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Kikas K, Werner-Seidler A, Upton E, Newby J. Illness Anxiety Disorder: A Review of the Current Research and Future Directions. Curr Psychiatry Rep 2024; 26:331-339. [PMID: 38748190 PMCID: PMC11211185 DOI: 10.1007/s11920-024-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults. RECENT FINDINGS IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.
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Affiliation(s)
- Katarina Kikas
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Upton
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jill Newby
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
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Rimvall MK, Rask CU, Jensen JS, Olsen EM, Clemmensen L, Skovgaard AM, Verhulst F, van Os J, Jeppesen P. Exploring the interplay between psychotic experiences, functional somatic symptoms and health anxiety in childhood and adolescence - A longitudinal cohort study. Schizophr Res 2024; 267:322-329. [PMID: 38613863 DOI: 10.1016/j.schres.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Similarities exist between contemporary explanatory models underlying psychosis development, functional somatic symptoms, and health anxiety. The current study aimed to examine the potential interplay between psychotic experiences (and alternate measures of anomalous self-experiences and aberrant attribution of salience) and functional somatic symptoms on the outcome of health anxiety in youths. METHODS In a prospective general-population birth cohort, the Copenhagen Child Cohort 2000 (CCC2000), data from two time-points were available for 1122 individuals. We assessed the associations between psychotic experiences and functional somatic symptoms with health anxiety both cross-sectionally at ages 11- and 16-years, and longitudinally from age 11 to 16. Further, we examined if there was an interaction between these two domains on the outcome of health anxiety using the interaction contrast ratio. RESULTS Functional somatic symptoms and psychotic experiences were strongly cross-sectionally associated with health anxiety at both ages 11 and 16, even after adjustment for general psychopathology. In the longitudinal analyses, functional somatic symptoms, and psychotic experiences at age 11 were not individually associated with health anxiety at age 16 but having both functional somatic symptoms and psychotic experiences was: odds ratio 3.90, 95%CI 1.7-8.9, with suggestion of evidence for interaction beyond the additive effects. This association was attenuated after adjustment for general psychopathology: odds ratio 2.6, 95 % CI 1.0-6.4. CONCLUSION The strong associations between the domains support the idea of possible overlapping mechanisms underlying psychotic experiences, functional somatic symptoms, and health anxiety.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Charlotte Ulrikka Rask
- Aarhus University Hospital Psychiatry, Department of Child and Adolescent Psychiatry, Research Unit, Aarhus, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
| | - Jens Søndergaard Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Else Marie Olsen
- Psychiatric Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Center for Clinical Research and Prevention, the Capital Region of Denmark, Denmark
| | - Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Center on Mental Health (CORE), Copenhagen University Hospital, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Copenhagen, Denmark
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Child Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jim van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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Dalgaard IK, Rask CU, Bilenberg N, Hulgaard DR. Pandemic life in families with health anxiety symptoms, parental perspectives. Scand J Child Adolesc Psychiatr Psychol 2024; 12:23-32. [PMID: 38855577 PMCID: PMC11156484 DOI: 10.2478/sjcapp-2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Background The covid-19 pandemic has influenced children and parents worldwide. The pandemic has also been suggested to especially affect and exacerbate health anxiety (HA) symptoms in children and adolescents. However, there is limited understanding of the potential mechanisms challenges of families where parents themselves experience mental health issues such as high degree of HA symptoms. Objective The aim of this study was to explore parental experiences of pandemic life in families with continuously high levels of HA symptoms during the covid-19 pandemic. Method Six parents, identified with high levels of HA symptoms, participated in qualitative individual semi-structured interviews. Interviews were analysed according to Interpretative Phenomenological Analysis principles. Results Three main themes emerged. Theme 1) "Anxious children in a pandemic world" explores how pandemic - independent child factors including anxious temperament may have influenced the child pandemic experience. Theme 2) "Parental influences on child anxiety" describes parental reflections on their possible influence on child anxious thoughts. Theme 3) "Living with pandemic guidelines and restrictions" demonstrates the varying parental experiences of interventions and how these may affect HA thoughts. Conclusion Parents who themselves experience HA symptoms see their children, who also experience HA symptoms, to be particularly susceptible and vulnerable to both content and rhetoric of pandemic information. These children may however, experience school lockdown to be anxiety relieving. Parents who themselves have illness-related fears may not see themselves as perpetuating for their child's anxious thoughts.
