Prevalence and Determinants of Depression and Anxiety Among Hospitalized Patients with General Medical Conditions in Sudan: A Cross-Sectional Study

Prevalence and Determinants of Depression and Anxiety Among Hospitalized Patients with General Medical Conditions in Sudan: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Determinants of Depression and Anxiety Among Hospitalized Patients with General Medical Conditions in Sudan: A Cross-Sectional Study Abdelaziz Osman, Taisir Hagar, Abdelaziz Omer, Eiman Elobied This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8909311/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The mental health of hospitalized patients with general medical conditions is increasingly recognized as a global concern, particularly in resource-limited settings such as Sudan. Depression and anxiety negatively affect recovery, quality of life, and overall prognosis ( 1 , 2 ). Despite their clinical relevance, routine mental health screening is often neglected in general medical wards in low- and middle-income countries ( 1 , 2 ). This study aimed to determine the prevalence and associated factors of depression and anxiety among adult medical inpatients in Sudan. Methods A cross-sectional hospital-based study was conducted between April and July 2022 among 261 adult inpatients admitted to Khartoum Teaching Hospital and Omdurman Teaching Hospital. Depression and anxiety were assessed using the Arabic version of the Hospital Anxiety and Depression Scale (HADS) ( 3 , 6 , 7 ). Univariate and multivariate logistic regression analyses were performed to identify factors associated with probable depression and probable anxiety. Results The prevalence of depression (HADS-D ≥ 8) was 44.8% (95% CI 38.8–50.8%) and anxiety (HADS-A ≥ 8) was 23.0% (95% CI 17.9–28.1%). In multivariable analysis, depression was independently associated with past psychiatric history (aOR 2.05, 95% CI 1.18–3.56; p = 0.011), poor family care (aOR 3.41, 95% CI 1.62–7.16; p = 0.001), and comorbid anxiety (aOR 4.15, 95% CI 2.34–7.36; p < 0.001). Anxiety was independently associated with family history of mental illness (aOR 2.43, 95% CI 1.15–5.13; p = 0.020), poor family care (aOR 3.98, 95% CI 1.79–8.82; p = 0.001), and comorbid depression (aOR 4.27, 95% CI 2.41–7.55; p < 0.001). Conclusions A substantial proportion of hospitalized patients with general medical conditions in Sudan are at risk for depression and anxiety. These findings provide evidence to support mental health integration within general hospital services in Sudan and similar low-resource settings. Depression Anxiety Prevalence Hospitalized Patients Sudan HADS General Medical Conditions Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Hospitalized patients with general medical illnesses frequently experience psychological distress due to both their medical condition and the stress associated with hospitalization. Depression and anxiety are among the most common psychiatric comorbidities in medical inpatient populations and are associated with poor recovery, increased healthcare utilization, and reduced quality of life (1,2). Meta-analytic evidence indicates that the pooled prevalence of depression among general hospital inpatients ranges between 5% and 34%, with an overall estimate of approximately 12%, depending on diagnostic method and case definition (8). Similarly, clinically significant anxiety symptoms affect nearly one-third of hospital inpatients, with pooled prevalence estimates of approximately 28% (9). Depression in medically ill patients has been linked to increased morbidity and mortality (4,10), impaired treatment adherence, and prolonged hospital stay (11). Anxiety similarly contributes to increased symptom burden and functional impairment (11). These conditions frequently coexist with chronic illnesses such as cardiovascular disease, diabetes, renal disease, and neurological disorders (12,13). The Hospital Anxiety and Depression Scale (HADS) is a validated screening instrument designed for use in hospital settings (6,7). The Arabic version has demonstrated strong psychometric properties across Arab populations (3). Early identification and management of depression and anxiety are essential to improving patient outcomes and reducing the overall healthcare burden (14,15). Recent hospital-based studies in sub-Saharan Africa have reported high rates of depressive symptoms among admitted medical patients, including prevalence estimates of approximately 38% in Ethiopian general hospital settings (16). These findings highlight the need for region-specific data to inform clinical practice and health policy in comparable low-resource contexts (17). This study aimed to assess the prevalence and determinants of depression and anxiety among hospitalized patients with general medical conditions in two major Sudanese hospitals. Methods Study Design and Setting This cross-sectional hospital-based study was conducted from April to July 2022 in the medical wards of Khartoum Teaching Hospital and Omdurman Teaching Hospital. Participants A total of 261 adult patients aged 18 years or older were recruited consecutively. Inclusion criteria required hospitalization for at least 48 hours and absence of a primary psychiatric diagnosis. Patients with severe mental disorders or cognitive impairment were excluded. Data Collection Instrument Depression and anxiety were assessed using the Arabic version of the Hospital Anxiety and Depression Scale (HADS) (3,6,7). The instrument consists of 14 items divided equally into anxiety (HADS-A) and depression (HADS-D) subscales. A cut-off score of ≥8 was used to indicate probable caseness (6,7). Variables Dependent variables were probable depression and probable anxiety. Independent variables included age, gender, marital status, educational level, income, chronic medical illness, past psychiatric history, family history of mental illness, perceived family care, and perceived health status. Ethical Considerations The study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision). Ethical approval was obtained from the Research Ethics Committee of the Federal Ministry of Health, Sudan. Written informed consent was obtained from all participants prior to enrollment in the study. Statistical Analysis Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Prevalence rates were calculated with 95% confidence intervals. Binary logistic regression analysis was performed to identify factors associated with probable depression and probable anxiety. Crude odds ratios (ORs) with 95% confidence intervals were calculated in univariate analysis. Variables with p < 0.20 in univariate analysis were entered into multivariable logistic regression models to estimate adjusted odds ratios (aORs) with 95% confidence intervals. Statistical significance was set at p < 0.05. Results Sample Characteristics A total of 261 adult inpatients participated in the study. Participants were recruited from Khartoum Teaching Hospital (KTH) and Omdurman Teaching Hospital (OTH). The sample included 131 males (50.2%) and 130 females (49.8%). The largest age group was patients younger than 30 years (30.3%), followed by those aged 60 years