Moderating Effect of Trait Mindfulness in the Association Between Problematic Social Media Use and Anxiety Among Lebanese University Students.

Objective: Some evidence has shown that problematic social media use (PSMU) is linked to anxiety. However, the nature of this relationship remains unclear, controversial, and poorly addressed due, among others, to a lack of examination of potential moderating and mediating variables. The objective of this study was to test the hypothesis that trait mindfulness may act as a moderator in the association between PSMU and symptoms of anxiety in a sample of university students from Lebanon.Methods: We carried out a cross-sectional study among 363 students (mean age 22.65 years, 61.7% females) using an online survey. All participants were administered the Lebanese Anxiety Scale, the Freiburg Mindfulness Inventory, and the Social Media Disorder Scale. Students were recruited through convenience sampling from several universities in Lebanon between July and September 2021.Results: The multivariate analysis results showed that higher PSMU (B=0.88) was significantly related to more anxiety, whereas greater trait mindfulness (B= -0.42) was significantly related to less anxiety. The interaction of PSMU by mindfulness was significantly associated with anxiety (B=0.04; t357 = 2.34; P= .020). At low levels of mindfulness, higher PSMU was significantly associated with high levels of anxiety; anxiety levels decrease with moderate and high levels of mindfulness, respectively, despite the same level of high PSMU.Conclusion: Findings open up possibilities for new therapeutic approaches when dealing with PSMU among university students. Although further longitudinal studies are required, we preliminarily suggest that the use of trait mindfulness-based interventions may help reduce anxiety levels in students who present with severe PSMU.Prim Care Companion CNS Disord 2024;26(2):23m03664. Author affiliations are listed at the end of this article.

Does loneliness mediate the association between social media use disorder and sexual function in Lebanese university students?

Research on the association between social media use disorder (SMUD) and face-to-face sexual function remains controversial, surprisingly scarce and even non-existing in certain vulnerable populations such as university students. We aimed to explore the mediating role of loneliness between SMUD and two dimensions of sexual function (sexual arousal and desire) in a sample of Lebanese university students. A total of 363 university students participated in a cross-sectional survey. Sexual Dysfunction Questionnaire, Jong-Gierveld Loneliness Scale and Social Media Use Disorder scale were used to measure sexual function (desire and arousal), loneliness and SMUD respectively. The mediation analysis results showed that loneliness mediated the association between SMUD and sexual arousal (but not sexual desire). Higher SMUD was significantly associated with more loneliness, whereas more loneliness was significantly associated with less sexual arousal. Subsequently, higher SMUD was significantly associated with less sexual arousal. The present findings edge the university staff, clinicians, and researchers towards the psychological mechanisms that may help university students improve their sexual function, and calls for additional research in this area. Attention should be given to the possible potential role of moderating social media use in tackling loneliness and improving students' sexual function. In addition, routine sexual counseling should be considered when assessing and intervening with students having SMUD.

Psychometric properties of an Arabic translation of the short form of the metacognition questionnaire (MCQ-30) in a non-clinical adult sample.

BACKGROUND: Previous linguistic validations of the 30-item Metacognition Questionnaire (MCQ-30) have been performed in Western/Eastern populations, and no Arabic validated version exists to date for the wide Arabic-speaking populations in the Middle East-North African region and abroad. In this regard, we sought through the present study to test the psychometric properties of an Arabic translation of the MCQ-30 in a sample of Arabic-speaking community adults from Lebanon. METHODS: The sample of this cross-sectional study consisted of 423 participants (mean age: 38.13 ± 11.03 years; 61.2% females). The Metacognition Questionnaire-short form, Teruel Orthorexia Scale and Emotion regulation questionnaire were used to assess metacognition, orthorexia nervosa and emotion regulation (cognitive reappraisal and expressive suppression) respectively. RESULTS: Findings of Confirmatory Factor Analyses revealed that the five-factor model provided a good fit to the data. McDonald's ω coefficients ranged from 0.78 to 0.94 for the five MCQ-30 subscales, and was of 0.93 for the total score, hence supporting the adequacy of scale reliability. Results also supported configural, metric, and scalar equivalence of the five-factor model across gender groups. The MCQ-30 subscales showed patterns of correlations with the emotion regulation and disordered eating constructs in the expected directions, providing evidence of the criterion-related validity of the measure. In particular, positive emotion regulation strategies (i.e., cognitive reappraisal) were negatively correlated with cognitive self-consciousness and need to control thoughts; whereas maladaptive emotion regulation strategies (i.e., expressive suppression) showed positive correlations with lack of cognitive confidence, negative beliefs and need to control thoughts. Additionally, all metacognition dimensions (except for cognitive self-consciousness) were significantly and positively correlated with higher levels of orthorexia nervosa behaviors. CONCLUSIONS: Our findings preliminarily suggest that the scale is valid, reliable, and can be recommended for use among the broad Arabic-speaking community worldwide.

