Exploring attachment security in a sample of Lebanese adolescents: The validation of the Arabic IPPA-R.

Despite growing evidence supporting the importance of the quality of attachment during adolescence, no studies have been conducted to date in the Arab world due to an absence of valid and reliable tools to measure this construct in Arabic. The Inventory of Parent and Peer Attachment-Revised (IPPA-R) was devised as a self-report questionnaire in English to assess the quality of adolescent attachment to mother, father, and peers, each scale consisting of 25 items. The current study sets out to determine the psychometric properties of the Arabic IPPA-R and to explore attachment styles in Lebanon in a sample of 765 Lebanese adolescents. Results suggested a modified three-factor structure to reach satisfactory reliability of the Arabic IPPA-R, resulting in a modified questionnaire consisting of 19 items for each of mother (α = .82) and father (α = .85), and 21 items for peers (α = .89). Strict measurement invariance across gender was achieved for the IPPA-R parental forms, while only scalar invariance was achieved for the IPPA-R peers form. Overall, there were significant differences in attachment scores to mother and father, with adolescents scoring higher on attachment to mother, with both scores being significantly lower than attachment to peers. Gender differences were found on the peer scale with girls scoring significantly higher than boys. Results are interpreted from a cultural lens, emphasizing the importance of accounting for cultural, religious, and socio-economic factors in understanding adolescent attachment. This study is the first conducted in the Arab region and provides a road map to understanding gender-roles, parental expectations and adolescent perceived parenting, and their impact on adolescent attachment scores.

Predictors of Mental Health Literacy in a Sample of Health Care Major Students: Pilot Evaluation Study.

BACKGROUND: The numerous mental health awareness campaigns during the COVID-19 pandemic have shifted our understanding and perception of mental health. OBJECTIVE: The purpose of this study is to evaluate predictors of mental health literacy (MHL), that is, one's knowledge and beliefs about mental disorders. We evaluate whether digital health literacy, empathy, and mentalizing contribute to MHL. METHODS: Our sample consisted of 89 health care major students, aged between 17 and 32 years, studying at a university in Lebanon. The Mental Health Literacy Scale for Healthcare Students (MHLS-HS), the eHealth Literacy Questionnaire (eHLQ), the Basic Empathy Scale (BES), and the Reflective Functioning Questionnaire-8 (RFQ-8) were used. RESULTS: Multiple regression analyses revealed that the Engagement in Own Health subscale of digital health literacy constituted a predictor of MHL. While empathy and mentalizing did not directly predict MHL, they were found to predict components of MHL. CONCLUSIONS: This is the first study to evaluate digital health literacy, empathy, and mentalizing as predictors of MHL in Lebanon, a country where mental health is still considered taboo. Moreover, this pilot study is the first to provide some support for the predictive role of some digital health literacy subscales on MHL in light of the rise of the digital era following the COVID-19 pandemic.

The Influence of Multiple Community Level Traumatic Event Types on Mental Health Outcomes.

Lebanon witnessed three large-scale negative community level events in 2020; a severe economic crisis, the COVID-19 pandemic, and an explosion in the port of the capital city, Beirut, which resulted in the deaths of 218 individuals and several thousand injured. The current study examined the relationship between the number of community level events individuals identified as personally impactful and corresponding levels of anxiety, depression, and symptoms of PTSD. The study also examined the roles of specific protective factors including perceived social support, resilience, and religious coping. A total of 406 participants aged between 18 to 64 years completed validated self-report measures online in February 2021. Results indicated elevated levels of mental health difficulties within the sample with over half of the participants reporting moderate to severe anxiety and moderate to severe depression and meeting the cut-off for probable PTSD. Females had significantly higher scores on measures of depression, anxiety, and PTSD. Individuals reporting all three events as negatively impactful were 47% more likely to meet the cut-off for PTSD than individuals identifying a single event. Resilience appeared to be the strongest protective factor against elevated scores on all three mental health outcomes. Higher scores on negative religious coping were also associated with elevated PTSD scores. Low levels of resilience, higher negative religious coping, and being a female were identified as significant predictors of reaching the PTSD cut-off using binary logistic regression analysis.

