Acute Stress Disorder and PTSD

Acute Stress Disorder and Post Traumatic Syndrome

A study is being conducted at IDRAAC that looks specifically at ASD predicting full threshold PTSD and subthreshold PTSD. It is important to note that people with subthreshold PTSD have symptoms that fail to satisfy all of the PTSD diagnostic criteria. However, these symptoms are frequent and clinically significant.¹

Aim of the study: The goal of the study is to identify both full and subthreshold PTSD by looking at the severity of ASD and not just ASD diagnosis. It also looks at how important the time at which ASD was measured (wave 1 or wave 2) is.

Hypothesis: To find out if ASD data from waves 1 and 2 could be used as a diagnostic tool to predict PTSD or its subsyndromal forms (post Beirut Port Blast).

Methods:

Study design: Prospective cohort study is being carried out over several months, in the wake of the August 4, 2020, Beirut port explosion.

Settings: The Saint George Hospital University Medical Center (SGHUMC) in Beirut serves as the main center for recruiting participants for this study.

Characteristics of study participants: All SGHUMC employees over the age of 18 (including clinical and non-clinical staff) are eligible to participate.

Start date of data collection: 1-2 weeks post blast (Wave 1).

Follow up dates: 3-4 weeks post blast (Wave 2), six months after the blast (Wave 3).

Data collection: In the first wave, data is gathered in-person. However, online surveys are used to gather data in waves 2 and 3.

Follow up methods: In order to improve the follow-up, participants are prompted by SMS and emails with a link / QR code to repeat the survey after each wave.

Incentives: Participants have a chance to win a $200 gift card in a random drawing. They get a free lunch ticket to use in the hospital cafeteria, as well as free consultations with a psychologist or psychiatrist at SGHUMC for themselves or their family members.

Variables and measurements:

The survey inquiries about the sociodemographic characteristics of the participants (age, gender, education level), work environment (profession, department), and the explosion (location of the individual during the explosion, damage to one’s place, questions such as being injured, seeing dead bodies, mutilations, death of loved ones). For mental health problems, the Acute Stress Disorder Scale (ASDS) is used to measure ASD, the Patient Health Questionnaire (PHQ-9) is used to measure depression, and the General Anxiety Disorder (GAD-7) is used to measure anxiety.

The survey, in wave 3 of data collection, includes questions on adverse childhood events (physical/sexual abuse, neglect) as well as the PTSD checklist for DSM-5 (PCL-5) used for assessing full threshold and subthreshold PTSD.

Statistical analysis:

Data is analyzed using StataMP version 13. Frequencies and mean ± SD are used to report categorical and continuous variables respectively.

Results:

The overall number of participants at each wave, as well as the number of participants who are followed up from wave 1 and/or 2 to wave 3, is determined.
The characteristics of study’s participants are summarized using descriptive statistics (age, gender, profession, types of childhood adversities).
Additionally, variables related to the outcomes (ASD total score, frequency of ASD in waves 1 and 2, and prevalence of both full and subthreshold PTSD in wave 3) are presented.

Main results: To evaluate the sensitivity, specificity, PPV, and NPV of ASD diagnosis/severity in predicting both full and subthreshold PTSD.

Funding:

The study is self-funded and supported by anonymous donors.

1. McLaughlin KA, Koenen KC, Friedman MJ, Ruscio AM, Karam EG, Shahly V, et al. Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys. Biol Psychiatry. 2015 Feb 15;77(4):375–84. 

ADHD

Assessment of the Relation between ADHD and Bipolarity
IDRAAC is currently assessing the relation between adult ADHD and Bipolar Disorder as well as the comorbidities of ADHD with other mental health disorders in a Lebanese clinical population funded by a grant from the National Council for Scientific Research in Lebanon. This is one of the first studies in the Arab region which addresses the comorbidities in adult patients with ADHD in a clinical setting and explores their temperament profile.

To know more about our previous research on ADHD, kindly click on this link. 

