity (OR = 2.10, p = 0.015), psychological distress (OR = 2.29 p = 0.003), and OBMT (OR = 6.25, p < 0.001) were independently associated with PEs after adjustment for all variables.ConclusionsEthnicity, but not migration was independently associated with PEs. Evidence linking Arab ethnicity, female gender, and psychological distress to PEs through associations with OBMT was identified for future prospective investigations.

Monica Zolezzi,1,2 Nawal Bensmail,2 Farah Zahrah,2 Salma Mawfek Khaled,3 Tayseer El-Gaili4 1Clinical Pharmacy and Practice, 2College of Pharmacy, 3Research Unit, Social and Economic Survey Research Institute, 4Student Counseling Center, Qatar University, Doha, Qatar Background: Stigma in relation to mental illness is one of the main factors inhibiting people from seeking help. Studies have been undertaken looking into the knowledge, attitudes, and beliefs (KAB) about mental illness among residents in Qatar; however, none have looked specifically at students in higher education. The aim of this study was to understand the KAB toward mental illness among students at a Qatari university and determine if there are any differences based on gender, nationality, and college type. Methods: A convenience sample of students from all genders, colleges, and nationalities was approached to participate in a survey that consisted of four sections: demographic, beliefs, attitudes, and help-seeking and treatment preferences associated with mental illness. Chi-square testing was performed to test for differences in the distribution of proportions of our primary outcomes (students’ beliefs, attitudes, and help-seeking and treatment preferences). Results: A total of 282 students completed the survey. The majority of the participating students were females (59.3%), non-Qataris (64.3%), and enrolled in science-based colleges (62.7%). Beliefs reflecting poor mental health literacy, such as “medications to treat mental illness can cause addiction”, “mental illness is not like any other illness”, or that “mental illness is a punishment from God”, were reported by a majority of students (84.4%, 56.7%, and 50.2%, respectively). Stigmatizing attitudes that were endorsed by a majority of students included believing that people with mental illness cannot have regular jobs (60.2%), that people with mental illness are dangerous (65.7%), and that they would not marry someone with a mental illness (88.9%). Additionally, 33.6% of students indicated they would be ashamed to mention if someone in their family or they themself, had a mental illness. A vast majority of students (86.3%) indicated to prefer family and friend’s support as treatment options. Significant differences in KAB about mental illness between genders, colleges, and college type were found only for a few items. Conclusion: The findings of this study suggest that a high percentage of students reported KAB about mental illness, that are considered stigmatizing. Students’ KAB about mental illness was consistent with that reported by the general population in Qatar. Nevertheless, the sample was small and as such, larger studies from a randomly selected population are needed to confirm these findings. Keywords: knowledge, attitude and behavior, university students, stigmatization, mental illness

Aims: To estimate the prevalence of Insomnia Disorder in the household population of Qatar and explore potential associations with depressive and anxiety symptoms in addition to sociodemographic variables. Methods: Probability-based sampling was used to select a representative sample (N= 1,611) of Qatar’s household population. Face-to-face household interviews were conducted by trained staff using computer-assisted technology with consenting participants who were 18 years or older living in Qatar by the Social and Economic Research Institute (SESRI) at Qatar University as part of the Annual Omnibus survey in February/ March, 2019. The Sleep Condition Indicator (Epsie, 2014), a brief screening tool for DSM-5 criteria, was used to estimate the prevalence of insomnia in Qatar’s general population. Depressive and anxiety symptoms were ascertained using the PHQ-9 and GAD-2. Sociodemographic and health information including personal and family history of autoimmune disease were also collected. Univariate, bivariate, and multivariate statistics were conducted. Results: The prevalence of insomnia was 5.5% (95%CI: 4.3-6.7) and was higher in females (6.3%) than males (4.6%), though these differences were not statistically significant (P = 0.216). Insomnia was strongly associated with depressive (OR=5.4, P

