Psychometric Properties of an Arabic Translation of the short form of the Affective Lability Scale (ALS-18) in a non-clinical sample of Arabic-speaking adults.

Psychometric Properties of an Arabic Translation of the short form of the Affective Lability Scale (ALS-18) in a non-clinical sample of Arabic-speaking adults. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Properties of an Arabic Translation of the short form of the Affective Lability Scale (ALS-18) in a non-clinical sample of Arabic-speaking adults. Gaelle Kanj, Diana Malaeb, Fouad Sakr, Mariam Dabbous, Sahar Obeid, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4663963/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The present study aimed to investigate the psychometric properties of an Arabic version of the Affective Lability Scale in its short form (ALS-18) within an Arabic-speaking sample. Particularly, the concurrent validity, sex invariance and factorial structure were examined. Methods : The total sample of this cross-sectional study consisted of 748 adults, with a mean age of 34.48 ± 13.25 years, 66.5% females. The forward-backward translation method was applied. Results : The study’s findings denoted good internal consistency of the Arabic ALS-18 with values of McDonald’s ω and Cronbach’s α greater than .70. The fit of the scale’s original three-factor model was supported through confirmatory factor analyses. Sex invariance at the configural, metric, and scalar levels was established. The scale also yielded evidence of concurrent validity, being notably associated with increased measures of depression, anxiety and stress, and lower levels of self-esteem. Conclusion : Results revealed that the Arabic ALS-18 is a reliable and valid self-report measure that can be utilized among an Arabic-speaking population to assess affective lability. The availability of the Arabic version of the ALS-18 is deemed to increase its use for research and clinical purposes, globally benefiting Arabic-speaking individuals. Affective Lability Depression Anxiety Stress Self-esteem Psychometric Properties Arabic 1. Introduction Affective Lability (AL) is a multidimensional construct, defined as rapid, frequent, and intense oscillations in outward expression of emotions, yielding challenges in regulating the said fluctuations and their resulting behaviors [ 1,2 ]. Referring to a type of emotional reactivity, AL can incite heightened emotional reactions among individuals when faced with life events reminiscent to past emotional experiences that had a significant impact on them [ 3 ]. Harvey et al. [ 4 ] describe AL as the tendency to shift between various mood states similar to anger, hypomania, anxiety and depression. Beyond the general population, the prevalence of AL is found among individuals with diverse mental health disorders such as personality disorders, psychotic disorders, anxiety disorders or obsessive-compulsive disorders [ 1,5 ]. In such clinical populations, AL predicts multiple debilitating outcomes, such as disease progression, increased clinical burden and impaired social functioning [ 6 ], cognitive deficits [ 7 ] as well as suicidal ideation and attempts [ 8 ] Considering that AL is closely linked to the development of mental disorders, a psychometrically sound measure is required to accurately assess the construct in both clinical practice and scientific research. One comprehensive psychometric tool designed with the aim of evaluating changes across diverse modalities of affective functioning; assessing oscillations from one’s baseline mood (euthymic) to other affective domains, is the Affective Lability Scale (ALS) [ 4 ]. The original 54-item ALS developed by Harvey et al. [ 4 ] consists of six subscales elaborated to tap into one’s physiological perceptions, subjective experiences and behaviors, including “ depression, anxiety, elation, depression/anxiety, anger, and biphasic affect (depression/elation) ” [ 9 ]. These subscales are generated for six types of shifts in affect, measured through three dimensions, namely perceptions of behavioral, physiological, and emotional changes associated with cognition [ 4 ]. To address the ALS’s restricted empirical support concerning its factor structure [ 10 ] and length, a shorter version of 18 items (ALS-18) was elaborated by Oliver and Simons [ 9 ], comprising a three-factor model of AL. The latter scale retains a minimum of two items from the initial ALS’s subscales and shows a strong correlation with the total score of the original ALS (r = .94) [ 9 ]. The development of the ALS and ALS-18 was initially carried out in the English language and has since been adapted and/or validated in numerous other languages including Chinese [ 11 ], Greek [ 12 ], and Italian [ 13 ]. The two latter studies showed good internal reliability and consistency for the entirety of the ALS-18’s factors [ 12,13 ]. In fact, a minimum value of .85 for Cronbach’s alpha was found for all three factors. Conversely, the Chinese study [ 11 ] yielded contrary results; failing to support the three-model factor of the initial validation of the ALS-18 through its factor analysis. Nonetheless, the ALS-18 has not yet been validated in Arabic, to the extent of our knowledge. In addition, AL is a notable aspect of affect dysregulation on which a restricted number of research has been conducted in Arab contexts [ 14 ]. The lack of validated or adapted measures across cultures might pertain to that limit in the literature. Given that affect regulation has a culturally dependent nature [ 15 ], significant differences might be found between Western and Arab samples regarding AL. The validation of the ALS-18 among an Arabic-speaking sample might give rise to the appropriateness and usefulness of the scale in an Arab setting. Moreover, a shorter version, being further concise in nature, was deemed advantageous in terms of the administration of a scale examining AL among an Arab sample. In fact, the reduction in completion time, costs, and burden on respondents within Arab countries with low to middle income are noteworthy [ 16 ] as it increases response rates and data quality [ 17 ]. Given the aforementioned factors, the requirement for an Arabic version of the ALS-18 adequately translated and validated becomes evident. Subsequently, the objective of the current study was to assess the psychometric properties of an Arabic Translation of the short form of the ALS (ALS-18) in a non-clinical sample of Arabic-speaking adults from Lebanon. It is hypothesized that the scale in its Arabic version will (1) yield three-factor solution consistent with the original model, (2) show good composite reliability, (3) be invariant across sex groups, and (4) have adequate concurrent validity. 2. Methods 2.1. Procedures This cross-sectional study has been conducted during August 2023. The research team invited people to complete the survey via Google forms; those who agreed were requested to share the link with others, following the snowball sampling technique. Inclusion criteria comprised being an Arabic-speaking adult who resides in and is a citizen of Lebanon. Exclusions encompassed individuals declining to complete the questionnaire. The survey was conducted anonymously and participation was voluntary and without compensation. The study protocol was approved by the ethics committee of the School of Pharmacy at the Lebanese International University (Reference # 2023RC-023-LIUSOP). Informed consent was obtained from all subjects for study participation; the online submission of the soft copy was considered equivalent to receiving a written informed consent [ 18 ]. 2.2. Participants A total of 748 adults filled the survey, with a mean age of 34.48 ± 13.25 years and 66.5% females. 