Prevalence of mental disorders by sex among Hera General Hospital patients over the past 10 years

INTRODUCTION

Mental disorders manifest as social, occupational, or emotional dysfunctions.^[1] Each year around 14.3% of the deaths worldwide are due to mental disorders.^[2] Many countries struggle to recognize mental disorders and their impact on communities and the economic status of those countries.^[3] Mental health awareness in Saudi Arabia has improved in recent years as psychiatric treatment has become more acceptable in Saudi society.^[4] Many private and public psychiatric institutions in Saudi now have outstanding inpatient and outpatient services.^[5]

The most common disorder in the United States, Colombia, France, and Lebanon are anxiety disorders, whereas Ukraine has a higher prevalence of mood disorders, and Nigeria and Beijing have a higher prevalence of substance use disorders (SUDs).^[6] Patient health questionnaires in 431 primary health care patients in Saudi Arabia, found that 20% of the population had depression and 19.3% had somatic conditions.^[7] A self-medication questionnaire found that 28.5% of patients who attended primary health care had underlying mental disorders.^[8] Using the Rahim Anxiety-Depression Scale, Al-Khathami found that one in three primary health care patients suffered from some form of mental illness.^[9] Using the General Health Questionnaire-28, Al-Sughayr found mental illness in 48% of high schoolers, with a greater proportion among female students.^[10] A study in Latvia found the prevalence of mental disorders among primary care patients to be 37.2%, with a greater percentage among females.^[11]

The majority of Saudi Arabian studies.^[7-9] on the prevalence of mental disorders have used self-reporting questionnaires rather than a certified psychiatrist following standardized diagnostic criteria. The Rahim Anxiety-Depression Scale and self-reporting questionnaires used in these studies are simply instruments for mental health screening.^[12]

The aim of this study was to determine the prevalence of mental disorders by sex among patients of Hera General Hospital, Makkah, Saudi Arabia, using the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and the tenth revision of the International Classification of Diseases (ICD-10) and to establish the five most common disorders.

MATERIAL AND METHODS

We identified clusters of mental disorders seen at Hera General Hospital psychiatric clinic using the diagnostic criteria of the DSM-VI and ICD-10. These included major depressive disorder; anxiety disorders, including generalized anxiety disorder, specific phobias, acute anxiety disorder, Hypochondriasis, obsessive-compulsive disorder, mixed anxiety and depressive disorder, habit and impulse disorder, panic disorder, and social anxiety disorder; and Psychotic disorder due to substance abuse; schizophrenia, including schizoaffective disorder and schizophreniform disorder; Mental retardation; bipolar affective disorder; personality disorder; adjustment disorder; attention deficit hyperactive disorder (ADHD); dementia; sleep disorders; somatization disorders, including tic disorder, speech disturbances, and irritable bowel syndrome; and psychosexual disorder.

This was a cross-sectional study of patients at a psychiatric outpatient department from July 2009 to June 2019 in Hera General Hospital, Makkah, Saudi Arabia, with a total of 11,841 patients.

RESULTS

After following the inclusion and exclusion criteria, 2940 out of 11,841 subjects were included in the study population. Diagnostic frequencies were calculated [Table 1].

[Table 1] shows the five most frequently occurring mental disorders in the study ranked in order of prevalence: 1213 patients (41.3%) had a diagnosis of major depressive disorder, 650 patients (22.1%) were diagnosed with an anxiety disorder, 331 patients (11.3%) were diagnosed with a substance-induced psychotic disorder, 263 patients (8.9%) had a diagnosis of schizophrenia, and 207 patients (7%) were diagnosed with a mental retardation.

[Table 2] shows the sex of the sample. 1640 patients (55.8%) were female and 1300 (44.2%) were male. Of the 1213 patients with major depressive disorder, 781 (64.4%) were female and 432 (35.6%) were male. Of the 650 with anxiety disorders, 377 (58%) were female and 273 (42%) were male. Of the 331 patients diagnosed with substance-induced psychotic disorder, 210 (63.4%) were male and 121 (36.6%) were female. Of the 263 patients with schizophrenia, 110 (41.8%) were female and 153 (58.2%) were male. Of the 207 patients with a mental retardation, 115 (55.6%) were male and 92 (44.4%) were female [Table 3].