Background: The aim of this study was to compare the prevalence of depressive symptoms among migrants and non-migrants living in Qatar and identify variables associated with depressive symptomology in these groups, including culture of origin, time living in country and perceived quality of life. In addition, we tested if the latter two variables moderated the effect of culture of origin on depressive symptomology in the migrant groups. Subject and Methods: A telephone survey of a probability-based sample of 2,520 participants was conducted in February 2016. The sample was divided into three groups based on nationality and income: labour migrants (LMs), white-collar migrants (WCMs) and non-migrants or Qatari nationals (QNs). Participants completed the Whooley two-question test for depression. Results: The odds of depression were significantly increased in LMs (OR = 3.31, 95% CI = 2.36–4.65) and WCMs (OR = 1.40, 95% CI = 1.04–1.90) compared with non-migrants. Among LMs, having a problem with current employer in the last 3 months was also associated with depressive symptoms (OR = 2.10, 95% CI = 1.14–3.84). Culture of origin was significantly associated with depressive symptoms including South Asians (OR = 3.12, p

Background There is a paucity of epidemiological studies of depression in war-free Arab countries. This study estimated the prevalence and potential determinants of Subthreshold (SUBDE) and Major Depressive Episode (MDE) in migrants and non-migrants typical of Qatar and neighboring Gulf countries. Methods A telephone survey of a probability-based sample of 2,424 participants was conducted in February 2017. The sample was divided based on nationality and income: Low-Income Migrants (LIMs), High Income Migrants (HIMs), and non-migrants or Qatari Nationals (QNs). Participants completed the nine-item Physician Health Questionnaire (PHQ-9). Ethnicity, sociodemographics, health- and work-related information was collected. Bivariate and multinomial logistic regression analyses were used. Results Overall prevalence of any depression ranged between 4.2% (95% CI: 3.3–5.3) and 6.6% (95% CI: 5.4–7.9) for a cut-off of 12 and 10, respectively. The diagnostic algorithm for SUBDE and MDE resulted in estimates of 5.5% (95% CI: 4.4–6.8) and 3.6% (95% CI: 2.8–4.5), respectively. SUBDE, but not MDE rates, were significantly increased in LIMs (OR=2.96, p = 0.004) and HIMs (OR = 2.00, p = 0.014) compared with non-migrants. Arab ethnicity was significantly associated with SUBDE: relative to South Asians (OR = 3.77, p < 0.001) and other ethnicities (OR = 3.61, p = 0.029). Arab ethnicity was significantly associated with MDE: relative to South Asians (OR = 10.42, p < 0.001) and South East Asians (OR = 3.54, p = 0.007). Limitations Clinical diagnostic interviews for depression were not included. Conclusion Using the PHQ-9, depression prevalence in Qatar was comparable to general population estimates from Western countries. Migrant status and ethnicity were associated with SUBDE and MDE with implications for early screening and community intervention.

Western media globalization is implicated in the spread of the thin body ideal to traditional societies. Qatar&mdash, a small conservative Middle-Eastern country&mdash, has recently witnessed rapid Westernization, but the influence of Western media icons on women&rsquo, s body image dissatisfaction has rarely been studied here. A 2 (celebrity or model) &times, 3 (thin, average, or heavy) plus a control condition between-subject experiment tested the primary hypothesis that exposure to images of thin Western models or celebrities promotes a thinner body ideal compared to neutral images. A sample of young women (n = 1145) was randomly assigned to experimental images as part of an online survey. After exposure to images, participants rated their current and desired body size and shape, reported celebrity liking, and evaluated their favorite celebrity&rsquo, s body. We found little support for the desire of thinness. Viewing thin- and average-sized celebrities was significantly associated with desiring a heavier and a thinner look (respectively) among those favoring thin celebrities. Images of thin models induced the desire for a curvaceous body figure with hips especially among those favoring celebrities with hips. The findings highlight important nuances in the influence of Western media icons on body image among women in a non-Western culture.

University years are a critical period in which young people establish independence and adopt lasting health behaviors. The aim of this study was to estimate the associations between eating out, psychological distress, and disordered eating behaviors among young Arab females in Qatar a rapidly developing small nation. A cross-sectional probability-based survey of 1615 Qatar University's female students assessed the frequency of eating out (main independent variable) and other eating behaviors in relation to two main dependent variables, disordered eating and psychological distress, which were measured using the Eating Attitudes Test and the Kessler Psychological Distress Scale, respectively. Multivariable logistic-regression analyses were used to estimate these two main associations with and without adjustment for other potential confounding variables, including the main effects of psychological distress and disordered eating on each other. Of the students, 45% reported eating out 3 times or more a week. Furthermore, approximately 18% screened positive for disordered eating and 33% reported high levels of psychological distress in the past 30 days. After adjustment for other variables, eating out 5 times or more a week was not significantly associated with the odds of disordered eating (OR 1.21, p = 0.32). However, eating out 5 times or more per week was significantly associated with odds of having psychological distress (OR 1.46, p = 0.03). Both psychological distress and disordered eating were strongly associated with each other (OR 2.58, p