2.3. Measures 2.3.1. The Affective Lability Scale (ALS-18). The forward and backward translation method was applied to the ALS-18 following international guidelines [ 19 ]. The English version was translated to Arabic by a Lebanese translator who was completely unrelated to the study. Afterwards, a Lebanese psychologist with a full working proficiency in English, translated the Arabic version back to English. The initial and translated English versions were compared to detect and later eliminate any inconsistencies by a committee composed of the research team and the two translators [ 20,21 ]. A pilot study was conducted on 30 people before the start of the official data collection to ensure all questions are well understood; no changes were made consequently. The scale is composed of 18 items, rated on a 4-point Likert scale (“0= very uncharacteristic of me” to “3= very characteristic of me”). It yields three subscales: Anxiety/Depression, Depression/Elation, and Anger. The total score ranges between 0 and 54; higher scores indicate heightened affective lability. 2.3.2. The Arabic version of the Depression Anxiety Stress Scale (DASS-8) [ 22 ] comprises eight items rated on a four-point Likert scale. Those items yield three subscales: depression (three items e.g., “ felt down hearted and blue ”), anxiety (three items e.g., “ felt scared without reason ”), and stress (two items e.g., “ was using a lot of my mental energy ”). Higher scores indicate higher depression, anxiety and stress respectively. The reliability of the scale was good as follows: Depression (ω = 0.85/ α = 0.85), Anxiety (ω = 0.85/ α = 0.85), and Stress (α = 0.77). 2.3.3. The Arabic version of the Single Item Self-Esteem Scale (A-SISE) [ 23 ] consists of a single item in English as “ Please indicate to what extent the following statement applies to you. I have high self-esteem ”, and designed to efficiently assess global self-esteem [ 24 ]. Respondents are asked to rate the item on a 5-point Likert Scale (“ 1 = not at all true of me, 2 = rather not true of me, 3 = some part true of me, 4 = rather true of me, 5 = very true of me ”) [ 23 ]. 2.3.4. Demographics. Participants were asked to provide their demographic details consisting of age and sex. 2.4. Analytic Strategy 2.4.1. Confirmatory Factor Analysis (CFA). There were no missing responses in the dataset. Data from the total sample was used to conduct a CFA using the SPSS AMOS v.29 software. The minimum sample size to conduct a confirmatory factor analysis range from 3 to 20 times the number of the scale’s variables [ 25 ]. Therefore, a minimum sample of 360 participants was assumed needed to have enough statistical power based on a ratio of 20 participants per one item of the scale, which was exceeded in our sample. Our intention was to test the original model of the ALS-18 scores (i.e., three-factor model [ 26 ]) and, if divergent, carry out an exploratory-to-confirmatory factor analysis. Parameter estimates were obtained using the maximum likelihood method and fit indices. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 5 for χ²/df, and ≤ .08 for RMSEA, and .95 for CFI and TLI [ 27 ], and ≤ .05 for SRMR [ 28 ] indicate good fit of the model to the data. Multivariate normality was not verified at first (Bollen-Stine bootstrap p= .002); therefore, non-parametric bootstrapping procedure (available in AMOS) was performed. Evidence of convergent validity was assessed in this subsample using the average variance extracted (AVE), with values of ≥ 0.50 considered adequate [ 29 ]. 2.4.2. Sex invariance. To examine sex invariance of ALS-18 scores, multi-group CFA [ 30 ] using the total sample was conducted. Measurement invariance was assessed at the configural, metric, and scalar levels [ 31 ]. ΔCFI ≤ .010 and ΔRMSEA ≤ .015 or ΔSRMR ≤ .010 (.030 for factorial invariance) were accepted as evidence of invariance [ 30 ]. 2.5. Reliability and validity analyses. Composite reliability was assessed using McDonald’s ω and Cronbach’s α, with values greater than .70 reflecting adequate composite reliability [ 32 ]. All ALS-18 subscales scores were considered normally distributed according to their skewness and kurtosis values varying between ±1 [ 33 ]. Consequently, the Pearson test was used to correlate those scores with DASS-8 and A-SISE subscales scores. The Student t test was used to compare the ALS-18 subscales scores between sex groups. P < 0.05 was considered statistically significant. 3. Results 3.1. Confirmatory Factor Analysis of the ALS-18 CFA indicated that fit of the three-factor model of the ALS-18 scale was acceptable: χ 2 /df= 573.76/132 = 4.35, RMSEA = 0.067 (90% CI 0.061, 0.073), SRMR = 0.028, CFI = 0.957, TLI = 0.950. The standardized estimates of factor loadings were all adequate for all models (see Table 1). The AVE value was also adequate (= 0.63). The reliability of the scale was good as follows: Anxiety/Depression (ω = 0.89/ α = 0.89), Depression/Elation (ω = 0.93/ α = 0.93), and Anger (ω = 0.90/ α = 0.90) respectively. CFA of the second-order model indicated that fit of the total ALS-18 score was acceptable: χ 2 /df= 572.36/132 = 4.34, RMSEA = 0.067 (90% CI 0.061, 0.073), SRMR = 0.028, CFI = 0.957, TLI = 0.950. Table 1. Factor Loadings derived from the Confirmatory Factor Analysis of the three-factor model of the Affective Liability Scale in the total sample. CFA Factor 1: Depression-Anxiety 1. At times I feel just as realized as everyone else and then within minutes I become so nervous that I feel light-headed and dizzy. .67 2. One minute I can be feeling OK and then the next minute I’m tense, jittery, and nervous. .79 3. Many times I feel very nervous and tense and then suddenly feel very sad and down. .85 4. Sometimes I go from feeling extremely anxious about something to feeling very down about it. .80 5. I shift back and forth from feeling perfectly calm to feeling uptight and nervous. .84 Factor 2: Depression-Elation 6. There are times when I have very little energy and then soon afterwards I have the same energy level as most people. .75 7. Sometimes I can think clearly and concentrate well one minute and then the next minute I have a great deal of difficulty concentrating and thinking clearly. .79 8. I switch back and forth between being extremely energetic and having so little energy that it’s a huge effort just to get where I’m going. .78 9. There are times when I feel absolutely wonderful about myself but soon afterwards I often feel that I am just about the same as everyone else. .80 10. I shift back and forth between being very unproductive and being just as productive as everyone else. .76 11. Sometimes I feel extremely energetic one minute and then the next minute I might have so little energy that I can barely do a thing. .82 12. There are times when I have more energy than usual and more than most people and then soon afterwards I have about the same energy level as everyone else. .81 13. At times I feel that I’m doing everything at a slow pace but then soon afterwards I feel that I’m no more slowed down than anyone else. .77 Factor 3: Anger 14. I frequently switch from being able to control my temper very well to not being able to control it very well at all. .83 15. There are times when I feel perfectly calm one minute and then the next minute the least little thing makes me furious. .81 16. Frequently, I will be feeling OK but then I suddenly get so mad that I could hit something. .81 17. There are times when I am so mad that I can barely stop yelling and other times shortly afterwards when I wouldn’t think of yelling at all. .78 18. There are times when I’m so mad that my heart starts pounding and/or I start shaking and then shortly afterwards I feel quite relaxed. .77 3.2. Sex Invariance of the ALS-18 scale As reported in Table 2, we were able to show the invariance across sex at the configural, metric, and scalar levels. Females had significantly higher depression-anxiety (6.36 ± 3.68 vs 5.49 ± 3.57, t (747) = -3.10, p = .002), depression-elation (10.80 ± 5.76 vs 8.98 ± 5.58, t (747) = -4.12, p < .001) and anger (5.50 ± 3.68 vs 6.25 ± 3.74, t (747) = -2.60, p = .009). Table 2. Measurement Invariance of the Affective Liability Scale across sex in the total sample. Model CFI RMSEA SRMR Model Comparison ΔCFI ΔRMSEA ΔSRMR Configural .939 .057 .043 Metric .938 .056 .046 Configural vs metric .001 .001 .003 Scalar .937 .055 .047 Metric vs scalar .001 .001 .001 Note. CFI = Comparative fit index; RMSEA = Steiger-Lind root mean square error of approximation; SRMR = Standardized root mean square residual. 3.3. Concurrent validity of the ALS-18 scale Higher ALS-18 depression-anxiety, ALS-18 depression-elation and ALS-18 anger were significantly associated with higher depression, anxiety and stress (as measured by DASS-8 scale) and lower self-esteem (Table 3). Table 3. Correlation matrix of continuous variables. 