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Previous research demonstrated a relationship between ON and disordered eating symptoms (eating concern, restraint, cognitive preoccupations about body shape and weight) and disordered eating attitudes (DEA). Since screening for orthorexia nervosa is now part of clinical practice, the measurement instruments to be used must be clinically significant, reliable, valid and sensitive to our target population. The main objective of the present study was to confirm the factor structure of the Arabic version of the ORTO-R using a first sample of Lebanese adults and confirm those results on another sample. The secondary objective was to assess sex differences in terms of ON and DEA, as well as to examine whether symptoms of ON were related to DEA in Lebanese adults. A total of 783 Lebanese adults was selected to participate in this cross-sectional study (January-May 2018) using a proportionate random sample from all Lebanese governorates. The mean age of the total sample was 27.78 ± 11.60 years (Min. 18 -Max. 84) (33.5% females) and their mean BMI was 24.36 ± 5.31 kg/m.sup.2 . All items of the ORTO-R were extracted during the factor analysis and yielded a two-factor solution with Eigenvalues > 1 (variance explained = 50.07%; KMO = 0.570; Bartlett's sphericity test p<0.001; [alpha].sub.Cronbach = 0.755). This factor structure was confirmed by a confirmatory factor analysis; the Maximum Likelihood Chi-Square = 26.894 and Degrees of Freedom = 8, which gave a X2/df = 3.36. The Tucker Lewis Index (TLI) value was 0.914, whereas the standardized root mean square residual (SRMR) value was 0.032. The root mean square error of approximation (RMSEA) value was 0.077 [95% CI 0.046-0.111] (pclose = 0.07) and comparative fit index (CFI) value was 0.967 respectively, indicating a good fit of the model. There was also no measurement invariance between genders. Female gender was significantly associated with lower ORTO-R scores (more orthorexia nervosa) compared to males (B = -0.65; p = 0.026, 95% CI -1.22- -0.08; ɳ.sup.2 = 0.006). However, no significant difference was found between genders in terms of EAT-26 scores (B = 0.23; p = 0.813, 95% CI -1.66-2.12; ɳ.sup.2 = 0.0001). Higher ORTO-R scores (lower/ less pathological ON tendencies and behaviors) were significantly related to higher EAT-26 total scores (higher levels of DEA) as well as higher dieting, bulimia and oral control scores in both females (from a weak to a moderate positive correlation) and males (a weak positive correlation). This cross-sectional population-based study confirmed the factor structure of the Arabic version of the ORTO-R, demonstrated an association between ON and DEA and revealed more ON among females compared to males.