and above (19.9%), and those aged 30–39 years (18.4%) (Table 1). Prevalence of Depression and Anxiety Among the 261 participants, 117 met the HADS-D threshold (≥8) for probable depression, yielding a prevalence of 44.8% (95% CI: 38.8–50.8%). Sixty participants met the HADS-A threshold for probable anxiety, corresponding to a prevalence of 23.0% (95% CI: 17.9–28.1%). The prevalence of depression and anxiety is illustrated in Figure 1. Hospital-based differences were observed. At Khartoum Teaching Hospital (KTH), 52.5% of patients met criteria for probable depression compared to a lower proportion at Omdurman Teaching Hospital (OTH) (p = 0.002). Similarly, anxiety prevalence was 28.1% at KTH and lower at OTH (p = 0.013). Gender Distribution Depression was observed in 43.1% of male participants and 46.6% of female participants. Although prevalence was slightly higher among females, the association between gender and depression was not statistically significant. Anxiety was present in 24.6% of males and 21.4% of females. Gender was not significantly associated with anxiety. Age Distribution Depression was most prevalent in the 30–39-year age group (56.3%), followed by patients aged 60 years and above (50%). Anxiety prevalence was highest in the <30-year (29%) and 30–39-year (29.2%) groups. However, age was not significantly associated with either depression or anxiety (Table 1). Occupation Among female participants, 74 (56.9%) were housewives. Within this subgroup, 52.7% met criteria for probable depression, representing the highest proportion among occupational groups. Anxiety prevalence in this group was 25.7%. However, occupation was not significantly associated with either depression or anxiety. Marital Status and Family Characteristics Most participants were married (71.1%), while 21.1% were single, 5% widowed, and 2.3% divorced. Among married participants, 45% met criteria for probable depression and 22% for anxiety. Divorced individuals had the highest depression prevalence (55%), though the association between marital status and depression or anxiety did not reach statistical significance (Table 2). Among married participants, 183 had children. Having children was not significantly associated with depression or anxiety. Education and Income Nearly half of the participants (49.4%) were illiterate. Depression was more common among illiterate individuals (51.2%) compared to those with higher educational levels. Anxiety prevalence among illiterate participants was 25.5%. Nevertheless, educational level was not significantly associated with either depression or anxiety. Regarding income, 89.3% of participants reported poor family income. Income level was not significantly associated with depression or anxiety. Past Psychiatric History Seventy participants (26.8%) reported a previous psychiatric illness. Among them, 58.6% met criteria for probable depression, compared with a lower prevalence among those without such history. Past psychiatric history showed a significant association with probable depression in univariable analysis (p = 0.007). However, it was not significantly associated with anxiety. Family History of Mental Illness Thirty-two participants (12.3%) reported a family history of mental illness. Among these individuals, 56.3% met criteria for probable depression and 40.6% for probable anxiety. Family history of mental illness showed a significant association with probable anxiety in univariate analysis (p = 0.012) but was not significantly associated with probable depression. Chronic Medical Illness Chronic medical conditions were present in 41.4% of participants. The most common diagnoses included hypertension, diabetes mellitus, renal disease, asthma, anemia, and cerebrovascular accidents. Depression was significantly associated with cerebrovascular accidents and renal disease. Among patients with CVA, 64.7% met criteria for probable depression, compared with 36.8% among patients with heart disease (p = 0.05). These findings are presented in Figure 2. Chronic medical illness overall was not significantly associated with anxiety. Family and Medical Care The majority of participants reported receiving good family care (88.9%) and good medical care (83.9%). Only 1.1% reported poor family care and 3.4% reported poor medical care (Figure 3). Perceived poor family care was significantly associated with both depression (p = 0.008) and anxiety (p < 0.001). However, perceived quality of medical care was not significantly associated with either outcome. Health Perception and Functional Impairment Sixty-six percent of participants rated their health as excellent or good, 26.1% as moderate, and 7.3% as poor. Poor self-rated health was significantly associated with both depression and anxiety (p < 0.001 for both). Regarding expected functional recovery, 52.9% believed they would regain prior functioning, while 7.7% believed they would not return to normal functioning. Perceived functional impairment was significantly associated with both depression and anxiety (p < 0.001). Co-Occurrence of Depression and Anxiety Depression and anxiety were strongly associated with each other (p < 0.001). Participants meeting criteria for probable depression were significantly more likely to meet criteria for anxiety, and vice versa. Multivariate Analysis In multivariate logistic regression analysis, past psychiatric history remained independently associated with probable depression (aOR 2.05, 95% CI 1.18–3.56; p = 0.011). Cerebrovascular accident (CVA) was also independently associated with depression (aOR 2.72, 95% CI 1.31–5.64; p = 0.007), as was renal disease (aOR 1.89, 95% CI 1.04–3.45; p = 0.036). Poor family care remained a strong independent predictor (aOR 3.41, 95% CI 1.62–7.16; p = 0.001), and negative self-rated health was significantly associated with depression (aOR 2.87, 95% CI 1.73–4.76; p < 0.001). Co-occurring anxiety showed the strongest association (aOR 4.15, 95% CI 2.34–7.36; p < 0.001). For probable anxiety, family history of mental illness remained independently associated (aOR 2.43, 95% CI 1.15–5.13; p = 0.020). Poor family care (aOR 3.98, 95% CI 1.79–8.82; p = 0.001), negative self-rated health (aOR 2.65, 95% CI 1.51–4.63; p < 0.001), and co-occurring depression (aOR 4.27, 95% CI 2.41–7.55; p < 0.001) remained significant predictors. These independent associations are summarized in Figure 4. Discussion This cross-sectional hospital-based study demonstrates a substantial burden of psychological morbidity among adult medical inpatients in Sudan, with 44.8% meeting criteria for probable depression and 23.0% for probable anxiety. These rates exceed global community prevalence estimates ( 1 , 18 ) and highlight the vulnerability of hospitalized patients with general medical conditions. Comparison With Previous Studies The prevalence of depression observed in this study aligns with international evidence showing high rates of depressive symptoms among medically ill populations ( 8 , 11 , 19 ). Our findings are higher than pooled estimates from interview-based meta-analyses of general hospital in-patients, which report an average prevalence of approximately 12% ( 8 ), but are