1 2 3 4 5 6 1. ALS-18 depression-anxiety 1 2. ALS-18 depression-elation .84*** 1 3. ALS-18 anger .81*** .84*** 1 4. DASS Depression .49*** .49*** .49*** 1 5. DASS Anxiety .52*** .49*** .53*** .83*** 1 6. DASS stress .47*** .46*** .47*** .76*** .74*** 1 7. Self-esteem -.14*** -.11** -.11** -.13*** -.15*** -.03 ** p < .01; *** p < .001 4. Discussion AL is a broad term employed to allude to emotion fluctuations, and is considered a predictor of various mental health disorders’ features, clinical course, and outcomes, including bipolar, personality or anxiety disorders [ 1,34 ]. For research purposes as well as preventive and clinical practice, the availability of reliable and valid scales for AL screening is of high importance. In this vein, validating the short form of the ALS in the Arabic language was deemed indispensable for the improvement of our comprehension of the ALS-18’ s practicality within the settings of Arab research. Factually, the administration of short scales requires reduced time and effort from respondents, heightening its convenience among the Arab population contending with a lack of psychometric soundness in tools for research, resources’ shortage, and financial turmoil [ 35 ]. The investigation of the psychometric properties of the Arabic ALS-18 conducted through this present study revealed a good reliability and acceptable fit of the ALS-18 three-factor model and second-order model. Additionally, the scale showed notable concurrent validity, as well as an invariance across sex. In summary, the Arabic version of the ALS-18 is presumed suitable and convenient for screening affective lability among non-clinical Arab populations. The internal consistency of the Arabic ALS-18 underscored in our results is deemed adequate for the scale’s three dimensions as follows: Anxiety/Depression (AD) (ω = 0.89/ α = 0.89), Depression/Elation (DE) (ω = 0.93/ α = 0.93), and Anger (ω = 0.90/ α = 0.90). Our results are consistent with previously conducted studies investigating the psychometric properties of the 3-factor ALS-18. Among a population of undergraduates, Cronbach’s alpha coefficients obtained in the first study of the development of the ALS Short Form [ 9 ] were of .87 for AD, .81 for DE, and .82 for Anger. An investigation of the psychometric properties carried out a few years later among individuals with personality disorders and control groups [ 26 ], and within a Chinese population [ 11 ] yielded similar results, with coefficient alpha respectively equaling .82 and .87 for AD, .78 and .865 for DE, as well as .87 and .81 for Anger. The use of McDonald's ω presents an advantage to the current study, in comparison with only using Cronbach's alpha coefficient in the foregoing research, as the former coefficient’s effectiveness is considered greater than that of the latter [ 36 ]. Moreover, our findings underscore a notable invariance across sex at the metric, scalar and configural levels among an Arabic-speaking sample, ensuring that its factorial structure do not vary between sex in the stated population [ 16 ]. To the extent of our knowledge, the measurement invariance across sex is scarce in the literature. Indeed, few studies have examined this characteristic, one of which was conducted by Harvey et al. [ 4 ] on the ALS initial 54-item version. The later researchers highlighted differences among sex solely for the depression scale. Similarly, in their research within a Portuguese sample, Almeida et al. [ 3 ] found notably higher sores among women than men on the total and subscales’ scores. Contardi et al. [ 13 ] contend that the ALS-18’s scores show no association with sex. The present study showed significantly higher scores on AD, DE, and Anger among female respondents in comparison to male respondents. The distinctions in emotional experiences among males and females have indeed been underscored through precedent research, particularly concerning the frequency of negative emotions [ 3 ]. In fact, Gunnlaugsson et al. [ 37 ] postulates that women have a predisposition to heightened levels of AL. This may explain the increased susceptibility of females to diverse mental health disorders relating to emotions and its fluctuations [ 38,39 ]. Findings of the present study highlighted a significant association between greater all three ALS-18 dimensions (i.e., depression-anxiety, depression-elation and anger) scores and higher depression, anxiety, and stress, indicating that individuals with increased AL would tend to experience high levels of psychological distress. These results would also suggest the role of a risk factor that affective lability may play for depression, anxiety, and stress [ 11 ]. Despite the contrasting results from Oliver and Simons [ 9 ] offering no further clarifications, our findings are supported by numerous previous studies [ 11,13,40,41 ]. In fact, the association observed can be uncovered by the high comorbidity existing between depression and anxiety [ 42 ]. Furthermore, a link between depression and the ALS-18 factor of anger was established, supporting the idea that anger is a prominent feature of depression and significantly contributes to its development [ 43 ]. Moreover, stress is identified among affective lability, depression, and anxiety [ 44 ]. Additionally, an association between higher ALS depression-anxiety, ALS depression-elation and ALS anger, and lower self-esteem. The latter concept has become central in psychology, defined as “ the individual's positive or negative attitude toward the self as a totality ” [ 45 ]. It has been shown that poor self-esteem correlates with various mental disorders with affect and emotion regulation emerging as crucial factors [ 46 ]. In other words, self-esteem is associated with the two extensively studied emotion regulation strategies: individuals employing reappraisal to manage emotions tend to exhibit higher self-esteem [ 46 ]. Furthermore, fluctuations in self-esteem and mood are significant characteristics observed in clinical conditions like depression [ 47 ]. Individuals with low self-esteem often interpret their daily events as less positive and more influential on their emotional states [ 48 ]. Limitations and Research perspective The current study has several notable strengths worth highlighting. The recruitment of an adequate sample size, the involvement from both sex groups, and the use of validated measures for concurrent validity analyses enrich the research. Furthermore, validating and investigating the psychometric characteristics of a shortened version of the ALS in an Arab-speaking community marks a significant step forward in the field. Another advantage would be the use of McDonald's ω for examination of the internal consistency and sex invariance. Additionally, it is imperative that some limits be recognized and addressed in further research projects. The primary drawback lies in the fact that generalizability of conclusions cannot be made due to the sole recruitment of a non-clinical sample obtained using the snowball technique. Also, the present study abstained from investigating some psychometric characteristics of the Arabic ALS-18, such as test-retest reliability and divergent validity, calling for more research in these areas. Finally, future validation studies still need to verify that the Arabic ALS-18 is valid, reliable and suitable for use among clinical populations, such as patients with bipolar disorders, depressive disorders or personality disorders. 