Factors associated with general well-being among Lebanese adults: The role of emotional intelligence, fear of COVID, healthy lifestyle, coping strategies (avoidance and approach)

Adaptive versus maladaptive coping strategies: insight from Lebanese young adults navigating multiple crises

BACKGROUND

Coping strategies are composites of cognitive and behavioral efforts to manage the internal and external demands of stressful situations. They have been documented to relate to general well-being and mental health. However, not all types of coping are created equal, and adaptive versus maladaptive strategies seem to have understudied differential impacts, notably with accumulated adversities.

METHODS

We examined coping strategies in a sample of 489 Lebanese university students during accumulating crises, including socio-political unrest and the COVID- 19 pandemic. They were asked to fill out an online survey including standardized questionnaires of well-being (WEMWBS), depression (PHQ- 9), anxiety (HAM-A), intolerance of uncertainty (IUS), and coping (Brief COPE), in addition to demographics and questions about their attitudes and future perspectives.

RESULTS

The results highlight that adaptive coping strategies positively correlate with psychological well-being, whereas maladaptive ones are associated with higher levels of psychopathology. Specifically, it was shown that a positive association exists between anxiety, depression, intolerance of uncertainty, and maladaptive coping strategies while evidencing a negative association between the latter and well-being. Our multinominal regression showed that anxiety, intolerance of uncertainty and well-being were associated with low levels of adaptive coping when taking adaptive coping as a dependent variable.

CONCLUSION

Our study mainly highlights the relation between coping, uncertainty, and mental health. Although intended to help relieve tension, maladaptive strategies might worsen it instead. We emphasize previous findings to promote healthy adaptive coping strategies in times of unprecedented crises.

Psychometric properties of the Arabic version of the Young Schema Questionnaire Short Form-Version 3 (YSQ-S3)

It is well evidenced that Early Maladaptive Schemas (EMS) are important mental health determinants, particularly in adolescents and young adults. The short version of the Young Schema Questionnaire (YSQ-S3) is widely used globally to assess EMS, and has yet to be validated in the Arabic language. The aim of the current study was to validate the Arabic version of the YSQ-S3 in Arabic-speaking young adults from Lebanon. This cross-sectional study was carried out between September and December 2020. A total of 1175 participants was recruited through convenience sampling. The data was collected through an online questionnaire containing the following sections: sociodemographic information about the participants, Young Schema Questionnaire-Short Form Version 3 (YSQ-S3), the Lebanese Anxiety Scale (LAS-10), the Beirut Distress Scale (BDS-10) and the Montgomery-Asberg Depression Rating Scale (MADRS). Confirmatory Factor Analysis showed a reasonable fit to the 5-domain structure of the questionnaire. All scores showed high McDonald's omega values (0.91-0.97). Additionally, all maladaptive domains were significantly and positively correlated with more depression, anxiety and stress, attesting for their concurrent validity. Finally, analyses supported the measurement invariance of the Arabic YSQ-S3, with no difference found between men and women in all domains. The results of the current study suggest that the YSQ-S3 is a valid instrument to assess EMS among the Arabic-speaking population. The validation of the Arabic version of the YSQ-S3 should facilitate the evaluation of EMS for clinicians in their practices.

Effects of Standard Tai Chi on Exercise Capacity and Mental Health in Exercise-Deprived Overweight/Obese Adults and Assessment of Participant Adherence

OBJECTIVE

To explore the effects of Tai Chi on body mass index (BMI), exercise capacity, and mental health of overweight/obese adults, and investigate factors influencing adherence to enhance adherence of Tai Chi as a sustainable exercise method.

METHODS

A randomized, controlled, exploratory clinical trial was conducted paired with a qualitative study of adherence management. A total of 20 overweight/obese participants were randomly assigned to a standard Tai Chi group (experimental) and a simplified Tai Chi group (control) for an 8-week intervention, 10 patients in each group, with a 12-month follow-up. BMI was calculated and exercise capacity including an isokinetic muscle strength and balance ability test were evaluated. Mental health was assessed using the General Well-Being Schedule (GWB), Pittsburgh Sleep Quality Index (PSQI), and Coping Self Efficacy Scale (CSES) at baseline, 4th week, and 8th week, respectively. The qualitative research included open-interviews with Tai Chi practitioners and semi-structured interviews with subjects.