Little is known about the impact of eating behaviors on weight management efforts among college students in non-Western settings. This study aimed to explore the relationship between eating behaviors, weight loss outcomes, and perceived weight loss difficulties (PWLD) among young Arab women trying to lose weight. A cross-sectional probability sample was used to recruit female university students aged 18 years and older in the state of Qatar. Participants (N = 937) completed an online survey measuring their attitudes and behaviors towards healthy eating, body image, and weight loss. More than two third (67.2%) reported facing difficulties when trying to lose weight and around one-third (31.2%) screened positive for disordered eating. Chi-squared and logistic regression analyses showed a strong and independent association between unsuccessful weight loss including lack of weight loss or maintenance after weight loss attempts, and PWLD (OR 8.6, p = .002). In addition, eating meals a few hours before sleeping (OR 1.98; p = .02) and having disordered eating (OR 2.28; p = .02) were positively associated with PWLD. BMI, weight loss goal and skipping breakfast were not associated with PWLD after adjustment for all covariates. Future studies are needed to develop better tools to comprehensively assess PWLD and validate against short- and long-term measured weight loss outcomes.

Reports of bidirectional associations between smoking and major depression (MD) have been interpreted as providing evidence for confounding by shared-vulnerability factors (SV) that predispose individuals to both conditions. If this is true, then smoking cessation may not reduce the risk of MD. From clinical practice and public health perspectives, the long-term outcomes associated with smoking persistence and cessation are potentially important and deserve exploration. To this end, the 12-year risk of MD in persistent heavy smokers and abstainers who were former-heavy smokers with and without adjustment for potential confounders were compared.Follow-up data from the National Population Health Survey (NPHS) was used. Multinomial logistic (ML) models were fit to identify potential confounders. Using proportional hazard (PH) models, unadjusted and adjusted hazard ratios (HRs) for MD outcome were estimated for different smoking patterns.The unadjusted HR relating the risk of MD among current-heavy versus former-heavy smokers was 4.3 (95% CI: 2.6-6.9, p 0.001). Current-heavy smoking predicted onset of MD (HR = 3.1, 95% CI: 1.9-5.2, p 0.001) even after adjustment for age, sex and stress - the main confounders. However, this was not the case for the never, former-light, and current-light categories. Evidence of decreased risk of MD among former-heavy relative to current-heavy smokers as function of smoking cessation maintenance time was also found.Contrary to common beliefs about the benefits of smoking for mental health, our results suggest that current-heavy rather than ever-heavy smoking is a major determinant of MD risk and point towards the benefits of smoking cessation maintenance.

Objective: Most psychiatric epidemiologic studies have used cross-sectional methods, resulting in a lack of information about the longitudinal course of depressive disorders. The objective of our study was to describe the longitudinal epidemiology of major depressive episodes (MDEs) in a Canadian sample using data from the National Population Health Survey (NPHS). Methods: The NPHS started data collection in 1994 and has evaluated past-year MDE using repeat interviews of the same cohort every 2 years since then. In our study, we examined the number of weeks depressed during years when MDEs occurred, the proportion of respondents having MDEs at consecutive cycles, and MDE counts during follow-up. Results: A sizable proportion of MDEs were brief: about one-half of respondents with past-year MDE reported 8 or fewer weeks of depression during that year. Less than 10% reported that they were depressed for the entire year. However, a larger proportion (19.1%) fulfilled criteria for MDE on consecutive interview cycles, suggesting either persistence or rapid recurrence. The mean number of detected MDEs among those with at least 1 detected MDE up to 2006 was 2. Positive family history, evidence of comorbidity, negative cognitive style, stress, pain, and smoking were associated with a more negative course. Conclusions: The longitudinal course of MDE in the general population is heterogeneous, including a mixture of brief and more protracted MDEs. Many risk factors for MDE are also associated with a negative course, exceptions being (younger) age and sex. These epidemiologic observations may assist with identification of patients requiring more intensive management in clinical practice.

