Profiles of intuitive eating in adults: the role of self-esteem, interoceptive awareness, and motivation for healthy eating

OBJECTIVE

Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach.

DESIGN

Cross-sectional study.

SETTING

Lebanese governorates.

PARTICIPANTS

359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES).

RESULTS

Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015).

CONCLUSIONS

Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating.

Are the presence of asthma and the COVID-19 infection associated with behavioral changes in Lebanese adolescents?

BACKGROUND

Little evidence is available about psychological stressors in Lebanese asthmatic adolescents, where health-risk behaviors are a serious threat to public health. In addition, the COVID-19 epidemic has had a substantial influence on adolescents' mental health globally, especially in Lebanon, where the ongoing economic and political challenges have largely impacted their psychological well-being. This study aimed to explore the association of asthma and the COVID-19 infection with behaviors among Lebanese adolescents.

METHODS

Data were collected in July 2023, using the snowball sampling technique. Inclusion criteria for participation in the study included being of a resident and citizen of Lebanon and aged 12-18 years. Behavioral problems were assessed using the Youth Self-Report (YSR) scale, which yields nine subscales (anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score.

RESULTS

Asthma was significantly associated with somatic complaints (Beta [β] = 2.98), attention problems (β = 0.01), and other behavioral problems (β = 0.68). Having contracted the COVID-19 infection, compared to healthy asymptomatic state (β = 1.55), was significantly associated with more anxious behaviors. In the case of stratifying the analysis in terms of gender, the results showed that the presence of asthma was significantly associated with more social behaviors (β = 3.31), thought problems (β = 2.91), attention problems (β = 0.02), other behavioral problems (β = 1.71), and total behavioral problems (β = 5.71) in males. In case stratifying the analysis as to school type, the presence of asthma was significantly associated with more somatic complaints (β = 2.77) in participants from private schools whereas it was significantly associated with more total behavioral problems (total YSR scores) (β = 5.05) in participants from public schools.

CONCLUSION

It is confirmed that asthma and psychiatric disorders are interconnected, so it would be of great importance to include screening through a psychological intervention in treating asthmatic adolescents by means of (1) recognizing factors affecting patients' mental health, and (2) regulating uncontrolled behaviors that can exacerbate symptoms in order to avoid the future morbidity.

Association of behaviors and asthma control in a sample of Lebanese adolescents with asthma

BACKGROUND

The relationship between behavioral problems and asthma is bidirectional; while the presence of a chronic disease such as asthma might predispose the person to stress, anxiety, and other behavioral issues, behavioral problems might in turn cause uncontrolled asthma through nonadherence to asthma management strategies. In Lebanon, behavioral problems and uncontrolled asthma could be of significant concern for adolescents. Consequently, we found it necessary to evaluate association between behavioral problems and uncontrolled asthma in a sample of Lebanese adolescents.

METHODS

Data for this cross-sectional study were collected using the snowball sampling technique in July 2023. The questionnaire was developed with Google Forms and distributed to participants via social media platforms and messaging applications. The Asthma Control Test (ACT) was used to check for uncontrolled asthma, and the Youth Self-Report (YSR) scale was used to assess behavioral problems. It yields nine subscales (anxious-depressed, withdrawn-depressed, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, aggressive behavior, and other problems) and a total score.

RESULTS

When taking each behavior score as an independent variable, older age was associated with lower ACT scores (more controlled asthma); F(15, 186) = 3.66, P = 0.014, and 95% Confidence Interval (CI) [-0.85, -0.10]. Living in a rural area, compared to urban was associated with higher ACT scores, P = 0.018, and 95% Confidence Interval (CI) [0.28, 2.94]. The intake of the COVID-19 vaccine, P = 0.003 and 95% CI [0.73, 3.55]; waterpipe smoking, P = 0.017 and 95% CI [0.38, 3.85]; and having more somatic complaints, P = 0.005 and 95% CI [0.04, 0.25], also were significantly associated with higher ACT scores (more uncontrolled asthma). When taking the total behavior score as an independent variable, higher YSR scores were associated with higher ACT scores (more uncontrolled asthma), F(10, 191) = 4.30, P = 0.038, and 95% CI [0.003, 0.10].

CONCLUSION

Our findings support the inclusion of mental health treatments for better asthma control and point to a link between behavioral issues and uncontrolled asthma. In a developing nation without a clear established strategy for asthma prevention, the findings of this study could help develop potentially beneficial public health treatments.

Psychometric properties of an Arabic translation of the short entrapment scale in a non-clinical sample of young adults

BACKGROUND

Entrapment is the feeling of wanting to leave an unbearable situation but believing that there are no options to do so. An Arabic entrapment Scale will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection.

OBJECTIVE

In the current study, we aim to evaluate the psychometric properties of a translated Arabic version of the Entrapment Scale Short Form (E-SF).

METHODS

Three hundred eighty-nine Lebanese citizens were enrolled in this cross-sectional study.

RESULTS

The mean age of participants was 23.03 years (SD = 2.93), 69.4% being women. To examine the factor structure of the entrapment scale, we used an exploratory-to-confirmatory factor analysis (EFA-to-CFA) strategy. EFA and CFA results indicated that the fit of the unidimensional model of the Arabic Entrapment Scale (A-ES) was generally acceptable. Composite reliability of scores was adequate in the total sample (ω = .87). All indices suggested that configural, metric, and scalar invariance was supported across genders. Entrapment was positively and significantly correlated with suicidal ideation, alcohol use disorder, psychological distress, and orthorexia nervosa, suggesting convergent and divergent validity.

CONCLUSION

The A-ES was found to be a valid and reliable tool to assess the degree of entrapment in Lebanese young adults. The A-ES will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection.