Bipolar Disorder

Identifying Longitudinal Voice Patterns in Patients with Bipolar Disorder
IDRAAC has started working on an innovative research study in collaboration with the University of Michigan in the USA and funded by the National Institutes of Health NIH which uses a cell phone-based system to detect subtle changes in speech and motion of bipolar disorder patients allowing to predict subsequent risks for mood changes and this is studied in the course of the daily use of the phone. Changes in speech patterns are highly reflective of underlying mood shifts where it has been shown that there is a periodicity of the illness that oscillates between a manic energized state with charged emotions and pressured rapid speech to a depressed emotional phase with retarded movements and inhibited quality and quantity of speech. The use of this cell-phone based system will allow a continuous monitoring of these changes and predict any manic or depressive episode.  
This innovative study will aid in developing a practical solution to assist in the longitudinal management of bipolar patients and would be a substantial advance in preventive care. 

Temperament and Bipolar Disorders
IDRAAC is working on looking at which temperaments are associated with different bipolar subtypes using the TEMPS-A.  

Assessment of the Relation between ADHD and Bipolarity
IDRAAC is currently assessing the relation between adult ADHD and Bipolar Disorder as well as the comorbidities of ADHD with other mental health disorders in a Lebanese clinical population funded by a grant from the National Council for Scientific Research in Lebanon. This is one of the first studies in the Arab region which addresses the comorbidities in adult patients with ADHD in a clinical setting and explores their temperament profile. 

To know more about our previous research on Bipolar Disorder, kindly click on this link. 

Beirut Blast

Acute Stress Disorder Assessment of Staff at Saint George University Hospital Medical Center (SGHUMC) following the Beirut Blast and Prospective Follow-Up (Wave 1 & 2)

IDRAAC launched a prospective cohort study to describe, examine, and assess the impact of the Beirut’s explosions on the mental health of SGHUMC staff, especially pertaining to Acute Stress Disorder (ASD).
This study included a baseline assessment of acute stress levels (after an average of 10 days of the explosion) with a follow-up after 3 weeks from the explosion.
Staff at SGHUMC who underwent PCR testing were approached to be enrolled in this study and were handed a self-filled questionnaire (available in two languages) that included a screening of ASD and questions related to the explosion.
A second assessment was initiated 3 weeks after the explosion.
This assessment was in the form of an online survey sent to all the hospital’s staff and it included a similar scale to the one used in wave 1 addressing a different timeframe. 
Staff who felt the need to seek mental health support were referred to the walk-in clinic  and hotline and those at high risk were contacted for further support. 
Analysis is under way and will be submitted for publication in a scientific journal.

For a specific study predicting Acute Stress Disorder and PTSD, click on this link. 

The HEalth caRe wOrkErS Study: HEROES- LEBANON

IDRAAC is taking part in a multinational study which will allow the understanding of the COVID19 pandemic, the economic situation and the Beirut Blast effects on health workers. This study is conducted in coordination with the National Mental Health Program at the Ministry of Public Health in Lebanon (MOPH) and is the largest study to be done in Lebanon among health workers addressing the effects of the COVID-19 pandemic, the Beirut Port Blast and the economic situation.
The study is a prospective cohort study including a baseline assessment and three follow up assessments (after 3, 6, and 12 months). Collaborators from 32 countries in 5 continents (America, Europe, Africa, Asia, and Oceania) will participate in the study and it is coordinated by the University of Chile and Columbia University.
Participants will answer an online questionnaire including a screening on psychiatric symptoms, questions on several emotional and social factors affected by the COVID-19 pandemic and questions on their economic situation and previous stressors. The study in Lebanon has been adapted to assess the particular stressors and psychological adversities of the Beirut Port blast.

Bullying

Bullying and Mental Health
IDRAAC is working on several research projects related to bullying in class and its relation to mental disorders in Lebanon. Bullying is currently considered a traumatic event with important mental health implications on the affected person. To date, no studies in the Arab world have assessed it in a comprehensive manner and studied its relation to preexisting and consequent mental disorders. 
Another study we are conducting at present is a comprehensive review of the publications on bullying in the Arab world. IDRAAC is assessing the various forms of bullying: direct confrontation (verbal, physical), rumors, social media, as well as the issue of inequality of power. IDRAAC is evaluating the profiles of bullying (victim, perpetrator and both) in the clinical setting and assessing the temporal relation of bullying to a variety of mental disorders (depression, anxiety, PTSD, suicidality etc..) and its effect on school performance as well as family life and social interactions.
We are also assessing the reaction to bullying by the child/adolescent, the school and the family and the co-occurrence of bullying and childhood adversities.
We are also validating the scales used during the bullying study.