IntroductionDissatisfaction with health care performance is an important source of information about health care reforms as perceived by the public as it is associated with negative beliefs about health system. Previous studies have shown that dissatisfaction with health care has a long-term negative impact on the health care users' relationship with healthcare providers, health related behaviors, and health outcomes. In addition, a recent study conducted in Qatar, showed that approximately 24% of the studied population who used health care in the past 12 months prior to the study were dissatisfied with health care services provided in the country. Given that dissatisfaction with care can negatively impact on help-seeking behaviors, this finding could have grave public health implications. This has been witnessed in the context of high prevalence of chronic health conditions in Qatar where long-term relations with healthcare professionals are necessary for better chronic disease management, reduced disease-related complications, and mortality. This study aims to identify the sources of dissatisfaction with medical care among adults, Qataris and white collar migrants aged eighteen years or older.MethodsThis study is based on secondary data from a larger national survey, which was conducted during the fall of 2012 for the purpose of collecting household-based information on health services utilization and health-related expenditures. Disproportionate stratified probability sampling was employed to select a representative sample of households. A final sample of 3,080 completed face-to-face interviews (1,528 Qataris and 1,552 White Collar Migrants) using computer assisted personal interviewing (CAPI) method for a raw response rate of 78.1%. The sample included individuals who may or may not have used Qatar's health care system during the 12 months prior to survey administration. Respondents were asked to discuss the reasons for their discontent with healthcare services in Qatar by selecting pre-coded categories of dissatisfaction including: Waiting time to see the provider, language used to communicate, clarity of how things are explained to the patient, poor services provided (such as cleanliness, reception, respect, and parking), inability to choose provider or doctor, high costs and other reasons to be specified by respondents. A total of 711 open-ended responses to the “Other” category were translated, coded and analyzed qualitatively. “Crowdedness”, “staff and physicians' incompetence”, “medical errors”, “discrimination”, “disrespect”, and “lack of staff and services” are all themes that emerged as reasons for dissatisfaction. Analysis Arabic responses were translated into English and researchers discussed any dissimilar results until an agreement was reached on all translated responses. Upon reviewing the responses, themes, which were different from the pre-specified answer choices of the questionnaire, emerged. The researchers then coded the responses by assigning codes to each response, then compared against each other. Coding discrepancy was discussed until an agreement was reached. The codes of the open-ended responses were later merged with those of the pre-specified categories and the corresponding frequency for each coding category was calculated using STATA. The Alberta Quality Matrix for Health was used to guide the analysis of the themes based on the six dimensions of health system quality.ResultsThe analysis of the open-ended responses that probed into reasons for respondents' dissatisfaction revealed thirteen categories of dissatisfaction that were related to four different dimensions of quality of healthcare, based on the Alberta Quality Matrix for Health. The most common dimension of dissatisfaction with health care in Qatar was accessibility, which refers to the provision of health service in the most optimum setting and within “reasonable time and distance”. Safety was the second most common dimension reported by the respondents. This construct relates to minimizing any threats that could cause harm. Acceptability, such as the provision of respectful and patient-centered health services was the third dimension identified, followed by efficiency, which is mainly related to the optimal use of resources, to achieve the best desired health outcomes.ConclusionIdentifying the roots of dissatisfaction with health care services among distinct social groups can be achieved by analyzing responses to simple open-ended questions in routinely administered population health surveys. This is important for monitoring the quality of care in heterogeneous population contexts as well as engaging the public in the process of developing a world-class health care system as per Qatar's national vision of 2030. This research highlights priority needs to be addressed by the Qatari government in order to increase health care satisfaction as part of the quest for better health care in the country.

