The mediating role of anxiety and depression between problematic social media use and bulimia nervosa among Lebanese university students.

BACKGROUND: Bulimia nervosa (BN) is a disorder that is characterized by binge eating and inappropriate compensatory behavior to control weight. The aim of this study was to evaluate the mediating role of anxiety and depression between problematic social media use (PSMU) and BN among a sample of Lebanese university students. METHODS: This cross-sectional study was carried out between July and September 2021; a total of 363 university students was recruited through convenience sampling. The PROCESS SPSS Macro version 3.4, model four was used to test the indirect effect and calculate three pathways. Pathway A determined the regression coefficient for the effect of PSMU on mental health issues (depression/anxiety); Pathway B examined the association between mental health issues on BN, and Pathway C' estimated the direct effect of PSMU on BN. Pathway AB was used to calculate the indirect effect of PSMU on BN via depression/anxiety. RESULTS: Results showed that depression and anxiety partially mediated the association between PSMU and BN. Higher levels of PSMU were associated with more depression and anxiety; higher depression and anxiety were associated with more BN. PSMU was directly and significantly associated with more BN. When entering anxiety (M1) then depression (M2) as consecutive mediators in a first model, the results showed that only depression mediated the association between PSMU and bulimia. When taking depression (M1) then anxiety (M2) as consecutive mediators in a second model, the results showed that the mediation PSMU → Depression → Anxiety → Bulimia was significant. Higher PSMU was significantly associated with more depression, which was significantly associated with more anxiety, which was significantly associated with more bulimia. Finally, higher PSMU was directly and significantly associated with more bulimia CONCLUSION: The current paper highlights the relationship that social media use has on BN and other aspects of mental health such as anxiety and depression in Lebanon. Future studies should replicate the mediation analysis conducted in the current study while taking into account other eating disorders. Additional investigations of BN and its correlates must strive to improve the comprehension of these associations' pathways through designs that allow to draw temporal frameworks, in order to efficiently treat this eating disorder and prevent its negative outcomes.

Exploring the association between lifetime traumatic experiences and positive psychotic symptoms in a group of long-stay patients with schizophrenia: the mediating effect of depression, anxiety, and distress.

BACKGROUND: Positive psychotic symptoms of schizophrenia are generally characterized by hallucinations and delusions. We propose to assess the relationship between total composite trauma and positive psychotic symptoms, along with the mediation effect of cognition, fear of COVID-19, insomnia, anxiety, distress, and depression of Lebanese patients with schizophrenia. METHODS: A cross-sectional study was carried out, between June and July 2021, by deriving data from 155 long-stay in-patients diagnosed with schizophrenia. RESULTS: Depression, anxiety, and distress but not cognitive impairment, insomnia, and fear of COVID-19) mediated the association between lifetime traumatic experiences and positive psychotic symptoms. Higher traumatic experiences were associated with greater depression, anxiety, and distress, indicating a significant positive total effect on positive psychotic scores. Moreover, higher depression, anxiety, and distress were significantly associated with higher positive psychotic symptoms. CONCLUSION: Our results contribute to the existing knowledge by suggesting other possible intervention paths through mediating factors. Interventions that improve anxiety, depression, and distress severity may be effective in reducing positive psychotic symptoms among patients with schizophrenia having experienced lifetime trauma.

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.

Nomophobia and temperaments in Lebanon: Results of a national study.

OBJECTIVES: Assess the association between nomophobia and temperaments in the Lebanese population. METHODS: The cross-sectional study was conducted between January and July 2019 (N = 2260). RESULTS: A total of 1089 of the participants (48.3%) appeared to have moderate nomophobia while 349 (15.5%) were found to exhibit severe nomophobia. Multivariable analysis showed that higher hyperthymic temperament (ß = -0.34) was associated with less nomophobia, whereas higher irritable temperament (ß = 0.43) was associated with more nomophobia. PRACTICAL IMPLICATIONS: The findings obtained from our study showed that a more irritable temperament was significantly associated with a more severe nomophobia, while hyperthymic temperament was associated with less nomophobia. They open up new perspectives for the evaluation of the temperaments among nomophobics with a better focus on the personality model and how they can predict nomophobia.