Psychometric properties of an Arabic translation of the short form of the metacognition questionnaire (MCQ-30) in a non-clinical adult sample

BACKGROUND

Previous linguistic validations of the 30-item Metacognition Questionnaire (MCQ-30) have been performed in Western/Eastern populations, and no Arabic validated version exists to date for the wide Arabic-speaking populations in the Middle East-North African region and abroad. In this regard, we sought through the present study to test the psychometric properties of an Arabic translation of the MCQ-30 in a sample of Arabic-speaking community adults from Lebanon.

METHODS

The sample of this cross-sectional study consisted of 423 participants (mean age: 38.13 ± 11.03 years; 61.2% females). The Metacognition Questionnaire-short form, Teruel Orthorexia Scale and Emotion regulation questionnaire were used to assess metacognition, orthorexia nervosa and emotion regulation (cognitive reappraisal and expressive suppression) respectively.

RESULTS

Findings of Confirmatory Factor Analyses revealed that the five-factor model provided a good fit to the data. McDonald's ω coefficients ranged from 0.78 to 0.94 for the five MCQ-30 subscales, and was of 0.93 for the total score, hence supporting the adequacy of scale reliability. Results also supported configural, metric, and scalar equivalence of the five-factor model across gender groups. The MCQ-30 subscales showed patterns of correlations with the emotion regulation and disordered eating constructs in the expected directions, providing evidence of the criterion-related validity of the measure. In particular, positive emotion regulation strategies (i.e., cognitive reappraisal) were negatively correlated with cognitive self-consciousness and need to control thoughts; whereas maladaptive emotion regulation strategies (i.e., expressive suppression) showed positive correlations with lack of cognitive confidence, negative beliefs and need to control thoughts. Additionally, all metacognition dimensions (except for cognitive self-consciousness) were significantly and positively correlated with higher levels of orthorexia nervosa behaviors.

CONCLUSIONS

Our findings preliminarily suggest that the scale is valid, reliable, and can be recommended for use among the broad Arabic-speaking community worldwide.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies

BACKGROUND

Dysfunctional metacognitive processes and emotional dysregulation have been widely documented in the eating disorder literature. Despite numerous research and recent consensus suggesting the categorization of orthorexia nervosa as a form of eating disorder, no previous study has examined whether aberrant metacognitive processes also correlate with orthorexia nervosa tendencies. This paper investigates potential associations between symptoms of orthorexia nervosa and dysfunctional metacognitive processes while also exploring whether such relationships may be influenced by adaptive/maladaptive emotion regulation strategies.

METHODS

We conducted a cross-sectional study in all Lebanese governorates. In total, 423 Lebanese adults completed an online questionnaire including the Teruel Orthorexia Scale, the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale - 16 Item Version, and the Metacognitions Questionnaire - Short Form.

RESULTS

Higher physical activity, expressive suppression, emotion regulation difficulties, positive metacognitive beliefs about worry, and need to control thoughts were significantly associated with higher orthorexia nervosa. Additionally, the emotion regulation strategies moderated the relationships between two dysfunctional metacognitive processes and orthorexia nervosa. Specifically, cognitive self-consciousness was negatively related to orthorexia nervosa only in individuals with low (versus higher) emotion suppression (maladaptive emotion regulation strategy). In contrast, negative beliefs about worry uncontrollability and danger positively predicted orthorexia nervosa only in individuals with lower (versus high) cognitive reappraisal (adaptive emotion regulation strategy). Lower socio-economic status and having a university level of education compared to secondary level were significantly associated with lower orthorexia nervosa.

CONCLUSION

Our study provides the first empirical evidence for the existence of significant associations between dysfunctional metacognitive processes and orthorexia nervosa. It also highlights that these pathways are considerably modulated by individuals' ability to regulate their emotions adaptively versus maladaptively. Our findings thus suggest that therapies aimed at improving thought monitoring and emotional regulation may be beneficial for individuals with symptoms of orthorexia nervosa.

Psychometric properties of an Arabic translation of the multidimensional assessment of interoceptive awareness (MAIA-2) questionnaire in a non-clinical sample of Arabic-speaking adults

BACKGROUND

Interoception refers to processes through which the nervous system identifies, analyzes, and integrates the information generated by the physiological state of the body (e.g., from internal organs such as the stomach, heart, or lungs). Despite its potential interest for clinical research and its wide use globally, no Arabic adaptation and validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire exists to date. The goal of this study was to examine the psychometric properties of an Arabic translation of the MAIA-2 in a sample of Arabic-speaking community adults from Lebanon. We hypothesized that the Arabic version of the MAIA-2 would yield adequate internal consistency coefficients; the 8-factor structure model would show a good fit to our data, with measurement invariance and good convergent validity.

METHOD

The Arabic adaptation of the MAIA-2 was developed using the forward-backward translation method. A non-clinical sample of Arabic-speaking adults (n = 359, 59.9% females, mean age = 22.75 years (SD = 7.04)) took part of this validation study. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 3 for χ²/df, and ≤ 0.08 for RMSEA, and 0.90 for CFI and TLI indicate good fit of the model to the data.

RESULTS

Confirmatory Factor Analyses corroborated the validity of the original 8-factor structure of the MAIA-2 [χ2/df = 1603.86/601 = 2.67, RMSEA = 0.068 (90% CI 0.064, 0.072), SRMR = 0.058, CFI = 0.903, TLI = 0.892]. Reliability estimates in our sample revealed good internal consistency, with McDonald's ω coefficients for the subscales ranging from 0.86 to 0.93. Our analyses also revealed measurement invariance of the Arabic MAIA-2 for gender. No statistically significant difference between men and women in all dimensions, except for the not worrying and attention regulation subscales where men scored significantly higher than women. Finally, the Arabic MAIA-2 dimensions showed positive correlations with the intuitive eating dimension "Reliance on Hunger and Satiety Cues", thus providing support for convergent validity.

