Laila Farhood

The impact of war on the physical and mental health of the family: The Lebanese experience

This paper addresses the impact of war-related stressful life events on the health of families living through the war conditions prevailing in Lebanon for the past 12 years. Health outcome is represented by indicators of somatization, depression, psychological symptoms, interpersonal relations and marital relations. Associations are described between elements of war stress and the health outcome variables for mothers, fathers and adolescents in a sample of Beirut families. The role of the mediating factors of social support and social class is also discussed.

Exposure to War-Related Traumatic Events, Prevalence of PTSD, and General Psychiatric Morbidity in a Civilian Population From Southern Lebanon:

The South of Lebanon has experienced prolonged armed conflict. The current study aims to investigate the degree of exposure to traumatic events and prevalence of posttraumatic stress disorder (PTSD) and nonspecific general psychiatric morbidity in a civilian population from the South of Lebanon. The design was cross-sectional with random sampling. War-related traumatic events and symptoms of PTSD were assessed by the Harvard Trauma Questionnaire and general psychiatric morbidity by the General Health Questionnaire (GHQ-28). Almost all participants, 97.7%, had experienced, witnessed, or heard of a war-related traumatic event. Current PTSD prevalence was 29.3%. PTSD symptoms correlated highly with GHQ-28 symptoms, r = .73 (p < .0001). The present study indicates a need for psychological interventions in the population and studies to assess such interventions.

Predictors of psychological distress in Lebanese hostages of war

A cross-sectional study addressed the experience of Lebanese hostages of war in Lebanon. It specifically assessed the prevalence of general distress and its relationship to captivity-related factors and selected psychosocial variables. Trained field researchers using standard measurements interviewed 118 Lebanese hostages released from Khiam prison, an Israeli detention center in Lebanon. Questionnaires administered included the GHQ-12 and the Harvard Trauma Questionnaire. Individuals were detained for 3.4 years on average, and 86% were tortured. Psychological distress was present in 42.1% of the sample compared to 27.8% among the control group. In the multivariate analysis, the significant predictors for distress were: years of education and increase in religiosity after release. In conclusion, even after 2 years of release, more than one-third of the Lebanese hostages released from Khiam prison were found to have psychological distress. Caregivers need to pay special attention to the mental health of hostages of war. The paper discusses the meaning and implications of the factors predicting resilience and vulnerability in this particular population.

Testing a model of family stress and coping based on war and non-war stressors, family resources and coping among Lebanese families

This study was undertaken to describe the objective stressors, perceived stress, coping, and resources of families living in Beirut during the Lebanese war (1975-1991) and to test a model predicting the relationships of these variables to family adaptation. The sample consisted of 438 families chosen at random. Independent variables included objective stressors and perceived stress. The mediating variables were family resources and coping strategies. The dependent variables were health and interactional indicators of family adaptation: physical and psychological health, depression, and interpersonal and marital relationships. Findings provided support for the theoretical framework. Multiple regression analyses revealed that perceived stress, rather than the objective occurrence of events, predicted family adaptation. Family resources, particularly social support, positively impacted family adaptation and was associated with increased use of cognitive coping. The findings provide a theoretical model which, on further testing, can serve as a basis for practice by health professionals when working with traumatized families.

Understanding Post-Conflict Mental Health: Assessment of PTSD, Depression, General Health and Life Events in Civilian Population One Year after the 2006 War in South Lebanon

Understanding Post-Conflict Mental Health: Assessment of PTSD, Depression, General Health and Life Events in Civilian Population One Year after the 2006 War in South Lebanon Assessing the psychological impact of war is crucial to meet the needs of communities following conflict. To date, mental health in Lebanon’s southern civilians has not been assessed in relation to the 2006 War. In 2007, face-to-face interviews were conducted in ten villages in South Lebanon. The sample, consisting of 991 adults, was chosen through random sampling using a crosssectional design. The study evaluated PTSD, traumatic events, depression and general health status. Of the total sample, 17.8% met threshold criteria for PTSD, 14.7% for depression and the average GHQ score was 4.31. Significant differences were observed across villages. This study revealed that war-related life events and exposure are highly associated with psychiatric problems one year following a violent conflict.

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. Highlights of the article Identifying predictors of PTSD-depression co-occurrence is paramount to sound assessment and intervention planning. Comorbidity was most strongly predicted by female gender, health problems, social life events, and HTQ witnessed events. Unemployment, having below secondary education, and low social support were also found to predict comorbidity. The substantial overlap in the risk factor profiles that were observed may suggest that PTSD and MDD co-occurrence represent a single general construct derived from traumatic stress.

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.

Comparison of quality of life in a group of Lebanese type 1 diabetics on insulin pump and those on multiple daily injections.

AIM The aim of the study is to investigate the differences in the quality of life (QOL) in Lebanese youths with type 1 diabetes using continuous subcutaneous insulin infusion (CSII) and those using multiple daily injections (MDI) treatment modalities. METHODS A descriptive, cross-sectional, comparative matched design was used. The sample included 36 adolescents and young adults on one of two treatment modalities (CSII or MDI) and matched for age, gender, and level of education. QOL was measured with the Indiana Diabetes Quality of Life for Youth and latest HbA1C level was recorded. RESULTS The CSII group had significantly lower HbA1C levels (p < 0.001), and reported better health perception (p = 0.029), more satisfaction with life (p = 0.002), less impact of the disease (p = 0.002), and fewer worries about their disease (p = 0.029), compared to the MDI group. The overall quality of life score was also significantly better in the CSII group than in the MDI group (p = 0.001). CONCLUSIONS Findings suggest that CSII is associated with better glycemic control and QOL in the Lebanese youth population with type 1 diabetes.

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.