Factors associated with depression among the Lebanese population: Results of a cross-sectional study

Perceived social competencies as moderators: examining the relationship between psychological distress and aggression, hostility, and anger in Lebanese adults

INTRODUCTION

The majority of people experience anger at some point in their lives when confronted with unpleasant situations. In social settings, anger can lead to aggressive and hostile in the absence of adequate social competences. Our study aims to examine the moderating role of perceived social competences in the association between psychological distress and anger expression (trait anger, hostility, physical aggression, and verbal aggression) among a sample of Lebanese adults.

METHODS

403 participants above 18 years (the mean age was 24.56 ± 8.46) were enrolled in the cross-sectional study with 73% female participants. The candidates were asked to complete a structured questionnaire including the following scales: (1) Buss-Perry Aggression Questionnaire-Short Form (BPAQ-SF), (2) the Depression Anxiety Stress Scale (DASS-8), (3) Perceived Social Competencies (PSC), and (4) The De Jong-Gierveld Loneliness Scale.

RESULTS

The interaction psychological distress by perceived social competence was not significantly associated with physical aggression, verbal aggression, or hostility but was significantly associated with anger. After adjusting the results over variables that showed a p <.25 in the bivariate analysis, this association was significant at low (Beta = 0.24; p <.001), moderate (Beta = 0.20; p <.001) and high (Beta = 0.16; p <.001) levels of perceived social competencies, where higher psychological distress was significantly associated with more anger. On another note, with higher perceived social competence, we find a decrease in levels of psychological distress in our sample.

CONCLUSION

This study provided evidence that perceived social competencies such as communication skills, empathy and prosocial behaviors act as moderators in the association between psychological distress and anger. In future works, investigating and building advanced program in order to develop social competences of individuals might prove important. It is crucial to implement such strategies and projects in schools: this educational setting could be fruitful in a way that social skills could be instilled during childhood and anger-aggressive behaviors could be managed throughout adulthood.

Prevalence of anxiety and depression among Lebanese women using oral contraceptives: a cross-sectional study

BACKGROUND

Oral contraceptives (OCs) are used worldwide, including Lebanese women. However, the association between OCs use and anxiety or depression remains unclear. This study aims to assess the prevalence of anxiety and depression among Lebanese women using oral contraceptive pills and investigate the differential impact of combined oral contraceptives (COCs) versus progestogen-only pills (POPs) on mental health outcomes.

METHODS

A cross-sectional study was conducted among a sample of Lebanese women using OCs between January and March 2023. Nine hundred nighty seven out of the 2051 women who took part in the survey met our criteria and were included in this study. Data on anxiety and depression were collected using validated and reliable scales, the Arabic versions of the Generalized Anxiety Disorder-7 Questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses, including multivariate analysis, were performed to assess the association between OCs type (COC vs. POP) and anxiety/depression.

RESULTS

The prevalence of anxiety and depression among Lebanese women taking OCs was found to be 39.9% and 64.3%, respectively. Furthermore, the study revealed that POP users had 2.8 times higher odds of developing anxiety (adjusted odds ratio ORadj = 2.8 with 95% confidence interval CI of 1.770 to 4.435) p-value < 0.001 and 9.2 times higher odds of developing depression (adjusted odds ratio ORadj = 9.2 with 95% confidence interval CI of 5.790 to 14.506) p-value < 0.001 compared to COC users.

CONCLUSION

The results of this study shed light on the elevated prevalence of anxiety and depression among Lebanese women using OCs and emphasized the varying effects of COCs and POPs on their mental health outcomes. Further research is needed to comprehensively understand this association, considering both the dosage and specific type of oral contraceptive to improve the overall well-being of women using these contraceptives.

Association between time perspective and metacognition among Lebanese adults: the mediating role of mindfulness

BACKGROUND

Mindfulness may serve as a component of metacognitive beliefs and can also be viewed as a form of time perspective. The interplay between time perspective and metacognitive beliefs remains understudied. Both aspects, however, display considerable stability over time and significantly influence an individual's life and well-being. Lebanon, marked by its diverse and complex history, struggles with various political, social, and economic challenges. This study offers a valuable and unprecedented opportunity to examine these connections within a distinct cultural context, shedding light on the unique experiences of the Lebanese population. Therefore, our research aims to investigate the connection between time perspective and metacognition, with a focus on the role of mindfulness as a mediator.

