Shuliweeh Alenezi

Caregivers of patients with Severe Persistent Mental Illness (SPMI) face tremendous challenges. They often experience elevated levels of burden, depression, and anxiety. These factors negatively impact their quality of life (QoL). However, few studies have examined caregiver burden and its psychological effects in Saudi Arabia. This study aims to assess caregiver burden in relation to socio-demographic characteristics and its correlation with depression, anxiety, and QoL. The study tool consisted of validated questionnaire, including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), abridged Arabic version of the Zarit Burden Interview (ZBI), and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). A cross-sectional convenience sample of 120 participants was recruited from the Psychiatry Outpatient Clinics at King Saud University Medical City in Riyadh, Saudi Arabia. Our results showed a significant positive correlation between caregiver burden and depression and anxiety scores (p < 0.001). Moreover, significantly higher burden levels were found among female caregivers and those residing with patients, p = 0.04 and p = 0.002, respectively. Additionally, the severity of mental illness was also associated with an increased burden level (p = 0.001). Notably, spouses and children reported significantly higher burden levels (p = 0.036). In multivariable analyses, caregiver anxiety and perceived severity of the patient’s mental illness were independently associated with higher caregiver burden, while depressive and anxiety symptoms were independently associated with poorer quality of life.Furthermore, a significant negative correlation was found between caregiver burden and the physical and psychological QoL domains (p < 0.001 and p = 0.013, respectively). Collectively, our findings highlight the mental health challenges faced by caregivers of individuals with SPMI in Saudi Arabia, which negatively impact their QoL. Consequently, these findings substantiate the urgent need for targeted support interventions, particularly those addressing caregiver anxiety, depression, and the challenges associated with severe mental illness, especially for caregivers who live with or care for individuals with SPMI.

The circadian clock is an internal, ~ 24-hour biological timer that synchronizes physiology with the day-night cycle. Social jetlag. (SJL) describes

Background: Large sporting events, such as the FIFA World Cup, attract global attention and raise questions about psychological impact. Anxiety is among the most common mental health symptoms, but little is known about its predictors during international tournaments. This study explored predictors of anxiety during the FIFA 2022 World Cup. Methods: This cross-sectional study included 1,331 respondents mostly residing in Saudi Arabia who completed an online survey during the FIFA 2022 World Cup (November–December 2022). The survey included sociodemographic variables, items related to the World Cup viewing habits, perceived effects of the tournament, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Results: Although most respondents reported minimal anxiety symptoms (GAD-7 median score = 5, IQR = 6), 41.5% of the sample felt that watching the World Cup made them feel nervous. Females and younger adults reported significantly higher GAD-7 scores ( p < 0.001). Employment status and method of watching the matches were not significant predictors. Regression modelling revealed that age, gender, and perceived sleep disruption predicted 9.1% of the variance in GAD-7 scores ( p < 0.001). Younger age was the strongest predictor, while perceived sleep disturbance related to watching the matches predicted higher GAD-7 scores. Conclusions: This was a population-based study of anxiety during the FIFA 2022 World Cup. Younger adults were more likely to report elevated anxiety, and sleep disruption was linked to higher GAD-7 scores. These findings highlight modifiable and non-modifiable predictors of anxiety and may inform public health strategies ahead of FIFA 2026.

