Validation of the Hamilton Anxiety Rating Scale and State Trait Anxiety Inventory A and B in Arabic among the Lebanese population

Anxiety and Depression and Associated Risk Factors among Outpatients with Systemic Lupus Erythematosus: Eastern Province, Saudi Arabia

BACKGROUND

Although mood disorders are prevalent among systemic lupus erythematosus (SLE) patients, they are usually underrecognized. This study aimed to estimate the prevalence of anxiety and depression among Saudi SLE patients.

METHODS

This cross-sectional study was conducted among SLE patients from July 2022 to June 2023 in the Eastern Province of Saudi Arabia. A self-reported questionnaire was used to collect the data through validated tools including the Hamilton Anxiety Rating Scale-A and the Beck Depression Inventory score.

RESULTS

There were 133 females (91.7%) and 12 males (8.3%) included in this study. Based on the HAM-A score, 45.5% of participants had an anxiety disorder, and according to the BDI score, 46.2% had a depression disorder. Anxiety and depression were significantly associated with a longer duration of SLE, unemployment status, smoking, and the presence of comorbidities. Moreover, the present study found a significant association between depression and male gender.

CONCLUSION

This study found that Saudi SLE patients have a high prevalence of both anxiety and depression. Therefore, SLE patients should be screened for neuropsychiatric disorders during routine follow-ups and managed as early as possible.

Evaluation of Depression and Anxiety in Rheumatoid Arthritis Patients During COVID-19 Pandemic

Background

Rheumatoid arthritis (RA) disease activity, associated comorbidities, and therapy-related side effects impair the physical, social, and emotional dimensions of the patient's health. Presently, the ongoing COVID-19 pandemic has been associated with a broad range of psychosocial disorders in various populations. Patients with RA are especially vulnerable to such effects.

Objectives

Detect the prevalence of recent COVID-19 infection among patients with RA, assess depression and anxiety in these patients and their associated factors during the COVID-19 pandemic and their potential relation to disease activity.

Design and Methods

This is a cross-sectional study conducted on 120 adult Egyptian patients diagnosed with RA during the COVID-19 pandemic. The prevalence of recent COVID-19 infection among the patients was evaluated. The patients underwent psychological assessment using the Hamilton Depression Rating Scale (Ham-D) and the Hamilton Anxiety Rating Scale (Ham-A) to measure levels of depression and anxiety levels. The RA disease activity was assessed using Disease Activity Score (DAS) Das-28-ESR.

Results

This study encompasses a total of 120 RA patients. The prevalence of patients with a recent history of COVID-19 infection was 40.8%. Both groups exhibited significantly elevated mean scores on the Das-28-ESR scale and also scored higher on measures of depression and anxiety. Interestingly, the COVID-19 group exhibited a higher percentage of unmarried individuals, had educational attainment below the university level, and were unemployed. Patients with recent COVID-19 had significantly lower numbers of children, higher disease duration, higher Das-28-ESR scores, and elevated depression and anxiety scores. The statistical analysis revealed that the COVID-19 infection and disease duration were significant predictors of depression and anxiety. The results also exhibited that the depression score was positively correlated with age and DAS scores.

Conclusions

It was observed that patients diagnosed with RA revealed a higher prevalence of COVID-19 infection. The occurrence of depression and anxiety was observed to be widespread among patients diagnosed with RA and, more significantly, prevalent in RA patients who had a recent COVID-19 and had a higher level of disease activity. The occurrence of COVID-19 and disease duration were identified as factors that can anticipate the development of depression and anxiety.

Validation of an Arabic version of the eating disorder inventory's body dissatisfaction subscale among adolescents, adults, and pregnant women

INTRODUCTION

The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon.

METHODS

A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women.

RESULTS

The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity.

CONCLUSION

In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition.

Quality of Life Predictors in a Group of Informal Caregivers during the COVID-19 Pandemic

Background and Objectives: The informal caregiver's contribution to the wellbeing of dementia patients is critical since these individuals become dependent on others for all daily activities. Our goal was to investigate the dynamics of anxiety, depression, burnout, sleep, and their influence on quality of life over a 6-month period in the context of pandemic distress in a sample of informal caregivers of Alzheimer's patients. Materials and Methods: For this prospective, longitudinal study, we conducted a 6-month telephonic survey between 2021 and 2022, administering a series of questionnaires at three timepoints (baseline, 3 months and 6 months) to a group of informal caregivers of patients suffering from dementia due to Alzheimer's disease. Results: A total of 110 caregivers were included at baseline, out of which 96 continued to the second stage and 78 followed through to the last stage. The majority of the participants were female (most likely the patients' daughters), around 55 years old, living in urban areas, married, with children, having a high school degree or a higher education degree, and working in jobs that required physical presence; in the best-case scenario, they were sharing their responsibilities with another two-three caregivers. More than half of the 110 participants (50.9%) reported mild to moderate anxiety at baseline, and 27.3% reported significant anxiety, with no changes between the three timepoints, F(2, 154) = 0.551, p = 0.57; 25% reported moderate-severe depression at the start, with no changes between the three timepoints, F(2, 154) = 2.738, p = 0.068; and many reported a decrease in quality of life, poor quality of sleep, and decreased fear of COVID infection. Cynicism, professional effectiveness, anxiety, depression, and sleep quality explained up to 87.8% of the variance in quality of life. Conclusions: Caregivers' decreased quality of life during the pandemic was explained by their levels of burnout, anxiety, and depression throughout the 6-month period.

