The impact of armed conflict and displacement on children's mental health is strongly mediated by compromised parenting stemming from persistently high caregiver stress. Parenting interventions for refugees emphasize the acquisition of parenting knowledge and skills, while overlooking the deleterious effects of chronic stress on parenting. War Child Holland's Caregiver Support Intervention (CSI) aims to strengthen parenting by lowering stress and improving psychosocial wellbeing among refugee parents, while also increasing knowledge and skill related to positive parenting. The CSI is a nine-session group intervention delivered by non-specialist providers. We describe the findings of a two-arm pilot randomized controlled trial of the CSI with Syrian refugees in Lebanon. The primary aim was to test the feasibility of our study methodology prior to conducting a definitive RCT. We recruited 78 families (151 parents), who were randomized to the CSI or a waitlist control group. Data were collected at baseline and post-intervention. Randomization was successful, retention was high (99 %), as was intervention completion (95 % among women, 86 % among men). Implementation fidelity was excellent. Blinding was largely, though not completely effective. The CSI group showed significantly increased parental warmth and responsiveness, decreased harsh parenting, lowered stress and distress, improved psychosocial wellbeing, and improved stress management. CSI parents reported increased child psychosocial wellbeing. Control families showed no significant change on any variable. Findings demonstrate the feasibility of our methodology for a definitive RCT, and suggest that the CSI shows promise as a scalable approach to strengthening parenting in refugee communities. Trial registration # ISRCTN33665023.

Background: There is evidence that chronic stress negatively impacts parenting among refugees and other war-affected communities. Persistent parental stress and distress may lead to unresponsive, anxious, or overly harsh parenting and a corresponding increase in emotional and behavior problems among children. Most parenting interventions emphasize the acquisition of knowledge and skills; however, this overlooks the deleterious effects of chronic stress on parenting. The Caregiver Support Intervention (CSI) aims to strengthen quality of parenting skills by lowering stress and improving psychosocial wellbeing among refugee caregivers of children aged 3–12 years, while also increasing knowledge and skills related to positive parenting. The CSI is a nine-session psychosocial group intervention delivered by non-specialist providers. It is intended for all adult primary caregivers of children in high-adversity communities, rather than specifically targeting caregivers already showing signs of elevated distress. Methods/design: The primary objective of this study is to assess the effectiveness of the CSI through a parallel group randomized controlled study with Syrian refugee families in North Lebanon. Participants will be primary caregivers of children aged 3–12 years, with one index child per family. Families will be randomized to the CSI or a waitlist control group. A total of 240 families (480 caregivers) will be recruited into the study. Randomization will be at the family level, and CSI groups will be held separately for women and men. The study will be implemented in two waves. Outcomes for both arms will be assessed at baseline, post-intervention, and at a 3-month follow-up. The primary outcome is quality of parenting skills. Secondary outcomes include parental warmth and sensitivity, harsh parenting, parenting knowledge, and child psychosocial wellbeing. Putative mediators of the CSI on parenting are caregiver stress, distress, psychosocial wellbeing, and stress management. Discussion: This trial may establish the CSI as an effective intervention for strengthening parenting in families living in settings of high adversity, particularly refugee communities. Trial registration: International Society for the Registration of Clinical Trials, ISRCTN22321773. Registered on 5 August 2019

Background: Binge eating disorder (BED) is characterized by episodes of uncontrollable eating, defined by the rapid consumption of large quantities of food over a short period. This condition is associated with a variety of psychological and non-psychological factors, including behavioral, biological, genetic, neurological, and pharmacological influences, all of which adversely affect patients’ daily lives. BED is linked to numerous health consequences, such as obesity, atherosclerosis, diabetes, chronic pain, and hypertension. Although BED is not exclusive to individuals with obesity, it is more prevalent in this population, who also face a heightened risk of developing metabolic syndrome (MetS). The latter is a cluster of five risk factors—obesity, hyperlipidemia, hyperinsulinemia, hypertension, and hyperglycemia—that significantly increase the likelihood of chronic diseases. Methods: This narrative review synthesizes existing research to explore the association between BED and MetS, examining shared pathophysiological mechanisms and clinical implications. It also highlights the role of escalating food insecurity and ongoing political, economic, and health crises in the development of BED. Results: BED is significantly associated with MetS components, including hypertension, obesity, type 2 diabetes, and dyslipidemia, all contributing to increased morbidity and mortality. Beyond body weight, behavioral, genetic, biological, and neurological factors mediate this relationship. Conclusions: BED is strongly linked to MetS through shared behavioral, genetic, and biological pathways. Early detection, integrated management strategies, and further research are crucial to addressing the public health challenges posed by this association.