Validation of an Arabic version of the eating disorder inventory's body dissatisfaction subscale among adolescents, adults, and pregnant women.

INTRODUCTION: The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-oriented body dissatisfaction in research and clinical practice. However, no validated Arabic version of this scale exists to date. In this study, we sought to validate this instrument in three samples of native Arabic-speaking adolescents, adults, and pregnant women from Lebanon. METHODS: A total of 826 adults, 555 adolescents, and 433 pregnant women were included. To examine the factor structure of the BDS, we performed an exploratory factor analysis (EFA), using a principal component analysis via the FACTOR software on the first split-half subsample among Lebanese adults. We used data from the second split-half in the adult sample to conduct a Confirmatory Factor Analysis (CFA) through the SPSS AMOS v.29 software. That verified model was tested via CFA on adolescents and pregnant women. RESULTS: The EFA showed a bidimensional structure for the BDS, with all 9 items retained and divided into Factor 1 = Body Satisfaction (negatively-worded items) and Factor 2 = Body Dissatisfaction (positively-worded items). The CFA demonstrated invariable goodness-of-fit of the instrument in the three studied populations. McDonald's omega values were also adequate in the three samples, demonstrating its reliability. Moreover, the BDS showed invariance across sex among both adolescents and adults. Finally, higher BDS scores were correlated with more disordered eating, less body appreciation and less functionality appreciation, thus attesting to convergent validity of the scale. In addition, BDS scores correlated positively with depression and anxiety scores, indicating adequate patterns of divergent validity. CONCLUSION: In light of our findings, we endorse the use of the BDS by healthcare professionals in Arabic-speaking countries, in order to assess thinness-oriented body dissatisfaction in an appropriate and timely manner and ease early referral to a specialist, thereby preventing the deleterious health-related risks associated with this condition.

Body dissatisfaction is conceptualized as the pejorative subjective assessment of one's own body and discontent with the visual perception of it or with a particular feature of appearance, which is considered to be the most important global measure of stress related to the body. Body dissatisfaction has been found to be a predictor for the development of an eating disorder and occurs in individuals with different mental disorders. The 9-item Body Dissatisfaction Subscale (BDS) of the Eating Disorder Inventory is one of the most used tools for assessing thinness-focused body dissatisfaction, but has not yet been validated in Arabic. To this end, we aimed to translate and validate the Arabic version of the BDS in the present study, which would in turn facilitate research and improve clinical practices related to body dissatisfaction in Arabic-speaking nations. The present findings provide support for the psychometric properties of the Arabic version of the BDS for examining body dissatisfaction in Arabic-speaking adolescents, adults, and pregnant women in Lebanon.

Psychometric performance assessment of the Arabic version of the pregnancy experience scale-brief version (PES-brief) in an Arabic-speaking population.

OBJECTIVE: Although tools exist to assess psychological distress during pregnancy, a scarcity of instruments are designed to measure maternal perceptions of the more positive, uplifting features of pregnancy in addition to the more negative, hassling aspects. To address this shortcoming, DiPietro et al. developed the Pregnancy Experience Scale-Brief (PES-Brief). We aimed to assess the reliability and psychometric performance of an Arabic translation of the PES-Brief among Lebanese pregnant women. METHODS: The PES-Brief, the Patient Health Questionnaire, the Lebanese Anxiety Scale, and the Multidimensional Scale of Perceived Social Support were administered to 433 participants. PES-Brief scores were computed as frequency and intensity, with Hassles to Uplifts frequency and intensity ratios. RESULTS: The PES-Brief was internally consistent, with McDonald's ω = 0.87 for Uplifts and 0.81 for Hassles. Higher PES-Uplifts scores were significantly associated with lower depression and anxiety scores, and higher perceived social support; whereas higher PES-Hassles scores showed inverse correlations. The Hassles to Uplifts frequency and intensity ratios were 0.864 and 0.836, respectively, indicating that pregnant women were more uplifted than hassled. The CFA results confirmed the two-factor structure of the scale. CONCLUSION: Our findings suggest that the Arabic PES-Brief is a psychometrically valid and reliable scale that may be employed as a legitimate indicator of pregnancy-specific uplifts and hassles among Arabic-speaking populations. Our study prompts clinicians and researchers to benefit from this tool for capturing the integral psychological/emotional experience of women during pregnancy, which may facilitate pregnant women's support when needed.