METHODS

This cross-sectional study was conducted from August to November 2022 and involved participants from various regions of Lebanon. The questionnaire included sociodemographic data and scales such as the Arabic versions of the 15-item Short Form of the Zimbardo Time Perspective Inventory, the Metacognitions Questionnaire, the Freiburg Mindfulness Inventory and the Acceptance and Action Questionnaire (AAQ-2).

RESULTS

Our investigation recruited 423 participants. The analysis showed that individuals with a positive stance on their past, a hedonistic present, or a future-oriented outlook exhibited heightened levels of mindfulness. This elevated state of mindfulness, in turn, demonstrated a significant link to augmented cognitive self-consciousness (An increased introspection into one's own thoughts). We also observed a direct association between a future-focused time perspective and high scores of cognitive self-consciousness. Furthermore, mindfulness emerged as a crucial mediator in the relationships between time perspectives and negative beliefs about the danger of worry. Similarly, individuals with a positive view on their past, a hedonistic present orientation, or a future-focused mindset demonstrated elevated levels of mindfulness, which was correlated with less negative beliefs about the danger of worry. Notably, a positive past perspective was directly associated with less negative views on worry and the subsequent loss of control, whereas higher future focused time perspective scores was significantly and directly associated with more negative beliefs about worry, whereas more future focused time perspective was significantly and directly associated with more negative beliefs about worry.

CONCLUSION

Our findings found several meaningful associations between our variables, but it primarily underscored the significance of considering distinct subcomponents within mindfulness and psychopathological metacognition that may overlap, shedding light on their differential impacts on psychological well-being. We were also able to mirror the dual pathway theory of time perspective suggested in previous studies. These insights carry notable implications for the development and refinement of mindfulness-based and metacognitive interventions, emphasizing the need for tailored approaches that consider varying time perspectives. Continued investigation in this area promises to advance our understanding of these constructs and refine their practical applications in mental health interventions and well-being enhancement strategies.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety

INTRODUCTION

Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety.

METHODS

We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433).

RESULTS

In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta =  - 0.09) and increased disordered eating attitudes during pregnancy (beta =  - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance.

CONCLUSION

Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Association between alexithymia, emotional intelligence, smoking addiction, and alcohol use disorder among a sample of Lebanese adults

BACKGROUND

Alexithymia can be associated with worse addictive traits, while emotional intelligence is associated with better addictive outcomes. In Lebanon, the prevalence of cigarette and waterpipe smoking is on the rise, although people are aware of the associated harms. Also, around 11% of Lebanese adults have experienced alcohol use disorder (AUD). This study aimed to assess the association between alexithymia, emotional intelligence, smoking (cigarette and waterpipe), and AUD among a sample of Lebanese adults.

METHODS

A web-based cross-sectional study carried out between February and April 2020, during the lockdown period, enrolled 408 community-dwelling adults. The survey link was shared on social media to reach participants from all Lebanese districts/governorates.

RESULTS

Taking antidepressants (Beta = 4.37) was significantly associated with more cigarette dependence, while female gender (Beta = -1.52) and having a high vs. low monthly income (Beta = 1.02) were significantly associated with less cigarette dependence. None of the variables, including alexithymia, were significantly associated with waterpipe dependence. Female gender (Beta = -0.15) and higher emotional intelligence (Beta = -0.003) were significantly associated with less AUD, whereas higher alexithymia (Beta = 0.003) was significantly associated with more AUD.

CONCLUSION

This study could demonstrate a significant association between alexithymia and cigarette smoking and alexithymia and alcohol consumption. Future research is warranted to investigate the mediating effect of emotional intelligence and how these results may be used to meet the needs of alexithymic individuals with addictions.

Generic drugs use during the COVID-19 pandemic among Lebanese patients using psychotropics: An opportunity for generic drug promotion

Introduction

The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication.

Objectives

This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients.

Design

A cross-sectional study was performed over a period of 4 months (July-October 2021) targeting 128 patients using psychotropic drugs.

Results

The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend's advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist's recommendation were the main reported reasons for using generic drugs.

Conclusion

During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies.

The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults

BACKGROUND

The COVID-19 global pandemic initiated an unprecedented medico-psychological turmoil. Our study investigates the psychological impact of the viral spread and austere lockdown, and focuses mostly on potential protective factors in a politically and economically unstable society.

METHODS

A cross-sectional design was used to evaluate rates of mental distress in a sample of 348 Lebanese adults. Participants filled questionnaires of perceived stress (PSS), depression (PHQ-9), anxiety (GAD-7), PTSD (IES-22), as well as sleep (PSQi) and gratitude (GQ-6) immediately after 3 months of strict quarantine. Demographics included gender, age, employment and infection statuses. Correlations and regression models were used.

