The Life Orientation Test -Revised (LOT-R) [22] is a revision of the original Life Orientation Test [23] . It assesses optimism/pessimism using a series of questions that inquire about an individual's attitudes in daily life. This instrument has been widely validated [24] and used in both Ghana [25] and China. [14] Its 10 items generate an overall score, as well as two possible subscales: affirmation of optimism and affirmation of pessimism. The participant answers each item based on a 5-point scale, with response options ranging from strongly disagree to strongly agree. A higher score relates to a greater level of optimism.