New-onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination: a rare case report.

BACKGROUND: Rare cases of COVID-19 infection- and vaccine-triggered autoimmune diseases have been separately reported in the literature. In this paper, we report the first and unique case of new onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination in a previously healthy 26-year-old Tunisian female. CASE PRESENTATION: A 26-years old female with a family history of a mother diagnosed with schizophrenia, and no personal medical or psychiatric history, was diagnosed with mild COVID-19 infection four days after receiving the second dose of Pfizer-BioNTech COVID-19 vaccine. One month after receiving the vaccine, she presented to the psychiatric emergency department with acute psychomotor agitation, incoherent speech and total insomnia evolving for five days. She was firstly diagnosed with a brief psychotic disorder according to the DSM-5, and was prescribed risperidone (2 mg/day). On the seventh day of admission, she reported the onset of severe asthenia with dysphagia. Physical examination found fever, tachycardia, and multiple mouth ulcers. Neurological evaluation revealed a dysarthria with left hemiparesis. On laboratory tests, she had severe acute kidney failure, proteinuria, high CRP values, and pancytopenia. Immune tests identified the presence of antinuclear antibodies. Brain magnetic resonance imaging (MRI) revealed hyperintense signals in the left fronto-parietal lobes and the cerebellum. The patient was diagnosed with systemic lupus erythematosus (SLE) and put on anti-SLE drugs and antipsychotics, with a favorable evolution. CONCLUSIONS: The chronological relationship between COVID-19 infection, vaccination and the first lupus cerebritis manifestations is highly suggestive, albeit with no certainty, of the potential causal link. We suggest that precautionary measures should be taken to decrease the risk of SLE onset or exacerbation after COVID-19 vaccination, including a systematic COVID-19 testing before vaccination in individuals with specific predisposition.

Smartphone addiction and personality traits among Lebanese adults: the mediating role of self-esteem.

Smartphone usage in Lebanon is increasing constantly. Lebanese population especially university students were described to be at a higher risk of smartphone addiction compared to the general population. To our knowledge there has been no study in the literature that investigated the mediating effect of self-esteem when assessing personality traits and smartphone addiction in young adults. The aim of our study was to assess factors associated with smartphone addiction and investigate the mediating role of self-esteem in the association between smartphone addiction and personality traits. A cross-sectional study was carried out between August and September 2020, during the lockdown period imposed by the government for the COVID-19 pandemic and that coincides with the summer season vacation for most Lebanese, using a sample of community-dwelling participants aged 18 to 29 years. The snowball technique was followed for participants' recruitment. The results showed that the mean age of the participants was 22.25 ± 2.87 years, with 70.9% females. The results showed that 216 (46.9%) of the participants had smartphone addiction. Higher negative emotionality (Beta = 0.17) was significantly associated with more smartphone addiction, whereas higher self-esteem (Beta = -0.37) and household crowding index (Beta = -1.58) were significantly associated with less smartphone addiction. Self-esteem mediated the association between negative emotionality and smartphone addiction. Lebanese young adults were found to be at a high risk of smartphone addiction. These results might serve as a first step towards implementing preventive measures to reduce smartphone addiction. Improving face to face communication, as well as setting specific time for cell phone usage might help reduce the development of addictive behaviors.

Association between COVID-19 symptoms, COVID-19 vaccine, and somatization among a sample of the Lebanese adults.

Objectives: Long COVID syndrome, the poorly defined illness, has been increasingly mentioned in recent studies yet is still poorly understood especially when it comes to precipitating and modulating factors, the high prevalence of mental health problems associated with the COVID-19 pandemic has brought to light the hypothesis of the existence of a psychological component associated with the persistence of symptoms and if vaccination may serve as a modulating factor. This study aims to examine the prevalence of somatization disorders and association between persistent COVID-19 symptoms and COVID-19 vaccine with somatization among a sample of the Lebanese general population. Methods: A cross-sectional study was carried out between September and October 2021. The snowball sampling technique was picked to choose a sample that addressed all Lebanese Mohafazat. Patient Health Questionnaire-15 (PHQ-15) was used to assess somatization. Results: A total of 403 participants was enrolled in this study, with a mean age of 32.76 ± 13.24 years, 108 (26.8%) had medium somatization symptoms (PHQ-15 scores ≥10). Having persistent COVID symptoms (ß=2.15) was significantly associated with more somatization, whereas the intake of COVID vaccine (ß=-1.17) was significantly associated with less somatization. Conclusion: Long lasting COVID-19 symptoms were closely related to somatization, although the administration of the COVID-19 vaccine was associated with less somatization. However, further studies are needed to provide a better understanding of the relationship between long COVID and somatization, on one hand, and the modulating factors on the other hand.