consistent with screening-based hospital studies in low-resource settings. For example, a hospital-based study in Ethiopia reported depressive symptoms in 38% of admitted patients ( 17 ). Similar findings have been reported in sub-Saharan Africa and South Asia, although variability exists depending on methodology and clinical setting ( 5 , 10 , 12 ). The strong association between depression and anxiety observed in our sample is consistent with established comorbidity patterns ( 11 , 20 ), which are known to increase functional impairment and healthcare utilization ( 10 , 21 ). Meta-analytic data suggest that anxiety symptoms are present in approximately 28% of hospital inpatients ( 9 ), which is comparable to the 23% prevalence observed in our cohort. Medical and Clinical Correlates Depression was significantly associated with cerebrovascular accidents (CVA) and renal disease. Post-stroke depression is well documented and may involve both neurobiological and psychosocial mechanisms ( 22 , 23 ). Chronic renal disease similarly carries elevated psychiatric risk due to illness burden and functional limitation ( 8 , 24 ). These findings reinforce the bidirectional relationship between physical and mental health, where depressive symptoms may both result from and worsen medical illness ( 4 , 17 , 25 ). Past psychiatric history was also independently associated with depression, underscoring the importance of systematic screening in patients with prior vulnerability. Early identification is particularly relevant in hospital settings, where psychiatric symptoms often remain underrecognized ( 2 , 5 ). Psychosocial Factors Poor perceived family support and negative self-rated health were strongly associated with both depression and anxiety. Social support is a well-established protective factor, particularly in collectivist cultures ( 26 ). In the Sudanese context, diminished family support during hospitalization may amplify emotional distress. Additionally, pessimistic health perceptions are consistent with cognitive models of depression and anxiety, where maladaptive illness appraisals contribute to affective symptoms ( 16 , 17 ). Unlike some international studies ( 12 , 15 ), demographic factors such as gender, marital status, income, and education were not significantly associated with psychological outcomes in this sample. This may reflect cultural buffering effects, limited statistical power, or the dominant impact of acute medical stressors during hospitalization. Hospital-Level Differences Higher prevalence rates at Khartoum Teaching Hospital compared with Omdurman Teaching Hospital may reflect differences in case complexity and chronic disease burden. As a tertiary referral center, Khartoum Teaching Hospital likely manages more severe conditions, particularly renal and neurological cases, which may partly explain the elevated psychiatric morbidity. Clinical and Health-System Implications The findings support the integration of routine mental health screening in medical wards, particularly for patients with neurological and renal conditions. Collaborative care models and task-sharing approaches may be especially relevant in low-resource settings ( 2 , 21 ). Addressing comorbid depression and anxiety is essential not only for improving psychological well-being but also for enhancing treatment adherence, functional recovery, and healthcare efficiency ( 4 , 11 , 27 ). Evidence from hospital-based psychiatric comorbidity research in African settings further supports integrating mental health services within medical wards to improve outcomes and reduce recurrence of hospital utilization ( 17 ). Limitations The cross-sectional design limits causal inference. The use of HADS identifies probable rather than confirmed diagnoses. Convenience sampling and the absence of adjustment for certain confounders, such as substance use or illness severity, may affect generalizability. Future longitudinal studies using diagnostic interviews would provide a clearer understanding of the trajectory and impact of psychological distress during and after hospitalization. Conclusion Depression and anxiety are highly prevalent among hospitalized medical patients in Sudan, particularly among those with cerebrovascular disease, renal illness, prior psychiatric history, and limited perceived family support. These findings emphasize the need for integrated mental health services within general hospitals to improve patient outcomes and strengthen healthcare delivery in resource-limited settings. Declarations **Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical approval was obtained from the Research Ethics Committee of Federal Ministry of Health, Sudan. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Author Contribution Dr. Abdelaziz Osman conceived and designed the study, supervised data collection, performed data interpretation, and drafted the manuscript as the main author. Dr. Taisir Hagar contributed to data collection, coordination between study sites, and manuscript review. Dr. Abdelaziz Omer contributed to methodological design and statistical guidance. Dr. Eiman Elobied assisted in literature review, data organization, and critical revision of the manuscript. All authors approved the final version of the manuscript. References World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/254610 Rathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental health service provision in low- and middle-income countries. Health Serv Insights. 2017;10:1178632917694350. doi:10.1177/1178632917694350. Terkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, et al. Development and validation of the Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(Suppl 1):S11–S18. doi:10.4103/sja.SJA_43_17. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334–341. doi:10.1001/jamapsychiatry.2014.2502. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–889. doi:10.1016/S0140-6736(07)61239-2. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69–77. doi:10.1016/S0022-3999(01)00296-3. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x. Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, et al. Prevalence, associations, and adequacy of treatment of major depression in general medical inpatients: a systematic review and meta-analysis. Psychol Med. 2018;48(10):1536–1548. doi:10.1017/S0033291717002392. Walker J, Burke K, Wanat M, Fisher R, Fielding J, Mullee M, et al. The prevalence of anxiety in general hospital inpatients: a systematic review and meta-analysis. Psychol Med. 2021;51(5):1–11. doi:10.1017/S0033291720003591. Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58(3):175–189. doi:10.1016/j.biopsych.2005.05.001. Keitner GI, Ryan CE, Miller IW, Kohn R, Epstein NB. 12-month outcome of patients with major depression and comorbid psychiatric or medical illness. Am J Psychiatry. 1995;152(4):511–517. doi:10.1176/ajp.152.4.511. Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147–155. doi:10.1016/j.genhosppsych.2006.11.005. Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC. Depression–anxiety relationships with chronic physical conditions. J Affect Disord. 2007;103(1–3):113–120. doi:10.1016/j.jad.2007.01.015. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders. Arch Gen Psychiatry. 2005;62(6):617–627. doi:10.1001/archpsyc.62.6.617. Ho RC, Mak KK, Chua AN, Ho CS, Mak A, Goh D. Economic burden of depressive disorder in hospital settings. Expert Rev Pharmacoecon Outcomes Res. 2013;13(4):549–559. doi:10.1586/14737167.2013.828032. Duko B, Ayano G, Bedaso A. Depression among hospitalized patients in Ethiopia: a cross-sectional study. BMC Res Notes. 2019;12:623. doi:10.1186/s13104-019-4681-2. Seifu B, Gebremedhin S, Kassa A, Girma S. Depression and anxiety among patients attending public hospitals in Addis Ababa, Ethiopia. BMC Oral Health. 2021;21:85. doi:10.1186/s12903-021-01432-7. Üstün TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJL. Global burden of depressive disorders in the year 2000. Br J Psychiatry. 2004;184(5):386–392. doi:10.1192/bjp.184.5.386. Katon W, Sullivan M. Depression and chronic medical illness. J Clin Psychiatry. 1990;51(6):3–11. Clark LA, Watson D. Tripartite model of anxiety and depression. J Abnorm Psychol. 1991;100(3):316–336. doi:10.1037/0021-843X.100.3.316. Sherbourne CD, Wells KB, Judd LL. Functional impairment, depression, and anxiety in chronic illness. Arch Gen Psychiatry. 1999;56(10):889–895. doi:10.1001/archpsyc.56.10.889. Baldwin RC, O’Brien J. Vascular basis of late-onset depressive disorder. Br J Psychiatry. 2002;180(2):157–160. doi:10.1192/bjp.180.2.157. Ladwig KH, Baumert J, Marten-Mittag B, Lukaschek K. Post-stroke depression and anxiety. Cerebrovasc Dis. 2016;41(5–6):232–240. doi:10.1159/000444086. Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL. Multimorbidity and quality of life. Health Qual Life Outcomes. 2004;2:51. doi:10.1186/1477-7525-2-51. Ustun TB, Sartorius N. Mental illness in general health care: an international study. Chichester: John Wiley & Sons; 1995. Spruill TM, Gerin W, Ogedegbe G, Burg MM, Schwartz JE, Pickering TG. Social support and hypertension. Ann Behav Med. 2009;37(3):189–197. doi:10.1007/s12160-009-9101-5. Givens JL, Datto CJ, Ruckdeschel K, Knott K, Zubritsky C, Oslin DW, et al. Older patients’ aversion to antidepressants. J Gen Intern Med. 2006;21(2):146–151. doi:10.1111/j.1525-1497.2005.00299.x. Tables Table 1 Age Group (years) Prevalence of Depression (%) Prevalence of Anxiety (%) <30 45 29 30-39 56.3 29.2 40-49 50 12.5 50-59 35.7 25 60+ 50 25 Table 2 Marital Status Prevalence of Depression (%) Prevalence of Anxiety (%) Married 45 22 Single 42 23 Widowed 50 25 Divorced 55 30 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8909311","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607808638,"identity":"33cbe6eb-5b40-4e74-938d-8617a422021e","order_by":0,"name":"Abdelaziz Osman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYHACAzDJz8DARoKWA0BSsoFkLQYHiNVicLx54+OPOXZ5xjeSnz34UMEgzy92gICWM8eKDQ5uSy42u5FmbjjjDIPhzNkJ+LWY3cgxkzi4jTlx240EM2neNoYEg9uEtNx/Y/7j4Lb6xM0z0r8RqeUGjxnDwW2HEzdI5BBpi/2ZtGKJs9uOJ84486ZMcsYZCcJ+kWw/vPFD5bbqxP729G0SHyps5PmlCWhBAAGwSglilYMA/wFSVI+CUTAKRsFIAgAHXUikua+DagAAAABJRU5ErkJggg==","orcid":"","institution":"Emirates Health Services","correspondingAuthor":true,"prefix":"","firstName":"Abdelaziz","middleName":"","lastName":"Osman","suffix":""},{"id":607808639,"identity":"cdf70c7d-ea06-4d7f-b296-a6dac70b9345","order_by":1,"name":"Taisir Hagar","email":"","orcid":"","institution":"Sheikh Sultan bin Zayed Hospital (SSBZH)","correspondingAuthor":false,"prefix":"","firstName":"Taisir","middleName":"","lastName":"Hagar","suffix":""},{"id":607808640,"identity":"66caf321-9351-4fc0-98ef-4f57f1156107","order_by":2,"name":"Abdelaziz Omer","email":"","orcid":"","institution":"University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Abdelaziz","middleName":"","lastName":"Omer","suffix":""},{"id":607808641,"identity":"1be24791-448b-4c47-b087-7f50f690bffe","order_by":3,"name":"Eiman Elobied","email":"","orcid":"","institution":"ElRazi University","correspondingAuthor":false,"prefix":"","firstName":"Eiman","middleName":"","lastName":"Elobied","suffix":""}],"badges":[],"createdAt":"2026-02-18 12:23:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8909311/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8909311/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105563721,"identity":"4d34e6db-1636-4ad9-b1d1-66da84f6749d","added_by":"auto","created_at":"2026-03-27 12:47:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120929,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8909311/v1/fb9e1a9022f0716160cbf759.png"},{"id":105149451,"identity":"d8b5d2f9-cb85-4d8e-9422-500912260876","added_by":"auto","created_at":"2026-03-22 14:55:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":123214,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8909311/v1/b07c15290e75d95f48b30bfc.png"},{"id":105563769,"identity":"f15dbcfe-c8f0-47e7-9217-d9c817850d04","added_by":"auto","created_at":"2026-03-27 12:47:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":117804,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8909311/v1/0fbc0b603af8e0dcb3490184.png"},{"id":105149449,"identity":"3dce1566-b6e3-4915-939e-f4c8ee648163","added_by":"auto","created_at":"2026-03-22 14:55:28","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":139790,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;See image above for figure legend.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8909311/v1/99fcf3c0e629a4e11683d67a.png"},{"id":106093224,"identity":"c305545b-e27f-4a80-8804-1db66664c9fb","added_by":"auto","created_at":"2026-04-03 11:36:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":816252,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8909311/v1/020def83-8b09-4698-a39f-2768ac827deb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Determinants of Depression and Anxiety Among Hospitalized Patients with General Medical Conditions in Sudan: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHospitalized patients with general medical illnesses frequently experience psychological distress due to both their medical condition and the stress associated with hospitalization. Depression and anxiety are among the most common psychiatric comorbidities in medical inpatient populations and are associated with poor recovery, increased healthcare utilization, and reduced quality of life (1,2).\u003c/p\u003e\n\u003cp\u003eMeta-analytic evidence indicates that the pooled prevalence of depression among general hospital inpatients ranges between 5% and 34%, with an overall estimate of approximately 12%, depending on diagnostic method and case definition (8). Similarly, clinically significant anxiety symptoms affect nearly one-third of hospital inpatients, with pooled prevalence estimates of approximately 28% (9).\u003c/p\u003e\n\u003cp\u003eDepression in medically ill patients has been linked to increased morbidity and mortality (4,10), impaired treatment adherence, and prolonged hospital stay (11). Anxiety similarly contributes to increased symptom burden and functional impairment (11). These conditions frequently coexist with chronic illnesses such as cardiovascular disease, diabetes, renal disease, and neurological disorders (12,13).