The Hamilton Depression Rating Scale (HDRS or HAMD) is widely used scale for depression assessment. A shortened version of the HDRS, composed of 7 items, was implemented. The latter is timesaving compared to the original version, while still providing similar precision. Our objective in this study was to assess the psychometric properties of the Arabic HAMD-7 scale among non-clinical and clinical samples of Lebanese adults. In study 1, 443 Lebanese citizens enrolled in this cross-sectional study (June-September 2021). The total sample in study 1 was divided into two subsamples to conduct the exploratory-to-confirmatory factor analysis (EFA-to-CFA). Another cross-sectional study was conducted in September 2022 on another sample of Lebanese patients (independent from the sample of study 1) and included 150 patients attending two psychology clinics. The Montgomery-Asberg Depression Rating Scale (MADRS), Lebanese Depression Scale (LDS), Hamilton Anxiety Scale (HAM-A) and Lebanese Anxiety Scale (LAS) were used to assess the validity of the HAMD-7 scale. The results of the EFA (subsample 1; study 1) showed that the HAM-D-7 items converged into a one-factor solution (McDonald's ω = .78). The CFA (subsample 2; study 1) confirmed the one-factor solution obtained in the EFA (ω = .79). CFA indicated that fit of the one-factor model of the HAM-D-7 was acceptable: χ2/df = 27.88/14 = 1.99, RMSEA = .066 (90% CI = .028, .102), SRMR = .043, CFI = .960, TLI = .939. All indices suggested that configural, metric, and scalar invariance was supported across gender. The HAMD-7 scale score positively correlated with the MADRS (r = 0.809; p<0.001), LDS (r = 0.872; p<0.001), HAM-A (r = 0.645; p<0.001) and LAS (r = 0.651; p<0.001) scales scores. The optimal cutoff score between healthy individuals and depressive patients for the HAMD-7 was at a value = 5.50 (Se = 82.8% and Sp = 62.4%). The positive and negative predicted values for the HAMD-7 were 25.1% and 96.0%, respectively. The positive and negative likelihood ratios were 2.20 and 0.28 respectively. No significant difference was found between the non-clinical total sample (study 1) and the clinical sample (study 2) in terms of HAM-D-7 scores (5.24 ± 4.43 vs 4.54 ± 5.06; t(589) = 1.609; p = .108). Psychometric properties of the Arabic HAMD-7 scale are satisfactory, warranting its use clinically and in research. This scale seems highly efficient for ruling out depression; however, those with positive scores need a referral to a mental health professional for deeper evaluation. HAMD-7 might be self-administered by non-clinical subjects. Future studies are recommended to additionally confirm our results.

This study examined the mediating effect of psychological distress and wellbeing in the association between anti-mattering and irritability among a sample of Lebanese adolescents-a topic that remains largely underexplored in adolescent mental health research. A cross-sectional study was conducted during November 2023 and included 763 adolescents currently residing in Lebanon (mean age 16.08 ± 1.74 years, 37.6% males and 62.4% females) recruited from all Lebanese governorates using a snowball sampling technique. Data were collected via an online questionnaire and analyzed using the PROCESS Macro for mediation analysis. The findings indicated that both psychological distress (β = .39, BootSE = .04, 95% CI [.33,.46]) and wellbeing (β = .07, BootSE = .02, 95% CI [.03,.12]) partially mediated the relationship between anti-mattering and irritability. Adolescents with higher levels of anti-mattering reported greater distress and reduced wellbeing, both of which were associated with increased irritability. Our results highlight the psychological relevance of anti-mattering in adolescence and suggest that addressing feelings of insignificance may play a key role in managing emotional dysregulation. Mental health practitioners and educators should consider developing culturally sensitive interventions that target feelings of anti-mattering, enhance wellbeing, and reduce psychological distress. School-based programs promoting emotional support and social inclusion may prove especially beneficial. Future studies should investigate these associations longitudinally and across varied cultural contexts to better inform prevention and intervention strategies.

In recent decades, Food Literacy (FL) has gained significant attention in the fields of food and nutrition. It is considered a key determinant of public health and presents a promising approach to addressing health challenges like obesity and environmental sustainability. However, Lebanon currently lacks a validated tool to assess food literacy. In this context, the Short Food Literacy Questionnaire (SFLQ) offers potential for translation and cultural adaptation. Adapting an established tool for use in a new cultural setting enables cross-country comparisons and supports the development of cross-cultural study models. Therefore, this study aims to culturally adapt the SFLQ to assess food literacy among Lebanese adults, enhance their knowledge, and promote healthier lifestyle habits. A nationally representative sample of 450 adults was selected through probability cluster sampling from the eight Lebanese governorates. The SFLQ was administered between 11 December 2022 and 23 March 2023 to evaluate participants' food literacy. Confirmatory Factor Analysis was conducted using SPSS AMOS version 30, applying the maximum likelihood estimation method to obtain parameter estimates. The average age of the participants was 46.0 years, with women making up 59.0% of the sample. The one-factor model showed an acceptable fit after accounting for correlated residuals between items 4-5, 9-10 and 11-12 (RMSEA = 0.079 (90% CI 0.068, 0.091), SRMR = 0.053, CFI = 0.935, TLI = 0.916). Internal consistency was satisfactory (ω = .86/ α = .86). Measurement invariance across gender was confirmed at the configural, metric and scalar levels. Males had significantly higher average SFLQ scores than females (32.80 ± 7.91 vs 28.76 ± 9.26; p < 0.001, Cohen's d = 0.486). A significant negative correlation was observed between SFLQ and Household Food Insecurity Access scores (r = -0.28; p < 0.001). The SFLQ demonstrated strong internal consistency, indicating that it is a reliable tool for both research and clinical use. Expanding validation efforts to include a broader Arabic-speaking population, particularly individuals without internet access, would further strengthen the tool's applicability and cultural relevance across diverse contexts in the Arab world.

