|Year : 2021 | Volume
| Issue : 1 | Page : 9-15
Prevalence of anxiety and depression in Abu Dhabi residents in the year 2019 (a pilot study)
Fatma Mubarak1, Nisirn Esaadouni2
1 Department of Family Medicine, Mediclinic Al Noor Hospital, Abu Dhabi, UAE
2 Department of Psychiatry, Faculty of Medicine, Al-Mansoura University, Mansoura, Egypt
|Date of Submission||12-Aug-2020|
|Date of Decision||15-Aug-2020|
|Date of Acceptance||01-Sep-2020|
|Date of Web Publication||2-Apr-2021|
Department of Family Medicine, Mediclinic Al Noor Hospital, Mediclinic Middle East, Abu Dhabi
Source of Support: None, Conflict of Interest: None
Background and aim In the past, inattentively mental health disorders were not addressed properly owing to several factors. Despite that, depression and anxiety are commonly seen in the general practice, and there are no statistical data that reflect the effect of this problem. This is a pilot study that aims to reveal the percentage of depression and anxiety among the general population of Abu Dhabi.
Patients and methods This is a cross-sectional pilot study with a sample size of 176 individuals; the P value was set to be 0.05, and confidence interval is 95%. The data tools are self-administered questionnaires focusing on Patient Health Questionnaire 2 and 9 and General Anxiety Disorder 7 scale distributed to visitors attending Mediclinic Hospitals. Data analysis was done by using Statistical Package for Social Science.
Results The study showed that 53.98% of Abu Dhabi residents screened were negative for depression, whereas 46.02% were positive. Moreover, 62.50% of Abu Dhabi residents screened were found to have mild anxiety, 31.25% as moderate anxiety, and 6.25% had severe anxiety.
Conclusion There are emerging cases of depression and anxiety among Abu Dhabi residents, and further wide screening programs are required to be implemented to reduce the mental health-related sicknesses and empower the human nature with positive thinking attitude and well-being.
Keywords: anxiety, association, depression, prevalence, UAE
|How to cite this article:|
Mubarak F, Esaadouni N. Prevalence of anxiety and depression in Abu Dhabi residents in the year 2019 (a pilot study). Egypt J Psychiatr 2021;42:9-15
|How to cite this URL:|
Mubarak F, Esaadouni N. Prevalence of anxiety and depression in Abu Dhabi residents in the year 2019 (a pilot study). Egypt J Psychiatr [serial online] 2021 [cited 2021 Oct 27];42:9-15. Available from: http://new.ejpsy.eg.net/text.asp?2021/42/1/9/312990
| Introduction|| |
UAE has evolved in this past two decades. It is a country with seven emirates (Fatma Al-Maskari, 2011). The population was estimated to be 9.12 million in 2016 by the Federal Competitiveness and Statistics Authority (FCSA), whereas in 2018 was estimated to be 9.543 million according to World Bank (Blogger, 2018). Mental health and its disorders evolve as well whenever a country flourishes (Bahari, 2017; WHO, 2003; Rafia Ghubash, 2004). It is estimated that 20% of children and adolescents worldwide have mental health issues (Douglas and Maurer, 2012). However, in America, among five people, one will having a mental health disorder (WHO, 2014). Unfortunately, UAE has no recent or updated statistics about mental health issues owing to several reasons such as the culture and beliefs of the people, awareness and magnitude of this global burden in the society, few resources available to accommodate this issue, and the financial support, as the majority of the health sector is supported by the insurance companies, which not cover mental health (Abdulaa Abu Melall, 2014; Sayed, 2015). This study aims to reveal the percentage of depression and anxiety among the general population of residents in Abu Dhabi. Moreover, it aims to increase the awareness of mental health issues among the stake holders to facilitate further management of this global health issue financially and socially and to improve patient care and well-being. Moreover, it shows the associations of different factors like age, sex, level of education, presence of medical illnesses, and others and their relation to depression or anxiety level (Anuj Nautiyal, 2015).
In the Arab world, depression and anxiety have been emerging progressively (Ahmed Abdl Shafi, 2014). Different studies had proven the magnitude of this burden. A study conducted in Libya showed 7.6 and 1.5% of moderate depression and severe depression, respectively, seen in females between the ages of 14–18 years (Hnish, 2017).