5. Conclusion The current study sought to investigate the psychometric properties of the ALS-18 within an Arabic-speaking population, providing evidence of scale’s adequacy for assessing affective lability in Arab settings. Additional cross-cultural validations of the ALS-18 in various cultural and religious contexts across Arab countries is suggested. Providing scholars access to the Arabic version of the scale may expand study prospects in this topic across various Arab cultural backgrounds and contexts. Declarations Ethics Approval and Consent to Participate : Ethics approval for this study was obtained from the ethics committee of the School of Pharmacy at the Lebanese International University (2023RC-023-LIUSOP). Written informed consent was obtained from all subjects; the online submission of the soft copy was considered equivalent to receiving a written informed consent. All methods were performed in accordance with the relevant guidelines and regulations. Consent for publication: Not applicable. Availability of data and materials : All data generated or analyzed during this study are not publicly available due the restrictions from the ethics committee, but are available upon a reasonable request from the corresponding author. Competing interests: The authors have nothing to disclose. Funding: None. Author contributions: SH and FFR designed the study; GK drafted the manuscript; SH carried out the analysis and interpreted the results; DM, FS and MD collected the data, SO and FFR reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent. Acknowledgements: The authors would like to thank all participants. 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Psychol.Res. 2021;85(4):1732-1747. Bradley MM, Codispoti M, Sabatinelli D, Lang PJ. Emotion and motivation II: Sex differences in picture processing. . 2001;1(3):300. Weibel S, Micoulaud-Franchi J, Brandejsky L, et al. Psychometric properties and factor structure of the short form of the affective lability scale in adult patients with ADHD. . 2019;23(10):1079-1089. Li H. Maternal-infant attachment and its relationships with postpartum depression, anxiety, affective instability, stress, and social support in a canadian community sample. Psychiatr.Q. 2023;94(1):9-22. Pollack MH. Comorbid anxiety and depression. J.Clin.Psychiatry . 2005;66:22. Busch FN. Anger and depression. . 2009;15(4):271-278. Li H, Glecia A, Balbuena L. Confirmatory factor analysis of the affective lability scale-18 in a community sample of pregnant and postpartum women. . 2021;8(4):294-307. Rosenberg M, Schooler C, Schoenbach C, Rosenberg F. Global self-esteem and specific self-esteem: Different concepts, different outcomes. Am.Sociol.Rev. 1995:141-156. Mouatsou C, Koutra K. Emotion regulation in relation with resilience in emerging adults: The mediating role of self-esteem. . 2023;42(1):734-747. Kashdan TB, Uswatte G, Steger MF, Julian T. Fragile self-esteem and affective instability in posttraumatic stress disorder. Behav.Res.Ther. 2006;44(11):1609-1619. Campbell JD, Chew B, Scratchley LS. Cognitive and emotional reactions to daily events: The effects of self‐esteem and self‐complexity. J.Pers. 1991;59(3):473-505. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Introduction","content":"\u003cp\u003eAffective Lability (AL) is a multidimensional construct, defined as rapid, frequent, and intense oscillations in outward expression of emotions, yielding challenges in regulating the said fluctuations and their resulting behaviors [\u003csup\u003e1,2\u003c/sup\u003e]. Referring to a type of emotional reactivity, AL can incite heightened emotional reactions among individuals when faced with life events reminiscent to past emotional experiences that had a significant impact on them [\u003csup\u003e3\u003c/sup\u003e]. Harvey et al. [\u003csup\u003e4\u003c/sup\u003e] describe AL as the tendency to shift between various mood states similar to anger, hypomania, anxiety and depression. Beyond the general population, the prevalence of AL is found among individuals with diverse mental health disorders such as personality disorders, psychotic disorders, anxiety disorders or obsessive-compulsive disorders [\u003csup\u003e1,5\u003c/sup\u003e]. In such clinical populations, AL predicts multiple debilitating\u0026nbsp;outcomes, such as disease progression, increased clinical burden and impaired social functioning [\u003csup\u003e6\u003c/sup\u003e], cognitive deficits [\u003csup\u003e7\u003c/sup\u003e] as well as suicidal ideation and attempts [\u003csup\u003e8\u003c/sup\u003e] Considering that AL is closely linked to the development of mental disorders, a psychometrically sound measure is required to accurately assess the construct in both clinical practice and scientific research.\u003c/p\u003e\n\u003cp\u003eOne comprehensive psychometric tool designed with the aim of evaluating changes across diverse modalities of affective functioning; assessing oscillations from one\u0026rsquo;s baseline mood (euthymic) to other affective domains, is the Affective Lability Scale (ALS) [\u003csup\u003e4\u003c/sup\u003e]. The original 54-item ALS developed by Harvey et al. [\u003csup\u003e4\u003c/sup\u003e] consists of six subscales elaborated to tap into one\u0026rsquo;s physiological perceptions, subjective experiences and behaviors, including \u0026ldquo;\u003cem\u003edepression, anxiety, elation, depression/anxiety, anger, and biphasic affect (depression/elation)\u003c/em\u003e\u0026rdquo; [\u003csup\u003e9\u003c/sup\u003e]. These subscales are generated for six types of shifts in affect, measured through three dimensions, namely perceptions of behavioral, physiological, and emotional changes associated with cognition [\u003csup\u003e4\u003c/sup\u003e]. To address the ALS\u0026rsquo;s restricted empirical support concerning its factor structure [\u003csup\u003e10\u003c/sup\u003e] and length, a shorter version of 18 items (ALS-18) was elaborated by Oliver and Simons [\u003csup\u003e9\u003c/sup\u003e], comprising a three-factor model of AL. The latter scale retains a minimum of two items from the initial ALS\u0026rsquo;s subscales and shows a strong correlation with the total score of the original ALS (r = .94) [\u003csup\u003e9\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eThe development of the ALS and ALS-18 was initially carried out in the English language and has since been adapted and/or validated in numerous other languages including Chinese [\u003csup\u003e11\u003c/sup\u003e], Greek [\u003csup\u003e12\u003c/sup\u003e], and Italian [\u003csup\u003e13\u003c/sup\u003e]. The two latter studies showed good internal reliability and consistency for the entirety of the ALS-18\u0026rsquo;s factors [\u003csup\u003e12,13\u003c/sup\u003e]. In fact, a minimum value of .85 for Cronbach\u0026rsquo;s alpha was found for all three factors. Conversely, the Chinese study [\u003csup\u003e11\u003c/sup\u003e] yielded contrary results; failing to support the three-model factor of the initial validation of the ALS-18 through its factor analysis. Nonetheless, the ALS-18 has not yet been validated in Arabic, to the extent of our knowledge. In addition, AL is a notable aspect of affect dysregulation on which a restricted number of research has been conducted in Arab contexts [\u003csup\u003e14\u003c/sup\u003e]. The lack of validated or adapted measures across cultures might pertain to that limit in the literature. Given that affect regulation has a culturally dependent nature [\u003csup\u003e15\u003c/sup\u003e], significant differences might be found between Western and Arab samples regarding AL. The validation of the ALS-18\u0026nbsp;among an Arabic-speaking sample might give rise to the appropriateness and usefulness of the scale in an Arab setting. Moreover, a shorter version, being further concise in nature, was deemed advantageous in terms of the administration of a scale examining AL among an Arab sample. In fact, the reduction in completion time, costs, and burden on respondents within Arab countries with low to middle income are noteworthy [\u003csup\u003e16\u003c/sup\u003e] as it increases response rates and data quality [\u003csup\u003e17\u003c/sup\u003e]. Given the aforementioned factors, the requirement for an Arabic version of the ALS-18 adequately translated and validated becomes evident. Subsequently, the objective of the current study was to assess the psychometric properties of an Arabic Translation of the short form of the ALS (ALS-18) in a non-clinical sample of Arabic-speaking adults from Lebanon. It is hypothesized that the scale in its Arabic version will (1) yield three-factor solution consistent with the original model, (2) show good composite reliability, (3) be invariant across sex groups, and (4) have adequate concurrent validity.