Awareness of Depression Among Patients with Hematological Conditions in Saudi Arabia: Physicians' Perspective and Attitudes
Authors: Sayed Anwar A. 
Published: February 2021

Introduction: Benign hematological disorders (BHDs) such as anemias and sickle cell disease have a major burden of disease in Saudi Arabia (SA). Their prevalence is estimated to exceed 50% of the total population. and they are responsible for one fifth of total hospital admissions. Although treatable, most of these hematological conditions are of chronic nature and remain without a cure. The chronicity of these conditions poses a great risk of developing depression among patients, especially among those who experience symptoms. The development of depression, besides its own social and psychological burden on patients, it further worsens the impact of these BHDs as it negatively affects patients' compliance and adherence to treatment leading to worse prognosis.
One of the biggest challenges in managing depression, among those with BHDs, is its detection by the treating physician. This study aims to examine physicians' perception and attitude towards depression among their patients.
Methods: A cross-sectional study, in which an anonymized survey was distributed to 29 physicians who are working in SA who treat BHDs. Physicians who cannot read English, are no longer practising or not dealing with patients with hematological conditions were excluded from the study.
The survey had 2 sections to assess physicians' knowledge of depression and their attitudes towards it e.g. willingness to attend mental health training, discussion in current practice and updating working guidelines. A knowledge score (K score) and an attitude score (A score) were calculated based on their survey responses to a maximum of 16 and 4, respectively.
The distribution of K and A scores were determined using Shapiro Wilk Test. Multivariate analysis was used to compare K and A scores according to the independent physicians' variants. Correlations were determined using two-tailed Pearson's correlation coefficient. Statistical significance was denoted at a P value less than 0.05. This study was approved by Taibah University College of Medicine Research Ethics Committee.
Results: Twenty-nine physicians were enrolled in this study, of which 27% were female (n=8). The median physicians' age was 27 years (range 24 - 50 years old). Female physicians were significantly older than male physicians, and subsequently their years of experience was significantly longer (P value &lt; 0.0001). The physicians' specialties included Family Medicine (n=10), Internal Medicine (n=10), Pediatrics (n=2) and others (n=7). All but one physician completed their medical education in SA, and only 2 physicians completed their training outside SA.
Sixteen physicians have referred patients to a mental health specialist in the last 3 years, of which only 2 female physicians (25% of the total female physicians) as compared to 14 male physicians (~67%).The median K and A scores for the cohort was 9 (out of 16) and 2.5 (out of 4), respectively. There was no significant difference between the K score of the male and female physicians, however, female physicians had significantly lower A score. Using 2-way ANOVA to assess if physicians' gender and their referral of patients to mental health specialists affect any of the scores, it was found that gender significantly influence A score (P value &lt; 0.05). There was no statistical difference in K and A scores between physicians based on their place of work, the number of patients seen daily or whether they referred a patient to a mental health specialist in the last 3 years.
Both K and A scores correlated negatively with physicians' years of experience, however, only A scores correlated significantly with years of experience (r=-0.4, P value &lt; 0.01). Upon further grouping of physicians based on their years of experience (&lt;1 year; 1-5 years and &gt; 5 years), physicians with less than 1 year of experience had the highest K and A scores compared to the rest of the cohort.
Conclusion: This study demonstrates that early career physicians are more knowledgeable and have a better attitude towards depression, predominantly among male physicians. These findings indicate that undiagnosed depression among patients with BHDs can be attributed to physicians' knowledge and attitude towards depression. Training programs and practice guidelines should prepare physicians to adopt a holistic approach in dealing with patients with BHDs and actively screen for depression among their patients.

Disclosures
No relevant conflicts of interest to declare.