Psychiatric Annals

Original Research 

Prevalence of Psychiatric Disorders in Cardiac Outpatients

Ahmad Saad Alzahrani, MD; Abdullah Alqahtani, MD; Abeer Saleh, MD; Maryam Aloqalaa, MD; Abdulaziz Abdulmajeed, MD; Asrar Nadhrah, MD; Nada Alhazmi, MD

Abstract

This study aimed to determine the prevalence of psychiatric disorders in a sample of cardiac outpatients in Saudi Arabia. A semi-structured interview was performed for cardiac outpatients. Psychiatric diagnoses were confirmed by using a validated version of the Mini International Neuropsychiatric Interview (MINI). Of the 343 patients enrolled in the study, 93 patients (27.1%) met the criteria of having at least one psychiatric disorder. Past major depressive disorder (MDD) was the most prevalent disorder (14%), followed by current generalized anxiety disorder (GAD) (12.8%), and current MDD (8.5%). In multivariate logistic regression analyses, the diagnosis of psychiatric illness was more likely if the cardiac patient was divorced (odds ratio 6.139; 95% confidence interval, CI, 1.267–29.70), had a history of past psychiatric illness (odds ratio 2.828; 95% CI, 1.300–6.150), or currently smoked (odds ratio 2.106; 95% CI, 1.085–4.087). Psychiatric disorders were found to be common in cardiac outpatients, with MDD and GAD being the most prevalent. [Psychiatr Ann. 2020;50(9):403–415.]

Abstract

This study aimed to determine the prevalence of psychiatric disorders in a sample of cardiac outpatients in Saudi Arabia. A semi-structured interview was performed for cardiac outpatients. Psychiatric diagnoses were confirmed by using a validated version of the Mini International Neuropsychiatric Interview (MINI). Of the 343 patients enrolled in the study, 93 patients (27.1%) met the criteria of having at least one psychiatric disorder. Past major depressive disorder (MDD) was the most prevalent disorder (14%), followed by current generalized anxiety disorder (GAD) (12.8%), and current MDD (8.5%). In multivariate logistic regression analyses, the diagnosis of psychiatric illness was more likely if the cardiac patient was divorced (odds ratio 6.139; 95% confidence interval, CI, 1.267–29.70), had a history of past psychiatric illness (odds ratio 2.828; 95% CI, 1.300–6.150), or currently smoked (odds ratio 2.106; 95% CI, 1.085–4.087). Psychiatric disorders were found to be common in cardiac outpatients, with MDD and GAD being the most prevalent. [Psychiatr Ann. 2020;50(9):403–415.]

Significant mental health conditions are extremely common among patients with cardiovascular disease (CVD).1–3 For example, a meta-analysis review showed that 19.3% of patients with heart failure (HF) had a comorbid depressive disorder.3 For patients with coronary artery disease (CAD), including those with stable CAD, unstable angina, and myocardial infarction, it was estimated that clinically significant depressive symptoms occurred in 31% to 45% of patients.4 Anxiety is even more common than depression in people with CVD. A recent systematic review estimated a prevalence of 55.5% for elevated anxiety and 13.1% for anxiety disorders in patients with HF.5 Several other studies also indicated comorbid psychiatric conditions including panic disorder (5.3% in patients with CAD),6 posttraumatic stress disorders (4% to 24% in patients with CAD),7 substance use disorder (2.6% in patients with myocardial infarction [MI]),8 and eating disorders (10% in CAD patients).1 These rates of psychiatric illnesses in cardiac patients are higher than those in the general population and require attention with regard to impact on CVD.9,10

Results from several studies confirmed that depressive disorders were associated with detrimental cardiac outcomes including worsened medical morbidity, increased mortality, poor quality of life, adverse occupational impairment, and reduced treatment adherence.11–13 A recent systematic analysis showed that the risk of CAD patients with depression dying in the 2 years after the initial cardiac assessment was 2 times higher than that of CAD patients without depression.11 For CVD patients with anxiety disorders, continuous anxiety was found to be predictive of worsened physical signs and symptoms, disability, and reduced functional status.14 Return to work occurred more slowly for cardiac patients with anxiety in comparison to patients without anxiety.15 Panic disorder was associated with poorer clinical outcomes and with myocardial perfusion deficits.16