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Affiliation(s)
- Ida Kathrine Dalgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Research Unit, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Research Unit, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
| | - Ditte Roth Hulgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Research Unit, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Odense, Denmark
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Hannah K, Marie K, Olaf H, Stephan B, Andreas D, Wilson Michael L, Till B, Peter D. The global economic burden of health anxiety/hypochondriasis- a systematic review. BMC Public Health 2023; 23:2237. [PMID: 37957598 PMCID: PMC10644595 DOI: 10.1186/s12889-023-17159-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Recent studies have shown a lifetime prevalence of 5.7% for health anxiety/hypochondriasis resulting in increased healthcare service utilisation and disability as consequences. To the best of our knowledge, there has been no systematic review examining the global costs of hypochondriasis, encompassing both direct and indirect costs. Our objective was to synthesize the available evidence on the economic burden of health anxiety and hypochondriasis to identify research gaps and provide guidance and insights for policymakers and future research. METHODS A systematic literature search was conducted using PubMed, Web of Science, PsycInfo, EconLit, IBSS and Google Scholar without any time limit, up until April 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this search and the following article selection process. The included studies were systematically analysed and summarized using a predefined data extraction sheet. RESULTS Of the 3044 articles identified; 10 publications met our inclusion criteria. The results displayed significant variance in the overall costs listed among the studies. The reported economic burden of hypochondriasis ranged from 857.19 to 21137.55 US$ per capita per year. Most of the investigated costs were direct costs, whereas the assessment of indirect costs was strongly underrepresented. CONCLUSION This systematic review suggests that existing studies underestimate the costs of hypochondriasis due to missing information on indirect costs. Furthermore, there is no uniform data collection of the costs and definition of the disease, so that the few existing data are not comparable and difficult to evaluate. There is a need for standardised data collection and definition of hypochondriasis in future studies to identify major cost drivers as potential target point for interventions.
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Affiliation(s)
- Kawka Hannah
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany.
| | - Kurtz Marie
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Horstick Olaf
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Brenner Stephan
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Deckert Andreas
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Lowery Wilson Michael
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Baernighausen Till
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
| | - Dambach Peter
- Heidelberg Institute for Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, 69120, Heidelberg, Germany
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Lokajova A, Smahel D, Kvardova N. Health-related social media use and COVID-19 anxiety in adolescence: health anxiety as covariate and moderator. Front Psychol 2023; 14:1079730. [PMID: 37205077 PMCID: PMC10187632 DOI: 10.3389/fpsyg.2023.1079730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Background Adolescents can benefit from engagement with health-related content on social media (e.g., viewing, commenting, or sharing content related to diseases, prevention, or healthy lifestyle). Nevertheless, such content may be distressing or exaggerated and present a challenge to mental well-being, especially during the COVID-19 pandemic. Rumination about such content may lead to COVID-19 anxiety. Yet, the individual factors that would explain the association between health-related social media use (SMU) and COVID-19 anxiety are understudied. Objective In the current study, we aimed to fill the gap by investigating the association between health-related social media use (SMU) and COVID-19 anxiety in light of several individual factors: health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection. We (1) studied the relationship between individual factors and health-related SMU, (2) tested health anxiety as a moderator in the association between health-related SMU and COVID-19 anxiety, and (3) explored a direct effect of experience with COVID-19 on COVID-19 anxiety. Methods Using structural equation modeling, we analyzed cross-sectional data from a representative sample of 2,500 Czech adolescents aged 11-16, 50% girls. Sociodemographic measures, health-related SMU, COVIDCOVID-19 anxiety, health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection were assessed with an anonymous online survey. The data were collected in June 2021. Results We conducted a path analysis to test the main relationships and an additional simple-slopes analysis to explore the moderating effect of health anxiety. Higher health anxiety and eHealth literacy were associated with increased health-related SMU. The effect of experience with COVID-19 infection on both COVID-19 anxiety and health-related SMU was negligible. Health-related SMU and COVID-19 anxiety were positively associated, however, only for adolescents high in health anxiety. For other adolescents, the two variables were unrelated. Conclusion Our findings show that adolescents with higher health anxiety and eHealth literacy engage in health-related SMU more intensively. Furthermore, for adolescents high in health anxiety, the frequency of health-related SMU is associated with the risk of COVID-19 anxiety. This is likely due to differences in media use. Adolescents with high health anxiety may use social media for content that is more likely to lead to COVID-19 anxiety compared to other adolescents. We recommend focusing on the identification of such content, which may lead to more precise recommendations regarding health-related SMU compared to cut-back on the frequency of overall SMU.