COVID-19

IDRAAC started research projects related to the effect of COVID-19 on the mental health of different vulnerable groups and is currently working on the following 2 studies:

The HEalth caRe wOrkErS Study: HEROES- LEBANON

IDRAAC is taking part in a multinational study which will allow the understanding of the COVID19 pandemic, the economic situation and the Beirut Blast effects on health workers in 8 major hospitals in Beirut and Mount Lebanon (American University of Beirut Medical Center, Bellevue Medical Center, Hôpital Libanais Geitaoui, Hôtel Dieu de France, LAU Medical Center-Rizk Hospital, Mount Lebanon Hospital, Rafik Hariri University Hospital, St George Hospital University Medical Center). This study is conducted in coordination with the National Mental Health Program at the Ministry of Public Health in Lebanon (MOPH) and is the largest study to be done in Lebanon among health workers addressing the effects of the COVID-19 pandemic, the Beirut Port Blast and the economic situation.
The study is a prospective cohort study including a baseline assessment and three follow up assessments (after 3, 6, and 12 months). Collaborators from 32 countries in 5 continents (America, Europe, Africa, Asia, and Oceania) will participate in the study and it is coordinated by the University of Chile and Columbia University.
Participants will answer an online questionnaire including a screening on psychiatric symptoms, questions on several emotional and social factors affected by the COVID-19 pandemic and questions on their economic situation and previous stressors. The study in Lebanon has been adapted to assess the particular stressors and psychological adversities of the Beirut Port blast.

Assessment of Depression, Anxiety, PTSD and Suicidality in a Sample of Lebanese Adults undergoing dialysis following the Beirut Blast

IDRAAC is initiating a study which aims to assess depression, anxiety, suicidality and PTSD among hemodialysis patients. It will also examine the impact of traumatic events (COVID-19, Beirut explosion or other trauma) in addition to the financial situation, medical comorbidities, past psychiatric history, social isolation, cognitive impairment, religiosity, nutritional status, functional status in relation to depression, anxiety and PTSD occurrence.
This study will also follow hemodialysis patients longitudinally to recheck changes in prevalence rates of depression, anxiety and PTSD at 6 and 12 months.
The study will be implemented in two major hospitals: St George Hospital University Medical Center and Geitawi Hospital both of which suffered major damage during the Beirut Blast.

Childhood Adversities and Mental Health

Genetics

GENMOD Study
IDRAAC worked on a classroom-based intervention for PTSD, Depression and Anxiety targeting Lebanese and Syrian students attending 31 public schools in Lebanon. 
Moreover, in order to study the effectiveness of the intervention on developing resilience building strategies among students, genetic testing will be done to study the variability in response to war-related traumatic events. 
This study will advance the field of developmental psychology by investigating the molecular genetics of individual differences in Syrian refugee children’s response to acute war-related traumatic experiences and variability in response to psychological intervention of both Lebanese and Syrian children as a function of genetic factors. It will also allow to understand the interplay between mental disorders, the environment and genetic factors. 

BIOPATH Biological Pathways of Risk and Resilience in Syrian Refugee Children 
IDRAAC ran a prospective study funded by The National Institutes of Health NIH -USA and in collaboration with Queen Mary University London and Médecins du Monde which aimed at investigating the biological underpinnings of individual differences in refugee children’s response to acute war-related trauma exposure. This project studies genetic moderations of interventions related to mental health wellbeing of Syrian children and adolescents by measuring a plethora of mental health indicators, stressors, and environmental variables.  It also quite importantly aims at identifying specific gene variants in children who are more/less responsive to interventions. This project allows to understand the relationship between genetic, social, psychological and biological factors in relation to resilience.  

Elderly Mental Health

IDRAAC is working on different research projects related to elderly mental health.
These projects aim at investigating the prevalence of disorders among elderly age groups and their correlates as well as validating scales that detect dementia, depression and anxiety among the elderly. These studies are being used to prioritize and design community interventions and advocacy activities related to the elderly in Lebanon.

The TEC-MED Project (Development of a transcultural, social-ethical care model for dependent populations in the Mediterranean Sea Basin) 

Mental Health in the Arab World

IDRAAC has been reviewing since many years all the published studies about mental health in the Arab World (21 countries) since 1920.
The reviews have allowed the creation of the Mental Health Research in the Arab World database currently found on the IDRAAC website which contains the abstracts of all the published studies from the Arab World till 2018.