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.

Violence Against Women During COVID-19 Pandemic.

The objectives of this study were to correlate several factors - including depression, anxiety, stress and self-esteem levels in both men and women - with the occurrence of domestic violence against women (VAW) during quarantine. This cross-sectional study was carried out in April 2020, in the midst of the COVID-19 pandemic when lockdown procedures were implemented; 86 married couples participated in this study amounting to 172 responses in total. A different questionnaire was set for women and men; the couple filled out their respective questionnaire simultaneously, but privately where one did not see the answers of the other. Inclusion criteria included married couples of all ages that are living together during the lockdown of COVID-19. The results of this study showed that a higher total abuse score was found in 39 females (45.3%; CI: 0.34 - 0.56). Being a Muslim female (Beta =24.80) and females having higher anxiety (Beta=0.97) were significantly associated with higher total abuse scores, whereas higher stress score in female (Beta=-0.61) was significantly associated with lower total abuse scores. In conclusion, this study focuses on VAW as a serious problem while demonstrating its further emergence during quarantine. This study also focused on the effects brought on by lockdown policies, including social and economic factors, and their implications in the increase of VAW during this pandemic.

Cyberchondria severity and quality of life among Lebanese adults: the mediating role of fear of COVID-19, depression, anxiety, stress and obsessive-compulsive behavior-a structural equation model approach.

BACKGROUND: This study highlights the significant association between cyberchondria and quality of life among the Lebanese population in the time of COVID-19. The aim was to assess the association between cyberchondria and quality of life (QOL) of Lebanese community during the COVID-19 pandemic and assess the mediating effect of fear of COVID-19, depression, anxiety, stress and Yale-Brown Obsessive-Compulsive Scale in this association. METHODS: This cross-sectional study was carried out between December 2020 and January 2021, during the COVID-19 pandemic. A total of 449 persons participated in this study by filling the online questionnaire. Structural equation modeling (SEM) was performed to examine the structural relationship between cyberchondria severity, the mediator (anxiety, stress, depression, obsessive-compulsive disorder (OCD) and fear of COVID-19) and physical/mental QOL. RESULTS: Having a university level of education and older age were significantly associated with higher physical QOL scores, whereas higher obsession-compulsion disorder, higher stress and higher anxiety were significantly associated with lower physical QOL scores. Higher anxiety was significantly associated with lower mental QOL scores. The results of the SEM showed that stress, fear of COVID-19 and to a lesser limit OCD, mediated the association between cyberchondria severity and physical QOL, whereas anxiety, stress and fear of COVID-19 mediated the association between cyberchondria severity and mental QOL. CONCLUSION: This research reported interesting results encouraging more exploration of cyberchondria and its association with quality of life during this unique period of the pandemic. However, this virus has altered the lives of individuals all across the world, and the consequences will last for a long time. Along with all of the steps done to stop the development of COVID-19 and improve physical outcomes, mental health requires immediate care. More research is needed to determine the coping techniques people are employing to deal with the pandemic.

The Preschool Asthma Risk Factors Scale: A predictive tool for asthma and respiratory symptoms among preschool children in Lebanon

