Mapping Anxiety and Depression Among Patients with Behçet Disease in Saudi Arabia a Cross Sectional Study

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BD has been associated with psychiatric conditions, including depression and anxiety; however, evidence from Saudi Arabia remains limited. This study aimed to determine the prevalence of anxiety and depression among patients with BD in Saudi Arabia and to examine their association with demographic characteristics, comorbid conditions, and medication use. A cross-sectional study of 91 patients with BD was conducted at King Abdulaziz University Hospital (February–August 2024) using telephone interviews with the PHQ-9 and GAD-7 to assess depression and anxiety Results: A substantial mental health burden was observed among patients with BD. According to the GAD-7, 30.8% of participants had minimal anxiety, 41.8% mild anxiety, 19.8% moderate anxiety, and 7.7% severe anxiety. PHQ-9 results showed that 27.5% had minimal depression, 36.3% mild depression, 19.8% moderate depression, 8.8% moderately severe depression, and 7.7% severe depression. Clinically significant anxiety (GAD-7 ≥10) was present in 27.5% of patients, while clinically significant depression (PHQ-9 ≥10) was observed in 36.3%. Conclusion: Anxiety and depression are highly prevalent among patients with BD in Saudi Arabia, with most patients experiencing mild to moderate symptoms. These findings underscore the importance of routine mental health assessment and integrated care to improve overall patient well-being. Depression anxiety psychiatry mental health Behçet's disease Background Behçet's disease (BD) is a chronic, relapsing autoinflammatory disorder affecting arterial and venous vessels of all sizes, causing systemic inflammation of blood vessels with an unknown etiology [ 1 , 2 ]. The disease was first identified by Dr. Hulusi Behçet, a Turkish dermatologist, and subsequently named after him [ 3 , 4 ]. It is more frequently observed in countries along the Silk Road [ 5 ], and its prevalence and clinical expression are significantly influenced by geographic distribution and ethnicity [ 4 , 6 ]. Turkey has the highest reported prevalence of BD, ranging from 20 to 602 cases per 100,000 individuals, followed by Iran, with a prevalence of 68 cases per 100,000 individuals [ 4 ]. In Saudi Arabia, the prevalence of BD is roughly estimated at 20 per 100,000 individuals [ 4 ]. Time-trend studies have shown a global worsening in BD prevalence over the past decade, likely due to improved disease detection, increased case reporting, and migration from high-to low-prevalence regions [ 2 , 4 ]. Although BD affects both men and women equally, its manifestations tend to be more severe in men than that in women [ 5 ]. BD is characterized by multisystem involvement with heterogeneous clinical manifestations [ 1 ]. Dr. Behçet initially described the disease as a complex triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis [ 3 ]. Recurrent oral ulcers are the most prevalent initial symptom of BD, occurring in almost 97–100% of patients [ 7 ], followed by genital ulcers, which are present in approximately 62%–100% of patients [ 1 ]. Other clinical features of BD include skin manifestations, such as papulopustular lesions, erythema nodosum, and pseudofolliculitis [ 8 ]. Ocular inflammation likely occurs within 2–4 years of disease onset in approximately 20% of cases [ 1 , 9 ]. BD also affects the cardiovascular system, presenting as myocarditis and pericarditis [ 1 ], and can affect the pulmonary system, causing pulmonary artery aneurysms, a characteristic pathology associated with poor prognosis [ 1 ]. Although rare (5–10%), central nervous system involvement is a recognized complication of BD [ 1 , 4 ]. Fatigue is a common complaint among patients with both rheumatological and non-rheumatological diseases, impacting their quality of life [ 5 ]. BD, being a chronic disease with high mortality and morbidity rates, subjects’ patients to a continuous cycle of exacerbations and remissions, which can precipitate psychiatric conditions, such as depression and anxiety disorders [ 5 ]. BD diagnosis relies solely on clinical findings, as no specific diagnostic tests are currently available [ 6 ]. A cross-sectional study conducted in Turkey assessed the association among BD activity, depression, anxiety, and fatigue in patients with BD. The results indicated that anxiety and fatigue are more prevalent among patients with active BD than in healthy controls and those with inactive BD [ 5 ]. In 2023, a case-control study was conducted to evaluate sleep quality, anxiety, depression, and quality of life in patients with BD. This study revealed that BD is associated with poor sleep and high rates of anxiety and depression. Additionally, disease activity has been found to directly affect the degree of anxiety and depression, further reducing sleep quality and overall quality of life in patients with BD [ 10 ]. Another case-control study conducted in Egypt demonstrated that depression is a dominant comorbidity among patients with BD and is closely related to fatigue, the extent of vital organ involvement, and overall disease activity, all of which negatively impact the quality of life [ 11 ]. Depression and anxiety appear to be prevalent among patients with BD. Thus, early detection and treatment of these psychiatric issues are crucial for alleviating the symptoms and improving the quality of life. This study aimed to assess the association among BD, anxiety, and depression in Saudi Arabia by evaluating the prevalence and relationship of anxiety and depression among patients with BD at King Abdulaziz University Hospital (KAUH) in Jeddah. Methods Participants and Data Collection An interview-based, cross-sectional study was established from February to August 2024 to assess the burden and prevalence of psychiatric illness among patients diagnosed with BD who were followed up at the rheumatology clinics of KAUH in Jeddah, Saudi Arabia. The participants were selected from hospital records based on predefined inclusion and exclusion criteria. All the patients aged 18 years and older who were diagnosed with BD according to the Revised International Classification for Behçet's Disease criteria [ 12 ] and were registered at our center were included, regardless of the severity of BD or disease duration. Patients who failed to meet the diagnostic criteria, declined participation, faced language barriers, or were younger than 18 years were excluded. Before their contribution, all patients were thoroughly briefed about the study's objectives and provided informed consent at the beginning of the questionnaire. No personally identifiable information was collected. Data were collected directly from patients through phone interviews using the Generalized Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) to screen for anxiety and depression, respectively. Additionally, patients were instructed to provide demographic data, including age, nationality, sex, and details about comorbidities and current medications. Psychiatric Evaluations GAD-7 GAD-7 is a 7-item scale that assesses the symptom severity of GAD as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Participants assessed the frequency of symptoms using a 4-point scale: 'not at all' (0), 'several days' (1), 'more than half the days' (2), or 'nearly every day' (3) over the past 2 weeks. The scores for each item were summed to produce a total symptom severity score ranging from 0 to 21. Based on the total score, the GAD severity was categorized into four categories: 'minimal' (0–4), 'mild' (5–9), 'moderate' (10–14), and 'severe' (15+) [ 13 ]. Using a GAD-7 cut-off of ≥ 10 as the criterion for a positive screen, which provides Sensitivity 0.64, Specificity 0.91 for detecting generalized anxiety [ 14 ]. PHQ-9 The 9-item PHQ-9 was used for the identification and diagnosis of major depressive disorder (MDD). Each item was scored based on the persistence of symptoms over the past 2 weeks, ranging from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 27. Subsequently, patients were classified into four main categories based on their scores: 'minimal MDD' (0–4), 'mild MDD' (5–9), 'moderate MDD' (10–19), and 'severe MDD' (20–27) [ 15 ]. Using a PHQ-9 cut-off of ≥ 10 as the criterion for a positive screen, which provides a sensitivity of 88% and a specificity of 88% for Major Depressive Disorder [ 16 ]. A recent individual participant data meta-analysis of 100 studies (n = 44,503) confirmed that a PHQ-9 cut-off of ≥ 10 yields optimal accuracy, with sensitivity and specificity both at 0.85 [ 17 ]. Statistical Methods Descriptive statistics were employed to summarize the demographic characteristics of the study population, including age, sex, nationality, and prevalence of comorbidities, such as diabetes mellitus (DM), dyslipidemia, hypertension (HTN), and thyroid disease. These data were presented as frequencies and percentages for categorical variables and as means with standard deviations for continuous variables. Bivariate analyses were performed to explore the relationships among demographic factors, comorbidities, and levels of anxiety and depression. Pearson's chi-squared test was used to determine the statistical significance of these associations. A Sankey diagram was constructed to visualize the distribution and flow of individuals by sex, anxiety levels, and depression levels, offering a graphical representation of the interrelationships between these variables (Fig. 1 ). Statistical analyses were performed using IBM SPSS Statistics software version 26. All statistical tests were two-tailed, and the confidence interval was set at 95%. Statistical significance was set at p < 0.05. Results Figure 1 : illustrates the distribution and flow of patients with Behçet’s disease according to sex, anxiety severity (GAD-7), and depression severity (PHQ-9). Table 1 General Characteristics of the Study Sample Category Count Percentage Total Participants 91 - Age 18–39 51 56.0% 40–60 37 40.7% Above 60 3 3.3% Sex (Male) 55 60.4% Nationality (Saudi) 80 87.9% Hypertension No 76% Diabetes Mellitus No 85% Chronic Kidney Disease No 91% Dyslipidemia No 72% Thyroid Disease No 82% Of the 91 participants included in the study (Table 1 ), the majority (56.0%) were between the ages of 18 and 39, while 40.7% were