Impact of Intermittent Fasting on the Mental Health of Perimenopausal Women
Phase: NA
Conditions: Mental Health, Perimenopause, Intermittent Fasting
Sponsor: American University of Beirut Medical Center

 
 
 
 
Title: Impact of Intermittent Fasting on the Mental Health of Lebanese Perimenopausal 
Women 
 
PI: Dr. Nadia Dandan 
Co-PI: Dr. Rita El Khoury 
Collaborators: Dr. Lara Nasreddine, Dr. Faysal El Kak, Dr. Hani Tamim, and Dr. Maya 
Romani  
Research coordinator: Ms. Sara El Hajj 
 
Date of submission: 31/10/2024 
Date of revision:  22/1/2025 
 
Abstract 
Fasting is not merely about skipping meals or enduring long hours without food; instead, 
many who practice fasting see it as a strategic approach that enhances both health and 
well-being. Among the various forms of fasting, Intermittent Fasting (IF) is especially popular 
with the 16/8 method which involves eating within an 8-hour timeframe and fasting for the other 
16 hours, each day. For women approaching perimenopause, this method may provide distinct 
benefits. This stage is significant due to its substantial impact on women9s mental health and 
overall well-being, characterized by varying hormone levels that can result in physical and 
emotional symptoms. Although numerous studies have examined fasting, few specifically 
address the effects of intermittent fasting on women undergoing perimenopause. Consequently, 
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our study aims to investigate the impact of intermittent fasting on the mental health of women 
experiencing this stage. This study will employ a randomized control trial (RCT) design 
involving n=98 Lebanese women between the ages of 45 and 55. Participants will be assigned to 
either a control or experimental group. We will use independent t-tests to analyze the data. 
Ultimately, the aim of this study is to contribute to the expanding body of research on 
intermittent fasting and its potential benefits for women in the perimenopausal phase.  
Keywords: Intermittent fasting, mental health, perimenopause, depression, anxiety, sleep, 
cognition, metabolic health.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Introduction 
Fasting, particularly in the form of intermittent fasting (IF), has gained increasing 
attention for its potential benefits on both physical and mental health (Murta et al., 2023). This 
dietary strategy involves cycling between eating and fasting periods, which may enhance brain 
function and improve mood (Smart, 2024). The 16/8 method, a popular variation of intermittent 
fasting, allows for an 8-hour eating window followed by a 16-hour fast. Many individuals find 
this approach easy to integrate into their daily routines, as it often aligns with natural eating 
habits (Streit & Ajmera, 2024). Research has associated this strategy with improved metabolic 
health and weight loss (Streit & Ajmera, 2024). Fasting has been shown to support neurogenesis, 
lower stress, and balance hormones; processes associated with better emotional control and 
cognitive function (Watkins & Serpell, 2016). Notably, research indicates that IF may reduce 
anxiety and depressive symptoms, demonstrating the beneficial connection between fasting and 
mental health (Wiss, 2022). 
The effects of IF on mental health are complex and warrant further investigation. 
Preliminary evidence suggests that fasting can reduce anxiety and depressive symptoms without 
increasing fatigue (Wiss, 2022). Some studies indicate that IF may improve mood and cognitive 
function by enhancing brain signaling and reducing inflammation markers related to cognitive 
decline (Murta el al., 2023; Moss, 2023). However, individual responses to fasting can vary 
particularly for those with pre-existing mental health conditions. While some may experience 
elevated levels of low mood after fasting (Ding et al., 2018), others report improvements in 
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mood and reduction of depressive symptoms (Wang & Wi, 2022; Stec et al., 2023; Igwe et al., 
2023).  
According to Murta et al. (2023), perimenopausal women are a group at risk for obesity 
and mental health issues because of hormonal changes that occur during this time. 
Perimenopause, menopause, and postmenopause are all parts of the menopausal transition, which 
typically happens between the ages of 45 and 55. Estrogen fluctuations during this time can have 
an impact on mood, metabolism, and general health. The Stages of Reproductive Aging 
Workshop (STRAW) defines perimenopause as a transitional phase that occurs late in women's 
reproductive life, just before the final menopausal period (Prior et al., 2021).  
The perimenopausal stage is associated with an emergence of new physical and mental 
symptoms. For example, cognitive changes include a decrease in executive function, learning 
memory, attention, working memory, and processing speed (McCabe et al., 2010). A 
cross-sectional study carried out in Lebanon found that 62.5% of women between the ages of 45 
and 67 had a considerably lower quality of life as a result of hot flushes (Ahmadieh & Jradi, 
2021). Lifestyle modifications  were suggested to  reduce perimenopausal symptoms and 
frequently eliminate the need for medical intervention (Freeman et al., 20214). For instance, the 
adoption of a heart healthy diet that limits fats, sugar, and salt and promotes whole, unprocessed 
foods, was proposed to help with symptoms9 management (Drewnowski & Almiron-Roig, 2010). 
Furthermore, regular exercise was reported to help in  controlling weight, enhancing mood, and 
improving  sleep. The reduction of  alcohol and caffeine may  also help to decrease symptoms 
such as anxiety and hot flashes. During this time of change, stress-reduction methods such as 
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yoga, meditation, or deep breathing exercises are also useful for fostering mental wellness 
(Cramer et al., 2013).  
Hormonal Replacement Therapy (HRT) is frequently utilized to help ease menopausal 
symptoms and restore hormone balance in women. Penkriton (2023) reported that hormone 
replacement therapy can greatly improve the quality of life for women going through 
perimenopause symptoms. Additionally, Toffol et al. (2015) stated that hormones play a role in 
mood regulation, since changes during perimenopause may result in heightened anxiety and 
depression. However, there is still a large group of women who are hesitant to use HRT. In fact, 
one study found that only 37.6% of perimenopausal women currently use HRT, with decisions 
influenced by cultural preferences and concerns over side effects (Brozon et al., 2024). 
Furthermore, numerous women opt for alternative therapies or lifestyle changes instead of 
hormonal treatments, indicating a complicated relationship between the perceived advantages of 
HRT and personal choices in health care (Lannon, 1994). Ultimately, fasting could be an 
alternative, slightly less effective, way of dealing with acute perimenopausal symptoms. 
However, fasting can have less side effects than HRT and women could be more inclined to 
adopt it as an intervention.  
 
