Prevalence, symptom patterns and comorbidity of anxiety and depressive disorders in primary care in Qatar

Aim The aim of this study was to assess the prevalence of anxiety and depressive disorders in a Qatari population who attend the primary health care settings and examine their symptom patterns and comorbidity. Design This is a prospective cross-sectional study conducted during the period from July 2009 to December 2009. Setting Primary Health Care Center and the Supreme Council of Health in the State of Qatar. Subjects A total of 2,080 Qatari subjects aged 18-65 years were approached and 1,660 (79.8%) patients participated in this study. Methods The study was based on a face-to-face interview with a designed diagnostic screening questionnaire, which consisted of 14 items for anxiety and depression disorders. Socio-demographic characteristics, comorbidity factors, and medical history of patients were collected. The Hospital Anxiety and Depression Rating Scale (HADS), which consisted of seven items for anxiety (HADS-A) and seven for depression (HADS-D), was used. The items are scored on a 4-point scale from zero (not present) to 3 (considerable). The HADS-A had an optimal cut-off >= 8 (sensitivity 0.87 and specificity 0.78), and the HADS-D had an optimal cut-off >= 8 (sensitivity 0.82 and specificity 0.86). The HADS scales generally used the cut-off score >= 8 to identify respondents with the possible presence of anxiety or depression. Results Of the studied Qatari subjects, 46.2% were males and 53.8% were females. The mean HADS-A anxiety symptom scores were 4.1 +/- 3.6 for males and 4.9 +/- 3.7 for females (p = 0.048) and with a prevalence of 18.7% among males and 24.6% among females (p = 0.017). The mean HADS-D depressive symptom scores were 8.0 +/- 6.3 for males and 10.8 +/- 7.5 for females (p = 0.041) and with a prevalence of 26.6% among males and 30.1% among females (p = 0.219). Qatari women were at higher risk for depression (53.1 vs. 46.9%) and anxiety disorder (56.7 vs. 43.3%) as compared to men. More than half of the sufferers with anxiety (56.7%) and depression (53.1%) were Qatari women with a higher frequency in the age group 18-34 years. There were significant differences between men and women with depression in terms of age group (p = 0.004), marital status (p = 0.04), occupation (p < 0.001), and household income (p = 0.002). Nervousness was the most common symptom in subjects with anxiety disorders (68.4%), whereas sleep difficulty was the most common symptom in subjects with depressive disorder (59.4%). Diabetes mellitus (23.4 vs. 19.2%), hypertension (25.7 vs. 25.0%), headache and migraine (21.6 vs. 25.4%), and low back pain (22.2 vs. 28.6%) were the frequent comorbidity conditions in both anxiety and depressive disorders, respectively, in the studied subjects. Conclusion The findings of this study revealed that depression was more prevalent in the Qatari population than anxiety disorders. Women were likelier than men to have depression and anxiety disorders. The high-risk groups of depression and anxiety disorders were female gender, being married, middle aged, and highly educated.