Research & Publications
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 The L.E.B.A.N.O.N Study  L.E.B.A.N.O.N. Study
L.E.B.A.N.O.N. TEMP
Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) - WMH Study
- What are the World Mental Health Surveys (WMH)?
The WMH surveys are a WHO/Harvard initiative led by Dr. B.Ustun from WHO, (Geneva) and Dr. R. Kessler from Harvard University (USA). It is a worldwide exhaustive assessment of mental, behavioral and substance use disorders.
The following countries have been selected to participate: USA, Canada, Brazil, Cuba, Mexico, Japan, China, France, Colombia, Indonesia, Nepal, Nigeria, South Africa, Turkey, Germany, Italy, Sweden, Netherlands, Belgium, Spain, New Zealand, India, Lebanon, Ukraine, Panama and Peru. Lebanon is the only Arabic speaking country participating in this worldwide survey.
The objectives of WMH surveys are multifold and are mainly to assess the prevalence of mental health disorders, including substance use disorders, and to have accurate information on the quality and intricacies of couple life, on childhood and upbringing, and on the effect of stress on onset and course of mental disorders. It also assesses the effect of war, migration, economic burden and socio-demographic factors on mental health disorders and their adverse social consequences. Moreover, this study measures the temperament of the Lebanese and its impact on productivity, on quality and enjoyment of life and on mental health problems. Finally, accurate information has been collected on the impact of mental & physical health problems on the individual’s functioning, in addition to data on the utilization of services for emotional and psychiatric disorders (consultations, hospitalization and consumption of medications). Presentations based on this study can be found below.
For detailed information about the WMH initiative and the participating countries, please go to: www.hcp.med.harvard.edu/wmh
- Methods
In 2000, our group at IDRAAC decided to embark on this cross-national initiative and conduct the first national survey in the region, which studies extensively mental health disorders and other medical chronic illnesses. The L.E.B.A.N.O.N. national Study was based on a multistage household probability sample design without replacement. Households were selected from the five different Mohafazat representing the various demographic and socioeconomic levels in the country. Two thousand eight hundred fifty seven (2857) face-to-face interviews were conducted by lay interviewers who were intensively trained by two certified trainers at IDRAAC. Fourteen training sessions were conducted all over Lebanon to train the team of 350 fieldworkers. Data collection was strictly supervised at multiple levels with direct field back-check reaching up to 47% of the cases. Field quality control techniques included: field accompaniment, face-face visits and telephone back-check. Moreover, 100% of the completed interviews were fully edited with a re-editing rate of 20%. Data was entered using different softwares and extensive cleaning checks were implemented by both the Harvard Coordinating Center and IDRAAC’s team.
- Research Instrument
The L.E.B.A.N.O.N. Study used the WMH-CIDI (Composite International Diagnostic Interview), a fully structured diagnostic interview, to assess disorders and treatment. The WMH-CIDI was adapted to Arabic following a rigorous translation protocol. The WMH-CIDI assesses disorders based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10).
The wide spectrum of disorders and diseases assessed include:
- Anxiety Disorders: Generalized Anxiety Disorder, Specific Phobia, Social Phobia, Agoraphobia, Panic Disorder, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, etc…
- Mood Disorders: Major Depressive Disorder, Dysthymia and Bipolar Disorders)
- Substance Use Disorders: Alcohol, Illicit and licit drugs
- Other mental health disorders: Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder, etc…
- Other chronic medical conditions: Heart Problems, High Blood Pressure, Diabetes, Cancer, etc…
- Chronic Physical Conditions (prevalence, age of onset, treatment, disability…)
In addition, extensive data will also be available on the following:
- Disability (specific disability: impact of each of the disorders on daily activities, social life and work; general disability: effect of all physical and mental health problems on the respondent’s functioning)
- Service utilization for emotional problems (consultations, hospitalization, treatment expenses, compliance, utilization barriers…)
- Pharmacoepidemiology (use of any prescribed and non-prescribed medications, detailed information on the use of medications for nervous or emotional problems, etc…)
- Social support (frequency of contacts with family members and friends, perceived support from spouse, family and friends, quality of married life...)