 
 
 
 
 
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Research Gaps 
 
Most research studies exploring the effects of fasting on mental health have primarily 
focused on Ramadan fasting, which may not fully represent the broader category of fasting 
practices, including intermittent fasting. This emphasis on a singular type of fasting limits our 
understanding of how different, non-religious, fasting protocols may affect mental health 
outcomes. Additionally, muslims experience various lifestyle changes during Ramadan, such as 
alterations in meal times, sleep-wake cycles, mindfulness practices and physical activity levels, 
all of which can influence hormone levels and psychological well-being (Stec et al., 2023). 
Additionally, most of the current research on women9s mental well-being in 
perimenopause and menopause centers on the psychological difficulties linked to hormonal 
changes, such as higher levels of anxiety and depression. Research shows that these changes can 
worsen existing mental health problems, especially in women with prior mental health conditions 
(Stapel et al., 2022). There has also been research on the benefits of fasting on mental health 
outcomes (Reilly et al., 2023). We found one study by Reilly et al. (2023) that examined the 
effects of intermittent fasting on working memory of women transitioning into perimenopause. 
However, they did not investigate the effects on mental health outcomes. While each topic has 
been studied and investigated separately, there is no research that specifically looks at the 
intersection of fasting practices and the mental health issues experienced by women during 
perimenopause.  
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According to recent research, there are a number of restrictions on fasting9s impact on 
mental health and cognitive abilities. For instance, whereas some studies point to possible 
advantages of fasting, such as increased cognitive resilience (Mattson et al., 2018), other studies 
suggest that fasting may be linked to a decline in cognitive functioning (Behav, 2023). It is 
difficult to make firm conclusions regarding the effects of intermittent fasting on cognition due 
to the variety of fasting techniques and the scarcity of superior research (Kessler, 2024).  
 