Exploring the relationship between dysfunctional metacognitive processes and orthorexia nervosa: the moderating role of emotion regulation strategies.

BACKGROUND: Dysfunctional metacognitive processes and emotional dysregulation have been widely documented in the eating disorder literature. Despite numerous research and recent consensus suggesting the categorization of orthorexia nervosa as a form of eating disorder, no previous study has examined whether aberrant metacognitive processes also correlate with orthorexia nervosa tendencies. This paper investigates potential associations between symptoms of orthorexia nervosa and dysfunctional metacognitive processes while also exploring whether such relationships may be influenced by adaptive/maladaptive emotion regulation strategies. METHODS: We conducted a cross-sectional study in all Lebanese governorates. In total, 423 Lebanese adults completed an online questionnaire including the Teruel Orthorexia Scale, the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale - 16 Item Version, and the Metacognitions Questionnaire - Short Form. RESULTS: Higher physical activity, expressive suppression, emotion regulation difficulties, positive metacognitive beliefs about worry, and need to control thoughts were significantly associated with higher orthorexia nervosa. Additionally, the emotion regulation strategies moderated the relationships between two dysfunctional metacognitive processes and orthorexia nervosa. Specifically, cognitive self-consciousness was negatively related to orthorexia nervosa only in individuals with low (versus higher) emotion suppression (maladaptive emotion regulation strategy). In contrast, negative beliefs about worry uncontrollability and danger positively predicted orthorexia nervosa only in individuals with lower (versus high) cognitive reappraisal (adaptive emotion regulation strategy). Lower socio-economic status and having a university level of education compared to secondary level were significantly associated with lower orthorexia nervosa. CONCLUSION: Our study provides the first empirical evidence for the existence of significant associations between dysfunctional metacognitive processes and orthorexia nervosa. It also highlights that these pathways are considerably modulated by individuals' ability to regulate their emotions adaptively versus maladaptively. Our findings thus suggest that therapies aimed at improving thought monitoring and emotional regulation may be beneficial for individuals with symptoms of orthorexia nervosa.

Pregnancy through the Looking-Glass: correlates of disordered eating attitudes among a sample of Lebanese pregnant women.

INTRODUCTION: Despite the risks of gestational disordered eating for both the mother and fetus, research into this subject is scarce within developing countries, particularly in Lebanon. Our study's objective was to delve into the predictors of disordered eating attitudes during pregnancy among a sample of Lebanese pregnant women while assessing the potential mediating effect of body dissatisfaction between psychosocial factors and disordered eating attitudes in pregnancy. METHODS: We framed a cross-sectional study, built on self-report measures. Pregnant women of 18 years old and above were recruited from all the Lebanese governorates through an online survey (N = 433). RESULTS: The results showed that higher pregnancy-specific hassles (Beta = 0.19), media and pregnant celebrities' influence (Beta = 0.22), and body dissatisfaction (Beta = 0.17) were significantly associated with increased disordered eating attitudes in pregnancy; whereas higher perceived social support (Beta = -0.03), lower socio-economic status (Beta = -0.84), and multigravidity (Beta = -0.96) were significantly associated with less disordered eating attitudes during pregnancy. Body dissatisfaction mediated the association between pregnancy-specific hassles and disordered eating attitudes, and between social appearance concerns and disordered eating attitudes. CONCLUSION: Our study highlighted that antenatal care, particularly in Lebanon, should no longer be limited to biological monitoring but rather seek to identify possible eating disorders and mental health threats. Further investigations following longitudinal designs should pursue identifying additional correlates of gestational disordered eating in the clinical context, in furtherance of consolidating screening programs and building targeted treatment strategies.

Stressors in hospitalized patients and their associations with mental health outcomes: testing perceived social support and spiritual well-being as moderators.