Resilience plays a crucial role in mental health promotion and prevention, and was shown to be more represented in individuals who exhibit high levels of extraversion, openness, agreeableness, and conscientiousness. However, there is a lack of studies that comprehensively investigate the association between personality traits and resilience in Lebanon and Arab countries more broadly. The purpose of the present study was to complement the literature by investigating the direct and indirect effects between the five personality traits and resilience among a sample of Lebanese adults through the intermediary role of posttraumatic growth. A cross-sectional study was carried out between May and July 2022, and enrolled 387 participants, all aged above 18 years old and recruited from all Lebanon governorates. The questionnaire used included socio-demographic questions, and the following scales: Connor-Davidson Resilience Scale (CD-RISC) to assess resilience, post traumatic growth (PTG), and Big Five Inventory (BFI-2). The SPSS software v.25 was used for the statistical analysis. Post-traumatic growth mediated the association between extraversion / agreeableness / conscientiousness and resilience. Higher extraversion / agreeableness / conscientiousness was significantly associated with more post-traumatic growth. Higher post-traumatic growth was significantly associated with more resilience. Extraversion, but not agreeableness and conscientiousness, was significantly and directly associated with more resilience. Findings suggest that fostering PTG in individuals who experience adversity can help promote their resilience. Hence, it could be beneficial to design and apply programs aiming at supporting PTG among people who experience stressful and traumatizing situations, to consequently help them increase their sense of resilience.

Nomophobia, an abbreviation of \"No mobile phone phobia\", is characterized by the illogical fear of being detached from the mobile phone or unable to use it. Research have provided evidence of an association between increased cellular phone use and multiple health issues, such as anxiety, depression, insomnia, and others. To our knowledge, there are no Lebanese studies about nomophobia, despite the high incorporation rate of mobile phones in Lebanon and the likelihood of suffering from anxiety, depression, and other conditions due to nomophobic attitudes. The study objectives were to validate and confirm psychometric properties of the Nomophobia Questionnaire (NMP-Q) and examine the associations between particular psychological conditions (anxiety, depression, stress, insomnia and impulsivity) and nomophobia among a representative sample of Lebanese people. This cross-sectional study was carried out between January and July 2019. It enrolled 2260 residents of the community randomly selected from Lebanon's Mohafazat. Two villages per sub-district and households from each village were chosen using a random sampling technique. A questionnaire was distributed randomly to the households. SPSS version 25 was used to perform the statistical analysis. A multinomial regression was computed taking the nomophobia categories as the dependent variable (and taking the absence of nomophobia as the reference category) and all variables that showed a significant association in the bivariate analysis as independent variables. A total of 2260 (80.71%) out of 2800 questionnaires distributed was collected back. The mean age of the participants was 27.98 ± 9.66 years (58.8% females). Moreover, the mean nomophobia score was 71.56 ± 26.92 (median = 71; minimum = 14; maximum = 140). The results showed that 46 (2.0%) had no nomophobia, 769 (34.1%) mild nomophobia [95% CI 0.322-0.361], 1089 (48.3%) moderate nomophobia [95% CI 0.463-0.504] and 349 (15.5%) severe nomophobia [95% CI 0.140-0.170]. Items of the nomophobia scale converged over a solution of three factors that had an Eigenvalue over 1 (Factor 1 = emotions associated to losing connectedness, Factor 2 = not being able to communicate, Factor 3 = not being able to access information; total variance explained = 66.65%, and Cronbach's alpha = 0.948). The results of a multinomial regression, taking the nomophobia score as the dependent variable, showed that higher age was significantly associated with lower odds of having mild (aOR = 0.97), moderate (aOR = 0.93) and severe (aOR = 0.97) nomophobia respectively. Higher anxiety (aOR = 1.09) and higher insomnia (aOR = 1.04) were significantly associated with higher odds of having severe nomophobia. The results suggest a positive correlation between nomophobia and psychological conditions. There is a need for longitudinal and prospective studies that furnish information with regards of the impact of time on the variables measured, in order to better understand the nature, causes, and attributes of nomophobia.