Cyberchondria Severity and Quality of Life Among Lebanese Adults: The Moderating Effect of Emotions.

Objective: To examine the correlation between cyberchondria and quality of life (QOL) among Lebanese adults during the COVID-19 pandemic, taking into consideration the moderating role of emotions (emotion regulation and positive and negative affect). The following questions were examined: (1) Do greater cyberchondria severity and fear of COVID-19 lead to poorer quality of physical and mental health? (2) How is positive and negative affect related to physical and mental QOL? and (3) How do emotion suppression and cognitive reappraisal correlate with physical and mental QOL, particularly in those with higher cyberchondria?Methods: This cross-sectional study was performed between December 2020 and January 2021 during the COVID-19 pandemic. The study enrolled 449 participants who completed an online questionnaire. The questionnaire included sociodemographic questions and the following scales: Cyberchondria Severity Scale, Quality of Life Short Form-12 Health Survey, Fear of COVID-19 Scale, Emotion Regulation Questionnaire, and Positive and Negative Affect Schedule.Results: The results showed that more positive affect (B = 0.17) and negative affect (B = 0.19) were positively correlated with higher physical QOL scores. More positive affect (B = 0.33) and cognitive reappraisal (B = 0.09) were significantly associated with higher mental QOL scores. The interactions between cyberchondria severity by cognitive reappraisal and cyberchondria severity by emotion suppression were significantly associated with mental QOL (P < .001 for both). In people with high cyberchondria severity, having high cognitive reappraisal was strongly correlated with better mental QOL. In people with high cyberchondria severity, having low emotion suppression was significantly correlated with better mental QOL (P < .001).Conclusions: Exposure to copious amounts of information, whether from verifiable sources or not, can instigate anxious symptoms in individuals who lack adaptive emotion regulation ability. Further studies are needed to identify factors related to health crisis response and their moderators, which can be useful to better understand the incidence and development of anxiety and allow health professionals to develop and implement preventive and therapeutic interventions.

Eating habits and lifestyle behaviors during COVID-19 lockdown: The Lebanese experience.

OBJECTIVES: This study aimed to assess dietary intake and lifestyle habits followed during the COVID-19 pandemic and subsequent lockdowns, as well as the level of adherence to the Mediterranean diet (MD), among a sample of the Lebanese population. METHODS: A cross-sectional study was conducted during the government-enforced lockdown. A validated, online, questionnaire was used to collect information about dietary and lifestyle habits. The Mediterranean diet adherence screener (MEDAS) was used to assess adherence to the MD. RESULTS: A total of 1684 participants responded to the survey. Their mean age was 23.92 ± 7.62 years, and 70.4% were females. Approximately a third of the participants reported that their dietary habits did not change and 42.3% acknowledged that their eating habits deteriorated during the lockdown. Participants smoked less and slept more during the lockdown compared to before it. Approximately 19.2% of the sample reported low adherence to the MD whereas 63.9% and 16.9% described moderate and high adherence respectively. Only age was significantly associated with higher MD adherence. CONCLUSION: Dietary intake and MD adherence were suboptimal during the COVID-19 lockdown among the sample of the Lebanese population. It is critical that the Lebanese government implements public health programs in order to promote awareness about the importance of adhering to a healthy lifestyle and making appropriate dietary and lifestyle choices.

Traversing mental health disorders during pregnancy: Lebanese women's experiences of antepartum depression and anxiety.