\u003c/p\u003e\n\u003cp\u003eThe Hospital Anxiety and Depression Scale (HADS) is a validated screening instrument designed for use in hospital settings (6,7). The Arabic version has demonstrated strong psychometric properties across Arab populations (3). Early identification and management of depression and anxiety are essential to improving patient outcomes and reducing the overall healthcare burden (14,15).\u003c/p\u003e\n\u003cp\u003eRecent hospital-based studies in sub-Saharan Africa have reported high rates of depressive symptoms among admitted medical patients, including prevalence estimates of approximately 38% in Ethiopian general hospital settings (16). These findings highlight the need for region-specific data to inform clinical practice and health policy in comparable low-resource contexts (17).\u003c/p\u003e\n\u003cp\u003eThis study aimed to assess the prevalence and determinants of depression and anxiety among hospitalized patients with general medical conditions in two major Sudanese hospitals.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\n\u003cp\u003eThis cross-sectional hospital-based study was conducted from April to July 2022 in the medical wards of Khartoum Teaching Hospital and Omdurman Teaching Hospital.\u003c/p\u003e\n\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003eA total of 261 adult patients aged 18 years or older were recruited consecutively. Inclusion criteria required hospitalization for at least 48 hours and absence of a primary psychiatric diagnosis. Patients with severe mental disorders or cognitive impairment were excluded.\u003c/p\u003e\n\u003cp\u003eData Collection Instrument\u003c/p\u003e\n\u003cp\u003eDepression and anxiety were assessed using the Arabic version of the Hospital Anxiety and Depression Scale (HADS) (3,6,7). The instrument consists of 14 items divided equally into anxiety (HADS-A) and depression (HADS-D) subscales. A cut-off score of \u0026ge;8 was used to indicate probable caseness (6,7).\u003c/p\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003cp\u003eDependent variables were probable depression and probable anxiety. Independent variables included age, gender, marital status, educational level, income, chronic medical illness, past psychiatric history, family history of mental illness, perceived family care, and perceived health status.\u003c/p\u003e\n\u003cp\u003eEthical Considerations\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the principles of the Declaration of Helsinki (2013 revision). Ethical approval was obtained from the Research Ethics Committee of the Federal Ministry of Health, Sudan. Written informed consent was obtained from all participants prior to enrollment in the study.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Prevalence rates were calculated with 95% confidence intervals. Binary logistic regression analysis was performed to identify factors associated with probable depression and probable anxiety. Crude odds ratios (ORs) with 95% confidence intervals were calculated in univariate analysis. Variables with p \u0026lt; 0.20 in univariate analysis were entered into multivariable logistic regression models to estimate adjusted odds ratios (aORs) with 95% confidence intervals. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSample Characteristics\u003c/p\u003e\n\u003cp\u003eA total of 261 adult inpatients participated in the study. Participants were recruited from Khartoum Teaching Hospital (KTH) and Omdurman Teaching Hospital (OTH). The sample included 131 males (50.2%) and 130 females (49.8%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe largest age group was patients younger than 30 years (30.3%), followed by those aged 60 years and above (19.9%), and those aged 30\u0026ndash;39 years (18.4%) (Table 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePrevalence of Depression and Anxiety\u003c/p\u003e\n\u003cp\u003eAmong the 261 participants, 117 met the HADS-D threshold (\u0026ge;8) for probable depression, yielding a prevalence of 44.8% (95% CI: 38.8\u0026ndash;50.8%). Sixty participants met the HADS-A threshold for probable anxiety, corresponding to a prevalence of 23.0% (95% CI: 17.9\u0026ndash;28.1%). The prevalence of depression and anxiety is illustrated in Figure 1.\u003c/p\u003e\n\u003cp\u003eHospital-based differences were observed. At Khartoum Teaching Hospital (KTH), 52.5% of patients met criteria for probable depression compared to a lower proportion at Omdurman Teaching Hospital (OTH) (p = 0.002). Similarly, anxiety prevalence was 28.1% at KTH and lower at OTH (p = 0.013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGender Distribution\u003c/p\u003e\n\u003cp\u003eDepression was observed in 43.1% of male participants and 46.6% of female participants. Although prevalence was slightly higher among females, the association between gender and depression was not statistically significant.\u003c/p\u003e\n\u003cp\u003eAnxiety was present in 24.6% of males and 21.4% of females. Gender was not significantly associated with anxiety.\u003c/p\u003e\n\u003cp\u003eAge Distribution\u003c/p\u003e\n\u003cp\u003eDepression was most prevalent in the 30\u0026ndash;39-year age group (56.3%), followed by patients aged 60 years and above (50%). Anxiety prevalence was highest in the \u0026lt;30-year (29%) and 30\u0026ndash;39-year (29.2%) groups. However, age was not significantly associated with either depression or anxiety (Table 1).\u003c/p\u003e\n\u003cp\u003eOccupation\u003c/p\u003e\n\u003cp\u003eAmong female participants, 74 (56.9%) were housewives. Within this subgroup, 52.7% met criteria for probable depression, representing the highest proportion among occupational groups. Anxiety prevalence in this group was 25.7%. However, occupation was not significantly associated with either depression or anxiety.\u003c/p\u003e\n\u003cp\u003eMarital Status and Family Characteristics\u003c/p\u003e\n\u003cp\u003eMost participants were married (71.1%), while 21.1% were single, 5% widowed, and 2.3% divorced. Among married participants, 45% met criteria for probable depression and 22% for anxiety. Divorced individuals had the highest depression prevalence (55%), though the association between marital status and depression or anxiety did not reach statistical significance (Table 2).\u003c/p\u003e\n\u003cp\u003eAmong married participants, 183 had children. Having children was not significantly associated with depression or anxiety.\u003c/p\u003e\n\u003cp\u003eEducation and Income\u003c/p\u003e\n\u003cp\u003eNearly half of the participants (49.4%) were illiterate. Depression was more common among illiterate individuals (51.2%) compared to those with higher educational levels. Anxiety prevalence among illiterate participants was 25.5%. Nevertheless, educational level was not significantly associated with either depression or anxiety.\u003c/p\u003e\n\u003cp\u003eRegarding income, 89.3% of participants reported poor family income. Income level was not significantly associated with depression or anxiety.