Association between parental divorce and mental health outcomes among Lebanese adolescents: results of a national study

Background

In Lebanon, divorce rates have jumped from nearly 7000 in recent years to 8580 in 2017, an increase of 22.5%, with North Lebanon recording the highest number, followed by Beirut, likely resulting in increased behavioral problems in the offspring of divorced parents. Furthermore, one out of two Lebanese adolescents whose biological parents were divorced, separated, or deceased has a psychiatric disorder. More information regarding the impact of divorce on the mental health of Lebanese adolescents is still missing. The objective of this study was to explore the association between divorce and mental health outcomes, particularly depression, anxiety, and suicidal ideation among Lebanese adolescents.

Methods

A cross-sectional study conducted between January and May 2019 enrolled 1810 adolescents aged 14 to 17 years, using a simple randomization method to choose schools. A proportionate number of schools was selected from each of the five Lebanese Mohafazat (Beirut, Mount Lebanon, North, South, and Beqaa), based on the list of the Ministry of Education and Higher Education. A total of 18 private schools were approached; two declined, and 16 accepted to participate.

Results

The mean age of participants was 15.42 ± 1.14 years, with 53.3% females. After adjustment for the covariates (age, sex, and house crowding index), the results showed that adolescents whose parents are separated compared to living together had more social fear (Standardized Beta (SB = 0.270) and avoidance (SB = 0.188), higher depression (SB = 0.045), and higher suicidal ideation (SB = 0.370).

Conclusion

Our findings reveal that teens with divorced parents had higher social fear and avoidance, depression, and suicidal ideation, highlighting the need for adequate prevention programs to support both children and parents during this emotionally difficult period.

Prevalence and Factors Associated with Insomnia Among a Representative Sample of the Lebanese Population: Results of a Cross-Sectional Study

The objectives of the study were to identify the prevalence of insomnia among a representative sample of the Lebanese population and to assess potential factors associated with insomnia among this group. A cross-sectional study was done in the Lebanese population from August 2017 to April 2018 enrolling 789 participants using a proportionate random sample from all five Lebanese governorates. Participants filled a self-administered Arabic questionnaire. The Athens Insomnia Scale was used to diagnose insomnia. The Hamilton Depression Rating Scale and the Generalized Anxiety Disorder Scale were used to measure depression and anxiety, respectively. The prevalence of insomnia was 47.1% in the population sampled. The mean age of the participants was 37 years (64% females). Death in the family [adjusted odds ratio (aORa) = 1.59], drinking caffeine before sleep more than 2 days per week compared to none (aORa = 1.57), increased stress (aORa = 1.03), increased depression (aORa = 1.14), and anxiety scores (aORa = 1.07) were associated with higher odds of insomnia. The prevalence of insomnia was very high in the Lebanese population, and it was mainly associated with modifiable, treatable risk factors. Improved knowledge and adequate screening for insomnia are needed to promote better sleep quality.

Development of the Lebanese insomnia scale (LIS-18): a new scale to assess insomnia in adult patients

OBJECTIVE

To define the development and validation of the Lebanese Insomnia Scale (LIS-18) to be used for the evaluation of insomnia in Lebanese adult patients.

METHODS

A first cross-sectional study, conducted between August 2017 and April 2018, enrolled 789 participants (sample 1). A second sample was recruited in May 2018 to confirm the results obtained from the first sample.

RESULTS

Five factors derived from the LIS-18 scale items with an Eigenvalue over 1, explaining a total of 59.64% of the variance (Cronbach's alpha = 0.821). The first ROC curve, comparing participants with diagnosed insomnia to healthy individuals, showed that the optimal score was seen at a cutoff of 58.00, with a good sensitivity and specificity at this cutoff (93.3 and 88.4%, respectively). A second ROC curve, comparing participants taking drug medication for insomnia vs. those not taking drug, showed that the optimal score was seen at a cutoff of 52.50, with a good sensitivity and specificity at this cutoff (89.5 and 80.0%, respectively). A third ROC curve, comparing participants diagnosed by a physician or taking drug medication for insomnia and healthy control without insomnia drug, showed that the optimal score was seen at 51.50, with good sensitivity and specificity at this cutoff as well (90.0 and 78.10%, respectively). The positive predicted value (PPV) of the LIS-18 score in sample 2 was 93.3%, whereas the negative predicted value (NPV) was 88.4%.

CONCLUSION

The results demonstrate that the LIS-18 can be used in clinical practice and research to measure insomnia.