Translation, cultural adaptation and evaluation of the psychometric properties of the Hamilton Anxiety Scale among a sample of Portuguese adult patients with mental health disorders

BACKGROUND

Only a few anxiety assessment tools that nurses may administer are validated forthe Portuguese population exist in the literature. Thus, this study aimed to translate and culturally adapt the Hamilton Anxiety Scale for the Portuguese population and assess its psychometric properties in a sample of adult people with mental health disorders.

METHODS

This psychometric study uses a convenience sample of adult patients with mental health disorders.

RESULTS

The confirmatory factor analysis confirmed the two factors of the original version of the tool. The internal consistency (Cronbach's alpha) was high, at .92, as well as the inter-rater reliability (intraclass correlation coefficient) (.91).

CONCLUSIONS

The validity and reliability of the instrument are supported. However, the Hamilton Anxiety Scale should be used cautiously in the Portuguese population because the correlation with the "Anxiety State" subscale of the State-Trait Anxiety Inventory is not statistically significant.

Mental health literacy: Perspectives from Northern Kenya Turkana adolescents

Mental illness accounts for high levels of morbidity, mortality and poor quality of life among young people. Depression, anxiety, conduct issues and hyperactive disorder account for 13% of the global burden of disease that affects one in seven adolescents. In Kenya, not much is documented about the mental health of non-school-going adolescents, and yet they make up about 1.8 million of the country's population. An ethnographic study by Focus Group Discussions with 32 rural northern Kenya Turkana-based adolescents divided into school and nonschool groups was conducted. We read out vignettes in which the main character exhibited symptoms of depression, schizophrenia or anxiety and explored their knowledge of causes and management options for the same, and then analyzed the data thematically. Participants described the conditions without referring to the local names we had collected earlier: depression (Akiyalolong), schizophrenia (waarit/Ngikerep) and anxiety (Ngatameta naaronok). They assigned curses, guilt, hunger pangs, and evil spells as causes, and believed friends and age-mates, parents, teachers, and the local chief, among others, could help, but rarely medical intervention. Interventions to improve the adolescent's knowledge of mental illness are a much-needed support for the health of young people.

Spectrochemical approach combined with symptoms data to diagnose fibromyalgia through paper spray ionization mass spectrometry (PSI-MS) and multivariate classification

This study performs a chemical investigation of blood plasma samples from patients with and without fibromyalgia, combined with some of the symptoms and their levels of intensity used in the diagnosis of this disease. The symptoms evaluated were: visual analogue pain scale (VAS); fibromyalgia impact questionnaire (FIQ); Hamilton anxiety rating scale (HAM); Tampa Scale for Kinesiophobia (TAMPA); quality of life Questionnaire-physical and mental health (QL); and Pain Catastrophizing Scale (CAT). Plasma samples were analyzed by paper spray ionization mass spectrometry (PSI-MS). Spectral data were organized into datasets and related to each of the symptoms measured. The datasets were submitted to multivariate classification using supervised models such as principal component analysis with linear discriminant analysis (PCA-LDA), successive projections algorithm with linear discriminant analysis (SPA-LDA), genetic algorithm with linear discriminant analysis (GA-LDA) and their versions with quadratic discriminant analysis (PCA/SPA/GA-QDA) and support vector machines (PCA/SPA/GA-SVM). These algorithm combinations were performed aiming the best class separation. Good discrimination between the controls and fibromyalgia samples were observed using PCA-LDA, where the spectral data associated with the CAT symptom achieved 100% classification sensitivity, and associated with the VAS symptom achieved 100% classification specificity, with both symptoms at the moderate level of intensity. The spectral variable at 579 m/z was found to be substantially significant for classification according to the PCA loadings. According to the human metabolites database, this variable can be associated with a LysoPC compound, which comprises a class of metabolites already evidenced in other studies for fibromyalgia diagnosis. This study proposed an investigation of spectral data combined with clinical data to compare the classification ability of different datasets. The good classification results obtained confirm this technique is as a good analytical tool for the detection of fibromyalgia, and provides theoretical support for other studies about fibromyalgia diagnosis.

Teacher Burnout in the Time of COVID-19: Antecedents and Psychological Consequences

The important, frontline role of teachers during the COVID-19 pandemic has often gone unrecognized, and attention to their mental health and well-being is often only the focus of scholarly research. The unprecedented challenges that teachers faced during the COVID-19 pandemic and the stresses and strains associated with it have severely impacted their psychological well-being. This study examined the predictors and the psychological consequences of burnout. Participants (N = 355) were schoolteachers in South Africa who completed the Perceived Vulnerability to Disease Questionnaire, the Fear of COVID-19 Scale, the Role Orientation Questionnaire, the Maslach Burnout Inventory, the Centre for Epidemiological Depression Scale, the Beck Hopelessness Scale, the Satisfaction with Life Scale, and the trait scale of the State-Trait Anxiety Inventory. The results of a multiple regression showed that fear of COVID-19, role ambiguity, and role conflict were significant predictors of emotional exhaustion and depersonalization, while perceived infectability and role ambiguity significantly predicted personal accomplishment. Gender and age also predicted emotional exhaustion and depersonalization, respectively, and age was also a significant predictor of personal accomplishment. Generally, the dimensions of burnout were significant predictors of indices of psychological well-being-namely, depression, hopelessness, anxiety, and life satisfaction-with the exception of the association between depersonalization and life satisfaction. Our results suggest that intervention efforts to reduce burnout need to provide teachers with adequate job resources to buffer against the demands and stressors associated with their work.