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Hulgaard D, Rask CU, Boye H, Larsen PV, Christesen HT, Andersen MS, Jensen TK, Bilenberg N. Health anxiety symptoms in Danish children during the first lockdown period of the COVID-19 pandemic: an Odense Child Cohort study. Nord J Psychiatry 2022; 76:330-337. [PMID: 34591725 DOI: 10.1080/08039488.2021.1970804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has a severe impact on the general population. During the pandemic, children may develop emotional and psychological symptoms, including increased worries about health and illness, known as health anxiety symptoms (HASs). We aimed to explore HAS in 7-9-year-old children from the Danish Odense Child Cohort (OCC) during the first COVID-19 lockdown period in Denmark, and to examine associations with potential risk factors. MATERIAL AND METHODS OCC is a cohort of children born between 2010 and 2012, which originally recruited 2874 of 6707 pregnancies (43%). Among the current OCC population of 2430 singleton children, 994 participated in this study (response rate 40%). Children and their parents filled out questionnaires about child HAS, family exposure to COVID-19 infection and parental HAS. Adjusted odds ratios (aORs) were calculated between high score child HAS (≥90th percentile) and covariates by use of logistic regression. RESULTS Most children (n = 686, 69%) reported few worries about their health. Children reporting high score HAS also had higher levels of internalizing symptoms at age 5; aOR 2.15 (1.20;3.85), p = .010, and higher levels of maternal and paternal HAS; aOR 2.40 (1.44;3.97), p = .001, and 2.00 (1.10;3.65), p = .023, whereas no association with child sex or familial exposure to COVID-19 was detected (n = 65, 6.5%). CONCLUSIONS High score child HAS during the first lockdown period of the COVID-19 pandemic was not associated with family exposure to COVID-19 infection, but to being a more anxious child a priori and to HAS in parents.
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Affiliation(s)
- Ditte Hulgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Charlotte Ulrikka Rask
- Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Research Unit, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henriette Boye
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense, Denmark.,OPEN Patient data Explorative Network (OPEN), University of Southern Denmark, Odense, Denmark
| | - Pia Veldt Larsen
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Henrik Thybo Christesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense, Denmark
| | | | - Tina Kold Jensen
- Odense University Hospital, Hans Christian Andersen Children's Hospital, Odense, Denmark.,IST - Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Niels Bilenberg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Khan YS, Jouda M, Albobali Y, Osman Abouelseoud M, Souid A, AlMeraisi MJ, Alabdulla M. COVID-19 pandemic fears and obsessive-compulsive symptoms in adolescents with pre-existing mental disorders: An exploratory cross-sectional study. Clin Child Psychol Psychiatry 2022; 27:89-103. [PMID: 34049450 PMCID: PMC8814615 DOI: 10.1177/13591045211017606] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. AIM To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. METHODS A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. RESULTS A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant - {r = 0.405, Sig. (two-tailed) = 0.001}. CONCLUSION Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.
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Affiliation(s)
| | - Muayad Jouda
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Albobali
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | | | - Aouatef Souid
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
| | | | - Majid Alabdulla
- Mental Health Service, Hamad Medical Corporation, Doha, Qatar
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