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Assimamaw NT, Gonete AT, Angaw DA, Techane MA, Kelkay MM, Terefe B. Ethiopian women's tokophobia of childbirth and its predictors: a systematic review and meta-analysis. Front Glob Womens Health 2024; 5:1334103. [PMID: 39156006 PMCID: PMC11329013 DOI: 10.3389/fgwh.2024.1334103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/22/2024] [Indexed: 08/20/2024] Open
Abstract
Background Fear of childbirth is recognized as a growing problem in developing countries, including Ethiopia. The impact of this fear on women's reproductive choices and decisions is significant. Therefore, the systematic review and meta-analysis will help to consolidate the existing research on childbirth-related fear in Ethiopia. Synthesizing the findings and providing a pooled prevalence estimate, can contribute to a better understanding of the scale of the problem in the country. Objective This systematic review and meta-analysis assessed the pooled prevalence of childbirth-related fear and its associated factors among pregnant mothers in Ethiopia. Methods PubMed, Google Scholar, and African Journals Online were searched for included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of childbirth-related fear. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific region where the study was conducted. Funnel plot and Egger's regression test were used to check for publication bias. STATA version 14 statistical software was used for meta-analysis. Results A total of 2,015 pregnant mothers were included. The combined prevalence of fear of childbirth among pregnant mothers was found to be 21% (95% CI: 19-22; I 2 = 0.00%, p value < 0.001). Based on the subgroup analysis, the prevalence of fear of childbirth among pregnant mothers was 24% in SNNPRs, 25% in Oromia, and 11% in Addis Ababa. Conclusion The findings of the meta-analysis indicating a high prevalence of fear of childbirth among pregnant mothers in Ethiopia and identifying associated risk factors highlight the importance of addressing this issue within the healthcare system. Integrating prevention-based services for mothers with childbirth fears into the antenatal care model could be a valuable approach to support women and mitigate the impact of fear on their reproductive experiences. Systematic Review Registration https://www.crd.york.ac.uk/prospero/#myprospero, identifier [CRD42023411103].
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Affiliation(s)
- Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistu Mekonnen Kelkay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Yılmaz FA, Avci D. The Relationship Between Psychological Pain, Spiritual Well-Being, and Social Support in Turkish Women Undergoing Therapeutic or Elective Abortion. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02087-4. [PMID: 39017826 DOI: 10.1007/s10943-024-02087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
This study was conducted to determine the relationship between psychological pain, spiritual well-being, and social support among Turkish women undergoing therapeutic or elective abortion. The cross-sectional study was conducted with 342 women who were hospitalized in the gynecology and obstetrics service of a city hospital between March 2021 and December 2022 in Turkey. The mean psychological pain, spiritual well-being and perceived social support scores of women undergoing therapeutic/elective abortion were 26.96 ± 11.21, 110.72 ± 13.09 and 64.09 ± 15.62, respectively. There were a significant negative correlation between psychological pain with spiritual well-being and social support. According to linear regression analysis, spiritual well-being, social support, age, employment status, economic level, history of abortion, number of abortion, current abortion type, and gestational week were statistically significant predictive factors of psychological pain. Therefore, healthcare providers can provide individualized psychosocial-spiritual care and counseling services that decrease psychological pain in women after therapeutic or elective abortion.
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Affiliation(s)
- Figen Alp Yılmaz
- Faculty of Health Sciences, Alanya Alaaddin Keykubat University, Antalya, Turkey.
