Self-medication with prescription drugs, particularly psychotropic medications such as benzodiazepines and Selective Serotonin Reuptake Inhibitors (SSRIs), has become a prominent global public health concern. This issue is particularly acute in countries where pharmaceutical regulations are inconsistently enforced, allowing individuals to access potentially harmful medications without professional oversight. Anxiety disorders are among the most prevalent mental health conditions worldwide, contributing significantly to the global disease burden and often prompting individuals to seek quick relief through pharmacological means.   A growing body of literature has explored the drivers and consequences of self-medication behaviors. Shabbir et al. [1] found that 55.2% of medical students in Pakistan reported self-medicating, compared to 44.8% of non-medical students, often citing time constraints and previous experience as motivators. Turner et al. [2] proposed that individuals with anxiety or mood disorders frequently resort to substance use as a coping mechanism, with up to 24.1% engaging in self-medication with drugs or alcohol. Menary et al. [3] further linked self-medication in anxiety populations to increased risk of alcohol dependence. During the COVID-19 pandemic, Chopra et al. [4] reported a notable surge in self-medication, attributing this to heightened stress and limited access to healthcare services.   In Saudi Arabia, similar trends have been documented. Alsini et al. [5] found that 6.4% of medical students self-prescribed beta-blockers, while Aljhani et al. [6] reported that 22.7% of pharmacists used sleep aids without consultation. Additionally, Albawardi et al. [7] noted that 9.5% of mental health professionals had engaged in unsupervised psychotropic use. Alhur et al. [8] identified elevated awareness of psychotropic medications among youth, yet observed that many obtained these drugs through unregulated channels. However, prior research has not sufficiently examined the combined influence of demographic variables, stress factors and attitudes on self-medication with anxiety drugs within the general Saudi population.   This study aims to fill this gap by evaluating the prevalence, knowledge, attitudes and behaviors related to the self-medication of anxiety drugs among adults in Saudi Arabia. It further investigates the associations between educational attainment, gender and awareness levels.   This paper contributes empirically by offering nationally relevant data on self-medication practices and theoretically by highlighting the disconnect between awareness and behavior. Findings are intended to inform health policy, educational campaigns and regulatory strategies aligned with Saudi Arabia’s Vision 2030 healthcare objectives.

Study Design This study employed a cross-sectional observational design to assess the prevalence, knowledge, attitudes and behaviors associated with self-medication using anxiety drugs among the Saudi Arabian population. The approach was selected to capture a broad snapshot of community-level patterns and to explore associations between sociodemographic variables and medication practices at a single point in time.   Data Collection and Participants Data were collected through a structured electronic questionnaire disseminated via social media platforms and professional networks between January and February 2025. The questionnaire was available in Arabic to ensure accessibility and clarity. A total of 807 participants were included in the final analysis. Inclusion criteria comprised individuals aged 18 years and older who resided in Saudi Arabia and voluntarily consented to participate. Responses with incomplete data or duplicated entries were excluded to maintain data integrity.   Instrument Design The questionnaire consisted of four sections:   Sociodemographic characteristics Knowledge and awareness of anxiety disorders and medication side effects Attitudes toward self-medication practices Self-reported behaviors related to the use of anti-anxiety medications   The instrument was pilot-tested for clarity and face validity with a sample of 30 respondents prior to full distribution.   Statistical Analysis Descriptive statistics were used to summarize demographic data and response frequencies. Chi-square tests were applied to examine associations between categorical variables, including gender, education level and awareness of anxiety disorders. A significance level of p<0.05 was considered statistically significant. All analyses were performed using SPSS software version 26 (IBM Corp., Armonk, NY, USA).