Another study done in Saudi Arabia showed medical students had higher baseline traits of depression and anxiety at ∼30 and 47%, respectively, during their regular classes (Kulsoom and Afsar, 2015). Besides, Gulf Cooperation Council reviewed mental health-related researches and published a review in 2016, which clearly showed multiple gaps like sociocultural, women empowering, and other factors between the population and the service providers (Hickey et al., 2016).
| Patients and methods|| |
The study was designed as a cross-sectional pilot study. The target population was general adults with Abu Dhabi residency and multinational citizenships. It was conducted from January 2019 to December 2019.
The sample size was 264 individuals calculated by using the Cochran’s Formula. The total distributed questionnaires were 297, and only 176 that met the inclusion criteria were included in the study; the response rate was 71.54%. The study’s precision is set to be 0.05, and estimated true proportion taken from previous studies is 19.9%=0.2. The P value was set to be 0.05 and confidence interval was 95%.
The sample of population was recruited from visitors who attended Mediclinic Hospitals in Abu Dhabi. The inclusion criteria were all adults from ages of 18 till 75 years and residents who live exclusively in Abu Dhabi.
The exclusion criteria were participants with known history of depression and anxiety disorder, incomplete questionnaires, residents who lives outside of Abu Dhabi, pregnant women, and children and adolescents.
The data tool was a self-administered questionnaire. It was divided into three parts: part 1 discussed about demographic and personal data, part 2 discussed depression by using International validated PHQ2 and PHQ9 (Patient Health Questionnaire) questionnaires, and part 3 discussed anxiety by using international validated General Anxiety Disorder 7 (GAD7) scale Bruce Arroll (2010), Das (2018).
Simple randomization was used, a first-come first-served method. The questionnaires were distributed in the waiting areas of different clinics.
The data were collected by the investigator only; no third party had the access to the data. Besides, analysis of the data was also done by the investigator only, and the electronic files were encrypted with a password to ensure the safety and confidentiality of the data. However, the hard copies of the data were stored in a closed box, which is kept in a closed drawer board that only the investigator can access located at ethical and research department.
The study results were generated by using Statistical Package for Social Science, version 26 to analyze the data. The statistical tests used were general frequencies, χ2 test, and Fisher’s exact test.
This study did not involve collection of tissue or fluid samples, and had neither any risk nor harm to the participants.
| Results|| |
The study enrolled 64.20% of female population, whereas male population was 35.80%. The UAE nationals in the study were 11.36%, whereas non-UAE nationals were 87.50%. Moreover, 74.43% of participants were married, 22.16% single, and 2.84% were either separated or widowed. Most participants were among medium group of financial status, representing ∼70.45%, whereas 9.66% were high, and 17.05% were among low financial status. Overall, 63.64% of participants were college and university graduates, 19.32% were primary and secondary school qualified, and 15.91% held postgraduate degree. In addition, more than 80% of participants were younger than 48 years of age, whereas 15.91% were between 49 and 63 years of age and 0.57% were above 64 years of age. Most of the participants were holding jobs, representing ∼72.16%, whereas 26.14% were unemployed. Overall, 54.55% did not mentioned their profession, whereas others had different professions like administration-related works, teachers, engineers, health-related jobs, and others. The analysis also showed most of participants were living with small family type, whereas 7.95% were extended types, and 18.75% were living alone. Besides, most of the participants were healthy and not complaining of any medical illnesses, representing ∼77.84%, whereas 22.16% were known to have medical illnesses.
[Figure 1] shows the analysis of PHQ2 screening, where 53.98% of Abu Dhabi residents were negative for depression and 46.02% were positive for depression. The positive participants underwent PHQ9 screening, as shown in [Figure 2], and were found to have different grades of depression: 46.02% classified as minimal depression, 32.39% as mild depression, 14.77% as moderate depression, 3.98% as moderately severe depression, and 2.84% as severe depression.
|Figure 1 The total score of PHQ2 screening of depression among participants, which indicates the percentage of positive cases with depression among general population of Abu Dhabi. PHQ, Patient Health Questionnaire.|
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|Figure 2 The total score of PHQ9 with different grades of depression among participants who were found to be positive in PHQ2 screening. PHQ, Patient Health Questionnaire.|
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Next, GAD screening ([Figure 3]) showed 62.05% of Abu Dhabi residents had mild anxiety, 31.25% as moderate anxiety, and 6.25% had severe anxiety.
|Figure 3 The total score of anxiety among participants, which shows the positive cases of anxieties among general population of Abu Dhabi.|
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The associations between depression using PHQ2 screening and different factors as mentioned earlier showed that there is no association between depression and different sexes, different nationalities, social status, financial status, levels of education, employment status, type of residence, or presence of medical illnesses, and it was not clinically significant. Moreover, the associations between depression using PHQ9 screening and different factors had no association, and it was not clinically significant ([Table 1] and [Table 2]).
