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Background: The psychological mechanisms that underlie the relationship between self-esteem and life satisfaction remain unclear and not well-understood. We sought through the present study to test the hypothesis that perfectionism plays a significant mediating role in the association between self-esteem and satisfaction with life among Lebanese university students., Methods: A cross-sectional study was performed in a sample of 363 students (61.7% females, mean age = 22.65 ± 3.48 years). Three research instruments were used: satisfaction with life scale, Rosenberg self-esteem scale and big three perfectionism scale., Results: Higher self-esteem was significantly associated with lower self-critical perfectionism (Beta = - 0.47), whereas higher self-critical perfectionism was significantly associated with lower satisfaction in life (Beta = - 0.29). Finally, higher self-esteem was significantly and directly associated with higher satisfaction with life (Beta = 0.48)., Conclusion: The present preliminary findings point to the role of self-critical perfectionism as a buffer between self-esteem and satisfaction with life, suggesting the roles of self-esteem and perfectionism as promising avenues for promoting satisfaction with life in adolescent students., (© 2023. The Author(s).)

The cognitive attentional syndrome (CAS) is a core concept within metacognitive theory. The premise of the CAS is related to metacognition, however its role in psychopathology is distinct. Due to the complex nature of the CAS, a theoretically driven and psychometrically sound self-report measure of the CAS for the Arabic population is yet to be developed. We translated the Multidimensional Cognitive Attentional Syndrome Scale (MCASS) into the Arabic language and tested its structural validity. The MCASS was translated according to the standard guidelines of forward-translation followed by backward-translation. In Study 1, the MCASS was administered to a larger sample ( N = 1027), selected from 22 Arabic-speaking countries in the Arab League countries, and exploratory factor analysis (EFA) was used to examine the factor structure of the measure. Those who participated in Study 1 were excluded from participating in Study 2. Confirmatory factor analysis (CFA) was used in Study 2 ( N = 567) to assess the latent factor structure of MCASS, which supported a six-factor model. Results support multidimensional assessment of the CAS using the MCASS, and demonstrate suitability for use in Arab speaking samples. Implications of this study and recommendations for use of the Arabic version of MCASS are discussed.

Background: Despite a large body of research has shown that smartphone addiction (SA) is associated with aggressive behaviors, only a few mediators have been previously examined in this relationship among early adolescent students. No previous studies have explored, to our knowledge, the indirect role of cognitive function despite its great importance during this life period. This study is intended to verify whether cognitive function have indirect effects on the relationship between SA and aggression among high-school students in the context of Lebanese culture., Methods: This was a cross-sectional designed study, conducted between January and May 2022, and enrolling 379 Lebanese adolescent students (aged 13-17 years). The Cognitive Functioning Self-Assessment Scale, the Buss-Perry Aggression Questionnaire-Short Form, and the Smartphone Addiction Scale-Short form were used., Results: The bivariate analysis results revealed that higher SA and worse cognitive function were significantly associated with more physical aggression, verbal aggression, anger and hostility. The mediation analyses found that cognitive function mediated the association between SA and physical aggression, verbal aggression, anger and hostility. Higher SA was significantly associated with worse cognitive function and more physical aggression, verbal aggression, anger and hostility. Finally, worse cognitive function was significantly associated with more physical aggression, verbal aggression, anger and hostility., Conclusion: Our findings cautiously suggest that, to reduce adolescent students' aggression, interventions that promote cognitive performance may be effective. Particularly, students who are addicted to smartphones and show aggressive tendencies require interventions designed to improve cognition function., (© 2022. The Author(s).)

Background: Given the high clinical utility of grit, and the lack of measures that assess this construct among the Arabic-speaking populations, we propose to examine the psychometric properties of an Arabic translation of the Oviedo Grit Scale (A-EGO) in terms of internal consistency, factor structure, convergent validity, and measurement invariance in a sample of Lebanese adults from the general population., Methods: We performed a cross-sectional, online study among 575 participants from the Lebanese general population (mean age = 26.28 years [SD: 8.83], 72.7% females). The unidimensional factorial structure of the A-EGO was analyzed by confirmatory factor analysis (CFA) using the MPlus8 program. The mean and variance adjusted weighted least squares (WLSMV) was used as the estimation method. The reliability of the scores, the evidence of validity in terms of measurement invariance and correlation with other variables were analyzed., Results: The present results show that the 10 items of the A-EGO loaded on one factor. The internal consistency was excellent in our sample, as evidenced by a Cronbach's alpha value of .93. Multi-group confirmatory factor analyses demonstrated invariance across gender, governorate, and marital status at the configural, metric and scalar levels. Additionally, A-EGO scores showed moderate and positive correlations with self-control (r = .442), conscientiousness (r = .478), and productiveness facet (r = .506), supporting the convergent validity of the A-EGO., Conclusion: Our findings indicate that the A-EGO has good psychometric properties and can be recommended for the assessment of grit among the broader Arabic-speaking people worldwide. Making this scale available in the Arabic language will hopefully foster research in this area in Arab countries., (© 2022. The Author(s).)

Background: All available scales to screen for child abuse may be challenging to administer due to their length. Indeed, a higher number of items is associated with more administration time and less motivation to engage in responding. We aimed through this study to examine the psychometric properties of a brief Arabic version of the Child Abuse Self Report Scale (CASRS-12) in terms of factorial structure, internal consistency, divergent validity, and correlations with measures of bullying victimization, eating attitudes and perceived social support., Methods: We performed a cross-sectional, web-based study among Community Lebanese adolescents; where two samples have been used (Sample 1: N = 852, aged 15.34 ± 1.18 years, 54.8% females; Sample 2: N = 404, aged 16.60 ± 1.51 years, 57.2% females). The construct validity was tested using both exploratory and confirmatory factor analyses., Results: Results revealed that both EFA and CFA yielded a four-factor structure for the CASRS-12 that mirrors the original four factors captured by the original CASRS. The scale also showed a good internal consistency as evidenced through McDonald's ω values ranging from 0.87 to 0.93 for the four subscales; and configural, metric, and scalar invariance across gender. Finally, we found that all CASRS-12 dimensions were significantly and positively correlated with more inappropriate eating attitudes and lower social support; and that psychological, physical, and sexual abuse correlated with higher bullying victimization CONCLUSION: In light of these findings, we potentially encourage clinicians and researchers to use this scale as a valid and reliable measure of child abuse among Arabic-speaking populations., (© 2022. The Author(s).)