RESULTS

Results indicated a very high prevalence of mental distress, in addition to major alterations in sleep quality and quantity. Younger age and unemployment correlated with more severe symptoms. Sleep was found to be a protective factor against all studied psychological distress, and gratitude further mitigated effects of depression.

CONCLUSIONS

Mental health significantly degrades post-COVID lockdown, even in the absence of direct viral threat. Yet simple behavioral and cognitive changes like sleep and attitude of gratitude could provide protective factors against these psychological distresses. Such changes should be further explored and advocated as cost-efficient self-care practices to buffer this devastating public health burden, especially in unstable socio-political environments.

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.

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.

Dissociative experiences among Lebanese university students: Association with mental health issues, the economic crisis, the COVID-19 pandemic, and the Beirut port explosion

BACKGROUND

Dissociative experiences are psychological manifestations characterized by a loss of connection and continuity between thoughts, emotions, environment, behavior, and identity. Lebanon has been facing indescribable events in the last few years, including the COVID-19 pandemic, the Beirut explosion, a crushing economic crisis with the highest inflation rate the country has known in over three decades. The aim of this study was to evaluate the correlation between dissociative experiences and post-traumatic stress symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and other mental health issues in a sample of Lebanese university students.

METHODS

This cross-sectional study enrolled 419 active university students (18-35 years) from all over Lebanon (May and August 2021). The respondents received the online soft copy of a survey by a snowball sampling technique through social media and messaging apps. The questionnaire included sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire.

RESULTS

The two-factor model of the DES fitted best according to CFI, RMSEA and χ2/df values, but modestly according to TLI. The two factors were absorption and amnesia/depersonalization. Higher stress (Beta = 0.95) and more PTSD from the Beirut blast (Beta = 0.29) and from the economic crisis (Beta = 0.23) were significantly associated with more absorption. A personal history of depression (Beta = 6.03), higher stress (Beta = 0.36) and more PTSD from the Beirut blast (Beta = 0.27) and from the COVID-19 pandemic (Beta = 0.16) were significantly associated with more amnesia/depersonalization.

CONCLUSION

Significant rates of dissociative experiences and their sub-manifestations (amnesia/depersonalization and absorption) were found among Lebanese university students, with remarkable co-occurrence of a traumatic/stressful pattern, whether on an individual (history of PTSD) or a collective level (Post-traumatic manifestations from Beirut blast, COVID-19 pandemic and/or economic crisis), or whether correlated to an acute single event or to certain chronic stressors, or even to a personal history of depression. Such findings must raise the attention to serious mental and psychosocial alteration in the Lebanese national identity.

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.

Parental divorce and smoking dependence in Lebanese adolescents: the mediating effect of mental health problems

BACKGROUND

Lebanon has the highest prevalence estimates among Middle Eastern countries and Arab women regarding cigarette smoking, with 43% of men and 28% of women involved in such trends. Marital disruption is a tremendous source of irritability and discomfort that may hinder a child's healthy development, creating perturbing distress and increasing disobedience that may exacerbate smoking addiction. Additionally, Lebanese adolescents are inflicted by high emotional and economic instability levels, rendering increased susceptibility to distress and propensity to engage in addictive behavior. This study aims to investigate the association between parental divorce and smoking dependence among Lebanese adolescents, along with exploring the potential mediating effect of mental health disorders of such correlation.

METHODS

A total of 1810 adolescents (14 and 17 years) enrolled in this cross-sectional survey-based study (January-May 2019). Linear regressions were conducted to check for variables associated with cigarette and waterpipe dependence. PROCESS v3.4 model 4 was used to check for the mediating effect of mental health disorders between parental divorce and smoking dependence.

RESULTS

Higher suicidal ideation and having divorced parents vs living together were significantly associated with more cigarette and waterpipe dependence. Higher anxiety was significantly associated with more waterpipe dependence. Insomnia and suicidal ideation played a mediating role between parental divorce and cigarette/waterpipe dependence.

CONCLUSION

Our results consolidate the results found in the literature about the association between parental divorce and smoking addiction and the mediating effect of mental health issues. We do not know still in the divorce itself or factors related to it are incriminated in the higher amount of smoking in those adolescents. Those results should be used to inspire parents about the deleterious effect of divorce on their children to lower their risk of smoking addiction. Further longitudinal studies are needed to better understand the complexity of such associations and to see whether the divorce experience by itself or the factors that accompany it are involved in the increased smoking addiction among adolescents.

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.