aged 40–60, and 3.3% were above 60 years. The sample was predominantly male (60.4%) and Saudi nationals (87.9%). Regarding comorbidities, a large proportion of participants reported an absence of certain chronic conditions: 76% did not have hypertension, 85% did not have diabetes mellitus, 91% did not have chronic kidney disease, 72% did not have dyslipidemia, and 82% did not have thyroid disease. As detailed in Table 2 , which presents the associations between demographic factors, comorbidities, and anxiety levels measured by the GAD-7 scale, no demographic variables or comorbid conditions demonstrated a statistically significant association with anxiety severity at the p < .05 level. Nonetheless, there was a non-significant tendency for patients with hypertension to exhibit increased anxiety levels (p = .050). The distribution of participants across anxiety categories was as follows: 28 (30.8%) had minimal anxiety, 38 (41.8%) had mild anxiety, 18 (19.8%) had moderate anxiety, and 7 (7.7%) had severe anxiety. A visual trend suggested that a higher percentage of patients with hypertension were present in the moderate (27.8%) and severe (28.6%) anxiety categories compared to those with minimal (21.4%) or mild (5.3%) anxiety. Other variables, including age, gender, nationality, history of thrombotic events, diabetes mellitus, dyslipidemia, and thyroid disease, showed no significant differences in their distribution across the anxiety severity groups (all p > .05). Table 2 Associations among Demographic Factors, Comorbidities, and Anxiety Levels in Patients with Behçet’s Disease: A Comparative Analysis Using the GAD-7 Scale Minimal anxiety 0–4 Mild anxiety 5–9 Moderate anxiety 10–14 Severe anxiety 15–21 Total p Total n (%) 28 (30.8) 38 (41.8) 18 (19.8) 7 (7.7) 91 Age 39 − 18 18 (64.3) 20 (52.6) 11 (61.1) 2 (28.6) 51 (56.0) 0.393 40–60 8 (28.6) 17 (44.7) 7 (38.9) 5 (71.4) 37 (40.7) Above 60 2 (7.1) 1 (2.6) 0 (0.0) 0 (0.0) 3 (3.3) Gender Female 10 (35.7) 12 (31.6) 9 (50.0) 5 (71.4) 36 (39.6) 0.184 Male 18 (64.3) 26 (68.4) 9 (50.0) 2 (28.6) 55 (60.4) Nationality Non-Saudi 2 (7.1) 4 (10.5) 2 (11.1) 3 (42.9) 11 (12.1) 0.109 Saudi 26 (92.9) 34 (89.5) 16 (88.9) 4 (57.1) 80 (87.9) Thrombotic events Yes 9 (32.1) 5 (13.2) 2 (11.1) 1 (14.3) 17 (18.7) 0.208 No 19 (67.9) 33 (86.8) 16 (88.9) 6 (85.7) 74 (81.3) Hypertension Yes 6 (21.4) 2 (5.3) 5 (27.8) 2 (28.6) 15 (16.5) 0.050 No 22 (78.6) 36 (94.7) 13 (72.2) 5 (71.4) 76 (83.5) Diabetes mellitus Yes 1 (3.6) 3 (7.9) 0 (0.0) 2 (28.6) 6 (6.6) 0.098 No 27 (96.4) 35 (92.1) 18 (100.0) 5 (71.4) 85 (93.4) Dyslipidemia Yes 6 (21.4) 9 (23.7) 3 (16.7) 1 (14.3) 19 (20.9) 0.978 No 22 (78.6) 29 (76.3) 15 (83.3) 6 (85.7) 72 (79.1) Thyroid disease Yes 2 (7.1) 3 (7.9) 2 (11.1) 2 (28.6) 9 (9.9) 0.315 No 26 (92.9) 35 (92.1) 16 (88.9) 5 (71.4) 82 (90.1) As shown in Table 3 , which details the associations between demographic factors, comorbidities, and levels of depression as measured by the PHQ-9, dyslipidemia was the only variable to demonstrate a statistically significant association with depression severity (p = .022). The distribution of patients across depression categories was as follows: 25 (27.5%) had minimal depression, 33 (36.3%) had mild depression, 18 (19.8%) had moderate depression, 8 (8.8%) had moderately severe depression, and 7 (7.7%) had severe depression. The presence of dyslipidemia was notably more common in the mild (36.4%) and moderate (27.8%) depression categories, while it was absent in all patients with moderately severe or severe depression and present in only 8.0% of those with minimal depression. No other demographic or clinical variables, including age, gender, nationality, history of thrombotic events, hypertension, diabetes mellitus, or thyroid disease, showed a significant association with depression severity (all p > .05). Table 3 Associations among Demographic Factors, Comorbidities, and Depression Levels in Patients with Behçet’s Disease: A Comparative Analysis Using the PHQ-9 Scale Minimal depression 0–4 Mild depression 5–9 Moderate depression 10–14 Moderately severe depression 15–19 Severe depression 20–27 Total p Total n (%) 25 (27.5) 33 (36.3) 18 (19.8) 8 (8.8) 7 (7.7) 91 Age 39 − 18 14 (56.0) 19 (57.6) 8 (44.4) 4 (50.0) 6 (85.7) 51 (56.0) 0.693 40–60 10 (40.0) 12 (36.4) 10 (55.6) 4 (50.0) 1 (14.3) 37 (40.7) Above 60 1 (4.0) 2 (6.1) 0 (0.0) 0 (0.0) 0 (0.0) 3 (3.3) Gender Female 8 (32.0) 14 (42.4) 7 (38.9) 4 (50.0) 3 (42.9) 36 (39.6) 0.884 Male 17 (68.0) 19 (57.6) 11 (61.1) 4 (50.0) 4 (57.1) 55 (60.4) Nationality Non-Saudi 3 (12.0) 4 (12.1) 1 (5.6) 2 (25.0) 1 (14.3) 11 (12.1) 0.676 Saudi 22 (88.0) 29 (87.9) 17 (94.4) 6 (75.0) 6 (85.7) 80 (87.9) Thrombotic events Yes 8 (32.0) 5 (15.2) 3 (16.7) 1 (12.5) 0 (0.0) 17 (18.7) 0.354 No 17 (68.0) 28 (84.8) 15 (83.3) 7 (87.5) 7 (100.0) 74 (81.3) Hypertension Yes 2 (8.0) 6 (18.2) 6 (33.3) 1 (12.5) 0 (0.0) 15 (16.5) 0.197 No 23 (92.0) 27 (81.8) 12 (66.7) 7 (87.5) 7 (100.0) 76 (83.5) Diabetes mellitus Yes 2 (8.0) 1 (3.0) 2 (11.1) 1 (12.5) 0 (0.0) 6 (6.6) 0.586 No 23 (92.0) 32 (97.0) 16 (88.9) 7 (87.5) 7 (100.0) 85 (93.4) Dyslipidemia Yes 2 (8.0) 12 (36.4) 5 (27.8) 0 (0.0) 0 (0.0) 19 (20.9) 0.022 No 23 (92.0) 21 (63.6) 13 (72.2) 8 (100.0) 7 (100.0) 72 (79.1) Thyroid disease Yes 1 (4.0) 3 (9.1) 5 (27.8) 0 (0.0) 0 (0.0) 9 (9.9) 0.124 No 24 (96.0) 30 (90.9) 13 (72.2) 8 (100.0) 7 (100.0) 82 (90.1) Table 4 Demographic and Comorbid Factors Associated with Low (< 10) and High (≥ 10) GAD-7 and PHQ-9 Scores in Patients with Behçet’s Disease Score GAD-7 < 10 ≥ 10 Total p Total n (%) 66 (72.5) 25 (27.5) 91 Colchicine No 29 (43.9) 13 (52.0) 42 (46.2) 0.651 Yes 37 (56.1) 12 (48.0) 49 (53.8) Azathioprine No 40 (60.6) 16 (64.0) 56 (61.5) 0.956 Yes 26 (39.4) 9 (36.0) 35 (38.5) Cortisone No 44 (66.7) 17 (68.0) 61 (67.0) 1.000 Yes 22 (33.3) 8 (32.0) 30 (33.0) Adalimumab No 51 (77.3) 18 (72.0) 69 (75.8) 0.802 Yes 15 (22.7) 7 (28.0) 22 (24.2) PHQ-9 Total n (%) 58 (63.7) 33 (36.3) 91 Colchicine No 26 (44.8) 16 (48.5) 42 (46.2) 0.906 Yes 32 (55.2) 17 (51.5) 49 (53.8) Azathioprine No 37 (63.8) 19 (57.6) 56 (61.5) 0.717 Yes 21 (36.2) 14 (42.4) 35 (38.5) Cortisone No 39 (67.2) 22 (66.7) 61 (67.0) 1.000 Yes 19 (32.8) 11 (33.3) 30 (33.0) Adalimumab No 45 (77.6) 24 (72.7) 69 (75.8) 0.79 Yes 13 (22.4) 9 (27.3) 22 (24.2) Table 4 analyzes the association between specific BD medications and the presence of clinically significant anxiety or depression, none of the evaluated medications demonstrated a statistically significant relationship with high symptom scores. For anxiety (GAD-7 ≥ 10), the use of colchicine (p = .651), azathioprine (p = .956), cortisone (p = 1.000), and adalimumab (p = .802) showed no significant difference in distribution between patients with low and high anxiety scores. Similarly, for depression (PHQ-9 ≥ 10), the use of colchicine (p = .906), azathioprine (p = .717), cortisone (p = 1.000), and adalimumab (p = .790) also revealed no significant association with the presence of clinically significant depression. These results indicate that, within this patient sample, the use of these common BD medications was not a significant factor associated with the severity of anxiety or depression. Discussion This study screened patients with BD receiving follow-up care for anxiety and depression symptoms at King Abdulaziz University Hospital. To our knowledge, this is the first study to examine the prevalence of depression and anxiety disorders among patients with BD in Saudi Arabia. In the present study, we observed a high prevalence of anxiety and depression symptoms among patients with BD. Anxiety and depression affected approximately one in three patients, with younger patients and females showing a trend toward higher anxiety with no statically significance. Regarding comorbidities, dyslipidemia was significantly associated with higher depressive symptoms, while hypertension showed a non-significant trend toward higher anxiety. No significant associations were found with the type of treatments, suggesting that psychiatric symptoms may be more closely related to disease burden and comorbidities than to therapy. These findings highlight the importance of routine mental health assessment and integrated care for this population. Neuropsychiatric manifestations, including anxiety and depression, are frequently reported in BD [ 10 ]. The results indicated a notable prevalence of anxiety symptoms, with most patients experiencing mild to moderate levels of anxiety. Consistent with our findings, a single-center cross-sectional study in Turkey reported that 43.2% of BD patients exhibited anxiety, which was significantly correlated with disease activity [ 18 ]. Similarly, a study in France assessing psychiatric symptoms and cognitive disorders in BD patients found anxiety to be the most frequent symptom (47.4%), followed by somatization and phobia [ 19 ]. Additionally, previous case–control studies from Egypt and Turkey showed that anxiety levels were significantly higher in BD patients, with anxiety present in 31.1% of patients versus 13.5% of controls, and more severe symptoms in those with active disease [ 20 , 21 ]. Overall, anxiety and depression in patients with BD are influenced by many factors, including disease activity, disease duration, and symptom variability [ 22 , 23 ]. This study also explored the associations between demographic characteristics, comorbidities, and anxiety levels in patients with BD. Our research indicated that hypertension was associated with a non-significant inclination towards increased anxiety. Similarly, previous studies have indicated that anxiety is more prevalent among hypertensive patients, with these conditions often coexisting [ 24 – 26 ]. A 2023 study further supported this by investigating the mechanisms and risk factors of hypertension and anxiety, demonstrating that both share common risk factors, including age, obesity, sex, alcohol abuse, smoking, lead exposure, and traffic noise [ 24 ]. In our study, a significant proportion of patients with BD exhibited depression ranging from mild to severe. Similarly, a study conducted in Egypt found that the frequency of depression among patients with BD was notably high [ 11 ]. In contrast, several studies have reported a lower prevalence of depression. For instance, a study in Korea found that the depression rate among patients with BD was 46%, while three studies