Introduction: There have been no previous meta-analytic studies that have looked at the prevalence of insomnia symptoms in different COVID-19 groups using a single assessment instrument to evaluate insomnia symptoms while maintaining data homogeneity. The current review's associated goal is to undertake an individual participant data (IPD) analysis to further investigate past meta-analyses, a method that has been shown to be more robust than standard meta-analyses., Meethods: Only studies that used the Insomnia Severity Index (ISI) to assess insomnia are used in this analysis. The IPDMA was performed and registered in PROSPERO in compliance with the PRISMA IPD Statement (CRD42021275817). From November 2019 to August 2021, researchers explored seventeen databases and six preprint services for relevant studies., Results: The pooled estimate of insomnia symptoms (subthreshold and clinically significant) was 52.57%. An estimated 16.66% of the population suffered from clinically significant insomnia, of which 13.75% suffered from moderate insomnia, and 2.50% suffered from severe insomnia. The different populations' grouping had no statistically significant differences in the prevalence of insomnia symptoms. Insomnia symptoms did not appear to be associated with age or sex., Conclusion: Our findings imply that the COVID-19 pandemic is linked to a significant rise in subthreshold insomnia symptoms, but not to moderate or severe insomnia. Educating people from all walks of life about the importance of sleep and the risk of acquiring insomnia symptoms during this or future pandemics should be a top concern., Competing Interests: Declaration of competing interest The authors do not have any conflicts of interest to disclose., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Adolescents are at high risk of incident psychopathology. Fleeting psychotic experiences (PEs) that emerge in young people in response to stress may be warning signs that are missed by research that fails to study stressed populations, such as late high school and college/university students. Our aim in this systematic review was to conduct a meta-analysis that estimates prevalence rates of PEs in students, and to assess whether these rates differ by gender, age, culture, and COVID-19 exposure., Method: We searched nine electronic databases, from their inception until January 31, 2022 for relevant studies. We pooled the estimates using the DerSimonian-Laird technique and random-effects meta-analysis. Our main outcome was the prevalence of self-reported PEs in high school and college/university students. We subsequently analyzed our data by age, gender, population, country, culture, evaluation tool, and COVID-19 exposure., Results: Out of 486 studies retrieved, a total of 59 independent studies met inclusion criteria reporting 210' 024 students from 21 different countries. Nearly one in four students (23.31%; 95% CI 18.41%-29.05%), reported having experienced PEs (heterogeneity [Q = 22,698.23 (62), p = 0.001] τ 2  = 1.4418 [1.0415-2.1391], τ = 1.2007 [1.0205-1.4626], I 2  = 99.7%, H = 19.13 [18.59-19.69]). The 95% prediction intervals were 04.01%-68.85%. Subgroup analyses showed that the pooled prevalence differed significantly by population, culture, and COVID-19 exposure., Conclusion: This meta-analysis revealed high prevalence rates of self-reported PEs among teen and young adult students, which may have significance for mental health screening in school settings. An important realization is that PEs may have very different mental health meaning in different cultures., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The purpose of this review was to estimate the prevalence of screen-based disordered eating (SBDE) and several potential risk factors in university undergraduate students around the world., Methods: An electronic search of nine data bases was conducted from the inception of the databases until 1st October 2021. Disordered eating was defined as the percentage of students scoring at or above established cut-offs on validated screening measures. Global data were also analyzed by country, research measure, and culture. Other confounders in this review were age, BMI, and sex., Results: Using random-effects meta-analysis, the mean estimate of the distribution of effects for the prevalence of SBDE among university students (K = 105, N = 145,629) was [95% CI] = 19.7% [17.9%; 21.6%], I 2  = 98.2%, Cochran's Q p value = 0.001. Bayesian meta-analysis produced an estimate of 0.24, 95% credible intervals [0.20, 0.30], τ = 92%. Whether the country in which the students were studying was Western or non-Western did not moderate these effects, but as either the mean BMI of the sample or the percentage of the sample that was female increased, the prevalence of SBDE increased., Conclusions: These findings support previous studies indicating that many undergraduate students are struggling with disordered eating or a diagnosable eating disorder, but are neither receiver effective prevention nor accessing accurate diagnosis and available treatment. It is particularly important to develop ever more valid ways of identifying students with high levels of disordered eating and offering them original or culturally appropriate and effective prevention or early treatment., Level of Evidence: I, systematic review and meta-analysis., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Teachers have a crucial active role in provision of mental health services to students and fighting against mental health stigma in schools, hence their attitudes and beliefs toward mental illness should be assessed., Method: We carried-out a cross-sectional study with a non-probabilistic sample of 304 higher secondary school teachers. We used a structured questionnaire in which a vignette describing an individual with schizophrenia was presented, and was followed by a series of stigma-related questions., Results: A substantial proportion of teachers endorsed stressful life events (79.6%) as a cause of schizophrenia, elicited feelings of discomfort (41.4%) and incomprehension (41.1%) with the person displaying symptoms of schizophrenia, and agreed that the person's condition will deteriorate even more (45.4%). Teachers perceived that the person described in the vignette is dependent on others, lacks will, is different from others and is unpredictable in 65.1%, 59.2%, 55.6%, and 49.7% of cases, respectively. In addition, 38.5% and 34.2% of teachers recommended turning to traditional healers and to a Sheikh or an imam of a mosque, respectively. Regarding gender effects, females with schizophrenia were regarded as more likely to be unable to make her own decisions and to be dependent on others than males, and were less likely to be recommended for seeking help from a family physician or to consult a psychiatric hospital than males., Conclusion: In the light of our findings, raising awareness of teachers of the impact of mental health issues on students should be prioritized in high schools in Tunisia.

Background: The profile of adolescents with orthorexic eating behaviors remains to be explored. This study is the first to explore the typology of Lebanese adolescents from a large non-clinical sample based on orthorexia nervosa (ON) and healthy orthorexia (HO)., Method: A total of 555 adolescents (aged between 15 and 18 years) completed a set of questionnaires assessing orthorexic behaviors, self-esteem, stress, depressive and anxiety symptoms. Cluster analysis based on ON and HO scores was used to identify the typology of the sample. More precisely, this analysis was used to reveal and distinguish between naturally occurring subgroups of individuals with different orthorexic eating profiles, within the studied sample. Further, a series of one-way ANOVA was used to compare observed clusters based on their scores on used questionnaires. This analysis was used to capture the behavioral and psychological differences between previously yielded subgroups of individuals., Results: Cluster analysis based on ON and HO scores yielded 3 distinct groups: "Low orthorexia", "Moderate in-between orthorexia" and "High in-between orthorexia". While the first group represented individuals with no particular (healthy or pathological) interest in healthy eating, the two latter groups represented those with respectively moderate and high degrees of an interest in healthy eating that has both pathological and healthy aspects. Significant differences between clusters regarding their levels of stress, depression, anxiety and self-esteem was observed, yet they were found to be negligible due to poor effect sizes., Conclusion: Findings from this study suggest that ON and HO can indeed co-occur among adolescents, that this co-occurrence can be experienced at different severity levels. Low effect sizes for ANOVA comparisons may suggest the possibility of the co-occurrence of ON and HO reducing the negative effects of ON behavior to some degree. The potential role of confusion around what constitutes "healthy eating" in the emergence of these "in-between orthorexia" profiles is put forward., (© 2022. The Author(s).)

Objectives: To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia., Methods: A total of 131 patients diagnosed with schizophrenia participated in this cross-sectional study., Results: Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = -1.59, p = 0.009) were significantly associated with higher mean aggression scores., Practical Implications: Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies., (© 2022 Wiley Periodicals LLC.)

