Pia Zeinoun

Reliability and validity of the Arabic Screen for Child Anxiety Related Emotional Disorders (SCARED) in a clinical sample

This study aimed at investigating the reliability and validity of the Arabic Screen for Child Anxiety Related Emotional Disorders (SCARED) as a first child and adolescent anxiety screening tool in the Arab World. The English parent (SCARED-P) and child (SCARED-C) versions were translated into Arabic and administered along with the Arabic Strengths and Difficulties Questionnaire (SDQ) to 77 parents and 67 children attending a Psychiatry clinic. DSM-IV-TR diagnoses were made by a psychiatrist without knowledge of the scale scores. Internal consistency was confirmed by Cronbachs α=0.92 for SCARED-P and 0.91 for SCARED-C. Their subscales had internal consistencies between 0.65 and 0.89. Parent-child agreement was r=0.67, p<0.001. SCARED-P demonstrated good discriminant validity between participants with anxiety disorders and those with other psychiatric disorders (t(72)=3.13, p=0.003). For SCARED-C, this difference was significant when participants with depressive disorders were excluded (t(43)=2.58, p=0.01). Convergent validity was evident through a significant correlation between SCARED-P and the parent SDQ emotional subscale (r=0.70, p<0.001), and SCARED-C and the child SDQ emotional subscale (r=0.70, p<0.001). Divergent validity with the SDQ hyperactivity subscale was observed as no significant correlation was found. Overall, the Arabic SCARED demonstrated satisfactory psychometric properties in a clinical sample in Lebanon.

Validation of an Arabic multi-informant psychiatric diagnostic interview for children and adolescents: Development and Well Being Assessment-Arabic (DAWBA-Arabic)

BACKGROUND Countries in the Arab region lack a valid Arabic psychiatric diagnostic interview for children and adolescents. We set out to establish the diagnostic validity of the Arabic version of the Development and Well Being Assessment (DAWBA-Arabic), a multi-informant structured interview for predicting DSM-IV-TR diagnoses. METHODS The DAWBA was translated, updated, and administered to 45 participants (child and adolescent psychiatric outpatients and their parents) as part of a clinic registry. Two clinicians, blinded to their respective diagnoses, formulated the DAWBA diagnoses. Participants also underwent a clinical evaluation by a child and adolescent psychiatrist who generated clinical diagnoses according to the DSM-IV-TR. RESULTS Inter-rater reliabilities were .93, .82, and .72 for disruptive disorders, mood disorders and anxiety disorders respectively. Agreement between DAWBA and clinical diagnoses was substantial for disruptive disorders (κ=.0.82) and mood disorders (κ=0.74), and moderate for anxiety disorders (κ=0.46). CONCLUSION The DAWBA-Arabic could serve as a valid and reliable clinical tool for assessing psychiatric disorders among children and adolescents in the Arab region.

On enhancing the cross-cultural comparability of Likert-Scale Personality and Value Measures: A comparison of common procedures : Enhancing comparability

This study aims to evaluate a number of procedures that have been proposed to enhance cross–cultural comparability of personality and value data. A priori procedures (anchoring vignettes and direct measures of response styles (i.e. acquiescence, extremity, midpoint responding, and social desirability), a posteriori procedures focusing on data transformations prior to analysis (ipsatization and item parcelling), and two data modelling procedures (treating data as continuous vs as ordered categories) were compared using data collected from university students in 16 countries. We found that (i) anchoring vignettes showed lack of invariance, so they were not bias–free; (ii) anchoring vignettes showed higher internal consistencies than raw scores where all other correction procedures, notably ipsatization, showed lower internal consistencies; (iii) in measurement invariance testing, no procedure yielded scalar invariance; anchoring vignettes and item parcelling slightly improved comparability, response style correction did not affect it, and ipsatization resulted in lower comparability; (iv) treating Likert–scale data as categorical resulted in higher levels of comparability; (v) factor scores of scales extracted from different procedures showed similar correlational patterning; and (vi) response style correction was the only procedure that suggested improvement in external validity of country–level conscientiousness. We conclude that, although no procedure resolves all comparability issues, anchoring vignettes, parcelling, and treating data as ordered categories seem promising to alleviate incomparability. We advise caution in uncritically applying any of these procedures. Copyright

