Postpartum Depression and Anxiety among Lebanese Women: Correlates and Scales Psychometric Properties.

Background: We found that it was important to fill a gap in the literature and check the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) and Perinatal Anxiety Screening Scale (PASS) in the Arabic language and delineate factors associated with postnatal depression (PPD) and anxiety (PPA) among Lebanese women 4−6 weeks after delivery. Methods: This cross-sectional study carried out between July 2018 and March 2019 enrolled 295 participants who came for a postnatal checkup at four clinics. Results: The EPDS and PASS scales' items converged over two- and four-factor solutions, explaining 62.51% and 53.33% of the variance, respectively (KMO EPDS = 0.816, αCronbach EPDS = 0.826; KMO PASS = 0.878, αCronbach PASS = 0.920; Bartlett's test of sphericity p < 0.001). Higher postpartum anxiety (Beta = 0.256), higher postpartum insomnia (Beta = 0.079), having hypotension during pregnancy (Beta = 2.760), and having a second (Beta = 1.663) or a third baby or more (Beta = 2.470) compared with the first one were significantly associated with higher postpartum depression. Higher postpartum depression (Beta = 1.33) was significantly associated with higher postpartum anxiety, whereas having a baby through a planned pregnancy (Beta = −4.365) and having a baby who ate regularly (Beta = −3.639) were significantly associated with lower postpartum anxiety. Conclusion: Depression and anxiety prevalence rates in the Lebanese population were higher compared with other countries, which may be due in part to the differences in regional, social and environmental culture.

Computer Vision Syndrome in Lebanese Male Adolescents: Correlates With Mental Health and Mediating Effect of Stress.

Objective: To determine the prevalence of computer vision syndrome (CVS) and the relationship between CVS and depression, anxiety, insomnia, stress, and aggression among a sample of Lebanese male adolescents.Methods: This cross-sectional observational study enrolled 389 male Lebanese students (aged 13-17 years) between October and December 2019.Results: After adjusting for the covariates (age, body mass index, and House Crowding Index), those with CVS had significantly higher mean depression (P < .001), anxiety (P = .003), and insomnia (P = .007) scores compared to those without CVS. The presence of CVS was associated with significantly higher depression (B = 3.25), anxiety (B = 4.11), and insomnia (B = 4.49), but not aggression. Stress mediated the association between CVS and depression, anxiety, insomnia, and aggression (P < .001 for all).Conclusions: The findings of this study indicate the importance of recognizing CVS in adolescents and raising awareness of time spent daily using computers and other electronic devices.

Association of violent video games with alcohol use disorder and smoking dependence among male adolescents in Lebanon.

BACKGROUND: With the well-known serious effects of alcohol and nicotine dependence on adolescents' well-being, and knowing that males are more exposed to violent video gaming, this study was conducted to examine the association between exposure to violent video gaming and alcohol, cigarette, and waterpipe dependence among male Lebanese adolescents. METHODS: This was a cross-sectional observational study conducted with Lebanese male students (13-17 years old) between October and December 2019. The Video Game Questionnaire was utilized to assess the content of violence in video games. For the assessment of alcohol, cigarette, and waterpipe dependence, the Alcohol Use Disorders Identification Test scale (AUDIT), Fagerström Test for Nicotine Dependence (FTND), and Lebanese Waterpipe Dependence Scale (LWDS) were used, respectively. Log transformation was used for the three addiction scores. Four linear regressions were performed taking the AUDIT, FTND, LWDS, and violent video gaming scores as dependent variables. RESULTS: From the 388 students enroled (mean age= 15.83 ± 1.93 years), 190 (48.8%) were classified as having violent video gaming. Older age (beta=0.049) and more violent video gaming (beta=0.006) were significantly associated with more cigarette dependence. More violent video gaming (beta=0.003) was significantly associated with more waterpipe dependence. Older age (beta=-0.090) was significantly associated with lower alcohol use disorder, whereas more violent video gaming (beta=0.005) was significantly associated with more alcohol use disorder. CONCLUSION: The study supports an association between higher exposure to violent video game and higher alcohol and smoking dependence among male teenagers in Lebanon. Hence, support and guidance should be implemented to raise awareness and protect teenagers.

Eating disorders and their relationship with menopausal phases among a sample of middle-aged Lebanese women.