Introduction: NOMOPHOBIA is a term used to describe an anxiety disorder in which people fear being disconnected from their mobile phones. Strong associations between nomophobia and insomnia have previously been documented. However, there is no clear explanation for this relationship between the two disorders. The present study was designed to first determine the diagnostic precision of the Insomnia Severity Index (ISI) various components in detecting or classifying nomophobia; and second, examine the diagnostic performance of the identified ISI components in classifying nomophobia., Methods: From a previous study 549 participants completed demographic information, the Nomophobia Questionnaire (NMP-Q), and the ISI. The sample was divided into two parts so that each part represented the original sample, using a 40% (n = 209) allocation for sample 1 and 60% (n = 340) for sample 2. To determine common components between nomophobia and insomnia, an exploratory factor analysis was performed using sample 1 to determine the diagnostic precision of the ISI's various components in detecting or classifying nomophobia. A test of the ISI and a cut-off value (ISI-4 ≥2) was then conducted on Sample 2 to determine whether they would accurately identify significant nomophobia., Results: Sleep dissatisfaction was a common component of insomnia and nomophobia. Sleep dissatisfaction had excellent diagnostic accuracy in detecting individuals with nomophobia (sensitivity 75.13%, specificity 100%, Youden' index 0.75, area under curve 0.88)., Conclusion: Questioning patients sleep dissatisfaction may serve as a marker for both nomophobia and insomnia, both of which may demand more comprehensive evaluation., (Copyright © 2022 Elsevier B.V. All rights reserved.)

We examined the immediate impact of a social media outage on nomophobia and associated symptoms using a longitudinal cohort design. Data were collected at two timepoints, baseline (T1) and during the social media outage of 4 October 2021 (T2). T1 was collected in August-September 2021 as part of the baseline of an ongoing study. The nomophobia questionnaire (NMP-Q), Generalized Anxiety Disorder-7 scale (GAD-7), and Athens insomnia scale (AIS) were administered to 2706 healthy participants from the general Bahraini population (56% females, mean age 33.57 ± 11.65 years). Approximately one month later, during the social media outage, 306 of the study participants were opportunistically assessed using the NMP-Q. At baseline, we found that nomophobia levels strongly correlated positively with both insomnia ( p = 0.001) and anxiety symptoms ( p = 0.001). This is the first report to examine the impact of a social media outage on nomophobia. Our findings indicate that symptoms of nomophobia increased significantly during a social media outage. Baseline insomnia scores predicted a surge in the global scores of nomophobia symptoms during a social media outage.

There is strong evidence that sleep disturbances are commonly experienced by people with psychosis. Evidence has also shown that sleep disturbances are present since the very early stages of the disease, even during the pre-diagnostic phase. More recently, research involving young individuals at ultra-high risk (UHR) for psychosis documented frequent occurrence of sleep disturbances in this group. The very early onset of sleep disturbances in the course of psychosis has drawn attention to the possible links between sleep parameters and the risk of psychosis. To date, the nature of sleep disturbances characterizing the UHR stage remains unclear, with available studies having yielded mixed findings. In this regard, we performed this review to update the body of literature on the nature of sleep disturbances, their underlying mechanisms, their clinical and functional consequences, the prevention and intervention strategies in the at-risk for psychosis population. Our findings provided further support to the presence of disturbed sleep in UHR individuals as evidenced by subjective and objective sleep measures such as polysomnography, sleep electroencephalograms, and actigraphy. Reviewing the possible mechanisms underlying the relationship between sleep and psychosis emphasized its complex and multifactorial nature which is yet to be determined and understood. Further research is warranted to determine which facets of sleep disturbances are most detrimental to this specific population, and to what extent they can be causal factors or markers of psychosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fekih-Romdhane, Hallit, Cheour and Jahrami.)

Work addiction is considered a public health concern, as it can lead to negative and harmful health outcomes. However, patterns leading from work addiction to mental health concerns remain so far largely unknown and under-studied. We aimed to verify whether the relationship between work addiction and psychological distress (i.e., depression, anxiety, and stress) is mediated by food addiction among young adult workers in the context of Lebanese culture. The second objective was to validate the Arabic version of the Bergen Work Addiction Scale (BWAS). The online cross-sectional survey was conducted among 1268 Lebanese young adult workers (65.1% females, mean age 26.18 years) using the Bergen Work Addiction Scale, the Depression Anxiety and Stress Scale, the Yale Food Addiction Scale, and the Three-Factor Eating Questionnaire. The PROCESS SPSS Macro version 3.4, model four, was used to compute the mediation analysis. Findings revealed that 175 (13.8%) were presented as work-addicted individuals, and 226 (17.8%) exhibited addictive -like eating behaviors. Bivariate analyses showed that higher degree of work addiction and food addiction was significantly associated with higher levels of depression, anxiety, and stress. The results of the mediation analysis showed that the association between work addiction and depression, anxiety, and stress was mediated by food addiction. In light of our findings, we cautiously suggest that the link of work addiction to psychological distress via food addiction implies that strategies targeting food addiction might mitigate the harmful effects of work addiction on workers' mental health., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The struggle with breast cancer (BC) is often associated with positive changes after diagnosis and treatment, that are being referred to as posttraumatic growth (PTG). We aimed to examine PTG and its relationship with psychosocial (i.e., psychological distress, spiritual well-being, social support), sociodemographic and cancer-related variables in Tunisian women operated on for breast cancer. This was a cross-sectional study. Seventy-nine (79) postoperative BC women were administered the Post-Traumatic Growth Inventory, the Spiritual Well-being Scale, the Depression, Anxiety and Stress Scales, and the Multidimensional Scale of Perceived Social Support. The changes most frequently reported by participants were discovering that they were stronger than they thought they were (70.0%), having stronger religious faith (65.0%), and being better able to accept the way things work out (63.8%). Multivariate analysis showed that anxiety and social support remained significantly associated with PTG, while no significant relationship has been found for spiritual well-being. Overall, the present study adds to the existing body of research by identifying factors related to women' s experience of PTG in a previously unexplored Arab Muslim cultural context, Tunisia. We believe that our findings may help inform strategies aiming at promoting positive psychological changes after experiencing BC, at least in our context.

Background: Medical students are at a significant risk of experiencing psychological issues, such as burnout. Over the past few years, more studies have been conducted on this topic, producing different results., Aims: The purpose of this review was to determine the global pooled prevalence rate and risk factors associated with burnout and its components among undergraduate (pre-intern) medical students., Method: From inception until 30 November 2021, nine electronic databases were used for an electronic search. Using random-effects meta-analysis, we pooled the estimates using the DerSimonian-Laird method. The prevalence of burnout in medical students was the primary outcome of interest. Data were analyzed globally, by country, by research measure. Age and sex were examined as confounders using meta-regression analysis., Results: A random-effects meta-analysis of 42 studies involving 26,824 evaluating the prevalence of burnout in medical students showed an overall prevalence rate 37.23% [32.66%; 42.05%], Q  = 2,267.15(41), p  < .0001, τ 2  = .42, τ = .65, I 2  = 98.2%; H  = 7.5. Prevalence of emotional exhaustion, depersonalization, and personal accomplishment were 38.08% [30.67%; 46.10%], 35.07% [26.74%; 44.41%], and 37.23% [32.66%; 42.05%], respectively. Variations were observed between countries and research measures. Age (older) and sex (female) were both significant predictors of burnout., Conclusion: The prevalence of burnout in medical students was estimated to be 37.23%. It is urgent that future studies serve as a basis for the development of prevention and treatment programs to prevent and treat burnout in students.