Objective: Prior studies have reported that major depressive episodes (MDEs) are associated with elevated mortality. However, the association has not always persisted after adjustment for other mortality risk factors. In our study, we examine this issue using data from a longitudinal Canadian study (the National Population Health Survey [NPHS]). The NPHS included a more comprehensive set of mortality determinants than prior studies, allowing a more comprehensive assessment of the effect of MDEs on mortality. Methods: The NPHS began data collection in 1994 and follow-up data were available to 2006 at the time of this analysis. The NPHS assessed depression using a short-form version of the Composite International Diagnostic Interview. Mortality was assessed as part of the cohort's follow-up, including linkage to vital statistics data. Results: During follow-up, 2019 deaths occurred in the eligible part of the NPHS cohort. Consistent with prior studies, MDEs were strongly predictive of mortality when basic adjustments were made for age and sex (hazard ratio [HR] 2.0, 95% Cl 1.4 to 2.9). The association disappeared with adjustment for other variables that predict mortality risk (HR 1.1, 95% Cl 0.7 to 1.7). Conclusions: MDE is a strong predictor of mortality in the general population. This analysis failed to identify an independent effect of MDE when adjustments were made for other risk factors. However, the lack of a strong independent effect on mortality does not preclude an etiologic impact of MDE. MDE itself is intertwined with health-related changes that predict mortality and its impact may be mediated by these variables.

Background Previous studies have linked major depressive episodes (MDEs) to obesity. The association may be partially mediated by antidepressant medication use. In the current study we examine changes in weight and BMI in relation to MDE and antidepressant use in a general population cohort. Methods Data from a Canadian longitudinal study, the National Population Health Survey (NPHS) were used. The NPHS has collected data from a community cohort since 1994 using interviews spaced two years apart. The NPHS includes the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). Self-reported height and weight are also recorded. Linear regression was used to describe associations between weight, BMI and MDE. Results The pattern of weight change varied by age. Respondents under the age of 65 tended to gain weight over time, whereas those over the age of 65 tended to lose weight. Respondents in the younger category gained more weight if they had MDE or took antidepressant medications. However, the extent of weight gain was modest, those with MDE and those taking an antidepressant gaining an average of approximately 1 kg over 12 years of follow-up. Limitations The study used self-reported weight, which may be inaccurate. Measurements were made two years apart. The measure of MDE was an abbreviated diagnostic interview. Conclusions Both MDE and antidepressant medication use are associated with a modest increase in weight in people under 65. These results may be useful for physicians and other health professionals in planning dietary and weight-management regimens for depressed patients.

Objective: To describe the 12-month prevalence of major depression in relation to smoking status, nicotine dependence levels, commitment to quit, attempts to quit, and maintenance of smoking cessation in the Canadian general population. Method: Data from Public Use Microdata File of the Canadian Community Health Survey: Health and Well-Being were used. The Composite International Diagnostic Interview—Short Form (CIDI-SF) for major depression was used to assess depressive disorder status. The survey also included a smoking module. There were 49 249 respondents assessed by the CIDI-SF, of whom 10 236 were administered the smoking module. Analyses used appropriate measures to deal with survey design effects. Result: The prevalence of major depression was highest in current smokers, followed by ever smokers, former smokers, and was lowest in the never smokers. This pattern persisted after stratification for age and sex. For quitting, the prevalence of major depression was highest among people who tried to quit, followed by those who considered quitting, those who quit in the past year, and lowest among those who maintained their smoking cessation status for longer than 1 year. The prevalence of depression among those with a high nicotine dependence level, as assessed by the Fagerstrom Tolerance Questionnaire, was about twice that of people with a low nicotine dependence level. Conclusion: The strikingly high prevalence of major depression among current smokers who are young, trying to quit, and with high nicotine dependence levels in the general population indicates that further longitudinal exploration of this topic is urgently needed.

Several studies have suggested that there may be an increased prevalence of affective disorders in people with motor neuron disease (MND). However, the literature is inconsistent, possibly because of small sample sizes in the existing studies. The Canadian province of Alberta has a universal health care system in which physician contacts are recorded along with ICD-9-CM diagnostic codes. In this analysis, diagnostic codes indicative of MND and affective disorders were used. Stratified analysis and logistic regression were used in the analysis. There were 336 cases of MND leading to a prevalence of 14.5 per 100,000 in provincial residents ≧20 years old. Affective disorders were identified in 8.6% of the total population during the same year. The crude odds ratio for affective disorders in MND was 2.3 (95% CI = 1.7–3.0). However, the prevalence of affective disorders declined with increasing illness duration.