Mediating effect of psychological distress and mindful eating behaviors between orthorexia nervosa and academic self-efficacy among Lebanese university female students.

OBJECTIVES: This study examined the mediating effect of psychological distress and mindful eating behaviors between orthorexia nervosa and academic self-efficacy among Lebanese university female students. METHODS: A total of 769 female participants enrolled in this cross-sectional study (mean age 21.58 ± 3.20 years). A self-administered questionnaire was distributed among university female students. The questionnaire consisted of Mindful Eating Behaviors Scale, ORTO-R, Depression Anxiety Stress Scale, and Arabic version of Academic Self-Efficacy Scale. RESULTS: The results showed that psychological distress fully mediated the association between orthorexia nervosa and academic self-efficacy; higher orthorexia nervosa was significantly associated with less psychological distress (ß= -0.31, p =.05), with more psychological distress significantly associated with lower academic self-efficacy (ß= -0.32, p =.09). Focused eating fully mediated the association between orthorexia nervosa and academic self-efficacy; higher orthorexia nervosa was significantly associated with less focused eating (ß=-0.09, p =.04), with more focused eating significantly associated with better academic self-efficacy (ß = 1.40, p =.10). Orthorexia nervosa was not directly associated with academic self-efficacy in both models. CONCLUSION: This study shed light on important connections between orthorexia nervosa, psychological distress, mindful eating behaviors, and academic self-efficacy within the Lebanese context. The findings will have practical implications for both educational institutions and healthcare providers striving to support young female adults' overall well-being and academic success.

Does mindfulness moderate the association between impulsivity and well-being in Lebanese university students?

Limited evidence showed that impulsivity is negatively related to life satisfaction and wellbeing; however, the mechanisms underlying this relationship remain unclear. We aimed through this work to investigate the relationship between impulsivity dimensions and well-being and to explore the moderator role of mindfulness on this relationship in a sample of Lebanese university students. This cross-sectional study was carried out among 363 university students recruited through convenience sampling through several universities in Lebanon's governorates. Higher mindfulness was significantly associated with better wellbeing in the models that considered urgency and sensation seeking as independent variables. A lack of premeditation and a lack of perseverance were both inversely associated with well-being. The interaction lack of perseverance by mindfulness was significantly associated with wellbeing; for students who were low in mindfulness, more lack of perseverance was significantly associated with a lower wellbeing. Our study suggested that mindfulness practice may offer a promising avenue for implementing strategies aiming at improving the well-being of students with high levels of impulsivity.

Association between time perspective and metacognition among Lebanese adults: the mediating role of mindfulness.

BACKGROUND: Mindfulness may serve as a component of metacognitive beliefs and can also be viewed as a form of time perspective. The interplay between time perspective and metacognitive beliefs remains understudied. Both aspects, however, display considerable stability over time and significantly influence an individual's life and well-being. Lebanon, marked by its diverse and complex history, struggles with various political, social, and economic challenges. This study offers a valuable and unprecedented opportunity to examine these connections within a distinct cultural context, shedding light on the unique experiences of the Lebanese population. Therefore, our research aims to investigate the connection between time perspective and metacognition, with a focus on the role of mindfulness as a mediator. METHODS: This cross-sectional study was conducted from August to November 2022 and involved participants from various regions of Lebanon. The questionnaire included sociodemographic data and scales such as the Arabic versions of the 15-item Short Form of the Zimbardo Time Perspective Inventory, the Metacognitions Questionnaire, the Freiburg Mindfulness Inventory and the Acceptance and Action Questionnaire (AAQ-2). RESULTS: Our investigation recruited 423 participants. The analysis showed that individuals with a positive stance on their past, a hedonistic present, or a future-oriented outlook exhibited heightened levels of mindfulness. This elevated state of mindfulness, in turn, demonstrated a significant link to augmented cognitive self-consciousness (An increased introspection into one's own thoughts). We also observed a direct association between a future-focused time perspective and high scores of cognitive self-consciousness. Furthermore, mindfulness emerged as a crucial mediator in the relationships between time perspectives and negative beliefs about the danger of worry. Similarly, individuals with a positive view on their past, a hedonistic present orientation, or a future-focused mindset demonstrated elevated levels of mindfulness, which was correlated with less negative beliefs about the danger of worry. Notably, a positive past perspective was directly associated with less negative views on worry and the subsequent loss of control, whereas higher future focused time perspective scores was significantly and directly associated with more negative beliefs about worry, whereas more future focused time perspective was significantly and directly associated with more negative beliefs about worry. CONCLUSION: Our findings found several meaningful associations between our variables, but it primarily underscored the significance of considering distinct subcomponents within mindfulness and psychopathological metacognition that may overlap, shedding light on their differential impacts on psychological well-being. We were also able to mirror the dual pathway theory of time perspective suggested in previous studies. These insights carry notable implications for the development and refinement of mindfulness-based and metacognitive interventions, emphasizing the need for tailored approaches that consider varying time perspectives. Continued investigation in this area promises to advance our understanding of these constructs and refine their practical applications in mental health interventions and well-being enhancement strategies.

