Association of Computer Vision Syndrome with Depression/Anxiety among Lebanese Young Adults: The Mediating Effect of Stress.

Computers have become indispensable in daily activities. With this excess use of electronics, computer vision syndrome (CVS), a highly prevalent condition, is associated with various symptoms. Although understanding the relationship between CVS and mental health has been reported, the impact of CVS has not been explored on more than one psychological aspect. We hypothesize that higher CVS symptoms could be associated with higher levels of anxiety and depression, mediated by higher stress. Therefore, the objective of this study was to determine the association between CVS and depression and anxiety among a sample of Lebanese young adults, along with evaluating the mediating effect of stress on these associations. Between August 2020 and April 2021, 749 participants completed an online questionnaire for this cross-sectional study. Females compared to males (Beta = 3.73) and those with CVS compared to those who did not (Beta = 3.14) were significantly associated with more anxiety, whereas having a university level of education compared to secondary or less (Beta = -3.02) was significantly associated with less anxiety. Females compared to males (Beta = 2.55) and those with CVS compared to those without (Beta = 2.61) were significantly associated with more depression, whereas being of an older age (Beta = -0.18) was significantly associated with less depression. Stress partially mediated the association between CVS and anxiety and between CVS and depression. More CVS was significantly associated with more stress (Beta = 3.05). Higher stress was significantly associated with more anxiety (Beta = 0.70) and depression (Beta = 0.71), whereas more CVS was significantly and directly associated with more anxiety (Beta = 3.14) and depression (Beta = 2.61). This study is the first worldwide to evaluate an association between CVS and mental health. Our results serve as a starting point for healthcare providers (psychiatrists and psychologists, most importantly) to look deeper into CVS when looking for reasons behind mental health issues. Further studies are warranted to confirm our results and look for more factors and mediators in such associations.

Kluyvera ascorbata: An Unusual Cause of Septic Shock in a Patient With Urothelial Cancer.

Kluyvera ascorbata is a gram-negative bacillus which is a rare cause of clinically significant infections in humans. We report a rare case of K. ascorbata infection causing septic shock in a patient with a history of urothelial cancer. After the antimicrobial susceptibility testing, the patient was successfully treated with ceftriaxone. Recognition of the disease-producing potential of this rare pathogen with prompt initiation of effective antimicrobial coverage is paramount for appropriate management in the adult immunocompromised population. To our knowledge, this is the first case report of septic shock secondary to K. ascorbata urinary tract infection.

Association Between Computer Vision Syndrome, Insomnia, and Migraine Among Lebanese Adults: The Mediating Effect of Stress.

Objective: Computer vision syndrome (CVS) refers to a group of ocular and extraocular symptoms due to prolonged digital device screen use. The objective of this study was to assess the correlation between CVS, insomnia, and migraine, taking into consideration stress as a mediating factor between these 3 variables.Methods: This cross-sectional study was conducted between August 2020 and April 2021 using an online questionnaire filled out by 749 participants. Participants were enrolled using a snowball sampling technique. The link to the Arabic questionnaire was sent to the individuals by WhatsApp and by e-mail.Results: The prevalence of CVS among participants was 70.5%. The presence of CVS (ß = 3.26) was significantly associated with higher insomnia. The presence of CVS (adjusted odds ratio [aOR] = 1.66) and higher stress (aOR = 1.09) was significantly associated with higher odds of having migraine. Stress fully mediated the association between CVS and migraine by 52.76% and between CVS and insomnia by 79.99%.Conclusion: CVS was significantly associated with insomnia and migraine. Stress mediated the relationship between CVS and insomnia, and between CVS and migraine. The precise mechanisms behind these associations were not evaluated in this study, with the hope that future research will provide more information on this topic.

Binge eating, orthorexia nervosa, restrained eating, and quality of life: a population study in Lebanon.

OBJECTIVES: To assess the implication of disordered eating behaviors (DEBs) on the quality of life (QOL) of a sample of the Lebanese population, after adjustment over sociodemographic characteristics of those participants. Secondary objective aimed to assess the role of body dissatisfaction (BD) in the association of DEBs and QOL. METHODS: This cross-sectional study was done between January and May 2018 and enrolled 811 participants from the community. A proportionate random sample technique was used to select the sample from all Lebanese Mohafazat. The World Health Organization Quality-of-life (WHOQOL)-BREF was used to assess the QOL and it includes four domains: physical health, psychological health, social relations, and environment. RESULTS: Body dissatisfaction was found to be a major confounding factor contributing to psychological and environmental HQOL impairments in patient with restrained eating. Nevertheless, orthorexia nervosa was associated with QOL impairments in its physical and environmental domains, regardless of body dissatisfaction that was shown to be a major contributor for QOL impairments. Similarly, ON was directly correlated with QOL of life impairment in its physical and environmental domains, independently of all other risk factors. CONCLUSION: When adding body dissatisfaction as a confounding variable, restrained eating and orthorexia nervosa remained significantly associated with quality-of-life impairments. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