BACKGROUND: Although hospitalization can be a burdensome experience for all patients, research into the sources of this distress and potential protective factors has so far been scattered, specifically among the broad hospitalized population across all disease types and inpatient units. The present study explores the frequency and nature of the foremost experienced hassles among a sample of Lebanese hospitalized patients, tracing their correlations with depression and anxiety while also investigating positive coping (i.e., perceived social support and spiritual well-being) as potential moderator of these relationships. METHODS: A total of 452 Lebanese inpatients from all medical units filled a survey composed of a list of 38 stressors experienced during hospitalization and other measures assessing depression, anxiety, perceived social support, and spiritual well-being. RESULTS: Pain was the most common stressor experienced by the patients (88.9%), followed by the feeling of being overwhelmed (80.3%). When conducting a factor analysis, 18 stressors loaded on 4 distinct factors, hence yielding 4 main stressor groups (i.e., Illness Apprehension, Hopelessness/Uselessness, Social Isolation, and Spiritual Concerns). The multivariable analysis showed that increased illness apprehension (Beta = 0.69) and hopelessness (Beta = 1.37), being married (Beta = 1.17) or divorced (Beta = 1.38) compared to single, being admitted in a two-bed room compared to one-bed (Beta = 1.59), higher financial burden (Beta = 0.24), and lower socio-economic status (Beta = 1.60) were significantly associated with higher anxiety. Additionally, increased hopelessness (Beta = 0.82) and being married (Beta = 0.79) compared to single were significantly associated with higher depression. However, among patients experiencing high levels of stressors, those with high spiritual well-being and perceived social support had lower depressive/anxiety symptoms. CONCLUSION: Our study characterized the principal stressors encountered during hospitalization, underscoring their associations with Lebanese inpatients' mental health. On the other hand, as perceived social support and spiritual well-being acted as negative moderators of these associations, intervention programs aimed at enhancing such adaptive coping techniques are strongly called upon to palliate the psychological distress of patients in hospital settings.

Exploring the indirect effect of loneliness in the association between problematic use of social networks and cognitive function in Lebanese adolescents.

BACKGROUND: Problematic use of social networks is a widespread problem that may exert deleterious impacts on cognitive functions. Moreover, studies have added an important link between loneliness and its harmful effect on cognitive functions. Other studies have also revealed that problematic use of social networks among teenagers has a pejorative influence on their social interactions, leading to increased social isolation. Therefore, the goal of our research was to investigate the link between problematic use of social networks and cognitive function in a group of Lebanese adolescents while also taking into consideration the indirect role of loneliness in this relationship. METHODS: This cross-sectional study, which was carried out between January and April 2022, included 379 teenagers (aged between 13 and 17 years), from all Lebanese governorates. The PROCESS SPSS Macro version 3.4, model four was used to compute three pathways. Pathway A determined the regression coefficient for the effect of problematic use of social networks on loneliness; Pathway B examined the association between loneliness and cognitive function, and Pathway C' estimated the direct effect of problematic use of social networks on cognitive function. RESULTS: Higher negative social comparison, addictive consequences of problematic use of social networks, and loneliness were significantly associated with worse cognitive function. Loneliness mediated the association between negative social comparison and worse cognitive function, as well as between addictive consequences of problematic use of social networks and worse cognitive function. In addition, higher financial burden was significantly correlated with worse cognitive function, whereas higher physical activity was related to better cognitive function. CONCLUSION: In sum, the current study supports that problematic use of social networks is negatively associated with adolescents' cognitive function, where loneliness seems to play a pivotal role in this equation. The results thus endorse the importance of helping Lebanese adolescents to overcome problematic use of social networks and recover from their loneliness, to achieve a better cognitive/academic performance.

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.

Associations Between Eating Attitudes, Mental Health, and Sexual Dysfunction during Pregnancy.