from Turkey reported frequencies of 40.6%, 43%, and 29.5% [ 5 , 27 , 28 ]. The observed discrepancies in depression prevalence among patients with BD could be attributed to the utilization of different assessment methods for depression, variation in sample sizes, and the diverse lifestyles of individuals. Given that BD is a chronic disorder characterized by exacerbation and remission, it can remarkably impact the quality of life [ 22 ]. Corticosteroids are commonly prescribed to patients with active autoimmune diseases, including BD. Long-term use of steroids, particularly at high doses, causes mental disorders, including anxiety, depression, and psychosis [ 29 ]. The current study examined the association between certain medications used for BD and the degree of anxiety and depression. The findings indicated that medications, such as colchicine, azathioprine, cortisone, and adalimumab, may not significantly affect anxiety and depression in patients with BD. These results are consistent with those of a previous study conducted in Turkey [ 30 ]. However, regarding corticosteroids, these findings differ from those of another study that assessed the effects of local corticosteroids, particularly inhaled forms, as well as systemic corticosteroids on psychiatric disorders, which found a link between decreased executive cognitive functioning and an increased risk of mood and anxiety disorders in the general adult population [ 31 ]. Conversely, a study from Egypt found that depressed patients with BD were more frequently treated with biological agents, including cyclosporine A and cyclophosphamide, than were their non-depressed counterparts. Additionally, a significant correlation was observed between the severity of depression and the use of these medications [ 11 ]. Further long-term studies with larger cohorts are required to achieve a deeper understanding of the efficacy of these medications and their relationship with anxiety and depression. Owing to the rarity of BD, the sample size of the study was relatively small, which may limit both the generalizability and reliability of the findings. Since no formal a priori power calculation was conducted, the analyses should be viewed as exploratory. As a result, the lack of statistically significant associations, especially in subgroup analyses, should be approached with caution, as the study might not have had sufficient power to identify small effects. In particular, the low frequency of certain comorbid conditions such as diabetes mellitus, hypertension, and chronic kidney disease within the sample may reduce the ability to draw firm conclusions about their association with BD. The younger age distribution of the study population further influences this limitation. The study was conducted at a single center, which limits the diversity of the patient population and might affect the generalizability of the results. Nevertheless, the controlled setting provided consistent data collection procedures, enhancing the reliability of the findings within this context. The cross-sectional design of this study restricts its ability to establish causality or monitor changes over time. Nevertheless, it provides valuable insights into the mental health status of patients with BD. While validated scales may be subject to potential response bias from patient recall and subjective reporting, they still provide a standardized measure of anxiety and depression. Additionally, the study did not account for confounding factors, such as socioeconomic, status education level, severity of BD or disease duration, which could influence mental health outcomes. Despite these limitations, this study lays important groundwork for future research. Prospective, longitudinal projects with larger and more diverse samples are required to explore the dynamics of anxiety and depression in patients with BD and to assess the long-term effects of interventions, thereby building on these initial findings. Conclusion This study highlights the notable prevalence of anxiety and depression among patients with BD in Saudi Arabia, with mild to moderate symptoms being the most common. This underscores the critical need for early detection and intervention for mental health concerns in patients with BD, particularly given the chronic nature of the disease and its impact on quality of life. Addressing these psychiatric comorbidities through integrated care approaches can help alleviate psychological distress and improve overall patient outcomes in BD management. Future studies should explore long-term mental health strategies and their effectiveness in this patient population. Abbreviations BD: Behçet's Disease PHQ-9: Patient Health Questionnaire-9 GAD-7: Generalized Anxiety Disorder-7 Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Bioethics Committee of Scientific and Medical Research at KAUH (Approval number: HA-02-J-008). Participants were informed about the study’s purpose and objectives and provided voluntary consent before participation. Informed consent was obtained from all participants, who were assured that their data would be securely stored and handled with strict confidentiality. Consent for publication The patient has consented to the submission of the case base review for submission to the journal. Availability of data and materials The raw data used in this study cannot be shared due to confidentiality agreements. However, summary statistics or additional details can be made available upon reasonable request, subject to approval from the relevant authorities. Competing interests  The authors declare that they have no competing interests. Funding None. Author contributions M. Mustafa and Y. Bawazir supervised the conception, design, and drafting of this manuscript. S.A. and M.Z. were responsible for data collection and writing the original draft. N.Butt conducted the data analysis and interpretation. All authors have revised the manuscript and approved the final manuscript. Acknowledgment The authors thank the participants for their cooperation. References El-Garf A, Abdo M, Alkemary A, Mohamed S (2019) Behçet’s disease patterns and subsets in a cohort of Egyptian patients. Egypt Rheumatol 41:135–138. Alharthy F, Almaqati AS, Alsulami S, Ahmad A (2023) Behçet’s disease in Saudi Arabia: Clinical and demographic characteristics. Cureus 15:e34867. Turgut YB, Turgut M (2020) Turkish scientist Hulusi Behçet (1889–1948) and his contribution to the medical world. Childs Nerv Syst 36:665–666. doi:10.1007/s00381-019-04081-8. Al Zahrani FM, Alsultan B, Alahmari H, Almannaa A, Asseri M, Alhayaza S, et al. (2019) Behçet’s disease presentations and care outcomes in a tertiary hospital in south-western Saudi Arabia. Int J Rheum Dis 22:1466–1473. Can Sandikci S, Colak S, Omma A, Enecik ME (2019) An evaluation of depression, anxiety and fatigue in patients with Behçet’s disease. Int J Rheum Dis 22:974–979. Sibley C, Yazici Y, Tascilar K, Khan N, Bata Y, Yazici H, et al. (2014) Behçet syndrome manifestations and activity in the United States versus Turkey – A cross-sectional cohort comparison. J Rheumatol 41:1379–1384. El Menyawi MM, Raslan HM, Edrees A (2009) Clinical features of Behçet’s disease in Egypt. Rheumatol Int 29:641–646. Davatchi F, Shahram F, Chams-Davatchi C, Shams H, Nadji A, Akhlaghi M, et al. (2010) Behçet’s disease: From east to west. Clin Rheumatol 29:823–833. Calamia KT, Wilson FC, Icen M, Crowson CyS, Gabriel SE, Kremers HM (2009) Epidemiology and clinical characteristics of Behçet’s disease in the US: A population-based study. Arthritis Care Res 61:600–604. Shaddad AM, Hussein AARM, Safwat SM, Talaat EA, Farrag S, Gamal NM, et al. (2023) Assessment of sleep quality, anxiety, depression, and quality of life in Behçet’s disease. Egypt J Bronchol 17:1–10. doi:10.1186/s43168-023-00200-x. Fawzy RM, Abd-Elmaksoud SF, Elolemy GG (2021) Depression in Behçet’s disease patients: Relationship with disease pattern, activity and quality of life. Egypt Rheumatol 43:325–329. Davatchi F, Assaad-Khalil S, Calamia KT, Crook JE, Sadeghi-Abdollahi B, Schirmer M (2014) The International Criteria for Behçet’s Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 28:338–347. Generalized Anxiety Disorder 7-item (GAD-7) – Mental Health Screening – National HIV Curriculum. Available at: https://www.hiv.uw.edu/page/mental-health-screening/gad-7. Aktürk Z, Hapfelmeier A, Fomenko A, Dümmler D, Eck S, Olm M, Gehrmann J, von Schrottenberg V, Rehder R, Dawson S, Löwe B, Rücker G, Schneider A, Linde K (2025) Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. Cochrane Database Syst Rev 3(3):CD015455. Patient Health Questionnaire-9 (PHQ-9) – Mental Health Screening – National HIV Curriculum. Available at: https://www.hiv.uw.edu/page/mental-health-screening/phq-9#. Patient Health Questionnaire (PHQ) – American Psychological Association. Available at: https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health (apa.org in Bing). Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration (2019) Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 365:l1476. Can Sandikci S, Colak S, Omma A, Enecik ME (2019) An evaluation of depression, anxiety and fatigue in patients with Behçet’s disease. Int J Rheum Dis 22(6):974–979. Urbain F, Hardy-Léger I, Adebs-Nasser G, de Menthon M, Pivert C, Mausoléo A, Laparra A, Lerolle N, Domnariu PA, Lambotte O, Denier C, Goujard C, Castro-Gordon A, Noel N (2023) Psychiatric symptoms and cognitive disorders in Behçet’s disease: A single-center, cross-sectional study. J Clin Med 12(9):3149. Dawa GA, Toukhey MAE, Sherby NA, et al. (2024) Functional disability among Behçet’s disease patients: its relation to disease activity, depression, and fatigue. Egypt Rheumatol Rehabil 51:63. Shaddad AM, Hussein AARM, Safwat SM, et al. (2023) Assessment of sleep quality, anxiety, depression, and quality of life in Behçet’s disease. Egypt J Bronchol 17:26. Gur A, Sarac AJ, Burkan YK, Nas K, Cevik R (2006) Arthropathy, quality of life, depression, and anxiety in Behçet’s disease: Relationship between arthritis and these factors. Clin Rheumatol 25:524–531. Tsutsui H, Kikuchi H, Oguchi H, Nomura K, Ohkubo T (2020) Identification of physical and psychosocial problems based on symptoms in patients with Behçet’s disease. Rheumatol Int 40:81–89. doi:10.1007/s00296-019-04488-1. Qiu T, Jiang Z, Chen X, Dai Y, Zhao H (2023) Comorbidity of anxiety and hypertension: Common risk factors and potential mechanisms. Int J Hypertens 2023:9619388. doi:10.1155/2023/9619388. Lim LF, Solmi M, Cortese S (2021) Association between anxiety and hypertension in adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 131:96–119. Cheung BMY, Au THY, Chan SY, Lam CM, Lau Sh, Lee RP, et al. (2005) The relationship between hypertension and anxiety or depression in Hong Kong Chinese. Exp Clin Cardiol 10:21–24. Available from: /pmc/articles/PMC2716224. Ilhan B, Can M, Alibaz-Oner F, Yilmaz-Oner S, Polat-Korkmaz O, Ozen G, et al. (2018) Fatigue in patients with Behçet’s syndrome: Relationship with quality of life, depression, anxiety, disability and disease activity. Int J Rheum Dis 21:2139–2145. Polat Korkmaz Ö, Aksoy A, Ilhan B, Alibaz-Oner F, Direskeneli H (2022) Sleep quality and its association with disease activity, depression and quality of life in Behçet’s disease patients. Ulus Romatoloji Derg 14:81–86. Alturaymi MA, Almadhi OF, Alageel YS, Bin Dayel M, Alsubayyil MS, Alkhateeb BF (2023) The association between prolonged use of oral corticosteroids and mental disorders: Do steroids have a role in developing mental disorders? Cureus 15:e37627. Melikoglu MA, Melikoglu M (2010) The relationship between disease activity and depression in patients with Behçet’s disease and rheumatoid arthritis. Rheumatol Int 30:941–946. Savas M, Vinkers CH, Rosmalen JGM, Hartman CA, Wester VL, Van Den Akker ELT, et al. (2020) Systemic and local corticosteroid use is associated with reduced executive cognition, and mood and anxiety disorders. Neuroendocrinology 110:282–291. doi:10.1159/000501617. Additional Declarations No competing interests reported. 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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-8646928","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585920145,"identity":"b243db0a-4e66-406e-adb4-8efbc80fa10e","order_by":0,"name":"Mohammad Mustafa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYBACgwMQmp+BvYHBgIGBmbAWS7CWBAbJBp4DRGqxh2uRSACxiNBidvx0muTPH3YS/DPfGBQwVFgnNvAffoBfy5ncbdI8CckSErdzDAwYzqQnNkikGeDXcgCohSGBuY4BpIWx7TBQCwN+LQbn326T/JFQLyF/8wxQyz+gFv7jH/BruZG7TYIn4bCEwQ0eoJYGoBaGHAK23Hi72Zon7biE4Zm0AoOEY+nGbRI5BQQclrvx5g+bagm544e3GXyosZbt5z++Aa8WZMBmkAAiiVYPBMwPSFE9CkbBKBgFIwcAANxrSQcKpPdSAAAAAElFTkSuQmCC","orcid":"","institution":"University of Jeddah","correspondingAuthor":true,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Mustafa","suffix":""},{"id":585920146,"identity":"33be43b5-6869-4649-b728-5c53eace37bc","order_by":1,"name":"Sadin Ayman Alamri","email":"","orcid":"","institution":"King Faisal Specialist Hospital and Research Center","correspondingAuthor":false,"prefix":"","firstName":"Sadin","middleName":"Ayman","lastName":"Alamri","suffix":""},{"id":585920147,"identity":"9d25ec82-52d1-4b00-8c8b-52eb3e51d821","order_by":2,"name":"Manal Mutlaq Alzahrani","email":"","orcid":"","institution":"King Faisal Specialist Hospital \u0026 Research Centre","correspondingAuthor":false,"prefix":"","firstName":"Manal","middleName":"Mutlaq","lastName":"Alzahrani","suffix":""},{"id":585920148,"identity":"50c5bec8-e7ef-48d8-b9c5-ebd93e56c013","order_by":3,"name":"Nadeem Shafique Butt","email":"","orcid":"","institution":"King Abdulaziz University","correspondingAuthor":false,"prefix":"","firstName":"Nadeem","middleName":"Shafique","lastName":"Butt","suffix":""},{"id":585920149,"identity":"b8b9b27a-ba7a-45a6-b304-a95439f9f6c5","order_by":4,"name":"Yasser Bawazir","email":"","orcid":"","institution":"King Abdulaziz University","correspondingAuthor":false,"prefix":"","firstName":"Yasser","middleName":"","lastName":"Bawazir","suffix":""}],"badges":[],"createdAt":"2026-01-20 08:50:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8646928/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8646928/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102295717,"identity":"2681110f-eb9a-4ace-9e83-6297be7751e6","added_by":"auto","created_at":"2026-02-10 10:14:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":847490,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8646928/v1/4454d298-2ced-4334-8a48-ee7e58aba577.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mapping Anxiety and Depression Among Patients with Behçet Disease in Saudi Arabia a Cross Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eBeh\u0026ccedil;et's disease (BD) is a chronic, relapsing autoinflammatory disorder affecting arterial and venous vessels of all sizes, causing systemic inflammation of blood vessels with an unknown etiology [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The disease was first identified by Dr. Hulusi Beh\u0026ccedil;et, a Turkish dermatologist, and subsequently named after him [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is more frequently observed in countries along the Silk Road [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and its prevalence and clinical expression are significantly influenced by geographic distribution and ethnicity [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Turkey has the highest reported prevalence of BD, ranging from 20 to 602 cases per 100,000 individuals, followed by Iran, with a prevalence of 68 cases per 100,000 individuals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Saudi Arabia, the prevalence of BD is roughly estimated at 20 per 100,000 individuals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Time-trend studies have shown a global worsening in BD prevalence over the past decade, likely due to improved disease detection, increased case reporting, and migration from high-to low-prevalence regions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although BD affects both men and women equally, its manifestations tend to be more severe in men than that in women [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBD is characterized by multisystem involvement with heterogeneous clinical manifestations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Dr. Beh\u0026ccedil;et initially described the disease as a complex triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Recurrent oral ulcers are the most prevalent initial symptom of BD, occurring in almost 97\u0026ndash;100% of patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], followed by genital ulcers, which are present in approximately 62%\u0026ndash;100% of patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Other clinical features of BD include skin manifestations, such as papulopustular lesions, erythema nodosum, and pseudofolliculitis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Ocular inflammation likely occurs within 2\u0026ndash;4 years of disease onset in approximately 20% of cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. BD also affects the cardiovascular system, presenting as myocarditis and pericarditis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and can affect the pulmonary system, causing pulmonary artery aneurysms, a characteristic pathology associated with poor prognosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Although rare (5\u0026ndash;10%), central nervous system involvement is a recognized complication of BD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFatigue is a common complaint among patients with both rheumatological and non-rheumatological diseases, impacting their quality of life [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. BD, being a chronic disease with high mortality and morbidity rates, subjects\u0026rsquo; patients to a continuous cycle of exacerbations and remissions, which can precipitate psychiatric conditions, such as depression and anxiety disorders [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. BD diagnosis relies solely on clinical findings, as no specific diagnostic tests are currently available [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA cross-sectional study conducted in Turkey assessed the association among BD activity, depression, anxiety, and fatigue in patients with BD. The results indicated that anxiety and fatigue are more prevalent among patients with active BD than in healthy controls and those with inactive BD [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2023, a case-control study was conducted to evaluate sleep quality, anxiety, depression, and quality of life in patients with BD. This study revealed that BD is associated with poor sleep and high rates of anxiety and depression. Additionally, disease activity has been found to directly affect the degree of anxiety and depression, further reducing sleep quality and overall quality of life in patients with BD [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother case-control study conducted in Egypt demonstrated that depression is a dominant comorbidity among patients with BD and is closely related to fatigue, the extent of vital organ involvement, and overall disease activity, all of which negatively impact the quality of life [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDepression and anxiety appear to be prevalent among patients with BD. Thus, early detection and treatment of these psychiatric issues are crucial for alleviating the symptoms and improving the quality of life. This study aimed to assess the association among BD, anxiety, and depression in Saudi Arabia by evaluating the prevalence and relationship of anxiety and depression among patients with BD at King Abdulaziz University Hospital (KAUH) in Jeddah.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Data Collection\u003c/h2\u003e \u003cp\u003eAn interview-based, cross-sectional study was established from February to August 2024 to assess the burden and prevalence of psychiatric illness among patients diagnosed with BD who were followed up at the rheumatology clinics of KAUH in Jeddah, Saudi Arabia. The participants were selected from hospital records based on predefined inclusion and exclusion criteria. All the patients aged 18 years and older who were diagnosed with BD according to the Revised International Classification for Beh\u0026ccedil;et's Disease criteria [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and were registered at our center were included, regardless of the severity of BD or disease duration. Patients who failed to meet the diagnostic criteria, declined participation, faced language barriers, or were younger than 18 years were excluded. Before their contribution, all patients were thoroughly briefed about the study's objectives and provided informed consent at the beginning of the questionnaire. No personally identifiable information was collected. Data were collected directly from patients through phone interviews using the Generalized Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) to screen for anxiety and depression, respectively. Additionally, patients were instructed to provide demographic data, including age, nationality, sex, and details about comorbidities and current medications.