Saudi Cultural Missions Theses & Dissertations
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Item Restricted EVALUATING THE EFFECTIVENESS OF THE SLEEPTRACKER APP FOR DETECTING ANXIETY AND DEPRESSION-RELATED SLEEP DISTURBANCES(University of Bristol, 2025-03-19) Alamoudi, Doaa; Nabney, Ian; Crawley, Esther; Bennett, SarahSleep is necessary for the proper functioning of our bodies and minds because it helps our bodies to recuperate and rebuild while our minds organise and evaluate memories. Poor sleep, on the other hand, can have a severe impact on both physical and emotional well-being, leading to a variety of health problems such as anxiety, depression, heart disease, obesity, dementia, diabetes, and cancer. University students, in particular, are at risk of poor sleep quality and mental health issues, which can exacerbate the risk of anxiety and despair. It is critical to treat sleep disorders and prioritise adequate sleep practises in order to ensure good health and well-being. Many individuals may be unaware they suffer from conditions like insomnia, depression, or anxiety, often because they fail to recognize the symptoms. These issues are typically diagnosed by medical professionals during consultations. While experts understand the connection between poor sleep patterns and mental health, this knowledge gap among the general population highlights the potential for technological intervention. Computer science, particularly through smartphone technology, can bridge this gap by enabling early detection and intervention, helping to preserve mental health. This thesis aims to explore and develop methods using current mobile technology specifically, built-in sensors to diagnose sleep issues and provide interventions for associated mental health problems, focusing on young adults. Existing literature on using mobile sensors to track sleep and mental health reveals several limitations, which this thesis seeks to address. While numerous mobile apps track behavioural signals, such as sleep, and correlate them with mental health, many rely on wearable or non-wearable sensors (e.g., accelerometers, microphones, GPS, light, and screen on/off sensors), but each has limitations in terms of accuracy and usability. This thesis centers on the development of SleepTracker, an app designed to go beyond basic sleep tracking to address mental health concerns like depression and anxiety often associated with insomnia. The SleepTracker app was developed with the goal of accurately detecting sleep duration and disturbances using mobile phone sensors, specifically screen on/off events and accelerometer data. Its development was structured in two distinct phases, each building on the last to progressively enhance the app’s functionality, data accuracy, and user experience. In the first phase, initial development efforts focused on refining the app’s core algorithms through iterative testing. This phase was supported by a Patient and Public Involvement (PPI) session, where users provided feedback on the app’s feasibility and potential benefits. Following this, two field tests were conducted to validate the app’s ability to detect sleep patterns accurately: the first test spanned six nights, while the second test ran for seven nights. The results from these field tests, along with post-test survey feedback, informed the subsequent steps in the app’s development. As the study progressed to the second phase, an enhanced algorithm was introduced to detect sleep disturbances based on screen on/off activity and accelerometer data. Prior to launching this phase, an additional PPI session was held to refine the study’s focus, gathering user insights specifically on the app's aim to investigate links between sleep disturbances and mental health concerns such as anxiety and depression. This 56-day phase involved ongoing data collection and analysis to explore these relationships further, enabling the app to evolve into a tool capable of identifying potential mental health risks associated with sleep issues. To ensure data security and privacy throughout both phases, two separate databases were created: one storing sensitive personal information (e.g., name, email, gender, ethnicity) and another for sleep and sensor data. In the first phase, Firebase was used for data storage; however, due to concerns raised by the ethics committee regarding enhanced data protection, the app transitioned to Amazon Web Services (AWS) in the second phase. This move, along with the separation of databases, was critical in maintaining data integrity and anonymity, providing a strong foundation for ethical compliance and secure data management. At the conclusion of the study, the SleepTracker app’s acceptability was evaluated using both quantitative and qualitative analyses. The quantitative analysis focused on numerical data collected through participant surveys, applying a theoretical framework based on the Technology Acceptance Model (TAM). The qualitative analysis used thematic analysis to explore participants’ experiences with the app, uncovering a range of insights regarding its usability