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

OBJECTIVE: To create a Lebanese Depression Scale (LDS) and evaluate its performance on a group of Lebanese individuals. METHODS: This cross-sectional analysis enrolled 997 residents (January-December 2018). RESULTS: The elements in the Lebanese Depression Scale-19 items (LDS-19) scale converged over a combination of four factors (αCronbach = .864). The correlation was positive between the LDS-19 and both the Hamilton Anxiety Scale score (r = .637; P < .001) and Lebanese Anxiety Scale score (r = .694; P < .001). According to the receiver-operating characteristics curve, the optimal score for the LDS-19 scale, which was a cutoff between healthy controls and depressive patients, was 18.50 (80.3% and 75.8%, respectively); the scale's positive predictive value was 31.0%, while the negative predictive value was 96.5%. PRACTICE IMPLICATIONS: The LDS-19 is a useful tool to screen for depression in the Lebanese population, in both clinical and research settings.

Validation of the Arabic version of the ORTO-15 questionnaire in a sample of the Lebanese population.

PURPOSE: The aim of the study was to develop an Arabic version of the ORTO-15 test and to examine the scale reliability and validity among a sample of the Lebanese population. METHODS: This was a cross-sectional study, conducted between January and May 2018, which enrolled 806 participants, divided into two equal samples, from all Lebanese governorates. The ORTO-15 scale was used to evaluate orthorexia nervosa (ON) tendencies and behaviors among participants. RESULTS: The factor analysis conducted on sample 1 suggested a three-factor structure for the ORTO-15 explaining a total of 50.59% of the variance. All items could be extracted from the list; none of the items was removed. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.82). Higher body dissatisfaction (r = - 0.082), higher restrained eating (r = - 0.13) and higher eating attitudes (EAT score) (r = - 0.13) were significantly associated with higher levels of orthorexia tendencies and behaviors (lower ORTO-15 score). We could not detect any significant association between BMI and ORTO-15 test. A confirmatory factor analysis performed on sample 2 supported the three-factor structure of the ORTO-15 test obtained in the first sample. The following results were obtained: the Maximum Likelihood Chi Square = 22.0 and Degrees of Freedom = 9, which gave a × 2/df = 2.4. For non-centrality fit indices, the Steiger-Lind RMSEA was 0.10 [0.040-0.208]. Moreover, the Joreskog GFI equaled 0.926 and AGFI equaled 0.901. CONCLUSION: The Arabic version of the ORTO-15 test can be used to screen for ON tendencies and behaviors. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Validation of the Arabic version of the binge eating scale and correlates of binge eating disorder among a sample of the Lebanese population.

OBJECTIVES: To test the psychometric properties of the Arabic version of the Binge Eating Scale (BES), a self-questionnaire assessing binge eating, in a sample of the Lebanese population. The secondary objective was to evaluate factors associated with binge eating. METHODS: This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The BES was administered to study its psychometric properties. The sample was divided into two separate samples (405 for sample 1 and 406 for sample 2). An exploratory factor analysis was executed on Sample 1, followed by a confirmatory factor analysis on Sample 2 using the structure obtained in Sample 1. Three hierarchical stepwise linear regressions were conducted to assess factors associated with binge eating. RESULTS: The factor analysis suggested a two-factor structure for the BES explaining a total of 41.4% of the variance. All items could be extracted from the list. The internal consistency of the measurement was adequate (Cronbach's alpha = 0.86). The confirmatory factor analysis revealed an adequate fit to the model with satisfactory Maximum Likelihood Chi-Square/Degrees of Freedom (χ2/df), Steiger-Lind RMSEA, Joreskog GFI, and AGFI. Higher BMI, depression, anxiety, emotional eating, greater body dissatisfaction, and more pressure from media to lose weight were associated with higher binge eating. Higher expressive suppression facet score was associated with lower binge eating. CONCLUSION: The Arabic version of BES could be a useful tool for screening and assessing the binge eating behaviors in clinical practice and research. Also, being dissatisfied with one's body size, having a history of sexual abuse, family history of binge eating, increased depressive/anxiety symptoms, and lower self-esteem seem to be associated with higher BES scores.

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.

Factors associated with restrained eating and validation of the Arabic version of the restrained eating scale among an adult representative sample of the Lebanese population: a cross-sectional study.