Background: The Preschool Asthma Risk Factor Scale (PS-ARFS) is a tool that enables clinicians to assess environmental exposure of preschool children, history of parental asthma, and dietary habits. The objective of this study was to evaluate the PS-ARFS ability to predict asthma diagnosis and respiratory symptoms 1 year after baseline assessment and improve the scale if necessary. Methods: A prospective cohort study conducted between November 2018 and March 2019 in three Lebanese schools (from three different Lebanese Governorates) enrolled 515 preschool children aged 3–5 years. Parents completed a detailed questionnaire sent with their children (Phase 1; T0). All parents who participated in Phase 1 were invited to take the same survey by telephone (Phase 2; T1), 1 year later. The interview was conducted by one study-independent person. Of the total sample, 141 (27.4%) children were lost to follow-up. Results: Higher odds of asthma diagnosis at 1 year were significantly associated with playing outside (adjusted odds ratio [aOR] = 3.958) and having a heating system in the bedroom (aOR = 6.986) at baseline, but inversely associated with the female gender (aOR = 0.365). Based on those results, the improved PS-ARFS-I was generated. A higher PS-ARFS-I at T0 was significantly associated with higher odds of asthma at T1 (aOR = 1.08; p < 0.001; 95% confidence interval [CI] 1.05–1.10); similar results were obtained with the longer PS-ARFS (aOR = 1.079; p < 0.001; 95% CI 1.050–1.109). Moreover, among non-asthmatic children at baseline, the PS-ARFS score predicted wheezing and cough at T1 but not bronchial secretions; the PS-ARFS-I score at baseline did not predict symptoms at T1. Conclusion: This study shows that the PS-ARFS-I and PS-ARFS could predict diagnosed asthma at 1-year follow-up (AU)

Preconception exposure to over-the-counter medications and antibiotics and the risk of childhood asthma in Lebanon: A cross-sectional study

Objective: The aim of this study was to elucidate the relationship between the mother’s use of over-the-counter (OTC) medications during pregnancy and asthma in Lebanese children. Methods: A cross-sectional study was conducted on Lebanese students in both public and private schools, between January and September 2017, involving 1000 children aged between 4 and 17 years. Results: The intake of any medication as an independent variable throughout pregnancy reveals that being in a public school compared to a private one (Beta = 0.344) and breastfeeding (Beta = 0.51) were highly associated with lower odds of asthma, while having a positive family of allergic rhinitis (Beta = 2.129) and the intake of any medication during pregnancy (Beta = 7.052) were highly associated with higher odds of asthma. A second logistic regression, taking as the dependent variable asthmatic versus healthy children and taking each OTC drug as an independent variable, showed that taking paracetamol once per week during pregnancy (Beta = 4.66) and proton pump inhibitors (PPIs) once per month (Beta = 3.498) compared to no intake were significantly correlated with higher probability of asthma. Conclusion: Our findings showed that the intake of paracetamol, vitamin C, and PPIs during pregnancy is strongly correlated with asthma in the offspring. Since these factors are avoidable, it is necessary to raise awareness among healthcare professionals to reduce the prevalence of asthma in children (AU)

Preconception exposure to over-the-counter medications and antibiotics and the risk of childhood asthma in Lebanon: A cross-sectional study.

OBJECTIVE: The aim of this study was to elucidate the relationship between the mother's use of over-the-counter (OTC) medications during pregnancy and asthma in Lebanese children. METHODS: A cross-sectional study was conducted on Lebanese students in both public and private schools, between January and September 2017, involving 1000 children aged between 4 and 17 years. RESULTS: The intake of any medication as an independent variable throughout pregnancy reveals that being in a public school compared to a private one (Beta = 0.344) and breastfeeding (Beta = 0.51) were highly associated with lower odds of asthma, while having a positive family of allergic rhinitis (Beta = 2.129) and the intake of any medication during pregnancy (Beta = 7.052) were highly associated with higher odds of asthma.A second logistic regression, taking as the dependent variable asthmatic versus healthy children and taking each OTC drug as an independent variable, showed that taking paracetamol once per week during pregnancy (Beta = 4.66) and proton pump inhibitors (PPIs) once per month (Beta = 3.498) compared to no intake were significantly correlated with higher probability of asthma. CONCLUSION: Our findings showed that the intake of paracetamol, vitamin C, and PPIs during pregnancy is strongly correlated with asthma in the offspring. Since these factors are avoidable, it is necessary to raise awareness among healthcare professionals to reduce the prevalence of asthma in children.

Does Stockholm Syndrome Exist in Lebanon? Results of a Cross-Sectional Study Considering the Factors Associated With Violence Against Women in a Lebanese Representative Sample.

