The Lebanese Depression Scale: A scale to screen for depression in the Lebanese population

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.

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.

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.

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.