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePsychiatric Evaluations\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eGAD-7\u003c/h2\u003e \u003cp\u003eGAD-7 is a 7-item scale that assesses the symptom severity of GAD as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Participants assessed the frequency of symptoms using a 4-point scale: 'not at all' (0), 'several days' (1), 'more than half the days' (2), or 'nearly every day' (3) over the past 2 weeks. The scores for each item were summed to produce a total symptom severity score ranging from 0 to 21. Based on the total score, the GAD severity was categorized into four categories: 'minimal' (0\u0026ndash;4), 'mild' (5\u0026ndash;9), 'moderate' (10\u0026ndash;14), and 'severe' (15+) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Using a GAD-7 cut-off of \u0026ge;\u0026thinsp;10 as the criterion for a positive screen, which provides Sensitivity 0.64, Specificity 0.91 for detecting generalized anxiety [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePHQ-9\u003c/h3\u003e\n\u003cp\u003eThe 9-item PHQ-9 was used for the identification and diagnosis of major depressive disorder (MDD). Each item was scored based on the persistence of symptoms over the past 2 weeks, ranging from 0 (not at all) to 3 (nearly every day), with total scores ranging from 0 to 27. Subsequently, patients were classified into four main categories based on their scores: 'minimal MDD' (0\u0026ndash;4), 'mild MDD' (5\u0026ndash;9), 'moderate MDD' (10\u0026ndash;19), and 'severe MDD' (20\u0026ndash;27) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Using a PHQ-9 cut-off of \u0026ge;\u0026thinsp;10 as the criterion for a positive screen, which provides a sensitivity of 88% and a specificity of 88% for Major Depressive Disorder [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A recent individual participant data meta-analysis of 100 studies (n\u0026thinsp;=\u0026thinsp;44,503) confirmed that a PHQ-9 cut-off of \u0026ge;\u0026thinsp;10 yields optimal accuracy, with sensitivity and specificity both at \u003cb\u003e0.85\u003c/b\u003e [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStatistical Methods\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were employed to summarize the demographic characteristics of the study population, including age, sex, nationality, and prevalence of comorbidities, such as diabetes mellitus (DM), dyslipidemia, hypertension (HTN), and thyroid disease. These data were presented as frequencies and percentages for categorical variables and as means with standard deviations for continuous variables.\u003c/p\u003e \u003cp\u003eBivariate analyses were performed to explore the relationships among demographic factors, comorbidities, and levels of anxiety and depression. Pearson's chi-squared test was used to determine the statistical significance of these associations. A Sankey diagram was constructed to visualize the distribution and flow of individuals by sex, anxiety levels, and depression levels, offering a graphical representation of the interrelationships between these variables (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics software version 26. All statistical tests were two-tailed, and the confidence interval was set at 95%. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e: illustrates the distribution and flow of patients with Behçet’s disease according to sex, anxiety severity (GAD-7), and depression severity (PHQ-9).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral Characteristics of the Study Sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal Participants\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18–39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.0%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40–60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.7%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.4%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality (Saudi)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.9%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic Kidney Disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid Disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOf the 91 participants included in the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), the majority (56.0%) were between the ages of 18 and 39, while 40.7% were aged 40–60, and 3.3% were above 60 years. The sample was predominantly male (60.4%) and Saudi nationals (87.9%). Regarding comorbidities, a large proportion of participants reported an absence of certain chronic conditions: 76% did not have hypertension, 85% did not have diabetes mellitus, 91% did not have chronic kidney disease, 72% did not have dyslipidemia, and 82% did not have thyroid disease.\u003c/p\u003e\u003cp\u003eAs detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which presents the associations between demographic factors, comorbidities, and anxiety levels measured by the GAD-7 scale, no demographic variables or comorbid conditions demonstrated a statistically significant association with anxiety severity at the p \u0026lt; .05 level. Nonetheless, there was a non-significant tendency for patients with hypertension to exhibit increased anxiety levels (p = .050). The distribution of participants across anxiety categories was as follows: 28 (30.8%) had minimal anxiety, 38 (41.8%) had mild anxiety, 18 (19.8%) had moderate anxiety, and 7 (7.7%) had severe anxiety. A visual trend suggested that a higher percentage of patients with hypertension were present in the moderate (27.8%) and severe (28.6%) anxiety categories compared to those with minimal (21.4%) or mild (5.3%) anxiety. Other variables, including age, gender, nationality, history of thrombotic events, diabetes mellitus, dyslipidemia, and thyroid disease, showed no significant differences in their distribution across the anxiety severity groups (all p \u0026gt; .05).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations among Demographic Factors, Comorbidities, and Anxiety Levels in Patients with Behçet’s Disease: A Comparative Analysis Using the GAD-7 Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimal anxiety 0–4\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMild anxiety 5–9\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate anxiety 10–14\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSevere anxiety 15–21\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (30.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38 (41.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (7.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 − 18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (64.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (61.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51 (56.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40–60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (44.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37 (40.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (3.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (35.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36 (39.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.184\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18 (64.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (68.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55 (60.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (10.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (12.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (92.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34 (89.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80 (87.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombotic events\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (32.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e17 (18.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (67.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33 (86.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74 (81.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (21.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (5.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (27.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15 (16.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (78.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36 (94.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (72.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e76 (83.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (6.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (96.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35 (92.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e85 (93.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (21.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19 (20.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (78.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15 (83.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e72 (79.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (7.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (9.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (92.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35 (92.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82 (90.