Although the prevalence of psychiatric illnesses among cardiac patients was high, most studies were focused on a discrete psychiatric condition or on one group of psychological symptoms. Other studies looked at one cardiac condition in a specific setting. The prevalence of psychiatric conditions in cardiac outpatients has not been studied extensively, especially in the Middle East. Hence, we aimed in this study to estimate the prevalence of psychiatric disorders in a general cardiac outpatient setting in Saudi Arabia.

Method

Study Design and Setting

This cross-sectional study was conducted from July 2017 to January 2018 at the Cardiology Outpatient Department of King Abdullah Medical City (KAMC). At the time of the study, KAMC provided tertiary health care to residents of Saudi Arabia. The majority of the patients resided on the western coast of the country. The study was approved by the Institutional Review Board of KAMC (No. 17-372).

Sample Size Calculation

The sample size was determined by reviewing previous studies that examined the prevalence of psychiatric disorders in cardiac outpatients. The prevalence of major depressive disorders for outpatients with CAD was reported to be in the range of 29% to 31% by Bankier et al.1 Thus, the number of cardiac outpatients needed in our study was calculated to be 341 when assuming a 95% confidence level with a 0.1 confidence interval.17 A total of 343 outpatients were enrolled in the study.

Participants

We included outpatients visiting the cardiac outpatient department of KAMC age 18 years or older who consented to participate. Through reviewing their medical files, patients with moderate to severe neurocognitive impairment (such as dementia and intellectual disability) and patients with a language barrier were excluded from the study.

Psychiatric Assessment and Questionnaire

Psychiatric diagnoses were established by using a validated Arabic version of the Mini International Neuropsychiatric Interview 6 (MINI).18 The MINI is a brief diagnostic instrument for the major Axis I psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR)19 and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).20 It has been validated against the Structured Clinical Interview for DSM diagnoses and the Composite International Diagnostic Interview for ICD-10.21,22 Sociodemographic information, clinical data, and comorbidities were recorded using a questionnaire in a semi-structured interview.

A.S.A and A.A., both of whom are psychosomatic medicine psychiatrists with more than 5 years of clinical experience, trained A.S., M.A., A.A., A. N., and N.A. (medical students of the 5th years and 6th year), on how to conduct the MINI. All diagnoses were reviewed by both the first and the second authors.

Recruitment Procedure

The total number of recruited patients was 341. Cardiac outpatients were recruited from the cardiac outpatient list and were consecutively stratified by gender. Upon arrival at the clinic, patients were asked if they would like to participate in a research study that included an interview about mood, psychiatric symptoms, and sociodemographic data. Patients were informed that the research study might lead to one or more psychiatric diagnoses. They were given the option to either contact one of the psychiatrists or to book an appointment at the Mental Health Clinic of the hospital after their cardiac appointment. Consenting patients were interviewed in a separate room in the clinic just before or immediately after their cardiac appointment. Clinical data were collected from medical records.

Statistical Analysis

Data collection and statistical analyses were performed using SPSS Statistics 21. Patient characteristics were presented using count (percentage) or mean ± standard deviation. Groups of patients with and without psychiatric disorders were compared using independent t-tests, chi-square tests, and Fisher's exact tests.

Logistic regression models were generated to assess the relationship between predictor variables and three dependent outcomes, including overall psychiatric diagnosis, and specifically major depressive disorder (MDD) and generalized anxiety disorder (GAD). Statistical significance was determined using a level of alpha = 0.05.