Validation of the Arabic version of the 35-item TEMPS-M in a community sample of adults

BACKGROUND

To our knowledge, no brief version of the Temperament Evaluation in Memphis Pisa and San Diego (TEMPS-M) is available so far in the Arabic language, which might have resulted in limited research in this field from Arab countries. We aimed through this study to validate the 35-item TEMPS-M into the Arabic language in a sample of non-clinical Lebanese adults.

METHODS

We used an online cross-sectional survey targeting non-clinical Lebanese adults from the general population. A confirmatory factor analysis was conducted to test the factorial structure of the TEMPS-M.

RESULTS

All five temperament subscales achieved good/very good internal consistencies in the present study (depressive: α = 0.78, cyclothymic: α = 0.86, hyperthymic: α = 0.83, irritable: α = 0.87, and anxious: α = 0.87). The five-factor solution of the TEMPS-M displayed a good CFI of 0.94, TLI of .94 and a GFI of .95, but a poor RMSEA of .10 [90% CI .10, .11]. The five affective temperaments showed positive correlations with personality dysfunction domains, thus attesting for convergent validity. In addition, positive correlations between all affective temperament dimensions and anxiety/depression scores were found. We also tested for gender invariance, and found that configural, metric, and scalar invariance were supported across gender.

CONCLUSION

Our data suggest that the psychometric properties of the Arabic TEMPS-M are good. Making this scale available in Arabic will hopefully encourage Arab researchers to investigate this under-explored topic in their countries, and advance knowledge on how culture impacts the prevalence, development and course of temperament.

Depression, anxiety, insomnia, stress, and the way of coping emotions as risk factors for ischemic stroke and their influence on stroke severity: A case-control study in Lebanon

BACKGROUND

Stroke is a leading cause of disability and death worldwide. There are numerous debates regarding the relationship between depression, anxiety, insomnia, perceived stress, and ischemic stroke. Moreover, no research on the efficacy of emotion regulation, which is critical for various components of healthy affective and social adaptability, is being conducted. To the best of our knowledge, this is the first study in the MENA region to shed light on the relationship between these conditions and stroke risk, aiming to determine whether depression, anxiety, insomnia, stress, and the way of coping with emotions may be risk factors for ischemic stroke occurrence and to further investigate the ability of two specific types of emotion regulation (cognitive reappraisal and expressive suppression) as possible moderators of the relationship between these psychological diseases and ischemic stroke risk. As a secondary objective, we sought to determine how these pre-existing conditions affect stroke severity levels.

METHODS

This is a case-control survey study involving 113 Lebanese inpatients with a clinical diagnosis of ischemic stroke admitted in hospitals and rehabilitation centers in Beirut and Mount Lebanon, and 451 gender-matched volunteers without clinical signs of stroke as controls recruited from the same hospitals as the cases or attending outpatient clinics for illnesses or treatments unconnected to stroke or transient ischemic attack, as well as visitors or relatives of inpatients (April 2020-April 2021). Data was collected by filling out an anonymous paper-based questionnaire.

RESULTS

According to the outcomes of the regression model, depression (aOR: 1.232, 95%CI: 1.008-1.506), perceived stress (aOR: 1.690, 95%CI: 1.413-2.022), a lower educational level (aOR: 0.335, 95%CI: 0.011-10.579), and being married (aOR: 3.862, 95%CI: 1.509-9.888) were associated with an increased risk of ischemic stroke. The moderation analysis revealed that expressive suppression had a significant moderating effect on the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke risk, resulting in an increased risk of stroke incidence. In contrast, cognitive reappraisal significantly reduced the risk of ischemic stroke by moderating the association between ischemic stroke risk and the following independent variables: perceived stress and insomnia. On the other hand, our multinomial regression model revealed that the odds of moderate to severe/severe stroke were significantly higher in people with pre-stroke depression (aOR: 1.088, 95% CI: 0.747-1.586) and perceived stress (aOR: 2.564, 95% CI: 1.604-4.100) compared to people who had never had a stroke.

CONCLUSION

Despite several limitations, the findings of our study suggest that people who are depressed or stressed are more likely to have an ischemic stroke. Consequently, additional research into the causes and effects of depression and perceived stress may provide new directions for preventive strategies that can help reduce the risk of stroke. Since pre-stroke depression and perceived stress were also found to be strongly correlated with stroke severity, future studies should evaluate the association between pre-stroke depression, perceived stress, and stroke severity to gain a deeper understanding of the complex interaction between these variables. Lastly, the study shed new light on the role of emotion regulation in the relationship between depression, anxiety, perceived stress, insomnia, and ischemic stroke.