Hypothesis 
 
In comparison to women who do not engage in intermittent fasting, perimenopausal 
women who practice intermittent fasting, over a period of minimum of 3 months, will report 
better mental health outcomes, such as improvement in baseline depression and anxiety levels, 
sleep quality, body satisfaction, and cognitive <fogginess=. In addition, we hypothesize that, in 
comparison to the group that did not engage in intermittent fasting, perimenopausal women who 
fast will experience improved health outcomes as indicated by healthy BMI and improved sexual 
health satisfaction.  
 
Objectives 
 
The aim of the study is to assess the impact of a six month intervention involving 
intermittent fasting on the mental health outcomes of perimenopausal Lebanese women.  
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The primary outcome includes evaluating the impact of intermittent fasting on the change in 
baseline score of participants on the depression scale, at 3 months post-intervention.  
 
Secondary outcomes include anxiety level, sleep quality, body image satisfaction, 
cognitive performance, sexual health as well as the overall Body Mass Index (BMI) of 
participants.  
 
Significance and Clinical Implications 
 By focusing on how IF can influence psychological and overall well-being during 
perimenopause, we seek to develop tailored interventions that address the unique mental health 
needs of this vulnerable population (Wiss, 2022; Berthlot et al., 2021). Understanding the 
relationship between IF and mental health can provide valuable insights for supporting women 
during this critical life stage while contributing to broader discussions about nutrition and mental 
wellness.  
As women look for non-pharmacological ways to handle menopausal symptoms, 
investigating the impact of fasting may result in innovative, less invasive, approaches to boost 
mental and overall health. We hope that this study can be a first step in encouraging and shaping 
alternative methods that promote women9s well-being during a challenging and less researched 
stage of life.  
 
 
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Methodology  
Study design 
This 6- month labeled customized controlled trial (RCT) will assess how intermittent 
fasting affects the mental health of perimenopausal women. The purpose of the study is to 
ascertain whether, in contrast to conventional dietary guidance, an intermittent fasting regimen 
can result in significant improvements in psychological well-being. In order to accomplish the 
goals of the study, participants will be randomized into two groups: a control group that will get 
conventional dietary guidance and an experimental group that will adhere to a 16/8 intermittent 
fasting regimen. To guarantee fair distribution, a computer-generated randomization technique 
will be used enabling a direct comparison of the two groups9 mental health results.  
Participants 
For this study, Lebanese women between the ages of 45 and 55 will be approached at a 
tertiary care hospital in Lebanon's Family Medicine and OBGYN clinics. Women who are in the 
perimenopausal stage as defined by the STRAW criteria (stages -2 and -1) and have a 
Menopause Rating Scale (MRS) score equal or above 11 may be qualified to participate in the 
study.  
The initial stage of menopause is identified by STRAW as having a higher fluctuation in 
the length of menstrual cycles, with a consistent variance of 7 days or more between consecutive 
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cycles. Stages -2 signifies the beginning of the early perimenopause transition phase, which 
eventually advances into stage -1, known as the late perimenopause. Our assessment will not 
include measuring FSH levels; instead, we will use clinical criteria as shown in figure 1 (see 
STRAW image below) (Prior et al.,2011). Additionally, the MRS consists of 11 questions 
assessing the severity of menopausal symptoms in three domains: somatic, psychological, and 
urogenital. By using this scale, we can identify if a woman has entered perimenopause and thus, 
assess her eligibility for the study. The patient will need to be cleared by the RN in the clinic and 
the treating physician needs to agree on the patient starting the fasting intervention.  
The exclusion criteria will include women who are on hormone replacement therapy, 
people with severe illnesses that could prevent fasting (including uncontrolled diabetes, heart 
disease, hypertension, cancer or kidney issues), and people with current formal mental health 
diagnosis as diagnosed by DSM V (whether taking medications or not and if in therapy), or 
women experiencing any type of dementia. Additional exclusions include women experiencing 
surgical menopause, premature ovarian failure, undergoing chemotherapy, or radiotherapy, 
ovarian cancer survivors, pregnant women, those undergoing endometriosis treatment, thyroid 
problems, or on hormone therapy. Participants will be provided with adequate mental health 
refferal to NGOs and removed from the trial if they exhibit suicidal thoughts (a score of greater 
than 0 on the PHQ 9 question number 9). Participants who do not speak English will be excluded 
from this study. 
 