| | - Dilek Avci
- Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balikesir, Turkey
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Behmanesh F, Alijanpour M, Yahyavi F, Nikpour M, Haghighi T, Karimnezhad Sorkhi F, Mohsenzadeh F, Hajian K, Faramarzi M. Spiritual Health, Anxiety and Fear of Childbirth in Iran: Is there Any Relationship? JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02067-8. [PMID: 38850299 DOI: 10.1007/s10943-024-02067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/10/2024]
Abstract
The most common reason for mothers' request for a cesarean section is fear of childbirth. The present study was conducted to determine the relationship between spiritual health and anxiety and fear of childbirth in pregnant women. This correlational cross-sectional study was performed on 426 pregnant women who were referred to Yahyanejad Hospital in Babol, Iran, during 2018-2021. These pregnant women were hospitalized in the maternity ward for vaginal delivery. Convenience sampling bases on inclusion criteria were done to select the subjects. The questionnaires used in this study included Demographic and Obstetric Questionnaire, Anxiety and Fear of Childbirth Questionnaire by Pirdel et al., and Palutzian & Ellison Spiritual Well-being Scale. Data were analyzed using SPSS version 16 using descriptive and analytical indicators and linear and multiple correlation tests. The results of the study showed that all pregnant women experienced moderate (23.1) or severe (76.9) fear and anxiety, and none of the women had low fear and anxiety. Moreover, all women in this study had moderate (50.5) or high (49.5) spiritual health. The results of linear regression test showed that there is a significant and inverse relationship between spiritual health and anxiety and fear of childbirth (R: - 0.12, CI - 0.14, - 0.019, P = 0.011). Furthermore, the results of multivariate linear regression test after adjustments for intervening demographic and midwifery variables showed a significant relationship between spiritual health (R: - 0.12, CI - 0.14, - 0.02, P = 0.009), education level and number of pregnancies, and anxiety and fear of childbirth. The results of the study showed that with the increase in spiritual health, anxiety and fear of childbirth decreases. Therefore, it can be inferred that women need spiritual care in addition to medical care to deal with fear and anxiety during pregnancy and childbirth.
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Affiliation(s)
- Fereshteh Behmanesh
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Masoumeh Alijanpour
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Fatemeh Yahyavi
- Department of Midwifery, Babol Branch, Islamic Azad University, Babol, Islamic Republic of Iran
| | - Maryam Nikpour
- Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
| | - Tahereh Haghighi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | | | - Farideh Mohsenzadeh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Karimollah Hajian
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mahbobeh Faramarzi
- Population, Family and Spiritual Health Research Center, Health Research Center, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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da Costa Silveira de Camargo J, Dos Santos Oliveira Gama F, Ochiai AM, Araújo NM, Pinheiro LR, Néné M, Grande MCLR. Spiritual Experiences of Portuguese Women Who had a Water Birth. JOURNAL OF RELIGION AND HEALTH 2023; 62:3267-3284. [PMID: 37193939 DOI: 10.1007/s10943-023-01826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 05/18/2023]
Abstract
This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.
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Affiliation(s)
- Joyce da Costa Silveira de Camargo
- Abel Salazar Institute of Sciences, Biomedical of the University of Porto, Porto, Portugal.
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil.
| | - Flávia Dos Santos Oliveira Gama
- Management of Historical and Cultural Heritage, Federal University of Minas Gerais, Belo Horizonte, Brazil
- School of Arts, Sciences and Humanities at the University of Sao Paulo, Rua Arlindo Béttio, 1000, Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Angela Megumi Ochiai
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
- Midwifery Program of the School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Natalucia Matos Araújo
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
- Midwifery Program of the School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Leonor Ramos Pinheiro
- Faculty of Public Health, University of Sao Paulo, Midwife at Casa Angela - Humanized Childbirth Center, Sao Paulo, SP, Brazil
| | - Manuela Néné
- School of Health of Portuguese Red Cross, Lisbon, Portugal
- CINTESIS - NursID - Innovation and Development in Nursing, Porto, Portugal
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The effect of spiritual well-being on illness perception of lung cancer patıents. Support Care Cancer 2023; 31:107. [PMID: 36625978 DOI: 10.1007/s00520-022-07527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/06/2022] [Indexed: 01/11/2023]
Abstract
The aim of this study is to examine the effect of spiritual well-being on the perception of people who have lung cancer. The study was conducted with 100 volunteered patients with living lung cancer who were monitored and treated at a university hospital in Turkey. Patient Identification Form, Spiritual Well-Being Scale and Illness Perception Scale were used for the data collection procedure. Using SPSS 21.0 program, independent sample t-test and one-way ANOVA test were performed in statistical analyses. The probability value was considered significant as p < 0.05. The mean score of Spiritual Well Being (SWB) was found 28.48 ± 7.20. The findings were as follows: (1) the patients who stated that they comply with the drug treatment had a high score, and SWB scores were found to be lower in those who thought that the disease could not be cured. (2) there was a significant positive relationship among SWB and sub-dimensions of the illness perceptions; acute-chronic duration (p = .668), personal control (p = .811), treatment control (p = .682), emotional representation (p = 0.184) 3), as the SWB mean score increases, the scores in the illness perception section increase 4; however, when the SWB score increases, the cyclic time decreases. It was concluded that the spiritual well-being of people who have lung cancer positively affects the perception of the disease. It was further suggested that spiritual well-being should be evaluated and improved within holistic care in order to ensure patients perception of disease and compliance with treatment.