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e, which details the associations between demographic factors, comorbidities, and levels of depression as measured by the PHQ-9, dyslipidemia was the only variable to demonstrate a statistically significant association with depression severity (p = .022). The distribution of patients across depression categories was as follows: 25 (27.5%) had minimal depression, 33 (36.3%) had mild depression, 18 (19.8%) had moderate depression, 8 (8.8%) had moderately severe depression, and 7 (7.7%) had severe depression. The presence of dyslipidemia was notably more common in the mild (36.4%) and moderate (27.8%) depression categories, while it was absent in all patients with moderately severe or severe depression and present in only 8.0% of those with minimal depression. No other demographic or clinical variables, including age, gender, nationality, history of thrombotic events, hypertension, diabetes mellitus, or thyroid disease, showed a significant association with depression severity (all p \u0026gt; .05).\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations among Demographic Factors, Comorbidities, and Depression Levels in Patients with Behçet’s Disease: A Comparative Analysis Using the PHQ-9 Scale\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimal depression 0–4\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMild depression 5–9\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate depression 10–14\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModerately severe depression 15–19\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSevere depression 20–27\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (27.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33 (36.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e18 (19.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (8.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (7.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 − 18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (56.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (57.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8 (44.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51 (56.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.693\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40–60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (40.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (36.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e10 (55.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37 (40.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove 60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 (3.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (42.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36 (39.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (68.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (57.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11 (61.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4 (50.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55 (60.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Saudi\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (12.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (12.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1 (5.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2 (25.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11 (12.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.676\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSaudi\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (88.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (87.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e17 (94.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6 (75.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e80 (87.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThrombotic events\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (15.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17 (18.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17 (68.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (84.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15 (83.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e74 (81.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (18.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6 (33.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (16.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (92.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (81.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12 (66.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e76 (83.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (11.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6 (6.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (92.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32 (97.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16 (88.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85 (93.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (8.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (36.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (27.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19 (20.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (92.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (63.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (72.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e72 (79.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThyroid disease\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (4.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (9.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5 (27.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9 (9.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (96.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (90.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (72.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82 (90.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and Comorbid Factors Associated with Low (\u0026lt; 10) and High (≥ 10) GAD-7 and PHQ-9 Scores in Patients with Behçet’s Disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eScore\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD-7\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt; 10\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e≥ 10\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (72.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (27.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColchicine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (43.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (52.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (46.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.651\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (56.1)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (48.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (53.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzathioprine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (60.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (64.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (61.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.956\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (39.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (36.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (38.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCortisone\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44 (66.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (68.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (67.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (33.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (32.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (33.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdalimumab\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (77.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (72.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (75.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (22.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (28.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (24.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHQ-9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal n (%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (63.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33 (36.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColchicine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (44.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (48.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (46.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 (55.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (51.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (53.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzathioprine\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37 (63.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19 (57.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56 (61.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21 (36.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (42.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (38.5)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCortisone\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39 (67.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (66.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (67.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (32.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (33.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (33.0)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdalimumab\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45 (77.6)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (72.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69 (75.8)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (22.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (27.3)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (24.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e analyzes the association between specific BD medications and the presence of clinically significant anxiety or depression, none of the evaluated medications demonstrated a statistically significant relationship with high symptom scores. For anxiety (GAD-7 ≥ 10), the use of colchicine (p = .651), azathioprine (p = .956), cortisone (p = 1.000), and adalimumab (p = .802) showed no significant difference in distribution between patients with low and high anxiety scores.