This cross-sectional study looked into sexual dysfunctions in a sample of Lebanese pregnant women (N = 433) while assessing their psychopathological correlates. It was a first attempt in research to examine the role of disordered eating attitudes in pregnancy, using the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale. The pre/post comparison in terms of sexual functioning was based on the women's recall, using the Pregnancy Sexual Response Inventory. According to the pregnant persons perceptions of their sexual functioning before and during pregnancy, 66.1% of the participants reported a lower frequency of sexual activity during pregnancy, 52.7% lower sexual desire, and 47.3% dyspareunia; 33% were sexually satisfied contrasted to 70% before pregnancy. Pregnancy was significantly associated with lower sexual outcomes compared to before. Higher anxiety and more disordered eating attitudes during pregnancy were significantly associated with lower sexuality composite scores. Our study accentuates the need for rigorous medical guidance on sexual activity during pregnancy and highlights dysfunctional eating behaviors and anxiety disorders as pejorative predictors of the sexual response among pregnant women. It thus sustains the hypothesis that mental health disorders pertain to the pathogenesis of sexual problems and should therefore be targeted in sexual health promotion during prenatal care.

Drunkorexia Among a Sample of Lebanese Adults: The Role of Early Maladaptive Schemas.

Background: Drunkorexia is a food and alcohol disturbance described as being a range of disordered and compensatory eating behaviors that co-occur with excessive alcohol consumption. The remarkable correlation, highlighted in the literature, between dysfunctional cognitions and both eating disorders and substance use disorders is able to emphasize that cognitive phenomena can be an intrapersonal factor linked to drunkorexia disorder. The aim of this study was to assess the correlation between early maladaptive schemas (EMSs) and drunkorexia among a sample of Lebanese adults.Method: We conducted a cross-sectional study across all the Lebanese governorates (September-December 2020; N = 258). The Drunkorexia Motives and Behaviors Scales, Drunkorexia Fails Scale, Drunkorexia during an Alcohol Consumption Event Scale, and Post-Drinking Compensation Scale were used to assess drunkorexia, whereas the Young Schema Questionnaire-Short Form three was used to measure EMSs.Results: Emotional deprivation and subjugation were significantly associated with more drunkorexia motives, whereas emotional inhibition was significantly associated with less drunkorexia motives. Failure was significantly associated with more drunkorexia behaviors. Abandonment and mistrust were significantly associated with more drunkorexia fails, whereas unrelenting standards was significantly associated with less drunkorexia fails. Subjugation was significantly associated with more drunkorexia during alcohol consumption on events. Social isolation was significantly associated with more post-drinking compensation, whereas unrelenting standards was significantly associated with less post-drinking compensation.Conclusion: Our findings showed that drunkorexia is positively associated with EMSs, delineating as well the specific relationships between dysfunctional cognitive schemas and drunkorexia's maladaptive behavioral aspects. They support the hypothesis that EMSs might play an important role in drunkorexia's development and perpetuation. This study could therefore serve healthcare professionals for the cognitive approach of patients with concomitant alcohol misuse and eating disorders while emphasizing the value of cognitive-behavioral interventions-namely schema therapy.

Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess: a case report.

BACKGROUND: Human brucellosis is the most frequently contracted zoonotic infection worldwide. Although being an old disease that carries minimal risks of mortality, it remains a source of considerable sequelae and disability. However, noncontiguous multifocal spinal involvement is an exceptional presentation of brucellosis; additionally, an associated paravertebral abscess is extremely rare. CASE PRESENTATION: This paper focuses on a 67-year-old Lebanese woman with noncontiguous multifocal Brucella spondylodiscitis, involving the T12-L1 and L3-L4 segments, with paravertebral abscess formation. She presented with a 3-week history of acute severe lumbar back pain, radiating to the lower extremities and associated with impaired mobility and lower extremity weakness. The patient complained of night sweating but had no fever. No lymphadenopathy, hepatomegaly, or splenomegaly could be observed. She had painful percussion of the lumbar spine, painful passive mobilization, and paravertebral tenderness, yet her neurological examination was completely normal. BrucellaCapt test was positive at a titer of 1/5120 (reference range 1/180). The patient was treated with an inpatient regimen for 2 weeks, which was followed by an outpatient oral antibiotic regimen with doxycycline, rifampin, and ciprofloxacin to complete a total treatment duration of 3 months. Magnetic resonance imaging was performed at the end of the treatment and showed a complete resolution of the paravertebral abscess. CONCLUSION: Noncontiguous multifocal Brucella spondylodiscitis with paravertebral abscess is an extremely rare presentation. It may be effectively managed by antibiotic therapy, without surgery or drainage, in the absence of neurological complications. Nonetheless, the principal challenge to an efficient management is establishing the diagnosis of Brucella in the first place. In endemic countries, a strong suspicion of spinal involvement of brucellosis should be elicited in front of back pain presentations-even in the absence of fever and other related symptoms.