Psychometric properties of the short form of the Freiburg Mindfulness Inventory in the Arabic language.

Interests in including mindfulness techniques in medical and psychological fields have been increasing recently. Accordingly, it is important to validate the short form of the Freiburg Mindfulness Inventory (FMI-14) to help professionals living in Arabic speaking countries. Thus, we aimed to validate the FMI-14 in the Arabic language (FMI-Ar) in Arabic-speaking university students from Lebanon. We carried-out a cross-sectional study between July and September 2021; 363 university students (mean age 22.65 ± 3.48 years, 61.7% females) were enrolled. The McDonald's omega and Cronbach's alpha values for the total score were excellent (0.92 for both). Confirmatory factor analysis of the one-factor model of the FMI-Ar showed satisfactory fit indices: χ2/df = 218.33/77 = 2.83, RMSEA = 0.071 [0.060-0.082], CFI = 0.92, and TLI = 0.90. Additionally, the FMI score was negatively associated with depression (r = -0.51; p = 0.001) and anxiety (r = -0.48; p < 0.001). All hypotheses (factor, convergent, and divergent validity) related to the FMI-Ar were verified in our study. Therefore, professionals can now benefit from the FMI-Ar, a suitable scale to measure mindfulness among Lebanese University students.

Defining and supporting a professional role for pharmacists associated with traditional and complementary medicines: a cross-country survey of pharmacists.

Introduction: An estimated 80% of the world's population use traditional and complementary medicine (T&CM) products as part of their healthcare, with many accessed through pharmacy. This cross-cultural study posed a set of professional practice responsibilities and actions to pharmacists related to T&CM products, with a view toward developing consensus, safeguarding, and promoting the health of the public. Methods: Data were collected from 2,810 pharmacists across nine countries during 2022 via a cross-sectional online survey reported in accordance with the guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Of the 2,810 participants from nine countries, 2,341 completed all sections of the survey. Of these, most agreed (69%) that T&CM product use was common in the community they served, but most did not have adequate training to support consumer needs. Over 75% acknowledged that there were known and unknown safety risks associated with T&CM use. Of 18 professional responsibilities posed, 92% agreed that pharmacists should be able to inform consumers about potential risks, including T&CM side effects and drug-herb interactions. The provision of accurate scientific information on the effectiveness of T&CM products, skills to guide consumers in making informed decisions, and communication with other healthcare professionals to support appropriate and safe T&CM product use were all ranked with high levels of agreement. In order to effectively fulfill these responsibilities, pharmacists agreed that regulatory reforms, development of T&CM education and training, and access to quality products supported by high-quality evidence were needed. Conclusion: General agreement from across nine countries on eighteen professional responsibilities and several stakeholder actions serve as a foundation for the discussion and development of international T&CM guidelines for pharmacists.

Caring for a Mentally Ill Patient at Home, Mental Health, Religiosity, and Spirituality and Their Association With Family Caregivers' Quality of Life in Lebanon.