INTRODUCTION: Over the past few years, Lebanon-a developing country-has faced a plethora of economic and political challenges, with more than half of the general population presenting depressive and anxiety symptoms. However, when it comes to maternal mental health during pregnancy, the last examination in Lebanon dates far back to 2005. Our study's aim was to help delineate the factors associated with Lebanese women's mental health disorders during pregnancy, namely antepartum depression and anxiety. METHODS: We launched a cross-sectional study among Lebanese pregnant women (age ≥ 18 years) between June and July 2021, during the COVID-19 lockdown (N = 433). RESULTS: In total, 87.8% of the participants experienced depression (mild to severe), where severe depression was observed in 7.9%. In addition, 70.3% had a significant level of anxiety. Increased pregnancy-specific hassles (beta = 0.93), being Muslim compared to Christians (beta = 3.19), being afraid of an existing aggressor (beta = 8.75), urinary tract infections (beta = 2.02), and higher gestational age (beta = 0.07) were significantly associated with higher depression, whereas higher physical activity index (beta = - 0.09) and increased disordered eating attitudes during pregnancy (beta = - 0.27) were significantly associated with less depression, all accounting for 60.4% of the model's variance. Additionally, increased pregnancy-specific hassles (beta = 0.54), being Muslim compared to Christians (beta = 2.42), urinary tract infections (beta = 1.72), and having been emotionally or physically abused (beta = 1.19) were significantly associated with higher levels of anxiety and could predict 49% of the total variance. CONCLUSION: Our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese pregnant women, namely cultural beliefs, pregnancy-related distress, medical complications during pregnancy, and a history of abuse. Therefore, it would be judicious to implement screening programs targeting pregnant women at risk for antepartum depression and anxiety. In addition, high rates of prenatal depression and anxiety were detected among our sample, supporting that recognizing and treating maternal mental health disorders should be prioritized during antenatal care in Lebanon.

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults.

OBJECTIVE: This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults. METHODS: A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test. RESULTS: After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R2 = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (ß = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R2 = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (ß = 0.06) and more disordered eating attitudes (higher EAT scores) (ß = 0.13) were associated with higher levels of ON (Table 5). CONCLUSION: The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating. LEVEL OF EVIDENCE: 5.

A 1-year analysis of adverse events following COVID-19 vaccination in Lebanon: a retrospective study.

BACKGROUND: Since the deployment of Coronavirus Disease 2019 (COVID-19) vaccines, skepticism about the safety, incidence, and severity of Adverse Events Following Immunization (AEFI) was a concern. The study has two main objectives. First, to analyze AEFIs following COVID-19 vaccines (Pfizer-BioNTech, AstraZeneca, Sputnik, and Sinopharm) during the vaccination campaign in Lebanon and correlate them with age and gender. Second, to correlate Pfizer-BioNTech and AstraZeneca vaccines' AEFI with the dose administered. METHODS: A retrospective study was carried out between February 14th, 2021, and February 14th, 2022. AEFI case reports received to the Lebanese Pharmacovigilance (PV) Program were cleaned, validated, and analyzed using SPSS software. RESULTS: A total of 6808 AEFI case reports were received to the Lebanese PV Program during the period of this study. Case reports were mostly received from females (60.7%) and from vaccine recipients aged 18-44 years. As for the vaccine type, AEFIs occurred more frequently with the AstraZeneca vaccine compared to the Pfizer-BioNTech vaccine. The latter had AEFIs mainly following dose 2, whereas AEFIs with the AstraZeneca vaccine were more frequently reported after dose 1, with general body pain being the most reported systemic AEFI with PZ (34.6%), while fatigue was the most reported AEFI with AZ vaccine (56.5%). CONCLUSIONS: The AEFI reported with COVID-19 vaccines in Lebanon were aligned with those reported worldwide. The incidence of rare serious AEFIs should not discourage the public from getting vaccinated. Further studies are needed to evaluate their long-term potential risk.

Cognitive function in recovered COVID-19 Lebanese patients with schizophrenia.