and effectiveness. Together, these analyses provided a holistic understanding of the SleepTracker app’s feasibility and its potential for monitoring mental health. In summary, the SleepTracker app shows promise as a tool for monitoring sleep patterns and identifying potential mental health concerns among young adults. Its integration of advanced technology and data-driven algorithms offers the potential to yield significant insights into the intricate relationship between sleep disturbances and mental health. This research aims to contribute to improved mental well-being and address the challenges posed by sleep-related issues in future health interventions.3 0Item Restricted The Relationship between Child Maltreatment, Religiosity, and Adult-onset Anxiety and Depressive Disorders among Participants in the Saudi National Mental Health Survey (SNMHS)(University of Washington, 2024) Gadi, Ghadah; Sharif, MienahThis dissertation explores the interrelationships among childhood maltreatment (CM), religiosity, and adult-onset depressive and anxiety disorders using data from the Saudi National Mental Health Survey (SNMHS). It addresses whether parental religiosity is associated with CM and differs by gender, the influence of CM on adult religiosity and its gender-dependence, and the association between CM and adult-onset anxiety and depressive disorders with religiosity as a moderating factor. The first study (Chapter 2) investigates the correlation between parental religiosity and CM, finding no overall significant association but a significant protective effect against CM, particularly physical abuse, among males. The second study (chapter 3) explores the impact of CM on adult religiosity, revealing no significant association or gender differences. The third study (Chapter 4) examines the link between CM and adult-onset anxiety and depressive disorders, with religiosity moderating these effects. Sexual abuse significantly increases the risk of depressive disorders, while physical abuse increases anxiety disorder risk. Seeking religious comfort moderates these associations. In conclusion, this dissertation highlights that parental religiosity generally protects against CM, especially physical abuse among males, while CM does not influence adult religiosity. CM is associated with higher risks of mental health disorders, with religious coping moderating these effects. The findings emphasize the need for culturally tailored interventions in Saudi Arabia to promote healthy religious parenting, encourage seeking professional help, and address cultural and gender dynamics influencing CM experiences and mental health outcomes.17 0Item Restricted DUAL BURDEN: HCV ANTIBODY POSITIVITY AND DEPRESSION DIAGNOSIS IN UNITED STATES ADULTS(New York University, 2024-06-24) Alserhani, Asma; Coyle, ChristianaBackground: Hepatitis C virus (HCV) infection and depression are significant public health concerns, with previous studies suggesting a complex relationship between the two conditions. This study aimed to investigate the association between HCV infection and depression among U.S. adults using a nationally representative sample. Methods: A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2015-2020. The study included 8,443 participants aged 18 years and above who completed the depression screening questionnaire and underwent HCV testing. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), and HCV infection was determined by the presence of HCV RNA. Multivariable logistic regression was used to examine the association between HCV infection and depression while adjusting for potential confounders. Results: In the bivariate analysis, HCV-positive individuals had a significantly higher prevalence of depression compared to HCV-negative individuals. However, after adjusting for potential confounders in the multivariable analysis, the association between HCV status and depression was no longer statistically significant. Age, marital status, and smoking status emerged as significant predictors of depression in the adjusted model. Conclusion: This study found a significant association between HCV infection and depression in the bivariate analysis, but this relationship was attenuated after adjusting for potential confounders. The findings highlight the importance of considering multiple risk factors when assessing the mental health of individuals with HCV infection and underscore the need for targeted interventions to prevent and treat depression in high-risk groups.21 0Item Restricted The interplay between thyroid function and mental disorders(Queen Mary University of London, 2023-12-10) Alsharari, Hussain; Marouli, EiriniThe thyroid gland, central to human development, growth, and metabolism, produces crucial hormones, thyroxine (T4) and triiodothyronine (T3), regulated by thyroid stimulating hormone (TSH) from the pituitary gland. Beyond traditional roles, recent advancements reveal an expanded role of thyroid hormones, influencing nervous system regulation and impacting diverse physiological processes. This scientific investigation endeavors to delve comprehensively