A cross-sectional survey of the prevalence and determinants of comorbid psychological distress in attendees at two general hospitals in Gaza

• Published in: The Lancet (British edition) 2021-07, Vol.398, p.S52-S52
• Main Authors: Yaghi, Mohammad, Chatterjee, Sudipto, Alissawi, Fouad, Daher, Mahmoud, Khader, Yehia, Abu Shawish, Mohammad, Imad, Osama
• Format: Article
• Language: English
• Subjects: Aggression; Anxiety disorders; Comorbidity; Cross-sectional studies; Data collection; Education; Emergency medical care; Emergency medical services; Emergency response; Health problems; Health promotion; Hospitals; Income; Men; Mental depression; Mental disorders; Mental health; Palestinian Territories; Polls & surveys; Psychiatric services; Psychological stress; Questionnaires; Regression analysis; Risk analysis; Risk factors; Sexual assault; Social conditions; Social problems; Social sciences; Statistical analysis; Stress (Psychology); Surveys; Women
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(21)01538-5

There is an absence of mental health services within general hospitals in Gaza. As part of the Ministry of Health plan to develop mental health liaison services, a cross-sectional survey of the prevalence of and risk factors for psychological distress in attendees at two general hospitals was undertaken to estimate and highlight the need for establishing such services. 20 volunteers aged 24–30 years with a degree in psychological or social science from a university accredited by the Palestinian Ministry of Education and Higher Education, and with experience in field data collection for studies in mental health, were selected and trained in the use of the Arabic version of the 12-item General Health Questionnaire (GHQ-12), an internationally and well validated tool for measuring psychological distress in adults. The volunteers were supervised as they screened adult attendees at emergency rooms, inpatient wards and outpatient departments, and women attending the maternity units at two of the largest general hospitals in Gaza (Nasser and Indonesian) over seven consecutive days (March 18–23, 2018). Attendees at emergency and outpatient departments were included if they were on repeat visits with medically unexplained somatic complaints, if they attended with complaints resulting from any kind of social problem, physical or sexual violence, or had a history of any kind of chronic disease. All patients from the internal medicine and inpatient departments were included. The data from the questionnaires were collated and analysed with descriptive and inferential statistics. 1789 attendees (791 men and 998 women) were screened using the GHQ-12. Of these attendees, 23·8% (426 of 1789) had a GHQ-12 score of 6 or 7, indicating the presence of significant psychological distress with a high possibility of caseness (ie, meeting the diagnostic threshold for clinical depression). 36·2% (648 of 1789) scored 8 or above, indicating the presence of moderate to severe depression or anxiety disorders that require immediate clinical intervention. For all of the hospital departments surveyed, individuals with scores of 6 or greater made up a large proportion of the attendees (385 of 660 [58·3%] in emergency rooms, 197 of 306 [64·4%] in inpatient wards, 430 of 711 [60·5%] in outpatient departments, and 62 of 112 [55·4%] in maternity units), in both hospitals. In addition, a set of risk factors were found to be significantly associated with GHQ-12 scores of 6 or greater. These were