Correlates of work productivity and maternal competence after having a baby: the roles of mother-infant bonding and maternal subjective experiences.

BACKGROUND: The law in Lebanon allows new mothers to take up to 10 weeks paid maternity leave, and some private organizations choose to give fathers 2 days of paternity leave in the absence of clear legislation. This falls short of the 6 months recommended for mothers in the literature. METHODS: The sample consisted of 97 Lebanese mothers with children between 6 and 24 months of age. First, we examined correlations between the length of maternity leave and measures of work productivity and maternal sense of competence in their new role as a parent. Second, we explored correlations between the length of maternity leave and mother-child adjustment measures (mother-infant bonding, maternal stress, and parenting guilt). Finally, we looked for predictors of work productivity and maternal sense of competence in demographic variables, mother-child adjustment measures, and partner attachment scores. RESULTS: Results showed significant correlations between work productivity and maternal sense of competence, irrespective of the length of maternity leave. Regression analyses showed that working for pleasure, mother-infant healthy bonding, and positive subjective experience of being back to work were significant predictors of work productivity, and that maternal stress predicted maternal competence. CONCLUSION: These findings are discussed within the framework of providing suggestions facilitating mothers' transition back to work and increasing work productivity after having a baby.

The Psychological Impact of the COVID-19 Outbreak on Pregnancy and Mother-infant Prenatal Bonding.

This study aimed to assess the impact of the COVID-19 stress and anxiety on prenatal attachment during the second trimester of gestation. Pregnancy is an important stage for mothers-to-be in creating representations of themselves as a "mother", with the developing attachment relationship to the unborn child considered as a milestone in the future parent's developmental trajectory. The outbreak of the COVID-19 pandemic and the national health measures installed can hence have consequences on these representations and on prenatal attachment. Our sample consisted of 95 mothers that were recruited from a prenatal ultrasound screening center. Results suggested that the COVID-19 pandemic significantly affected prenatal attachment (PAI) with significant correlations between PAI total score and age, anxiety (DASS) and stress (IES-R). When entered in one model looking for predictors of PAI total score, age and COVID-19 stress were the only variables found to significantly predict prenatal attachment. We argue for a cultural component in explaining these results, hypothesizing that stress could trigger defensive strategies, leading to more investment in the attachment relationship, potentially playing the role of a protective factor.

Prevalence and correlates of mental health difficulties following the beirut port explosion: The roles of mentalizing and resilience.

OBJECTIVE: Research has consistently highlighted an increased prevalence of mental health problems, such posttraumatic stress disorder (PTSD), depression, and anxiety, following both man-made and natural disasters. Mentalizing and resilience have been previously identified as potential protective factors against the onset of mental health difficulties following such events. METHOD: This study first identified the prevalence of PTSD symptoms, depression, anxiety, and stress and subsequently assessed mentalizing abilities and resilience as predictors of PTSD symptomatology in a sample of 521 Lebanese participants following the Beirut Port explosion on August 4, 2020. RESULTS: Findings were consistent with existing literature highlighting elevated rates of PTSD, depression, and anxiety subsequent to man-made disasters, with higher rates of mental health symptoms observed among women, those with a preexisting diagnosis of psychiatric disorder (1.5 times more likely to meet the PTSD Checklist for DSM-5 [PCL-5] cutoff score), and those who had to move houses (over 2 times more likely to meet PCL-5 cutoff) as a consequence of the explosion. Higher mentalizing capacities were positively correlated with higher resilience scores and lower indices of mental health difficulties. Each unit increase in resilience scores was associated with a 3% reduction in meeting PCL-5 cutoff, and poorer mentalizing abilities was associated with a 2-fold increase in the risk of meeting PCL-5 cutoff. CONCLUSIONS: Presence of a previous psychiatric diagnosis, having to move houses, lower mentalizing capacities, and lower resilience scores were found to predict elevated PCL-5 scores. Findings are discussed within the framework of recommendations for interventions targeting people affected by traumatic events. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers.