Background/Objectives: Emotional eating can pose a significant threat to one’s health as it can be a predictor of eating disorders. It involves eating in response to emotional distress rather than physical hunger and is widely associated with insecure attachment patterns. However, it remains unclear whether this relationship is consistent across cultures and in the general population. This review aimed to examine the relationship between different conceptualizations of attachment and emotional eating in non-clinical adolescent and adult populations. Methods: Nineteen eligible studies were identified through searches of five databases, including ProQuest, Scopus, Google Scholar, PubMed, and ProQuest Dissertations and Theses Global (PQDT), which covers peer-reviewed literature published between 1990 and 2025. Both quantitative and qualitative studies were included, spanning attachment styles, representations, and states. Results: The findings consistently revealed that general secure attachment styles are associated with lower levels of EE. In comparison, insecure–anxious and disorganized attachment styles are positively associated with higher EE levels. In contrast, avoidant attachment showed a weak or inconsistent association. Mediators such as difficulties with emotion regulation, perceived hunger, and body dissatisfaction were frequently identified, and stress emerged as a relevant moderator. Notably, attachment to specific figures (e.g., romantic partners versus caregivers) and cultural context were poorly addressed, which may influence the strength and consistency of the associations. The review also highlights conceptual gaps in the literature, including a limited focus on early attachment representations, context-specific attachment scripts, and the cultural validity of these concepts. Most studies were cross-sectional and conducted in Western contexts, which limited their causal interpretation and generalizability. Conclusions: These findings underscore the importance of attachment-based frameworks in understanding and preventing EE. They suggest the necessity to conduct further studies that are more nuanced, longitudinal, culturally diverse, and that consider sex and pubertal changes for a better understanding of the relationship between attachment and EE. This review contributes to prevention efforts and global health strategies by addressing the relational and emotional determinants of unhealthy eating behaviors in the general population.

Cette étude vise à identifier les liens entre les styles d’attachement des parents (n=110) des enfants ayant un trouble déficitaire de l’attention avec ou sans hyperactivité (TDAH) et les pratiques éducatives associées aux dimensions spécifiques du TDAH (inattention et hyperactivité). Les parents des enfants ayant un TDAH semblent être pour la plupart insécurisés et particulièrement préoccupés. Les parents insécurisés en général et les préoccupés en particulier rapportent significativement moins de discipline verbale positive, moins de félicitations et récompenses, moins de supervision adaptée et plus de discipline sévère et inconstante que les parents sécurisés. Par ailleurs, plus les parents exercent une pauvre supervision plus les enfants déploient des comportements hyperactifs. En somme cette étude souligne l’importance relative du style d’attachement des parents et de leurs pratiques éducatives comme facteur de risque au développement ou à l’exacerbation des symptômes pouvant s’apparenter au TDAH.

Background: Palliative care access remains limited in Lebanon, particularly outside the capital. Data on public palliative care knowledge and perceptions in general and among disadvantaged populations remain insufficient. Objective: This study aimed to assess palliative care awareness and knowledge among community users of a non-governmental organization serving socioeconomically disadvantaged populations in Tripoli, north of Lebanon. Methods: A cross-sectional study was conducted using a structured survey targeting 400 individuals using the Palliative Care Knowledge Scale (PaCKS) in the colloquial Arabic language. Data on palliative care awareness and background information were collected. Multivariable binary logistic regression using stepwise backward selection was conducted to identify predictors associated with palliative care knowledge levels and common misconceptions. Results: Low awareness of palliative care was observed, with 95.8% of participants reporting never having heard of it. PaCKS’s mean score was 9.24 ± 2.89; 40.8% ( N = 163) had high scores (11–13), 42.8% ( N = 171) had moderate scores (7–10), and 16.5% ( N = 66) had low scores (0–6). Common misconceptions included perceiving palliative care to be limited to hospital care, to cancer, and to end of life. Higher educational attainment was a strong and stable predictor of palliative care knowledge and common misconceptions. Participants with middle or high school education had 1.754 higher odds ( p = 0.013), and those with university education had 4.938 higher odds ( p < 0.001) for higher knowledge compared to participants with no or primary education, potentially indicating a graded association. More than half of the participants expressed interest in having information about palliative care made generally available. Conclusion: Our results indicate low awareness and several misconceptions about palliative care along with the presence of health inequities. Low educational attainment, mainly linked to socioeconomic disadvantage, may limit health literacy, and as such, reduce access to information and the ability to understand complex concepts such as palliative care. These findings highlight the urgent need for a collaborative, multi-sectoral system-thinking, community-centered, and equity-driven approach that involves the community, researchers, healthcare providers, and policymakers.