Focus Groups Investigating Mental Health Attitudes and Beliefs of Parents and Teachers in South Lebanon: Are They Culturally Determined?

INTRODUCTION: The wars that Lebanon had endured led to a devastating number of deaths, injuries, and displacements. Such tragedies have detrimentally affected its civilians psychologically. PURPOSE: To identify knowledge, attitudes, and practices of teachers and parents concerning child/adolescent mental health. METHOD: Using purposeful sampling, five focus groups were conducted with teachers and parents of students from elementary, middle, and secondary levels in two private hub schools in South Lebanon. RESULTS: A total of 27 teachers and 18 parents participated separately in focus groups. Three themes emerged: (a) Mental health care is a priority for overall health, (b) Mental illness is a cultural taboo, and (c) There is a need for better education and cultural understanding about mental health. DISCUSSION: This is the first study in Lebanon directly targeted at parents' and teachers' mental health concerns. Such findings will add to transcultural nursing knowledge about the importance of mental health care.

PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample.

BACKGROUND: Armed conflict, occupation, and political and economic instability that are particularly experienced by the civilian Lebanese population of South Lebanon would almost inevitably affect these individuals psychologically. Therefore, identifying predictors of co-occurring mental disorders is paramount to sound assessment and intervention planning. OBJECTIVE: This study aims to determine the prevalence and predictors of co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) in a post-war population from South Lebanon. METHOD: A total of 991 citizens from 10 villages were interviewed using a cross-sectional design through random sampling. The prevalence of PTSD, MDD, or both was 23.4%. To identify predictors of PTSD and depression co-occurrence, multinomial logistic regression was used. Participants were divided into four groups (participants with no PTSD or depression, participants with PTSD only, participants with depression only, and participants with PTSD-depression comorbidity). RESULTS: Among the significant predictors of PTSD-depression co-occurrence, female gender, health problems, social life events, and witnessed traumatic events were most consistently found. Additionally, employment and educational status, as well as social support, were found to significantly predict co-occurrence. CONCLUSIONS: Results reveal the distinct risk and protective factors that characterize the PTSD-depression profile. These findings will hopefully assist in the development of interventions that are sensitive to individuals' psychosocial milieu.

Validation of an Arabic version of the GHQ-28 against the Beck depression inventory for screening for depression in war-exposed civilians.

This study estimates the psychometric properties of the Arabic GHQ-28 against the BDI-II for screening for depression in war-exposed civilians. Two data sets collected in a civilian sample from South Lebanon were analyzed. Internal consistency in the two samples was high for the GHQ-28 (0.91 and 0.80) and the BDI-II (0.88 and 0.84). The BDI-II was significantly correlated with the GHQ-28 total score and the Depression subscale. The GHQ-28 yielded similar findings for depression cut-off scores compared to the BDI-II: for the GHQ-28 total score, a cut-off at 5/6 is recommended for detecting "severe/moderate" depression, and 8/9 for "severe" only, while from the Depression subscale analysis the recommendation was to use 8/9 as a cutoff for "severe/moderate" and 9/10 for "severe" depression. The Arabic GHQ-28 was found to be a valid instrument for screening for depression in the studied population.

Group mental health interventions in civilian populations in war-conflict areas: a Lebanese pilot study.

PURPOSE: Cognitive behavioral (CB) group therapy is an effective therapeutic intervention to treat war-related trauma. The aim of this pilot study was to describe the effects of conducting CB group therapy in a civilian population exposed to war in southern Lebanon. METHOD: Participants presenting with psychiatric symptoms attended an 8-week CB group therapy intervention adapted to the Lebanese culture. Observations from therapists' field notes were reviewed and grouped into commonalities. FINDINGS: A majority of the total participants (N = 10) reported satisfaction with the CB therapy and a decrease in symptoms. Field notes revealed positive group interactions (i.e., sharing information, cohesiveness), therapeutic benefits (i.e., symptom identification, destigmatizing mental illness, learning coping strategies), and barriers to attendance (i.e., stigma, personal constraints). CONCLUSION AND IMPLICATIONS: CB group therapy is a promising intervention for civilian survivors of war trauma. Challenges to conducting such interventions in a war-conflict area are discussed. Future research and intervention planning should address challenges faced during this study to better meet mental health needs.