Results

Sample Characteristics

Initially, 346 cardiac outpatients were approached. Five patients were not enrolled due to conflicting appointments or to unwillingness to participate in the study. The total number of enrolled patients was 341. Patient age was 18 to 90 years (55.54 ± 13.83 years). Ninety-one percent of the patients were Saudi. Ninety-three patients (27.1%) met the criteria of at least one psychiatric disorder based on the MINI assessment. The patients with at least one psychiatric disorder were significantly younger (P < 0.018) and single or divorced (P < .036) than the patients without any psychiatric disorder. The demographic and clinical characteristics of the participants are presented in Table 1.

Demographic and Clinical Characteristics of Patients (N = 343)Demographic and Clinical Characteristics of Patients (N = 343)

Table 1:

Demographic and Clinical Characteristics of Patients (N = 343)

Hypertension (53.4%), dyslipidemia (53.4%), and diabetes (46.9%) were common morbidities among the participants. About 3% of the patients had chronic kidney disease (CKD). Other medical conditions included asthma (2.3%), hypothyroidism (2.3%), rheumatoid arthritis (1.8%), cancers (1.2%), systemic lupus erythematosus (0.6%), and hepatitis (0.6%). Fifty patients (14.7%) confirmed that they currently smoked cigarettes. The psychiatric patients reported current cigarette smoking more than the patients without any psychiatric disorder (P < .004) (Table 1).

Cardiac conditions were grouped according to their frequency in our sample. The 228 patients who had CAD could be divided as follows: 82 patients had valvular heart disease (VHD), 51 patients had congestive heart failure (CHF), 85 patients had arrhythmias, and 10 patients had other cardiac conditions. The other cardiac conditions included congenital heart diseases (8 patients), atrioventricular septal defect (1 patient), and Marfan syndrome (1 patient) (Table 2). Some patients had more than one condition.

Distribution and Frequency of Psychiatric Disorders (Using DSM-IV-TR Criteria) in Cardiac Outpatients with Different Cardiac Diseases (N = 343)

Table 2:

Distribution and Frequency of Psychiatric Disorders (Using DSM-IV-TR Criteria) in Cardiac Outpatients with Different Cardiac Diseases (N = 343)

Prevalence of Psychiatric Disorders

Among the 343 participants, 93 (27.1%) met the criteria for at least one psychiatric disorder based on the MINI assessment. In these patients, a past diagnosis of MDD was found to be the most prevalent disorder (14%), followed by current GAD (12.8%), and current MDD (8.5%). With regard to specific cardiac conditions, 58 (25.4%) patients with a psychiatric disorder had CAD, 27 (32.9%) had VHD, 10 (19.6%) had CHF, and 26 (30.6%) had arrhythmias.

Thirty-three patients (9.6%) reported having been diagnosed with a psychiatric illness prior to the start of the study. Past diagnoses included MDD (4 patients), GAD (3 patients), postpartum psychosis (1 patient), and panic disorder (1 patient). The other past psychiatric disorders were either reported as symptoms (eg, insomnia) or were not recalled by the patients. Sixteen of the 33 patients were found to have at least one psychiatric diagnosis based on the MINI assessment (P < .004).

Forty-one patients reported a family history of a psychiatric diagnosis. Among these patients, only nine were found to have at least one psychiatric illness based on the MINI assessment. Reported psychiatric illnesses in the families included MDD (7 patients), obsessive-compulsive disorder (2 patients), schizophrenia (4 patients), bipolar disorder (1 patient), autism spectrum disorder (1 patient), and unknown diagnoses (26 patients) (Table 2).

Psychiatric Comorbidities

The complete overlap of comorbid psychiatric illnesses is presented in Table 3. The mean number of comorbid psychiatric disorders per psychiatric patients was 1.6. Among these patients, 24 (25.8%) fulfilled the criteria for two psychiatric disorders whereas 13 (14.1%) were diagnosed with three psychiatric disorders. Only two patients (2.1%) met the criteria for four psychiatric disorders, and one patient fulfilled the criteria for five psychiatric disorders (1.1%). The most frequent comorbid psychiatric diagnoses were GAD and past MDD (20 patients) followed by GAD and current MDD (14 patients).