OBJECTIVES: The objective of our study was to evaluate the association between the transition to menopause, body dissatisfaction, and abnormal eating habits (restrained eating, binge eating, and orthorexia nervosa) in a sample of middle-aged Lebanese women. METHODS: A cross-sectional study conducted between July 2019 and January 2020 enrolled 1001 women aged 40 years and above from all Lebanese governorates. Data were collected by face-to-face interviews with all participants. The Body dissatisfaction subscale of the Eating Disorder Inventory­second version was used to assess body dissatisfaction, whereas the Binge Eating Scale, Dutch Restrained Eating Scale, ORTO-15, Dusseldorf Orthorexia Scale (DOS), and Teruel Orthorexia Scale (TOS) were used to assess eating disorders (binge eating, restrained eating and orthorexia nervosa respectively. Multivariable analysis of covariance (MANCOVA) was used to compare multiple measures among the three menopausal phases, after adjustment over potential confounding variables (age, monthly income, body mass index, marital status, education level, and body dissatisfaction). RESULTS: Postmenopause was significantly associated with more orthorexia nervosa tendencies (lower ORTO-15 scores) than premenopause (ß = - 1.87; p = 0.022). Perimenopause was associated with more binge eating (ß = 1.56; p = 0.031), and less orthorexia nervosa (as measured by the DOS) than premenopause, with this association tending to significance (ß = - 1.10; p = 0.051). Furthermore, higher body dissatisfaction was significantly associated with higher restrained eating (ß = 0.02; p < 0.001), binge eating (ß = 0.48; p < 0.001), and orthorexia nervosa as measured by ORTO-15 (ß = - 0.17; p < 0.001) and TOS (ß = 0.08; p = 0.002), but not DOS. CONCLUSION: Our study showed that menopausal stages are associated with some disordered eating behaviors (binge eating and orthorexia nervosa) among middle-aged women. Those results may serve as a first step towards spreading awareness among women within this age group regarding eating attitudes. Moreover, healthcare professionals should screen for the presence of disordered eating during those women's routine visits to the clinics.

Association of problematic internet use with depression, impulsivity, anger, aggression, and social anxiety: Results of a national study among Lebanese adolescents.

IMPORTANCE: Several studies conducted worldwide (mostly in Western countries) highlighted the negative effects of problematic internet use, particularly among adolescents aged 12 to 17, including depression, impulsivity, aggression, and social fear and avoidance. In Lebanon, literature on the prevalence and impact of problematic internet use among adolescents is limited. OBJECTIVE: This study aim was to study the association between problematic internet use and depression, impulsivity, anger, aggression and social phobia among Lebanese adolescents. METHODS: A cross-sectional study was performed on 1103 young adolescents (14-17 years), recruited from October 2017 till April 2018. The Internet Addiction Test (IAT) was used to evaluate the level of problematic internet use. Data were analyzed using the MANCOVA analysis. The main independent variable of interest was the IAT, while the dependent variables included the psychological scales. RESULTS: The multivariate analysis taking the psychological scales as the dependent variables and the problematic internet use (IAT score) as an independent variable, showed that problematic internet use was associated with higher depression, impulsivity, aggression, anger, hostility and social anxiety. INTERPRETATION: Problematic internet use has become an important health issue that should not be overlooked, particularly because of the increased use of the internet by adolescents. Educational programs on early exposure to the internet should be developed.

Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon.

OBJECTIVES: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese preschool children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]). METHODS: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits. RESULTS: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing outdoors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 and OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing outdoor × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P < 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%. CONCLUSION: PS-ARFS is suggested for screening of asthma in preschool children in an epidemiological setting and in the absence of spirometry.

Hygiene hypothesis: association between hygiene and asthma among preschool children in Lebanon.

OBJECTIVES: To validate a scale to assess the hygiene hypothesis and the association between hygiene and asthma among Lebanese preschool children aged 3-5 years. METHODS: This cross-sectional study, conducted between November 2018 and March 2019, enrolled 515 preschool children. Asthma and potential risk factors, including hygiene, were assessed using a standardized questionnaire. A specific hygiene hypothesis scale has been generated and validated for this purpose. RESULTS: The hygiene hypothesis scale items converged over a solution of nine factors that had an Eigenvalue over 1, explaining a total of 65.86% of the variance. An acceptable Cronbach's alpha value was recorded for the hygiene hypothesis scale (0.696). Variables correlated with higher odds of asthma were male gender (ORa = 0.41 for females), living near a prairie sprayed with pesticides (ORa = 3.09), having a heating system in the bedroom compared to the sitting room (ORa = 9.97), attending kindergarten (ORa = 2.80), having a mother who smokes waterpipe compared to not smoking (ORa = 3.34), having a mother with a history of asthma (ORa = 5.50), and having respiratory infections (ORa = 14.72). However, the hygiene hypothesis score was not associated with higher odds of asthma (p = 0.881). CONCLUSIONS: The current results suggested that neither home cleaning nor personal cleanliness was correlated with asthma in preschool children. Larger prospective studies that measure the intensity and duration of exposure to each toxicant are suggested to better assess the hygiene hypothesis items and their association with asthma.

Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon

OBJECTIVES: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese pre-school children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]).METHODS: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits. RESULTS: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing out-doors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 a n d OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing out-door × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P< 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%.CONCLUSION: PS-ARFS is suggested for screening of asthma in preschool children in an epidemio-logical setting and in the absence of spirometry

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Hygiene hypothesis: association between hygiene and asthma among preschool children in Lebanon

OBJECTIVES: To validate a scale to assess the hygiene hypothesis and the association between hygiene and asthma among Lebanese preschool children aged 3-5 years. METHODS: This cross-sectional study, conducted between November 2018 and March 2019, enrolled 515 preschool children. Asthma and potential risk factors, including hygiene, were assessed using a standardized questionnaire. A specific hygiene hypothesis scale has been gen­erated and validated for this purpose. RESULTS: The hygiene hypothesis scale items converged over a solution of nine factors that had an Eigenvalue over 1, explaining a total of 65.86% of the variance. An acceptable Cronbach's alpha value was recorded for the hygiene hypothesis scale (0.696). Variables correlated with higher odds of asthma were male gender (ORa = 0.41 for females), living near a prairie sprayed with pesticides (ORa = 3.09), having a heating system in the bedroom compared to the sitting room (ORa = 9.97), attending kindergarten (ORa = 2.80), having a mother who smokes water­pipe compared to not smoking (ORa = 3.34), having a mother with a history of asthma (ORa = 5.50), and having respiratory infections (ORa = 14.72). However, the hygiene hypothesis score was not associated with higher odds of asthma (p = 0.881). CONCLUSIONS: The current results suggested that neither home cleaning nor personal cleanliness was correlated with asthma in preschool children. Larger prospective studies that measure the intensity and duration of exposure to each toxicant are suggested to better assess the hygiene hypothesis items and their association with asthma

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Factors associated with problematic social media use among a sample of Lebanese adults: The mediating role of emotional intelligence.

PURPOSE: To assess the relationship of smoking (cigarettes or waterpipe), alcohol drinking, alexithymia, self-esteem, anxiety, depression, stress, social phobia, emotional intelligence, impulsivity, insomnia, physical health, and loneliness with problematic social media use (PSMU) in a sample of Lebanese citizens. METHODS: This cross-sectional study enrolled 466 participants (January-May 2019). RESULTS: Higher anxiety, alcohol use disorder, and social phobia were correlated with elevated PSMU, while older age was associated with lower PSMU. Emotional intelligence partially mediated the association between alexithymia and PSMU by 4.55%. PRACTICAL IMPLICATIONS: Since these manifestations are preventable, spreading awareness through our schools, educational programs, and even healthcare professionals would considerably reduce the pace at which young adults are transforming into anxious and distorted individuals.

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.

Social media use disorder and alexithymia: Any association between the two? Results of a cross-sectional study among Lebanese adults.

PURPOSE: To learn more about the association between social media use disorder and alexithymia among Lebanese people. DESIGN/METHODS: Four hundred fifty-six residents participated in this cross-sectional study which was carried out between January and December 2018. FINDINGS: The results showed that 107 (23.7%) participants were classified as having social media use disorder. Higher social media use disorder score (ß = .52), higher perceived stress (ß = .35), and higher depression (ß = .12) were significantly associated with more alexithymia. PRACTICE IMPLICATIONS: Our results have shown that social media use disorder and being depressed and stressed were associated with higher levels of alexithymia. Psychologists/health practitioners can benefit from these findings in their future prevention and intervention plans. People who negatively utilize social media platforms can then be offered with appropriate counseling and coping mechanisms.

Validation of the Arabic version of the Eating Attitude Test in Lebanon: a population study.

OBJECTIVES: To validate an Arabic version of the Eating Attitude Test (EAT-26) and identify factors (such as depression, stress, anxiety and body dissatisfaction) that might be associated with disordered eating among a sample of the Lebanese population. DESIGN: Cross-sectional study. SETTING: All Lebanese governorates. PARTICIPANTS: A total of 811 participants randomly selected participated in this 5-month study (January-May 2018). RESULTS: The EAT-26 scale items converged over a solution of six factors that had an eigenvalue over 1, explaining a total of 60·07 % of the variance (Cronbach's α = 0·895). The prevalence of disordered eating attitudes was 23·8 %. Higher EAT-26 scores (disordered eating attitudes) were significantly associated with higher depression (ß = 0·325), higher emotional eating (ß = 0·083), daily weighing (ß = 3·430), higher physical activity (ß = 0·05), starving to reduce weight (ß = 4·94) and feeling pressure from TV/magazine to lose weight (ß = 3·95). CONCLUSIONS: The Arabic version of EAT-26 can be a useful instrument for screening and assessing disordered eating attitudes in clinical practice and research. Some factors seem to be associated with more disordered eating attitudes among participants for whom psychological counseling may be needed. Yet, our findings are considered preliminary, and further studies are warranted to confirm them.