Temperament

Affective Temperament
IDRAAC has been working on a multitude of projects related to studying temperament and has evaluated the role of temperament as a risk or as a protective factor in epidemiological studies the stability of temperament in a clinical setting, studying the association 

Temperament, at present, is being studied in two research projects related to Bipolar Disorder and ADHD:

Temperament and Bipolar Disorders
IDRAAC is working on looking at which temperaments are associated with different bipolar subtypes using the TEMPS-A.  

Assessment of the Relation between ADHD and Bipolarity and the Temperament Profile of ADHD Patients
IDRAAC is currently assessing the relation between adult ADHD and Bipolar Disorder as well as the comorbidities of ADHD with other mental health disorders in a Lebanese clinical population. This is a pioneering study which addresses the comorbidities in adult ADHD patients in a clinical setting and simultaneously explores the temperament profile of adult ADHD patients. 

Productivity and Mental Health

Mental Health Treatment

IDRAAC is working on different research projects related to assessing the pattern of treatment of mental disorders in Lebanon which includes the access to treatment, stigma related to treatment, type of treatment, human resources, pharmacologic medications, utilization of services, etc.
IDRAAC is also working on a research project related to assessing the pattern of psychotropic medications use in Lebanon. As psychotropic medications prescriptions and use has increased worldwide, little information is available about their use in the Lebanese population. IDRAAC is exploring the patterns of psychotropic use in Lebanon and its correlation with the presence or absence of 12-month DSM-IV mental disorders.
In addition, IDRAAC has been analyzing the effect of different community interventions as they play a role in mental health prevention and treatment.

Examples of community interventions  that are being evaluated for their effectiveness are listed below. You can have more details on  the following link. 

• GENMOD Study: which is a classroom-based intervention for PTSD, Depression and Anxiety targeting Lebanese and Syrian students attending public schools in Lebanon. This study also aims at by investigating the molecular genetics of individual differences in Syrian refugee children’s response to acute war-related traumatic experiences and variability in response to psychological intervention of both Lebanese and Syrian children as a function of genetic factors. 
• Addressing the Needs of the Total Assyrian Community in Lebanon: which is a project aimed at addressing the needs of all age groups from the Assyrian community: the children, the adults and the elderly through providing mental health and psychosocial support and capacity building to the Assyrian community workers. The project consisted of different activities such as a classroom-based intervention and a parenting program which served as a means to improve the health and mental health status of this group which has suffered from the effects of war and displacement. IDRAAC is currently investigating the results of the different interventions on the mental health of the beneficiaries.
• Biological Pathways of Risk and Resilience in Syrian Refugee Children BIOPATH: which aims at investigating the biological underpinnings of individual differences in refugee children’s response to acute war-related trauma exposure. This project studies genetic moderations of interventions related to mental health wellbeing of Syrian children and adolescents  by measuring pre-post changes in psychological variables and identifying specific gene variants in children who are more/less responsive to interventions.
• Wellbeing of Syrian Refugee Families- mainly Women and Youth-in Lebanon: An Integrated Intervention: which targeted both Syrian refugees and the Lebanese hosting communities and aimed to improve the mental and social wellbeing of Syrian refugee families in Lebanon and enable the Lebanese government to provide support. As a result, the project built the capacity of refugee mothers in developing alternative strategies for parenting children and women benefited from gender-based violence sessions delivered by trained social workers. Students and teachers were also trained on resilience building techniques through a classroom-based intervention to build resilience and positive coping among students which was implemented in schools. IDRAAC is currently investigating the results of this multi-faceted project on the beneficiaries.
• Turning Teachers Into Educators of Tolerance and Conflict Resolution: which aims to improve the capacity of public school teachers to become mediators of behavioral change and contribute to build tolerance, decrease violence and conflicts among Syrian and Lebanese students through a classroom-based intervention. IDRAAC is studying the improvement mental disorders outcomes among the beneficiaries of this intervention.    
• The School Program for Building Resilience and Coping: which aimed at teaching school-age children and adolescents emotional, behavioral and cognitive tools to face stressful situations in daily life. IDRAAC is currently assessing the effectiveness of this intervention among the students, their teachers and parents on various aspects.