CONCLUSION

We contribute the literature by providing the first Arabic adaptation and validation of a measure assessing the multidimensional construct of self-reported interoception. The Arabic MAIA-2 demonstrated good psychometric properties. We thus preliminarily recommend its use to measure the interoceptive awareness construct among Arabic-speaking communities worldwide.

Depressive symptoms among a sample of Lebanese adolescents: Scale validation and correlates with disordered eating

BACKGROUND

Adolescence is a transitional phase that brings many psychological and physiological challenges that increase emotional vulnerability and threaten the adolescent's mental well-being. Indeed, mental illnesses, such as depression and eating disorders, show an alarming increase in prevalence after puberty. Adolescent depression is particularly concerning owing to the fact that it is a principal cause of disability among adolescents, an important risk factor for suicidality, and is associated with higher risks of present and subsequent morbidity. Our study aimed at (1) examining the psychometric properties of the Patient Health Questionnaire-9 (PHQ-9) and (2) evaluating the correlation between depression, eating disorders, stress, and other variables in a sample of Lebanese adolescents.

METHODS

This cross-sectional research enlisted 555 Lebanese teenagers (15-18 years) from all Lebanese governorates (May-June 2020). The confirmatory factor analysis of the PHQ-9 scale items was carried out using the SPSS AMOS program v.24. The relative chi-square, the root mean square error of approximation (RMSEA), Tucker Lewis Index (TLI) and the comparative fit index (CFI) were all utilized as goodness-of-fit indexes.

RESULTS

The median age of the participants was 16.66 ± 1.00 years, with 75.7% females. Among these 555 adolescents, 62.9% had mild-to-moderate depression and 14% reported moderately severe-to-severe depression, while only 23.1% were classified as not suffering from depression. Confirmatory factor analysis of the PHQ-9 scale was conducted using the one-factor structure that is described in the literature; the fit indices obtained were acceptable as follows: χ²/df= 136.26/27 =5.05, CFI=0.92, TLI=0.90 and RMSEA=0.085 [0.072-0.100]. However, the modification indices between items 6 and 9 were high; after correlating these two items, the fit indices improved more as follows: χ²/df= 105.59/26=4.06, CFI=0.94, TLI=0.92 and RMSEA=0.074 [0.060-0.089]. The multivariable analysis results showed that more stress (β=0.59), female sex (β=1.54), and more binge eating (β=0.16) were significantly associated with more depression.

CONCLUSION

This study supports the validity of the PHQ-9, which presents as a reliable tool for the evaluation of depression in future epidemiological studies of Lebanese adolescents. It also elucidates the high level of depression among this age group and its correlation with modifiable and unmodifiable factors.

Attachment styles and orthorexia nervosa among Lebanese adolescents: The indirect effect of self-esteem

BACKGROUND

Orthorexia nervosa (ON), defined as the pathological obsession for pure foods, remains a novelty in the field of eating disorders. Many studies in the literature have shown that attachment styles correlate with the development of eating disorders. Patients with eating disorders were found to be more avoidant and anxious and less secure than individuals who do not have eating disorders. However, studies on the relationship between attachment styles and ON remain limited, particularly in adolescents. This study assessed the relationship between attachment styles and ON in Lebanese adolescents (15-18 years), along with evaluating the indirect effect of self-esteem on this association.

METHODS

This study used a cross-sectional design and was carried out during May-June 2020 with 555 students (15-18 years) enrolled. The Düsseldorf Orthorexia Scale was utilized to screen for ON tendencies. A linear regression was conducted taking the DOS score as the dependent variable. The PROCESS Macro was used to test the indirect effect of self-esteem between attachment styles and ON.

RESULTS

Higher fearful and preoccupied attachment styles, female gender, and more physical activity were significantly associated with more ON tendencies, whereas higher self-esteem was significantly associated with less ON tendencies. When adjusting for all sociodemographic characteristics and other attachment styles, none of the attachment styles remained significantly correlated with ON tendencies. Self-esteem mediated the association between secure attachment style and ON and between dismissive attachment style and ON.

CONCLUSIONS

The rise in ON warrants further studies and investigations to raise awareness and plan behavioral interventions in order to treat it.

Exploring the indirect effect of loneliness in the association between problematic use of social networks and cognitive function in Lebanese adolescents

BACKGROUND

Problematic use of social networks is a widespread problem that may exert deleterious impacts on cognitive functions. Moreover, studies have added an important link between loneliness and its harmful effect on cognitive functions. Other studies have also revealed that problematic use of social networks among teenagers has a pejorative influence on their social interactions, leading to increased social isolation. Therefore, the goal of our research was to investigate the link between problematic use of social networks and cognitive function in a group of Lebanese adolescents while also taking into consideration the indirect role of loneliness in this relationship.

METHODS

This cross-sectional study, which was carried out between January and April 2022, included 379 teenagers (aged between 13 and 17 years), from all Lebanese governorates. The PROCESS SPSS Macro version 3.4, model four was used to compute three pathways. Pathway A determined the regression coefficient for the effect of problematic use of social networks on loneliness; Pathway B examined the association between loneliness and cognitive function, and Pathway C' estimated the direct effect of problematic use of social networks on cognitive function.

RESULTS

Higher negative social comparison, addictive consequences of problematic use of social networks, and loneliness were significantly associated with worse cognitive function. Loneliness mediated the association between negative social comparison and worse cognitive function, as well as between addictive consequences of problematic use of social networks and worse cognitive function. In addition, higher financial burden was significantly correlated with worse cognitive function, whereas higher physical activity was related to better cognitive function.