Objective: To evaluate the effect of depression, anxiety, stress, insomnia, work fatigue, religiosity, and spirituality on quality of life (QOL) among family caregivers of people with mental Illness and those who care for family members without mental illness.Methods: A case-control study was conducted between July and September 2019 that enrolled 600 caregivers using a proportionate sample from all Lebanese governorates. Participants completed a 2-part questionnaire. The first part assessed sociodemographic and other characteristics and the second part comprised various scales including the Quality of Life 12-Item Short Form Health Survey, 9-Item Patient Health Questionnaire, Generalized Anxiety Disorder 7 Item, Perceived Stress Scale, Work Fatigue Inventory, Lebanese Insomnia Scale, Mature Religiosity Scale, and Spirituality Index of Well-Being.Results: Higher stress (P < .001), higher depression (P < .001), higher emotional work fatigue (P < .001), married parents compared to single (P = .026), having a child with an intellectual disability (P = .002), and sleep-wake disorders (P = .003) were significantly associated with lower physical QOL, whereas higher spirituality (P < .001) was associated with higher physical QOL. Higher insomnia (P = .01), higher anxiety (P = .017), higher mental work fatigue (P < .001), living with a patient having a mental psychiatric illness (P = .023), caregivers with a chronic disease (P = .040), and taking care of a child with depressive disorders (P = .027) were significantly associated with lower mental QOL, whereas higher spirituality was significantly associated with higher mental QOL.Conclusions: The care of a person with mental illness involves multiple challenges and problems, leading to negative impacts on the familial caregivers' mental health and magnified by the absence of sufficient support and awareness and training programs in Lebanon.Prim Care Companion CNS Disord 2023;25(4)22m03333. Author affiliations are listed at the end of this article.

Mindfulness among lebanese university students and its indirect effect between mental health and wellbeing.

BACKGROUND: University students are a high-risk population for developing mental health issues. Mindfulness, the non-judgmental awareness of the present moment, has an effective role in numerous psychological contexts among students. However, no previous studies have investigated the association between mindfulness, mental health and wellbeing among Lebanese university students. Therefore, this study aimed to assess the mediating effect of mindfulness in the association between mental health and wellbeing in this population. METHODS: This cross-sectional study enrolled 363 Lebanese university students recruited through convenience sampling (July-September 2021). The Wellbeing Index Scale, Lebanese Anxiety Scale, Patient Health Questionnaire and Freiburg Mindfulness Inventory were used to assess subjective well-being, anxiety, depression and mindfulness respectively. RESULTS: Our findings showed that higher mindfulness (Beta = 0.18; p < 0.001) was significantly correlated with a higher wellbeing, whereas more depression (Beta=-0.36; p < 0.001) was significantly associated with a lower wellbeing. The results of the indirect effect analysis showed that mindfulness mediated the association between anxiety and wellbeing and between depression and wellbeing. Higher anxiety/depression were significantly associated with lower mindfulness and a lower wellbeing (direct effect). Moreover, higher mindfulness was significantly associated with a higher wellbeing. CONCLUSION: Mindfulness is associated with improved wellbeing and plays an indirect role between mental health issues and wellbeing. Our results suggest that mindfulness presents an adaptive approach and coping method associated with improved students' wellbeing.

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.

The association between fear of COVID-19 and depression, anxiety, and psychosis among Lebanese chronic patients with schizophrenia: any moderating effect of spirituality?

AIM: To assess whether fear of coronavirus disease 2019 (COVID-19) is associated with depression, anxiety, and psychosis and to evaluate if these variables are correlated with the interaction between spirituality and fear of COVID-19. METHODS: Between September and November 2020, this cross-sectional study enrolled 118 chronic schizophrenia patients. The interview with patients included Fear of COVID-19 Scale, Lebanese Anxiety Scale-10, Montgomery-Asberg Depression Rating Scale, Positive and Negative Syndrome Scale (PANSS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being-12. The results were analyzed by using linear regressions (Enter method), with anxiety, depression, total PANSS score, positive PANSS, negative PANSS, and general psychopathology PANSS subscales as dependent variables. Spirituality, fear of COVID-19, and the interaction of spirituality with fear of COVID-19 were independents variables. RESULTS: Fear of COVID-19 was positively correlated with increased total PANSS scores (Beta=0.90, P=0.030). Higher spirituality was significantly associated with lower anxiety (Beta=-0.14, P=0.009), lower depression (Beta=-0.21, P=0.001), lower total PANSS score (Beta=-0.90, P=0.004), lower negative PANSS score (Beta=-0.23, P=0.009), and lower general psychopathology PANSS score (Beta=-0.61, P=0.001). In patients with high fear of COVID-19, having low spirituality was significantly associated with higher anxiety, depression, and psychotic symptoms. CONCLUSION: This study suggests a positive correlation between fear of COVID-19 and higher psychosis among inpatients with schizophrenia. The interaction of spirituality with fear of COVID-19 was correlated with reduced anxiety, depression, and psychosis.

Does self-esteem mediate the association between perfectionism and mindfulness among Lebanese university students?