Association of the time spent on social media news with depression and suicidal ideation among a sample of Lebanese adults during the COVID-19 pandemic and the Lebanese economic crisis

The main objectives were to associate between social media news consumption during these unstable times and depression, as well as suicidal ideation among a sample of Lebanese adults, in addition to associate between fear of Covid-19, depression and suicidal ideation. Secondary objectives aimed to check the mediating effect of depression in the association between time spent on social media to get the news and the presence of suicidal ideation. This is a cross-sectional study executed between April and May 2021. It involved 402 Lebanese citizens aged 18 years and above, selected randomly from all Lebanese districts. Having cancer (Beta = 0.20) or lung disease (Beta = 0.27), more fear of COVID-19 (Beta = 0.16), a higher time spent on social media for news (Beta = 0.13) and a higher household crowding index (Beta = 0.29) were significantly associated with more depression, whereas having a pet in the house (Beta = -0.13) and working in the medical field (Beta = -0.17) were significantly associated with less depression. Higher depression (aOR = 1.19) was significantly associated with higher odds of having suicidal ideation, whereas more fear of COVID-19 (aOR = 0.84) and older age (aOR = 0.96) were significantly associated with less odds of having suicidal ideation. Depression did not mediate the association between time spent on social media to get the news and suicidal ideation. This study showed that more time spent on social media reading the news is associated with higher depression but not suicidal ideation. Fear of Covid-19 is associated with more depression, but less suicidal ideation. Further studies are needed to identify the causality between social media news consumption, depression and suicidal ideation. Moreover, awareness campaigns should be organized to teach people how to consume social media news in a responsible way, without letting it affect their emotions directly, which may cause psychological disorders.

Personality traits and quality of life among Lebanese medical students: any mediating effect of emotional intelligence? A path analysis approach

BACKGROUND

Medicine is an incredibly demanding career that appears to leave many medical students at risk of fatigue, anxiety, depression and burnout. Since adaptation and lifestyle changes are important, quality of life (QOL) of students during medical school could be impaired. Personality traits and emotional intelligence (EI) facets may be both linked to medical student's QOL. To our knowledge, no studies have been done on the concurrent and prospective relationship between QOL-related personality traits and EI in Lebanese medical students. This study aimed to investigate the role of EI as a mediator between personality traits and QOL among a sample of Lebanese medical students.

METHODS

This research is a descriptive cross-sectional survey study involving 293 Lebanese medical students recruited from all 7 Faculties of Medicine in Lebanon (June-December 2019). Structural equation modeling (SEM) was performed using SPSS AMOS v.24 to examine the structural relationship between each personality trait taken as independent variables, QOL as the dependent variable, and emotional intelligence as the mediator, among university students. The relative Chi-square (χ²/df), root mean square error of approximation (RMSEA) statistic, Tucker Lewis Index (TFI) and the comparative fit index (CFI) were used to evaluate the goodness-of-fit of the model.

RESULTS

Higher conscientiousness was significantly associated with more EI (Beta = 0.38; p < 0.001) and lower QOL (Beta = - 0.14; p = 0.025). The indirect relationships between conscientiousness, EI and QOL showed that EI mediated the association between conscientiousness and QOL (Beta = 0.17; 95% CI - 0.73 to - 0.004; p = 0.037). The fit indices of this model were adequate for χ²/df, RMSEA and CFI but not TLI. Higher openness to experience was significantly associated with more EI (Beta = 0.48; p < 0.001) and lower QOL (Beta = - 0.38; p < 0.001). The indirect relationships between openness to experience, EI and QOL showed that EI mediated the association between openness to experience and QOL (Beta = 0.30; 95% CI - 1.11 to - 0.03; p = 0.04). The fit indices were adequate for χ²/df and CFI but not RMSEA and TLI. EI did not mediate the association between the other three personality traits (extroversion, agreeableness and neuroticism) and QOL.

CONCLUSION

This current research has shed considerable light on the nexus of associations between EI, personality traits and well-being, nonetheless, led to the creation of more puzzling questions. On the whole, it seems that EI and its components can be used as an evaluation instrument in relates with Lebanese medical students' personality profile as a means of future training to improve quality of life during medical education.

Couple's Satisfaction among Lebanese adults: validation of the Toronto Alexithymia Scale and Couple Satisfaction Index-4 scales, association with attachment styles and mediating role of alexithymia

Background

Lebanon is passing through an economic crisis leading to a decreased monthly income within a couple and more couple’s dissatisfaction. Furthermore, many studies postulate that the different types of attachment styles affect the romantic relationship experienced between adults. The main objectives of our study were to (1) validate the Toronto Alexithymia Scale (TAS) and Couple Satisfaction Index-4 (CSI-4) scales, and (2) assess the association between attachment styles and couple satisfaction and evaluate the mediating role of alexithymia in these associations.