Table 1 presents the demographic characteristics of the participants. The majority of respondents were between the ages of 18-25 (38.46%), followed by those aged 26-35 (22.33%). Gender distribution showed that females comprised 63.10% of the sample, while males accounted for 36.90%. Regarding educational attainment, most participants held a Bachelor's degree (63.40%), with a smaller proportion having a Master's degree (22.10%) or a PhD or higher (9.20%).   As shown in Table 2, a significant majority (84.10%) of respondents reported having heard of anxiety disorders, while 6.90% had not and 9.00% were unsure. When asked about the potential side effects of anxiety medication, the most commonly identified effects were drowsiness (24.90%) and headaches (23.20%), while 16.10% noted dependence or addiction as a risk. Interestingly, 12.00% believed there were no side effects and 23.70% were uncertain.   Table 3 summarizes participants’ attitudes toward self-medication. A majority strongly disagreed (35.90%) or disagreed (24.10%) with the notion that self-medication is harmless when recommended by friends or family. Conversely, only 12.50% strongly agreed with this statement. Regarding the effectiveness of therapy over medication for anxiety, a notable proportion of respondents (30.30%) strongly agreed, while 24.30% agreed, suggesting that many favor non-pharmacological interventions.   Table 1: Demographic Information Category Frequency Percentage Age 18-25 310 38.46 26-35 180 22.33 36-45 145 17.99 46-55 121 15.01 Under 18 30 3.72 Gender Male 297 36.90 Female 509 63.10 Education Level Bachelor's Degree 511 63.40 Master's Degree 178 22.10 PhD or Higher 74 9.20   Table 2: Knowledge and Awareness Response Frequency Percentage Have heard of anxiety disorders Yes 678 84.10% No 56 6.90% Not Sure 72 9.00% Side Effects of Anxiety Medication Drowsiness 201 24.90% Dependence or Addiction 130 16.10% Headaches 187 23.20% No Side Effects 97 12.00% Not Sure 191 23.70%   Table 3: Attitudes Toward Self-Medication Response Frequency Percentage Self-medication is harmless if recommended by friends/family Strongly Disagree 290 35.90% Disagree 194 24.10% Neutral 123 15.30% Agree 98 12.20% Strongly Agree 101 12.50% Therapy is more beneficial than medication for anxiety Strongly Disagree 71 8.80% Disagree 150 18.60% Neutral 145 18.00% Agree 196 24.30% Strongly Agree 244 30.30%   Table 4: Behavior and Practices Response Frequency Percentage Ever taken anti-anxiety medication without a prescription? Yes 198 24.60% No 608 75.40% Reasons for self-medication Stress due to exams/work 102 51.50% Lack of time to see a doctor 47 23.70% Belief in knowing the right medication 21 10.60% Advice from friends/family 28 14.20%   Table 5: Chi-Square Test Results Test Chi-Square Value p-Value Degrees of Freedom Gender vs. Self-Medication 2.2965 0.1297 1 Education Level vs. Knowledge 29.4813 0.001 10 Awareness vs. Attitudes 1.5094 0.9589 6   As indicated in Table 4, 24.60% of respondents admitted to taking anti-anxiety medication without a prescription, while the majority (75.40%) had not. Among those who self-medicated, stress due to exams or work was the most frequently cited reason (51.50%), followed by a lack of time to visit a doctor (23.70%). Only 10.60% self-medicated due to believing they knew the right medication, while 14.20% did so based on advice from friends or family.   Figure 1 highlights recommendations for mitigating self-medication. The most commonly suggested solution was stronger regulations on pharmacies (35.80%), followed closely by increased public awareness campaigns (32.90%). Easier access to mental health professionals (21.80%) and counseling and educational programs (9.30%) were also proposed as potential interventions.   Table 5 presents the results of the chi-square tests conducted to assess associations between key variables. A significant relationship was found between education level and knowledge of anxiety disorders (p = 0.001), suggesting that higher education levels are associated with greater awareness. However, no significant associations were found between gender and self-medication (p = 0.1297) or between awareness of anxiety disorders and attitudes toward self-medication (p = 0.9589).   This study aimed to examine the prevalence, knowledge, attitudes and behaviors associated with self-medication using anti-anxiety medications in Saudi Arabia. The findings indicate that approximately one in four respondents (24.6%) reported using such medications without a prescription, addressing the core research question regarding the extent of unsupervised psychotropic drug use in the population.   Academic and occupational stress emerged as the most frequently cited driver of self-medication, corroborating prior findings by Chopra et al. [4], who observed increased self-medication during periods of heightened anxiety, such as the COVID-19 pandemic [4]. This aligns with broader concerns raised in regional studies, including Alhur et al. [8], regarding the systemic nature of medication misuse linked to social pressures and inadequate regulatory enforcement.   Despite high general awareness of anxiety disorders (84.1%), only a minority (16.1%) recognized addiction as a potential side effect of anti-anxiety drugs, revealing a critical gap in specific pharmacological knowledge. This observation supports prior research suggesting that knowledge alone does not equate to safe behavior, particularly when access to prescription medication is unregulated [8]. The persistent uncertainty reported by 23.7% of participants further highlights the need for targeted health education addressing drug dependency and long-term safety.   Attitudes toward self-medication were mixed. While a majority rejected informal recommendations from non-professionals, a notable minority accepted them. Encouragingly, over 54% of respondents favored psychological therapy over pharmacological treatment, reflecting a potential cultural openness to non-drug interventions that could be leveraged in mental health promotion strategies.   The statistical analysis revealed a significant association between education level and awareness of anxiety disorders (p = 0.001), supporting findings by Shabbir et al. [1] and Alhur et al. [8] that link educational attainment to informed health choices. However, the absence of a statistically significant gender-based difference in self-medication behavior (p = 0.1297) suggests that this issue spans demographic boundaries and is not confined to specific subpopulations.   Participants proposed several strategies to mitigate self-medication, most notably strengthening pharmacy regulations (35.8%) and launching public awareness campaigns (32.9%). These recommendations are consistent with earlier work by Alsini et al. [5] and Albawardi et al. [7], both of whom emphasized regulatory reform even among healthcare professionals. Additionally, the need to foster trust in healthcare systems and address digital literacy challenges-previously highlighted by Alhur et al. [9-13] remains a relevant consideration, as such factors may discourage formal consultations and inadvertently encourage self-treatment.   Limitations of the study include its reliance on self-reported data, which may be influenced by recall or social desirability bias. The cross-sectional design also limits causal interpretation. Moreover, the online distribution of the survey may have excluded individuals without digital access, potentially underrepresenting certain demographic groups.   Future research should explore longitudinal patterns of self-medication behavior to understand persistence over time, examine healthcare providers’ perspectives on public access to anxiety medications and assess the effectiveness of targeted interventions such as digital literacy programs or pharmacy policy changes.