Validation and psychometric properties of the Arabic version of Hamilton Depression Rating Scale 7 items (HAMD-7) among non-clinical and clinical samples of Lebanese adults

BACKGROUND

The Hamilton Depression Rating Scale (HDRS or HAMD) is widely used scale for depression assessment. A shortened version of the HDRS, composed of 7 items, was implemented. The latter is timesaving compared to the original version, while still providing similar precision. Our objective in this study was to assess the psychometric properties of the Arabic HAMD-7 scale among non-clinical and clinical samples of Lebanese adults.

METHODS

In study 1, 443 Lebanese citizens enrolled in this cross-sectional study (June-September 2021). The total sample in study 1 was divided into two subsamples to conduct the exploratory-to-confirmatory factor analysis (EFA-to-CFA). Another cross-sectional study was conducted in September 2022 on another sample of Lebanese patients (independent from the sample of study 1) and included 150 patients attending two psychology clinics. The Montgomery-Asberg Depression Rating Scale (MADRS), Lebanese Depression Scale (LDS), Hamilton Anxiety Scale (HAM-A) and Lebanese Anxiety Scale (LAS) were used to assess the validity of the HAMD-7 scale.

RESULTS

The results of the EFA (subsample 1; study 1) showed that the HAM-D-7 items converged into a one-factor solution (McDonald's ω = .78). The CFA (subsample 2; study 1) confirmed the one-factor solution obtained in the EFA (ω = .79). CFA indicated that fit of the one-factor model of the HAM-D-7 was acceptable: χ2/df = 27.88/14 = 1.99, RMSEA = .066 (90% CI = .028, .102), SRMR = .043, CFI = .960, TLI = .939. All indices suggested that configural, metric, and scalar invariance was supported across gender. The HAMD-7 scale score positively correlated with the MADRS (r = 0.809; p<0.001), LDS (r = 0.872; p<0.001), HAM-A (r = 0.645; p<0.001) and LAS (r = 0.651; p<0.001) scales scores. The optimal cutoff score between healthy individuals and depressive patients for the HAMD-7 was at a value = 5.50 (Se = 82.8% and Sp = 62.4%). The positive and negative predicted values for the HAMD-7 were 25.1% and 96.0%, respectively. The positive and negative likelihood ratios were 2.20 and 0.28 respectively. No significant difference was found between the non-clinical total sample (study 1) and the clinical sample (study 2) in terms of HAM-D-7 scores (5.24 ± 4.43 vs 4.54 ± 5.06; t(589) = 1.609; p = .108).

CONCLUSION

Psychometric properties of the Arabic HAMD-7 scale are satisfactory, warranting its use clinically and in research. This scale seems highly efficient for ruling out depression; however, those with positive scores need a referral to a mental health professional for deeper evaluation. HAMD-7 might be self-administered by non-clinical subjects. Future studies are recommended to additionally confirm our results.

"In-between orthorexia" profile: the co-occurrence of pathological and healthy orthorexia among male and female non-clinical adolescents

BACKGROUND

The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO).

METHOD

A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals.

RESULTS

Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes.

CONCLUSION

Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward.

Is problematic social media use associated with higher addictions (alcohol, smoking, and waterpipe) among Lebanese adults?

PURPOSE

To evaluate the correlation between problematic social media use, alcohol use disorder, and smoking addiction through both cigarettes and waterpipe, among a sample of Lebanese adults.

METHODS

This cross-sectional study was carried out between January and April 2019. It enrolled 461 residents of the community randomly selected from Lebanon's districts in a proportionate rate.

RESULTS

Higher problematic social media use was significantly associated with more waterpipe addiction but not cigarette dependence and alcohol use disorder.

Factors associated with anxiety symptoms among medical laboratory professionals in Khobar: Single institution study

Background

A clinical professional has a challenging role during the coronavirus disease (COVID-19) pandemic in providing timely and accurate results with limited resources and a rapid increase in the number of samples to be tested. However, during the ongoing pandemic, the anxiety level of Medical Laboratory Professionals (MLT) has not been studied in Saudi Arabia within the hospital environment.

Aim

To determine the associated factors related with anxiety level of MLT at King Fahd Hospital of the University (KFHU) during the COVID-19 pandemic.

Methods

The study design was a cross-sectional quantitative study. Data were collected by administering a paper-based questionnaire that was distributed among MLT at KFHU. The questionnaire consisted of three sections. The first two sections were prepared by the researchers and included participant demographics and questions related to COVID-19. The third section used the Hamilton Anxiety Scale to assess anxiety levels.

Result

The study revealed that 70.4% of MLT showed no signs of anxiety, while 19.2% showed mild/moderate anxiety levels, and approximately 10.4% showed severe to extreme anxiety levels. In addition, a significant association between the anxiety level and difficulty breathing among MLT wearing personal protective equipment was observed. Moreover, a significant association between sex and anxiety level was identified. Females MLT had higher percentages of severe anxiety (12.8% vs. 5.1%) and mild/moderate anxiety (24.4 vs. 7.7%) than males.

Conclusions

Protecting the mental health status of MLT is an essential part of public health measures to fight the COVID-19 pandemic.