Methods

This cross-sectional study involved 445 Lebanese participants (April–May 2021). A confirmatory factor analysis (CFA) was carried out using SPSS AMOS v.24 on the couple satisfaction index and Toronto alexithymia scales’ items. A linear regression was conducted, taking the couple satisfaction index as the dependent variable.

Results

The CFA results of the CSI-4 scale indicated an excellent fit (χ²/df = 3.845/2 = 1.92, TLI = 0.992, RMSEA = 0.046 [95% CI 0.001–0.115] (pclose = 0.436) and CFI = 0.998). The CFA of the TAS indicated a good/acceptable fit (χ²/df = 422.31/132 = 3.2, TLI = 0.89, RMSEA = 0.07 [95% CI 0.063–0.078] (pclose < 0.001) and CFI = 0.91) (items 4 and 8 were removed due to low factor loading (< 0.4)). Being married and higher secure attachment style were significantly associated with more couple satisfaction, whereas older age, higher household crowding index, more alexithymia and mode depression were significantly associated with less couple satisfaction. In addition, alexithymia mediated the association between secure attachment style and couple satisfaction, between preoccupied attachment style and couple satisfaction and between dismissing attachment style and couple satisfaction.

Conclusion

Couple’s satisfaction is positively associated with secure attachment style. In addition, alexithymia plays a mediating role between couple’s satisfaction and attachment styles. Upcoming studies should determine if other mental illnesses play a mediating role between attachment style and couple satisfaction.

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

General well-being is best described as the state of mind that gives people happiness and satisfaction in life. This concept is influenced by behaviors and attitudes that individuals do on a daily basis. The purpose of this study was to understand how general well-being is correlated with other factors such as emotional intelligence, Covid-19-induced fear, healthy lifestyle, and coping strategies. This cross-sectional study was carried out between December 2020 and January 2021 during the COVID-19 pandemic when lockdown restrictions were implemented at different instances. A total of 470 individuals participated. The results of a linear regression, taking the general well-being schedule score as the dependent variable, showed that more avoidance coping (B = 1.05, t(459) =8.44, p < 0.001), higher healthy lifestyle scores (B = 0.45, t(459) = 5.45, p < 0.001), and more approach coping (B = 0.42, t(459) = 4.03, p < 0.001) were significantly associated with higher GWB schedule scores. Moreover, having more fear of COVID-19 (B = -0.62, t(459) = -5.09, p < 0.001) and female gender (B = -6.80, t(459) = -4.34, p < 0.001) were significantly associated with lower GWB schedule scores. To our knowledge, this is the first study in Lebanon to evaluate GWB and factors that predict it among the general population. Nevertheless, more comprehensive future studies with longitudinal designs, more diverse socio-demographic backgrounds of sampled population recruited via probability sampling, and more reliable and valid instruments utilized are warranted to confirm our findings and draw a more certain conclusion.

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.

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.

Psychological impact of COVID-19 on emergency department healthcare workers in a tertiary care center during a national economic crisis

Background

Since the declaration of the novel Corona Virus Disease (COVID-19) as a global pandemic by the World Health Organization, frontline healthcare workers (HCWs) and staff in the Emergency Departments (ED) started experiencing feelings of anxiety and fear from the projected exponential spread and the potential burden on the healthcare system and infrastructure. In Lebanon, major local factors contributing to this fear were the rapid escalation of COVID-19 cases across the country, the lack of preparedness, and the shortage of personal protective equipment, in addition to the evolving economic crisis and financial restrictions. This study aims to investigate the immediate psychological impact of the COVID-19 outbreak on ED staff working in a hospital environment in relation to their household income.

Methods

Self-reported cross-sectional survey was delivered to the frontline staff working at the Department of Emergency Medicine of AUBMC in Beirut, Lebanon. General demographic characteristics, scores of Generalized Anxiety Disorder 7 (GAD-7), scores of Patient Health Questionnaire 9 (PHQ-9), and scores of Burnout Measure-Short (BMS) version were collected.

Results

74 HCWs (49.6%) participated in the study. The mean age for participants was (31.78 ± 9.49). More than half of the participants were nurses and more than 70% reported a monthly salary of less than 2000 USD. The household income was negatively associated with the participants' scores on the GAD-7 and PHQ-9, but not the BMS. Previous mental health diagnosis was positively associated with the PHQ-9 and BMS scores, while seeking mental health care was negatively associated with the PHQ-9 and BMS scores.