CONCLUSION

In sum, the current study supports that problematic use of social networks is negatively associated with adolescents' cognitive function, where loneliness seems to play a pivotal role in this equation. The results thus endorse the importance of helping Lebanese adolescents to overcome problematic use of social networks and recover from their loneliness, to achieve a better cognitive/academic performance.

Cyberchondria Severity and Quality of Life Among Lebanese Adults: The Moderating Effect of Emotions

Objective: To examine the correlation between cyberchondria and quality of life (QOL) among Lebanese adults during the COVID-19 pandemic, taking into consideration the moderating role of emotions (emotion regulation and positive and negative affect). The following questions were examined: (1) Do greater cyberchondria severity and fear of COVID-19 lead to poorer quality of physical and mental health? (2) How is positive and negative affect related to physical and mental QOL? and (3) How do emotion suppression and cognitive reappraisal correlate with physical and mental QOL, particularly in those with higher cyberchondria?

Methods: This cross-sectional study was performed between December 2020 and January 2021 during the COVID-19 pandemic. The study enrolled 449 participants who completed an online questionnaire. The questionnaire included sociodemographic questions and the following scales: Cyberchondria Severity Scale, Quality of Life Short Form-12 Health Survey, Fear of COVID-19 Scale, Emotion Regulation Questionnaire, and Positive and Negative Affect Schedule.

Results: The results showed that more positive affect (B = 0.17) and negative affect (B = 0.19) were positively correlated with higher physical QOL scores. More positive affect (B = 0.33) and cognitive reappraisal (B = 0.09) were significantly associated with higher mental QOL scores. The interactions between cyberchondria severity by cognitive reappraisal and cyberchondria severity by emotion suppression were significantly associated with mental QOL (P < .001 for both). In people with high cyberchondria severity, having high cognitive reappraisal was strongly correlated with better mental QOL. In people with high cyberchondria severity, having low emotion suppression was significantly correlated with better mental QOL (P < .001).

Conclusions: Exposure to copious amounts of information, whether from verifiable sources or not, can instigate anxious symptoms in individuals who lack adaptive emotion regulation ability. Further studies are needed to identify factors related to health crisis response and their moderators, which can be useful to better understand the incidence and development of anxiety and allow health professionals to develop and implement preventive and therapeutic interventions.

Psychometric properties of the Arabic version of the Intuitive Eating Scale-2 (IES-2) in a sample of community adults

BACKGROUND

There is a growing attention on intuitive eating (IE) styles in the Western world that has not yet reached Arab countries, which is likely due to the lack of psychometrically sound measures of the IE construct for Arabic-speaking people. The current study aims to examine the psychometric properties of an Arabic translation of the most widely used measure of IE-the Intuitive Eating Scale-2 (IES-2), in an Arabic-speaking community population from Lebanon.

METHODS

Two samples of Arabic-speaking community adults from Lebanon (sample 1: n = 359, 59.9% females, age 22.75 ± 7.04 years; sample 2: n = 444, 72.7% females, age 27.25 ± 9.53 years) were recruited through online convenience sampling. The translation and back-translation method was applied to the IES-2 for linguistic validation. Factorial validity was investigated using an Exploratory Factor Analysis & Confirmatory Factor Analysis strategy. Composite reliability and sex invariance were examined. We also tested convergent and criterion-related validity through correlations with other theoretically plausible constructs.

RESULTS

Nine out of the original 23 items were removed because they either loaded below 0.40 and/or cross-loaded too highly on multiple factors. This resulted in four domains (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) and 14 items retained. Internal reliability estimates were excellent, with McDonald's ω values ranging from 0.828 to 0.923 for the four factors. Multigroup analysis established configural, thresholds, metric, scalar, strict invariance across gender. Finally, higher IES-2 total scores were significantly correlated with lower body dissatisfaction scores and more positive eating attitudes, thus attesting to convergent and criterion-related validity of the scale.

CONCLUSIONS

The current findings provide preliminary evidence for the appropriate psychometric qualities of the Arabic 14-item, four-factor structure IES-2; thereby supporting its use at least among Arabic-speaking community adults.

Translation and validation of the mindful eating behaviour scale in the Arabic language

BACKGROUND

There has been a drastic increase in the prevalence of obesity and its related diseases in the Arabic-speaking countries during the last decades along with a lack of public awareness about this awareness about this public health problem. This calls for the development of novel prevention and intervention strategies that are based on new approaches, including mindful eating. In this context, we aimed through this study to explore the factor structure, composite reliability, measurement invariance across sex, convergent and divergent validity of an Arabic translation of the Mindful Eating Behaviour Scale (MEBS).

METHODS

A cross-sectional study carried out between September and November 2022, and enrolled 359 participants, all aged above 18 years old and recruited from all Lebanon governorates. The questionnaire used included socio-demographic questions, and the following scales: The Mindful Eating Behavior Scale (MEBS), Rosenberg Self-Esteem Scale (RSES), Intuitive Eating Scale-2, and Depression Anxiety Stress Scale (DASS-8).

RESULTS

McDonald's ω values ranged from .82 to .95 or the four mindful eating domains, indicating the excellent internal consistency reliability of the scale. Our study also showed that fit indices from the confirmatory factor analysis confirmed the original four-factor structure model of the MEBS. Furthermore, our analyses suggested that configural, metric, and scalar invariance was supported across sex. Our results found no sex difference in all MEBS subscales scores. Finally, we found positive correlations between Focused eating, Hunger and satiety cues on one hand, and intuitive eating on the other hand. Moreover, greater Hunger and satiety cues scores were correlated with higher self-esteem and lower body mass index.