Possible association between the lrrk2 gene and anxiety behavior: a systematic literature review

Alterations to the LRRK2 gene have been associated with Parkinson's disease and alcohol consumption in animals and humans. Furthermore, these disorders are strongly related to anxiety disorders (ADs). Thus, we investigated how the LRRK2 gene might influence anxiety in humans and mice. We elaborated a systematic review based on the PRISMA Statement of studies that investigated levels of anxiety in animal or human models with alterations in the LRRK2 gene. The search was conducted in the PubMed, Scopus, and Web of Science databases, and in reference lists with descriptors related to ADs and the LRRK2. From the 62 articles assessed for eligibility, 16 were included: 11 conducted in humans and seven, in mice. Lrrk2 KO mice and the LRRK2 G2019S, LRRK2 R1441G, and LRRK2 R1441C variants were addressed. Five articles reported an increase in anxiety levels concerning the LRRK2 variants. Decreased anxiety levels were observed in two articles, one focusing on the LRRK2 G2019S and the other, on the Lrrk2 KO mice. Eight other articles reported no differences in anxiety levels in individuals with Lrrk2 alterations compared to their healthy controls. This study discusses a possible influence between the LRRK2 gene and anxiety, adding information to the existing knowledge respecting the influence of genetics on anxiety.

Association between mental illness and cycle phases and physical, social, and task attraction in female university students

PURPOSE

To examine the association between menstrual cycle phases and other factors (depression, anxiety, and stress) with social, physical, and task attraction.

METHODS

This cross-sectional study enrolled 662 female university students (December 2019-January 2020).

RESULTS

Higher stress was associated with higher social and task attraction. Higher stress and depression were associated with higher physical attraction, whereas higher anxiety was associated with lower physical attraction. None of the cycle's phases was associated with attraction.

PRACTICAL IMPLICATIONS

This study results showed a lot of contradictory information to what is present in the literature, in addition to new associations that are not tackled enough in the literature. Therefore, there is a crucial need for new firm studies that explore the relationship between women's hormonal levels and attraction levels.

Factors of body dissatisfaction among lebanese adolescents: the indirect effect of self-esteem between mental health and body dissatisfaction

Background

Body dissatisfaction (BD) rates are alarmingly high, especially among adolescents, thus. Having a better understanding of correlates associated with BD seems to be an important issue in this developmental context. Furthermore, as adolescence is an essential time in the development of self-perception and self-esteem the current study assesses factors associated with BD among Lebanese adolescents and evaluates the indirect effect of self-esteem between depression/anxiety/stress and BD.

Methods

This is a cross-sectional study among 555 Lebanese adolescents, ages 15–18, who completed an online survey incorporating BD, socioeconomic status, weight and height, physical activity index, Rosenberg Self Esteem Scale, Beirut Distress Scale, Hamilton Anxiety Rating Scale, Patient Health Questionnaire-9, Pittsburgh Sleep Quality Index and Global Physical Activity Questionnaire.

Results

The results of a stepwise linear regression, taking the body dissatisfaction score as the dependent variable, showed that higher BMI (B = 0.47), feeling pressured by media/TV to lose weight (Beta = 2.80), higher depression (Beta = 0.39), exercising to lose weight (Beta = 1.84) and following a diet to lose weight (Beta = 1.58) were significantly associated with more body dissatisfaction, whereas higher self-esteem (Beta=-0.11) and more psychological distress (Beta=-0.21) were significantly associated with less body dissatisfaction. Self-esteem played an indirect role in the associations between anxiety and body dissatisfaction and stress and body dissatisfaction.

Conclusions

BD is common among young Lebanese adolescents. Treating adolescents with low self-esteem and psychological issues is crucial in preventing anticipated BD and future eating disorders.

Assessment of the cognitive function in adult Egyptian patients with obstructive sleep apnea using the Montreal Cognitive Assessment: a retrospective large-scale study

STUDY OBJECTIVES

Sleep apnea is a chronic disorder associated with multiple recognized comorbidities. Only a few studies focus on evaluating the cognitive profile in patients diagnosed with sleep apnea. The aim of the study was to assess the cognitive functions in this population using the Montreal Cognitive Assessment.

METHODS

The study cohort was 1,445 adult patients who were referred for overnight polysomnography, 764 cases and 681 healthy controls. All participants' clinical data and comorbidities were taken, and they all performed overnight polysomnography and Montreal Cognitive Assessment.

RESULTS

A significantly higher proportion (57.5%) of sleep apnea groups were males; 15.7% were illiterate compared to the non-sleep apnea group. Hypertension and diabetes mellitus were significantly more prevalent among studied patients with sleep apnea, and the mean total score for the Montreal Cognitive Assessment scale was significantly lower among those with sleep apnea at P < .001. Those with no sleep apnea showed a significantly higher function in all attributes compared to patients with sleep apnea-namely, language, orientation, abstraction, naming, attention, and recall (P < .05).

CONCLUSIONS

Logistic regression analysis was conducted to investigate predictors for occurrence of cognitive impairment (Montreal Cognitive Assessment score < 26) among the studied sample (n = 1,445). The overall model was significant at P < .001. Variables that showed significance in univariate analysis were entered in the model. Significant predictors for cognitive impairment were being male, older age, diabetic, hypertensive, and with a lower level of education and having sleep apnea.

CITATION

Mekky JF, Yousof S, Elsayed I, Elsemelawy R, Mahmoud H, Elweshahi H. Assessment of the cognitive functions in adult Egyptian patients with obstructive sleep apnea using the Montreal Cognitive Assessment: a retrospective large-scale study. J Clin Sleep Med. 2022;18(3):721-729.

Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population

PURPOSE

To develop and validate a short version of the Beirut Distress Scale (BDS-22), the BDS-10, in the Lebanese population, and evaluate the association between psychological distress and other mental disorders.

METHODS

A total of 2260 participants was enrolled in this cross-sectional study (January-July 2019).

RESULTS

Items converged over a solution of two factors (Factor 1 = Mood, affect and cognitive symptoms; Factor 2 = Physical symptoms; total variance explained = 64.51%). A significantly high correlation was found between BDS-10 and BDS-22 (r = 0.963, p < 0.001). Higher depression, anxiety, and insomnia were significantly associated with higher stress (higher BDS-10 and BDS-22 scores).

PRACTICE IMPLICATIONS

This new short tool is valid and reliable to screen for psychological distress, influencing mood and affect, and physical and cognitive functions.

Efficacy and safety of daily home-based transcranial direct current stimulation as adjunct treatment for bipolar depressive episodes: Double-blind sham-controlled randomized clinical trial

BACKGROUND

Although transcranial direct current stimulation (tDCS) is known to be a promising therapeutic modality for unipolar depression, the efficacy and safety of tDCS for bipolar depressive episodes (BD) are still unknown and clinical trials of home-based tDCS treatment are scarce. As a result, we set out to investigate the efficacy and safety of home-based tDCS for the treatment BD.

METHODS

Participants (n = 64), diagnosed as bipolar disorder as per the diagnostic and statistical manual of mental disorders (DSM-5), were randomly assigned to receive tDCS. Hamilton Depression Rating Scale (HDRS-17) scores were measured at the baseline, week 2, 4, and 6, and home-based tDCS (for 30 min with 2 mA) was self-administered daily.

RESULTS

Of the 64 patients (15.6% bipolar disorder I, 84.4% bipolar disorder II), 41 patients completed the entire assessment. In the intention-to-treat analysis, time-group interaction for the HDRS-17 [F _{(3, 146.36)} = 2.060; p = 0.108] and adverse effect differences between two groups were not statistically significant, except the pain score, which was higher in the active group than the sham group (week 0-2: p < 0.01, week 2-4: p < 0.05, and week 4-6: p < 0.01).

CONCLUSION

Even though we found no evidence for the efficacy of home-based tDCS for patients with BD, this tool was found to be a safe and tolerable treatment modality for BD.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/show/NCT03974815], identifier [NCT03974815].

Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress?

BACKGROUND

There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia.

METHODS

This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists.

RESULTS

Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia.

CONCLUSION

Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.

Binge eating behavior in a sample of Lebanese Adolescents: Correlates and Binge Eating Scale validation

BACKGROUND

Binge eating disorder is a common eating disorder among the adolescent population. The available literature in the Middle East in general, and Lebanon specifically, is relatively scarce and/or outdated. The objectives of this study were to (1) validate the Binge Eating Scale (BES) for use in Lebanese adolescents, and (2) assess correlates of binge eating behavior among this population.

METHODS

A cross-sectional study conducted between May and June 2020, enrolling 555 adolescents between the ages of 15-18 years old from all Lebanese governorates. The Binge Eating Scale was used to screen for the presence/absence of binge eating.

RESULTS

A confirmatory factor analysis revealed that the one-factorial model fits the data best. The results of a linear regression, taking the binge eating score as the dependent variable, showed that higher body dissatisfaction, more alcohol use disorder, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Higher self-esteem was significantly associated with less binge eating.

CONCLUSION

The Arabic Version of the BES scale seems to be a reliable tool to be used in Lebanese adolescents for the assessment of binge eating. More body dissatisfaction, lower self-esteem, increased depressive symptoms were associated with more binge eating. We hope this tool will be a reliable one to be used in epidemiological studies and research about eating behaviors/disorders. The results showed that higher body dissatisfaction, higher depression, vomiting to lose weight and starving to lose weight were significantly associated with more binge eating. Our study also showed that the Binge Eating Scale is an adapted and validated tool to be used among Lebanese adolescents for the assessment of binge eating. We hope that the study results will help clinicians in the screening and management of Binge Eating behaviors among Lebanese adolescents.

Factors associated with problematic social media use among a sample of Lebanese adults: The mediating role of emotional intelligence

PURPOSE

To assess the relationship of smoking (cigarettes or waterpipe), alcohol drinking, alexithymia, self-esteem, anxiety, depression, stress, social phobia, emotional intelligence, impulsivity, insomnia, physical health, and loneliness with problematic social media use (PSMU) in a sample of Lebanese citizens.

METHODS

This cross-sectional study enrolled 466 participants (January-May 2019).

RESULTS

Higher anxiety, alcohol use disorder, and social phobia were correlated with elevated PSMU, while older age was associated with lower PSMU. Emotional intelligence partially mediated the association between alexithymia and PSMU by 4.55%.

PRACTICAL IMPLICATIONS

Since these manifestations are preventable, spreading awareness through our schools, educational programs, and even healthcare professionals would considerably reduce the pace at which young adults are transforming into anxious and distorted individuals.