Background/Objectives: Diabetes distress is a significant, often unaddressed, aspect of type 1 diabetes (T1D) management. The Type 1 Diabetes Distress Scale (T1-DDS) is a key assessment tool, but no validated Arabic version exists for Saudi Arabia’s large T1D population. This study aimed to translate, culturally adapt, and validate the Arabic T1-DDS to enable accurate assessment of diabetes-specific distress in Saudi adults with T1D. Methods: A cross-sectional study was conducted among Saudi adults with self-reported T1D. The T1-DDS underwent forward-backward translation, expert panel review, and cognitive debriefing. Participants completed an online survey containing the 28-item Arabic T1-DDS, the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). Psychometric evaluation included exploratory and confirmatory factor analysis (EFA, CFA), internal consistency (Cronbach’s α), and convergent validity. A multivariable generalized linear model identified predictors of distress. Results: The analysis included 837 participants (73.8% female, mean age 27.22 ± 7.8 years). The Arabic T1-DDS demonstrated excellent reliability (α = 0.934). EFA/CFA supported a robust four-factor structure, confirming model fit (χ²/df = 1.313, CFI = 1.000, RMSEA = 0.019). The mean overall distress score was 2.74 (SD = 1.05), with 72.4% reporting moderate-to-high distress. Distress correlated moderately with depression (r = 0.58) and anxiety (r = 0.52). Multivariable analysis identified higher PHQ-9 (RR = 1.178) and GAD-7 scores (RR = 1.063) as significant predictors of elevated distress, while insulin pump use was protective (RR = 0.938). Conclusions: The Arabic T1-DDS is a valid and reliable tool for Saudi adults with T1D. Its use revealed a high prevalence of diabetes distress, strongly linked to psychological symptoms and mitigated by insulin pump therapy. Integrating this scale into routine clinical care can facilitate timely psychosocial support, potentially improving patient outcomes.

Introduction: The circadian clock is an internal, ∼24-hour biological timer that synchronizes physiology with the day-night cycle. Social jetlag (SJL) describes the misalignment between this internal clock and social schedules, a condition affecting approximately 70% of the population and linked to a spectrum of metabolic, mental, and cognitive health issues. This study examined how the 2022 FIFA World Cup disrupted normal children’s sleep routines and other associated factors from parents’ prospect. Methods: An online, cross-sectional survey was distributed to parents (N=848). The questionnaire collected sociodemographic data, children’s habitual sleep habits, and changes perceived during the 2022 FIFA World Cup. SJL was defined as a ≥1-hour delay in bedtime on weekends versus weekdays. Multivariable logistic regression analyses identified factors associated with perceived sleep changes and SJL. Results: Over half (53.4%) of the children exhibited pre-existing weekend SJL. Children aged 5-11 (OR=1.847, p<0.001), higher socioeconomic status (OR=1.383, p<0.001), international residency (OR=2.845, p<0.001) were significant predictors of baseline weekend SJL. During the tournament, 33% and 17.8% of parents reported their children had delayed sleep (≥1 hour) on weekdays and weekends due to match watching, respectively. Regression analysis revealed that these parental perceived FIFA impact on their children sleep was significantly associated with weekdays SJL OR= 1.958, p=0.001 and weekends OR= 1.784, p=0.009 during the FIFIA season. Discussion: Our findings indicate that major social events can exacerbate circadian misalignment and SJL, likely driven by social conformation. The high prevalence of baseline SL confirms it is a widespread pediatric health issue. The vulnerability of the 5-11 age group shows SJL is not exclusively an adolescent problem. Conclusion: Major sporting events significantly disrupt children’s sleep schedules, compounding the public health issue of chronic SJL. Proactive guidance for families is needed during such events. More importantly, these findings underscore the urgent need for structural changes to align social schedules with pediatric circadian biology.