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study has been conducted during August 2023. The research team invited people to complete the survey via Google forms; those who agreed were requested to share the link with others, following the snowball sampling technique. Inclusion criteria comprised being an Arabic-speaking adult who resides in and is a citizen of Lebanon. Exclusions encompassed individuals declining to complete the questionnaire. The survey was conducted anonymously and participation was voluntary and without compensation. The study protocol was approved by the ethics committee of the School of Pharmacy at the Lebanese International University (Reference # 2023RC-023-LIUSOP).\u0026nbsp;Informed consent was obtained from all subjects for study participation; the online submission of the soft copy was considered equivalent to receiving a written informed consent [\u003csup\u003e18\u003c/sup\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 748 adults filled the survey, with a mean age of 34.48 \u0026plusmn; 13.25 years and 66.5% females.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1. The Affective Lability Scale (ALS-18).\u0026nbsp;\u003c/strong\u003eThe forward and backward translation method was applied to the ALS-18 following international guidelines [\u003csup\u003e19\u003c/sup\u003e]. The English version was translated to Arabic by a Lebanese translator who was completely unrelated to the study. Afterwards, a Lebanese psychologist with a full working proficiency in English, translated the Arabic version back to English. The initial and translated English versions were compared to detect and later eliminate any inconsistencies by a committee composed of the research team and the two translators [\u003csup\u003e20,21\u003c/sup\u003e]. A pilot study was conducted on 30 people before the start of the official data collection to ensure all questions are well understood; no changes were made consequently. The scale is composed of 18 items, rated on a 4-point Likert scale (\u0026ldquo;0= very uncharacteristic of me\u0026rdquo; to \u0026ldquo;3= very characteristic of me\u0026rdquo;). It yields three subscales: Anxiety/Depression, Depression/Elation, and Anger. The total score ranges between 0 and 54; higher scores indicate heightened affective lability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2.\u003c/strong\u003e \u003cstrong\u003eThe Arabic version of the Depression Anxiety Stress Scale (DASS-8)\u003c/strong\u003e [\u003csup\u003e22\u003c/sup\u003e] comprises eight items rated on a four-point Likert scale. Those items yield three subscales: depression (three items e.g., \u0026ldquo;\u003cem\u003efelt down hearted and blue\u003c/em\u003e\u0026rdquo;), anxiety (three items e.g., \u0026ldquo;\u003cem\u003efelt scared without reason\u003c/em\u003e\u0026rdquo;), and stress (two items e.g., \u0026ldquo;\u003cem\u003ewas using a lot of my mental energy\u003c/em\u003e\u0026rdquo;). Higher scores indicate higher depression, anxiety and stress respectively. The reliability of the scale was good as follows: Depression (\u0026omega; = 0.85/ \u0026alpha; = 0.85), Anxiety (\u0026omega; = 0.85/ \u0026alpha; = 0.85), and Stress (\u0026alpha; = 0.77).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.3. The Arabic version of the Single Item Self-Esteem Scale (A-SISE)\u0026nbsp;\u003c/strong\u003e[\u003csup\u003e23\u003c/sup\u003e] consists of a single item in English as \u0026ldquo;\u003cem\u003ePlease indicate to what extent the following statement applies to you. I have high self-esteem\u003c/em\u003e\u0026rdquo;, and designed to efficiently assess global self-esteem [\u003csup\u003e24\u003c/sup\u003e]. Respondents are asked to rate the item on a 5-point Likert Scale (\u0026ldquo;\u003cem\u003e1\u0026thinsp;=\u0026thinsp;not at all true of me, 2\u0026thinsp;=\u0026thinsp;rather not true of me, 3\u0026thinsp;=\u0026thinsp;some part true of me, 4\u0026thinsp;=\u0026thinsp;rather true of me, 5\u0026thinsp;=\u0026thinsp;very true of me\u003c/em\u003e\u0026rdquo;) [\u003csup\u003e23\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.4. Demographics.\u003c/strong\u003e Participants were asked to provide their demographic details consisting of age and sex.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Analytic Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.1. Confirmatory Factor Analysis (CFA).\u0026nbsp;\u003c/strong\u003eThere were no missing responses in the dataset. Data from the total sample was used to conduct a\u0026nbsp;CFA\u0026nbsp;using the SPSS AMOS v.29 software. The minimum sample size to conduct a confirmatory factor analysis range from 3 to 20 times the number of the scale\u0026rsquo;s variables [\u003csup\u003e25\u003c/sup\u003e]. Therefore, a minimum sample of 360 participants was assumed needed to have enough statistical power based on a ratio of 20 participants per one item of the scale, which was exceeded in our sample. Our intention was to test the original model of the ALS-18\u0026nbsp;scores (i.e., three-factor model [\u003csup\u003e26\u003c/sup\u003e]) and, if divergent, carry out an exploratory-to-confirmatory factor analysis. Parameter estimates were obtained using the maximum likelihood method and fit indices.\u0026nbsp;To check if the model was adequate, several fit indices were calculated: the normed model chi-square (\u0026chi;\u0026sup2;/df), the Steiger-Lind root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR),\u0026nbsp;the Tucker-Lewis Index (TLI) and the comparative fit index (CFI).\u0026nbsp;Values\u0026nbsp;\u0026le;\u0026nbsp;5 for\u0026nbsp;\u0026chi;\u0026sup2;/df, and \u0026le; .08 for RMSEA, and .95 for CFI and TLI [\u003csup\u003e27\u003c/sup\u003e], and \u0026le; .05 for SRMR [\u003csup\u003e28\u003c/sup\u003e] indicate good fit of the model to the data. Multivariate normality was not verified at first (Bollen-Stine bootstrap p= .002); therefore, non-parametric bootstrapping procedure (available in AMOS) was performed.\u0026nbsp;Evidence of convergent validity was assessed in this subsample using the average variance extracted (AVE), with values of\u0026thinsp;\u0026ge;\u0026thinsp;0.50 considered adequate [\u003csup\u003e29\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2. Sex invariance.\u0026nbsp;\u003c/strong\u003eTo examine sex invariance of ALS-18 scores, multi-group CFA [\u003csup\u003e30\u003c/sup\u003e] using the total sample was conducted. Measurement invariance was assessed at the\u0026nbsp;configural, metric, and scalar\u0026nbsp;levels [\u003csup\u003e31\u003c/sup\u003e]. \u0026Delta;CFI\u0026nbsp;\u0026le; .010 and\u0026nbsp;\u0026Delta;RMSEA\u0026nbsp;\u0026le;\u0026nbsp;.015 or \u0026Delta;SRMR\u0026nbsp;\u0026le;\u0026nbsp;.010 (.030 for factorial invariance)\u0026nbsp;were accepted\u0026nbsp;as evidence of invariance [\u003csup\u003e30\u003c/sup\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Reliability and validity analyses.\u0026nbsp;\u003c/strong\u003eComposite reliability\u0026nbsp;was assessed using McDonald\u0026rsquo;s\u0026nbsp;\u0026omega; and Cronbach\u0026rsquo;s \u0026alpha;, with values\u0026nbsp;greater\u0026nbsp;than\u0026nbsp;.70 reflecting adequate composite reliability [\u003csup\u003e32\u003c/sup\u003e].\u0026nbsp;All ALS-18 subscales scores were considered normally distributed according to their skewness and kurtosis values varying between \u0026plusmn;1 [\u003csup\u003e33\u003c/sup\u003e]. Consequently, the Pearson test was used to correlate those scores with DASS-8 and A-SISE subscales scores. The Student \u003cem\u003et\u003c/em\u003e test was used to compare the ALS-18 subscales scores between sex groups. \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Confirmatory Factor Analysis of the ALS-18\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCFA indicated that fit of the three-factor model of the ALS-18 scale was acceptable: \u0026chi;\u003csup\u003e2\u003c/sup\u003e/df= 573.76/132 = 4.35,\u0026nbsp;RMSEA = 0.067\u0026nbsp;(90% CI 0.061, 0.073), SRMR = 0.028, CFI = 0.957, TLI = 0.950. The standardized estimates of factor loadings were all adequate for all models (see Table 1). The AVE value was also adequate (= 0.63). The reliability of the scale was good as follows: Anxiety/Depression (\u0026omega; = 0.89/ \u0026alpha; = 0.89), Depression/Elation (\u0026omega; = 0.93/ \u0026alpha; = 0.93), and Anger (\u0026omega; = 0.90/ \u0026alpha; = 0.90) respectively.