INTRODUCTION: While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. OBJECTIVE: This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. METHODS: An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. RESULTS: In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. CONCLUSIONS: This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

Mentalizing Glasses: Multifocal Attention in Mentalization-Based Treatment and the Role of the Supervision.

Bifocal attention has been conceptualized differently by various scholars; however, all converge in the idea that the therapeutic process includes the need for the therapist to focus his attention on more than one aspect of the therapeutic setting. We propose a novel view in the application of bifocal attention within the mentalizing framework (MBT) of working with children, adolescents, and their families. We start by providing a short history of the evolution of the construct of bifocal attention, followed by a brief description of the structure of MBT for children and adolescents, emphasizing the crucial role of bifocal and multiple attentions in the mentalizing therapist. We close by discussing the importance of continued supervision in facilitating the maintaining of mentalizing glasses in therapy.

Telepsychotherapy During the COVID-19 Pandemic: The Experience of Lebanese Mental Health Professionals.

The COVID-19 pandemic has taken the mental health system by surprise, with the state of lockdown forcing businesses to close their doors, including many mental health services. This has driven many psychotherapists and other mental health professionals towards telepsychotherapy, relying on online consultations to provide continuity of care. However, the adoption of telepsychotherapy required major adaptations from both mental health professionals and patients. This study set out to explore the predictors of the use of online consultations and the perceived level of comfort using telepsychotherapy in a sample of 73 Lebanese mental health professionals. Data was collected via online dissemination of a survey. Results show that 82% of participants made use of online consultations in the past few days, reflecting the adaptation of Lebanese mental health professionals to the atypical newly imposed situation triggered by the COVID-19 pandemic and its consequent lockdown. Having previous experience in the use of online consultations and perceived level of telepresence were significant predictors of the level of comfort of mental health professionals in the execution online consultations. We suggest that more awareness and trainings are required around the practice of telepsychotherapy outside the context of the COVID-19 pandemic.

Letter to the Editor in response to 'Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study'.

Twin-twin transfusion syndrome is a highly morbid condition that can affect parental attachment and depression risk. Studies addressing this rare condition are hard to conduct and thus lacking in the literature. In this letter to the editor, we acknowledge the article of Mackie et al. entitled "Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study" to be of high importance and impact, but would like to discuss the extent of its conclusions, and push towards bigger studies in this field.

The Mental States Task (MST): Correlates and New Perspectives on Mentalizing in a Lebanese Student Sample.

Mentalizing is defined as one's capacity to think in terms of mental states underlying one's own and others' behaviors. It has been posited to develop within the context of a secure attachment relationship and has been linked to a myriad of psychological adjustment variables. Given the scarcity of research on mentalizing in Lebanon, this study aimed to investigate mentalizing in a sample of 293 Lebanese undergraduate students using a novel tool, the Mental State Task (MST). Higher mentalizing scores were found to be positively correlated with self-esteem, neurotic defenses, authenticity and adaptive emotion regulation strategies, as well as negatively correlated with psychological symptomatology. This study also provided descriptions of the six mental states measured by the MST continuum based on their correlations with related constructs. Findings diverge with the literature in relation to the association between defense styles and MST scores, which were posited to reflect cultural specificities of this sample.

The role of perceived social support on depression and sleep during the COVID-19 pandemic.

The aim of the present study was to examine the role of perceived social support pertaining to a range of psychological health outcomes amongst individuals undergoing social isolation and social distancing during COVID-19. A total of 2,020 participants provided responses to an online cross-sectional survey comprised of validated instruments including the Multidimensional Scale of Perceived Social Support (MSPSS), the Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), the Brief Irritability Test (BITe) and the UCLA Loneliness Scale (UCLA-LS). Individuals experiencing self-isolation had significantly higher rates of depression, irritability and loneliness compared to those who were not. The risk for elevated levels of depression symptoms was 63% lower in individuals who reported higher levels of social support compared to those with low perceived social support. Similarly, those with high social support had a 52% lower risk of poor sleep quality compared to those with low social support. Social support was found to be significantly associated with elevated risk for depression and poorer sleep quality. The results contribute to our understanding of differential psychological outcomes for individuals experiencing anti-pandemic measures.