Background Poor sleep quality in children can lead to physical and psychosocial problems. The FIFA World Cup has been shown to impact adult behaviors, but its effect on children’s sleep patterns is less understood. The study aimed to evaluate the impact of the FIFA World Cup 2022 (FWC-2022) on children’s sleep patterns. Methods A cross-sectional survey was conducted between 27 November and 25 December 2022, targeting parents in Saudi Arabia (Arabia standard time) and countries with a +6-hour time difference. Participants completed the validated Children’s Sleep Habits Questionnaire (CSHQ), alongside demographics, time spent watching matches, and parental perceptions on sleep. Results A total of 848 parents participated, with 60.6% being mothers. The study found that children averaged 9.10 hours of sleep; 64.2% of parents observed no change, while 10.4% reported substantial changes. Parents aged ≥45 and those noticing shifts in sleep habits reported higher problematic sleep scores. Larger families reported fewer sleep issues, with a negative correlation between family size and sleep problems. Children’s CSHQ scores indicate mild to moderate sleep difficulties across domains. No significant differences were observed between Saudi Arabia and countries with +6-hour time difference. However, one-third of children experienced delays in sleep onset exceeding one hour on weekdays during the World Cup. Conclusion Sociodemographic factors, family dynamics, and major events like the FWC-2022 influence parental perceptions of child sleep issues. Older parents and smaller families reported more challenges, while higher socioeconomic status was linked to fewer bedtime difficulties. Our findings may be particularly relevant for FIFA 2026, where transcontinental hosting across North America will expose children globally to matches at even more variable times. Subtle impacts of prolonged event schedules highlight the need for interventions supporting healthy routines during such events, potentially through engaging, sleep-friendly technologies.

Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the prevalence of DEBs and analyze its associations with glycemic control and diabetes-related complications. Methods: A cross-cultural validation study was conducted following the COSMIN guidelines. The DEPS-R questionnaire was translated into Arabic through forward and backward translation involving expert panels, including psychiatrists, diabetologists, and linguists. A sample of 409 people with type 1 diabetes (PwT1D) (58.4% females) aged 12–20 years was recruited from outpatient diabetes clinics in the five main regions of Saudi Arabia. Participants completed the Arabic DEPS-R and the validated Arabic version of the SCOFF questionnaire. Sociodemographic, anthropometric, and biochemical data were collected, and statistical analyses, including confirmatory factor analysis (CFA) and internal consistency tests, were conducted. Results: The Arabic DEPS-R exhibits strong internal consistency (Cronbach’s alpha = 0.829) and high test–retest reliability (ICC = 0.861), with a CFA supporting a three-factor structure, namely body weight perception, disordered eating behaviors (DEBs), and bulimic tendencies. Notably, higher DEPS-R scores are significantly linked to elevated HbA1c levels, increased BMI, and more frequent insulin use. Alarmingly, 52.8% of participants show high-risk DEB, which is directly associated with poor glycemic control (HbA1c ≥ 8.1%) and a heightened risk of diabetic ketoacidosis (DKA). Conclusions: The Arabic DEPS-R is a valid and reliable tool for screening DEBs among Saudi adolescents with T1D. Findings underscore the necessity for early identification and intervention to mitigate the impact of EDs on diabetes management and overall health outcomes.

Background: The COVID-19 pandemic triggered a global transition to distance learning, which significantly impacted children’s mental health. In Saudi Arabia, remote education began on 8 March 2020, lasting between 1.5 to 2.5 years. This study aims to explore the psychological effects of distance learning on children and adolescents, with a focus on mental health challenges and coping mechanisms. Methods: A cross-sectional study was conducted using an online survey distributed to parents of children aged 6 to 18 in the major metropolitan areas of Jeddah and Riyadh. The survey included demographic questions and the Arabic version of the Vanderbilt ADHD Diagnostic Rating Scale, a tool for assessing behavioral challenges, anxiety, and symptoms of attention deficit hyperactivity disorder (ADHD). Results: A total of 71.6% of families reported a positive experience with distance learning. A significant correlation was found between parents’ marital status and children’s ability to cope with remote education. Interestingly, children without ADHD symptoms experienced three times more negative outcomes than those with ADHD symptoms. However, despite reporting fewer negative experiences, children with ADHD exhibited increased symptom severity and academic difficulties. Of the students, 5.4% were diagnosed with predominantly inattentive ADHD, 1.8% with predominantly hyperactive/impulsive ADHD, and 3.9% with combined ADHD. Additionally, 7.2% of students screened positive for oppositional defiant disorder, 1.5% for conduct disorder, and 6.6% for anxiety or depression. Children from separated or divorced families were more likely to exhibit ADHD symptoms (p = 0.002). Children with ADHD symptoms reported a more positive experience with distance learning (p < 0.05). Conclusion: This study represents the first comprehensive, multi-city investigation in Saudi Arabia examining the relationship between distance learning, sociodemographic factors, and mental health symptoms in children. The findings highlight the psychological challenges faced by children during the pandemic and emphasize the need for targeted interventions to support both mental health and academic outcomes. These results offer valuable insights for future research and inform strategies to address children’s well-being in scenarios involving distance learning.