\u003c/p\u003e\u003cp\u003eSimilarly, for depression (PHQ-9 ≥ 10), the use of colchicine (p = .906), azathioprine (p = .717), cortisone (p = 1.000), and adalimumab (p = .790) also revealed no significant association with the presence of clinically significant depression. These results indicate that, within this patient sample, the use of these common BD medications was not a significant factor associated with the severity of anxiety or depression.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study screened patients with BD receiving follow-up care for anxiety and depression symptoms at King Abdulaziz University Hospital. To our knowledge, this is the first study to examine the prevalence of depression and anxiety disorders among patients with BD in Saudi Arabia.\u003c/p\u003e \u003cp\u003eIn the present study, we observed a high prevalence of anxiety and depression symptoms among patients with BD. Anxiety and depression affected approximately one in three patients, with younger patients and females showing a trend toward higher anxiety with no statically significance. Regarding comorbidities, dyslipidemia was significantly associated with higher depressive symptoms, while hypertension showed a non-significant trend toward higher anxiety. No significant associations were found with the type of treatments, suggesting that psychiatric symptoms may be more closely related to disease burden and comorbidities than to therapy. These findings highlight the importance of routine mental health assessment and integrated care for this population.\u003c/p\u003e \u003cp\u003eNeuropsychiatric manifestations, including anxiety and depression, are frequently reported in BD [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The results indicated a notable prevalence of anxiety symptoms, with most patients experiencing mild to moderate levels of anxiety. Consistent with our findings, a single-center cross-sectional study in Turkey reported that 43.2% of BD patients exhibited anxiety, which was significantly correlated with disease activity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly, a study in France assessing psychiatric symptoms and cognitive disorders in BD patients found anxiety to be the most frequent symptom (47.4%), followed by somatization and phobia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Additionally, previous case\u0026ndash;control studies from Egypt and Turkey showed that anxiety levels were significantly higher in BD patients, with anxiety present in 31.1% of patients versus 13.5% of controls, and more severe symptoms in those with active disease [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Overall, anxiety and depression in patients with BD are influenced by many factors, including disease activity, disease duration, and symptom variability [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study also explored the associations between demographic characteristics, comorbidities, and anxiety levels in patients with BD. Our research indicated that hypertension was associated with a non-significant inclination towards increased anxiety. Similarly, previous studies have indicated that anxiety is more prevalent among hypertensive patients, with these conditions often coexisting [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. A 2023 study further supported this by investigating the mechanisms and risk factors of hypertension and anxiety, demonstrating that both share common risk factors, including age, obesity, sex, alcohol abuse, smoking, lead exposure, and traffic noise [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, a significant proportion of patients with BD exhibited depression ranging from mild to severe. Similarly, a study conducted in Egypt found that the frequency of depression among patients with BD was notably high [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In contrast, several studies have reported a lower prevalence of depression. For instance, a study in Korea found that the depression rate among patients with BD was 46%, while three studies from Turkey reported frequencies of 40.6%, 43%, and 29.5% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The observed discrepancies in depression prevalence among patients with BD could be attributed to the utilization of different assessment methods for depression, variation in sample sizes, and the diverse lifestyles of individuals. Given that BD is a chronic disorder characterized by exacerbation and remission, it can remarkably impact the quality of life [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCorticosteroids are commonly prescribed to patients with active autoimmune diseases, including BD. Long-term use of steroids, particularly at high doses, causes mental disorders, including anxiety, depression, and psychosis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The current study examined the association between certain medications used for BD and the degree of anxiety and depression. The findings indicated that medications, such as colchicine, azathioprine, cortisone, and adalimumab, may not significantly affect anxiety and depression in patients with BD. These results are consistent with those of a previous study conducted in Turkey [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, regarding corticosteroids, these findings differ from those of another study that assessed the effects of local corticosteroids, particularly inhaled forms, as well as systemic corticosteroids on psychiatric disorders, which found a link between decreased executive cognitive functioning and an increased risk of mood and anxiety disorders in the general adult population [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Conversely, a study from Egypt found that depressed patients with BD were more frequently treated with biological agents, including cyclosporine A and cyclophosphamide, than were their non-depressed counterparts. Additionally, a significant correlation was observed between the severity of depression and the use of these medications [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Further long-term studies with larger cohorts are required to achieve a deeper understanding of the efficacy of these medications and their relationship with anxiety and depression.\u003c/p\u003e \u003cp\u003eOwing to the rarity of BD, the sample size of the study was relatively small, which may limit both the generalizability and reliability of the findings. Since no formal a priori power calculation was conducted, the analyses should be viewed as exploratory. As a result, the lack of statistically significant associations, especially in subgroup analyses, should be approached with caution, as the study might not have had sufficient power to identify small effects. In particular, the low frequency of certain comorbid conditions such as diabetes mellitus, hypertension, and chronic kidney disease within the sample may reduce the ability to draw firm conclusions about their association with BD. The younger age distribution of the study population further influences this limitation.\u003c/p\u003e \u003cp\u003eThe study was conducted at a single center, which limits the diversity of the patient population and might affect the generalizability of the results. Nevertheless, the controlled setting provided consistent data collection procedures, enhancing the reliability of the findings within this context. The cross-sectional design of this study restricts its ability to establish causality or monitor changes over time. Nevertheless, it provides valuable insights into the mental health status of patients with BD.\u003c/p\u003e \u003cp\u003eWhile validated scales may be subject to potential response bias from patient recall and subjective reporting, they still provide a standardized measure of anxiety and depression. Additionally, the study did not account for confounding factors, such as socioeconomic, status education level, severity of BD or disease duration, which could influence mental health outcomes.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study lays important groundwork for future research. Prospective, longitudinal projects with larger and more diverse samples are required to explore the dynamics of anxiety and depression in patients with BD and to assess the long-term effects of interventions, thereby building on these initial findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the notable prevalence of anxiety and depression among patients with BD in Saudi Arabia, with mild to moderate symptoms being the most common. This underscores the critical need for early detection and intervention for mental health concerns in patients with BD, particularly given the chronic nature of the disease and its impact on quality of life. Addressing these psychiatric comorbidities through integrated care approaches can help alleviate psychological distress and improve overall patient outcomes in BD management. Future studies should explore long-term mental health strategies and their effectiveness in this patient population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBD: Behçet's Disease\u003c/p\u003e\n\u003cp\u003ePHQ-9: Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003eGAD-7: Generalized Anxiety Disorder-7\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Bioethics Committee of Scientific and Medical Research at KAUH (Approval number: HA-02-J-008). Participants were informed about the study’s purpose and objectives and provided voluntary consent before participation. Informed consent was obtained from all participants, who were assured that their data would be securely stored and handled with strict confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient has consented to the submission of the case base review for submission to the journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe raw data used in this study cannot be shared due to confidentiality agreements. However, summary statistics or additional details can be made available upon reasonable request, subject to approval from the relevant authorities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eM. Mustafa and Y. Bawazir supervised the conception, design, and drafting of this manuscript. S.A. and M.Z. were responsible for data collection and writing the original draft. N.Butt conducted the data analysis and interpretation. All authors have revised the manuscript and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the participants for their cooperation.