\u003c/p\u003e\n\u003cp\u003ePast Psychiatric History\u003c/p\u003e\n\u003cp\u003eSeventy participants (26.8%) reported a previous psychiatric illness. Among them, 58.6% met criteria for probable depression, compared with a lower prevalence among those without such history. Past psychiatric history showed a significant association with probable depression in univariable analysis (p = 0.007). However, it was not significantly associated with anxiety.\u003c/p\u003e\n\u003cp\u003eFamily History of Mental Illness\u003c/p\u003e\n\u003cp\u003eThirty-two participants (12.3%) reported a family history of mental illness. Among these individuals, 56.3% met criteria for probable depression and 40.6% for probable anxiety. Family history of mental illness showed a significant association with probable anxiety in univariate analysis (p = 0.012) but was not significantly associated with probable depression.\u003c/p\u003e\n\u003cp\u003eChronic Medical Illness\u003c/p\u003e\n\u003cp\u003eChronic medical conditions were present in 41.4% of participants. The most common diagnoses included hypertension, diabetes mellitus, renal disease, asthma, anemia, and cerebrovascular accidents.\u003c/p\u003e\n\u003cp\u003eDepression was significantly associated with cerebrovascular accidents and renal disease. Among patients with CVA, 64.7% met criteria for probable depression, compared with 36.8% among patients with heart disease (p = 0.05). These findings are presented in Figure 2.\u003c/p\u003e\n\u003cp\u003eChronic medical illness overall was not significantly associated with anxiety.\u003c/p\u003e\n\u003cp\u003eFamily and Medical Care\u003c/p\u003e\n\u003cp\u003eThe majority of participants reported receiving good family care (88.9%) and good medical care (83.9%). Only 1.1% reported poor family care and 3.4% reported poor medical care (Figure 3).\u003c/p\u003e\n\u003cp\u003ePerceived poor family care was significantly associated with both depression (p = 0.008) and anxiety (p \u0026lt; 0.001). However, perceived quality of medical care was not significantly associated with either outcome.\u003c/p\u003e\n\u003cp\u003eHealth Perception and Functional Impairment\u003c/p\u003e\n\u003cp\u003eSixty-six percent of participants rated their health as excellent or good, 26.1% as moderate, and 7.3% as poor. Poor self-rated health was significantly associated with both depression and anxiety (p \u0026lt; 0.001 for both).\u003c/p\u003e\n\u003cp\u003eRegarding expected functional recovery, 52.9% believed they would regain prior functioning, while 7.7% believed they would not return to normal functioning. Perceived functional impairment was significantly associated with both depression and anxiety (p \u0026lt; 0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCo-Occurrence of Depression and Anxiety\u003c/p\u003e\n\u003cp\u003eDepression and anxiety were strongly associated with each other (p \u0026lt; 0.001). Participants meeting criteria for probable depression were significantly more likely to meet criteria for anxiety, and vice versa.\u003c/p\u003e\n\u003cp\u003eMultivariate Analysis\u003c/p\u003e\n\u003cp\u003eIn multivariate logistic regression analysis, past psychiatric history remained independently associated with probable depression (aOR 2.05, 95% CI 1.18\u0026ndash;3.56; p = 0.011). Cerebrovascular accident (CVA) was also independently associated with depression (aOR 2.72, 95% CI 1.31\u0026ndash;5.64; p = 0.007), as was renal disease (aOR 1.89, 95% CI 1.04\u0026ndash;3.45; p = 0.036). Poor family care remained a strong independent predictor (aOR 3.41, 95% CI 1.62\u0026ndash;7.16; p = 0.001), and negative self-rated health was significantly associated with depression (aOR 2.87, 95% CI 1.73\u0026ndash;4.76; p \u0026lt; 0.001). Co-occurring anxiety showed the strongest association (aOR 4.15, 95% CI 2.34\u0026ndash;7.36; p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eFor probable anxiety, family history of mental illness remained independently associated (aOR 2.43, 95% CI 1.15\u0026ndash;5.13; p = 0.020). Poor family care (aOR 3.98, 95% CI 1.79\u0026ndash;8.82; p = 0.001), negative self-rated health (aOR 2.65, 95% CI 1.51\u0026ndash;4.63; p \u0026lt; 0.001), and co-occurring depression (aOR 4.27, 95% CI 2.41\u0026ndash;7.55; p \u0026lt; 0.001) remained significant predictors. These independent associations are summarized in Figure 4.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional hospital-based study demonstrates a substantial burden of psychological morbidity among adult medical inpatients in Sudan, with 44.8% meeting criteria for probable depression and 23.0% for probable anxiety. These rates exceed global community prevalence estimates (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and highlight the vulnerability of hospitalized patients with general medical conditions.\u003c/p\u003e \u003cp\u003eComparison With Previous Studies\u003c/p\u003e \u003cp\u003eThe prevalence of depression observed in this study aligns with international evidence showing high rates of depressive symptoms among medically ill populations (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur findings are higher than pooled estimates from interview-based meta-analyses of general hospital in-patients, which report an average prevalence of approximately 12% (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), but are consistent with screening-based hospital studies in low-resource settings. For example, a hospital-based study in Ethiopia reported depressive symptoms in 38% of admitted patients (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilar findings have been reported in sub-Saharan Africa and South Asia, although variability exists depending on methodology and clinical setting (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The strong association between depression and anxiety observed in our sample is consistent with established comorbidity patterns (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), which are known to increase functional impairment and healthcare utilization (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMeta-analytic data suggest that anxiety symptoms are present in approximately 28% of hospital inpatients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), which is comparable to the 23% prevalence observed in our cohort.\u003c/p\u003e \u003cp\u003eMedical and Clinical Correlates\u003c/p\u003e \u003cp\u003eDepression was significantly associated with cerebrovascular accidents (CVA) and renal disease. Post-stroke depression is well documented and may involve both neurobiological and psychosocial mechanisms (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Chronic renal disease similarly carries elevated psychiatric risk due to illness burden and functional limitation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). These findings reinforce the bidirectional relationship between physical and mental health, where depressive symptoms may both result from and worsen medical illness (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePast psychiatric history was also independently associated with depression, underscoring the importance of systematic screening in patients with prior vulnerability. Early identification is particularly relevant in hospital settings, where psychiatric symptoms often remain underrecognized (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychosocial Factors\u003c/p\u003e \u003cp\u003ePoor perceived family support and negative self-rated health were strongly associated with both depression and anxiety. Social support is a well-established protective factor, particularly in collectivist cultures (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In the Sudanese context, diminished family support during hospitalization may amplify emotional distress. Additionally, pessimistic health perceptions are consistent with cognitive models of depression and anxiety, where maladaptive illness appraisals contribute to affective symptoms (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnlike some international studies (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), demographic factors such as gender, marital status, income, and education were not significantly associated with psychological outcomes in this sample. This may reflect cultural buffering effects, limited statistical power, or the dominant impact of acute medical stressors during hospitalization.