OBJECTIVES: To evaluate the associations between mindfulness, self-esteem and perfectionism in a Lebanese sample of university students, as well as the indirect effect of self-esteem between mindfulness and perfectionism was investigated. METHODS: This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. An online survey that included a part that collected sociodemographic information, the Freiburg Mindfulness Inventory to assess mindfulness, the Rosenberg Self-Esteem Scale to assess self-esteem and the Big Three Perfectionism Scale to assess perfectionism was completed by participants. RESULTS: Higher self-esteem (Beta = 1.30) was significantly associated with more mindfulness, whereas higher self-critical perfectionism (Beta = - 0.61) was significantly associated with less mindfulness. Self-esteem mediated the association between self-critical and narcissistic perfectionism and mindfulness. More perfectionism was significantly and directly associated with less mindfulness and lower self-esteem, whereas higher self-esteem was significantly associated with more mindfulness. CONCLUSION: This study provides valuable findings that enable practitioners to effectively identify people needing interventions to improve psychological health through mindfulness, self-esteem and perfectionism. The conclusions that can be deduced from this study can help educational psychologists and counselors guide university students towards effective mindfulness practices that can increase self-esteem levels and balance maladaptive perfectionism that can cause distress and impairment in the social and academic settings.

Presence of a psychiatric patient at home and work fatigue in family caregivers: The moderating effect of spirituality.

OBJECTIVES: To assess the association between the mental health of caregivers having a psychiatric patient at home and work fatigue, and if this association is moderated by spirituality. METHODS: This case-control study enrolled 600 caregivers (July-September 2019). RESULTS: Stress, anxiety, insomnia and the presence of a psychiatric patient at home were associated with higher levels of physical, mental, and emotional work fatigue. In the case of caregivers who have a psychiatric patient at home, those with low spirituality had more mental and emotional work fatigue. PRACTICAL IMPLICATIONS: Healthcare professionals should enlighten caregivers more on the risks and the consequences of their job, assist them with information on what to expect, and teach them how to normalize feelings that they may face.

Is the presence of a psychiatric patient at home associated with higher addictions (alcohol, cigarette, and waterpipe dependence) in caregivers? The role of work fatigue, mental illness, spirituality, and religiosity.

PURPOSE: To assess if living with a psychiatric patient, depression, anxiety, stress, fatigue, insomnia, spirituality, and religiosity would be associated with more problematic alcohol use, cigarette, and waterpipe dependence in Lebanese caregivers. METHODS: A case-control study was performed in Lebanon that recruited 587 caregivers (July-September 2019). RESULTS: Higher religiosity was associated with lower problematic alcohol use. Having low versus no income was significantly associated with more cigarette dependence. Being Christian and high anxiety were significantly associated with more waterpipe dependence, whereas higher insomnia was significantly associated with lower waterpipe dependence. PRACTICAL IMPLICATIONS: Family caregivers go through a lot of stress and burden and need help coping with it in a healthy way for better outcomes for them and the care recipient.

Impact of spirituality and religiosity on suicidal risk among a sample of lebanese psychiatric in-patients.

OBJECTIVES: To evaluate the prevalence of suicidality among the psychiatric inpatients community in Lebanon, and to elucidate the effect of religiosity and spirituality on suicidal thoughts or behaviours. METHODS: A total sample of 159 patient consecutively admitted to a psychiatric hospital was interviewed. The Ask Suicide-screening Questionnaire (ASQ) was used to assess suicidal risk; the Mature Religiosity Scale (MRS) and the Spirituality Index for Well Being (SIWB) scales were used to assess religiosity and spirituality. RESULTS: We found that 45.6% of the participants screened positively on the ASQ, including 37.5% with acute suicidal ideation. A backward logistic regression, taking the negative/positive screening ASQ as the dependent variable, showed that a positive family history of suicide and depression were significantly associated with higher positive suicidal screening, whereas higher spirituality was significantly associated with lower positive suicidal screening. When forcing the mature religiosity scale as an independent variable, the results remained the same. CONCLUSION: Spiritual well-being might be considered an important factor to explore among psychiatric patients. Psychiatric inpatients have a high risk for suicide; the challenge remains for clinicians to identify upon admission patients that are most likely to die from suicide.Key pointsA positive family history of suicide and depression was significantly associated with higher suicidality.Higher spirituality, but not religiosity, was significantly associated with lower suicidality.Spiritual well-being might be considered an important factor to explore among psychiatric patients.The challenge remains for clinicians to identify patients that are most likely to die from suicide upon admission.