Prevalence and predictors for post-traumatic stress disorder, depression and general health in a population from six villages in South Lebanon.

OBJECTIVE: To determine the prevalence and predictors of psychiatric disorders in a general population from South Lebanon, an area that was under military occupation for more than 20 years. METHOD: This study assessed post-traumatic stress disorder (PTSD) and depression thresholds along with general health (GHQ) among 625 citizens in six villages in South Lebanon using a cross-sectional design through random sampling. RESULTS: The prevalence ranged from 17.6 to 33.3% for PTSD and from 9.2 to 19.7% for depression. GHQ total score was found to be 6.7 significantly greater than the internationally established mean score of 5.0. Social support, financial resources, gender, and war exposure were significantly related to PTSD and depression thresholds. CONCLUSION: The results strongly suggest that the general population in South Lebanon suffer from mental health disorders calling for appropriate psychiatric interventions and development planning.

Detainment and health: the case of the Lebanese hostages of war.

The purpose of the current research was to compare former detainees of Khiam prison to a comparison group regarding depression, anxiety, presence of chronic diseases, smoking, and alcohol drinking. The sample consisted of 118 ex-detainees and 90 community controls. The Beck Depression Inventory, the Hamilton Anxiety Scale, the Clinician-Administered Post-Traumatic Stress Disorder Scale, and the Harvard Trauma Questionnaire were used. The ex-detainees suffered from an increased level of depression, high anxiety scores, increased chronic diseases, smoked more, and consumed more alcohol than their comparison group. Regression analyses showed that detainment independently predicted depression and anxiety.

The impact of high and low stress on the health of Lebanese families.

During the Lebanese war (1975-1991) families were subjected to a substantial number of war and nonwar life events that were shown to have a negative impact on family adaptation. The study was undertaken to classify and predict family adaptation outcomes in high and low perceived stress groups for war and nonwar life events. The study took the form of an analysis of cross-sectional data of families in Beirut. The cluster sample consisted of 438 families chosen at random. Variables included perceived stress for war and nonwar events, and health and interactional indicators of the outcome family adaptation assessed in terms of physical and psychological health, depression, and interpersonal and marital relationships. Families were classified into high/low stress based on their score for war and non-war life events. Based on discriminant function analysis, a significant difference existed between the high- and low-stress groups (for war, nonwar, and a combination of the two) on all predictor variables. Interpersonal relationships, physical health, and depression were the best predictors of membership in the high/low war stress groups. In the perceived nonwar stress groups, depression, interpersonal relationships, marital relations, and physical and psychological health were the best predictors separating high/low stress groups. When the combination score of war and nonwar stress was used, interpersonal relationships, physical health, depression, and marital relations were the best predictors distinguishing among the groups. Findings indicated a high degree of consistency in the prediction and classification of the high/low stress groups and for all stress categories. Families in the low-stress groups had a more positive adaptation than those in the high-stress groups and could be classified on the basis of their stress score. Families in the high-stress groups had more complaints than their counterparts in the low-stress groups. This classification may help mental health professionals understand how families adapt in response to normative and non-normative life situations.

PTSD, depression, and health status in Lebanese civilians exposed to a church explosion.

OBJECTIVE: This study examined the effect of stressors on PTSD, depression, and health status in a sample of Lebanese civilians exposed to a church explosion and their comparison groups (33 victims, 30 family members, and 30 neighbors) one year after the event. METHOD: This descriptive study used interviews that were conducted with the participants in their homes. The main outcome measures were the Clinician Administered PTSD Scale Version I, Beck Depression Inventory, and change in health service utilization in the past year. Multivariate analysis was done using logistic regression to predict the study outcomes. RESULTS: PTSD was present in 17.2% of the total sample, depression in 41.9% and the mean increase in doctors' visits was 2.05 +/- 2.97. In the victims' group, 39% met PTSD diagnostic criteria, 51% were depressed, and 45% reported deterioration in their health status. These rates were significantly higher than those in the comparison groups. Also, females were 2.62 times more at risk than males for depression. Victims were 7.35 times and those with financial problems 2.67 times more at risk of having increased doctor's visits than their family or neighbor comparison groups. CONCLUSION: The results suggest that PTSD, depression, and health status deterioration in trauma victims may persist over time. Resources such as social support can help attenuate the symptoms of those at a higher risk.