INTRODUCTION: It remains unclear whether COVID-19 which is an infectious disease caused by the SARS-CoV-2 virus is associated with the deterioration of cognitive function among patients with schizophrenia. This study aimed to evaluate changes in cognitive function before and after COVID-19 and associated factors among patients with schizophrenia at the Psychiatric Hospital of the Cross (HPC). METHODS: A prospective cohort study was conducted among 95 patients with schizophrenia followed from mid-2019 until June 2021 at the Psychiatric Hospital of the Cross (HPC). This cohort was divided into a group diagnosed with COVID-19 (n = 71) and another not diagnosed with COVID-19 (n = 24). The questionnaire included the Brief Assessment of Cognition in Schizophrenia (BACS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Activities of Daily Living (ADL). RESULTS: The repeated-measures ANOVA showed no significant effect of time and the interaction between time and being diagnosed or not with COVID-19 on cognition. However, being diagnosed or not with COVID-19 had a significant effect on global cognitive function (p = 0.046), verbal memory (p = 0.046), and working memory (p = 0.047). The interaction between being diagnosed with COVID-19 and cognitive impairment at baseline was significantly associated with a higher cognitive deficit (Beta = 0.81; p = 0.005). Clinical symptoms, autonomy, and depression were not associated with the cognition (p > 0.05 for all). CONCLUSION: COVID-19 disease affected global cognition and memory: patients diagnosed with COVID-19 had more deficits in these domains than those without COVID-19. Further studies are necessary to clarify the variation of cognitive function among schizophrenic patients with COVID-19.

ChatGPT Output Regarding Compulsory Vaccination and COVID-19 Vaccine Conspiracy: A Descriptive Study at the Outset of a Paradigm Shift in Online Search for Information.

BACKGROUND: Being on the verge of a revolutionary approach to gathering information, ChatGPT (an artificial intelligence (AI)-based language model developed by OpenAI, and capable of producing human-like text) could be the prime motive of a paradigm shift on how humans will acquire information. Despite the concerns related to the use of such a promising tool in relation to the future of the quality of education, this technology will soon be incorporated into web search engines mandating the need to evaluate the output of such a tool. Previous studies showed that dependence on some sources of online information (e.g., social media platforms) was associated with higher rates of vaccination hesitancy. Therefore, the aim of the current study was to describe the output of ChatGPT regarding coronavirus disease 2019 (COVID-19) vaccine conspiracy beliefs. and compulsory vaccination. METHODS: The current descriptive study was conducted on January 14, 2023 using the ChatGPT from OpenAI (OpenAI, L.L.C., San Francisco, CA, USA). The output was evaluated by two authors and the degree of agreement regarding the correctness, clarity, conciseness, and bias was evaluated using Cohen's kappa. RESULTS: The ChatGPT responses were dismissive of conspiratorial ideas about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) origins labeling it as non-credible and lacking scientific evidence. Additionally, ChatGPT responses were totally against COVID-19 vaccine conspiracy statements. Regarding compulsory vaccination, ChatGPT responses were neutral citing the following as advantages of this strategy: protecting public health, maintaining herd immunity, reducing the spread of disease, cost-effectiveness, and legal obligation, and on the other hand, it cited the following as disadvantages of compulsory vaccination: ethical and legal concerns, mistrust and resistance, logistical challenges, and limited resources and knowledge. CONCLUSIONS: The current study showed that ChatGPT could be a source of information to challenge COVID-19 vaccine conspiracies. For compulsory vaccination, ChatGPT resonated with the divided opinion in the scientific community toward such a strategy; nevertheless, it detailed the pros and cons of this approach. As it currently stands, the judicious use of ChatGPT could be utilized as a user-friendly source of COVID-19 vaccine information that could challenge conspiracy ideas with clear, concise, and non-biased content. However, ChatGPT content cannot be used as an alternative to the original reliable sources of vaccine information (e.g., the World Health Organization [WHO] and the Centers for Disease Control and Prevention [CDC]).

Does Problematic Use of Social Network Mediate the Association between Bullying Victimization and Loneliness among Lebanese Adolescents?