The aim of this study is to validate the Stockholm syndrome scale (SSS) in Arabic, assess the correlation of the Stockholm syndrome in women who are victims of domestic violence, and evaluate the factors that enhance the level of violation among a representative sample of the Lebanese population. This is a cross-sectional study conducted on Lebanese women between September and December 2018. Participants enrolled in this study were from all of Lebanon's governorates and selected using an equitable representative sample. Being divorced (ß = 9.83); with low educational level (ß = 5.47); having a partner that takes substance (ß = 16.17); addicted to alcohol (ß = 8.21); addicted to gambling (ß = 11.91); have a history of threats, violence, assaults, and crimes (ß = 17.83); higher stressful life experiences (ß = 0.75); and higher SSS score (ß = 0.04) were significantly associated with higher partner physical and nonphysical abuse scale. For the validation of the SSS, five items (items 3, 20, 30, 38, and 40) were removed because none over-correlated with each other (r >.9), had a low load on the factors (<.3), or a weak commonality (<.3). SSS items converged on a seven-factor solution with Eigenvalues greater than 1, accounting for a total of 66.59% of the variance (α = .970). Our study revealed a positive association between the Stockholm syndrome and the violence against women and evaluated many factors that increase this association. Divorced women, with low educational level, having a partner addicted to alcohol, to illegal substance or to gambling, having a history of threats, violence, assaults, and crimes were more prone to experience physical and nonphysical abuse.

Factors associated with violence against women in a representative sample of the Lebanese population: results of a cross-sectional study.

To evaluate the prevalence of violence against women (VAW) and assess factors associated with VAW among a representative sample of the Lebanese population. This cross-sectional study was carried out between September and December 2018. Participants from all Lebanese governorates were enrolled in this study using a proportionate random sample. The percentages of women who were exposed to physical and non-physical abuse were 37.1% and 49.4% respectively. Factors associated with physical abuse were being divorced, having a partner addicted to substances and alcohol, or with a history of threats, violence, assaults, and crimes, higher stressful life experiences, and abuse reported from childhood (physical, sexual, or psychological). Non-physical abuse was associated with abuse reported from childhood (physical, sexual, or psychological), higher stressful life experiences, and the fact that the partner is addicted to substances and alcohol, or has a history of threats. Our results suggest that being divorced, illiterate, and unemployed, having an addicted partner, and having experienced child abuse are all factors that are associated with more violence against women.

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.

Emotional eating among Lebanese adults: scale validation, prevalence and correlates.

OBJECTIVES: The present study aimed at developing an Arabic version of the Emotional Eating Scale (EES) and examining its reliability and validity among a sample of the Lebanese population. The secondary objective was to evaluate the correlation between emotional eating and body dissatisfaction along with depression and/or self-esteem among a representative sample of the Lebanese population. METHODS: This cross-sectional study was conducted between January and May 2018. The sample was drawn proportionately from all Lebanese Mohafazat. RESULTS: All items could be extracted from the list, except items 17 and 19. The EES items converged over a solution of four factors that had an Eigenvalue over 1, explaining a total of 67.06% of the variance (KMO = 0.939; Bartlett's test of sphericity p < 0.001; αCronbach = 0.952). A higher body dissatisfaction was significantly associated with higher emotional eating (ß = 0.31) and lower self-esteem (ß = - 0.054); however, no significant association was found with depression. Self-esteem and depression were not found to be significantly associated with emotional eating. When introducing depression and self-esteem as mediator factors for body dissatisfaction and emotional eating, body dissatisfaction did not remain significantly associated with emotional eating. CONCLUSION: In this study, the Emotional Eating Scale was validated in Arabic among the Lebanese adult population, making this scale usable in further Lebanese research. Moreover, our results showed that body dissatisfaction was positively correlated with emotional eating and self-esteem, but not with depression. A positive association between body dissatisfaction and emotional eating was also demonstrated. This research offers new perspectives for the evaluation of emotional eating among the Lebanese adult population. LEVEL OF EVIDENCE: Level V Cross-sectional descriptive study.

Newborn's first bath: any preferred timing? A pilot study from Lebanon.