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Rasouli R, Maleki A, Zenoozian S. Can integrating religiosity and spirituality into postpartum care improve the quality of life in women with preeclampsia. Front Psychiatry 2023; 14:985428. [PMID: 37181893 PMCID: PMC10174295 DOI: 10.3389/fpsyt.2023.985428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Background Women with a history of preeclampsia frequently have a lower level of physical well-being and emotional problems. Objective This study aimed to determine the effect of integrating religiosity and spirituality into postpartum care can improve the quality of life in women with preeclampsia. Methods This study was a randomized controlled clinical trial conducted on 40 women with preeclampsia. All eligible participants were allocated to two control and intervention groups using a random blocking method. Data were collected using Mother-Generated Index (MGI) in pre-intervention and 6 weeks later and analyzed using descriptive statistics, Chi-square test, and independent t-tests. The significance level was p < 0.05. Results The mean, Standard deviation (SD) of the total score of MGI before intervention in the intervention group was 5.35 (1.09) which increased to 8.00 (0.50) 6 weeks after intervention. In the control group, the pre-test score of MGI was 5.81 (0.97) which increased to 6.69 (1.37) after 6 weeks of follow-up. The difference between the two groups was statistically significant after the intervention based on an independent t-test (p = 0.001).The mean (SD) of five subscales included Feelings toward herself, Feelings toward the child, Feelings toward her husband and others, Feelings toward sex, and Physical health status after intervention in the intervention group statistically significantly increased compared to the control group (p < 0.011). Conclusion The integration of spiritual counseling with the educational content of postpartum care had a positive impact on improving the postpartum QoL of women with preeclampsia. For better conclusions, a study with a large sample size needed to be conducted in the future. Clinical Trial Registration https://en.irct.ir/user/trial/50832/view, identifier IRCT20150731023423N16.
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Affiliation(s)
- Robab Rasouli
- School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azam Maleki
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- *Correspondence: Azam Maleki, ;
| | - Saeedeh Zenoozian
- Department of Clinical Psychology, School of Medicine, Dr Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
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MonfaredKashki M, Maleki A, Amini K. The effect of integrating midwifery counseling with a spiritual content on improving the antenatal quality of life: A randomized controlled trials. JOURNAL OF MOTHER AND CHILD 2022; 26:18-26. [PMID: 35853465 PMCID: PMC10062411 DOI: 10.34763/jmotherandchild.20222601.d-22-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 02/06/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Poor antenatal Quality of Life (QoL) is associated with adverse outcomes. OBJECTIVE This study was performed to examine the effect of integrating midwifery counseling with spiritual content on improving the antenatal quality of life. METHOD This randomized controlled trial was performed on 60 first-time pregnant women who were referred to two childbirth preparation centers in Zanjan city, Iran in 2019. The counseling was conducted in eight sessions. The QoL SF-36 questionnaire was completed before and two months after the intervention. Data were analyzed using the chi-square test, independent t-test, and paired-samples t-test. The level of significance was p<0.05. RESULTS After intervention based on an independent t-test the total score of QoL was significantly greater in the intervention group compared to the control group (p=0.001). After the intervention, the mean scores of four domains of QoL (Role-Physical, General Health, Vitality, Role-Emotional, and Mental Health) were significantly higher than the control group(p=0.001). While in terms of Physical Functioning, Bodily Pain and Social Functioning domains were not statistically significant (p>0.05). CONCLUSION Integrating midwifery counseling with spiritual content had a positive impact on improving the psychological aspect of quality of life more than the physical and social aspects. It can be used by providers for planning antenatal care programs.