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Figure 1. STRAW (Stages of Reproductive Aging Workshop). Prior, Jerilynn & Hitchcoc, 
Christine. (2011). The endocrinology of perimenopause.   
 
 
Sample size calculation 
To calculate the sample size for this study, we aimed to detect significant changes in 
depression scores at 3 months post-intervention, as the primary outcome. Assuming an effect size 
of 3 (Cohen’s d), a standard deviation of 5.25, and a significance level of 0.05, we determined 
that a total of n= 98 participants (n= 49 per group) would be required to achieve 80% statistical 
power. These parameters are based on a study by Al-Ozairi et al. (2019), which investigated the 
effects of fasting during the month of Ramadan on depression and diabetes outcomes. Although 
Ramadan fasting differs from the 16/8 intermittent fasting regimen employed in our study, the 
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standard deviation of 5.25 on PHQ9 scores from Al-Ozairi et al.’s provides a relevant reference 
point for our calculations.  
Given the estimated dropout rate of 30% in 3 months, we plan to recruit up to a total of 
140 participants to ensure adequate statistical power by the end of the study. This approach will 
allow for a robust statistical analysis and the detection of significant differences between the 
experimental and control groups over the intervention period.  
Procedure 
In this six-month parallel- group Randomized Controlled Trial (RCT), perimenopausal 
Lebanese women9s mental health outcomes will be investigated in relation to intermittent fasting.  
Women, between the ages of 45 to 55, who fulfill criteria for the perimenopause stages -2 
and -1 as per the STRAW criteria and the Menopause Rating Scale (MRS) will be recruited to 
participate in the study. The nurse at the OBGYN and family medicine clinics at the American 
University of Beirut Medical Center (AUBMC) will initially approach the participant checking if 
they are willing to take part in the study, based on age. 
 Women who show interest will be escorted to a private room by the research assistant 
(RA) who will go over the informed consent, explaining the study9s goal and procedure. Once 
participants sign the informed consent, they will be asked to fill out a questionnaire created to 
determine if they qualify for the study (Appendix I). They will also be asked to complete the 
MRS. We will develop a mechanism whereby the nurse will ask the treating physician whether 
the participant can actually partake in the fasting intervention. The completion of the two scales 
and the informed consent will need approximately 20 mins.  
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After confirming eligibility, participants will complete the required scales, to collect 
baseline data on their overall symptoms. Their body composition will also be assessed using a 
bioelectrical impedance device, which will be placed in the site where data collection is 
happening. This process will take 40 minutes.  
Participants will then be assigned at random to either the experimental group or control 
group. This randomized process will be carried out utilizing a computer- generated 
randomization scheme. In order to avoid bias in selection, this scheme will be developed prior to 
recruitment of any participant. Once the participant is given an ID, this will be matched with the 
database created. The patient will be given their allocation in an envelope and will be asked to 
present it to the RA. This procedure upholds the study9s design integrity and guarantees that 
group assignments are unbiased.     
The experimental group will be provided with instructions on how to follow a 16/8 
intermittent regimen: fasting for 16 hours and consuming meals within an 8 hour-period. This 
group will be asked to track their intermittent fasting routines using a designed schedule 
(Appendix J). The control group will receive food-based dietary guidelines for Lebanese adults 
(FBDG English Version.pdf) ,which will be explained by the RA.  
One week prior to re-assessment (on weeks 6, 12, 24) individuals will receive an email or 
phone call to return to the clinic for follow – up visits. During these visits, participants will fill 
out the scales by themselves in a room to avoid inflating social desirability bias. The RA will 
only take their body composition and will administer the MoCa test. Both tests cannot be 
self-administered.  
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In between these periods, participants in the intervention group will receive weekly 
phone calls intended to encourage adherence among participants, decrease withdrawal 
occurrences, and provide individualized motivation for those fasting. These calls will also serve 
as a check in to make sure that participants who are fasting are not experiencing any side effects 
such as dizziness, fatigue, low energy levels, or low blood sugar, and excessive weight loss. If 
they do report any of the aforementioned symptoms, they will be referred to Family Medicine for 
a free of charge medical consultation. If they are deemed unable to continue the intervention, 
they will be asked to withdraw from the study.  
All participants will be compensated for their 3 additional visits.  
Statistical Analysis 
We will analyze the data using Statistical Package for Social Sciences (SPSS). 
Descriptive analysis will be carried out by presenting the number and percentage for categorical 
variables or the mean and standard deviation for normally distributed continuous variables, or the 
median and interquartile range (IQR) for skewed continuous variables. The association between 
the groups and the different continuous variables will be carried out using the independent t-test 
or the Mann Whitney test, as appropriate. On the other hand, the association between the groups 
and the different categorical variables will be carried out using the Chi square test or Fishers 
exact test, as appropriate.  
Multivariate linear regression analyses will be carried out to account for confounding 
variables. The outcome will be the PHQ-9 and the main independent variable will be the 
intervention group. Factors included in the regression analysis will be selected based on clinical 
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and statistical grounds. The beta estimate and the 95% confidence interval (CI) will be calculated 
for this association. Moreover, linear Mixed Effects Modeling will also be used to account for 
incomplete data.  
Finally, the main analysis will be carried out according to the Intent to treat (ITT) to 
assess the effectiveness of the interval. Moreover, as a secondary analysis, the per protocol 
analysis will be also carried out to assess the efficacy of the intervention.  
Measures  
 