Frequency of Overlap of Comorbid Psychiatric Disorders (N = 343)

Table 3:

Frequency of Overlap of Comorbid Psychiatric Disorders (N = 343)

Predictors of Psychiatric Disorders

Univariate logistic regression was used to examine factors that might predict the diagnosis of MDD or GAD. Factors included in the univariate analyses were gender, age, marital status, educational level, occupation, income, medical background, past and family psychiatric history, cardiac disease, and the number of cardiac disease comorbidities (Table 4).

Univariate Logistic Regression Analysis of Sociodemographic and Illness-Related Characteristic Predicting Any Psychiatric Disorder, Major Depressive Disorder, or Generalized Anxiety DisorderUnivariate Logistic Regression Analysis of Sociodemographic and Illness-Related Characteristic Predicting Any Psychiatric Disorder, Major Depressive Disorder, or Generalized Anxiety Disorder

Table 4:

Univariate Logistic Regression Analysis of Sociodemographic and Illness-Related Characteristic Predicting Any Psychiatric Disorder, Major Depressive Disorder, or Generalized Anxiety Disorder

Divorce status, education level, current smoking, and a history of a past psychiatric illness significantly predicted a diagnosis of psychiatric illness. MDD was significantly related to female gender, a history of past psychiatric illness, and a comorbid cardiac condition. Conditions from the other cardiac disease category were significantly associated with the diagnosis of MDD. A diagnosis of GAD was predicted by primary school status and current smoking.

In multivariate logistic regression analyses, we excluded factors that were not significantly associated in univariate analyses with the diagnosis of psychiatric disorder; these were MDD and GAD. Cardiac patients were more likely to be diagnosed with a psychiatric disorder if they were divorced (odds ratio [OR] 6.139; 95% CI, 1.267–29.70), current smokers (OR 2.106; 95% CI, 1.085–4.087), or had a history of a past psychiatric illness (OR 2.828; 95% CI, 1.300–6.150). For MDD, cardiac patients were more likely to be diagnosed with MDD if they were female (OR 2.381; 95% CI, 1.342–4.222) or had a history of a past psychiatric disorder (OR 3.176; 95% CI, 1.456–6.928). For GAD, nonsignificant associations were found between factors and the response variable (Table 5).

Multivariate Logistic Regression Analysis Predicting Any Psychiatric Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder

Table 5:

Multivariate Logistic Regression Analysis Predicting Any Psychiatric Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder

Discussion

To our knowledge, this study provides the first data about the prevalence of common psychiatric disorders in a general cardiac outpatient setting using a diagnostic instrument in the Middle East. We found that more than the one-fourth (27.1%) of patients attending the KAMC cardiac outpatient clinic had at least one psychiatric disorder. Depressive disorders were the most common (19.8%) followed by GAD (12.8%).

Our findings agree with those from previous studies showing a high prevalence of current, past, and recurrent MDD in different cardiac conditions.1,3,23 In particular, Bankier et al.1 found a prevalence of 29% and 31% for past MDD and recurrent MDD in CAD outpatients, respectively. In a cohort study of almost 60,000 patients with CAD visiting a primary health care clinic, 21.8% developed clinical depression within 5 years.23 For patients with CHF, 19.3% experienced MDD based on a systematic review performed in 2006.3 Little is known about the prevalence of depression for patients with VHD or arrhythmias. In a small number of patients (n = 65) with an implantable cardioverter defibrillator, 32.5% of patients with shock and 20% of patients without shock were diagnosed with current MDD, respectively.24 Regarding suicide risk, only five patients (1.5%) were found to have a high risk of suicide risk, one patient had moderate risk (0.3%), and four patients had low risk (1.2%). Although studies on the association between suicide and cardiac conditions showed a significant association,25–27 predicting imminent suicide (ie, had plan and intent) among cardiac patients through a self-reported questionnaire or diagnostic instruments remains difficult.28,29

