Psychological problems in Saudi Arabian primary care patients : a preliminary exploration of barriers to effective treatment
The importance of primary care in treating Psychological Disorder (PO) has
repeatedly been emphasized. Many patients with psychological needs may find
several barriers to receiving benefit from their GP. Unfortunately, there is no study
within Saudi Arabian (SA) primary care about the prevalence of PO and the process
of dealing with it. Therefore, this thesis reports the results of four studies. The first
three quantitative studies and the fourth, qualitative, study attempted to explore PO
and relevant barriers to receiving help from the GP.
Study One was conducted in Saudi primary care (N=224 patients) in one specific area
(Assir Area). It contains two chapters: in the first chapter assessment included
prevalence of PO, prevalence of medically unexplained symptoms (MUS), and GPs'
ability to detect PD. Findings from this chapter suggest that PO is high using GHQ-I2
and GHQ-28. Only about 15 percent of the sample was MUS. GPs were likely to
misdiagnose PD. In the second chapter assessment included patients' aetiological
beliefs, reasons for delay in seeking help, sources of help consulted, stigma,
satisfaction, and patient intentions. There were significant differences between cases
and non-cases related to their beliefs, stigma, and patient intentions. Cases reported
more psychological and cultural beliefs than non-cases did. Women reported more
stigmatization than men.
Study Two (N=104 patients) had the specific aim of comparing the two methods of
wording format for answering the GHQ-12: the Arabic method of wording vs. the
Goldberg method of wording. The Arabic HADS was used as a gold standard
criterion. Findings from this study suggest that the Arabic answering format works in
almost the same as the Goldberg answering format.
Study Three (N=606 patients) was conducted in primary care in different
geographical areas of Saudi Arabia. This study contains four chapters: prevalence of
PO and MUS, patients' beliefs, patients' intentions, and GPs' diagnoses and treatment
decisions. Prevalence of PO and MUS were compared with Study One, and were
almost the same. Two scoring methods of the GHQ-12 were tested vs. the HADS.
GPs were again likely to misdiagnose PD. Cases reported more psychological and
cultural beliefs than non-cases did. Cases' beliefs changed after consultation to be
more physical. Cases showed more need for emotional support from their GP than
non-cases. GPs' assessments of patients' intentions were significantly different from
what patients requested. There was no clear evidence that the GPs' decisions for cases
were different from non-cases.
Study Four was qualitative (N=27 patients). This study examined the ways in which
psychological, physical and cultural factors interacted in patients' beliefs about their
symptoms and what patients want from their GPs and how they respond to GPs.
Patients with beliefs that psychological factors are involved in their problems also
report more beliefs in cultural reasons for their symptoms and they believe more in
cultural sources of help. Patients reported that they consulted their GPs for more than
medication and drugs alone.
This thesis concludes that Saudi primary care patients with psychological disorders
encounter several barriers which need to be overcome if they are to receive proper
help. Primary care providers need to educate patients, train GPs and provide help for
psychological disorders presented in cultural ways, especially for women and for
those patients with cultural needs.