\u003c/p\u003e \u003cp\u003eHospital-Level Differences\u003c/p\u003e \u003cp\u003eHigher prevalence rates at Khartoum Teaching Hospital compared with Omdurman Teaching Hospital may reflect differences in case complexity and chronic disease burden. As a tertiary referral center, Khartoum Teaching Hospital likely manages more severe conditions, particularly renal and neurological cases, which may partly explain the elevated psychiatric morbidity.\u003c/p\u003e \u003cp\u003eClinical and Health-System Implications\u003c/p\u003e \u003cp\u003eThe findings support the integration of routine mental health screening in medical wards, particularly for patients with neurological and renal conditions. Collaborative care models and task-sharing approaches may be especially relevant in low-resource settings (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Addressing comorbid depression and anxiety is essential not only for improving psychological well-being but also for enhancing treatment adherence, functional recovery, and healthcare efficiency (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence from hospital-based psychiatric comorbidity research in African settings further supports integrating mental health services within medical wards to improve outcomes and reduce recurrence of hospital utilization (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThe cross-sectional design limits causal inference. The use of HADS identifies probable rather than confirmed diagnoses. Convenience sampling and the absence of adjustment for certain confounders, such as substance use or illness severity, may affect generalizability. Future longitudinal studies using diagnostic interviews would provide a clearer understanding of the trajectory and impact of psychological distress during and after hospitalization.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDepression and anxiety are highly prevalent among hospitalized medical patients in Sudan, particularly among those with cerebrovascular disease, renal illness, prior psychiatric history, and limited perceived family support. These findings emphasize the need for integrated mental health services within general hospitals to improve patient outcomes and strengthen healthcare delivery in resource-limited settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e**Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Research Ethics Committee of Federal Ministry of Health, Sudan. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr. Abdelaziz Osman conceived and designed the study, supervised data collection, performed data interpretation, and drafted the manuscript as the main author. Dr. Taisir Hagar contributed to data collection, coordination between study sites, and manuscript review. Dr. Abdelaziz Omer contributed to methodological design and statistical guidance. Dr. Eiman Elobied assisted in literature review, data organization, and critical revision of the manuscript. All authors approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/handle/10665/254610\u003c/li\u003e\n\u003cli\u003eRathod S, Pinninti N, Irfan M, Gorczynski P, Rathod P, Gega L, et al. Mental health service provision in low- and middle-income countries. Health Serv Insights. 2017;10:1178632917694350. doi:10.1177/1178632917694350.\u003c/li\u003e\n\u003cli\u003eTerkawi AS, Tsang S, AlKahtani GJ, Al-Mousa SH, Al Musaed S, AlZoraigi US, et al. Development and validation of the Arabic version of the Hospital Anxiety and Depression Scale. Saudi J Anaesth. 2017;11(Suppl 1):S11\u0026ndash;S18. doi:10.4103/sja.SJA_43_17.\u003c/li\u003e\n\u003cli\u003eWalker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334\u0026ndash;341. doi:10.1001/jamapsychiatry.2014.2502.\u003c/li\u003e\n\u003cli\u003eSaxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878\u0026ndash;889. doi:10.1016/S0140-6736(07)61239-2.\u003c/li\u003e\n\u003cli\u003eBjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52(2):69\u0026ndash;77. doi:10.1016/S0022-3999(01)00296-3.\u003c/li\u003e\n\u003cli\u003eZigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361\u0026ndash;370. doi:10.1111/j.1600-0447.1983.tb09716.x.\u003c/li\u003e\n\u003cli\u003eWalker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, et al. Prevalence, associations, and adequacy of treatment of major depression in general medical inpatients: a systematic review and meta-analysis. Psychol Med. 2018;48(10):1536\u0026ndash;1548. doi:10.1017/S0033291717002392.\u003c/li\u003e\n\u003cli\u003eWalker J, Burke K, Wanat M, Fisher R, Fielding J, Mullee M, et al. The prevalence of anxiety in general hospital inpatients: a systematic review and meta-analysis. Psychol Med. 2021;51(5):1\u0026ndash;11. doi:10.1017/S0033291720003591.\u003c/li\u003e\n\u003cli\u003eEvans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58(3):175\u0026ndash;189. doi:10.1016/j.biopsych.2005.05.001.\u003c/li\u003e\n\u003cli\u003eKeitner GI, Ryan CE, Miller IW, Kohn R, Epstein NB. 12-month outcome of patients with major depression and comorbid psychiatric or medical illness. Am J Psychiatry. 1995;152(4):511\u0026ndash;517. doi:10.1176/ajp.152.4.511.\u003c/li\u003e\n\u003cli\u003eKaton W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147\u0026ndash;155. doi:10.1016/j.genhosppsych.2006.11.005.\u003c/li\u003e\n\u003cli\u003eScott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC. Depression\u0026ndash;anxiety relationships with chronic physical conditions. J Affect Disord. 2007;103(1\u0026ndash;3):113\u0026ndash;120. doi:10.1016/j.jad.2007.01.015.\u003c/li\u003e\n\u003cli\u003eKessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders. Arch Gen Psychiatry. 2005;62(6):617\u0026ndash;627. doi:10.1001/archpsyc.62.6.617.\u003c/li\u003e\n\u003cli\u003eHo RC, Mak KK, Chua AN, Ho CS, Mak A, Goh D. Economic burden of depressive disorder in hospital settings. Expert Rev Pharmacoecon Outcomes Res. 2013;13(4):549\u0026ndash;559. doi:10.1586/14737167.2013.828032.\u003c/li\u003e\n\u003cli\u003eDuko B, Ayano G, Bedaso A. Depression among hospitalized patients in Ethiopia: a cross-sectional study. BMC Res Notes. 2019;12:623. doi:10.1186/s13104-019-4681-2.