\u003c/p\u003e\n\u003cp\u003eCFA of the second-order model indicated that fit of the total ALS-18 score was acceptable: \u0026chi;\u003csup\u003e2\u003c/sup\u003e/df= 572.36/132 = 4.34, RMSEA = 0.067 (90% CI 0.061, 0.073), SRMR = 0.028, CFI = 0.957, TLI = 0.950.\u003c/p\u003e\n\u003cp\u003eTable 1.\u003cem\u003e\u0026nbsp;Factor Loadings derived from the Confirmatory Factor Analysis of the three-factor model of the Affective Liability Scale in the total sample.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"622\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003eCFA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eFactor 1: Depression-Anxiety\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e1. At times I feel just as realized as everyone else and then within minutes I become so nervous that I feel light-headed and dizzy.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e2. One minute I can be feeling OK and then the next minute I\u0026rsquo;m tense, jittery, and nervous.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e3. Many times I feel very nervous and tense and then suddenly feel very sad and down.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e4. Sometimes I go from feeling extremely anxious about something to feeling very down about it.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e5. I shift back and forth from feeling perfectly calm to feeling uptight and nervous.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eFactor 2: Depression-Elation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e6. There are times when I have very little energy and then soon afterwards I have the same energy level as most people.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e7. Sometimes I can think clearly and concentrate well one minute and then the next minute I have a great deal of difficulty concentrating and thinking clearly.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e8. I switch back and forth between being extremely energetic and having so little energy that it\u0026rsquo;s a huge effort just to get where I\u0026rsquo;m going.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e9. There are times when I feel absolutely wonderful about myself but soon afterwards I often feel that I am just about the same as everyone else.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e10. I shift back and forth between being very unproductive and being just as productive as everyone else.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e11. Sometimes I feel extremely energetic one minute and then the next minute I might have so little energy that I can barely do a thing.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e12. There are times when I have more energy than usual and more than most people and then soon afterwards I have about the same energy level as everyone else.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e13. At times I feel that I\u0026rsquo;m doing everything at a slow pace but then soon afterwards I feel that I\u0026rsquo;m no more slowed down than anyone else.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eFactor 3: Anger\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e14. I frequently switch from being able to control my temper very well to not being able to control it very well at all.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e15. There are times when I feel perfectly calm one minute and then the next minute the least little thing makes me furious.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e16. Frequently, I will be feeling OK but then I suddenly get so mad that I could hit something.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e17. There are times when I am so mad that I can barely stop yelling and other times shortly afterwards when I wouldn\u0026rsquo;t think of yelling at all.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"88.10289389067525%\" valign=\"top\"\u003e\n \u003cp\u003e18. There are times when I\u0026rsquo;m so mad that my heart starts pounding and/or I start shaking and then shortly afterwards I feel quite relaxed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.897106109324758%\" valign=\"top\"\u003e\n \u003cp\u003e.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Sex Invariance of the ALS-18 scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs reported in Table 2, we were able to show the invariance across sex at the configural, metric, and scalar levels. Females had significantly higher depression-anxiety (6.36 \u0026plusmn; 3.68 vs 5.49 \u0026plusmn; 3.57, \u003cem\u003et\u003c/em\u003e(747) = -3.10, \u003cem\u003ep\u003c/em\u003e = .002), depression-elation (10.80 \u0026plusmn; 5.76 vs 8.98 \u0026plusmn; 5.58, \u003cem\u003et\u003c/em\u003e(747) = -4.12, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and anger (5.50 \u0026plusmn; 3.68 vs 6.25 \u0026plusmn; 3.74, \u003cem\u003et\u003c/em\u003e(747) = -2.60, \u003cem\u003ep\u003c/em\u003e = .009).\u003c/p\u003e\n\u003cp\u003eTable 2. \u003cem\u003eMeasurement Invariance of the Affective Liability Scale across sex in the total sample.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"73%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003eSRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.958333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eModel Comparison\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Delta;CFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Delta;RMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026Delta;SRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eConfigural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.958333333333332%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eMetric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.938\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.958333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eConfigural vs metric\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.583333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eScalar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.375%\" valign=\"top\"\u003e\n \u003cp\u003e.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.958333333333332%\" valign=\"top\"\u003e\n \u003cp\u003eMetric vs scalar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.458333333333334%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e CFI = Comparative fit index; RMSEA = Steiger-Lind root mean square error of approximation; SRMR = Standardized root mean square residual.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Concurrent validity\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eof the ALS-18 scale\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigher ALS-18 depression-anxiety, ALS-18 depression-elation and ALS-18 anger were significantly associated with higher depression, anxiety and stress\u0026nbsp;(as measured by DASS-8 scale) and lower self-esteem (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Correlation matrix of continuous variables.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e1. ALS-18\u0026nbsp;depression-anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e2. ALS-18\u0026nbsp;depression-elation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e.84***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e3. ALS-18\u0026nbsp;anger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e.81***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.84***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e4. DASS Depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e.49***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.49***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.49***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e5. DASS Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e.52***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.49***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.53***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.83***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e6. DASS stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e.47***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.46***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.47***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.76***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e.74***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.681818181818183%\" valign=\"top\" style=\"width: 18.2776%;\"\u003e\n \u003cp\u003e7. Self-esteem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.03896103896104%\" valign=\"top\" style=\"width: 6.6464%;\"\u003e\n \u003cp\u003e-.14***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e-.11**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e-.11**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e-.13***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.363636363636363%\" valign=\"top\" style=\"width: 6.8419%;\"\u003e\n \u003cp\u003e-.15***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.662337662337663%\" valign=\"top\" style=\"width: 7.5261%;\"\u003e\n \u003cp\u003e-.