Conclusion

At our tertiary care center in a low-income, low resource country amidst the COVID-19 pandemic, the HCWs reported marked psychological disturbances on different scales. In particular, the financial burden was associated with increased anxiety and clinical depression, but was not associated with burnout.

Anxiety, Depression and Quality of Life-A Systematic Review of Evidence from Longitudinal Observational Studies

This review aimed to systematically review observational studies investigating the longitudinal association between anxiety, depression and quality of life (QoL). A systematic search of five electronic databases (PubMed, PsycINFO, PSYNDEX, NHS EED and EconLit) as well as forward/backward reference searches were conducted to identify observational studies on the longitudinal association between anxiety, depression and QoL. Studies were synthesized narratively. Additionally, a random-effects meta-analysis was performed using studies applying the mental and physical summary scores (MCS, PCS) of the Short Form Health Survey. The review was prospectively registered with PROSPERO and a study protocol was published. n = 47 studies on heterogeneous research questions were included, with sample sizes ranging from n = 28 to 43,093. Narrative synthesis indicated that QoL was reduced before disorder onset, dropped further during the disorder and improved with remission. Before onset and after remission, QoL was lower in comparison to healthy comparisons. n = 8 studies were included in random-effects meta-analyses. The pooled estimates of QoL at follow-up (FU) were of small to large effect sizes and showed that QoL at FU differed by disorder status at baseline as well as by disorder course over time. Disorder course groups differed in their MCS scores at baseline. Effect sizes were generally larger for MCS relative to PCS. The results highlight the relevance of preventive measures and treatment. Future research should consider individual QoL domains, individual anxiety/depressive disorders as well as the course of both over time to allow more differentiated statements in a meta-analysis.

Premenstrual dysphoric disorder and childhood maltreatment, adulthood stressful life events and depression among Lebanese university students: a structural equation modeling approach

BACKGROUND

Premenstrual Syndrome (PMS) is a cyclic sequence of physical and behavioral symptoms that arise in the second half of the menstrual cycle. The extreme type of PMS is Premenstrual Dysphoric Disorder (PMDD). The current study aims at examining 1) the effects of childhood maltreatment and current life's stressful events on PMDD, and 2) the mediating role of depression in these associations among Lebanese university female students.

METHODS

This cross-sectional study was conducted between February and March 2021 during the COVID-19 pandemic. Lebanese students were recruited using a snowball technique from all national universities in Lebanon via an auto-administrated online survey. Structural equation modeling was performed to examine the structural relationship between childhood maltreatment and life's stressful events, depression and PMDD.

RESULTS

Higher life's stressful events (Beta = 0.18; p < 0.001), physical (Beta = 0.19; p < 0.001), sexual (Beta = 0.18; p < 0.001) and psychological (Beta = 0.33; p < 0.001) abuse were significantly associated with higher depression. Moreover, higher sexual (Beta = 0.11; p = 0.021) and psychological (Beta = 0.11; p = 0.040) abuse and higher depression (Beta = 0.37; p < 0.001) were significantly associated with higher PMDD. The indirect relationships between psychological abuse/sexual abuse, depression and PMDD showed that depression mediated the association between both psychological (Beta = 0.22; p = 0.001) and sexual (Beta = 0.38; p = 0.004) abuse and PMDD.

CONCLUSION

This work presents a unique analysis using the structural equation model that enlightens the effect of childhood maltreatment, particularly sexual and psychological abuse on PMMD symptoms, with depression playing the role of a mediating factor. It would be interesting to test, in future studies, whether there are other mediating factors besides depression that could be indirect indicators of PMDD.

Sleep disorders in a sample of Lebanese children: the role of parental mental health and child nutrition and activity

BACKGROUND

Sleep habits are an important component of a child's health and it is affected by parent-child relationship. Also, child's diet and nutrition appear to be an important factor affecting sleep health. Few studies have addressed the effect of parental emotional disturbance that can leave on children's sleep. Therefore, the objective of our study was to assess the prevalence of sleep disorders in pre- and school-aged children and evaluate its relation with parental mental health and child's nutrition and activity.

METHODS

A cross-sectional study, conducted between October 2020 and January 2021, which enrolled 402 Lebanese parents from all over Lebanon. The questionnaire was distributed online using the snowball technique. The Pediatric Sleep Questionnaire (PSQ) was used to assess pediatric sleep behaviors and the Family Nutrition and physical activity questionnaire was used to assess parental behaviors that might predispose children for obesity.