DISCUSSION

Major depressive disorder was the most common disorder in our study population, with a prevalence of 41.3% among a population diagnosed with mental disorders. This is significantly higher than the prevalence of 19.3% found in an equivalent population in the psychiatric outpatient department clinic in King Fahd Hospital of the University, Dammam, Saudi Araiba.^[13] Picco et al. have reported that major depressive disorder is more common in females than in males with a ratio of 1.5:1, which is consistent with our finding.^[14]

Anxiety disorders were the second most common mental disorder in this study, accounting for 22.1% of our sample. This is significantly lower than the prevalence of 35.1% found by Alharbi at two tertiary-care military hospitals in Riyadh, Saudi Arabia.^[15] There was little relationship between anxiety disorders and sex in this study as the male to female ratio was 1:1.38. This is higher than the ratio found by Alharbi of 1:1.27.^[15]

Substance-induced psychotic disorder accounted for 11.3% of the population of this study. Multiple studies have been conducted into SUD, with approximately 8% of Saudis having abused substances, most commonly, amphetamines.^[16] Another study reported that 13% of the worldwide population suffers from SUD.^[17] Lambert et al. indicate that 74% of those with SUD will experience a psychotic episode.^[18] This is expressed by the following mathematical equation: percentage of SUD in worldwide population/100 × percentage of psychotic episode from SUD/100 = new data × 100 = percentage of psychotic disorder due to SUD.

Psychotic disorder due to SUD was higher in our population than in the worldwide population. Males showed a higher prevalence for substance-induced psychotic disorder than females, with a ratio of 2:1, which is consistent with previous research by Ochoa et al.^[19]

We found that 8.9% of the psychiatric sample from Hera General Hospital suffered from schizophrenia. In a study by Sarwat, the estimated lifetime prevalence of schizophrenia among a psychiatric population was found to be 4.3%.^[20] There was a slightly higher prevalence of schizophrenia among males than females in our sample, with a ratio of 1.39:1. This is supported by previous research indicating that males have a two to three times greater risk of schizophrenia than females.^[19]

Mental retardation has a global prevalence between 1% and 3% and tends to affect more males than females.^[21] However, the prevalence in our sample was 7% from the psychiatric population which is 4%-6% higher than that in the global population. The sex ratio was in accord with that of previous research. The prevalence of bipolar spectrum disorders in two tertiary care military hospital found to be 7.1%. This is higher than our finding that 2% of the study population was diagnosed with bipolar affective disorder.^[15] Sex played no significant role in bipolar affective disorder in this study, and previous research has similarly found no such association.^[15,22]

ADHD accounted for 1.1% of our study population with lacking of articles on similar study population, comparison and supporting our finding is difficult to be accomplished. Research indicates that females are less likely to develop ADHD than males, with an approximate ratio of 1:4. Our findings were in accord with this.^[23]

Adjustment disorder accounted for 1.8% of the diagnoses in our sample. This is higher than that found in a German study, which indicated a prevalence of <1% for adjustment disorder.^[24] Previous research has found no relationship between adjustment disorder and sex. However, in our sample, 66% of the 53 subjects with this condition were female. This may be due to the small number of the sample with the condition.^[25]

The percentage of patients in our sample with dementia was 1.3%. However, this only represents dementia with behavioral disturbances. Alkhunizan et al. reported that the prevalence of dementia in Saudi Arabia is 6.4%.^[26] We, therefore, speculate that one in five patients with dementia will experience behavioral disturbances that require treatment from a mental health professional. Ruitenberg et al. found sex to be unrelated to unspecified dementia but Alzheimer’s disease and vascular dementia are more common in females than in males. In our sample, unspecified dementia occurred more often in females than males at a ratio of 2:1.^[27,28]

In our sample, 0.7% had a sleep disorder. However, this cannot be considered representative as sleep disorders rarely require psychiatric treatment and can usually be managed at the level of primary health care, internal medicine, or by referral to a pulmonologist. We found no sex differences in sleep disorders. Our study population had a higher overall percentage of females (55.8%) than males (44.2%). Mood disorders and anxiety disorders were more common in females than males and substance-induced psychotic disorder and schizophrenia were more common in males than females. These findings are consistent with previous research.

CONCLUSION

Mental disorders manifest as social, occupational, or emotional dysfunctions. Major depressive disorder is the most common mental disorder seen at Hera General Hospital, and the majority of individuals with this condition are female. We urge fellow medical professions to work toward identifying the causes of mental disorders in each country and to work with governments to reduce their incidence. We urge our fellow researchers to contribute to the advancement of mental health research and the identification of risks for mental illness among the global population.