Introduction: Autism spectrum disorder (ASD) is one of the national mental health priorities that has manifested a wide variability in practice in the Kingdom of Saudi Arabia (KSA). This work aimed to adapt evidence‐based clinical practice guidelines (CPGs) for ASD to synthesize the first national CPG for the management of children with ASD in KSA.Methods: The CPG adaptation group comprised multidisciplinary expert clinicians and a CPG methodologist following the KSU‑Modified‑ADAPTE methodology. The last search date for source evidence‐based guidelines was March 2022.Recommendations: Three main categories of recommendations were included: (i) prevention and early identification, coding, psychometric tools, telehealth, risk factors and referral criteria, (ii) diagnosis, differential diagnosis, investigations and family support, (iii) interventions with problem minimization and avoidance, treatment goals, physical wellbeing, nonpharmacological interventions, sensory integration, parent‐mediated interventions, cognitive behavioural therapy, pharmacological interventions, psycho‐education of the family, special cases or comorbidities, sleep management, gastrointestinal and feeding interventions, the transition of care from paediatrics to adulthood. CPG implementation tools included a baseline assessment tool, clinical scenarios, pathways, quality measures, referral forms, screening tools and useful online resources. The adapted CPG presents practical, evidence‑based guidance with implementation tools for managing children with ASD in KSA. The project illustrated the applicability of the KSU‑modified‑ADAPTE and highlighted the importance of collaboration between clinicians and methodologists for adapting national CPGs.

Introduction: The COVID-19 pandemic prompted a global shift to distance learning, profoundly affecting children's mental health. In Saudi Arabia, remote education was implemented on March 8, 2020, impacting students across various factors, such as age, vaccination status, and school system. This shift lasted between 1.5 to 2.5 years, influencing students’ experiences differently. This study explores the psychological impact of distance learning on children and adolescents, with the goal of informing mental health advocacy and guiding educational strategies in scenarios where distance learning becomes essential. Methods: We conducted a cross-sectional study using an online survey distributed to parents of children aged 6 to 18 in the major metropolitan areas of Jeddah and Riyadh. The survey collected demographic information and included the validated Arabic version of the Vanderbilt ADHD Diagnostic Rating Scale. This tool assesses behavioral challenges, anxiety, and symptoms of attention deficit hyperactivity disorder (ADHD). Results: The study found that 71.6% of families reported a positive experience with distance learning. A significant correlation was identified between parents' marital status and children's ability to cope with remote education. Interestingly, students without ADHD symptoms experienced three times more negative outcomes than those with ADHD. However, despite reporting fewer negative experiences, children with ADHD symptomatology faced heightened symptom severity and academic difficulties. The results further indicated that 5.4% of students were classified with ADHD predominantly inattentive presentation, 1.8% with predominantly hyperactive/impulsive presentation, and 3.9% with combined ADHD presentation. Additionally, 7.2% of students screened positive for oppositional defiant disorder, 1.5% for conduct disorder, and 6.6% for anxiety or depression. Conclusion: This study is the first comprehensive, multi-city investigation in Saudi Arabia to analyze the relationship between distance learning experiences, sociodemographic factors, and mental health symptoms in children. The findings provide essential insights for future research and offer a foundation for developing targeted interventions to support children’s mental health and education in the region.