Participants will be initially asked to complete a general questionnaire addressing: Age, 
area of residency, weight/height, marital status, educational level, number of children, 
employment status, household9s average monthly salary, smoking habits and level of physical 
activity.  
 
The Patient Health Questionnaire (PHQ-9) (Appendix A) is a self-administered tool 
designed to screen for depression by evaluating symptoms based on DSM-5 criteria. It consists 
of nine items scored of <not at all= 0=, <several days= = 1, <more than half the days =2=, and 
<nearly everyday =3=. The cut-off scores to assess the severity of depression are: <0-4= no 
depressive symptoms=, <5-9= mild depressive symptoms=, <10-14= moderate depressive 
symptoms=, < 15-19= moderately severe depressive symptoms=, <20-27 = severe depressive 
symptoms=. With coefficients ranging from 0.83 to 0.90 and Cronbahc9s alpha of 0.89 to 0.94, 
the PHQ-9 demonstrates good reliability. This scale has been used in the Arab population and in 
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two Lebanese studies: Al Jammal (2023) in patients with heart failure and Suwaya et al. (2022) 
in a Lebanese psychiatric outpatient sample.  
 
The Generalized Anxiety Disorder 7-item scale (GAD-7) (Appendix B) is an instrument 
designed to assess the severity of generalized anxiety disorder (GAD). Each item prompts 
individuals to evaluate how often they have been bothered by specific anxiety symptoms over 
the past two weeks, with response options of <not at all= 0=, <several days= = 1, <more than half 
the days =2=, and <nearly everyday =3=. The cut-offs are: <0-4= none to minimal anxiety=, 
<5-9= mild anxiety=, < 10-14= moderate anxiety=, 815-21= severe anxiety". Alpha coefficient is 
as high as 0.92, which indicates high remarkable internal consistency. Additionally, strong test 
retest reliability is demonstrated by the intraclass correlation coefficients, which range from 
0.83 to 0.92 and indicate score stability over time. This scale has been used in the Arab 
population  and used in a Lebanese study Suwaya et al. (2022) in a Lebanese psychiatric 
outpatient sample.  
 
The Pittsburgh Sleep Quality Index (PSQI) (Appendix C) is a widely used self-report 
questionnaire that evaluates sleep quality over a one-month period. It consists of 19 items that 
generate seven component scores, providing a comprehensive assessment of various aspects of 
sleep. With an alpha of 0.83 and test retest reliability of 0.85, the PSQI demonstrates good 
reliability. This scale has been used in the Arab population  and used in a Lebanese study by 
Kabrita and Hajjar-Muca (2016) to assess sleep quality among university students in Lebanon.  
 
 
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The Body Appreciation Scale-2 (BAS-2) (Appendix D) is a 10-item measure designed to 
assess an individual9s acceptance, positive regard, and respect for their own body. Its alpha 
coefficient is between 0.87 and 0.94 and indicates good internal consistency and strong 
reliability. Additionally, it endorses strong test-retest reliability with values ranging between 
0.80 to 0.88. This scale has been used in the Arab population, including its two-short forms, in 
Lebanese Arabic-speaking adults, assessing its factor structure, reliability, and validity based on 
a study done by Fekih-Romdhane and Azzi (2023).  
 