BACKGROUND: Previous research suggests that restrained eating is problematic in Lebanon and is associated with the occurrence of clinically diagnosed eating disorders. Because of the alarming prevalence and severity of these disorders, the aim of this study is to investigate factors that may contribute to restrained eating in adults among a representative sample of the Lebanese population. METHODS: This is a cross-sectional study conducted between January and May 2018; 811 adult participants were enrolled from all Lebanese districts. The Dutch Restrained Eating scale was used to measure body disturbance. The factors that were assessed in the questionnaire were body dissatisfaction, self-esteem, perceived stress, anxiety, depression, emotion regulation, emotional eating and adult attachment styles. RESULTS: The mean age of the participants was 27.59 ± 11.76 years, and included 66.5% females. In the absence of a cutoff value for the Dutch Restrained Eating scale, we took the median (2.6) as the cutoff value. The results showed that 391 (48.3%) had restrained eating. The Dutch Restrained Eating scale items converged over a solution of one factor that had an Eigenvalue over 1, explaining a total of 60.69% of the variance (Cronbach's alpha was high =0.928). The linear regression results, taking the Dutch restrained eating scale as the dependent variable, showed that being a female (Beta = 0.31), increased age (Beta = 0.01), higher body mass index (Beta = 0.01), an intermediate monthly income (Beta = 0.25), higher body dissatisfaction scores (Beta = 0.03), higher adult anxiety attachment style (Beta = 0.008), higher emotion regulation cognitive reappraisal facet (Beta = 0.01), feeling pressure from TV/magazine to lose weight (Beta = 0.45) and practicing sport activities (Beta = 0.41) were associated with higher restrained eating scores. CONCLUSION: Our findings show that numerous factors are associated with restrained eating in the Lebanese community. They include body dissatisfaction, cognitive reappraisal, female gender, eating attitudes, social media pressure and adult attachment. Therefore, the development of prevention strategies directed at an improved body image perception and increasing knowledge about factors that might influence this body image and critical thinking regarding media images is warranted, with the ultimate goal of promoting healthier choices in the Lebanese population.

Factors associated with body dissatisfaction among the Lebanese population.

OBJECTIVE: To evaluate the factors associated with body dissatisfaction among the Lebanese population, including sociodemographic characteristics, self-esteem, stress, anxiety, depression, emotional regulation, emotional eating and the adult attachment style. METHODS: This cross-sectional study, conducted between January and May 2018, enrolled 811 adult participants from all districts of Lebanon. The body dissatisfaction subscale of the eating disorder inventory version 2 (EDI-2) was used to measure body disturbance. RESULTS: The mean age of the participants was 27.59 ± 11.76 years, with 66.5% females. The final model of the regression analysis showed that a higher binge eating score (Beta = 0.202), being married (Beta = 1.233), having a family history of eating disorders (Beta = 1.933), higher BMI (Beta = 0.076), dieting to lose weight (past 30 days) (Beta = 2.345), receiving comments from the family (Beta = 2.234) and pressure from TV/magazines to lose weight (Beta = 1.320), vomiting or taking laxatives to lose weight (past 30 days) (Beta = 1.861), higher depression (Beta = 0.103) and higher perceived stress (Beta = 0.107) were associated with a higher body dissatisfaction score. However, higher self-esteem (Beta = - 0.246), increased physical activity (Beta = - 0.022) and being divorced (Beta = - 4.226) were significantly associated with a lower body dissatisfaction score. CONCLUSION: A significant association was found in this current study between the main variables: depression, self-esteem, social anxiety, eating disorders, family and television pressure and body image dissatisfaction. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Correlates of orthorexia nervosa among a representative sample of the Lebanese population.

INTRODUCTION: Orthorexia nervosa (ON), or the pathological preoccupation and "fixation on healthy food" has been emerging as a new eating disorder. A limited amount of literature exists today on the prevalence of ON. The objective of the current study was to assess factors associated with ON tendencies and behaviors among a representative sample of the Lebanese population. METHODS: This was a cross-sectional study, conducted between January and May 2018, which enrolled 811 participants from all Lebanese governorates. The ORTHO-15 scale was used to evaluate ON tendencies and behaviors among participants. Scores below 40 indicate the presence of ON. RESULTS: The results showed that 589 (75.2%) participants had ON tendencies and behaviors. The results of the multivariable analysis taking the ORTHO-15 score as the dependent variable, showed that female gender (Beta = - 0.739), starving to lose weight (Beta = - 0.859), convincing others to follow a diet (Beta = - 0.971), thinking that eating out is unhealthy (Beta = - 0.931) and increased EAT (eating attitudes test) scores (Beta = - 0.087) were associated with higher level of orthorexia tendencies and behaviors (lower ORTHO-15 scores). CONCLUSION: A highly unexpected prevalence of ON tendencies and behaviors was found in our sample. The Lebanese population might have high preoccupation behavior towards healthy and proper nutrition. Social awareness and behavioral intervention programs are warranted to follow a healthy diet and lifestyle behaviors, and consequently overcome ON. LEVEL OF EVIDENCE: Level 5, cross-sectional descriptive study.