(1) Background: Bullying victimization has been associated with several behavioral outcomes, particularly loneliness. Similarly, an increase in social network use has been identified in recent years, particularly during the COVID-19 pandemic, and has been shown to be associated with bullying and loneliness. Investigating the mediating factors of loneliness among bullied adolescents is useful for taking preventive measures in the Lebanese population. This study aims to examine the association between bullying victimization and loneliness among Lebanese adolescents while considering the indirect effect of problematic social network use. (2) Methods: We carried out a cross-sectional study, between January and April 2022, that enrolled 379 adolescent Lebanese students (64.9% females, mean age 16.07 ± 1.19 years) who were current residents of Lebanon (15 to 18 years), and were from the five governorates of Lebanon (Beirut, Mount Lebanon, North, South and Bekaa). The snowball method was applied to select our sample; an electronic copy of the questionnaire was created using the Google Forms software and an online strategy was designed to collect the data. (3) Results: Negative social comparison and addictive consequences of problematic use of social network mediated the association between bullying victimization and loneliness. Higher bullying victimization was significantly associated with higher negative social comparison and addictive consequences of problematic use of social network, which in turn were significantly associated with more loneliness. Finally, higher bullying victimization was directly significantly associated with more loneliness. (4) Conclusions: Studying the mediating factors of loneliness in bullied adolescents can improve our understanding of this topic, allowing us to propose new interventions to prevent psychological problems in adolescents. Future studies are needed to further clarify the physiological processes that underlie the associations between social triggers and loneliness during adolescence.

Personality traits and perceived cognitive function in lebanese healthcare professionals.

BACKGROUND: The healthcare field, a well-known field associated with variety of stressors, leaves healthcare professionals at an increased risk of both physical and mental problems. COVID-19 pandemic has recently been added to the stressful factors by endangering further the cognitive function of healthcare workers. On another hand, personality traits have been shown to have pervasive associations with functioning across various cognitive domains. Thus, this study aims to evaluate association between personality traits and perceived cognitive function among healthcare professionals in Lebanon during the collapsing period (following the severe economic crisis and the COVID-19 pandemic). METHODS: This cross-sectional study was conducted between November 2021 and January 2022 enrolled 406 Lebanese participants using the convenience sampling technique for data collection. Healthcare professionals from all specialties who received the online link to the survey were eligible to participate. The Big Five Inventory-2 (BFI-2) and Fact Cog scale were used to assess personality traits and cognitive function. RESULTS: After adjustment over all variables (age, gender, household crowding index, physical activity index, marital status, profession and the other four personality traits), higher negative emotionality was significantly associated with a worse cognitive function, whereas more extroversion and conscientiousness were significantly associated with a better cognitive function. CONCLUSION: Our study adds to the narrow body of research revolving around the relationship between personality traits and perceived cognitive function in Lebanese healthcare professionals during these hard times in Lebanon. These results show that the choice of these cognitive processes is strongly affected by different personality traits, such as extroversion, conscientiousness, and negative emotionality. This study encourages the need to conduct further research that assess the changes in cognition in life stressors along with personality traits.

The co-moderating effect of social support and religiosity in the association between psychological distress and coping strategies in a sample of lebanese adults.

BACKGROUND: Coping involves attempts to mitigate the negative repercussions of stressful situations including psychological distress. The aim of this study was to assess factors affecting coping and examine the role of social support and religiosity in moderating the association between psychological distress and coping strategies in a sample of Lebanese adults. METHODS: A cross-sectional study was carried out between May and July 2022, enrolling 387 participants. The study participants were asked to complete a self-administered survey containing the Multidimensional Scale of Perceived Social Support Arabic Version, the Mature Religiosity Scale, the Depression Anxiety Stress Scale, and the Coping Strategies Inventory-Short Form. RESULTS: Higher levels of social support and mature religiosity were significantly associated with higher problem- and emotion-focused engagement scores and lower problem- and emotion-focus disengagement scores. In people experiencing high psychological distress, having low mature religiosity was significantly associated with higher problem-focused disengagement, seen at all levels of social support. In people experiencing high psychological distress, having moderate mature religiosity was significantly associated with higher problem-focused disengagement, seen at both moderate and high levels of social support. CONCLUSION: Our findings provide novel insight into the moderating effect of mature religiosity in the association between psychological distress and coping strategies affecting adaptive behavior to stress.