Given their clinical significance and impact on stress response and their potential malleability, resilience and posttraumatic growth (PTG) should receive greater attention as relevant constructs in clinical and research practice in the Arab context. We aimed through the present study to test the psychometric properties of Arabic translations of the 10-item Connor-Davidson Resilience scale (CD-RISC-10), the 10-item and the 8-item Post-Traumatic Growth Inventory-Short Form (PTGI-SF) in a sample of Lebanese adults from the general population. Three hundred eighty-seven Arabic-speaking participants (mean age = 26.17; 58.4% females) responded to a self-report web-based questionnaire. The forward and backward translation method was applied with the approval of the original developers of the scales. Confirmatory factor analysis indicated that fit of the one-factor model was acceptable, and all indices suggested that configural, metric, and scalar invariance was supported across gender for all the three scales. The CD-RISC-10, the 10-item and the 8-item PTGI-SF yielded a good internal consistency, with a McDonald's ω of .89, .95, and .93, respectively. Higher resilience and higher PTG were significantly and positively associated with greater cognitive reappraisal and lower emotion suppression, supporting convergent validity. We preliminarily suggest that these Arabic instruments are appropriate for use in Lebanese community adults to assess different positive responses after life crises, identify people with lack or low levels of resilience and growth who might need intervention, and monitor their response to therapy. Further cross-cultural validations should seek to extend their use in broader Arabic-speaking populations and settings.

Background Salameh et al. developed the Lebanese Waterpipe Dependence Scale (LWDS-11) that assesses nicotine dependence among adult waterpipe smokers. In view of the high waterpipe use among Lebanese youth and other neighboring countries, it was deemed necessary to check the psychometric properties of the LWDS-11, originally adapted to the Lebanese population, to measure nicotine dependence among adolescents. Methods Two cross-sectional investigations were conducted; Study 1 (January and May 2019) enrolled a total of 449 students who were exclusive waterpipe smokers; this sample was used to conduct the exploratory factor analysis. Study 2 enrolled another sample composed of 243 waterpipe smoking adolescents. This sample was independent from the first one and was used to conduct the confirmatory analysis. Results The results also showed that 312 (69.5%) [95% CI 0.652–0.738] had high waterpipe dependence (scores of ≥10). Results of the factor analysis in sample 1 showed that all LWDS-11 items were extracted following the factor analysis. Items converged over a solution of one factor; total variance explained = 70.45%, α Cronbach  = 0.96). The results of the confirmatory factor analysis were as follows: the Maximum Likelihood Chi-Square = 129.58 and Degrees of Freedom = 45, which gave a χ 2 /df = 2.88. For non-centrality fit indices, the Steiger-Lind Root Mean Square Error of Approximation (RMSEA) was 0.08 [0.071–0.106]. Moreover, the Comparative Fit Index (CFI) value was 0.77. Conclusion The preliminary results suggest that the LWDS-11 has good psychometric properties to measure waterpipe dependence among adolescents. We hope this tool would serve the benefit of research and epidemiology.

