Saudi National Mental Health Survey Research Articles

The Saudi National Mental Health Survey: Sample design and weight development

ObjectivesTo describe the sample design and weighting procedures used in the Saudi National Mental Health Survey (SNMHS).MethodsA multistage clustered area probability design was used to select the SNMHS sample with one male and one female KSA citizen ages 15–65 surveyed in each sample household.ResultsA design representative of the household population was developed and modified iteratively to adjust for unanticipated field complications. These modifications, along with variation in within‐household probabilities of selection and geographic–demographic variation in response rates were accounted for through survey weights. Design‐based estimation methods were used to adjust for the effects of these weights and of geographic clustering. Design effects were estimated and simulations were carried out on bias‐variancetrade‐offs in weight trimming to evaluate the implication of design features for precision of estimates.ConclusionsThe multiple purposes of the survey will require the use of different weights for different types of analyses, including household and person weights as well as weights for proxy reports about household members whose disabilities prevented them from participating in the survey. It will be important to use these different weights appropriately in the diverse analyses that will be undertaken with the SNMHS data.

Lifetime treatment of DSM-IV mental disorders in the Saudi National Mental Health Survey.

ObjectivesTo estimate lifetime treatment rates of mental disorders in the Saudi National Mental Health Survey (SNMHS).MethodsThe 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.ResultsLifetime 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.ConclusionsUnmet 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.

Twelve-month treatment of mental disorders in the Saudi National Mental Health Survey.

ObjectivesTo estimate treatment rates of 12‐month mental disorders in the Saudi National Mental Health Survey (SNMHS).MethodsThe 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.ResultsAbout 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.ConclusionsA 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.

Barriers to Mental Health Treatment in the Saudi National Mental Health Survey.

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 15–65 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 “low perceived need”) 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.

Using knowledge management tools in the Saudi National Mental Health Survey helpdesk: pre and post study

BackgroundWith 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.AimThe 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.MethodsThe 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.ResultsThe average time to resolve a reported problem decreased overall, decreased at each priority level and led to increased first contact resolution.ConclusionThis 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.

Implementing the TRAPD model for the Saudi adaptation of the World Mental Health Composite International Diagnostic Interview 3.0

BackgroundThe 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 presentationThis 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.ConclusionThe 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.

Probing for sensitivity in translated survey questions: Differences in respondent feedback across cognitive probe types

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.

Evidence-based guideline implementation of quality assurance and quality control procedures in the Saudi National Mental Health Survey

BackgroundThe 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 presentationThe 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.ConclusionsSurvey 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.

The Saudi National Mental Health Survey: Methodological and logistical challenges from the pilot study

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.