- Childhood adversities (early separation from either parents, neglect, physical abuse, homelessness, etc…)
- Others: religious beliefs and commitment, cultural belonging and identification, temperament, family structure, employment and work history, etc…
Moreover, extensive information covering service utilization (consultations, hospitalization,..) and medication intake, economic status ( income, employment,…), social network, marital life, childhood experiences, war exposure, religious commitment, etc…. have been collected
- Couples Sub-sample
A 10% couple sub-sample was also selected to participate in an extensive assessment about marital relations (exposure to physical abuse, disagreement due to: handling family finance, matters of recreation, friends, philosophy of life, making major decisions, etc… thoughts of regret or divorce, involvement in decision making, spouse behavior including: alcohol or drug use, involvement in extramarital affairs, criminal activities…)
- The first paper on World Mental Health Published
The Journal of the American Medical Association (JAMA) published the first paper of the World Mental Health Study in its June 2, 2004 issue (Vol. 291, No. 21: 2581 – 2590.) The title of the article is "Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys". The abstract for this paper is below. To read the full text, please contact us
AUTHORS: The WHO World Mental Health Survey Consortium; Lebanon: Elie G. Karam, John A. Fayyad, Aimée N. Karam, Zeina N. Mneimneh
ABSTRACT:
Context: Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries.
Objective: To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative.
Design, Setting, and Participants: Face-to-face household surveys of 60,463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia.
Main Outcome Measures: The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview.
Results: The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an inter-quartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5% to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country.
Conclusions: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious case. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
- Lancet publishes IDRAAC paper from the L.E.B.A.N.O.N. Study
The Lancet Journal published a paper from IDRAAC in its March 25, 2006 issue titled: “Prevalence and treatment of mental disorders in Lebanon: a national epidemiological survey”, Volume 367, Number 9515: 1000-1006.
AUTHORS: Karam EG, Mneimneh ZN, Karam AN, Fayyad JA, Nasser SC, Chatterji S, Kessler RC
ABSTRACT:
Background: Mental disorders are believed to account for a large portion of disease burden worldwide. However, no national studies have been undertaken to assess this assumption in the Arab world..
Methods: As part of the WHO World Mental Health (WMH) Survey Initiative, a nationally representative psychiatric epidemiological survey of 2857 adults (aged 18 years) was done in Lebanon between September, 2002, and September, 2003, through a study called LEBANON (Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation). 12-month prevalence and severity of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) disorders, and treatment were assessed with the WHO Composite International Diagnostic Interview (CIDI, version 3.0). Information was also obtained for sociodemographics and exposure to traumatic events in the Lebanon wars.
Findings: 308 (17.0%) of respondents met criteria for at least one 12-month DSM-IV/CIDI disorder, 108 (27.0%) of whom were classified serious and an additional 112 (36.0%) moderate. Nearly half of respondents had a history of exposure to war-related traumatic events. Significantly elevated odds ratios (OR) of mood, anxiety, and impulse-control disorders were associated with two (OR 2.0-3.6) or more (2.2-9.1) war-related traumatic events, resulting in substantially higher proportions of moderate and severe 12-month mental disorders in respondents exposed to multiple war-related traumata (16.8-20.4%) compared with other respondents (3.3-3.5%). Only 47 (10.9%) respondents with 12-month disorders obtained treatment. 85% of people were treated in the general medical sector and the mental-health-care system, and the rest by religious or spiritual advisers, counsellors, herbalists, or fortune-tellers.
Interpretation: Mental disorders are common in Lebanon, with a prevalence equivalent to that in Western Europe. However, the number of individuals with mental disorders who are not receiving treatment is considerably higher in Lebanon than in Western countries.
To read the full text, please contact us.
- PLOS publishes IDRAAC paper from the L.E.B.A.N.O.N. Study
The PLOS Journal published a paper from IDRAAC in its April 1, 2008 issue titled: “Lifetime Prevalence of Mental Disorders in Lebanon: First Onset, Treatment, and Exposure to War”. Volume 5. Number 4: e61
AUTHORS: Karam EG, Mneimneh ZN, Fayyad JA, Dimassi H, Karam AN, Nasser SC, Chatterji S, Kessler RC
ABSTRACT:
Background: There are no published data on national lifetime prevalence and treatment of mental disorders in the Arab region. Furthermore, the effect of war on first onset of disorders has not been addressed previously on a national level, especially in the Arab region. Thus, the current study aims at investigating the lifetime prevalence, treatment, age of onset of mental disorders, and their relationship to war in Lebanon.