Initial psychometric properties of an Arabic version of the disordered eating attitudes in pregnancy scale (A-DEAPS) among Lebanese pregnant women.

BACKGROUND: Pregorexia refers to the excessive fear of pregnancy-induced weight gain and the drive to control it through various measures (e.g., extreme restriction of calorie intake, excessive exercising, or diuretics and/or laxatives consumption). The Disordered Eating Attitudes in Pregnancy Scale (DEAPS, Bannatyne et al., in: Disordered eating in pregnancy: the development and validation of a pregnancy-specific screening instrument. Bond University, 2018) is a brief pregnancy-specific instrument developed to screen for antenatal eating disorders. Our study's objective was to examine the reliability and psychometric properties of the Arabic version of this pregnancy-specific scale among Lebanese pregnant women. METHODS: We conceived and implemented a cross-sectional survey between June and July 2021 (N = 433). The sample was randomly divided in two as per the SPSS data selection option; the first subsample was used to conduct the DEAPS items' exploratory factor analysis (EFA), whereas the second was used for the confirmatory factor analysis (CFA). Within this study, we described multiple indices of goodness-of-fit: the Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Tucker Lewis Index (TLI), and Comparative Fit Index (CFI). RESULTS: An EFA was conducted on subsample 1 (N = 207), chosen randomly from the original sample. With the exception of item 8, all other 13 items converged over a two-factor solution [Factor 1 (3 items): Body Image Concerns during Pregnancy, and Factor 2 (10 items): Disordered Eating Attitudes during Pregnancy]. In subsample 2 (N = 226), the CFA results showed that the one-factor model (Factor 2: 10 items), which derived from the EFA conducted on subsample 1, fitted well accordingly to CFI, TLI, and χ2/df values, and fitted modestly according to RMSEA. The CFA estimates obtained for model 1 (original scale of 14 items) and model 2 (according to the two-factor solution obtained from the EFA in subsample 1) fitted less than the third model (Factor 2). The analysis thus suggested retaining only Factor 2 with 10 items in the Arabic version of the scale. CONCLUSION: Our study was able to provide preliminary evidence that the Arabic 10-item version of the DEAPS seems to be a good and reliable tool for the assessment of disordered eating attitudes among Lebanese pregnant women.

Pregnancy remains a complex "biopsychosocial phenomenon" that can witness the emergence of concerns about weight, body image, femininity, and self-esteem. Pregorexia refers to the excessive fear of pregnancy-induced weight gain and the drive to control it through various measures (e.g., extreme restriction of calorie intake, excessive exercising, or diuretics and/or laxatives consumption). The Disordered Eating Attitudes in Pregnancy Scale (DEAPS, Bannatyne et al., in: Disordered eating in pregnancy: the development and validation of a pregnancy-specific screening instrument. Bond University, 2018) is a brief pregnancy-specific instrument developed to screen for antenatal eating disorders. Our study's objective was to examine the reliability and psychometric properties of the Arabic version of this pregnancy-specific scale among Lebanese pregnant women. Ultimately, our study was able to provide preliminary evidence that the Arabic 10-item version of the DEAPS seems to be a good and reliable tool for the assessment of disordered eating attitudes among Lebanese pregnant women.

Association of Social Media Use Disorder and Orthorexia Nervosa Among Lebanese University Students: The Indirect Effect of Loneliness and Factor Structure of the Social Media Use Disorder Short Form and the Jong-Gierveld Loneliness Scales.