Psychosocial Interventions

Community interventions play a role in mental health prevention and treatment and IDRAAC has also worked on several community interventions that provide psychosocial support to different groups and is working on evaluating the effectiveness of these interventions and factors that play a role in this area. 

GENMOD Study
IDRAAC worked on a classroom-based intervention for PTSD, Depression and Anxiety targeting Lebanese and Syrian students attending 31 schools in Lebanon. 
Moreover, in order to study the effectiveness of the intervention on developing resilience building strategies among students, genetic testing will be done to study the variability in response to war-related traumatic events. 
This study will advance the field of developmental psychology by investigating the molecular genetics of individual differences in Syrian refugee children’s response to acute war-related traumatic experiences and variability in response to psychological intervention of both Lebanese and Syrian children as a function of genetic factors. It will also allow to understand the interplay between mental disorders, the environment and genetic factors. 

Addressing the Needs of the Total Assyrian Community in Lebanon 
IDRAAC received a grant from the French Embassy in Lebanon to implement a project aiming at addressing the needs of the whole Assyrian community: the Assyrian Refugee community and the Assyrian Lebanese Hosting community. The project targeted all the age groups from the Assyrian community: the children, the adults and the elderly through providing mental health and psychosocial support and capacity building to the Assyrian community workers. The project consisted of different activities which served as a means to improve the health and mental health status of this group which has suffered from the effects of war and displacement.
The following activities will be evaluated:

- The classroom-based sessions to build resilience and positive coping among students which was implemented in Assyrian schools to check the improvement in the aggression, hyperactivity, attitudes, behaviors and impulsivity of the students as well as anxiety and depression.
- The positive parenting program where Assyrian community workers provided sessions to mothers in the Assyrian community. IDRAAC is currently analyzing the effectiveness of these interventions and the decrease in children’s psychosocial problems after the intervention (emotional, conduct, hyperactivity /inattention and peer relationship problems) as well as parenting methods (decrease in shouting, hitting of the children, punishment, scolding the child).

Biological Pathways of Risk and Resilience in Syrian Refugee Children BIOPATH
IDRAAC is conducting a prospective study funded by The National Institutes of Health NIH -USA and in collaboration with Queen Mary University London and Médecins du Monde which aims at investigating the biological underpinnings of individual differences in refugee children’s response to acute war-related trauma exposure. This project studies genetic moderations of interventions related to mental health wellbeing of Syrian and Lebanese children by measuring pre-post changes in psychological variables and identifying specific gene variants in children who are more/less responsive to interventions. This project allows to understand the relationship between genetic, social, psychological and biological factors in relation to resilience.  

Wellbeing of Syrian Refugee Families- mainly Women and Youth-in Lebanon: An Integrated Intervention
IDRAAC, in partnership with UNFPA and with the support of the Ministry of Social Affairs implemented a mental health project funded by the U.S. government to provide psychosocial support to women and youth. This project targeted both Syrian refugees and the Lebanese hosting communities and aimed to improve the mental and social wellbeing of Syrian refugee families in Lebanon and enable the Lebanese government to provide support. As a result, the project built the capacity of refugee mothers in developing alternative strategies for parenting children with the goal of decreasing violence and physical abuse towards their children and women benefited from gender-based violence sessions delivered by trained social workers. Students and teachers were also trained on resilience building techniques through a classroom-based intervention to build resilience and positive coping among students which was implemented in schools.
IDRAAC is investigating the results of this multi-faceted project by studying the improvement in PTSD, Depression and Anxiety. IDRAAC is also measuring mental disorders outcomes, personal competence, sensitivity, childhood adversities, positive home experiences, war trauma and predictors of PTSD.  

Turning Teachers Into Educators of Tolerance and Conflict Resolution
This project was implemented in partnership with the Ministry of Education and Higher Education (MEHE) and funded by the US Embassy in Lebanon. The aim of this project was to improve the capacity of public school teachers to become mediators of behavioral change and contribute to build tolerance, decrease violence and conflicts among Syrian and Lebanese students. This classroom-based intervention consisted of 13 sessions which were conducted in public schools distributed in the Cazas of Aley, Metn and Sidon. The teachers were trained in order to enhance the capacity of public schools educators to build tolerance, and manage aggression and impulsivity among Syrian and Lebanese students .The teachers were selected as mediators of change as they play a critical role in children’s lives and are familiar with their world and needs.
IDRAAC is studying the improvement in PTSD, Depression and Anxiety. IDRAAC is also measuring mental disorders outcomes, personal competence, sensitivity, childhood adversities, positive home experiences, war trauma and predictors of PTSD.  