CONCLUSION

Our findings support the psychometric reliability and validity of the Arabic MEBS. We suggest, accordingly, that the scale will be of high clinical and research utility, and will help in the development of information-based interventions focused on mindful eating that are aimed to combat eating disorders and obesity in the Arab world.

Development of scales to measure Lebanese university students’ perceived knowledge about and attitudes about cannabis use: initial psychometric properties

Background

For a long period, cannabis in Lebanon was categorized as an illegal psychoactive substance criminalized by law, despite being the 3rd largest producer of cannabis resin after Morocco and Afghanistan. The current available literature on the topic in Lebanon is scarce, as perceived knowledge towards cannabis use in the general population is not well established, and public health policies are absent. In the context of future legalization of cannabis for both medical and recreational purposes, what is the public’s perception of cannabis perceived knowledge about and attitude against cannabis use? The objectives of this study were to create two scales to assess perceived knowledge towards cannabis use and attitude against cannabis use and check their psychometric properties in a sample of Lebanese university students.

Methods

The study was designed as a cross-sectional study involving 415 Lebanese university students aged between 18 and 30 years. Students were only recruited from one university and were sent an email with a brief description of the study and a link to the questionnaire. The questionnaire items covered perceived knowledge and attitude about cannabis use, recovered and adapted from available literature.

Results

Perceived knowledge items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 64% of the variance (factor 1 = perceived knowledge about cannabis quality of life improvement; factor 2 = perceived knowledge about cannabis psychiatric use; factor 3 = perceived knowledge about cannabis risks; factor 4 = perceived knowledge about cannabis neurological use). Attitude items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 58.2% of the variance (factor 1 = negative attitude about cannabis use; factor 2 = positive attitude about cannabis use). Good Cronbach’s alpha values were found for the perceived knowledge and attitude scales (α = 0.78 and α = 0.73 respectively). Greater perceived knowledge was found in male participants and in those who have tried cannabis for recreational purposes. Greater perceived knowledge was also associated with stronger attitude about cannabis use and older age. Furthermore, greater mean attitude about cannabis use scores were significantly found in male participants and in those who have tried cannabis for recreational or medicinal purposes.

Conclusion

Primary results showed acceptable psychometric properties for the perceived knowledge towards and attitudes about cannabis use scale. Further studies are needed in order to validate them among the general population and assess more psychometric properties of these scales.

Association between the bi-dimensional aspect of orthorexia and healthy behaviors among lebanese adolescents

BACKGROUND

Recently, there has been a blooming focus on "eating healthy and clean", with the ideal of being healthy becoming a popular lifestyle trend. Previous research suggested the presence of two forms of orthorexia: Orthorexia Nervosa (OrNe) and Healthy Orthorexia (HeOr). Taking into consideration that orthorexia thoughts are led by the desire to reach an optimal physical health, the dedication to a healthy living may require healthy lifestyle habits: smoking cessation, moderate alcohol intake, and increased physical activity. The main study aim was to determine, among Lebanese adolescents, the association between healthy behaviors and the two likely forms of orthorexia (OrNe and HeOr), given that the adolescent phase is a risky period in the development of eating disorders.

METHODS

A cross-sectional study, conducted between January and April 2022, enrolled 444 adolescents aged between 14 and 18 years, with an equitable random sample from all the Lebanese governorates (mean age 16.23 ± 1.15 years; 60.1% females). The Teruel Orthorexia Scale (TOS) was used to assess orthorexic eating tendencies. The Lebanese Waterpipe Dependence Scale, the Fagerström Test for Nicotine Dependence and the Alcohol Use Disorder Identification Test scales, all validated in adolescents, were used to evaluate the association between orthorexia and healthy behaviors.

RESULTS

Higher TOS OrNe scores were significantly and highly correlated with the TOS HeOr scores (r = 0.68; p < 0.001). In the bivariate analysis, waterpipe smoking was weakly but significantly associated with more OrNe, whereas more physical activity was significantly and moderately associated with more HeOr. After adjusting over all sociodemographic characteristics, other behaviors and the other dimension of orthorexia, more alcohol use disorder was significantly but strongly associated with higher OrNe, whereas more physical activity remained significantly associated with higher HeOr.

CONCLUSION

In light of our results, OrNe and HeOr might be considered as different entities, mainly in their associations with alcohol consumption and physical activity. This supports the hypothesis of OrNe being a new form of eating disorder, whereas HeOr possibly showing protective characteristics. Orthorexia is still a topic of controversy, especially in the probable presence of two facets that are still difficult to differentiate.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Validation of the Arabic version of the Dusseldorf Orthorexia Scale (DOS) among Lebanese adolescents

BACKGROUND

Orthorexia Nervosa (ON) is defined as a pathological preoccupation characterized by obsessive beliefs and compulsive behaviors regarding 'pure' eating behaviors. Many scales have been established and display good results regarding reliability and validity measures, including but not limited to ORTO-R (revised version of ORTO-15), Eating Habits Questionnaire, Teruel Orthorexia Scale (TOS) and the Düsseldorf Orthorexia Scale (DOS). Among these, the DOS seems to be a promising measure for multiple reasons. The current paper aims to validate the DOS, a measure of ON, in a non-Western population of Lebanese adolescents.

METHODS

This was a cross-sectional designed study, conducted between May and June 2020, which enrolled 555 adolescents (15-18 years old; 75.7% females). Due the coronavirus pandemic outbreak, the data were gathered through snowball sampling using an online questionnaire. The DOS, TOS and ORTO-R scales were used in this study to screen for orthorexic tendencies and behaviors.