RESULTS

A total of 76 (19%) children had sleep disorders (PSQ scores of 8 or more). The multivariable analysis showed that higher paternal depression (Beta = 0.079, p = 0.010), maternal depression (Beta = 0.089, p = 0.001) and higher anxiety in the father (Beta = 0.064, p = 0.021) were significantly associated with higher PSQ scores (worse sleep) in the child. Higher Family Nutrition and Physical Activity Screening Tool scores in the child (Beta = -0.161, p < 0.001) was significantly associated with lower PSQ scores (better sleep).

CONCLUSION

Paternal anxiety and depression, as well as maternal depression, were factors associated with children's sleeping disorders. Future studies are needed to assess parental influence on child's development.

Prevalence of Mental Disorders in the WHO Eastern Mediterranean Region: A Systematic Review and Meta-Analysis

Objectives: To synthesize the prevalence of mental and substance use disorders in countries of the Eastern Mediterranean Region (EMR) of the World Health Organization. Methods: The literature search was conducted across several databases in two phases. First, we searched for systematic reviews and/or meta-analyses published before 2014, reporting prevalence estimates for mental disorders in the EMR. Then, we identified new primary cross-sectional or longitudinal studies published between 2014 and 2020. Studies were included if they had a sample size of ≥ 450 and were conducted among the general adult population. Current, period and lifetime prevalence estimates for each disorder were pooled using random-effects meta-analyses, and subgroup analyses and meta-regressions were conducted. Findings: Prevalence estimates were extracted from 54 cross-sectional studies across 15 countries within the EMR. Pooled analyses of current, period and lifetime prevalence showed the highest prevalence for depression (14.8%, 95% confidence interval, CI: 10.7-20.1%), followed by generalized anxiety disorder (GAD) (10.4%, 95% CI: 7.1-14.7%), post-traumatic stress disorder (7.2%, 95% CI: 2.9-16.6%), substance use (4.0%, 95% CI: 3.1-5.2%), obsessive compulsive disorder (2.8%, 95% CI: 1.6-4.9%), phobic disorders (1.8%, 95% CI: 1.1-2.8%), panic disorders (1.1%, 95% CI: 0.6-2.2%), bipolar disorders (0.7%, 95% CI: 0.3-1.6%), and psychosis (0.5%, 95% CI: 0.3-0.9%). Populations exposed to adverse events had higher prevalence of mental disorders than the general population. Period and lifetime prevalence showed little difference across mental disorders. More pronounced differences in prevalence were seen for depression and GAD, specifically between current and lifetime prevalence (depression: current prevalence 20.5% (95% CI: 14.9-27.4%), vs. lifetime prevalence: 4.2% (95%CI: 1.8-9.6%); GAD: current prevalence 10.3% (95% CI: 6.1-17.0), vs. lifetime prevalence: 4.5% (95% CI: 2.4-8.3%). Differences between current and lifetime prevalence of mental disorders may be due to the use of different screening instruments and thresholds being applied. Conclusion: The prevalence of mental and substance use disorders in the EMR is high. Despite substantial inter-survey heterogeneity, our estimates align with previous global and regional data on mental disorders. Our meta-review provides new evidence on the burden of mental health problems in the EMR. Systematic Review Registration: PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020187388.

Gender-specific factors associated with risk of depression among Lebanese older adults

BACKGROUND

Depression among older adults is a frequent and underdiagnosed condition. However, there is a paucity of research on mental health problems among elderly people in Arab countries. The purpose of this study was to describe the risk of depression among a representative sample of older Lebanese adults living in rural areas and to identify gender-specific factors associated with depression risk.

METHODS

This study included a randomly selected sample of 823 rural elderly people aged ≥65 years without cognitive decline. Data, including sociodemographic characteristics, living condition, health and functional status, were collected during face-to-face interviews. Depression was assessed by the five-item Geriatric Depression Scale.

RESULTS

Risk for depression was significantly higher in women than in men (39.5% vs 26.2%, P < 0.001). Among men, reporting a higher versus a lower income (adjusted odds ratio (AOR) = 0.299) and being physically active significantly decreased the odds of depressive symptoms. In addition, physical disability (AOR = 3.03) and a high level of loneliness (AOR = 41.76) were significantly related to an increased risk of depression. Among women, daily or occasional physical activity was related to a reduced risk of depression compared to sedentary lifestyles (AOR = 0.35; AOR = 0.50). Furthermore digestive symptoms (AOR = 1.98), poor nutritional status (AOR = 1.99), and strong feelings of loneliness (AOR = 10.86) were significantly related to an increased odds of depression.