GAD was found to be common in our sample, with 13% prevalence. Previous studies showed that estimated prevalence of GAD varied by cardiac condition, by type of diagnostic instrument, and by clinical setting. For example, the prevalence of GAD in patients with CAD was estimated in the range of 5% to 7%.30,31 For patients with CHF, 13% were found to have GAD based on a recent systematic review.5 Prevalence of GAD for patients with arrhythmia was different for those who received defibrillator shock (37.5%) compared to those who were not shocked (8%).24 Comorbidity with GAD was prevalent in our sample (Table 3). In one study, comorbidity with depressive and anxiety symptoms was found to be extremely high in patients with CAD (61.7%) as well as significantly predictive of high mortality rates.32

Although 3.5% of our sample was diagnosed with panic disorder, the prevalence of panic disorder in cardiac patients was not detected in some studies whereas other studies found it to be extremely common.33 Prevalence ranged from 10% to 50% in other studies.34 This wide range reflects the diversity of demographic and clinical backgrounds of cardiac patients. For example, the incidence of panic disorder in patients with arrhythmias who received defibrillator shock (21%) was found to be higher than those who did not receive the shock (6.9%).35 The prevalence of panic disorder among patients with CHF was found to be 10% in one study.36 Similarly, the prevalence of posttraumatic stress disorder in our sample was found to be 2%; however, previous studies reported a range of prevalence rates across different cardiac conditions: 4% to 24% of patients with CAD, about 20% of patients with implantable cardioverter defibrillator, and 19% to 38% of patients who suffered cardiac arrest.7

Little is known about predictors of psychiatric disorders in cardiac patients. In our study, divorce, having a history of past psychiatric disorder, and current smoking status significantly predicted psychiatric disorder after controlling for other factors. In a study of CAD inpatients, female sex, history of ischemic cardiopathy, and the presence of arterial hypertension significantly predicted a “probable psychiatric case.”37 Marital status was found to have a significant correlation with mental conditions in the general population, as married persons were found to have a reduced risk of first onset for most psychiatric illnesses. Regarding smoking, it was not only found to be associated with mental illnesses but also with higher levels of smoking than among smokers in the general population.38

Study Limitations

Although this study was the first to use a validated diagnostic instrument to detect psychiatric illnesses in a representative sample size of cardiac outpatients in the Middle East, it included several limitations. First, the research design was cross-sectional and carried out at one center. Second, some clinical information related to the cardiac condition was not collected, such as severity of the cardiac condition, cardiac surgery status, having an implantable cardio-defibrillator device, and whether a patient received defibrillator shock or not. Third, sampling was consecutive. A stratified random sampling based on the prevalence of each cardiac condition would provide better representation. Also, this nonprobability sampling method may impact the results of the logistic regression. Fourth, the validated diagnostic tool used was based on DSM-IV-TR,19 which is not the latest edition, because we could not find a validated instrument based on DSM-539 in Arabic. Lastly, this tool has been validated primarily in a setting of primary health care or psychiatric facility40 and not for patients with cardiac diseases who might share some of the neurovegetative symptoms of depression and anxiety, although the inclusive approach for diagnosing psychiatric disorders (ie, including neurovegetative symptoms even if they could have been symptoms of a medical disease in the diagnosis of a psychiatric disorder) has been suggested for medical illnesses.41

Conclusions

The prevalence of psychiatric disorders among a sample of cardiac outpatients in the Middle East was found to be common. Depressive and anxiety disorders were found to be the most common; however, other psychiatric disorders such as panic disorders and posttraumatic stress disorder should not be overlooked. We found that cardiac patients who were divorced, who had a history of a psychiatric disorder, and who were current smokers were more likely to have psychiatric conditions. Studies on risk factors for psychiatric disorders in cardiac patients are lacking and warrant further exploration.