Objectives: Awareness regarding organ donation has been steadily growing in the Arab world yet is still far from the current demand. A thorough analysis of population behavior toward organ donation can improve organ transplant education. Therefore, we designed this study to assess the knowledge, attitude, donation desires, and views on organ donation among adults in Arab countries., Materials and Methods: An observational cross- sectional study approach was used by assessing 1004 adult survey respondents from 22 Arab countries through the snowball sampling technique via social media platforms and emails. A fact sheet was used to collect demographic information, which was followed by a predesigned questionnaire to assess the attitude and willingness of participants toward solid-organ donation., Results: Results showed that only 17.0% of respondents had willingness to donate in the future, and only 2.0% respondents were already organ donors or registered as organ donors. Respondents indicated that the most acceptable organs to be donated after death were kidneys (57.8%), followed by liver (45.1%) and heart (42.3%). Regarding the type of surgery for living donation, 48.1% of the respondents had no surgery type preference, whereas 12.9% would only agree to laparoscopic intervention. A significant difference (P < .001) was noted among respondents with transplant experience and without experience regarding organ donation willingness. In terms of paired exchange and list exchange donation, 18.0% indicated that they would refuse to donate, 23.0% would accept, and 19.0% would accept if no alternative was available., Conclusions: This study highlighted the psychology of the Arab world and factors influencing decisions toward solid-organ donation and transplant. The biggest factor for unwillingness to donate organs was posttransplant health-related risks; almost 50% of respondents were afraid of health complications. A need for awareness and education regarding the importance of organ donation and transplant emerged as common themes in this study.

Background: Eating disorders are quite common around the world, disabling, and potentially lethal; but they remain so far under-captured and subject to substantial delays in treatment. We propose through this study to develop and validate a shortened version of the Eating Attitude Test (EAT) in the Arabic language among non-clinical Arabic-speaking Lebanese participants from the general population., Methods: 1175 participants enrolled in this cross-sectional study, based on an online survey. The Eating Attitude Test-26 items, Drunkorexia Motives and Behaviors Scales and Lebanese Anxiety Scale were used to answer our objectives., Results: Our results confirmed validity and reliability of the questionnaire. Exploratory Factor Analyses showed that all items converged over a one-factor solution, with an excellent Cronbach's alpha (> 0.9). Confirmatory Factor Analyses found that the 7-item-version yielded excellent model fit. The instrument also revealed strong evidence of divergent validity, being highly correlated with measures of anxiety and drunkorexia motives and behaviors., Discussion: Findings provided evidence supporting that the Arabic seven-item one-factor structure of the scale (EAT-7) is valid, reliable, and can be used in clinical practice, preventive interventions and future eating disorders research in Arab settings., (© 2022. The Author(s).)

The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) ( p = 0.03, Cohen's d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) ( p = 0.001, Cohen's d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.

Purpose: Medical students have a higher risk of developing psychological issues, such as feeding and eating disorders (FEDs). In the past few years, a major increase was observed in the number of studies on the topic. The goal of this review was to estimate the prevalence risk of FEDs and its associated risk factors in medical students., Methods: Nine electronic databases were used to conduct an electronic search from the inception of the databases until 15 th September 2021. The DerSimonian-Laird technique was used to pool the estimates using random-effects meta-analysis. The prevalence of FEDs risk in medical students was the major outcome of interest. Data were analyzed globally, by country, by research measure and by culture. Sex, age, and body mass index were examined as potential confounders using meta-regression analysis., Results: A random-effects meta-analysis evaluating the prevalence of FEDs in medical students (K = 35, N = 21,383) generated a pooled prevalence rate of 17.35% (95% CI 14.15-21.10%), heterogeneity [Q = 1528 (34), P = 0.001], τ 2  = 0.51 (95% CI 0.36-1.05), τ = 0.71 (95% CI 0.59-1.02), I 2  = 97.8%; H = 6.70 (95% CI 6.19-7.26). Age and sex were not significant predictors. Body mass index, culture and used research tool were significant confounders., Conclusion: The prevalence of FEDs symptoms in medical students was estimated to be 17.35%. Future prospective studies are urgently needed to construct prevention and treatment programs to provide better outcomes for students at risk of or suffering from FEDs., Level of Evidence: Level I, systematic review and meta-analysis., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Aim: We aimed to further elucidate the under-researched, underdiagnosed and misunderstood comorbid pica in the context of psychosis., Method: We report a case of teen-onset plastophagia in an antipsychotic-naïve girl at ultra-high risk (UHR) for psychosis., Results: HA is a 17-year-old unmarried girl who had a history of good premorbid functioning, no personal psychiatric history and an uncle with schizophrenia. She was referred to our psychiatry department with the complaint of having the habit of eating plastic for about 2 years. A thorough clinical history revealed that she developed, since more than a year, difficulty in school and interpersonal functioning. After clinical evaluation, a diagnosis of UHR with major depressive disorder, iron deficiency anaemia and pica was made., Conclusion: We draw attention to the possibility of an overlap between the pathogenesis of pica and psychosis, and we highlight the importance of early diagnosis and management of both pica and UHR since they can lead to serious medical and mental consequences., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Similarly to patients with schizophrenia, non-clinical individuals with schizotypal traits have been reported to show an increased risk for suicide-related outcomes. We aimed to assess suicidal ideation, and to determine factors that may have associations with help-seeking attitudes in high schizotypal individuals as compared to low schizotypal individuals., Method: We carried out a cross-sectional survey. The Schizotypal Personality Questionnaire, the attitudes toward seeking professional psychological help scale-short form, the disclosure expectations scale, the scale of suicide ideation, the stigma of suicide scale-short form, the literacy of suicide scale, and the depression anxiety stress scales were administered to 504 college students. A total of 51 students were classified in the high-schizotypy group, and 50 were classified in the low-schizotypy group., Results: High-schizotypal students experienced significantly more suicidal ideation, had greater literacy of suicide, had more glorification of suicide, had higher anticipated risks of disclosure and more negative help-seeking attitudes than low-schizotypal students. After controlling for sociodemographic (age, gender, income and tobacco use) and psychosocial variables (personal psychiatric history, family history of suicide, personal history of suicide attempt[s]), depression and suicide ideation), disclosure expectations had both a significant negative independent effect through anticipated risks, and a positive independent effect through anticipated benefits, on high-schizotypal students' help-seeking attitudes., Conclusion: The apprehension and reluctance to seek help found in high-schizotypal students highlight an urgent need to further understand barriers to help-seeking among at-risk adolescents, and what may motivate them to reach out for support when they are more at-risk for suicide., (© 2021 John Wiley & Sons Australia, Ltd.)