RESULTS

We tested four competing structural models of the DOS assessing its factorial validity. The results of the current investigation revealed that the one-factorial model is the best one to represent the structure of the questionnaire. We provided evidence for validity for the DOS through demonstrating that it correlates significantly with other measures of orthorexic behaviours (Teruel Orthorexia Scale and ORTO-R). Finally, we have gathered evidence that the orthorexic behaviours as measured by DOS are not associated with age (r = -.02; p = .589), household crowding index (r = .02; p = .578), and Body Mass Index (r = .04; p = .297). Yet, females as compared to males achieved higher scores (M = 20.07, SD = 6.38 vs M = 18.29, SD = 6.37; p = .005; d = .28).

CONCLUSION

The Arabic version of the DOS seems to be a structurally valid and internally consistent questionnaire measuring orthorexic eating behavior in a sample of Lebanese adolescents. This tool may be useful for psychologists, psychiatrists, dietitians and other clinicians in the assessment and the treatment of the multidimensional nature of ON.

Restrained eating in Lebanese adolescents: scale validation and correlates

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Correlates of bullying perpetration among Lebanese adolescents: a national study

Background

Presently, 1 in 4 Lebanese adolescents is involved in bullying, with 12% being perpetrators. In Lebanon, around 90% of bullying incidents occur in schools. Given the lack of studies tackling bullying perpetration in Lebanon, this study aims to identify and target risk factors of bullying perpetration among Lebanese adolescents, which would serve future prevention and intervention programs.

Methods

This cross-sectional study took place between January and May 2019 in a proportionate random sample of schools from all Lebanese districts. A total of 1810 (90.5%) out of 2000 students accepted to participate.

Results

Results showed that 831 (49.1%, CI: 0.46–0.51) participants had bullied other people. A stepwise linear regression, using as the dependent variable the bullying perpetration score, showed that higher psychological (β = 0.12; 95% CI 0.083–0.176), sexual (β = 0.26; 95% CI 0.128–0.411), neglect (β = 0.08; 95% CI 0.051–0.120), physical abuse (β = 0.13; 95% CI 0.036–0.235), higher internet addiction (β = 0.07; 95% CI 0.057–0.097), higher social fear (β = 0.10; 95% CI 0.075–0.140), and having separated parents (β = 1.60; 95% CI 0.561–2.650) were significantly associated with more bullying perpetration. Higher social avoidance (β = − 0.03; 95% CI -0.062- -0.003) was significantly associated with less bullying perpetration.

Conclusion

The results revealed that bullying perpetration is significantly associated with parental status, child abuse, internet addiction, and social fear. Educational and relevant governmental institutions could use our findings to develop and implement efficient bullying prevention and intervention programs for all involved parties.

Construction of the Lebanese Anxiety Scale (LAS-10): a new scale to assess anxiety in adult patients

Objective: The study objectives were (1) to create a new 10-item scale, the 'Lebanese Anxiety Scale' (LAS-10), inspired by the diagnostic criteria of DSM-5, and the HAM-A and STAI scales and (2) to evaluate the performance of this new scale on a sample of Lebanese individuals.Methods: This cross-sectional study enrolled 1332 community dwelling participants between November 2017 and March 2018.Results: In sample 1, the participants' mean age was 28.08 years (63.9% females). The LAS items converged over a solution of two factors that had an Eigenvalue over 1, explaining a total of 51.97% of the variance (α_Cronbach=0.857). The optimal cut-off between healthy controls and anxious patients was 13.50 according to the ROC curve. The sensitivity and specificity were good at this cut-off (77.5% and 70.8%, respectively). The area under the curve was high: 0.811 [0.778-0.845]; p < .001. The positive predicted value of the LAS-10 score in sample 1 was 26.9%, whereas the negative predicted value was 95.2%.Conclusion: The results of the present study show that the LAS-10 is a tool that can be used in clinical practice and research to screen for anxiety.KEY POINTSThe positive predicted value of the LAS-10 score was 26.9%.Its negative predicted value was 95.2%.People with scores above 13.5 be referred to a health care professional for further assessment.The LAS-10 is a tool can be used in clinical practice and research to screen for anxiety.Future studies are needed to validate the LAS-10 in other countries.

Risk and Protective Factors in Autism Spectrum Disorders: A Case Control Study in the Lebanese Population

Autism spectrum disorders (ASD) are among the most common childhood neurodevelopmental disorders. Identification of risk and protective factors are necessary to improve the guidance of prevention and intervention strategies. Our study aims to determine the potential risk and protective factors in ASD in the Lebanese population. Our case-control study included 100 ASD patients and 100 healthy matched controls recruited from all the Lebanese districts. The data collected from the questionnaires was analyzed using SPSS 23.0. Independent Student T-test and Chi-Square test were carried out for the bivariate analysis of the data. In addition, the variables revealing a p-value < 0.05 were used for the multivariate logistic regression analysis. Multivitamins intake, especially omega 3 and vitamin B (Odds Ratio (OR) = 0.257; 95% Confidence Interval (CI) [0.115–0.579]), rich cereal diet (OR = 0.212; 95% CI [0.089–0.510]), and supplementation in iron during pregnancy (OR = 0.229; 95% CI [0.083–0.627]) were identified as protective factors against ASD. On the other hand, stress during pregnancy (OR = 6.339; 95% CI [2.845–14.125]), the presence of ASD patients in the family (OR = 7.878; 95% CI [1.877–33.065]) and the presence of attention deficit hyperactivity disorder (ADHD) patients in the family (OR = 6.981; 95% CI [1.362–35.789]) were associated with ASD. This study shed light on risk and protective factors associated with ASD in the Lebanese population. Further rigorous research, taking into consideration these factors, is needed to assist in early detection, prevention and subsequent intervention targeting ASD and its associated comorbidities, given that our study is not experimental and does not prove causality.