RESULTS

The intervention was conducted in Haidian Park, Beijing, China from October 6, 2022, to January 1, 2023, without dropouts. After an 8-week intervention, the participants in the experimental group exhibited a significant decrease in BMI (P<0.05). Both groups demonstrated significant improvements in exercise capacity (P<0.05). The experimental group exhibited a significant enhancement in the GWB, PSQI and CSES (P<0.05). Only GWB had significant difference in the control group (P<0.05). The experimental group surpassed the control group in GWB and CSES (P<0.05). The adherence rate was 87.5% in the experimental group and 57.9% in the control group after 8 weeks intervention. Analysis on adherence identified 15 themes, the top 3 themes mentioned were as follows: mind-body effects, online and on-site guidance, training schedule (for subjects); mind-body effects, difficulties in practicing, and understanding of Tai Chi (for practitioners).

CONCLUSIONS

Both interventions were effective in improving exercise capacity. Tai Chi, integrating both physical and mental conditioning, reduced weight, improved exercise capacity and mental happiness, and increased adherence, providing a sustainable exercise program (ChiCTR2200063599).

Path analysis of the role of coping strategies between emotional intelligence and lifestyle habits during COVID-19 lockdown

The relationship between Emotional Intelligence (EI) and lifestyle choices during the COVID-19 pandemic is obscure and not very well understood. To clarify the mechanisms underlying this relationship, we proposed to test the hypothesis that different coping styles (avoidant and approach) have an indirect effect on the association between EI and many types of lifestyle habits. A cross-sectional study was conducted between December 2020 and January 2021. Our target sample consisted of Lebanese adults from the general population. In path analysis, approach coping mediated the association between EI and different lifestyle habits (rest, nutrition, general physical conditions), but not exercise. Furthermore, avoidant coping did mediate the association between EI and general physical conditions, but not between EI and other lifestyle choices (namely rest, exercise, and nutrition). To conclude, individuals with high EI, and that are users of approach coping strategies to deal with stressors, have increased rest time, healthy nutrition and general physical conditions. This cautiously implies that fostering approach coping may help improve the positive effects of EI on healthy lifestyles during crises such as this pandemic.

Coping during socio-political uncertainty

Introduction

Well-being of young adults is known to be compromised in times of significant changes, such as economic and political turmoil. This study focuses on university students in Lebanon during one of the most prominent social unrests of its modern history to determine potential understudied protective factors that would predict the youth capacity to strive.

Methods

A sample of 489 university students were asked to fill an online survey including standardized questionnaires of wellbeing (WEMWBS), depression (PHQ-9), anxiety (HAM-A), intolerance of uncertainty (IUS-12), coping (Brief COPE) in addition to demographics and questions about their attitudes and future perspectives.

Results

We found increased rates of mental distress, predominantly in women, with around 80% of the sample being highly intolerant to the uncertainty climate. Results unsurprisingly show that well-being negatively correlated with anxiety, depression and intolerance of uncertainty. Overall, mental distress was found to mediate the relation between uncertainty and wellbeing, and the relation between maladaptive coping and wellbeing. Students who were intolerant of uncertainty and who used maladaptive coping strategies were more likely develop anxiety and depression and subsequently report poorer wellbeing. Conversely, having adaptive strategies was directly linked to higher well-being.

Discussion

In spite of increased distress, some university students managed to preserve their well-being within a climate of severe socio-political uprise. These findings suggest that modifying subjective experience of events and using soft skillset could alleviate young adults' emotional distress in unstable societies.