Montreal Cognitive Assessment (MoCa) (Appendix E) consists of a 30-point screening 
test that assesses cognitive domains. It has a good internal consistency with a Cronbach9s alpha 
of 0.82 to 0.83. The MoCa demonstrates high test-retest reliability with an Intraclass Correlation 
Coefficient (ICC) of 0.92. The MoCa shows excellent sensitivity (90%) and good specificity 
(87%) for detecting mild cognitive impairment compared to the Mini-Mental State Examination 
(MMSE). Also, MoCa has been used in a study in Lebanon which reflects its broader acceptance 
in our clinical and research setting (Abou-Mrad, 2017).  
 
The Female Sexual Function Index (FSFI) (Appendix F) is a 19-item self-report 
questionnaire designed to assess sexual functioning in women across six domains: sexual desire, 
arousal, lubrication, orgasm, satisfaction, and pain associated with vaginal penetration. The 
FSFI shows strong reliability, with test- retest coefficients ranging from 0.79 to 0.86 and 
internal consistency (Cronbach9s alpha) values of 0.82 or higher. This scale has been used 
among the Arab population such as the Egyptian population, as detailed by (Anis et al.,2011).  
 
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The Menopause Rating Scale (MRS) (Appendix G) is an 11-item questionnaire that 
evaluates the severity of menopausal symptoms across three domains: somatic, psychological, 
and urogenital. Respondents rate their symptoms on a 5-point scale with response options 
<none=0=, < mild=1=, <moderate=2=, <severe=3=, <very severe=4=, higher scores indicating a 
greater burden of symptoms. Alpha values are typically above 0.80 and the scale has good 
test-retest reliability. This scale has been used in the Arab population. Abdelaziz et al. (2022) 
conducted a study exploring the relationship between sleep quality and menopausal symptoms 
among Saudi women, and additional studies have validated its use in Egypt.  
 
The International Physical Activity Questionnaire - Short Form (IPAQ) (Appendix H) is a 
9-item self-reported measure of physical activity designed for individual patients aged 15 to 69 
years. It can be used clinically and in population research to compare physical activity levels 
across different populations internationally. The IPAQ demonstrated good reliability, with 
test-retest reliability average coefficient of  0.8, indicating that it is a consistent tool for 
measuring physical activity over time. This scale has been cross-culturally adapted and used in 
Arabic-speaking populations. Also, it has been utilized in Kuwait (Garashi et al., 2020) and in 
Tunisia (Regaieg et al., 2015), supporting its applicability across diverse Arabic-speaking 
contexts.  
 
Feasibility and Potential Pitfalls 
 
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The study might face several limitations. First, participants might withdraw at any point 
during the study because of negative side effects of fasting or demotivation to engage in the 
intervention. This would impact our ability to retain data and thus, would impact our results. In 
order to reduce this risk, we will forecast needing a higher number of participants (up to n=140), 
in order to ultimately achieve our desired sample size (n=98). Second, with the country9s current 
situation and displacement of people from their homes, recruitment and retention of participants 
can be more challenging. For that purpose, we will be contacting participants on a weekly basis 
to provide support and check-ins. Finally, our study is restricted to women who speak English, 
since some of the scales being used are not translated to Arabic. This is a limitation in our setting 
and it will limit generalizability of our study, since some women from certain socio-economic 
and educational backgrounds might not be able to participate. We can improve this limitation in 
follow up studies, keeping in mind that this is a preliminary study on an understudied topic of 
interest.  
Ethics 
 
The study was submitted for IRB approval on 12/6/2024 (AUB IRB Protocol No.: 
SBS-2024-0499) and is currently under review.  
 
The risks associated with this research are minimal. Some women might experience 
distress while reporting on their mental health. Additionally, one of the scales addresses the 
sexual health of women participating in the study. If the participant does not wish to complete 
this scale she can inform the RA. In case of any physical side effects experienced from the 
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fasting intervention, the participants will be referred to family medicine for a check up. If the 
symptoms are moderate to severe, and based on physician9s recommendation, the participant will 
be asked to withdraw from the intervention.  
 