Association between parental separation and addictions in adolescents: results of a National Lebanese Study

Background

Since divorce rates are on the rise in Lebanon (an increase of 101% between 2006 and 2017) and since previous international studies have shown a relationship between divorced parents and adolescents’ addiction to smoking, alcohol, and the internet, assessing the background of the Lebanese situation was deemed necessary. The study objective was to investigate the association between the divorce of parents and smoking, alcohol, and internet addiction among a representative sample of Lebanese adolescents.

Methods

This study was a cross-sectional, conducted between January and May 2019 using a proportionate random sample of schools from all Lebanese Mohafazat. Out of 2000 questionnaires distributed; 1810 (90.5%) were completed and collected back.

Results

The mean age was 15.42 ± 1.14 years, with 53.3% females and 74.1% smokers. In addition, 11.9% [95% CI 0.104–0.134] of the adolescents had separated/divorced parents. Divorce in parents was significantly associated with higher alcohol use disorder (Beta = 8.035), higher cigarette dependence (Beta = 2.767) and a higher waterpipe dependence (Beta = 5.263) in adolescents. However, divorce in parents was not associated with internet addiction in adolescents.

Conclusion

Parental divorce is correlated to higher alcohol and smoking, but not internet addiction among adolescents. Children whose parents are divorced should be subject to continuous follow-up by their parents and by a psychiatrist/psychologist in order not to develop an addiction that could potentially harm them.

Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates

BACKGROUND

In addition to the unstable political situation, Lebanon had experienced a cycle of wars, local armed conflicts, terrorist attacks, and crises (lack of clean water, recurrent power failure, and waste mismanagement, in addition to the growing number of unemployed people, as the number of Syrian refugees has dramatically increased, and led to competition for jobs with locals. All these factors make the Lebanese population prone to mental disorders, particularly suicide, without clear management policies. This study aims to validate the Columbia-Suicide Severity Rating Scale (CSSRS), and determine the prevalence of suicidal ideation and associated factors among a Lebanese nationally representative sample of adolescents from 9th to 12th grades.

METHODS

Participants were 1810 adolescents who enrolled in this cross-sectional study (January-May 2019), using a proportionate random sample of schools from all Lebanese Mohafazat. The Columbia-Suicide Severity Rating Scale was used to screen for suicidal ideation.

RESULTS

The results showed that 28.9% had some type of suicidal ideation [95% CI 26.7-31.1%]. The CSSRS items converged on a one-factor solution, accounting for a total of 85.40% of the variance (α_Cronbach = 0.966). Higher psychological abuse (Beta = 0.041), child physical abuse (Beta = 0.030), alcohol dependence (Beta = 0.062), social fear (Beta = 0.028), victimization/bullying score (Beta = 0.028), impulsivity (Beta = 0.028) and internet addiction (Beta = 0.010) scores were significantly associated with higher suicidal ideation. Same applies to adolescents whose parents are separated compared to living together (Beta = 0.992) and in females compared to males (0.311). On another hand, a higher age (Beta = - 0.182) was significantly associated with lower suicidal ideation.

CONCLUSION

This study provides insights about suicidal ideation among Lebanese adolescents and related risk factors, such as child psychological and physical abuse, alcohol use disorders, social fear, bullying and victimization, impulsivity, and internet addiction.

Validation of the AUDIT scale and factors associated with alcohol use disorder in adolescents: results of a National Lebanese Study

BACKGROUND

This study objective was to evaluate the prevalence of alcohol use disorder (AUD) and related factors (smoking, internet addiction, social anxiety, child abuse, and bullying) among a representative sample of Lebanese adolescents, and to validate and confirm psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT).

METHODS

A cross-sectional study, conducted between January and May 2019, enrolled 1810 adolescents aged between 14 and 17 from schools of all Lebanese districts. From the total number of schools, a proportionate number was selected in each district. AUD was defined as a high AUDIT score (≥8; score range 0-40). A principal component analysis technique to confirm the validity of the construct of the AUDIT scale score was done and a confirmatory analysis to assess the structure of the instrument was conducted. Spearman correlation was used for linear correlation between continuous variables. The Mann-Whitney test was used to compare the means of two groups, while the Kruskal-Wallis test was used to compare three groups or more. A stepwise linear regression was conducted, taking the AUDIT total score as the dependent variable and taking child abuse (psychological, sexual, physical and verbal), cigarette and waterpipe smoking dependence, bullying, social phobia, and internet addiction as independent variables.

RESULTS

The mean AUDIT score was 6.46 ± 8.44 and high risk of AUD was found in 507 (28.0%) adolescents [95% CI 0.259-0.301]. One factor solution of the AUDIT scale was found after running the factor analysis (αCronbach = 0.978). Higher AUDIT scores were significantly associated with higher cigarette (Beta = 0.527; p < 0.001) and waterpipe (Beta = 0.299; p < 0.001) dependence, higher childhood sexual abuse (Beta = 0.656; p < 0.001) and neglect (Beta = 0.126; p < 0.001), higher bullying victimization (Beta = 0.236; p < 0.001).

CONCLUSION

Alcohol use disorder among Lebanese adolescents seems to be associated with several factors, such as cigarette and waterpipe dependence, parents' divorce, higher internet addiction, bullying victimization, and childhood sexual abuse and neglect. Parents and healthcare professionals could use this data for early interventions.