\u003c/li\u003e\n\u003cli\u003eSeifu B, Gebremedhin S, Kassa A, Girma S. Depression and anxiety among patients attending public hospitals in Addis Ababa, Ethiopia. BMC Oral Health. 2021;21:85. doi:10.1186/s12903-021-01432-7.\u003c/li\u003e\n\u003cli\u003e\u0026Uuml;st\u0026uuml;n TB, Ayuso-Mateos JL, Chatterji S, Mathers C, Murray CJL. Global burden of depressive disorders in the year 2000. Br J Psychiatry. 2004;184(5):386\u0026ndash;392. doi:10.1192/bjp.184.5.386.\u003c/li\u003e\n\u003cli\u003eKaton W, Sullivan M. Depression and chronic medical illness. J Clin Psychiatry. 1990;51(6):3\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eClark LA, Watson D. Tripartite model of anxiety and depression. J Abnorm Psychol. 1991;100(3):316\u0026ndash;336. doi:10.1037/0021-843X.100.3.316.\u003c/li\u003e\n\u003cli\u003eSherbourne CD, Wells KB, Judd LL. Functional impairment, depression, and anxiety in chronic illness. Arch Gen Psychiatry. 1999;56(10):889\u0026ndash;895. doi:10.1001/archpsyc.56.10.889.\u003c/li\u003e\n\u003cli\u003eBaldwin RC, O\u0026rsquo;Brien J. Vascular basis of late-onset depressive disorder. Br J Psychiatry. 2002;180(2):157\u0026ndash;160. doi:10.1192/bjp.180.2.157.\u003c/li\u003e\n\u003cli\u003eLadwig KH, Baumert J, Marten-Mittag B, Lukaschek K. Post-stroke depression and anxiety. Cerebrovasc Dis. 2016;41(5\u0026ndash;6):232\u0026ndash;240. doi:10.1159/000444086.\u003c/li\u003e\n\u003cli\u003eFortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL. Multimorbidity and quality of life. Health Qual Life Outcomes. 2004;2:51. doi:10.1186/1477-7525-2-51.\u003c/li\u003e\n\u003cli\u003eUstun TB, Sartorius N. Mental illness in general health care: an international study. Chichester: John Wiley \u0026amp; Sons; 1995.\u003c/li\u003e\n\u003cli\u003eSpruill TM, Gerin W, Ogedegbe G, Burg MM, Schwartz JE, Pickering TG. Social support and hypertension. Ann Behav Med. 2009;37(3):189\u0026ndash;197. doi:10.1007/s12160-009-9101-5.\u003c/li\u003e\n\u003cli\u003eGivens JL, Datto CJ, Ruckdeschel K, Knott K, Zubritsky C, Oslin DW, et al. Older patients\u0026rsquo; aversion to antidepressants. J Gen Intern Med. 2006;21(2):146\u0026ndash;151. doi:10.1111/j.1525-1497.2005.00299.x.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003eAge Group (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003ePrevalence of Depression (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003ePrevalence of Anxiety (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003e40-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003e35.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1379%;\"\u003e\n \u003cp\u003e60+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.2299%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.6322%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.605%;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.7983%;\"\u003e\n \u003cp\u003ePrevalence of Depression (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5966%;\"\u003e\n \u003cp\u003ePrevalence of Anxiety (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.605%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.7983%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5966%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.605%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.7983%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5966%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.605%;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.7983%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5966%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 32.605%;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 35.7983%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5966%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Anxiety, Prevalence, Hospitalized Patients, Sudan, HADS, General Medical Conditions","lastPublishedDoi":"10.21203/rs.3.rs-8909311/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8909311/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe mental health of hospitalized patients with general medical conditions is increasingly recognized as a global concern, particularly in resource-limited settings such as Sudan. Depression and anxiety negatively affect recovery, quality of life, and overall prognosis (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite their clinical relevance, routine mental health screening is often neglected in general medical wards in low- and middle-income countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This study aimed to determine the prevalence and associated factors of depression and anxiety among adult medical inpatients in Sudan.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional hospital-based study was conducted between April and July 2022 among 261 adult inpatients admitted to Khartoum Teaching Hospital and Omdurman Teaching Hospital. Depression and anxiety were assessed using the Arabic version of the Hospital Anxiety and Depression Scale (HADS) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Univariate and multivariate logistic regression analyses were performed to identify factors associated with probable depression and probable anxiety.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of depression (HADS-D\u0026thinsp;\u0026ge;\u0026thinsp;8) was 44.8% (95% CI 38.8\u0026ndash;50.8%) and anxiety (HADS-A\u0026thinsp;\u0026ge;\u0026thinsp;8) was 23.0% (95% CI 17.9\u0026ndash;28.1%). In multivariable analysis, depression was independently associated with past psychiatric history (aOR 2.05, 95% CI 1.18\u0026ndash;3.56; p\u0026thinsp;=\u0026thinsp;0.011), poor family care (aOR 3.41, 95% CI 1.62\u0026ndash;7.16; p\u0026thinsp;=\u0026thinsp;0.001), and comorbid anxiety (aOR 4.15, 95% CI 2.34\u0026ndash;7.36; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Anxiety was independently associated with family history of mental illness (aOR 2.43, 95% CI 1.15\u0026ndash;5.13; p\u0026thinsp;=\u0026thinsp;0.020), poor family care (aOR 3.98, 95% CI 1.79\u0026ndash;8.82; p\u0026thinsp;=\u0026thinsp;0.001), and comorbid depression (aOR 4.27, 95% CI 2.41\u0026ndash;7.55; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eA substantial proportion of hospitalized patients with general medical conditions in Sudan are at risk for depression and anxiety. These findings provide evidence to support mental health integration within general hospital services in Sudan and similar low-resource settings.\u003c/p\u003e","manuscriptTitle":"Prevalence and Determinants of Depression and Anxiety Among Hospitalized Patients with General Medical Conditions in Sudan: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-22 14:55:18","doi":"10.21203/rs.3.rs-8909311/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1794997f-f759-41f2-8973-0c94616c6676","owner":[],"postedDate":"March 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T18:24:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-22 14:55:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8909311","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8909311","identity":"rs-8909311","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}