OBJECTIVE: To try to find the most appropriate time for the newborn's first bath. This prospective randomized study was conducted in one hospital (July-September 2017). RESULTS: A higher percentage of newborns who had a skin-to-skin contact with their mothers had their bath at 24 h vs 2 h after birth (65.2% vs 33.3%; p = 0.01). A higher percentage of mothers who helped in their baby's bath had their baby's bath at 24 h vs 2 h (65.2% vs 5.9%; p < 0.001) and vs 6 h (65.2% vs 15.7%; p < 0.001) respectively. A higher mean incubation time was seen between newborns who had their bath at 2 h (2.10 vs 1.78; p = 0.002) and 6 h (2.18 vs 1.78; p = 0.003) compared to those who had their bath at 24 h respectively. A higher percentage of newborns who took their first bath 24 h after birth were calm compared to crying vigorously (38.6% vs 9.1%; p = 0.04). Delaying newborn first bath until 24 h of life was associated with benefits (reducing hypothermia and vigorous crying, benefit from the vernix caseosa on the skin and adequate time of skin-to-skin contact and mother participation in her child's bathing.

Factors influencing women's sex work in a Lebanese sample: results of a case-control study.

BACKGROUND: Many constituents contribute to the rise of sex work in Lebanon such as the socio-economic situation in the country (poverty, increased unemployment rates, and religious divisions), as well as the political and social instability. Several emotional and psychological factors such as depression, stress, anxiety, low self-esteem, emotional abuse, may force some people to rely on trading sex as a coping strategy for persevering. Therefore, it was deemed interesting to explore and understand factors that are correlated with sex work in Lebanon where no study, to our knowledge, has been written on this critical point. The objective of the study was to assess factors (such as trauma, child abuse, partner abuse, depression, anxiety, and stress) associated with women joining sex work among a sample of the Lebanese population. METHODS: A case-control study was conducted on a group of women (60 sex workers recruited from a prison for women) involved in sex work matched for age and sex with a control group (60 non-sex workers). Controls were chosen from the same prison population as the sex workers. RESULTS: A logistic regression was conducted, taking being a sex worker vs not as the dependent variable; independent factors were sociodemographic characteristics, child (psychological, neglect, physical and verbal) and inter partner violence (physical and non-physical), depression, anxiety and stress. Higher anxiety (aOR = 1.08) and higher inter partner physical violence (aOR = 1.02) were altogether related with higher chances of being a sex worker. CONCLUSION: This study proposes an association between child abuse, inter partner violence, alcohol consumption, anxiety, and sex work. Future research may also need to contemplate other factors not examined here, including parental substance use, personality traits, and many others.

Lebanese pharmacists' confidence and self-perceptions of computer literacy: scale validation and correlates.

BACKGROUND: Most pharmacists agree that continuing education (CE) programs positively affect their practice and increase their knowledge, with computer-based courses being their preferred type of CE (60.6%). The route to using medical e-services and e-learning is not straightforward. High setup costs and time commitments to sustain quality are issues brought up in this respect. Therefore, the objectives of this study were to validate the general confidence with computer use (GCWCU) scale and assess computer literacy and its associated factors among Lebanese pharmacists. METHODS: This cross-sectional study was conducted, using a random sample of Lebanese pharmacists from all districts of Lebanon. The general confidence with computer use (GCWCU) scale was used to assess computer literacy. RESULTS: This study enrolled 628 (83.73%) pharmacists. The GCWCU items converged over two factors (Cronbach's alpha = 0.716). A higher GCWCU was associated with the ease of access to the Order of Pharmacists of Lebanon e-library (beta = 2.58), owning a tablet (beta = 2.80), being connected for 4 h daily (beta = 2.71), the ease of access to the learning management system (beta = 2.39), holding a PhD (beta = 4.28) or a PharmD (beta = 1.16), and working in hospitals (beta = 2.60). CONCLUSION: This study showed that the GCWCU is adequate to assess computer literacy in Lebanese pharmacists and identified factors affecting and/or associated with computer literacy. It presented insights into essential computer skills and abilities of Lebanese pharmacists and identified factors associated with their general confidence with computer use in their practice. These findings would help decision-makers and CE providers design learning materials for pharmacists to improve their computer literacy for better practice and patient care.