Interaction between anxiety and depression on suicidal ideation, quality of life, and work productivity impairment: Results from a representative sample of the Lebanese population

PURPOSE

To assess the association between the interaction of anxiety and depression on the suicidal ideation, quality of life (QOL), and work productivity/impairment in Lebanon.

DESIGN

Cross-sectional.

METHODS

1487 participants were enrolled between November 2017 and March 2018.

RESULTS

The interaction of anxiety and depression (β = .101), higher depression alone (β = .021), higher anxiety traits (STAI-B) (β = .007) were associated with higher suicidal ideation. Higher depression (β = 1.177), having more anxiety traits (STAI-B) (β = .485) and higher anxiety (STAI-A) (β = .298) were associated with higher activity impairment. Higher depression, higher anxiety traits and state, were associated with lower mental and physical QOL.

PRACTICE IMPLICATIONS

Screening for anxiety and depression can help clinicians improve patients' QOL and work productivity and decrease the suicidal ideation risk.

Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study

OBJECTIVES

Patients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population.

METHODS

A cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively.

RESULTS

A high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score).

CONCLUSION

A mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted.

Association between orthorexia nervosa, eating attitudes and anxiety among medical students in Lebanese universities: results of a cross-sectional study

OBJECTIVE

The objective of the study was to evaluate the association between orthorexia nervosa (ON) tendencies and behaviors, eating attitudes (EAT) and anxiety among a representative sample of medical students in the Lebanese universities.

METHODS

This cross-sectional study, conducted between May 2018 and January 2019, enrolled 627 medical students using a proportionate random sample from all seven faculties of medicine in Lebanon. The ORTO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. The Eating Attitude Test-26 and the Hamilton Anxiety Rating A (HAM-A) scales (yielding a psychic and a somatic subscale scores) were used to assess eating attitudes and anxiety, respectively. It is noteworthy that the sum of the EAT items 6, 7, 16 and 17 responses yielded the EAT score that would predict ON.

RESULTS

The results of a linear regression, taking the ORTO-15 score (15 items) as the dependent variable and the EAT total score, the summated score of the EAT items that predict ON and the psychic and somatic anxiety subscales scores as independent variables, showed that a higher EAT score (β = - 0.094) was significantly associated with lower ORTO-15 scores (more orthorexia tendencies and behaviors); whereas, a higher psychic anxiety subscale score (β = 0.117) was significantly associated with higher ORTO-15 scores (lower orthorexia tendencies and behaviors).

CONCLUSION

This suggests a link between eating disorders and ON which is beyond ON tendencies observed in eating disorders but ON individuals simultaneously have lesser psychological distress and anxiety.

LEVEL OF EVIDENCE

Level 5, cross-sectional descriptive study.

Identification of rare copy number variations reveals PJA2, APCS, SYNPO, and TAC1 as novel candidate genes in Autism Spectrum Disorders

Background

There is a strong evidence for genetic factors as the main causes of Autism Spectrum Disorders (ASD). To date, hundreds of genes have been identified either by copy number variations (CNVs) and/or single nucleotide variations. However, despite all the findings, the genetics of these disorders have not been totally explored.

Methods

Thus, the aim of our work was to identify rare CNVs and genes present in these regions in ASD children, using a high‐resolution comparative genomic hybridization technique and quantitative PCR (qPCR) approach.

Results

Our results have shown 60–70 chromosomal aberrations per patient. We have initially selected 66 CNVs that have been further assessed using qPCR. Finally, we have validated 22 CNVs including 11 deletions and 11 duplications. Ten CNVs are de novo, 11 are inherited and one of unknown origin of transmission. Among the CNVs detected, novel ASD candidate genes PJA2, SYNPO, APCS, and TAC1 have been identified in our group of Lebanese patients. In addition, previously described CNVs have been identified containing genes such as SHANK3, MBP, CHL1, and others.

Conclusion

Our study broadens the population spectrum of studied ASD patients and adds new candidates at the list of genes contributing to these disorders.

Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon

INTRODUCTION

Lebanon is the main hosting country for the Syrian crisis, with more than one million Syrian refugees. The objective of this study was to determine the prevalence of post-traumatic stress disorder (PTSD), and identify its possible predictors, in a sample of Syrian refugees living in camps in Lebanon.

METHOD

We conducted a household survey on Syrian refugees between 18 and 65years old in 6 camps of the Central Bekaa region, using the Mini International Neuropsychiatric Interview (M.I.N.I.) as a diagnostic tool.

RESULTS

Among the 452 respondents, we found a lifetime prevalence of PTSD of 35.4%, and a point prevalence of 27.2%. The lifetime prevalence of SUD was 1.99% and the point prevalence 0.66%. Multivariate logistic regression could not identify any predictor of current PTSD among a list of demographic variables, but identified the Syrian hometown as a significant predictor of lifetime PTSD (p=.013), with refugees from Aleppo having significantly more PTSD than those coming from Homs (adjusted OR 2.14, 95% CI [1.28, 3.56], p=.004).

DISCUSSION

PTSD was a real mental health issue in our sample of adult Syrian refugees in Central Bekaa camps, unlike SUD.

Suicide Risk of Heroin Dependent Subjects in Lebanon

The aim is to determine the frequency of suicidal behavior and associated factors among heroin dependent inpatients. 61 heroin dependent inpatients (vs. 61 controls) were assessed on their pattern of substance use, impulsivity, depression and suicidal behavior. 37.7 % of patients had a personal history of suicidal attempt (SA), 14.8 % had current suicidal ideation. SA was associated to younger age at first substance use and to higher rates of depression and impulsivity. IV heroin overdose was the most frequent mode of SA (47.8 %). Long duration, multiple drug use, and family history of suicide were associated with higher risk of suicide among lebanese patients.