Mental Health Status of Expatriate Nurses in Northcentral Saudi Arabia

  • Mohamed Saddik Zaghloul
  • Juliann Saquib
  • Abdulrahman AlMazrou
  • Nazmus SaquibEmail author
Original Paper


Mental health status may vary by nationality among expatriate workers; no conclusive data is available in Saudi Arabia. We invited expatriate nurses employed in governmental hospitals in Al-Qassim, Saudi Arabia to fill out an electronic survey that contained questions on demography (including nationality), lifestyle, job, depression, anxiety, and stress (assessed with DASS-21 scale). We categorized each outcome into normal, mild to moderate, and severe, and used adjusted multinomial logistic regressions for analyses. Nurses (n = 999) were from India (54.1%), the Philippines/Indonesia (37.0%), Pakistan (4.9%) and Arab countries (4.0%). Indian nurses were three times (OR = 2.93; 95% CI 1.84, 4.67), Pakistani nurses were 2.5 times (OR = 2.54; 95% CI 1.07, 6.00), and Arab nurses were five times (OR = 5.65; 95% CI 2.40–13.31) more likely to suffer from severe depression compared to Filipino/Indonesian nurses (reference group). Results were similar for stress. Depression and stress varied significantly by nationality among expatriate nurses.


Depression Anxiety Stress Nationality Nurses Saudi Arabia 



The authors thank the administrators and the staff of General Directorate of Ministry of Health in the Al-Qassim region for facilitating the distribution of this survey to nurses working in the hospitals. We are also grateful to the nurses who took the time to participate in this study. The authors thank Ms. Erin Strotheide for her editorial contributions to this manuscript.


This study was funded by the Deanship of Research at Qassim University, but it had no involvement in the collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Compliance with Ethical Standards

Conflict of interest

The authors declare that we have no conflict of interest.

Ethical Approval

This study was approved by the Qassim Ethics Research Committee.


  1. 1.
    Silvey R. Transnational migration and the gender politics of scale: Indonesian domestic workers in Saudi Arabia. Singap J Trop Geogr. 2004;25(2):1–15.CrossRefGoogle Scholar
  2. 2.
    Farnandez B. Household help? Ethiopian women domestic workers’ labor migration to the Gulf countries. Asian Pac Migr J. 2004;20:433–57.CrossRefGoogle Scholar
  3. 3.
    Alsulaimani AA. Practical competency of Filipino nurses working in Taif city, Kingdom of Saudi Arabia. Saudi J Health Sci. 2014;3(2):85.CrossRefGoogle Scholar
  4. 4.
    Alghamdi MG, Urden LD. Transforming the nursing profession in Saudi Arabia. J Nurs Manag. 2016;24(1).Google Scholar
  5. 5.
    Almalki M, Fitzgerald G, Clark M. Health care system in Saudi Arabia: an overview. East Mediterr Health J. 2011;17(10):784–93.CrossRefGoogle Scholar
  6. 6.
    Tsai Y-C, Liu C-H. Factors and symptoms associated with work stress and health-promoting lifestyles among hospital staff: a pilot study in Taiwan. BMC Health Serv Res. 2012;12(1):199.CrossRefGoogle Scholar
  7. 7.
    Lindert J, Schouler-Ocak M, Heinz A, Priebe S. Mental health, health care utilisation of migrants in Europe. Eur Psychiatry. 2008;23:14–20.CrossRefGoogle Scholar
  8. 8.
    Zahid M, Fido A, Razik M, Mohsen M, El-Sayed A. Psychiatric morbidity among housemaids in Kuwait. Med Princ Pract. 2004;13(5):249–54.CrossRefGoogle Scholar
  9. 9.
    AbuMadini MS, Rahim SI. Psychiatric admission in a general hospital. Patients profile and patterns of service utilization over a decade. Saudi Med J. 2002;23(1):44–50.Google Scholar
  10. 10.
    Al Madni OM, Kharoshah MA, Zaki MK, Ghaleb SS. Hanging deaths in Dammam, Kingdom of Saudi Arabia. J Forensic Leg Med. 2010;17(5):265–8.CrossRefGoogle Scholar
  11. 11.
    Al Ansari A, Hamadeh RR, Ali MK, El Offi A. Suicide in Bahrain in the last decade. Crisis. 2007;28(1):11–5.CrossRefGoogle Scholar
  12. 12.
    Al-Maskari F, Shah SM, Al-Sharhan R, Al-Haj E, Al-Kaabi K, Khonji D, et al. Prevalence of depression and suicidal behaviors among male migrant workers in United Arab Emirates. J Immigr Minor Health. 2011;13(6):1027–32.CrossRefGoogle Scholar
  13. 13.
    Nadim W, AlOtaibi A, Al-Mohaimeed A, Ewid M, Sarhandi M, Saquib J, et al. Depression among migrant workers in Al-Qassim, Saudi Arabia. J Affect Disord. 2016;206:103–8.CrossRefGoogle Scholar
  14. 14.
    Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39.CrossRefGoogle Scholar
  15. 15.
    Norton PJ. Depression Anxiety and Stress Scales (DASS-21): psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20(3):253–65.CrossRefGoogle Scholar
  16. 16.
    Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111–31.CrossRefGoogle Scholar
  17. 17.
    Sarwani SAAL, Abdulla KB, Mandeel MAJ. Prevalence of stress, anxiety and depression among expatriate workers. Bahrain Med Bull. 2013;158(749):1–4.Google Scholar
  18. 18.
    Khalid S, Irfan U, Sheikh S, Faisal M. Frequency of stress and depression in female nurses working in a teaching hospital. Kust Med J. 2010;2:10–4.Google Scholar
  19. 19.
    Badil B, Shah H, Ali SA, Siddiqui A. Occupational stress among nurses of tertiary care hospitals in Karachi, Pakistan. J Dow Univ Health Sci. 2016;10(3).Google Scholar
  20. 20.
    Kane PP. Stress causing psychosomatic illness among nurses. Indian J Occup Environ Med. 2009;13(1):28.CrossRefGoogle Scholar
  21. 21.
    World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: WHO; 2017.Google Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of MedicineSulaiman Al Rajhi CollegesBukairyahSaudi Arabia
  2. 2.College of MedicineQassim UniversityBuraidahSaudi Arabia

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