The importance of national screening for mental health cannot be overstated. Mental health issues, particularly depression and anxiety, have become increasingly prevalent in recent years, posing a significant public health concern (1). Early identification and timely intervention have been shown to improve treatment outcomes and reduce the burden of mental health disorders on individuals, families, and society as a whole (2).

National screening programs can help identify individuals at risk for mental health disorders and facilitate their access to appropriate care. In addition, such programs can provide valuable data for researchers and policymakers, allowing them to better understand the prevalence, risk factors, and demographic characteristics of mental health disorders, and to design targeted interventions to address these issues (3). Furthermore, national screening programs can contribute to reducing the stigma associated with mental health disorders, as they underscore the importance of mental health as a public health priority (4).

Despite the increasing recognition of the importance of mental health, many individuals with depression and anxiety remain undiagnosed and untreated. According to the World Health Organization (5), the global prevalence of depression is estimated to be approximately 4.4% and anxiety disorders at about 3.6%. However, it has been estimated that up to 50% of individuals with these conditions do not receive a formal diagnosis or treatment (6).

There are several reasons for this high rate of undiagnosed mental health disorders. First, depression and anxiety symptoms can be non-specific and easily overlooked, particularly in primary care settings (7). Second, stigma and lack of awareness surrounding mental health can prevent individuals from seeking help (8). Finally, limited access to mental health care services, particularly in low-and middle-income countries, can further exacerbate the problem (9).

Saudi Arabia, like many other countries, faces significant challenges in addressing the mental health needs of its population (10, 11). A recent large national screening using the Patient health questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder 7 (GAD-7) in 2020 showed that the prevalence of Major Depressive Disorders (MDD) is at 13.8% while Generalized Anxiety Disorders were at 11.8% (12).

Several risk factors have been identified for depression and anxiety in Saudi Arabia, including female gender, low income, low educational level, unemployment, and chronic health conditions (12, 13). Furthermore, social factors such as marital status, family structure, and social support can also play a significant role in the development and maintenance of mental health disorders (12, 13).

Given the high prevalence of risk of MDD and GAD in Saudi Arabia and the associated burden on individuals and society, it is crucial to collect recent and frequent national statistics on these mental health disorders. Regularly updated data on the prevalence, risk factors, and demographic characteristics of depression and anxiety can help inform the development and implementation of targeted interventions and policies (1, 12).

Moreover, such data can contribute to raising awareness about mental health issues and combating the stigma associated with these disorders (4). Furthermore, accurate and up-to-date statistics can facilitate international comparisons and enable researchers to better understand the global context of mental health disorders, thereby informing global mental health initiatives and strategies (3).

In conclusion, the importance of national screening for mental health, particularly for depression and anxiety, cannot be overstated. Such programs can help identify individuals at risk, facilitate access to appropriate care, and provide valuable data for researchers, policymakers, and mental health advocates (14). In the context of Saudi Arabia, there is a pressing need for recent and frequent national statistics to inform targeted interventions and policies, reduce stigma, and contribute to the global understanding of mental health issues. Prior research on creating a national mental health screening surveillance system in Saudi Arabia took place in 2020, amid the COVID-19 pandemic. The system underwent testing in four phases, producing consistent and valid results (12, 14, 15). To maintain ongoing mental health monitoring, the National Center for Mental Health Promotion (NCMH) launched an annual program in 2022, utilizing the knowledge and infrastructure established during the 2020 surveillance system. Additionally, the 2020 surveillance system primarily concentrated on epidemic-related factors, such as national lockdowns and social distancing measures. While the new program plans to consider current and future large-scale events, its primary focus lies in addressing demographic and preventive factors, with long-term continuity.

Thus, this study aims to provide a recent mental health screening prevalence, including anxiety and depression screening in the general public and to explore the associated risk factors.

In this cross-sectional study, we achieved a response rate of 65.04% among the 6,015 participants, which is considered satisfactory for a phone interview survey (31). The quota sampling strategy employed in this study ensured an equal representation of both sexes, with 50% of the participants being female. The mean age of participants was 36.45, similar to the general population in Saudi Arabia (32).

The sample prevalence of people at risk of MDD and GAD were found to be 12.7 and 12.4% respectively, which is consistent with previous studies conducted in Saudi Arabia and overall lower than many other countries (12). Although this study results were similar to the results of the 2020 MHSS which were conducted during the COVID-19 epidemic, with the lack of more historical data we could not determine why the results are similar, thus, with the continuity of this national screening program over the coming years more understanding of mental health indicators could be generated. It is important to note that only a small proportion of participants were currently diagnosed and on treatment for depression (1.5%) and anxiety (0.5%), which highlights the potential underdiagnosis and undertreatment of mental health disorders in this population. This assumption is supported by the global prevalence of depression in 5% of adults, with 4% in men and 6% in women (33). Furthermore, a national screening study conducted in 2010 revealed that the 12-month prevalence of any DSM-IV/CIDI disorder is 20.2%, with anxiety disorders are the most common type of disorder, with a lifetime prevalence of 12.3%, followed by mood disorders at 6.8% (34).