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Affiliation(s)
- Masoumeh MonfaredKashki
- Student in Counseling in Midwifery, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Azam Maleki
- Social Determinants of Health Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kourosh Amini
- Department of Mental Health Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
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Durmuş M, Öztürk Z, Şener N, Eren SY. The Relationship between the Fear of Covid-19, Depression, and Spiritual Well-Being in Pregnant Women. JOURNAL OF RELIGION AND HEALTH 2022; 61:798-810. [PMID: 34704161 PMCID: PMC8547724 DOI: 10.1007/s10943-021-01448-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 05/17/2023]
Abstract
The purpose of this study was to explore the relationship between pregnant women's fear of coronavirus (COVID-19), depression, and spiritual well-being. This cross-sectional research was carried out with 336 pregnant women living in a city in the Eastern Anatolia region of Turkey between the 1st of March and 30th of March 2021. For data collection, the scales of the Fear of COVID-19, the Beck Depression Inventory, and the Spiritual Well-being were administered to the participants. The pregnant women's fear of COVID-19 was found to be at a moderate level, their depression was at a mild level, and their spiritual well-being was above the moderate level. It was found that there was a significant negative correlation between the spiritual well-being levels of pregnant women and their fear of COVID-19 and depression. Moreover, it was also found that there was a significant positive correlation between pregnant women's levels of fear of COVID-19 and depression (p < 0.001). It is recommended that relevant spiritual care practices can be disseminated and implemented effectively to reduce pregnant women's fear and depression during the pandemic. In addition, when providing care to pregnant women, health professionals can adopt a holistic approach to increase pregnant women's spiritual well-being.
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Affiliation(s)
- Mustafa Durmuş
- Department of Gerontology, Faculty of Health Sciences, Mus Alparslan University, 49100, Muş, Turkey.
| | - Zeynep Öztürk
- Department of Psychiatric Nursing, Faculty of Nursing, Ataturk University, 25240, Erzurum, Turkey
| | - Nurdilan Şener
- Department of Nursing, Faculty of Health Sciences, Fırat University, 23000, Elazığ, Turkey
| | - Saliha Yurtçiçek Eren
- Department of Midwifery, Faculty of Health Sciences, Mus Alparslan University, 49100, Muş, Turkey
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Bilgiç G, Çıtak Bilgin N. Relationship Between Fear of Childbirth and Psychological and Spiritual Well-Being in Pregnant Women. JOURNAL OF RELIGION AND HEALTH 2021; 60:295-310. [PMID: 32949330 DOI: 10.1007/s10943-020-01087-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 05/02/2023]
Abstract
The aim of the study was to investigate the relationship between fear of childbirth (FOC) and psychological (PWB) and spiritual well-being (SWB) in pregnant women. Descriptive and relational study was conducted with 338 pregnant women in Turkey. Information form, Wijma Delivery Expectancy/Experience Questionnaire-A, Spiritual Well-Being Scale and Psychological Well-Being Scale were used for data collection. There was a negative correlation between SWB and PWB and FOC in pregnant women. SWB explained 18% of the variance related to FOC which increased to 24% with PWB. SWB was a partial mediating variable in PWB and FOC relationship. PWB and SWB of pregnant women should be evaluated in order to reduce FOC. PWB and SWB of pregnant women should be evaluated in order to reduce FOC.
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Affiliation(s)
- Gamze Bilgiç
- Nursing Care Department, Erenköy Psychiatric Hospital, Kadıköy, Istanbul, Turkey
| | - Nevin Çıtak Bilgin
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Golkoy Campus, 14030, Bolu, Turkey.
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The Effect of Integrating Midwifery Counseling With a Spiritual Approach on Pregnant Women’s Spiritual Experience: A randomized Controlled Trial. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2020. [DOI: 10.52547/pcnm.10.2.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Badaoui A, Kassm SA, Naja W. Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues. Curr Psychiatry Rep 2019; 21:27. [PMID: 30868272 DOI: 10.1007/s11920-019-1010-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions. RECENT FINDINGS Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.
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Affiliation(s)
- Alexandra Badaoui
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon.
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
| | - Wadih Naja
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
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