The current study aims to examine the relationship between Social Media Use Disorder (SMUD) and Orthorexia Nervosa (ON), and evaluate the indirect effect of loneliness in this association. This cross-sectional study was carried out between July and September 2021. A total of 363 university students were recruited through convenience sampling through several universities in Lebanon's governorates. Data about information about the social media applications mostly used (Instagram, Facebook, Twitter, etc.), the number of times of entry to social media applications, the time spent on these applications, ON, loneliness and SMUD, were also collected. The Mplus v.7.2 software was used to estimate categorical confirmatory factor analyses (CFA) of the SMD and loneliness scales. The one-factorial model of the SMD scale fitted well according to χ2/df (69.71/27 = 2.58), TLI (.967), CFI (.956), and RMSEA values (.066; CI [.047-.085]; pclose = .079). The one-factorial model of the loneliness scale fitted well according to χ2/df (10.30/5 = 2.06) TLI (=0.97), CFI (=0.98), and RMSEA values (=0.054; CI [0.000-0.101]; pclose = 0.379). When entering the social media applications and time spent on these applications as independent variables in a first regression model, using Instagram (Beta = 2.73), using Tumblr (Beta = 3.22), spending 30-60 minutes per day on social media apps compared to less than 30 minutes (Beta = 2.33), higher physical activity index (Beta = 0.04) and loneliness (Beta = 0.67) were significantly associated with more ON. When entering the SMUD score as an independent variable in a second regression model, the results showed that higher SMUD (Beta = 0.50) was significantly associated with more ON. Also, loneliness played a partial indirect role in the association between SMUD and ON (by 16%). The current results can help mental health professionals better detect these potential psychological disorders and might help improve future treatment of issues related to ON and SMUD.

Pros and cons of telemedicine: implications in cardiology and cardiovascular medicine.

The COVID-19 pandemic has highlighted the vitalness of telehealth in our medical world, where considering a restructuring of healthcare services has become paramount. Indeed, in the context of this still ongoing pandemic, medical institutions must strive to improve telehealth technologies and implement solid future research directions in this growing field - to be able to persevere in meeting the needs of the patients. As long as no conclusive evidence exists regarding the fields where telemedicine is most worthwhile, healthcare systems will always keep the dread of wasting resources on developing ineffective programs. We gathered that telemedicine has been attributed a considerable attention in managing cardiac/cardiovascular conditions; nevertheless, further studies with solid designs are still needed to confirm its validity/utility within these specialties.

Maladaptive Cognitive Schemas as Predictors of Disordered Eating: Examining the Indirect Pathway through Emotion Regulation Difficulties.

A scarcity of research has looked into the association of maladaptive core beliefs with dysfunctional eating patterns. Moreover, no prior study has considered the potential role of difficulties in negative emotion regulation when disentangling the complex correlations between early maladaptive schemas and disturbed eating habits. Our study aimed at exploring the distinct relationships between early maladaptive schemas and disordered eating, while investigating the indirect role of emotion regulation difficulties within these associations. We collected data from 982 Lebanese young adults (18-30 years old), distributed across the five Lebanese governorates, who completed the Eating Attitudes Test (EAT-26), the Young Schema Questionnaire-Short Form 3 (YSQ-SF3), and the Difficulties in Emotion Regulation Scale-16 Item Version (DERS-16). The results showed that the disconnection and rejection schema domain, under which the early maladaptive schema of mistrust was the most predictive of disordered/inappropriate eating attitudes. All the remaining maladaptive schema domains (i.e., the impaired autonomy/performance, impaired limits, other-directedness, and overvigilance/inhibition schema domains) exerted significant indirect effects on disordered eating attitudes through difficulties in emotion regulation. Our findings gave prominence to a potential intrinsic mechanism through which maladaptive cognitive schemas are linked to disordered eating behaviors, emphasizing the role of emotion dysregulation as a cardinal actor within this model. They sustain the surmise that cognitively and emotionally vulnerable individuals exhibit stronger propensities for inappropriate dietary patterns, as a means to offset their inner weakness. This study broadens the medical community's insights into the underpinning processes behind eating disorder psychopathology and could therefore make a step towards the adoption of innovative therapeutic approaches that promote emotion regulation skills in the context of schema therapy.

Emotion regulation and drunkorexia behaviors among Lebanese adults: the indirect effects of positive and negative metacognition.

BACKGROUND: Although metacognition processes are a core feature of restrictive eating and alcohol cravings and entail an individual to control both of his/her emotions and thoughts, yet, to our knowledge, a scarcity of research has examined their potential role in drunkorexia as cognitive and emotional predictors. The following study investigates the different associations between two emotion regulation strategies (i.e. emotional suppression and cognitive reappraisal) and drunkorexia behaviors in a sample of Lebanese adults, exploring the possible indirect effects of positive and negative alcohol-related metacognitions. METHODS: This was a cross-sectional study that enrolled 335 participants (March-July 2021). RESULTS: Higher problematic alcohol use (beta = 5.56), higher physical activity index (beta = 0.08), higher expressive suppression (beta = 0.23), higher negative metacognitive beliefs about cognitive harm due to drinking (beta = 0.75) and higher cognitive reappraisal (beta = 0.20) were significantly associated with more drunkorexic behaviors. The positive metacognitive beliefs about cognitive self-regulation significantly mediated the association between cognitive reappraisal and drunkorexia behaviors. Both the positive metacognitive beliefs about cognitive self-regulation and the negative metacognitive beliefs about the uncontrollability of drinking significantly mediated the association between expressive suppression and drunkorexia behaviors. CONCLUSION: This study demonstrated that emotional and metacognitive processes are associated with drunkorexia, addressing as well the mediating effect between deficient emotional regulation and risky behavioral patterns. Overall, our results would speculate that the lack of emotional and cognitive assets might enhance internal distress perceived out of control, leading individuals to indulge in maladaptive behavioral patterns for managing the underlying impairment.