This systematic review and meta-analysis evaluated the extent of sleep disturbances during the COVID-19 pandemic. Eleven databases and six preprint repositories were searched for the period from November 1, 2019, to July 15, 2021. The DerSimonian and Laird method was used to develop random-effect meta-analyses. Two hundred and fifty studies comprising 493,475 participants from 49 countries were included. During COVID-19, the estimated global prevalence of sleep disturbances was 40.49% [37.56; 43.48%]. Bayesian meta-analysis revealed an odds of 0.68 [0.59; 0.77] which translates to a rate of approximately 41%. This provides reassurance that the estimated rate using classical meta-analysis is robust. Six major populations were identified; the estimated prevalence of sleep problem was 52.39% [41.69; 62.88%] among patients infected with COVID-19, 45.96% [36.90; 55.30%] among children and adolescents, 42.47% [37.95; 47.12%] among healthcare workers, 41.50% [32.98; 50.56%] among special populations with healthcare needs, 41.16% [28.76; 54.79%] among university students, and 36.73% [32.32; 41.38%] among the general population. Sleep disturbances were higher during lockdown compared to no lockdown, 42.49% versus 37.97%. Four in every ten individuals reported a sleep problem during the COVID-19 pandemic. Patients infected with the disease, children, and adolescents appeared to be the most affected groups., Competing Interests: Conflicts of interest The authors do not have any conflicts of interest to disclose., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and objective: Sleeping difficulties affect the overall health, nutrition, and wellbeing. The Mediterranean diet has proven effective in improving the quality of life and overall health of people of all ages. Therefore, this study aimed to determine whether adherence to the Mediterranean diet (MD) is linked to reduced insomnia in Arabic-speaking female adults in Jordan. Materials and Methods: A self-administered, cross-sectional survey was used to detect the relationship between MD and sleep quality in Arabic-speaking female adults. Data were collected from 917 Arabic-speaking female participants of 14 Arab nationalities in Jordan between March and May 2021 via social media. All participants answered the whole questionnaire, including questions on sociodemographic aspects, Mediterranean diet adherence, sleeping habits measured with the Athens Insomnia Scale (AIS), and lifestyle components such as smoking and dietary patterns. Results: The mean age of the 917 Arabic-speaking female participants was 36 ± 10 years. Most participants were unemployed (85%) single females (64%) with an undergraduate degree (74%). Most of them (86%) were non-smokers. More than half of the participants were Jordanians (57%). The BMI was normal for 52% of the participants, whereas 26% of them were overweight, and 12% were obese. One-way ANCOVA showed a statistically significant difference between MD adherence score categories and AIS, F (2, 914) = 3.36, p = 0.015. Among the MD adherence score categories, we found that between groups, MD scores above or equal to 10 were associated with a statistically significant difference in AIS. Cohen's value was calculated for the three MD score categories and indicated a 'small' effect size association between all adherence scores of the MD categories and AIS. Conclusions: In conclusion, our findings provide preliminary evidence that participants' adherence to the MD was significantly associated with better sleep and reduced insomnia symptoms, highlighting the need for further research.

Background: Early identification and prevention research has provided huge advances in our understanding of early screening and identification of young people at clinical high-risk (CHR). Most of these procedures were developed in high-income countries, yet middle-income countries in North Africa such as Tunisia can benefit from these empirically-based assessment approaches., Methods: Using established procedures, nine Tunisian psychiatric raters were trained on structured assessments: the CAARMS, BPRS, and SCID to high standards of interrater reliability. These raters developed a clinical high-risk program (CHiRP) in Tunisia and recruited 10 patients who were exhibiting possible signs of CHR. These patients were evaluated to determine if they met criteria for a CHR group, such as Attenuated Psychosis., Results: Trained raters met the following interrater reliability criteria for the CAARMS and BPRS (ICC = .80 or greater) and the SCID (Kappa = .75 or greater). Of 10 pilot patients, six were classified as CHR and belonging to the Attenuated Psychosis Group. One of the six patients converted to psychosis 3 months after study entry for a conversion rate of 17% which is comparable with currently published rates globally., Discussion: The first CHR program has been established in Tunisia, a middle-income country using methods developed in high income countries. Efforts aimed at assembling a group of prevention-oriented psychiatrists, obtaining administrative support, and training raters to high levels of interrater reliability were successful. The feasibility was demonstrated for screening, assessing, treating, and following-up of 10 CHR patients suggesting that conversion rates are comparable to those of Western and European countries., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Mental disorders are widespread among students. However, mental health help-seeking remains low. Several reviews and meta-analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help-seeking intentions and comfort with disclosing a mental illness., Method: The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9)., Results: We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self-discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help-seeking intentions (p < .001) and knowledge of mental illness (p = .019). Students' age negatively correlated with knowledge (p < .001, r = -.147). Pearson correlations indicated that help-seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p < .001, r = .103) and greater mental health knowledge (p < .001, r = .163); and that comfort with disclosing significantly and negatively correlated with attitudes (p < .001, r = -.125)., Conclusion: To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group., (© 2020 John Wiley & Sons Australia, Ltd.)

Aim: Prior research has consistently demonstrated a relationship between childhood trauma (CT) exposure and an increased risk of developing psychotic-like experiences (PLE) and disorders. Studying the link between CT and PLE in non-clinical populations with or without genetic risk factors could help elucidate the etiopathogeny of psychotic disorders, by removing the effect of confounding variables related to psychotic-spectrum illnesses., Method: A total of 60 non-affected siblings of patients with schizophrenia and 75 controls (aged 18-35 years) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences (CAPE) and the CT Questionnaire were used., Results: We found no significant difference with regard to positive dimension of the CAPE between the two groups. Siblings have reported higher CAPE negative symptoms scores than controls (27.9 vs 24.2; P = .015), and more emotional abuse and physical neglect during childhood than controls. After controlling for demographic and psychosocial variables, sexual abuse, emotional neglect and physical neglect were positively related to positive psychotic symptoms in the control group, whereas no dimension of CT has been linked to these symptoms in the sibling group., Conclusion: The link between CT and psychosis seems to be complex, not only dependent on genetic vulnerability or early environmental factors shared by siblings of patients with psychotic disorders, but also several other confounding factors, including other psychopathological symptoms. Prevention strategies for individuals at genetic risk of psychosis should pay particular attention to CT as a potential predictor of sub-clinical depression and psychosis., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Sleep disturbances in schizophrenia are common throughout its course including in the prodrome, and have been mainly attributed to severity of symptoms and antipsychotic use. We aimed to investigate whether early course patients with schizophrenia and young non-psychotic siblings of patients with schizophrenia also show sleep disturbances and whether sleep correlates with symptoms and functioning., Methods: Three study groups, that is, adults newly diagnosed with schizophrenia (n = 54), young non-psychotic siblings of schizophrenia patients (n = 56) and a sample of healthy controls matched to the patients and siblings (n = 61) were evaluated on Horne and Ostberg Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Severity of symptoms and functioning are assessed using the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale, respectively. Age, gender, occupation and marital status were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance., Results: Early course schizophrenia patients and non-psychotic siblings of schizophrenia patients showed significantly reduced sleep quality relative to healthy controls (P < .001). Schizophrenia patients had significantly higher daytime sleepiness compared to controls (P < .001). Chronotypes in schizophrenia patients and unaffected siblings did not significantly differ from those of the healthy controls., Conclusions: Like chronic medicated schizophrenia patients, early course schizophrenia patients and young non-psychotic siblings of individuals with schizophrenia have sleep disturbances. These findings indicate that sleep markers can distinguish unaffected siblings of schizophrenia from healthy controls and serve as an endophenotype for schizophrenia., (© 2020 John Wiley & Sons Australia, Ltd.)