A mixed-methods study of personality conceptions in the Levant: Jordan, Lebanon, Syria, and the West Bank

Personality taxonomies are investigated using either etic-style studies that test whether Western-developed models fit in a new culture, or emic-style studies that derive personality dimensions from a local culture, using a psycholexical approach. Recent studies have incorporated strengths from both approaches. We combine the 2 approaches in the first study of personality descriptors in spoken Arabic. In Study 1, we collected 17,283 responses from a sample of adults in Lebanon, Syria, Jordan, and the West Bank (N = 545). Qualitative analysis revealed 9 personality dimensions: Soft-Heartedness, Positive Social Relatedness, Integrity, Humility versus Dominance, Conscientiousness, Extraversion, Emotional Stability, Intellect, and Openness. In Study 2, we converted the qualitative model into an indigenous personality inventory and obtained self-ratings of a sample of adults in the same region (N = 395). We also simultaneously obtained self-ratings on an adapted etic inventory that measures the lexical Big Five (N = 325). Psychometric and conceptual considerations yielded a robust 7-factor indigenous model: Agreeableness/Soft Heartedness, Honesty/Integrity, Unconventionality, Emotional Stability, Conscientiousness, Extraversion/Positive Social Relatedness, and Intellect. Initial validation evidence shows that 5 of the 7 factors overlapped with the Big Five, whereas Honesty/Integrity and Unconventionality did not overlap. Also, scores on the indigenous tools were better predicted by relevant demographic variables than scores on the etic tool. Our study demonstrated the viability of combining etic and emic approaches as key to the understanding of personality in its cultural context.

Correlates of bullying and its relationship with psychiatric disorders in Lebanese adolescents

Understanding the contextual determinants of bullying behavior is pivotal for effective interventions. This paper describes the prevalence of bullying, its socio-demographic correlates and factors influencing its relationship with psychiatric disorders among a population-based sample of adolescents from Beirut recruited through a two-stage cluster sampling design. Recruited participants (n = 510) and their parents completed a battery of questionnaires and interviews including the Development and Wellbeing Assessment (DAWBA) and the Peer-Relations Questionnaire (PRQ). We found that around 30% of the adolescent participants were involved in bullying. Younger age, lower family income, lower parental education, receiving private tutoring, having an anxiety disorder and having a disruptive behavior disorder were correlated with being bullied by peers while lower family income, repeating a school-grade, and having a disruptive behavior disorder were associated with bullying others. Several factors including gender, age group, family income, and attending private versus public schools moderated the relationship between bullying behavior and having psychiatric disorders. Our findings thus highlight the complexity of the association between psychiatric disorders and bullying in settings like Lebanon.

Arab-Levantine Personality Structure: A Psycholexical Study of Modern Standard Arabic in Lebanon, Syria, Jordan, and the West Bank

OBJECTIVE The debate of whether personality traits are universal or culture-specific has been informed by psycholexical (or lexical) studies conducted in tens of languages and cultures. We contribute to this debate through a series of studies in which we investigated personality descriptors in Modern Standard Arabic, the variety of Arabic that is presumably common to about 26 countries and native to more than 200 million people. METHOD We identified an appropriate source of personality descriptors, extracted them, and systematically reduced them to 167 personality traits that are common, are not redundant with each other, and are familiar and commonly understood in Lebanon, Syria, Jordan, and the West Bank (Palestinian territories). RESULTS We then analyzed self- and peer ratings (N = 806) and identified a six-factor solution comprising Morality (I), Conscientiousness (II), Positive Emotionality (III), Dominance (IV), Agreeableness/Righteousness (V), and Emotional Stability (VI) without replicating an Openness factor. CONCLUSIONS The factors were narrower or broader variants of factors found in the Big Five and HEXACO models. Conceptual and methodological considerations may have impacted the factor structure.