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**\u003cem\u003ep\u003c/em\u003e \u0026lt; .01; ***\u003cem\u003ep\u003c/em\u003e \u0026lt; .001\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eAL is a broad term employed to allude to emotion fluctuations, and is considered a predictor of various mental health disorders\u0026rsquo; features, clinical course, and outcomes, including bipolar, personality or anxiety disorders [\u003csup\u003e1,34\u003c/sup\u003e]. For research purposes as well as preventive and clinical practice, the availability of reliable and valid scales for AL screening is of high importance. In this vein, validating the short form of the ALS in the Arabic language was deemed indispensable for the improvement of our comprehension of the ALS-18\u0026rsquo; s practicality within the settings of Arab research. Factually, the administration of short scales requires reduced time and effort from respondents, heightening its convenience among the Arab population contending with a lack of psychometric soundness in tools for research, resources\u0026rsquo; shortage, and financial turmoil [\u003csup\u003e35\u003c/sup\u003e]. The investigation of the psychometric properties of the Arabic ALS-18 conducted through this present study revealed a good reliability and acceptable fit of the ALS-18 three-factor model and second-order model. Additionally, the scale showed notable concurrent validity, as well as an invariance across sex. In summary, the Arabic version of the ALS-18 is presumed suitable and convenient for screening affective lability among non-clinical Arab populations.\u003c/p\u003e\n\u003cp\u003eThe internal consistency of the Arabic ALS-18 underscored in our results is deemed adequate for the scale\u0026rsquo;s three dimensions as follows:\u0026nbsp;Anxiety/Depression (AD) (\u0026omega; = 0.89/ \u0026alpha; = 0.89), Depression/Elation (DE) (\u0026omega; = 0.93/ \u0026alpha; = 0.93), and Anger (\u0026omega; = 0.90/ \u0026alpha; = 0.90). Our results are consistent with previously conducted studies investigating the psychometric properties of the 3-factor ALS-18. Among a population of undergraduates, Cronbach\u0026rsquo;s alpha coefficients obtained in the first study of the development of the ALS Short Form [\u003csup\u003e9\u003c/sup\u003e] were of .87 for AD, .81 for DE, and .82 for Anger. An investigation of the psychometric properties carried out a few years later among individuals with personality disorders and control groups [\u003csup\u003e26\u003c/sup\u003e], and within a Chinese population [\u003csup\u003e11\u003c/sup\u003e] yielded similar results, with coefficient alpha respectively equaling .82 and .87 for AD, .78 and .865 for DE, as well as .87 and .81 for Anger. The use of McDonald\u0026apos;s \u0026omega; presents an advantage to the current study, in comparison with only using Cronbach\u0026apos;s alpha coefficient in the foregoing research, as the former coefficient\u0026rsquo;s effectiveness is considered greater than that of the latter [\u003csup\u003e36\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003eMoreover, our findings underscore a notable invariance across sex at the metric, scalar and configural levels among an Arabic-speaking sample, ensuring that its factorial structure do not vary between sex in the stated population [\u003csup\u003e16\u003c/sup\u003e]. To the extent of our knowledge, the measurement invariance across sex is scarce in the literature. Indeed, few studies have examined this characteristic, one of which was conducted by Harvey et al. [\u003csup\u003e4\u003c/sup\u003e] on the ALS initial 54-item version. The later researchers highlighted differences among sex solely for the depression scale. Similarly, in their research within a Portuguese sample, Almeida et al. [\u003csup\u003e3\u003c/sup\u003e] found notably higher sores among women than men on the total and subscales\u0026rsquo; scores. Contardi et al. [\u003csup\u003e13\u003c/sup\u003e] contend that the ALS-18\u0026rsquo;s scores show no association with sex. The present study showed significantly higher scores on AD, DE, and Anger among female respondents in comparison to male respondents. The distinctions in emotional experiences among males and females have indeed been underscored through precedent research, particularly concerning the frequency of negative emotions [\u003csup\u003e3\u003c/sup\u003e]. In fact, Gunnlaugsson et al. [\u003csup\u003e37\u003c/sup\u003e] postulates that women have a predisposition to heightened levels of AL. This may explain the increased susceptibility of females to diverse mental health disorders relating to emotions and its fluctuations [\u003csup\u003e38,39\u003c/sup\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings of the present study highlighted a significant association between greater all three ALS-18 dimensions (i.e., depression-anxiety, depression-elation and anger) scores and higher depression, anxiety, and stress, indicating that individuals with increased AL would tend to experience high levels of psychological distress. These results would also suggest the role of a risk factor that affective lability may play for depression, anxiety, and stress [\u003csup\u003e11\u003c/sup\u003e]. \u0026nbsp;Despite the contrasting results from Oliver and Simons [\u003csup\u003e9\u003c/sup\u003e] offering no further clarifications, our findings are supported by numerous previous studies [\u003csup\u003e11,13,40,41\u003c/sup\u003e]. In fact, the association observed can be uncovered by the high comorbidity existing between depression and anxiety [ \u003csup\u003e42\u003c/sup\u003e]. Furthermore, a link between depression and the ALS-18 factor of anger was established, supporting the idea that anger is a prominent feature of depression and significantly contributes to its development [\u003csup\u003e43\u003c/sup\u003e]. Moreover, stress is identified among affective lability, depression, and anxiety [\u003csup\u003e44\u003c/sup\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, an association between higher ALS depression-anxiety, ALS depression-elation and ALS anger, and lower self-esteem. The latter concept has become central in psychology, defined as \u0026ldquo;\u003cem\u003ethe individual\u0026apos;s positive or negative attitude toward the self as a totality\u003c/em\u003e\u0026rdquo; [\u003csup\u003e45\u003c/sup\u003e]. It has been shown that poor self-esteem correlates with various mental disorders with affect and emotion regulation emerging as crucial factors [\u003csup\u003e46\u003c/sup\u003e]. In other words, self-esteem is associated with the two extensively studied emotion regulation strategies: individuals employing reappraisal to manage emotions tend to exhibit higher self-esteem [\u003csup\u003e46\u003c/sup\u003e]. Furthermore, fluctuations in self-esteem and mood are significant characteristics observed in clinical conditions like depression [\u003csup\u003e47\u003c/sup\u003e]. Individuals with low self-esteem often interpret their daily events as less positive and more influential on their emotional states [\u003csup\u003e48\u003c/sup\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Research perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study has several notable strengths worth highlighting. The recruitment of an adequate sample size, the involvement from both sex groups, and the use of validated measures for concurrent validity analyses enrich the research. Furthermore, validating and investigating the psychometric characteristics of a shortened version of the ALS in an Arab-speaking community marks a significant step forward in the field. Another advantage would be the use of McDonald\u0026apos;s \u0026omega; for examination of the internal consistency and sex invariance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, it is imperative that some limits be recognized and addressed in further research projects. The primary drawback lies in the fact that generalizability of conclusions cannot be made due to the sole recruitment of a non-clinical sample obtained using the snowball technique. Also, the present study abstained from investigating some psychometric characteristics of the Arabic ALS-18, such as test-retest reliability and divergent validity, calling for more research in these areas. Finally, future validation studies still need to verify that the Arabic ALS-18 is valid, reliable and suitable for use among clinical populations, such as patients with bipolar disorders, depressive disorders or personality disorders.