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Demographic and Clinical Characteristics of Patients (N = 343)

Demographic characteristic Total sample,aN (%) Patients with at least one psychiatric disorder,bn (%) Patients without any psychiatric disorders,cn (%) P valued
Age, years (mean ± SD) 55.54 ± 13.83 52.65 ± 12.70 56.62 ± 14.11 .018

Gender



  Male 173 (50.4) 39 (41.9) 134 (53.6) .055
  Female 170 (49.6) 54 (58.1) 116 (46.4)

Marital status


.036
  Single 24 (7) 5 (5.4) 19 (7.6)
  Married 251 (73.4) 65 (70.7) 186 (74.4)
  Widowed 54 (15.8) 14 (15.2) 40 (16)
  Divorced 13 (3.8) 8 (8.7) 5 (2.0)

Education



  Illiterate 95 (27.8) 18 (19.4) 77 (30.9) .207
  Primary school 65 (19) 21 (22.6) 44 (17.7)
  Intermediate/secondary 100 (29.2) 32 (34.4) 68 (27.3)
  Undergraduate 7 (2) 1 (1.1) 6 (2.4)
  Postgraduate 75 (21.9) 21 (22.6) 54 (21.7)

Occupation



  Yes 75 (22) 22 (23.7) 53 (21.4) .650
  No 266 (78) 71 (76.3) 195 (78.6)

Income (SAR)/month



  <5,000 165 (48.7) 41 (45.6) 124 (49.8) .613
  5,000–10,000 89 (26.3) 23 (25.6) 66 (26.5)
  >10,000 85 (25.1) 26 (28.9) 59 (23.7)

Medical background



  Smoking (current) 50 (14.7) 22 (23.7) 28 (11.3) .004
  Hypertension 183 (53.4) 43 (46.2) 140 (56) .107
  Diabetes 161 (46.9) 37 (39.8) 124 (49.6) .105
  Dyslipidemia 183 (53.4) 51 (54.8) 132 (52.8) .737
  CKD 10 (2.9) 3 (3.2) 7 (2.8) .835
  Other 32 (9.3) 16 (17.2) 16 (6.4) .002

Cardiac conditions



  CAD 228 (66.5) 58 (62.4) 170 (68) .326
  VHD 82 (23.9) 27 (29.0) 55 (22) .175
  Arrhythmias 85 (24.8) 26 (28.0) 59 (23.6) .406
  CHF 51 (14.9) 10 (10.8) 41 (16.4) .191
  Other 10 (2.9) 5 (5.4) 5 (2) .098

Past psychiatric history



  Personal 33 (9.6) 16 (17.2) 17 (6.8) .004
  Family 41 (12) 9 (9.7) 32 (12.8) .428

Distribution and Frequency of Psychiatric Disorders (Using DSM-IV-TR Criteria) in Cardiac Outpatients with Different Cardiac Diseases (N = 343)

Psychiatric disorder Total sample,aN (%) CAD,bn (%) VHD,cn (%) CHF,dn (%) Arrhythmias,en (%)
MDD 68 (19.8) 41 (18) 19 (23.2) 9 (17.6) 18 (21.2)
  Current 29 (8.5) 18 (7.9) 9 (11) 2 (3.9) 8 (9.4)
  Past 48 (14) 29 (12.7) 12 (14.6) 7 (13.7) 10 (11.8)
  Recurrent 11 (3.2) 8 (3.5) 2 (2.4) 2 (3.9) 3 (3.5)

Suicidality 5 (1.5) 3 (1.3) 2 (2.4) 0 2 (2.4)
  Low 4 (1.2) 2 (0.9) 2 (2.4) 0 2 (2.4)
  Moderate 1 (0.3) 1 (0.4) 0 0 0
  High 0 0 0 0 0

Panic disorder 12 (3.5) 7 (3.1) 7 (8.5)
  Current 2 (0.6) 1 (0.4) 1 (1.2) 0 0
  Lifetime 12 (3.5) 7 (3.1) 7 (8.5) 1 (2.0) 1 (1.2)

Agoraphobia 14 (4.1) 7 (3.1) 8 (9.8) 1 (2.0) 3 (3.5)