A case report of thyroid-associated Orbitopathy with elevated TPO antibodies.

BACKGROUND: Thyroid associated orbitopathy (TAO) is defined as an immune mediated inflammatory process affecting the extraocular muscles, connective and adipose tissue of uncertain etiopathogenesis. TAO are classically described in Grave's disease (GD) however it may occur in euthyroid and hypothyroid patients. Those patients usually test positive for Thyroid Stimulating Hormone receptor antibodies (TRAb). For instance, only few cases of severe Hashimoto's thyroiditis (HT) associated orbitopathy with negative TRAb are reported to date. CASE PRESENTATION: Herewith we report a rare case of a middle-aged female who presented with bilateral progressive upper and lower palpebral edema and a unilateral marked proptosis associated with asthenia, headache and decrease in visual acuity. Biological investigation was notable for high levels of anti-thyroid peroxidase antibodies (Anti-TPO) in an otherwise euthyroid patient with negative TRAb. Orbital Magnetic resonance imaging revealed edema of the extraocular muscles and inflammation of periorbital soft tissue. The patient received a treatment with intravenous methylprednisolone followed by oral treatment with prednisone. This regimen was both effective and safe with minimal metabolic side effects in our patient. CONCLUSION: Minor ocular manifestations of HT are common; however, severe sight threatening ophtalmopathy in the absence of TRAb is rare. Multiple differential diagnosis should be considered and investigated before diagnosing this rare entity. Management of similar cases is currently based on reports and no clear guidelines have been elaborated, corticosteroids is the mainstream of treatment with a potential benefit of selenium supplementation in mild to moderate cases.

Association between factors related to the pregnancy, neonatal period, and later complications (especially asthma) and menarcheal age in a sample of Lebanese girls.

BACKGROUND: Studies about the majority of the factors that may potentially influence the pubertal timing and menarche were controversial. The objective was to evaluate the association between factors related to the pregnancy, neonatal period, and the complications that may happen later in life and the menarcheal age in a sample of Lebanese girls admitted or not to the NICU at birth. Our secondary objective was to try to find, for the first time in literature, a correlation between respiratory distress at birth and the need of oxygen therapy with the age of the first menses in these girls. METHODS: It is a cross-sectional retrospective study, conducted between January and March 2019. Our sample included all the 2474 girls born in Notre-Dame-de-Secours hospital, between 2000 and 2005; the sample consisted of 297 girls (97 girls admitted to the NICU and 200 randomly chosen to participate in our study with a ratio of 1:2 (1 girl admitted to the NICU vs 2 girls born in the nursery). RESULTS: Asthma later in life was significantly associated with lower age at menarche in girls, whereas a higher mother's age at menarche and a higher gestational age were significantly associated with higher age at menarche in girls. When taking each cause of NICU admission as an independent variable, showed that a higher mother's age at menarche was significantly associated with higher age at menarche in girls, whereas a higher number of days of phototherapy, a preeclampsia in the mother during pregnancy and asthma later in life in the girl were significantly associated with a lower age at menarche in girls. CONCLUSION: The timing of menarche seems to be associated with many factors in Lebanese girls that should not be disregarded by physicians.

Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study.

OBJECTIVE: Spiritual well-being was found to have some protective effect against end-of life despair in cancer patients. We aimed at assessing the impact of spirituality on the quality of life, depression, and anxiety of Lebanese cancer patients. METHODS: Our observational transversal monocentric study was conducted between January and April 2016 among a convenient sample of 115 Lebanese cancer patients admitted to Hôtel-Dieu de France Hospital (HDF), Beirut-Lebanon. In addition to socio-demographic and clinical data, three questionnaires were used: EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 3rd version), FACIT-Sp-12 (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale, 4th version), and HADS (Hospital Anxiety and Depression Scale). Eighteen patients taking anxiolytic and/or antidepressants were not included in the analysis. The remaining 97 patients were analyzed. RESULTS: Better emotional and cognitive functioning was seen in patients with higher meaning, peace, faith, and total FACIT scores. Meaning, peace, and total FACIT scores were also higher among patients with better global health status and quality of life. Anxiety as well as depression was significantly associated to all spiritual well-being factors. CONCLUSION: Spirituality can improve quality of life and decrease the incidence of anxiety and depression in cancer patients. Our results highlight the need to incorporate spiritual care in healthcare systems.