Adaptive Coping Strategies at the Time of COVID-19: The Role of Social and General Trust

Research in the field shows the crucial role of trust in the functioning of many aspects of social life, especially when dealing with emergencies. We report the results of a study (N = 883) carried out in Italy during the first phase of the COVID-19 crisis to assess whether and how social trust (i.e., trust in those who have the authority and responsibility for making decisions, such as the Italian government, the regional government, the Civil Protection, the European Union, the Catholic Church, and the scientific community) and general trust (i.e., trust in the trustworthiness of other individuals, such as Italians and humankind) are associated with the employment of coping strategies in dealing with the challenges of the pandemic. Overall, the results highlight that trust in different authorities and institutions and trust in other human beings are positively associated with the adoption of adaptive coping strategies such as seeking social support, positive reinterpretation and growth, problem-solving orientation, and transcendent orientation. In contrast, they are negatively related to the adoption of maladaptive coping strategies such as avoidance. These findings point out the benefits of various types of trust in helping individuals deal with crises, such as the COVID-19 pandemic.

Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon

Almost one year since the COVID-19 was declared a global pandemic, mental distress remains elevated with high prevalence of post-traumatic stress disorder (PTSD). Yet studies suggest these challenging circumstances might be conducive of post-traumatic growth (PTG). This study aims to investigate the factors associated with growth after the original trauma. A sample of 252 Lebanese adults filled an online survey to determine levels of PTG, PTSD and gratitude using validated self-rating scales. Participants also subjectively evaluated the sources of their distress such as the COVID-19 pandemic, the Beirut port explosion and/or their deteriorating financials. The PTGi-SF evaluated dimensions of growth while the IES-R_22 measured the degree of distress post-trauma. The GQ-6 was used to measure the proneness to experience gratitude daily. Results indicated 41% of participants scored above the cutoff for PTSD symptomatology. Yet, PTSD was positively correlated, alongside gratitude and accumulated subjective distress, with higher levels of PTG. A forward linear regression taking PTG scores as the dependent variable further showed that more gratitude (Beta = 0.57), a higher impact of events (Beta = 0.16), and knowing anyone who died from COVID-19 (Beta = 3.93) were significantly associated with more growth. The study highlights elevated levels of PTSD symptoms in a context of a global pandemic worsened by financial and socio-political instabilities. It mostly identifies personal factors, including high initial symptomatology post-trauma and gratitude, related to the capacity for growth in spite of these accumulating hardships. As such, it advocates the need to investigate and bolster silver linings amidst unprecedented traumas.

Coping strategies and household stress/violence in remote Alaska: a longitudinal view across the COVID-19 pandemic

The COVID-19 pandemic has introduced novel stressors. Remote/rural communities have experienced additional difficulties, while also potentially benefitting from unique sources of resilience against such stressors. However, very little research has been conducted in remote/rural communities regarding coping and stress/violence. This study examines coping strategies and household stress/violence in remote Alaska communities across the pandemic through three online survey waves (November 2020-September 2021) (total n = 1,020). Across all waves, personal care was reported most frequently followed by social activities, religious activities, and traditional/subsistence activities. Substance use combined (alcohol, nicotine, marijuana) and seeking counselling were less frequently reported, with significant differences across gender and age categories. Less than 10% of individuals reported physical violence towards children and/or other adults within the household. Overall, these findings indicate that individuals are primarily relying on positive coping strategies to contend with additional stress brought into their lives by the COVID-19 pandemic.

Association between religiosity and orthorexia nervosa with the mediating role of self-esteem among a sample of the Lebanese population - short communication

BACKGROUND

Orthorexia Nervosa is not yet classified as an eating disorder albeit it can be found in different populations. This condition can be characterized by a preoccupation with the quality of food, accompanied by obsessive thoughts regarding eating behaviors, leading to malnutrition. Previous associations have been reported between high levels of eating disorders and lower levels of self-esteem; where individuals have low self-esteem due to the pressured felt to fit the norms of society in beauty standards. The aim of the present study was to evaluate the relationship between religiosity and orthorexia nervosa via either trait or state self-esteem.

METHODS

This study was conducted between September 2021 and February 2022 and included 428 participants from all Lebanese governorates. The Teruel Orthorexia Nervosa scale was used to measure orthorexia nervosa. The following scales state self-esteem and religiosity were used to measure self-esteem.