Dissociative experiences are psychological manifestations characterized by a loss of connection and continuity between thoughts, emotions, environment, behavior, and identity. Lebanon has been facing indescribable events in the last few years, including the COVID-19 pandemic, the Beirut explosion, a crushing economic crisis with the highest inflation rate the country has known in over three decades. The aim of this study was to evaluate the correlation between dissociative experiences and post-traumatic stress symptoms from the economic crisis, the Beirut blast, the COVID-19 pandemic, and other mental health issues in a sample of Lebanese university students. This cross-sectional study enrolled 419 active university students (18-35 years) from all over Lebanon (May and August 2021). The respondents received the online soft copy of a survey by a snowball sampling technique through social media and messaging apps. The questionnaire included sociodemographic data, the Dissociative Experience Scale (DES-II), the PTSD Checklist Specific Version (PCL-S), the Financial Wellbeing Scale, the Beirut Distress Scale, the Lebanese Anxiety Scale, the Patient Health Questionnaire. The two-factor model of the DES fitted best according to CFI, RMSEA and χ2/df values, but modestly according to TLI. The two factors were absorption and amnesia/depersonalization. Higher stress (Beta = 0.95) and more PTSD from the Beirut blast (Beta = 0.29) and from the economic crisis (Beta = 0.23) were significantly associated with more absorption. A personal history of depression (Beta = 6.03), higher stress (Beta = 0.36) and more PTSD from the Beirut blast (Beta = 0.27) and from the COVID-19 pandemic (Beta = 0.16) were significantly associated with more amnesia/depersonalization. Significant rates of dissociative experiences and their sub-manifestations (amnesia/depersonalization and absorption) were found among Lebanese university students, with remarkable co-occurrence of a traumatic/stressful pattern, whether on an individual (history of PTSD) or a collective level (Post-traumatic manifestations from Beirut blast, COVID-19 pandemic and/or economic crisis), or whether correlated to an acute single event or to certain chronic stressors, or even to a personal history of depression. Such findings must raise the attention to serious mental and psychosocial alteration in the Lebanese national identity.

Background Premenstrual Syndrome (PMS) is a cyclic sequence of physical and behavioral symptoms that arise in the second half of the menstrual cycle. The extreme type of PMS is Premenstrual Dysphoric Disorder (PMDD). The current study aims at examining 1) the effects of childhood maltreatment and current life’s stressful events on PMDD, and 2) the mediating role of depression in these associations among Lebanese university female students. Methods This cross-sectional study was conducted between February and March 2021 during the COVID-19 pandemic. Lebanese students were recruited using a snowball technique from all national universities in Lebanon via an auto-administrated online survey. Structural equation modeling was performed to examine the structural relationship between childhood maltreatment and life’s stressful events, depression and PMDD. Results Higher life’s stressful events (Beta = 0.18; p  < 0.001), physical (Beta = 0.19; p  < 0.001), sexual (Beta = 0.18; p  < 0.001) and psychological (Beta = 0.33; p  < 0.001) abuse were significantly associated with higher depression. Moreover, higher sexual (Beta = 0.11; p  = 0.021) and psychological (Beta = 0.11; p  = 0.040) abuse and higher depression (Beta = 0.37; p  < 0.001) were significantly associated with higher PMDD. The indirect relationships between psychological abuse/sexual abuse, depression and PMDD showed that depression mediated the association between both psychological (Beta = 0.22; p  = 0.001) and sexual (Beta = 0.38; p  = 0.004) abuse and PMDD. Conclusion This work presents a unique analysis using the structural equation model that enlightens the effect of childhood maltreatment, particularly sexual and psychological abuse on PMMD symptoms, with depression playing the role of a mediating factor. It would be interesting to test, in future studies, whether there are other mediating factors besides depression that could be indirect indicators of PMDD.