|Table 1 Relationship between anxiety and depression among positive screened cases of individuals|
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|Table 2 Relationship between anxiety and depression among positive screened cases of individuals|
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Surprisingly, the study did show an association of different nationalities with positive screened depressive individuals, and it was clinically significant. Moving to associations between anxiety using GAD7 scale and different factors, it showed no association and it was not clinically significant. On the contrary, the study did show an association of different nationalities and occupational status with anxiety-positive individuals, and it is clinically significant. Finally, the study showed a strong association between positive screened depressive participants and positive screened anxious participants, and it was clinically significant.
| Discussion|| |
UAE has been pioneer in multiple sectors, whether it is commercial, educational, financial, health sector, or others (Isra Ahmed, 2009; Ginneken, 2017; Jenny Liu, 2017). The government has a vision of healthy well-being of each individual living on this land. To keep up with this vision, mental health is very crucial to sustain the productivity and well-being of a person (Amal Benbella, 2018; Erin Bagalman, 2018; Jianlin Liu, 2017). This study is considered a pilot type which might be a key for better screening program and bigger sample sized population to be studied in the near future. Several studies were conducted earlier but were limited with certain groups of population either students in universities or medical residents or group of diabetic patients (Kassahun Habtamu, 2017; Khan, 2016). Moreover, the tool used to estimate the effect of this emerging problem was either DASS 21 or 22 (Monsef and Al Hajaj, 2015).
One of the strength of this study is the use of PHQ2 and PHQ9 correspondingly for depression and GAD7 for anxiety; they have more clinical value and are considered better diagnostic tools for depression and anxiety (Nabil Sulaiman, 2010).
In comparison to a study done in Kingdom of Saudi Arabia, the results were very much similar, as their study showed most cases were mild to moderate depression, and sex and level of education were associated with screened depression. However, this study showed the presence of medical illness was associated with PHQ2 screened depression and occupational status was associated with PHQ9 screened depression (Ahmad and AlHadi, 2017). Anxiety and depression have been associated with chronic conditions, as shown in several studies (Maan Hameed, 2019; Neslihan Lök, 2017; Olkin, 2019; Michelle Brown, 2016; Mcllvenny, 2000). For instance, a study done in UAE showed patients with multiple sclerosis had depression approximated to be 10.8% and had lower anxiety rate owing to possible underreporting of cases or time limitations (Waleed Al Qadhi, 2014).
In addition to this, an article based on children with cancer in Dutch hospitals recommended identifications and treatment of depression among patients with cancer did improve in disease progression, survival rate, and improvement of quality of life (Schiess et al., 2017).
Cases diagnosed to have depressive and anxiety symptoms, were called by the investigator to maintain the confidentiality of the participants, and they were offered to visit either a psychiatry or family medicine departments if they cannot afford the consultations as the insurance system in Abu Dhabi does not cover the mental health services. Some of participants were happy to get the help, whereas few showed resistance and refused to be seen by psychiatrist for unknown reasons.
Self-administered questionnaires were distributed by hand to hand to patients visiting Mediclinic hospital. It was very detailed and required hard copies to gather the data which often was incomplete or left blank with comments by participants who did not understand certain questions. Use of electronic surveys would have resulted in more paper saving and faster data collection time, but the honesty and answering each question with patience and full understanding would have been questionable. Hence, better solutions are needed to be elaborated in future studies.
In addition, having a bigger sample size with more UAE nationals would have reflected the true prevalence of depression and anxiety for the native population. However, Abu Dhabi’s non-UAE national population is considered semi-stable.
| Conclusion|| |
Depression and anxiety are presented in Abu Dhabi’s community. The various factors assumed to increase their susceptibilities to these mental illnesses need to be reconsidered in further studies. Mental health diseases need to be identified and managed properly with CBT and body, mind, and spiritual interventions, and if not treated successfully, they need to be considered psychiatric evaluations.
| Acknowledgements|| |
Written by the primary author, Dr Fatma Mubarak: (1) To My Beloved Family. (2) Dr Nehad Hassan Mahdy, Consultant in Public Health Medicine, Dubai Health Authority. (3) Late Dr Mario Patricolo, Consultant Paediatric Surgeon, Former Medical Director on Mediclinic Al Noor Hospital.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Abdallah Abu Mellal TA-A (2014). The prevalence of depressive symptoms and its socioeconomic determinants among university students in Al Ain, UAE. Int J Pharma Pharma Sci 6:309–312.