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEl-Garf A, Abdo M, Alkemary A, Mohamed S (2019) Beh\u0026ccedil;et\u0026rsquo;s disease patterns and subsets in a cohort of Egyptian patients. Egypt Rheumatol 41:135\u0026ndash;138.\u003c/li\u003e\n\u003cli\u003eAlharthy F, Almaqati AS, Alsulami S, Ahmad A (2023) Beh\u0026ccedil;et\u0026rsquo;s disease in Saudi Arabia: Clinical and demographic characteristics. Cureus 15:e34867.\u003c/li\u003e\n\u003cli\u003eTurgut YB, Turgut M (2020) Turkish scientist Hulusi Beh\u0026ccedil;et (1889\u0026ndash;1948) and his contribution to the medical world. Childs Nerv Syst 36:665\u0026ndash;666. doi:10.1007/s00381-019-04081-8.\u003c/li\u003e\n\u003cli\u003eAl Zahrani FM, Alsultan B, Alahmari H, Almannaa A, Asseri M, Alhayaza S, et al. (2019) Beh\u0026ccedil;et\u0026rsquo;s disease presentations and care outcomes in a tertiary hospital in south-western Saudi Arabia. Int J Rheum Dis 22:1466\u0026ndash;1473.\u003c/li\u003e\n\u003cli\u003eCan Sandikci S, Colak S, Omma A, Enecik ME (2019) An evaluation of depression, anxiety and fatigue in patients with Beh\u0026ccedil;et\u0026rsquo;s disease. Int J Rheum Dis 22:974\u0026ndash;979.\u003c/li\u003e\n\u003cli\u003eSibley C, Yazici Y, Tascilar K, Khan N, Bata Y, Yazici H, et al. (2014) Beh\u0026ccedil;et syndrome manifestations and activity in the United States versus Turkey \u0026ndash; A cross-sectional cohort comparison. J Rheumatol 41:1379\u0026ndash;1384.\u003c/li\u003e\n\u003cli\u003eEl Menyawi MM, Raslan HM, Edrees A (2009) Clinical features of Beh\u0026ccedil;et\u0026rsquo;s disease in Egypt. Rheumatol Int 29:641\u0026ndash;646.\u003c/li\u003e\n\u003cli\u003eDavatchi F, Shahram F, Chams-Davatchi C, Shams H, Nadji A, Akhlaghi M, et al. (2010) Beh\u0026ccedil;et\u0026rsquo;s disease: From east to west. Clin Rheumatol 29:823\u0026ndash;833.\u003c/li\u003e\n\u003cli\u003eCalamia KT, Wilson FC, Icen M, Crowson CyS, Gabriel SE, Kremers HM (2009) Epidemiology and clinical characteristics of Beh\u0026ccedil;et\u0026rsquo;s disease in the US: A population-based study. Arthritis Care Res 61:600\u0026ndash;604.\u003c/li\u003e\n\u003cli\u003eShaddad AM, Hussein AARM, Safwat SM, Talaat EA, Farrag S, Gamal NM, et al. (2023) Assessment of sleep quality, anxiety, depression, and quality of life in Beh\u0026ccedil;et\u0026rsquo;s disease. Egypt J Bronchol 17:1\u0026ndash;10. doi:10.1186/s43168-023-00200-x.\u003c/li\u003e\n\u003cli\u003eFawzy RM, Abd-Elmaksoud SF, Elolemy GG (2021) Depression in Beh\u0026ccedil;et\u0026rsquo;s disease patients: Relationship with disease pattern, activity and quality of life. Egypt Rheumatol 43:325\u0026ndash;329.\u003c/li\u003e\n\u003cli\u003eDavatchi F, Assaad-Khalil S, Calamia KT, Crook JE, Sadeghi-Abdollahi B, Schirmer M (2014) The International Criteria for Beh\u0026ccedil;et\u0026rsquo;s Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 28:338\u0026ndash;347.\u003c/li\u003e\n\u003cli\u003eGeneralized Anxiety Disorder 7-item (GAD-7) \u0026ndash; Mental Health Screening \u0026ndash; National HIV Curriculum. Available at: https://www.hiv.uw.edu/page/mental-health-screening/gad-7.\u003c/li\u003e\n\u003cli\u003eAkt\u0026uuml;rk Z, Hapfelmeier A, Fomenko A, D\u0026uuml;mmler D, Eck S, Olm M, Gehrmann J, von Schrottenberg V, Rehder R, Dawson S, L\u0026ouml;we B, R\u0026uuml;cker G, Schneider A, Linde K (2025) Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. Cochrane Database Syst Rev 3(3):CD015455.\u003c/li\u003e\n\u003cli\u003ePatient Health Questionnaire-9 (PHQ-9) \u0026ndash; Mental Health Screening \u0026ndash; National HIV Curriculum. Available at: https://www.hiv.uw.edu/page/mental-health-screening/phq-9#.\u003c/li\u003e\n\u003cli\u003ePatient Health Questionnaire (PHQ) \u0026ndash; American Psychological Association. Available at: https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health (apa.org in Bing).\u003c/li\u003e\n\u003cli\u003eLevis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration (2019) Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ 365:l1476.\u003c/li\u003e\n\u003cli\u003eCan Sandikci S, Colak S, Omma A, Enecik ME (2019) An evaluation of depression, anxiety and fatigue in patients with Beh\u0026ccedil;et\u0026rsquo;s disease. Int J Rheum Dis 22(6):974\u0026ndash;979.\u003c/li\u003e\n\u003cli\u003eUrbain F, Hardy-L\u0026eacute;ger I, Adebs-Nasser G, de Menthon M, Pivert C, Mausol\u0026eacute;o A, Laparra A, Lerolle N, Domnariu PA, Lambotte O, Denier C, Goujard C, Castro-Gordon A, Noel N (2023) Psychiatric symptoms and cognitive disorders in Beh\u0026ccedil;et\u0026rsquo;s disease: A single-center, cross-sectional study. J Clin Med 12(9):3149.\u003c/li\u003e\n\u003cli\u003eDawa GA, Toukhey MAE, Sherby NA, et al. (2024) Functional disability among Beh\u0026ccedil;et\u0026rsquo;s disease patients: its relation to disease activity, depression, and fatigue. Egypt Rheumatol Rehabil 51:63.\u003c/li\u003e\n\u003cli\u003eShaddad AM, Hussein AARM, Safwat SM, et al. (2023) Assessment of sleep quality, anxiety, depression, and quality of life in Beh\u0026ccedil;et\u0026rsquo;s disease. Egypt J Bronchol 17:26.\u003c/li\u003e\n\u003cli\u003eGur A, Sarac AJ, Burkan YK, Nas K, Cevik R (2006) Arthropathy, quality of life, depression, and anxiety in Beh\u0026ccedil;et\u0026rsquo;s disease: Relationship between arthritis and these factors. Clin Rheumatol 25:524\u0026ndash;531.\u003c/li\u003e\n\u003cli\u003eTsutsui H, Kikuchi H, Oguchi H, Nomura K, Ohkubo T (2020) Identification of physical and psychosocial problems based on symptoms in patients with Beh\u0026ccedil;et\u0026rsquo;s disease. Rheumatol Int 40:81\u0026ndash;89. doi:10.1007/s00296-019-04488-1.\u003c/li\u003e\n\u003cli\u003eQiu T, Jiang Z, Chen X, Dai Y, Zhao H (2023) Comorbidity of anxiety and hypertension: Common risk factors and potential mechanisms. Int J Hypertens 2023:9619388. doi:10.1155/2023/9619388.\u003c/li\u003e\n\u003cli\u003eLim LF, Solmi M, Cortese S (2021) Association between anxiety and hypertension in adults: A systematic review and meta-analysis. Neurosci Biobehav Rev 131:96\u0026ndash;119.\u003c/li\u003e\n\u003cli\u003eCheung BMY, Au THY, Chan SY, Lam CM, Lau Sh, Lee RP, et al. (2005) The relationship between hypertension and anxiety or depression in Hong Kong Chinese. Exp Clin Cardiol 10:21\u0026ndash;24. Available from: /pmc/articles/PMC2716224.\u003c/li\u003e\n\u003cli\u003eIlhan B, Can M, Alibaz-Oner F, Yilmaz-Oner S, Polat-Korkmaz O, Ozen G, et al. (2018) Fatigue in patients with Beh\u0026ccedil;et\u0026rsquo;s syndrome: Relationship with quality of life, depression, anxiety, disability and disease activity. Int J Rheum Dis 21:2139\u0026ndash;2145.\u003c/li\u003e\n\u003cli\u003ePolat Korkmaz \u0026Ouml;, Aksoy A, Ilhan B, Alibaz-Oner F, Direskeneli H (2022) Sleep quality and its association with disease activity, depression and quality of life in Beh\u0026ccedil;et\u0026rsquo;s disease patients. Ulus Romatoloji Derg 14:81\u0026ndash;86.\u003c/li\u003e\n\u003cli\u003eAlturaymi MA, Almadhi OF, Alageel YS, Bin Dayel M, Alsubayyil MS, Alkhateeb BF (2023) The association between prolonged use of oral corticosteroids and mental disorders: Do steroids have a role in developing mental disorders? Cureus 15:e37627.\u003c/li\u003e\n\u003cli\u003eMelikoglu MA, Melikoglu M (2010) The relationship between disease activity and depression in patients with Beh\u0026ccedil;et\u0026rsquo;s disease and rheumatoid arthritis. Rheumatol Int 30:941\u0026ndash;946.\u003c/li\u003e\n\u003cli\u003eSavas M, Vinkers CH, Rosmalen JGM, Hartman CA, Wester VL, Van Den Akker ELT, et al. (2020) Systemic and local corticosteroid use is associated with reduced executive cognition, and mood and anxiety disorders. Neuroendocrinology 110:282\u0026ndash;291. doi:10.1159/000501617.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"discover-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"discpsy","sideBox":"Learn more about [Discover Psychology](https://www.springer.com/44202)","snPcode":"","submissionUrl":"","title":"Discover Psychology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Depression, anxiety, psychiatry, mental health, Behçet's disease","lastPublishedDoi":"10.21203/rs.3.rs-8646928/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8646928/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Behçet’s disease (BD) is a chronic autoinflammatory disorder characterized by recurrent oral and genital ulcers and ocular inflammation, with potential multisystem involvement. BD has been associated with psychiatric conditions, including depression and anxiety; however, evidence from Saudi Arabia remains limited. This study aimed to determine the prevalence of anxiety and depression among patients with BD in Saudi Arabia and to examine their association with demographic characteristics, comorbid conditions, and medication use.\u003c/p\u003e\n\u003cp\u003eA cross-sectional study of 91 patients with BD was conducted at King Abdulaziz University Hospital (February–August 2024) using telephone interviews with the PHQ-9 and GAD-7 to assess depression and anxiety\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A substantial mental health burden was observed among patients with BD. According to the GAD-7, 30.8% of participants had minimal anxiety, 41.8% mild anxiety, 19.8% moderate anxiety, and 7.7% severe anxiety. PHQ-9 results showed that 27.5% had minimal depression, 36.3% mild depression, 19.8% moderate depression, 8.8% moderately severe depression, and 7.7% severe depression. Clinically significant anxiety (GAD-7 ≥10) was present in 27.5% of patients, while clinically significant depression (PHQ-9 ≥10) was observed in 36.3%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Anxiety and depression are highly prevalent among patients with BD in Saudi Arabia, with most patients experiencing mild to moderate symptoms. These findings underscore the importance of routine mental health assessment and integrated care to improve overall patient well-being.\u003c/p\u003e","manuscriptTitle":"Mapping Anxiety and Depression Among Patients with Behçet Disease in Saudi Arabia a Cross Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-06 17:46:48","doi":"10.21203/rs.3.rs-8646928/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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