Background: Considerable effort has been devoted to elucidating correlates of psychopathy in males, but only few researchers have turned their attention to this field in female counterparts, with most of the research in this field having been driven from western countries. We aimed to explore psychopathic traits, impulsiveness and psychiatric symptoms that characterize a Tunisian female prison population., Method: Data were collected in a cross-sectional design during September 2017. The sample was comprised of 100 adult females who were incarcerated at the "Manouba Women's Prison" at the time of the survey. The Levenson Self-Report Psychopathy Scale, the Barratt Impulsiveness Scale, and The Brief Symptom Inventory were used., Results: In the univariate analysis, socioeconomic level (p = .001), tobacco use (p = .001), poly drug use (p = .014) and physically aggressive behaviors in the 6 months before incarceration (p = .043) were significantly associated with psychopathy total scores. After multivariable adjustment, motor impulsiveness (β = 0.426, p < .01) and phobic anxiety (β = 0.284, p < .05) contributed significantly to the variance of psychopathy total scores., Conclusion: The current findings not only add to the growing body of literature on female psychopathy, but also help inform decision making about mental health-related programs and policies in female prison settings in underdeveloped and underrepresented countries similar to our sociocultural context., (Copyright © 2021 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Little consideration has been given to the impact of COVID-19 on people at risk of psychosis despite their particular preexisting vulnerability. We aimed to examine the role of coping strategies in determining the levels of fear in nonclinical students with high levels of self-reported schizotypal personality traits as compared to low-schizotypy controls., Method: This was a cross-sectional survey. The Schizotypal Personality Questionnaire, the Fear of COVID-19 Scale and The Brief-Coping Orientation to Problems Experienced were used., Results: High-schizotypy students had significantly higher maladaptive strategies scores and higher levels of fear of COVID-19 as compared to low-schizotypy students. Multivariate analyses have shown that high-schizotypy individuals were likely to rely on coping responses that are maladaptive (venting) and have potential exacerbating effects on fear of COVID-19, whereas low-schizotypy individuals were likely to use adaptive responses (acceptance) that seemed to be effective in reducing fear of COVID-19., Conclusion: This study provided preliminary cross-sectional evidence for a differential impact of COVID-19 on individuals according to their schizotypy features. However, larger longitudinal population-based studies are necessary to confirm our findings., Competing Interests: None., (© 2021 Elsevier Ltd. All rights reserved.)

Studies evaluating religious coping in Arab-Muslim populations are few. We aimed to evaluate religiosity and religious coping in a sample of breast cancer women, and to analyze the association between religiosity, religious coping, depression, anxiety, cancer clinical data, and sociodemographic data in our patients. A cross-sectional and descriptive study was conducted over a 4-month period in 61 newly diagnosed breast cancer women. We used the following scales: The Depression Anxiety Stress Scales (DASS-21), the Arabic-Brief Religious Coping Scale (A-BRCS) and the Arabic Religiosity Scale. The majority of participants (98.4%) had a moderate to high level of religiosity. A weak correlation was found between religious coping scores and stress, depression, and anxiety scores. Our patients had high scores of positive religious coping, with a mean score of 26.13 out of 28 and used more positive coping than negative coping to cope with the cancerous disease. High levels of affective religiosity were the main predictive factor of positive religious coping. Therapies should reinforce the positive religious coping patterns of breast cancer patients, and detect a possible resort to negative religious coping that may negatively affect the patients' quality of life.

Despite advances in medicine and technology, when facing epidemics people continue to turn to religion to deal with such unpredictable life-threatening events. We aimed to assess psychological distress in the general population of Tunisia during the COVID-19 pandemic and to examine the contribution of religious coping (RC) in the reports of anxiety and depression at the time of the survey. We carried out and online cross-sectional study using a non-probability snowball sampling technique. A total of 603 responses were recorded. The "Depression Anxiety Stress Scales," the "Brief religious coping scale" and the "Arabic religiosity scale" were used. We found that 28.3%, 24.4% and 19.4% of the participants reported severe or extremely severe levels of depression, anxiety and stress, respectively. The mean score for positive RC was 22.8 ± 5.3, while that for negative RC was 14 ± 5.8. After controlling for confounders, multivariate analysis showed that negative RC significantly and positively contributed to depression and anxiety scores in our respondents, indicating that greater use of negative RC was associated with higher levels of psychological distress. No significant relationship was found between overall religiosity or positive religious coping and either depression or anxiety symptoms. Religious beliefs may have an impact on how people cope with emerging infectious disease outbreaks. Religion should be considered by professionals as an important variable to consider in therapy for individuals who engage in RC or perceive religious needs.

Objective: Little is known about specific professional factors influencing medical students' suicidal ideation and behavior. We aimed to evaluate the prevalence and correlates of suicidal ideation in Tunisian medical students. Method: This was a cross-sectional study; 390 second-cycle medical students were enrolled at the Faculty of Medicine of Tunis. Participants responded to an anonymous questionnaire containing sociodemographic data, educational factors, the Suicidal Ideation Questionnaire (SIQ), and the Depression, Anxiety and Stress scales (DASS-21). Results: Eleven students (2.8%) had made one or more suicide attempts in their lifetime. For a threshold value of 41 based on the SIQ scale, 7.9% of students were considered to have a potential risk of suicide. The multiple hierarchical linear regression analysis identified as main factors independently associated with suicidal ideation: tobacco consumption, perceived sleep quality, depression symptoms, the personal history of suicide attempt, the satisfaction with student-supervisor relationship, and choosing to study medicine. Conclusion: Suicide prevention efforts should target high-risk students with prior personal or family history of suicidal behavior. Moreover, medical school authorities should put in place effective strategies to optimize the learning environment at their institutions.

Supporting medical students involves two broad concepts that are often confused, namely tutoring and mentoring. These approaches, implemented in a heterogeneous way in medical schools, have been the topic of numerous publications. The objective of this update was therefore to define, then clarify, based on a literature review, the common characteristics and the differences between tutoring and mentoring in medical studies.