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

Restrained eating disorder is prevalent worldwide across both ethnic and different cultural groups, and most importantly within the adolescent population. Additionally, comorbidities of restrained eating present a large burden on both physical and mental health of individuals. Moreover, literature is relatively scarce in Arab countries regarding eating disorders, let alone restrained eating, and among adolescent populations; hence, the aim of this study was to (1) validate the Dutch Restrained Eating Scale in a sample of Lebanese adolescents and (2) assess factors correlated with restrained eating (RE), while taking body dissatisfaction as a moderator between body mass index (BMI) and RE.

METHODS

This cross-sectional study, conducted between May and June 2020 during the lockdown period imposed by the Lebanese government, included 614 adolescents aged between 15 and 18 years from all Lebanese governorates (mean age of 16.66 ± 1.01 years). The scales used were: Dutch Restrained Eating Scale, body dissatisfaction subscale of the Eating Disorder Inventory-Second version, Rosenberg Self-Esteem Scale, Beirut Distress Scale (for psychological distress), Hamilton Anxiety Rating Scale and Patient Health Questionnaire (for depression).

RESULTS

The factor analysis yielded a one-factor solution with Eigen values > 1 (variance explained = 59.65 %; α_Cronbach = 0.924). Female gender (B = 0.19), higher BMI (B = 0.49), higher physical activity index (B = 0.17), following a diet to lose weight (B = 0.26), starving oneself to lose weight (B = 0.13), more body dissatisfaction (B = 1.09), and higher stress (B = 0.18) were significantly associated with more RE, whereas taking medications to lose weight (B=-0.10) was significantly associated with less RE. The interaction body mass index (BMI) by body dissatisfaction was significantly associated with RE; in the group with low BMI, higher body dissatisfaction was significantly associated with more RE.

CONCLUSIONS

Our study showed that the Dutch Restrained Eating scale is an adapted and validated tool to be used among Lebanese adolescents and revealed factors associated with restrained eating in this population. Since restrained eating has been associated with many clinically-diagnosed eating disorders, the results of this study might serve as a first step towards the development of prevention strategies targeted towards promoting a healthy lifestyle in Lebanese adolescents.

Nomophobia in Lebanon: Scale validation and association with psychological aspects

Objectives

Nomophobia, an abbreviation of “No mobile phone phobia”, is characterized by the illogical fear of being detached from the mobile phone or unable to use it. Research have provided evidence of an association between increased cellular phone use and multiple health issues, such as anxiety, depression, insomnia, and others. To our knowledge, there are no Lebanese studies about nomophobia, despite the high incorporation rate of mobile phones in Lebanon and the likelihood of suffering from anxiety, depression, and other conditions due to nomophobic attitudes. The study objectives were to validate and confirm psychometric properties of the Nomophobia Questionnaire (NMP-Q) and examine the associations between particular psychological conditions (anxiety, depression, stress, insomnia and impulsivity) and nomophobia among a representative sample of Lebanese people.

Methods

This cross-sectional study was carried out between January and July 2019. It enrolled 2260 residents of the community randomly selected from Lebanon’s Mohafazat. Two villages per sub-district and households from each village were chosen using a random sampling technique. A questionnaire was distributed randomly to the households. SPSS version 25 was used to perform the statistical analysis. A multinomial regression was computed taking the nomophobia categories as the dependent variable (and taking the absence of nomophobia as the reference category) and all variables that showed a significant association in the bivariate analysis as independent variables.

Results

A total of 2260 (80.71%) out of 2800 questionnaires distributed was collected back. The mean age of the participants was 27.98 ± 9.66 years (58.8% females). Moreover, the mean nomophobia score was 71.56 ± 26.92 (median = 71; minimum = 14; maximum = 140). The results showed that 46 (2.0%) had no nomophobia, 769 (34.1%) mild nomophobia [95% CI 0.322–0.361], 1089 (48.3%) moderate nomophobia [95% CI 0.463–0.504] and 349 (15.5%) severe nomophobia [95% CI 0.140–0.170]. Items of the nomophobia scale converged over a solution of three factors that had an Eigenvalue over 1 (Factor 1 = emotions associated to losing connectedness, Factor 2 = not being able to communicate, Factor 3 = not being able to access information; total variance explained = 66.65%, and Cronbach’s alpha = 0.948). The results of a multinomial regression, taking the nomophobia score as the dependent variable, showed that higher age was significantly associated with lower odds of having mild (aOR = 0.97), moderate (aOR = 0.93) and severe (aOR = 0.97) nomophobia respectively. Higher anxiety (aOR = 1.09) and higher insomnia (aOR = 1.04) were significantly associated with higher odds of having severe nomophobia.

Conclusion

The results suggest a positive correlation between nomophobia and psychological conditions. There is a need for longitudinal and prospective studies that furnish information with regards of the impact of time on the variables measured, in order to better understand the nature, causes, and attributes of nomophobia.

Suicidal ideation among Lebanese adults: scale validation and correlates

BACKGROUND

According to the World Health Organization (WHO) figures in 2015, the number of people attempting suicide worldwide per year exceeds 800,000 individuals. The majority of completed suicides (78%) occur in low- and middle-income countries. Therefore, this study aimed to validate the suicidal ideation subscale of the Columbia-Suicide Severity Rating Scale and evaluate risk factors (emotional intelligence, alexithymia, anxiety, depression, and stress) related to suicidal ideation among the Lebanese adult population.