This study aimed to examine the prevalence, knowledge, attitudes and behaviors associated with self-medication using anti-anxiety medications in Saudi Arabia. The findings indicate that approximately one in four respondents (24.6%) reported using such medications without a prescription, addressing the core research question regarding the extent of unsupervised psychotropic drug use in the population.   Academic and occupational stress emerged as the most frequently cited driver of self-medication, corroborating prior findings by Chopra et al. [4], who observed increased self-medication during periods of heightened anxiety, such as the COVID-19 pandemic [4]. This aligns with broader concerns raised in regional studies, including Alhur et al. (2024) [8], regarding the systemic nature of medication misuse linked to social pressures and inadequate regulatory enforcement.   Despite high general awareness of anxiety disorders (84.1%), only a minority (16.1%) recognized addiction as a potential side effect of anti-anxiety drugs, revealing a critical gap in specific pharmacological knowledge. This observation supports prior research suggesting that knowledge alone does not equate to safe behavior, particularly when access to prescription medication is unregulated [8]. The persistent uncertainty reported by 23.7% of participants further highlights the need for targeted health education addressing drug dependency and long-term safety.   Attitudes toward self-medication were mixed. While a majority rejected informal recommendations from non-professionals, a notable minority accepted them. Encouragingly, over 54% of respondents favored psychological therapy over pharmacological treatment, reflecting a potential cultural openness to non-drug interventions that could be leveraged in mental health promotion strategies.   The statistical analysis revealed a significant association between education level and awareness of anxiety disorders (p = 0.001), supporting findings by Shabbir et al. [1] and Alhur et al. [8] that link educational attainment to informed health choices. However, the absence of a statistically significant gender-based difference in self-medication behavior (p = 0.1297) suggests that this issue spans demographic boundaries and is not confined to specific subpopulations.   Participants proposed several strategies to mitigate self-medication, most notably strengthening pharmacy regulations (35.8%) and launching public awareness campaigns (32.9%). These recommendations are consistent with earlier work by Alsini et al. (2021) and Albawardi et al. (2024), both of whom emphasized regulatory reform even among healthcare professionals [5,7]. Additionally, the need to foster trust in healthcare systems and address digital literacy challenges-previously highlighted by Alhur et al. [9-13]-remains a relevant consideration, as such factors may discourage formal consultations and inadvertently encourage self-treatment.   Limitations of the study include its reliance on self-reported data, which may be influenced by recall or social desirability bias. The cross-sectional design also limits causal interpretation. Moreover, the online distribution of the survey may have excluded individuals without digital access, potentially underrepresenting certain demographic groups.   Future research should explore longitudinal patterns of self-medication behavior to understand persistence over time, examine healthcare providers’ perspectives on public access to anxiety medications and assess the effectiveness of targeted interventions such as digital literacy programs or pharmacy policy changes.

This study provides empirical evidence on the prevalence and underlying drivers of self-medication with anxiety drugs in Saudi Arabia, identifying it as a notable public health concern. Approximately one-quarter of respondents reported engaging in unsupervised use of psychotropic medications, underscoring the need for targeted regulatory, educational and clinical interventions.   The findings highlight stress-particularly from academic and occupational sources-as a primary motivator for self-medication and reveal persistent gaps in public understanding of the risks associated with such practices, including drug dependency and adverse effects. Despite high general awareness of anxiety disorders, knowledge of medication safety remains limited, indicating that awareness alone is insufficient to prevent misuse.   Educational attainment was significantly associated with greater awareness, reinforcing the theoretical premise that health literacy plays a critical role in informed decision-making. Moreover, the expressed public support for non-pharmacological interventions and policy reform suggests a readiness for culturally sensitive mental health initiatives.   From a policy perspective, the results advocate for enhanced regulation of pharmacy practices, widespread public health campaigns and expanded access to mental health services. These actions are essential to address misuse at both systemic and individual levels. As the Kingdom advances its Vision 2030 healthcare transformation, integrating evidence-based safeguards around psychotropic drug use will be vital for promoting safe, equitable and sustainable mental health care.   Ethical Statement Ethical approval for this study was obtained from the Institutional Review Board (IRB) at the University of Hail (Approval No. H-2025-005). Participation was voluntary and informed consent was obtained electronically prior to the initiation of the survey. All responses were anonymous and no identifiable personal data were collected, ensuring participant confidentiality and compliance with data protection standards.