Background: Admission to nursing homes is often associated with a change in the way the elderly live, possibly impacting quality of life (QOL). We aimed to assess QOL in elderly without dementia living in nursing homes, and to examine the association between QOL and sociodemographic features, comorbidities, level of dependency, and depression., Method: We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The Mini-mental state examination, the Geriatric depression scale, the Activity of daily living, the Cumulative illness rating scale-geriatric, and the 36-item Medical outcomes study short-form health survey-SF36 were used to assess cognitive functions, depression, level of dependency, comorbidities and QOL, respectively., Results: All dimensions of the physical and mental components of QOL were altered in our population, with an overall mean score of less than 66.7 for all domains. A significant correlation was found between the two physical and mental components of QOL and the level of dependency, depression scores as well as comorbidity scores. In the final model of hierarchical regression, which included demographic (age and gender), clinical (level of dependency and comorbidities), and psychosocial (depression and social support) variables, only social support was significantly associated with both QOL dimensions., Conclusion: Strengthening social support in institutions is strongly recommended, especially activities that promote interaction. When family members remain involved in the lives of their older relatives after institutionalization, policies such as family visits and the involvement of family members in the care provided should be strongly encouraged.

Although literature has documented widespread negative and stereotypical attitudes held by healthcare professionals towards the older adults, there is a current paucity of research about the perspective of psychiatrists. We aimed to identify the attitudes of Tunisian early career psychiatrists towards the older adults. This was a cross-sectional study conducted among 71 early career psychiatrists. Data were collected through anonymous online surveys. A series of 4 point Likert-type questions ("strongly agree", "somewhat agree", "somewhat disagree", "strongly disagree") asked participants about their beliefs about older patients, the characteristics of the psychiatric care of an older person and emotions related to caring for older patients. Psychiatrists agreed that the older patient: is frail and vulnerable in 64.8% of cases, does not trust his psychiatrist in 28% of cases, has problems of communication in 36.6% of the cases and shows hostile or aggressive behavior in 5.6% of the cases. A multivariate binary logistic regression analysis found that clinical experience would play an independent role in predicting the following beliefs and attitudes of early career psychiatrists towards older patients: the belief that the older patient often has perceptual disorders that he is fragile and vulnerable, that he often requires polypharmacy, and that his management exposes the psychiatrist to painful emotional experiences. Given the population aging, early career psychiatrists need to be equipped with skills to fulfil significant roles in responding to future health and support needs. Integrating clinical training in psychogeriatrics into the psychiatric curriculum is strongly recommended.

Background: There are very little data on the burden among caregivers of older adults with severe mental diseases. We aimed to assess the perceived burden among caregivers of family members with schizophrenia spectrum and bipolar disorders., Method: A cross-sectional study was carried out with 52 older patients with schizophrenia spectrum and bipolar disorders and their family caregivers. Caregivers were assessed with the medical outcome survey short form (SF-36), the Zarit Burden Interview (ZBI) and the Depression Anxiety and Stress scales (DASS-21)., Results: Caregivers' mental quality of life was impaired with an average mental score of 59.05. For a threshold value of 17, the level of perceived burden was considered as high for 42.3% of caregivers. After controlling for demographic variables (age and gender) and patients' health-related variables (level of dependency, comorbidities, age onset of illness, number of hospitalizations and duration of clinical remission), caregivers' levels of depression, stress, and SF-36 physical component significantly contributed to their perceived burden., Conclusions: Certain modifiable risk factors play an inescapable role in increasing the level of burden among caregivers of older patients with serious mental illnesses., Clinical Implications: Improving the quality of life and psychological well-being of family caregivers should be considered an integral part of treatment for serious mental illness in older adult patients.

Objectives: Prior literature has documented the global burden of serious mental illnesses. The present study aimed to compare the sleep quality in caregivers of older patients with schizophrenia spectrum and bipolar disorders with control participants who did not serve as caregivers., Methods: We performed a case-controlled, cross-sectional study among family caregivers of older patients with psychotic disorders in Razi Hospital, Tunisia. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index Scale (PSQI)., Results: Fifty caregivers of older patients (≥ 60 years) with schizophrenia spectrum and bipolar disorders, and 50 matched controls were enrolled. The three sub-dimensions of the PSQI, namely subjective sleep quality, sleep duration, and sleep efficiency, as well as overall PSQI scores, were worse for caregiver participants. Hierarchical multiple regression analyses predicting PSQI scores revealed that caregivers' age and marital status were the only significant predictors in the final model., Conclusions: Older adults with severe mental disorders constitute a vulnerable population which generates a significant burden of care, and impacts their caregivers' subjective sleep quality., Clinical Implications: Family interventions, including sleep interventions, should be considered as an integral component of treatment for serious mental illnesses. When promoting sleep quality, older and single caregivers should be targeted.

Despite the increased focus on non-clinical psychosis populations, no community surveys have properly investigated the phenotypal expression of Psychotic like experiences (PLEs) in the Arab-Muslim world. We aimed to examine the prevalence and correlates of PLEs in a large sample of Tunisian college students. A total of 1489 students (64.3% female, aged 18-40) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences was used to measure PLEs. The rates of PLEs found in our work were relatively high compared with those found in previous international studies, with 51.4% of the participants reporting at least one positive PLE 'nearly-always'. After controling for confounding variables, other drug use in the past year represented the only substance use variable among the significant predictors in the final model. Our findings should raise awareness of the need for implementing an early intervention programs in our region.

Background: Many studies have established a correlation between the increase of homicide rates, and economic crises and rapid social changes following historical events. We propose to analyse the impact of the Tunisian Revolution on homicide rates in Tunisia in a clinical population., Methods: We conducted a retrospective comparative study of all individuals who commited an homicide and were admitted, at least once, to the forensic psychiatry unit in Razi Hospital between January 1st, 2004 and December 31st, 2018 after a decision of irresponsibility by reason of insanity., Results: The number of homicides committed by the individuals with mental illness included in our study was multiplied by a factor of 1.3 after the revolution, with a prevalence of 11.0% between 2004 and 2011, compared to a prevalence of 14.7% during the period 2011-2018. No significant difference was noted between the two groups regarding the socio-demographic characteristics or the characteristics of the act committed., Conclusion: Our results highlighted that political and socio-economic crises following the Tunisian revolution significantly contributed to an increase of homicide rates in people with severe mental illness. Thus, macro-level socioeconomic determinants would be important to consider in homicide prevention strategies., Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest in this manuscript., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Death distress is a significant problem in the older population and may be more pronounced in certain vulnerable older people, including those living in nursing home facilities. We aimed to assess death obsession (DO) in elderly people without dementia living in nursing homes, and to examine the association between DO and religiosity., Methods: We carried out a cross-sectional survey involving 42 elderly subjects living in a nursing home in Manouba, Tunisia. The "Mini-Mental State Examination", "Geriatric Depression Scale", "Activity of Daily Living", "Cumulative Illness Rating Scale-Geriatric", "Death Obsession Scale", "Brief Religious Coping Scale" and "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping, and religiosity, respectively., Results: We found relatively high death obsession scores, with no gender differences (mean scores = 33.1 ± 18.1). Death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores based on the bivariate analysis. Similarly, multiple hierarchical regression revealed that religious variables (overall religiosity and religious coping) did not significantly contribute to variance in death obsession., Conclusion: Older people living in nursing homes have specific psychosocial and spiritual needs which health care providers should recognise, assess and treat appropriately, at an early stage.