into the intricate interplay between thyroid function and human health. The primary objectives include elucidating clinical features, risk factors, disease sub-groups, and responses to conventional therapeutic treatments. Genetic variations exert a significant influence on baseline serum hormone levels, contributing notably to the emergence of subclinical thyroid diseases. The focal points of the study are Hashimoto's and Graves' diseases, distinct autoimmune conditions disrupting thyroid function. The aim is to explore not only known causal associations but also potential mechanistic pathways involved in the pathophysiology of these diseases. The research underscores the pivotal roles of both genetic and environmental factors in the development of Hashimoto's and Graves' diseases, thereby emphasizing the imperative need for identifying and understanding relevant risk factors. Furthermore, the investigation accentuates the intricate association between thyroid function and mental health. The study establishes correlations between thyroid function and various mental health conditions, including depression, bipolar disorder, schizophrenia, and cognitive impairment. In advocating for a comprehensive approach to mental health care, the research underscores the nuanced and interconnected relationships between thyroid function and the spectrum of mental health conditions, highlighting the importance of holistic patient evaluation and targeted interventions.9 0Item Restricted Gender and intersectionality: Understanding and Addressing Women's Mental Health and Mental Health Policy within the Cultural Context of Saudi Arabia(University Of Glasgow, 2024-02-06) Alghamdi, NadiaAhmed Alhamd; Melville, CraigBackground: Intersectionality concerns the interconnected nature of social categories (e.g., race, gender, age, education) and how these ‘intersect’ to produce privilege and oppression. In the current context, this helps to understand women's mental health in socially disadvantaged positions, especially how intersections among gender inequality and factors such as socioeconomic status contribute to women’s mental health inequalities and experiences. Yet this remains an under researched area. This study’s overarching aim concerns understanding Saudi Arabian women’s mental health disorders, risks, challenges, and issues. For this, it has three objectives: to review the effects of intersectionality on this group within extant quantitative literature; to identify and explore the significant interactions among variables relating to this population’s social disadvantage and mental ill-health (e.g., gender and the risk of depression); and to analyse Saudi Arabia’s current mental health policy and gender equality. This study’s more specific aims involve furthering understanding of the effects of content, context, and actors behind mental health policies and programmes on Saudi women to help address their mental health needs. It takes the form of three studies. Study 1. This systematic review investigated quantitative methods used to study the intersectionality of multiple social disadvantages in women with common mental disorders. It reviewed studies on the intersectional effects of gender with multiple social disadvantages from the PROGRESS-Plus inequity framework and examined the quantitative methods these studies employ. The most common and means of studying intersectionality in mental health studies in the included studies was statistical interaction analysis. Other methods such as multilevel modelling and mediation decomposition analysis were also used. These robust statistical methods facilitate research on intersectional effects on mental health and improve understanding of the complex intersection of gender and other social disadvantages concerning women’s risk of common mental disorders. Study 2: This study analysed the National Survey of Saudi Food and Drug Authority dataset, a nationally representative sample of individuals aged 18–88 in Saudi Arabia (3,408 participants: 1,753 males and 1,655 females). Evaluating variable risks of depression using the PHQ-2 screening questionnaire, it found significant correlations between depression risk and the variables of gender, education, family income, and employment status. Although a subsequent multivariate analysis found the only significant predictors of depression risk to be female gender and education below the bachelor level. No interaction effects were observed, implying an additive effect of gender and education on the risk of depression. Study 3: This study analysed Saudi Arabia's mental health policies and gender equality. Using Walt and Gilson's health policy analysis framework, it highlights the need to address gender inequalities in the country's mental health policies. It provides evidence-based mental health policy recommendations relating to women in Saudi Arabia about enhancing their mental health and well-being and establishing an equal health system. Conclusions: Examining women’s mental health through an intersectionality lens can help policymakers address Saudi Arabian women’s mental