Our findings show that sex, region, education, monthly income, smoking cigarette, waterpipe smoking, physical activity, volunteering in the last 30 days, and practicing a daily hobby in the last 30 days were significantly associated with the risk of MDD and GAD. These results are in line with previous research that identified similar factors as predictors of mental health disorders (12, 35, 36).

In our study, females showed a higher risk for both MDD and GAD, which is consistent with previous literature (12, 37). Due to the limited number of prior studies examining regional differences in mental health prevalence, pinpointing a logical explanation proves challenging. However, potential reasons for these disparities may include variations in access to mental health services, cultural factors, socioeconomic differences, or it could be that regional classification is simply a random grouping variable with no real association to mental health (38). Moreover, there is limited information in the literature available on the association between region or city and mental health indicators such as depression or anxiety prevalence. However, existing studies do suggest that regional differences may exist in mental health prevalence (38). The social gradient, which is the relationship between social and economic factors and health outcomes, impacts both the risk of disorder and access to services, ultimately influencing mental health outcomes (38).

The association between lower education and income levels with increased risk of MDD and GAD has been well-documented (39, 40).

Smoking, waterpipe use, and physical inactivity were also significantly associated with increased risk of MDD and GAD, which is consistent with the literature (12, 41, 42). Interestingly, our study discovered a potential link between engaging in volunteer work or pursuing a daily hobby within the past 30 days and a reduced likelihood of being at risk for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). Although this cross-sectional study cannot establish causality, the results may suggest that involvement in such activities could provide behavioral activation and protective effects on mental health. Alternatively, individuals with MDD or GAD might be less able to participate in volunteer work, daily hobbies, or physical activities due to the impact of their mental condition (43–46).

Our findings contribute to the growing body of evidence on mental health risks in Saudi Arabia and the Middle East. The high prevalence of MDD and GAD risk, coupled with low diagnosis and treatment rates, calls for increased efforts in mental health promotion, early detection, and treatment accessibility. Additionally, our study highlights the importance of addressing modifiable risk factors such as smoking, physical inactivity, and socioeconomic disparities through targeted interventions. Nonetheless, it is worth noting that in 2019, Saudi Arabia established the NCMH to spearhead mental health promotion and prevention initiatives. In 2021, over 3,500 pages of mental health awareness content were published by NCMH, targeting prevention programs in schools, universities, and workplaces. Collaboration with educational institutions led to conferences, lectures, and teacher training sessions (47, 48). University programs included mental health promotion groups, student support centers, and over 650 awareness activities (47, 48). Workplace initiatives involved mental health first aid training, awareness sessions, and mental health ambassadors (47, 48). Four digital mental health platforms, including NCMH’s Qareboon app, provided thousands of free consultations (47, 48). NCMH also conducted workshops for mental health professionals, focusing on policies, regulations, disaster response, and specialized skills (47, 48).

Future research should explore longitudinal associations between these factors and mental health outcomes, as well as potential mediators and moderators of these relationships. In addition, there is a need for more comprehensive assessments of mental health disorders and their determinants in the region, which will inform the development and implementation of culturally appropriate and evidence-based interventions.

Limitations of the study include the cross-sectional design, which prevents the establishment of causal relationships between variables. Additionally, the use of self-report measures may introduce response bias. Although our study utilized quota sampling, which can be associated with selection bias risks, it was chosen over random probability sampling due to its previously proven consistency and sensitivity to mental health screening in Saudi Arabia and lower costs (15). Furthermore, employing a proportionally large sample and 52 quotas helps mitigate selection bias (31, 49, 50). Currently, in Saudi Arabia, generating a random national-level sample is only feasible through household surveys, which also have limitations caused by cultural factors. Additionally, the utilization of the ZDataCloud research data collection and governance system improved the quota sampling process by eliminating human selection bias. This enhancement as shown in the results led to a well-balanced sample across the 52 quotas, ensuring a more accurate representation of the targeted population. Nonetheless, the study provides valuable insights into the mental health risks and associated variables in the Saudi Arabian population, contributing to the development of effective mental health interventions and policies.

In conclusion, this cross-sectional study reveals a significant prevalence of individuals at risk for MDD and GAD in Saudi Arabia, and potential underdiagnosis and undertreatment of these mental health disorders. Our findings confirm the association of various factors such as sex, region, education, income, smoking, physical activity, and engagement in hobbies or volunteering with the risk of MDD and GAD. These results underline the need for targeted interventions addressing modifiable risk factors and promoting mental health awareness and treatment accessibility in Saudi Arabia. Future research should investigate longitudinal associations and comprehensive assessments of mental health disorders to inform culturally appropriate, evidence-based interventions. Despite the study’s limitations, it offers valuable insights for developing effective mental health policies and strategies in Saudi Arabia and the Middle East.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Sharik Association for Health Research’s ethics committee (Approval no. 04–2022). The patients/participants provided their written informed consent to participate in this study.

NA and NB participated in the conceptual design and formulation of the research questions. All authors participated in the development and review of the manuscript.

This study was funded by the National Center for Mental Health Promotion.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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