Background: The death distress would be one of the most important problems in the older population and would be more pronounced in some vulnerable older subjects, including those living in nursing homes facilities. We aimed to assess death obsession (DO) in elderly without dementia living in nursing homes, and to examine the association between DO and religiosity., Methods: We carried out a cross-sectional survey involving 42 old subjects living in Manouba nursing home. The "Mini-Mental State Examination", the "Geriatric Depression Scale", the "Activity of Daily Living", the "Cumulative Illness Rating Scale-Geriatric", the "Death Obsession Scale", the "Brief religious coping scale" and the "Arabic Religiosity Scale" were used to assess cognitive functions, depression, level of dependency, comorbidities, death obsession, religious coping and religiosity, respectively., Results: We found relatively high death obsession scores, with no gender differencies (mean scores = 33.1 ± 18.1). The death obsession was significantly and positively associated with comorbidity scores (p = 0.04). No significant correlation was found between death obsession scores and religiosity and religious coping scores in the bivariate analysis. Similarly, multiple hierarchical regression found that religious variables (global religiosity and religious coping) did not significantly contribute to the variance of the death obsession., Conclusion: Older people living in nursing homes have specific psychosocial and spiritual needs, that health care providors should recognize, assess and care for, early and adequately.

Background: Sleep disorders are a common complaint in breast cancer patients. These women suffer from fear of death, fear of suffering, treatment complications as well as social devaluation; all leading to feelings of hopelessness. The objectives of this work were to evaluate the quality of sleep in a group of breast cancer women, and to analyze the association between sleep quality, depression, and hopelessness., Methods: A cross-sectional study was carried out over a period of 3 months, including 50 women suffering from breast cancer and having received a surgical treatment of their disease. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The evaluation of depression was performed using the Beck Depression Inventory (BDI-II). Hopelessness was measured with the Beck hopelessness scale (BHS). All participants were screened using the Arab-language version of these scales., Results: Of 66% of breast cancer patients were considered as poor sleepers (PSQI scores >5), 30% of our sample had a moderate to severe depression, and 24% had a high level of hopelessness. PQSI scores were negatively correlated with depression (P < 0.001) and hopelessness scores (P < 0.001). Multivariate analysis retained as main predictors of the sleep quality habitation and hopelessness scores. After controlling for demographic (age) and social (habitation) variables, hopelessness significantly contributed to sleep quality., Conclusion: Hopelessness was positively associated to sleep disorders in women suffering from breast cancer. Hopelessness requires an appropriate management in order to prevent depression and suicide and to improve the quality of life of these patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Religiosity has been hypothesized to play protective roles against suicide. In Tunisia, despite the gravity of the issue after the 2011 Revolution and the rise of suicide rates among adolescents and young adults, a significant lack of data remains. The present work aimed to evaluate the associations between suicide and religiosity in university students. The Suicidal Ideations Questionnaire and The Arabic Religiosity scale were used to determine associations between suicidality and religiosity. We found a strong negative correlations found between suicidal ideations and the three sub-scores of religiosity after controlling for the associations between psychosocial variables and suicidal ideations scores. Our findings emphasize the importance of assessing the role of religiosity to the subject and understanding how suicide is conceptualized and perceived in the subject's religion when dealing with suicidal ideation and behaviors among college students. A better knowledge of religious beliefs and even an integration of Islamic beliefs and practices in the psychotherapeutic process of Muslim youth may be helpful to cope with suicide.

Cannabis use is widespread among people at ultra-high risk (UHR) for psychosis. The causal link as well as the temporal link between cannabis use and further occurrence of psychosis in UHR people remain inconclusive. Current science data supported an increased risk of transition to psychosis in cannabis users who are genetically predisposed to psychosis. This risk would be even greater in the presence of a family history of psychosis, in case of a strong use and an early onset use. Several models have been cited to explain the link between cannabis use and the subsequent onset of psychosis or prepsychotic states: cannabis-induced modifications of some brain structures, a dysregulation of the hypothalamic-pituitary axis and an alteration of normal neurological development via the endocannabinoid system. Cannabis represents a modifiable risk for psychosis. Current interventions aim to reduce or stop the cannabis use in order to reduce the risk of transition to psychosis., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: We aimed to evaluate the links between different sleep parameters and suicidal ideation and behavior in remitted bipolar I patients., Methods: One hundred eight remitted bipolar I patients were recruited from the psychiatry department of Razi Hospital. The third item of the "Hamilton Depression Rating Scale" was used to evaluate current suicidal behaviors. Circadian typology, daytime sleepiness and sleep quality were evaluated using the "Horne and Ostberg Morningness-Eveningness Questionnaire," the "Epworth Sleepiness Scale," and the "Pittsburgh Sleep Quality Index," respectively., Results: Current suicidal ideation and behavior were significantly associated with circadian typology, daytime sleepiness, and sleep quality. After controlling for demographic variables (age and gender) and psychosocial factors (depression and substance use), suicidal ideation significantly contributed to sleep quality. Depression was a significant predictor within the second step when entered with other psychosocial variables; however, once suicide variables were included, depression was no longer a significant predictor., Conclusions: An evaluation of sleep's quality should be included in the suicide risk assessment of bipolar I patients., (© 2019 Wiley Periodicals, Inc.)

Background: Current research has shown that experiencing childhood trauma may predispose individuals for psychosis and expression of Psychotic like experiences (PLEs). We aimed to examine the prevalence and characteristics of PLEs and depressive and negative experiences in a sample of Tunisian college students, and to evaluate the impact of childhood traumas in the occurrence and severity of these experiences at the time of the survey., Method: A total of 482 college students (63.7% female; aged 18-32) participated in a cross-sectional survey. The Positive Subscale of Community Assessment of Psychotic Experiences (CAPE) was used to measure PLEs. The Childhood Trauma Questionnaire was used to assess childhood trauma and neglect., Results: 53.5% (n = 258) of the students reported at least one positive PLE 'nearly always', and 40.9% (n = 197) reported at least one negative PLE with this frequency. After controlling for demographic variables (gender, age) and psychosocial factors (drug use, depression, anxiety and stress), sexual abuse significantly contributed to PLEs., Conclusion: There is a need for further cross-cultural research regarding the phenotypal expression of PLEs and its associated variables. Child sexual abuse victims should receive systematic and complete psychological screening during their adolescence/ early adulthood including, among others, PLEs and psychotic symptoms., (Copyright © 2019 Elsevier B.V. All rights reserved.)