The School Program for Building Resilience and Coping
IDRAAC implemented this project which aimed at teaching school-age children and adolescents emotional, behavioral and cognitive tools to face stressful situations in daily life and was funded by the European Union. Teachers were trained to become educators about resilience and coping and the program took place over 15 weekly classroom sessions that are incorporated in the curriculum of the academic year. 
The project took place in 17 schools, 10 private and 7 public where trained teachers delivered the classroom-based intervention.  Questionnaires were administered to students, teachers, and parents and IDRAAC is currently assessing the effectiveness of this intervention among the students, their teachers and parents on various aspects including personal competence, coping skills, anxiety, depressive symptoms, behavioral problems, aggression as well as exposure to stressful events. 

War and Trauma

IDRAAC has been working since its inception on research about war and mental health.
Currently, IDRAAC is working on research projects related to studying the association between temperament and war exposure on mental disorder outcomes. IDRAAC is also studying late onset of mood and anxiety disorders with regards to first onset exposure before the age of 18 years to war and non-war events in addition to childhood adversities. 
In addition, IDRAAC has worked on different community interventions for populations which were affected by war and refugees and is currently investigating the effectiveness of these interventions and the effects of war and traumatic events.
Examples of community interventions  during war periods which are being evaluated for their effectiveness are listed below. To know more, you can click on  the following link.  

• GENMOD Study: which is a classroom-based intervention for PTSD, Depression and Anxiety targeting Lebanese and Syrian students attending public schools in Lebanon. This study also aims at by investigating the molecular genetics of individual differences in Syrian refugee children’s response to acute war-related traumatic experiences and variability in response to psychological intervention of both Lebanese and Syrian children as a function of genetic factors.
• Addressing the Needs of the Total Assyrian Community in Lebanon: which is a project aimed at addressing the needs of all age groups from the Assyrian refugee community in Lebanon: the children, the adults and the elderly through providing mental health and psychosocial support and capacity building to the Assyrian community workers. The project consisted of different activities such as a classroom-based intervention and a parenting program which served as a means to improve the health and mental health status of this group which has suffered from the effects of war and displacement. IDRAAC is currently investigating the results of the different interventions on the mental health of the beneficiaries.
• Biological Pathways of Risk and Resilience in Syrian Refugee Children BIOPATH: which aims at investigating the biological underpinnings of individual differences in refugee children’s response to acute war-related trauma exposure. This project studies genetic moderations of interventions related to mental health wellbeing of Syrian and Lebanese children by measuring pre-post changes in psychological variables and identifying specific gene variants in children who are more/less responsive to interventions.
• Wellbeing of Syrian Refugee Families- mainly Women and Youth-in Lebanon: An Integrated Intervention: which targeted both Syrian refugees and the Lebanese hosting communities and aimed to improve the mental and social wellbeing of Syrian refugee families in Lebanon and enable the Lebanese government to provide support. As a result, the project built the capacity of refugee mothers in developing alternative strategies for parenting children and women benefited from gender-based violence sessions delivered by trained social workers. Students and teachers were also trained on resilience building techniques through a classroom-based intervention to build resilience and positive coping among students which was implemented in schools. IDRAAC is currently investigating the results of this multi-faceted project on the beneficiaries.
• Turning Teachers Into Educators of Tolerance and Conflict Resolution: which aimed to improve the capacity of public school teachers to become mediators of behavioral change and contribute to build tolerance, decrease violence and conflicts among Syrian refugees and Lebanese students through a classroom-based intervention. IDRAAC is studying the improvement mental disorders outcomes among the beneficiaries of this intervention. 
• The School Program for Building Resilience and Coping: which aimed at teaching school-age children and adolescents, which are living in areas recently subjected to war, emotional, behavioral and cognitive tools to face stressful situations in daily life. IDRAAC is currently assessing the effectiveness of this intervention among the students, their teachers and parents on various aspects.