Study Design and Sampling
A cross-sectional study was conducted from 10-18 May 2020, using an online-based questionnaire created on Google forms. Due to the government-mandated sanitary lockdown, the survey was distributed to participants through social media platforms and WhatsApp groups, using the snowball sampling technique. All individuals over 18 years of age with access to the Internet were eligible. A total of 502 respondents filled out the questionnaire that required between 15 and 20 minutes to complete.
Minimal sample size calculation
The minimum sample size was calculated using the G-Power software, version 3.0.10. The calculated effect size was 0.0526, expecting a squared multiple correlation of 0.05 (R2 deviation from 0) related to the Omnibus test of multiple regression. The minimum necessary sample was n=454, considering an alpha error of 5%, a power of 80%, and allowing 25 predictors to be included in the model.
The online questionnaire was available in Arabic, the native language in Lebanon. It consisted of three parts. The first part assessed the sociodemographic features of the participants, such as age, gender, marital status, educational level, employment status, region, household size, current household monthly income (divided into five levels, according to the official exchange rate: no income, low< 675,000 LBP (450 USD), moderate 675,000-1,500,000 LBP (450-1,000 USD), intermediate 1,500,000-3,000,000 LBP (1,000-2,000 USD), and high income >3,000,000 LBP (2,000USD)); the socioeconomic status was assessed using quartiles of individual income (household income divided by the household size). Questions were also asked about medical coverage, smoking and alcohol consumption, self-perception of the financial situation, having been infected or in contact with people infected with coronavirus, and physical activity before and during COVID-19.
The second part of the questionnaire, addressed to working people and those seeking a job, consisted of a set of 20 questions related to current employment and how it was affected by either the economic crisis or the COVID-19. Examples of questions asked: Do you have to go out to make a living despite the sanitary lockdown? Are you able to apply social distancing while working (1.5-2m safety distance)? Did your company change the working hours because of the economic crisis or the COVID-19 pandemic? Has your salary/income been affected by the economic crisis or the COVID-19 pandemic? Are you worried about the long-term impact of the economic crisis or the COVID-19 pandemic on your business/job? Did the economic crisis or the COVID-19 pandemic result in decreasing the salaries of employees? Did the economic crisis or the COVID-19 pandemic cause the dismissal of some employees? What were the criteria used to lay-off employees?
The third part consisted of the several measures using validated scales, after obtaining the due permission from their copyright holders when necessary:
The World Health Organization-Five Well-Being Index (WHO-5)
This short self-reported tool is validated in Lebanon22 and consists of five questions graded from 0 to 5 to evaluate mental well-being and quality of life in the past month. The total score ranges from 0 to 25; higher scores indicate a better quality of life (αCronbach=0.796).
The fear of COVID-19 scale
This 7-item tool is used to measure the extent of fear of the COVID-19 in adult people.23 It is scored on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The total score ranges from 1 to 35, with higher scores indicating a greater fear of COVID-19 (αCronbach=0.893).
The InCharge Financial Distress/Financial Well-Being Scale (IFDFW)
This tool includes eight items that assess the perceived financial distress/financial well-being on a linear scale from 1 to 10.24 Lower scores reflect higher financial distress and lower well-being (αCronbach=0.925). Since this tool is copyrighted, written permission was obtained from the authors for cross-cultural validation and use in Lebanon.
The Family APGAR Index
This short self-reported instrument evaluates the satisfaction with global family function.25 It consists of five questions, each corresponding to a component of family function, i.e., Adaptation, Partnership, Growth, Affection, and Resolve (APGAR). All items are scored on a 3-point Likert scale: 0 (hardly ever), 1 (some of the time), and 2 (almost always). The total score ranges from 0 to 10. Higher scores indicate higher satisfaction with family function (αCronbach=0.927).
Translation Procedure and Piloting
All the scales used in this paper were translated into Arabic, except for the WHO-5, already validated and available in this language. Three authors performed the forward translation, and the other three, the back translation. Discrepancies between original English versions and translated ones were resolved by consensus.
The questionnaire was pilot-tested with ten people unfamiliar with the study to get to the final version; answers were not included in the final dataset.
Data were collected using Google Forms and generated on an Excel sheet, then transferred to IBM SPSS® software, version 23.0 for analysis. The database was weighted according to gender, age, and region of residence, based on the Central Administration of Statistics,26 before analysing it.
For the descriptive analysis, frequencies and percentages were used for categorical variables, and means and standard deviation for quantitative variables. For the dependent variable (WHO-5), the median and interquartile range were presented as well.
The distribution of the WHO-5 variable was considered normal using visual inspection of the histogram, while the skewness and kurtosis were both lower than 1. These conditions are considered compatible with normality in a sample size higher than 300.27
For the bivariate analysis of continuous variables, the Student’s T-test was used to compare the means between two groups and ANOVA between three groups or more, after checking for homogeneity of variances using Levene’s test; when variances were not homogenous, the corrected T-Test and the Kruskal-Wallis test were used, respectively. Post-hoc analyses were conducted, after ANOVA and Kruskal-Wallis comparisons, using Bonferroni adjustment. The McNemar-Bowker test was used to compare categorical variables before and after the beginning of the economic crisis. A Spearman correlation coefficient was used to correlate between scale variables. In all cases, a p-value lower than 0.05 was considered significant.
As for the multivariable analysis, a multiple linear regression was conducted to assess the correlates of WHO-5 in the whole sample, after checking the residues normality, linearity of the relationship, absence of multicollinearity, and homoscedasticity assumptions; a stepwise method was used to reach the most parsimonious model. As for the workers/trying to work subgroup analysis, a linear regression using the Generalized Linear Model was used, since the additional variables related to work conditions were multinomial; the ENTER method was used to reach the appropriate model with appropriate assumptions. Independent variables included in the models had a p-value lower than 0.1 in the bivariate analysis, taking into account the allowed maximal number of variables to be included given the sample size. The beta coefficient, its 95% Confidence Interval (CI), and the p-value were reported in both models.