Emotion regulation among Lebanese adults: Validation of the Emotion Regulation Questionnaire and association with attachment styles.

PURPOSE: Validate the Emotion Regulation Questionnaire (ERQ) and evaluate factors associated with emotion regulation among Lebanese adults. METHODS: A proportionate random sample of 811 participants was chosen from all Lebanese governorates in this cross-sectional study. FINDINGS: The principal component analysis of the ERQ items yielded two factors (αCronbach = 0.764 and 0.658 for the Cognitive Reappraisal and Expressive Suppression facets, respectively). Higher secure attachment style was linked to higher cognitive reappraisal and expressive suppression. Higher anxious attachment style and anxiety were associated with lower cognitive reappraisal. PRACTICAL IMPLICATIONS: The Arabic version of the ERQ is a suitable tool for the assessment of emotion regulation tendencies in clinical practice and research. The study came up with results similar to the ones given by many international studies.

Corrigendum to "Knowledge, Attitude and Practice of Lebanese Community Pharmacists toward Chronic Obstructive Pulmonary Disease" [J Epidemiol Glob Health, 10(1), Pages 86-95].

The authors wish to state that in the above article, one of the authors (Marwan Akel) was excluded inadvertently during the peer review stage. The corrected author group read as follows.Souheil Hallit1,2,*, Rouba Karen Zeidan2,3, Sylvia Saade4, Aline Hajj5,6, Rabih Hallit1, Marwan Akel2,4, Charbel Yahchouchy3, Nelly Kheir7, Katia Iskandar8, Hala Sacre2,9, Pascale Salameh2,10,11.

Correction to: Social media use disorder and loneliness: any association between the two? Results of a cross-sectional study among Lebanese adults.

An amendment to this paper has been published and can be accessed via the original article.

Prevalence and Factors Associated with Insomnia Among a Representative Sample of the Lebanese Population: Results of a Cross-Sectional Study.

The objectives of the study were to identify the prevalence of insomnia among a representative sample of the Lebanese population and to assess potential factors associated with insomnia among this group. A cross-sectional study was done in the Lebanese population from August 2017 to April 2018 enrolling 789 participants using a proportionate random sample from all five Lebanese governorates. Participants filled a self-administered Arabic questionnaire. The Athens Insomnia Scale was used to diagnose insomnia. The Hamilton Depression Rating Scale and the Generalized Anxiety Disorder Scale were used to measure depression and anxiety, respectively. The prevalence of insomnia was 47.1% in the population sampled. The mean age of the participants was 37 years (64% females). Death in the family [adjusted odds ratio (aORa) = 1.59], drinking caffeine before sleep more than 2 days per week compared to none (aORa = 1.57), increased stress (aORa = 1.03), increased depression (aORa = 1.14), and anxiety scores (aORa = 1.07) were associated with higher odds of insomnia. The prevalence of insomnia was very high in the Lebanese population, and it was mainly associated with modifiable, treatable risk factors. Improved knowledge and adequate screening for insomnia are needed to promote better sleep quality.

Correction to: Social media use disorder and loneliness: any association between the two? Results of a cross-sectional study among Lebanese adults.

An amendment to this paper has been published and can be accessed via the original article.

Social media use disorder and loneliness: any association between the two? Results of a cross-sectional study among Lebanese adults.

BACKGROUND: In Lebanon, it is already established that mental disorders are prevalent among the population. Lebanese people are active users of social media platforms. To date, no study has previously explored the relationship between mental health and social media use disorder in Lebanon. The present study aims to learn more about the link between social media use disorder and loneliness among Lebanese people. METHODS: This cross-sectional study was carried out between January and December 2018. It enrolled 456 residents of the community randomly selected from Lebanon's governorates in a proportionate rate. RESULTS: The results showed that 107 (23.7%) participants were classified as having social media use disorder. The results of a stepwise linear regression, taking the loneliness score as the dependent variable, showed that female gender compared to males (Beta = 0.42), having a secondary level of education compared to illiteracy (Beta = 0.65), higher social media use disorder (Beta = 0.03) and higher insomnia (Beta = 0.02) and alexithymia (Beta = 0.02) were significantly associated with higher loneliness. CONCLUSION: The present study was able to contribute to the literature and showed the association between social media use disorder and loneliness. These findings can benefit psychologists and public health practitioners in their future prevention and intervention plans.

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

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