Methods and Findings: The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation study was carried out on a nationally representative sample of the Lebanese population (n¼2,857 adults). Respondents were interviewed using the fully structured WHO Composite International Diagnostic Interview 3.0. Lifetime prevalence of any Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) disorder was 25.8%. Anxiety (16.7%) and mood (12.6%) were more common than impulse control (4.4%) and substance (2.2%) disorders. Only a minority of
people with any mental disorder ever received professional treatment, with substantial delays (6 to 28 y) between the onset of disorders and onset of treatment. War exposure increased the risk of first onset of anxiety (odds ratio [OR] 5.92, 95% confidence interval [CI] 2.5–14.1), mood (OR 3.32, 95% CI 2.0–5.6), and impulse control disorders (OR 12.72, 95% CI 4.5–35.7).
Conclusions: About one-fourth of the sample (25.8%) met criteria for at least one of the DSM-IV disorders at some point in their lives. There is a substantial unmet need for early identification and treatment. Exposure to war events increases the odds of first onset of mental disorders.
To read the full text please, click here
To view the documentary perspective of exposure to war based on our article, by Prof. David Benedek and Prof. Robert Ursano click here
WMH Workgroups
Each year all international collaborators in the WMH consortium meet to discuss issues related to analysis and article writing. In this context, work groups with members from different countries have been created to discuss issues related specifically to drug abuse, suicide, ADHD, assortative mating, gender differences methodological aspects, government reports, and childhood adversities, with the latter being chaired by the Lebanese principal investigator.
- Funding
The L.E.B.A.N.O.N.-WMH survey is being mainly funded by IDRAAC with partial support from the Lebanese Ministry of Public Health, anonymous private donations to IDRAAC, the World Health Organization (WHO-Lebanon) and unrestricted grants from: Janssen Cilag, Eli Lilly, Glaxo Smith Kline, Roche and Novartis.
To view the list of publications from the above studies, please click here.
- IDRAAC’s Presentations and International Conferences about the L.E.B.A.N.O.N. study
Karam EG (September 2005). “The L.E.B.A.N.O.N. Study”. Presentation given at the XIII World Congress of Psychiatry , World Psychiatric Association (WPA), Cairo, Egypt.
Karam EG (June, 2004). “The World Mental Health Survey (WMH)”. Presentation given at 19th International Medical convention of the National Arab American Medical Association (NAAMA), Beirut, Lebanon.
Karam EG, Mneimneh Z, Karam A, Fayyad J, Chatila Y, Ghandour L, Cordahi-Tabet C (June, 2004). “Childhood Physical and Sexual abuse in Lebanon: An Epidemiologic Study”. Presentation at the First Arab International Society for Prevention of Child Abuse and Neglect (ISPCAN) Regional Conference, Amman, Jordan.
Karam EG (November, 2003). “The World Mental Health Survey (WMH)”. Presentation given during the 125th Annual Medical Conference on Adolescent Mental Health, Children’s Rights and Services, Saint George Hospital University Medical Center. Beirut, Lebanon
L.E.B.A.N.O.N. TEMP
IDRAAC has chosen the Temperament Evaluation of the Memphis Pisa Paris and San Diego Auto-Questionnaire (TEMPS-A) for the national assessment of affective temperament in Lebanon, as part of the national Lebanese Evaluation of the Burden of Ailments and Needs of the Nation (L.E.B.A.N.O.N.) study. This national study includes two components: the L.E.B.A.N.O.N. World Mental Health surveys where the Arabic Composite International Diagnostic Interview (CIDI 2000) was the instrument used for the diagnostic assessment of mental health disorders, and the L.E.B.A.N.O.N. – TEMP where the instrument used was the Lebanese-Arabic version of the TEMPS-A. Our group, IDRAAC, has translated, adapted and validated the TEMPS-A, from the original English TEMPS-A. Presentations based on this study can be found below.
To view the list of publications from the above studies, please click here.
- IDRAAC’s Presentations and International Conferences about the L.E.B.A.N.O.N. TEMP study
Karam EG (April 2006). Affective Temperaments, Axis I Disorders, and Correlates : The LEBANON Study. Research Presentation at the International Review of Bipolar Disorders, London, United Kingdom.
Karam EG (November, 2005). “Lebanese Affective Temperaments in the General Population: The LEBANON Study”. Research Presentation at the 2nd International Congress on Brain and Behaviour, Thessaloniki, Greece.
Karam EG (November, 2005). “Lebanese-Arabic TEMPS-A: Adaptation and Validity Clinical Utility”. Research Presentation at the Congres Annuel de L’Hopital Psychiatrique de la Croix :Les Personnalites Pathologiques, Beirut, Lebanon.
Karam EG (April, 2005). “Lebanese-Arabic TEMPS-A: Adaptation and Validity Clinical Utility”. Research Presentation at the International Review of Bipolar Disorders, Lyon, France.
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