RESULTS

Sociodemographic characteristics (age, gender, marital status, household crowding index, body mass index and education) were entered in the mediation model as confounding variables. Higher religiosity was significantly associated with higher state self-esteem (Beta = 0.07), while higher state self-esteem was significantly associated with lower identification of those that exhibited ON tendencies or symptoms (Beta= -0.11).

CONCLUSION

A high state self-esteem was correlated with a lower level of orthorexia nervosa. Higher religiosity was shown to be associated with higher self-esteem, which in turn was associated with a decrease in the scores of orthorexia nervosa.

Association between perfectionism and life satisfaction among a sample of the Lebanese population: The indirect role of social phobia and validation of the Arabic version of the Social Phobia Inventory

PURPOSE

To assess the psychometric properties of the Social Phobia Inventory (SPIN), and evaluate the indirect effect of social phobia between perfectionism and life satisfaction (LS).

METHODS

A cross-sectional study enrolled 683 Lebanese adults (April-May 2021).

RESULTS

The confirmatory factor analysis results confirmed the one-factor solution of the SPIN items (Cronbach's alpha = 0.92). Social phobia had an indirect effect in the association between rigid, self-critical, and narcissistic perfectionism and life satisfaction.

PRACTICE IMPLICATIONS

The study results confirm the psychometric properties of the SPIN to assess social phobia and constitute a preliminary database of the variables that interplay with LS in the Lebanese population. Future studies should suggest clinical tools and techniques to cope with anxiety or reduce perfectionism to enhance LS.

Work fatigue among Lebanese physicians and students during the COVID-19 pandemic: validation of the 3D-Work Fatigue Inventory (3D-WFI) and correlates

Background

Work fatigue is a work-related condition that affects physicians’ health, work attitude safety and performance. Work fatigue affects not only medical workers but can also leave a negative impact on patients. With the burden of the COVID-19 pandemic as well as the economic crisis Lebanese doctors have been facing in the last 2 years, the aim of our study was to validate the 3D-Work Fatigue Inventory (3D-WFI) among Lebanese physicians and assess the rate and correlates of work fatigue (physical, mental and emotional).

Methods

A cross-sectional study was undertaken through an anonymous self-administered questionnaire between October 2020 and January 2021. The SPSS AMOS software v.24 was used to conduct confirmatory factor analysis (CFA). To validate the 3D-WFI, multiple indices of goodness-of-fit were described: the Relative Chi-square (χ2/df) (cut-off values:< 2–5), the Root Mean Square Error of Approximation (RMSEA) (close and acceptable fit are considered for values < 0.05 and < 0.11 respectively), the Tucker Lewis Index (TLI) and the Comparative Fit Index (CFI) (acceptable values are ≥0.90).

Results

A total of 401 responses was collected; 66.1, 64.8 and 65.1% respondents had an intermediate to high level of emotional, mental and physical work fatigue respectively. The fit indices obtained in the CFA of the 3D-WFI items fitted well: CFI =0.98, TLI =0.98, RMSEA = 0.05; 95% CI 0.046–0.063; pclose = 0.20) and χ²(136) = 295.76. The correlation coefficients between the three factors (Factor 1 = Physical work fatigue, Factor 2 = Mental work fatigue, Factor 3 = Emotional work fatigue) were adequate as well: Factor 1-Factor 2 (r = 0.70), Factor 1-Factor 3 (r = 0.52) and Factor 2-Factor 3 (r = 0.65). In addition, feeling pressured by long working hours during the pandemic, having more hours of night duty per month, more stressful events in life, and higher depression were significantly associated with more physical and mental work fatigue. Higher depression and having more stressful events in life were significantly associated with more emotional work fatigue.

Conclusion

Work fatigue in Lebanese physicians seems to be associated with higher level of everyday stress, high work load and depression. Hospitals and local health authorities can use these results for early interventions that aim to reduce work fatigue and ensure the wellbeing of Lebanese physicians.