Ahmad N, AlHadi DS (2017). An Arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample. Ann Gen Psychiatry 16:32.
Ahmed Mohamed Abdel Shafi RM (2014). Cultural influences on the presentation of depression. Open J Psychiatry 4. Article ID: 50956, 5 pages 10.4236/ojpsych.2014.44045.
Amal Benbella FK (2018). Depression and anxiety among infertile Moroccan women: a crosssectional study in the reproductive health center in Rabat. J Depress Anxiety 7:3.
Anuj Nautiyal SM (2015). Prevalence of depression among geriatric people in Dehradun City of Uttarakhand, India. J Depress Anxiety 4:4.
Bahari NA (2017). The effectiveness of psycho-spiritual therapy among mentally ill patients. J Depress Anxiety 6:2.
Bruce Arroll FG-S (2010). Validation of PHQ-2 and PHQ-9 to screen for major depression in the primary care population. Ann Fam Med 8:348–353; DOI: https://doi.org/10.1370/afm.1139
Das S (2018). Global mental health, peace and sustainability: does yoga show the way? J Depress Anxiety 7:1.
Douglas M, Maurer DM (2012). Screening for depression. Am Fam Physician 85:139–144.
Erin Bagalman AS (2018). Prevalence of mental illness in the United States: data sources and estimates. Congressional Res Ser.
Ginneken VV (2017). Cancer, depression and cliniclowns. J Depress Anxiety S11. DOI: 10.4172/2167-1044.S11-e001
Hickey JE, Pryjmachuk S, Waterman H (2016). Mental illness research in the Gulf Cooperation Council: a scoping review. Health Res Policy Syst 14:59.
Hnish MA-J (2017). The prevalence of clinical depression among Libyan females of ages 14 to 18 years. J Depress Anxiety 6:3.
Isra Ahmed HB-F-S (2009). Cognitive emotions: depression and anxiety in medical students and staff. J Crit Care 24:e1–e7.
Jenny Liu SM (2017). The mental health of youth and young adults during the transition to adulthood in Egypt. HHS Public Access 36:1721–1758.
Jianlin Liu C-XP (2017). Emotional distress in newly diagnosed cancer outpatients: do depression and anxiety predict mortality and psychosocial outcomes after 1 year? J Depress Anxiety S11. DOI: 10.4172/2167-1044.S11-005
Kassahun Habtamu AM. (2017). Prevalence and associated factors of common mental disorders among Ethiopian migrant returnees from the Middle East and South Africa. BMC Psychiatry 17. DOI: 10.1186/s12888-017-1310-6
Khan SK (2016). Healthy diet a tool to reduce anxiety and depression. J Depress Anxiety 5:1.
Kulsoom B, Afsar NA (2015). Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr Dis Treat 11:1713-1722.
Maan Hameed Ibrahim A-A (2019). Assessing levels of loneliness among elderly people residing in the nursing homes of Baghdad City. J Depress Anxiety 8:2.
Monsef NA, Al Hajaj KE (2015). Perceived depression, anxiety and stress among Dubai Health Authority Residents, Dubai, UAE. Am J Psychol Cognit Sci 1:75–82.
Nabil Sulaiman A (2010). The prevalence and correlates of depression and anxiety in a sample of diabetic patients in Sharjah, United Arab Emirates. BMC Fam Pract 11:80. https://doi.org/10.1186/1471-2296-11-80
Neslihan Lök KB (2017). Factors affecting adolescent mental health. J Depress Anxiety 6:4.
Olkin MM (2019). Assessing social anxiety in Japanese and Japanese-Americans in the United States. J Depress Anxiety 8:1–10.
Rafia Ghubash O-R-S (2004). Profile of mental disorders among the elderly United Arab Emirates population: sociodemographic correlates. Int J Geriatr Psychiatry 19:344–351. DOI: 10.1002/gps.1101
Sayed MA (2015). Mental health services in the United Arab Emirates: challenges. Int J Emerg Mental Health Human Resil 17:661–663, ISSN 1522-4821
Schiess N, Huether K, Holroyd KB, Aziz F, Emam E, Shahrour T, Alsaadi T (2017). Multiple sclerosis, anxiety, and depression in the United Arab Emirates, does social stigma prevent treatment? Int J MS Care 041.
Michelle Brown DB (2016). Symptoms of anxiety and irritability in patients with major depressive disorder. J Depress Anxiety 5:3.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]