health issue . To reduce inequalities, advances must be made in women’s education, training, employment, socioeconomic status, access and participation, equality, and overall independence. However, this must take place within a wider targeted and tailored reform agenda (legal, policy, political, PR, cultural, religious, economic, careers, educational) within which women must actively participate. Urgent inclusive, deep, and far-reaching intersectional initiatives, adjustments, research and reforms are needed to elevate Saudi women’s circumstances, experiences, and mental health and thereby address the current issue and ultimately improve society overall.42 0Item Restricted The Effect of Physical Exercise as an Adjunctive Treatment to the Usual Treatment for Major Depressive Disorder: An Integrative Review(Saudi Digital Library, 2017) Alsolami, Eman; West, Sandra; Betihavas, VasilikiMajor depressive disorder (MDD) is a leading cause of disability around the world. The current treatment approach for MDD is limited. Physical exercise is a suggested treatment for depression and the use of exercise as an adjunctive therapy to the usual treatment of depression has received significant attention. The aim of this thesis is to evaluate whether physical exercise as an adjunctive therapy leads to an extra reduction in depressive symptoms compared with using the usual treatments alone. An integrative review was conducted by a systematic search in Scopus and PsycINFO databases. The search yielded 100articles, which were narrowed to 15 articles based on inclusion and exclusion criteria. The review found that using exercise as an adjunctive therapy to the usual treatment of depression decreased depressive symptoms more than using the usual treatment alone. It also found that this effect is not influenced by factors such as type of exercise, as aerobic and resistance exercise lead to the same effect. In addition, it found that exercise programs of short- and medium-duration were more effective than programs of a longer duration, and that hospital- and public-based exercise were more effective than home-based exercise. However, this review cannot determine whether the effect of using exercise as an adjunctive therapy to the usual treatments might be different based on the severity of depression and the patient’s age. This review suggests that using short and moderate programs of exercise as an adjunctive therapy to the usual treatment of depression can be an effective way to improve the depressive symptoms among adult patients with MDD.20 0Item Restricted The Effectiveness of Fcial Cues for Automatic Detection of Cognitive Impairment Using In-the-wild Data(Saudi Digital Library, 2023-11-30) Alzahrani, Fatimah; Christensen, Heidi; Maddock, SteveThe development of automatic methods for the early detection of cognitive impairment (CI) has attracted much research interest due to its crucial role in helping people get suitable treatment or care. People with CI may experience various changes in their facial cues, such as eye blink rate and head movement. This thesis aims to investigate the use of facial cues to develop an automatic system for detecting CI using in-the-wild data. Firstly, the 'in-the-wild data' term is defined, and associated challenges are identified by analysing datasets used in previous work. In-the-wild data can affect the reliability of the performance of state-of-the-art approaches. Second, this thesis investigates the automatic detection of neurodegenerative disorder, mild cognitive impairment and functional memory disorder, showing the applicability of detecting health conditions with similar symptoms. Then, a novel multiple thresholds (MTs) approach for detecting an eye blink rate feature is introduced. This approach addresses in-the-wild data challenges by generating multiple thresholds, resulting in a vector of blink rates for each participant. Then, the feasibility of this feature in detecting CI is examined. Other features considered are head turn rate, head turn statistical features, head movement statistical features and low-level features. The results show that these facial features significantly distinguish different health conditions.15 0Item Restricted The Management of New Patients Diagnosed with Major Depressive Disorder in General Practice Surgery: A Clinical Audit(Saudi Digital Library, 2026-10-20) Asiri, Jaber Ali M; Azimi, SafooraIntroduction Major depressive disorder is a mood disorder that may lead to a loss of interest, sadness, or a lack of self-esteem. It is one of the most common cognitive diseases in the United Kingdom, with an estimated incidence of one in six adults. We aimed to conduct a clinical audit to discuss the newly diagnosed depression management guidelines in the National institute for health and care excellence NICE guidelines 2022 in general practice surgery. Methods Based on 22 standards, the clinical audit evaluated GP in conformity with NICE guidelines 2022 [NG222] regarding depression management for new patients. The audit will be compared against the standards and similar audits in the literature