CONCLUSION

Elderly Lebanese people, especially women, were at high risk for depression. Among other gender-specific factors, loneliness was strongly associated with depressive disorders in both genders, with a four times greater odds ratio in men than in women.

Anxiety among Lebanese adolescents: scale validation and correlates

BACKGROUND

The Lebanese population has undergone several conflicts and were the most afflicted by shelling and chaos during the civil war from 1975 to 1990, or even by displacement, bereavement, emigration, family separations, not to mention the economic crises that have hit the country since 2019 under which young adults are still succumbing. Our study aims to validate the Lebanese Anxiety Scale and assess correlates of anxiety among Lebanese adolescents.

METHODS

A cross-sectional study was carried between January and May 2019, using a proportionate random sampling of schools from all five Lebanese governorates, among which 1810 adolescents aged 14 to 17 years.

RESULTS

All LAS items remained in the model and formed one factor solution that explained 61.38% of the total variance (KMO = 0.873; p_{Bartlett test} < 0.001), with an excellent Cronbach's alpha of 0.93. Higher neglect (B = 0.38), insomnia (B = 0.21) and child psychological abuse (B = 0.08) were significantly associated with more anxiety. Those results were considered adjusted overall sociodemographic variables since the latter had no statistically significant association with anxiety.

CONCLUSION

The study confirmed the association between anxiety and some variables such as psychological child abuse, neglect, and insomnia and emphasized the correlation between anxiety and these factors. Further, the LAS appears to be a short, valid and efficient tool for assessing anxiety among Lebanese adolescents. Further studies need to be carried to evaluate whether the LAS-10 gives a similar diagnosis to psychiatrists.

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.

Mental Health Outcomes of the COVID-19 Pandemic and a Collapsing Economy: Perspectives from a Developing Country

The COVID-19 pandemic has affected physical and mental health worldwide, particularly vulnerable populations with lower social and economic status. This study explored the independent and combined effects of the COVID-19 and economy-related variables on stress and anxiety among Lebanese adults in a developing country facing a severe socio-economic crisis and political turmoil. A cross-sectional study was conducted online between May 10 and 20, 2020, using the snowball sampling technique. All individuals over 18 were eligible. The final sample included 502 respondents. Higher stress and anxiety were associated with younger age, female gender, previous higher socio-economic status, having a family member with a chronic disease, fear of not getting access to treatment, fear of COVID-19, and physical violence at home. However, financial wellness and higher family satisfaction were significantly associated with lower stress. The multivariate analysis showed a significant interaction between fear of COVID-19 and financial wellness on estimated marginal means of stress and anxiety. The combined presence of fear of the pandemic and financial hardship is associated with higher stress and anxiety, particularly among women and younger Lebanese adults with difficult home circumstances. Thus, healthcare professionals need to screen for mental health problems among subgroups presenting multiple risk factors.

Alexithymia, aggressive behavior and depression among Lebanese adolescents: A cross-sectional study

BACKGROUND

For a long time, Lebanon has been considered an unstable country. This can have a negative impact on Lebanese adolescents that consequently face secondary emotional stress, leading to more mental health problems such as anxiety, depression, and alexithymia. The objective of this study was to assess the association between alexithymia, depression and aggressive behavior in a sample of Lebanese adolescents.

METHODS

This is a cross-sectional study, conducted between September 2018 and February 2019, which enrolled 568 young adolescents aged between 15 and 18 years using a proportionate sample from two Lebanese governorates. Out of 750 questionnaires distributed, 568 (75.73%) were completed and collected back.

RESULTS

The mean age was 15.87 ± 0.82 years, with 302 (53.2%) females; 180 (31.7%) were alexithymic, 193 (34.0%) and 181 (31.9%) had moderate (scores between (89 and 111) and high (scores ≥ 112) aggression respectively, whereas 176 (31.0%) and 149 (26.2%) had moderate (scores between 3 and 4) and high (scores ≥ 5) depression respectively. Higher levels of alexithymia were significantly associated with higher depression (Beta = 0.44), higher total aggression (Beta = 0.78), higher physical aggression (Beta = 0.24), higher verbal aggression (Beta = 0.14), higher anger (Beta = 0.22), and higher hostility (Beta = 0.19).

CONCLUSION

The prevalence of alexithymic behaviors, as well as aggression and depression in Lebanese students appears to be very high in comparison with students worldwide. Alexithymia was significantly associated with higher depression, physical and verbal aggression, anger and hostility among adolescents. Factors underlying the high level of alexithymia remain not fully elucidated.