A cross-sectional study of current and lifetime sexual hallucinations and delusions in Lebanese patients with schizophrenia: frequency, characterization, and association with childhood traumatic experiences and disease severity.

BACKGROUND: Till that date, a sparse body of research has been dedicated to perusing psychotic symptoms of sexual type, particularly in psychiatric populations. Our study's objective was to delineate psychotic symptoms with a sexual content, namely sexual delusions and hallucinations, among inpatients diagnosed with schizophrenia in Lebanon, and scrutinize their relationships with the severity of schizophrenia symptoms and childhood abusive events. METHODS: We conducted structured interviews with 167 chronic schizophrenia patients, who completed the Questionnaire for Psychotic Symptoms with a Sexual Content, the Child Abuse Self-Report Scale, and the Positive and Negative Syndrome Scale. RESULTS: 36.5% and 50.3% of the participants screened positive for current and lifetime episodes of sexual delusions and/or hallucinations, respectively. Alcohol drinking (aOR (adjusted odds ratio)current = 2.17; aORLifetime = 2.86) and increased psychological (aORcurrent = 1.09; aORLifetime = 1.09) and sexual (aORcurrent = 1.23; aORLifetime = 1.70) abuse were significantly associated with higher chances of experiencing current and lifetime sexual hallucinations and/or delusions. Additionally, an increased severity of schizophrenia symptoms (aOR = 1.02) was significantly associated with higher chances of current sexual hallucinations and/or delusions, whereas having a university level of education compared to primary (aOR = 0.15) was significantly associated with lower odds of current sexual hallucinations and/or delusions. CONCLUSION: In sum, our findings suggest that sexual psychotic symptoms are prevalent in chronic schizophrenia patients, providing support for their associations with antecedents of childhood traumatic experiences, illness severity, and substance use disorders. They endorse the vitalness of preventive measures against abuse, in order to circumvent such phenomenological outcomes. Our study offers the first data on sexual hallucinations and delusions in a non-Western psychiatric population, thus allowing clinicians and researchers to draw featural comparisons across different cultural settings.

Validation of the Arabic version of the ORTO-R among a sample of Lebanese young adults.

BACKGROUND: Within the literature, there is a variety of different measurement methods for orthorexic behaviours. The ORTO-15 is the one that attracted most research attention. Many scholars criticized the ORTO-15 for its unstable factor structure and over-estimation of the prevalence of orthorexia nervosa. For this purpose, Rogoza and Donini (Eat Weight Disord 26:887-895, 2020) re-assessed the original data and created a new tool, ORTO-R. The development of the ORTO-R theoretically solved many ambiguities associated with its parent measure. However, to date, no study, including the original one, tested the validity of the ORTO-R, leaving its utility somewhat speculative. METHODS: We gathered data from 363 Lebanese individuals, who answered the ORTO-R questions and a set of measures used to determine the validity of the scale (eating attitudes, perfectionism, body dissatisfaction, self-esteem, anxiety, and depression). Within this study, we analysed the internal consistency of the scale and different aspects of its validity (factorial, convergent, and divergent). RESULTS: Results supported all expectations; we successfully confirmed a one-factor measurement model of the ORTO-R, which appeared to be internally consistent. The ORTO-R score correlated positively to other orthorexic behaviours as well as to disordered eating attitudes, perfectionism, anxiety, and depression. It was also negatively related to self-esteem, but was unrelated to body dissatisfaction. CONCLUSION: The ORTO-R may be deemed as a valid instrument for the assessment of orthorexic behaviours. LEVEL OF EVIDENCE: V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.