Social phobia 2 (0.6) 1 (0.4) 2 (2.4) 1 (2.0) 1 (1.2)
  Generalized 2 (0.6) 1 (0.4) 2 (2.4) 1 (2.0) 1 (1.2)
  Non-generalized 0 0 0 0

OCD 1 (0.3) 0 1 (1.2) 1 (2) 1 (1.2)

PTSD 7 (2) 6 (2.6) 1 (1.2) 0 1 (1.2)

Substance abuse 2 (0.6) 2 (0.9) 0 0 0

Current psychotic disorder 1 (0.3) 0 1 (1.2) 0 1 (1.2)

GAD 44 (12.8) 32 (14) 11 (13.4) 3 (5.9) 11 (12.9)

Total patients with at least one psychiatric disorder 93 (27.1) 58 (25.4) 27 (32.9) 10 (19.6) 26 (30.6)

Frequency of Overlap of Comorbid Psychiatric Disorders (N = 343)


Current MDD Past MDD Recurrent MDD Current panic disorder Agoraphobia Social phobia OCD PTSD GAD
Current MDD (n = 29) 0 9 5 6 6 0 0 3 14
Past MDD (n = 48)
0 5 5 3 0 0 5 20
Recurrent MDD (n = 11)

0 2 2 0 1 1 6
Panic disorder (n = 12)


0 5 0 1 1 7
Agoraphobia (n = 14)



0 1 0 3 6
Social phobia (n = 2)




0 0 0 1
OCD (n = 1)





0 0 0
PTSD (n =7)






0 6
GAD (n = 44)







0

Univariate Logistic Regression Analysis of Sociodemographic and Illness-Related Characteristic Predicting Any Psychiatric Disorder, Major Depressive Disorder, or Generalized Anxiety Disorder

Variable Any psychiatric disorder Major depressive disorder Generalized anxiety disorder
Odds ratio 95% CI P valuea Odds ratio 95% CI P valuea Odds ratio 95% CI P valuea
Gender








  Male 1

1

1

  Female 1.6 0.99–2.59 .056 2.55 1.45–4.46 .001 1.40 0.74–2.65 .304

Age, years








  <40 1




1

  40–59 1.02 0.49–2.14 .95 1.30 0.55–3.05 .55 0.82 0.32–2.08 .673
  ≥60 0.67 0.31–1.43 .296 0.90 0.37–2.16 .808 0.63 0.24–1.64 .343

Marital status








  Single 1

1




  Married 1.33 0.48–3.70 .587 1.06 0.35–3.26 .915 3.48 0.46–26.65 .230
  Widowed 1.33 0.42–.423 .629 1.75 0.51–6.01 .374 3.43 0.40–29.52 .263
  Divorced 6.08 1.37–26.97 .018 3.12 0.66–14.72 .150 6.90 0.64–74.69 .112

Education level








  Illiterate 1
0 1

1

  Primary school 2.04 0.98–4.24 .055 1.06 0.48–2.37 .869 3.02 1.06–8.64 .039
  Intermediate/secondary school 2.01 1.04–3.91 .039 1.06 0.53–2.17 .853 2.62 0.97–7.06 .057
  Undergraduate 713 0.081–6.30 .761 2.47 0.26–23.99 .435
  Postgraduate 1.66 0.81–3.42 .165 1.25 0.60–2.64 .552 2.55 0.90–7.25 .079

Occupation








  No 1




1

  Yes 1.14 0.65–2.01 .650 1.12 0.59–2.10 .733 1.05 0.49–2.24 .900

Income (SAR)/month








  <5,000 1

1

1

  5,000–10,000 1.05 0.58–1.90 .862 0.99 0.51–1.93 .968 1.17 0.56–2.47 .675
  >10,000 1.33 0.75–2.38 .332 1.30 0.68–2.47 .432 0.81 0.35–1.86 .622