review. The data were collected for 77 patients, and statistical analysis was carried out using SPSS Statistics software version 29 (SPSS). Findings The results were significant regarding discussing treatment options and antidepressant preferences according to the patients, such as standards one, three, and five. Also, the pharmacological treatment was statistically significant (p < 0.001). Discussion Pharmacological treatment corresponded significantly to the NICE guidelines 2022, because most patients were on SSRI medications, the first line of treatment recommended for LS and MS depression. However, psychological therapy needed more explanation and adherence, and patient follow-up needed to be improved to ensure that the patient received medications regularly for six months.10 0Item Restricted The Relationship between Depression, Stress-Related Neurobiology, and Incident Heart Failure: Understanding the Neurobiological Mechanisms Underlying Exercise as a Preventive Measure(Saudi Digital Library, 2023-04) Alhamam, Abdulaziz Arif Abdulaziz; Tawakol, AhmedBackground: Depression is associated with risk of developing heart failure (HF). Also, higher stress-related neural activity (SNA) associates with subsequent risk of cardiovascular disease. We investigated whether depression predicts subsequent HF through heightened SNA. Methods: Individuals (N=102,028; median age 57 years; 42.6% male) enrolled in the Mass General Brigham Biobank were identified to study the association of depression and incident HF, subset of 1,227 who underwent clinically indicated 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging were retrospectively identified. SNA was measured using validated methods, as amygdalar metabolic activity corrected for regulatory brain (i.e., medial prefrontal cortical) activity. Depression and subsequent development of HF was determined via medical record review using International Classification of Diseases 10 (ICD-10) codes. Survival analyses using Cox and Kaplan-Meier models were performed. Results: Over a median follow-up period of 3.5 (IQR 2.0-5.0) years, 2,631 (2.6%) individuals developed HF (717 Heart failure with reduced ejection fraction (HFrEF), 1,214 Heart failure with preserved ejection fraction (HFpEF)). Individuals with subsequent HF (versus no HF) had higher baseline SNA (mean Z-score 0.19 ± 1.07 versus -0.08 ± 0.99; p=0.005, adjusted for age and sex). SNA associated with subsequent HF when divided into tertiles (Figure 2B) and as a continuous measure (standardized HR [95% CI]: 1.40 [1.13-1.74], p=0.002, adjusted for age, sex, hypertension, hyperlipidemia, diabetes, and smoking). The association between depression and HF subtype was stronger for HFpEF (1.46 [1.28-1.65], p<0.001) than for HFrEF (1.09 [0.92 -1.3], p=0.32). Conclusion: In this retrospective study of individuals with depression have higher risk of incident HF through heightened SNA with a somewhat stronger association for HFpEF. Understanding the link between depression and subsequent HF may provide important insights into better HF prevention and management strategies.16 0Item Restricted EXAMINING THE RELATIONSHIP BETWEEN ACCULTURATIVE STRESS AND DEPRESSION AMONG SAUDI INTERNATIONAL STUDENTS IN THE USA(Saudi Digital Library, 2023-08) Shawly, Alaa; Delmonico, DavidThis quantitative study explored Saudi international students’ acculturation processes through an examination of the relationship between acculturative stress and depression among Saudi international students in the U.S. Moreover, the study also examined the role of social resources—social support and the use of counseling services—in mediating this relationship. Data was collected through an online survey from 103 Saudi international students enrolled at universities across the U.S. The survey included three scales: the Acculturative Stress Scale for Saudi International Students (ASSSIS) (Bashir & Khalid, 2020), the Beck Depression Inventory (BDI) (Beck et al., 1996), and LEVEL 2–Depression–Adult (PROMIS Emotional Distress– Depression–Short Form) (Nolte et al., 2019). To answer the research questions, several analyses were conducted. A correlation analysis was used to examine the relationship between acculturative stress and depression. In addition, a path analysis was conducted to explore the role of mediator variables—social support and the use of counseling services—in the relationship between acculturative stress and depression. Results reveal a significant relationship between acculturative stress and depression among Saudi international students in the U.S. It was also found that social support and the use of counseling services do not function as mediators for the association between acculturative stress and depression. The results emphasize the importance of the acculturation process for Saudi international students and its impact on depression. Implications for the field of counseling are provided as well as limitations of the current study and potential directions for future research. acculturative stress, depression, Saudi international students, social support, counseling services11 0