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe current study sought to investigate the psychometric properties of the ALS-18 within an Arabic-speaking population, providing evidence of scale\u0026rsquo;s adequacy for assessing affective lability in Arab settings. Additional cross-cultural validations of the ALS-18 in various cultural and religious contexts across Arab countries is suggested. Providing scholars access to the Arabic version of the scale may expand study prospects in this topic across various Arab cultural backgrounds and contexts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e: Ethics approval for this study was obtained from the\u0026nbsp;ethics committee\u0026nbsp;of the School of Pharmacy at the Lebanese International University (2023RC-023-LIUSOP).\u0026nbsp;Written informed consent was obtained from all subjects; the online submission of the soft copy was considered equivalent to receiving a written informed consent.\u0026nbsp;All methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eAll data generated or analyzed during this study are not publicly available due the restrictions from the ethics committee, but are available upon a reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have nothing to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSH and FFR\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003edesigned the study; GK drafted the manuscript; SH carried out the analysis and interpreted the results; DM, FS and MD collected the data, SO and FFR reviewed the paper for intellectual content; all authors reviewed the final manuscript and gave their consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors would like to thank all participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychiatric Association D, American Psychiatric Association. \u003cem\u003eDiagnostic and statistical manual of mental disorders: DSM-5. \u003c/em\u003eVol 5. American psychiatric association Washington, DC; 2013.\u003c/li\u003e\n\u003cli\u003eLeaberry KD, Walerius DM, Rosen PJ, Fogleman ND. Emotional lability. \u003cem\u003eEncyclopedia of personality and individual differences\u003c/em\u003e. 2020:1319-1329.\u003c/li\u003e\n\u003cli\u003eAlmeida TC, Fernandes RM, Cunha O. Brief measure of affective lability among portuguese community and justice samples: Psychometrics and measurement invariance. \u003cem\u003eCrime \u0026amp; Delinquency\u003c/em\u003e. 2023:00111287221143931.\u003c/li\u003e\n\u003cli\u003eHarvey PD, Greenberg BR, Serper MR. The affective lability scales: Development, reliability, and validity. \u003cem\u003eJ Clin Psychol\u003c/em\u003e. 1989;45(5):786-793.\u003c/li\u003e\n\u003cli\u003eH\u0026oslash;egh MC, Melle I, Aminoff SR, et al. 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Validity and reliability of the arabic version of the self-report single-item self-esteem scale (A-SISE). \u003cem\u003eBMC Psychiatry\u003c/em\u003e. 2023;23(1):351.\u003c/li\u003e\n\u003cli\u003eBrailovskaia J, Margraf J. How to measure self-esteem with one item? validation of the german single-item self-esteem scale (G-SISE). . 2020;39(6):2192-2202.\u003c/li\u003e\n\u003cli\u003eMundfrom DJ, Shaw DG, Ke TL. Minimum sample size recommendations for conducting factor analyses. . 2005;5(2):159-168.\u003c/li\u003e\n\u003cli\u003eLook AE, Flory JD, Harvey PD, Siever LJ. Psychometric properties of a short form of the affective lability scale (ALS-18). . 2010;49(3):187-191.\u003c/li\u003e\n\u003cli\u003eHu L, Bentler PM. 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Confirmatory factor analysis of the affective lability scale-18 in a community sample of pregnant and postpartum women. . 2021;8(4):294-307.\u003c/li\u003e\n\u003cli\u003eRosenberg M, Schooler C, Schoenbach C, Rosenberg F. Global self-esteem and specific self-esteem: Different concepts, different outcomes. \u003cem\u003eAm.Sociol.Rev.\u003c/em\u003e 1995:141-156.\u003c/li\u003e\n\u003cli\u003eMouatsou C, Koutra K. Emotion regulation in relation with resilience in emerging adults: The mediating role of self-esteem. . 2023;42(1):734-747.\u003c/li\u003e\n\u003cli\u003eKashdan TB, Uswatte G, Steger MF, Julian T. Fragile self-esteem and affective instability in posttraumatic stress disorder. \u003cem\u003eBehav.Res.Ther.\u003c/em\u003e 2006;44(11):1609-1619.\u003c/li\u003e\n\u003cli\u003eCampbell JD, Chew B, Scratchley LS. Cognitive and emotional reactions to daily events: The effects of self‐esteem and self‐complexity. \u003cem\u003eJ.Pers.\u003c/em\u003e 1991;59(3):473-505.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Lebanese American University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Affective Lability, Depression, Anxiety, Stress, Self-esteem, Psychometric Properties, Arabic","lastPublishedDoi":"10.21203/rs.3.rs-4663963/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4663963/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The present study aimed to investigate the psychometric properties of an Arabic version of the Affective Lability Scale in its short form (ALS-18) within an Arabic-speaking sample. Particularly, the concurrent validity, sex invariance and factorial structure were examined.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The total sample of this cross-sectional study consisted of 748 adults, with a mean age of 34.48 ± 13.25 years, 66.5% females. The forward-backward translation method was applied.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The study’s findings denoted good internal consistency of the Arabic ALS-18 with values of McDonald’s ω and Cronbach’s α greater than .70. The fit of the scale’s original three-factor model was supported through confirmatory factor analyses. Sex invariance at the configural, metric, and scalar levels was established. The scale also yielded evidence of concurrent validity, being notably associated with increased measures of depression, anxiety and stress, and lower levels of self-esteem.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Results revealed that the Arabic ALS-18 is a reliable and valid self-report measure that can be utilized among an Arabic-speaking population to assess affective lability. The availability of the Arabic version of the ALS-18 is deemed to increase its use for research and clinical purposes, globally benefiting Arabic-speaking individuals.\u003c/p\u003e","manuscriptTitle":"Psychometric Properties of an Arabic Translation of the short form of the Affective Lability Scale (ALS-18) in a non-clinical sample of Arabic-speaking adults.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 12:24:23","doi":"10.21203/rs.3.rs-4663963/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a8beca5a-b9d4-406e-836c-792e0f7890a3","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-23T16:23:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-02 12:24:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4663963","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4663963","identity":"rs-4663963","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}