METHODS

A structured cross-sectional survey was carried out between November 2017 and March 2018, enrolling a proportionate random sample of 789 community-dwelling participants from all the Lebanese regions. A correlation analysis between the C-SSRS and anxiety and depression assessed the convergent validity of the scale. An exploratory and a confirmatory factor analysis validated its construct. Cronbach's alpha was used to assess internal consistency reliability. Multiple linear regression was performed using the suicidal ideation score as the dependent variable. All variables were included in the multivariable model.

RESULTS

The C-SSRS scale converged over a solution of one factor; the proportion of explained variance was 0.797. The Cronbach's alpha value was good (0.797). The convergent validity was tested with depression and anxiety scales. The results showed a moderate positive correlation between the suicide ideation score and depression (rho = 0.507, p < 0.001) and anxiety (rho = 0.402, p < 0.001). The multivariable analysis showed that higher depression (Unstandardized Beta, B = 0.035, p < 0.001), higher anxiety (B = 0.015, p = 0.008), and higher alcohol dependence (B = 0.024, p < 0.001) were significantly linked to higher suicidal ideation score. However, higher self-esteem (B = -0.041, p = 0.006) was significantly associated with lower suicidal ideation scores.

CONCLUSION

Our findings suggest that the Arabic version of the C-SSRS subscale could serve as an appropriate assessment tool for suicidal ideation. This paper also gave insights into factors correlated with higher suicidal ideation scores, such as depression, anxiety, and alcohol dependence. Further studies are necessary to confirm our findings and implement suicide prevention programs.

Correlates of emotional intelligence among Lebanese adults: the role of depression, anxiety, suicidal ideation, alcohol use disorder, alexithymia and work fatigue

BACKGROUND

Relationship between emotional intelligence and emotional variables such as stress, depression, anxiety and mental health has been well documented in child and adult samples. New insights into the association between emotional intelligence and different components of mental health in one study (cognitive, emotional and behavioral dimensions) can help patients, therapists, relatives, and friends to understand, explain, and cope with symptoms. There have been no studies assessing the association between the emotional intelligence (EI) with various factors in Lebanon. This study principal aim was to evaluate how EI is related to mental health issues: social anxiety, depression, alcohol use disorders (AUD), work fatigue, stress and alexithymia in Lebanon.

METHODS

789 participants were enrolled in a cross-sectional study between November 2017 and March 2018. A cluster analysis was used to evaluate participants' profiles with the help of emotional intelligence subscales, to separate the Lebanese population into equal limited units with different characteristics using the K-mean technique.

RESULTS

Three clusters were computed dividing participants into low EI (cluster 1; 24.5%), moderate EI (cluster 2; 43.7%) and high EI (cluster 3; 31.7%) respectively. Fitting into the cluster 1 (low EI) was significantly associated with higher AUD, alexithymia, anxiety, depression, perceived stress, social phobia, emotional, mental and physical work fatigue, suicidal ideation compared to cluster 3 (high EI). Fitting into the cluster 2 (moderate EI) was significantly correlated with higher AUD, depression, alexithymia, anxiety, perceived stress, social phobia, mental work fatigue and suicidal ideation compared to cluster 3 (high EI).

CONCLUSION

This study results suggest that emotional intelligence is related to different variables, warranting interventions to limit/decrease alcohol abuse and mental/psychological illnesses as much possible.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study

OBJECTIVES

To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population.

DESIGN

Cross-sectional study.

SETTING

All Lebanese governorates.

PARTICIPANTS

A total of 811 participants randomly selected participated in this 5-month study (January-May 2018).

RESULTS

The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (β = 0·325), higher emotional eating (β = 0·083), daily weighing (β = 3·430), higher physical activity (β = 0·05), starving to reduce weight (β = 4·94) and feeling pressure from TV/magazine to lose weight (β = 3·95).

CONCLUSIONS

The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

Factors influencing women's sex work in a Lebanese sample: results of a case-control study

BACKGROUND

Many constituents contribute to the rise of sex work in Lebanon such as the socio-economic situation in the country (poverty, increased unemployment rates, and religious divisions), as well as the political and social instability. Several emotional and psychological factors such as depression, stress, anxiety, low self-esteem, emotional abuse, may force some people to rely on trading sex as a coping strategy for persevering. Therefore, it was deemed interesting to explore and understand factors that are correlated with sex work in Lebanon where no study, to our knowledge, has been written on this critical point. The objective of the study was to assess factors (such as trauma, child abuse, partner abuse, depression, anxiety, and stress) associated with women joining sex work among a sample of the Lebanese population.

METHODS

A case-control study was conducted on a group of women (60 sex workers recruited from a prison for women) involved in sex work matched for age and sex with a control group (60 non-sex workers). Controls were chosen from the same prison population as the sex workers.

RESULTS

A logistic regression was conducted, taking being a sex worker vs not as the dependent variable; independent factors were sociodemographic characteristics, child (psychological, neglect, physical and verbal) and inter partner violence (physical and non-physical), depression, anxiety and stress. Higher anxiety (aOR = 1.08) and higher inter partner physical violence (aOR = 1.02) were altogether related with higher chances of being a sex worker.

CONCLUSION

This study proposes an association between child abuse, inter partner violence, alcohol consumption, anxiety, and sex work. Future research may also need to contemplate other factors not examined here, including parental substance use, personality traits, and many others.