Contextual challenges and solutions to undertaking a household adolescent mental health survey in a developing country

Recent epidemiological evidence for Lebanese adults along with the increased efforts for policy and service planning have demonstrated the importance of screening for rates of psychiatric disorders in the adolescent population. In response to this need, the Beirut Epidemiological Investigation of the Psychological Status of Youth was conducted in a community sample to estimate the prevalence of psychiatric disorders and their correlates among adolescents. The main aim of this report is to provide a synthesis of the research process and challenges faced in completing the first population-based mental health survey among children and adolescents in Lebanon. This report discusses the challenges faced and the lessons learnt in conducting such a survey. Themes discussed include working around the absence of a proper sampling framework, conducting a sound study with limited funding and the absence of a research culture. This report presents evidence-informed recommendations for similar future surveys. The report also establishes that a sound epidemiological survey is possible even where there are limited resources and challenging contexts such as security issues or the absence of a research culture.

Rey Figure Test with recognition trial: normative data for Lebanese adults

Abstract Objective: This study aimed to provide normative data for four trials of the Rey figure Test – a complex design used to assess visuoconstructional abilities, aspects of visual memory, and aspects of executive functioning. Despite its frequent clinical and research use in the Arab region, published studies regarding the measures’ adaptation or normative data remain absent. Method: We administered the Rey figure on a convenience sample of Lebanese (n = 254) aged 30 years to 99. Results: We examined the impact of relevant demographics, and found that age, gender, and years of education impacted scores, and norms were derived based on these variables. Such normative data for the Rey figure enhance its practicality and psychometric adequacy for use in research and clinical settings in Lebanon.

Prevalence and correlates of ADHD among adolescents in a Beirut community sample: results from the BEI-PSY Study

BackgroundThis study aims to investigate the prevalence, correlates and treatment seeking behavior related to ADHD among adolescents from Lebanon.MethodsFive hundred and ten adolescents were recruited through multistage stratified cluster sampling of households in Beirut, and separately interviewed along with one parent/legal guardian, using the DAWBA. All adolescents completed the PRQ and the SDQ; the parent/legal guardian also completed the SDQ and provided basic demographic information, including attitudes towards seeking mental health services.Results10.20% of the adolescents were diagnosed with ADHD. Having ADHD was associated with having academic difficulties and being involved in bullying. Adolescents with ADHD also had higher odds of drinking alcohol, smoking cigarettes, and having comorbid emotional and conduct disorders (compared to those without ADHD). Adolescents with ADHD and their parents reported a higher burden of illness and were more likely to consider seeing a mental health professional than healthy adolescents and their parents.ConclusionADHD among adolescents in Lebanon warrants closer attention, mainly increased awareness in the larger public, and stronger commitment to increase treatment resources to the community.

The Arabic Mood and Feelings Questionnaire: Psychometrics and Validity in a Clinical Sample

The purpose of this study was to provide clinicians in the Arab World with a child and adolescent depression screening tool. Child and parent versions of the Mood and Feelings Questionnaire (CMFQ and PMFQ respectively) were translated to Arabic and administered along with the Strengths and Difficulties Questionnaire (SDQ) to 30 children and adolescents and with mood disorders and 76 children and adolescents with other psychiatric disorders seeking treatment at a child and adolescent psychiatry clinic. DSM-IV diagnoses were generated through clinical interviews by a psychiatrist blinded to self-reports. Internal consistency for both versions was excellent with moderate inter-informant agreement and good convergent validity with the SDQ emotional symptoms subscales on the child and parent forms. The CMFQ and PMFQ significantly differentiated between currently depressed participants and those with other psychiatric disorders. CMFQ scores were a stronger predictor of categorization into depressed and non-depressed groups than the PMFQ. Two modes of cutoffs were calculated with one favoring sensitivity (a score of 26 for the CMFQ and 22 for the PMFQ) and another favoring specificity (a score of 31 for the CMFQ and 28 for the PMFQ).