Is cyberbullying perpetration associated with anxiety, depression and suicidal ideation among lebanese adolescents? Results from a cross-sectional study.

BACKGROUND: As cyberbullying is a new area of investigation, results worldwide point to the prevalence of cyberbullying perpetration. This study aimed to assess the association between cyberbullying perpetration, anxiety, depression and suicidal ideation among Lebanese adolescents. METHODS: This cross-sectional study was conducted between May and June 2021 and included a sample of adolescents aged between 13 and 16 years old, recruited from private schools chosen in a convenient way from all Lebanese districts. A total of 520 students accepted to participate in our study. To collect data, a questionnaire was shared by google form including: Cyber Bully/Cyber victim questionnaire; Lebanese Anxiety Scale; and Patient Health Questionnaire for Adolescents. RESULTS: The results of the linear regressions, taking anxiety and depression as dependent variables, showed that female gender, having kind of hard and very/extremely hard influence of problems on daily work, sexual cyberbullying in cyberspace, embarrassing and inserting malicious content in cyberspace and older age were significantly associated with more anxiety and depression. Having kind of hard influence of problems on daily work compared to not at all, higher anxiety, higher depression and higher household crowding index (lower socioeconomic status) were significantly associated with higher odds of having suicidal ideation in the last month. CONCLUSION: Cyberbullying perpetration and its associated factors reported in this study are significant enough to call for early detection and prevention strategies for Lebanese adolescents. At the school level, effective programs implemented in the school years are needed, aiming to develop social/emotional control, and conflict resolution skills as they might decrease engagement in cyberbullying perpetration among adolescents. Preventive interventions are needed to reduce the engagement of Lebanese adolescents in cyberbullying perpetration.

Menstrual symptoms variation among Lebanese women before and after the COVID-19 pandemic.

Objectives: Pandemic diseases and the confinement measures due to COVID-19 infection have introduced acute and persistent psychosocial stressors for different individuals with a greater influence on females manifested through changes in the menstrual cycle. The objective of this study was to assess Lebanese female of reproductive age about their menstrual cycle, their mental health, and their lifestyle, throughout the COVID-19 pandemic, Beirut blast, and the economic crises. Methods: A cross-sectional online study conducted between October and December 2021, enrolled 398 Lebanese women using the snowball technique. The Menstrual Symptom Questionnaire (MSQ) was used to assess menstrual symptoms. A repeated measures ANOVA was used to assess factors associated with the variation in MSQ scores after vs before the pandemic. Results: Our results showed that a significantly higher number of days of menses, number of pads per day and total MSQ score were significantly found after the pandemic compared to before it. More distress (Beta=0.68), more post-traumatic stress disorder due to COVID-19 (Beta=0.19), a higher number of waterpipes smoked per week (Beta=1.20) and being infected by COVID-19 compared to not (Beta=3.98) were significantly associated with an increase in the MSQ score after the pandemic compared to before it. Conclusion: Our main findings indicate that females had irregular menstrual cycles, unpredictable bleeding pattern, and intense symptoms severity post COVID-19 pandemic. Furthermore, stress post COVID-19 and Beirut blast tended to be associated with increased menstrual symptoms. Thus, vulnerable women should be identified and offered appropriate care, information, and awareness regarding their menstrual period during a pandemic.

Factors associated with posttraumatic growth: gratitude, PTSD and distress; one year into the COVID-19 pandemic in Lebanon.