Medical background








  Smoking 2.44 1.31–4.52 .005 1.51 .75–3.03 248 2.21 1.03–4.72 .42
  HTN 0.68 0.42–1.09 .108 0.98 0.58–1.67 .939 0.86 0.46–1.62 .633
  DM 0.67 0.41–1.09 .106 0.64 0.37–1.11 .110 0.93 0.50–1.76 .833
  Dyslipidemia 1.09 0.67–1.75 .737 1.22 0.72–2.09 .461 1.31 0.69–2.48 .415
  CKD 1.16 0.29–4.57 .835 0.44 0.06–3.54 .441 1.73 0.36–8.43 .496

Past psychiatric history








  Personal 2.84 1.37–5.88 .005 3.48 1.64–7.37 .001 1.59 0.61–4.09 .341
  Family 0.73 0.33–1.59 .430 0.81 0.34–1.92 .638 1.19 0.47–3.02 .713

Cardiac disease








  CAD 0.78 0.48–1.28 .326 0.72 0.41–1.24 .229 1.40 0.69–2.84 .348
  Valvular 1.45 0.85–2.49 .176 1.31 0.72–2.38 .385 1.07 0.52–2.23 .856
  CHF 0.61 0.29–1.28 .195 0.85 0.39–1.84 .673 0.38 0.11–1.29 .120
  Arrhythmias 1.26 0.73–2.15 .407 1.12 0.61–2.05 .719 1.01 0.49–2.11 .971
  Other 2.78 0.79–9.85 .112 4.29 1.20–15.25 .025 1.73 0.36–8.43 .496
  At least 2 cardiac diseases 1.26 0.73–2.20 .409 1.56 0.86–2.83 .145 0.86 0.39–1.87 .699
  At least 3 cardiac diseases 0.80 0.215–2.97 .739 0.73 0.16–3.36 .683 2.12 0.56–8.00 .270
  At least 4 cardiac diseases 1.35 0.12–15.04 .808

Multivariate Logistic Regression Analysis Predicting Any Psychiatric Disorder, Major Depressive Disorder, and Generalized Anxiety Disorder

Variable Any psychiatric disorder Major depressive disorder Generalized anxiety disorder
Odd ratio 95% CI P valuea Odds ratio 95% CI P valuea Odds ratio 95% CI P valuea
Gender






None were found significant
  Male


1




  Female


2.38 1.34–4.22 .003



Marital status








  Single 1







  Divorced 6.1 1.27–29.70 .024






Educational level








  Illiterate 1







  Primary school 1.84 0.84–4.00 .127





  Intermediate and secondary








school








  Undergraduate








  Postgraduate









Smoking 2.12 1.09–4.09 .028






Past psychiatric history








  Personal 2.83 1.30–6.15 .009 3.18 1.46–6.93 .004



Cardiac disease








  Other


2.82 0.73–10.90 .134


Authors

Ahmad Saad Alzahrani, MD, is a Consultant of Psychiatry and Psychosomatic Medicine, Mental Health Department, Neuroscience Center, King Abdullah Medical City; the Head of Mental Health Section, Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah Branch; and an Adjunct Assistant Professor, College of Medicine, Alfaisal University. Abdullah Alqahtani, MD, is a Consultant of Psychiatry and Psychosomatic Medicine and the Head of the Mental Health Department, Neuroscience Center, King Abdullah Medical City. Abeer Saleh, MD, is a Resident in Family Medicine, Department of Family Medicine, Ministry of Health, Saudi Arabia. Maryam Aloqalaa, MD, is a Resident in Emergency Medicine, Department of Emergency Medicine, King Abdulaziz Medical City. Abdulaziz Abdulmajeed, MD, is a Resident in Urology, Department of Urology, King Fahad Hospital. Asrar Nadhrah, MD, is a Resident in Family Medicine, Department of Family Medicine, King Fahad Medical City. Nada Alhazmi, MD, is a Resident in Emergency Medicine, Department of Emergency Medicine, King Abdulaziz Medical City.

Address correspondence to Ahmad Saad Alzahrani, MD, Neuroscience Department, King Faisal Specialist Hospital and Research Centre, Jeddah 23433, Saudi Arabia; email: dr_ahmadsz@yahoo.com.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20200807-01

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