The benefits of this study outweigh its risks. This study will hopefully provide insights 
into an under-researched area, which could potentially help women reduce their reliance on 
medications such as hormonal treatments. By exploring alternative approaches, this study aims to 
enhance women9s mental health while offering them more options for managing their health 
effectively. We will ensure that women who do not receive the intervention will be given 
nutritional counseling.  
Throughout the study and at baseline , in case participants were determined to suffer from 
mental health difficulties (score moderate to severe on PHQ 9 equal or above 15 and GAD 7 
equal or above 15), they will be offered a referral to a mental health professional. If they wish to 
start psychotherapy or psychiatric medication, priority will be given to this and will either not be 
included in the study or asked to withdraw. 
Participants are able to withdraw at any point during the study. This will not affect their 
treatment at AUBMC.  
Data from the study will be stored on the PI9s password protected computer for up to 3 
years after the end of the study.  
Budget  
 
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● 1 research assistant, full time salary, for 2 years and 6 months will be 25,000$ 
● Compensation for 140 participants will be 100$ in total per participant for 3 visits (total 
14.000$) 
● 2 Ipads total 700$  
● Total for 3 years= 39,700$ 
 
Commitment and Funds 
 
We have not applied for any other funds for this study.  
 
The PI will allocate 20% of her time on this study. She will be involved at all stages of 
the research. The Co- PI will allocate 15 % of their time on this study. The focus will be on 
actively engaging in conversation related to the recruitment and procedure phase. They will also 
be involved in editing and reviewing the results and discussion sections of the study. The 
collaborators will allocate 5-10 % of their time on this study mainly focusing on helping with 
specific elaboration of topics and providing expert opinion during the procedure phase and data 
analysis phase.  
 
The PI is currently involved in 2 other research projects as PI. First one is on 8Smoking 
prevalence in a psychiatric inpatient unit in Lebanon: The profiles of smokers and their smoking 
cessation method preference9 and second one is 8Prevalence of Perinatal Depression of Pregnant 
Patients Hospitalized at AUBMC, Lebanon: a Pilot Study9. In the first study we are in the 
recruitment phase and in the second study we are in the data analysis stage.  
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Timeline 
 
Figure 2. Timeline of study over 3 years 
 
 
 
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27 

 
 
 
 
Appendices  
 
Appendix A: Patient Health Questionnaire (PHQ-9) 
 
 
 
 
 
 
 
28 

 
 
 
 
Appendix B: Generalized Anxiety Disorder 7-item Scale (GAD-7) 
 
 
 
 
 
 
 
 
29 

 
 
 
 
Appendix C: Pittsburgh Sleep Quality Index (PSQI) 
 
30 

 
 
 
 
 
 
31 

 
 
 
 
Appendix D: Body Appreciation Scale (BAS-2) 
 
 
 
 
 
 
32 

 
 
 
 
Appendix E: Montreal Cognitive Assessment (MoCa) 
 
33 

 
 
 
 
Appendix F: Female Sexual Index (FSFI) 
 
 
 
 
 
 
 
34 

 
 
 
 
 
 
 
 
 
Appendix G: Menopause Rating Scale  
35 

 
 
 
 
 
36 

 
 
 
 
 
Appendix H: International Physical Activity Questionnaire- Short Form    
 
37 

 
 
 
 
 
 
38 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
39 

 
 
 
 
Appendix I: Demographics Questionnaire   
 
 
40 

 
 
 
 
 
41 

 
 
 
 
 
42 

 
 
 
 
 
43 

 
 
 
 
 
44 

 
 
 
 
 
45 

 
 
 
 
 
46 

 
 
 
 
 
47 

 
 
 
 
 
48 

 
 
 
 
 
 
 
 
Appendix J: Intermittent Fasting Tracker 
 
49 
  
Monday 
Tuesday 
Wednesday Thursday 
Friday 
Saturday 
Sunday 
Start of 
fasting 
  
  
  
  
  
  
  

 
 
 
 
 
 
50 
time 
(am/pm) 
End of 
fasting 
time 
(am/pm) 
  
  
  
  
  
  
  
Notes