Almost one year since the COVID-19 was declared a global pandemic, mental distress remains elevated with high prevalence of post-traumatic stress disorder (PTSD). Yet studies suggest these challenging circumstances might be conducive of post-traumatic growth (PTG). This study aims to investigate the factors associated with growth after the original trauma. A sample of 252 Lebanese adults filled an online survey to determine levels of PTG, PTSD and gratitude using validated self-rating scales. Participants also subjectively evaluated the sources of their distress such as the COVID-19 pandemic, the Beirut port explosion and/or their deteriorating financials. The PTGi-SF evaluated dimensions of growth while the IES-R_22 measured the degree of distress post-trauma. The GQ-6 was used to measure the proneness to experience gratitude daily. Results indicated 41% of participants scored above the cutoff for PTSD symptomatology. Yet, PTSD was positively correlated, alongside gratitude and accumulated subjective distress, with higher levels of PTG. A forward linear regression taking PTG scores as the dependent variable further showed that more gratitude (Beta = 0.57), a higher impact of events (Beta = 0.16), and knowing anyone who died from COVID-19 (Beta = 3.93) were significantly associated with more growth. The study highlights elevated levels of PTSD symptoms in a context of a global pandemic worsened by financial and socio-political instabilities. It mostly identifies personal factors, including high initial symptomatology post-trauma and gratitude, related to the capacity for growth in spite of these accumulating hardships. As such, it advocates the need to investigate and bolster silver linings amidst unprecedented traumas.

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.

Clinical and laboratory factors associated with mortality among hospitalized patients with COVID-19 infection in Lebanon: A multicenter study.

BACKGROUND: With the dire economic situation in Lebanon, many of the basic resources of the hospitals needed to help fight COVID-19 infections are not available. In this paper, we studied the possible factors associated with increased mortality in a sample of Lebanese adults enrolled in three hospitals. METHOD: In this retrospective cohort study, we analyzed data from 416 adults hospitalized in three institutions for a COVID-19 infection, from the opening of the COVID unit until their closure (period extending from March 2020 to June 2021). We used multivariate analyses to assess potential factors associated with COVID-19 mortality: gender, age, the presence of underlying medical conditions, and some medication taken during hospitalization. RESULTS: Using variables related to baseline characteristics entered as independent variables, acute kidney injury (aOR = 4.057) and older age (aOR = 1.053) were associated with a higher probability of death. After adjusting baseline characteristics and factors related to admission entered as independent variables, enoxaparin intake (aOR = 0.435) was significantly associated with a lower probability of death, whereas old age (aOR = 1.049) and ventilation (aOR = 1.2) were significantly associated with higher odds of death. When all variables that showed significance in bivariate analysis were entered, old age (aOR = 1.243) and highest PaCO2 during hospitalization (aOR = 1.192) were significantly associated with higher mortality. With a weak effect, atrial fibrillation, COPD, and higher leucocyte counts on admission were significantly associated with higher odds of death. CONCLUSION: These findings could help us prevent severe diseases in patients with several comorbidities and adjust therapeutic care to improve future outcomes. More studies should compare the outcome of different COVID-19 strains as well as the impact of vaccination on those with multiple comorbidities, especially on the mortality rate culminating from disease complications.

Dissociative experiences among Lebanese university students: Association with mental health issues, the economic crisis, the COVID-19 pandemic, and the Beirut port explosion.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Boredom Proneness, Loneliness, and Smartphone Addiction Among Lebanese Young Adults: The Mediating Role of Depression, Anxiety, and Stress.

Objective: To evaluate the association between boredom proneness, loneliness, and smartphone addiction among Lebanese young adults and examine the mediating role of depression, anxiety, and stress in this association.Methods: This cross-sectional study was conducted between August and September 2020 during the lockdown period of the coronavirus disease 2019 pandemic. An online survey was completed by 461 young adults aged 18 to 29 years.Results: The results showed that 66 of 134 males (49.3%, scores ≥ 31) and 143 of 327 females (43.7%, scores ≥ 33) had smartphone addiction. Smartphone addiction was significantly associated with higher boredom proneness (P < .001), anxiety (P = .012), and loneliness (P = .025). Anxiety mediated the association between boredom proneness and smartphone addiction and between loneliness and smartphone addiction, whereas depression and stress did not mediate the association between boredom/loneliness and smartphone addiction.Conclusions: Smartphone addiction is highly associated with psychological disorders, and screening strategies are needed to minimize addiction. This study emphasizes the importance of investigating the relation between smartphone addiction and psychological disorders.