Adult depression screening in Saudi primary care: prevalence, instrument and cost

Abstract

BackgroundBy the year 2020 depression would be the second major cause of disability adjusted life years lost, as reported by the World Health Organization. Depression is a mental illness which causes persistent low mood, a sense of despair, and has multiple risk factors. Its prevalence in primary care varies between 15.3-22%, with global prevalence up to 13% and between 17-46% in Saudi Arabia. Despite several studies that have shown benefit of early diagnosis and cost-savings of up to 80%, physicians in primary care setting continue to miss out on 30-50% of depressed patients in their practices.MethodsA cross sectional study was conducted at three large primary care centers in Riyadh, Saudi Arabia aiming at estimating point prevalence of depression and screening cost among primary care adult patients, and comparing Patient Health Questionnaires PHQ-2 with PHQ-9. Adult individuals were screened using Arabic version of PHQ-2 and PHQ-9. PHQ-2 scores were correlated with PHQ-9 scores using linear regression. A limited cost-analysis and cost saving estimates of depression screening was done using the Human Capital approach.ResultsPatients included in the survey analysis were 477, of whom 66.2% were females, 77.4% were married, and nearly 20% were illiterate. Patients exhibiting depressive symptoms on the basis of PHQ9 were 49.9%, of which 31% were mild, 13.4% moderate, 4.4% moderate-severe and 1.0% severe cases. Depression scores were significantly associated with female gender (p-value 0.049), and higher educational level (p-value 0.002). Regression analysis showed that PHQ-2 & PHQ-9 were strongly correlated R = 0.79, and R2 = 0.62. The cost-analysis showed savings of up to 500 SAR ($133) per adult patient screened once a year.ConclusionThe point prevalence of screened depression is high in primary care visitors in Saudi Arabia. Gender and higher level of education were found to be significantly associated with screened depression. Majority of cases were mild to moderate, PHQ-2 was equivocal to PHQ 9 in utility and that screening for depression in primary care setting is cost saving.

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

“…Comparable findings were reported in the U.S. National Comorbidity study, which observed that women had elevated rates of affective disorders and anxiety disorders whereas men had elevated rates of substance-use disorders and antisocial personality disorder 27 . Also, similar findings were reported in European studies 28,41 and a local primary care study 42 . Although the evidence of gender differences in the risk of schizophrenia is inconclusive, a meta-analysis observed the that men have a higher incidence and morbidity risk than women 43 .…”

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

“…In this study, the prevalence of depression was 46% and 42% for the anxiety. The rates of depression and anxiety were much higher than that reported in primary care setting in Saudi Arabia, which was 18.8% for depression41 and 5.3% for anxiety disorder 42…”

Magnitude of depression problem among primary care consumers in Saudi Arabia

“…The rate was lower than that reported in Riyadh (18.8%) and Kuwait (20.5%) [12,13] and higher than in Qatar (13.5%, 2010). [14] Similar studies conducted in European countries revealed a prevalence rate ranging from 16.5% to 22.8%, [15][16][17] indicating that the rates in Gulf Region are comparable with those of Europe.…”

“…[10,11] The scale consists of nine questions, for which the answers ranged from ''not at all'' (given a score of 0) to ''nearly every day'' (given a score of 3) experiencing the symptom within the last 2 weeks. The total score was calculated and categorized into no depression (0-4), mild depression (5-9), moderate depression (10)(11)(12)(13)(14), and severe depression (15+). Weight and height were also measured for 836 participants (with a response rate of 98.4%), and body mass index (BMI) was calculated and categorized into underweight (less than 18.5 kg/m 2 ), normal weight (18.5-24.9), overweight (25-29.9), obesity (30-34.9), and severe obesity (more than 35 kg/m 2 ).…”