2.2.4. Depressive Symptoms—The Center for Epidemiological Studies Depression Scale (CES-D)

The CES-D Scale is a 20-item inventory of symptoms of depression [74]. Respondents report how frequently symptoms have been experienced during the past month, using a 4-point Likert scale that ranges from 0 (rarely or none of the time; less than once a day) to 3 (most or all of the time; 5–7 days a week). Items include: "I was bothered by things that usually don't bother me" and "I felt depressed." The total score of the scale ranged from 0 to 60. Score above the stricter diagnostic cut-off point of 23 indicate severe levels of depressive symptoms [75]. In our previous studies, the Cronbach's internal consistency alpha coefficients for the Arabic version were around 0.90 [50]. In the current study, the internal consistency coefficient of the scale was 0.93.

#### 2.2.5. Demographics

Participants were asked to report their gender, age, marital status, institutional affiliation and academic year, parents' levels of education, and household income. The variable academic year was recoded to new variable; students in their first and second academic year were included in the group Year 1 + 2 and students in their third and fourth academic year were included in the group Year 3 + 4.
