ORIGINAL PAPER
Stress of COVID-19 and mental health outcomes in Palestine: the mediating role of well‑being and resilience
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1
University of Milano-Bicocca, Milan, Italy
2
An-Najah National University, Nablus, Occupied Palestinian Territories
Submission date: 2020-12-10
Final revision date: 2021-01-28
Acceptance date: 2021-01-29
Online publication date: 2021-03-15
Publication date: 2021-03-15
 
Health Psychology Report 2021;9(4):398–410
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
We tested the association between the stress of COVID-19 and mental distress manifested by anxiety, depression, and stress, and whether well-being and resilience mediate the relationship between the two variables in a population of Palestinian adults. Namely, we hypothesized that stress of COVID-19 will be positively associated with mental health problems (anxiety, depression, and stress); well-being and resilience will be negatively associated with mental health problems (anxiety, depression, and stress); and well-being and resilience will mediate the association between the stress of COVID-19 and mental health problems (anxiety, depression, and stress).

Material and methods:
Depression, Anxiety and Stress Scale-21, the Resilience Scale for Adults, the WHO-5 Well-Being Index, and the COVID-19 Stress Scales were administered to 860 participants via online survey. Structural equation modelling (SEM) was applied to address the study hypothesis.

Results:
Participants recorded a mild level of stress of COVID-19 and high scores for resilience and well-being. A conceptual model depicting COVID‑19 stress as a predictor, mental distress as an outcome variable, and resilience and subjective well-being as mediators was confirmed.

Conclusions:
Palestinians are exposed to mental distress in an environment characterized by ongoing stressors. Conversely, the capability of Palestinians to conserve good levels of well-being and resilience protects them from mental distress even in the wake of the COVID-19 outbreak. On the other hand, COVID-19 can be considered a new critical event demanding and diminishing the people’s resiliency recourses in Palestine. Implications for clinical practice and research are discussed.

 
REFERENCES (69)
1.
Agbaria, Q., & Natur, N. (2018). The relationship between violence in the family and adolescent’s aggression: The mediator role of self-control, social support, religiosity, and well-being. Children and Youth Services Review, 91, 447–456. https://doi.org/10.1016/j.chil....
 
2.
Abed, Y. (2020). COVID-19 in the Gaza Strip and the West Bank under the political conflict in Palestine. South Eastern European Journal of Public Health (SEEJPH). https://doi.org/10.4119/seejph....
 
3.
Ahmed, M. Z., Ahmed, O., Aibao, Z., Hanbin, S., Siyu, L., & Ahmad, A. (2020). Epidemic of COVID-19 in China and associated psychological problems. Asian Journal of Psychiatry, 51, 102092. https://doi.org/10.1016/j.ajp.....
 
4.
Ahuja, K. K., Banerjee, D., Chaudhary, K., & Gidwani, C. (2020). Fear, xenophobia, and collectivism as predictors of well-being during coronavirus disease 2019: an empirical study from India. International Journal of Social Psychiatry. https://doi.org/10.1177/002076....
 
5.
Aldwin, C. M. (2007). Stress, coping, and development: an integrative perspective. Guilford Press.
 
6.
AlKhaldi, M., Kaloti, R., Shella, D., Al Basuoni, A., & Meghari, H. (2020). Health system’s response to the COVID-19 pandemic in conflict settings: Policy reflections from Palestine. Global Public Health, 15, 1244–1256. https://doi.org/10.1080/174416....
 
7.
Alser, O., Alghoul, H., Alkhateeb, Z., Hamdan, A., Albaraqouni, L., & Saini, K. (2020). Healthcare workers preparedness for COVID-19 pandemic in the occupied Palestinian territory: a cross-sectional survey.
 
9.
Arslan, G., & Yildirim, M. (2020a). Meaningful living, resilience, affective balance, and psychological health problems during COVID-19. PsyArXiv. https://doi.org/10.31234/osf.i....
 
10.
Arslan, G., & Yıldırım, M. (2020b). Coronavirus stress, meaningful living, optimism, and depressive symptoms: a study of moderated mediation model. PsyArXiv. https://doi.org/10.31234/osf.i....
 
11.
Asi, Y. M., Unruh, L., & Liu, X. (2018). Conflict and well-being: a comparative study of health-related quality of life, stress, and insecurity of university students in the West Bank and Jordan. Quality of Life Research, 27, 1381–1391. https://doi.org/10.1007/s11136....
 
12.
Bosqui, T. (2020). The need to shift to a contextualized and collective mental health paradigm: Learning from crisis-hit Lebanon. Global Mental Health, 7, e26. https://doi.org/10.1017/gmh.20....
 
13.
Burtscher, J., Burtscher, M., & Millet, G. P. (2020). (Indoor) isolation, stress, and physical inactivity: Vicious circles accelerated by COVID‐19? Scandinavian Journal of Medicine & Science in Sports, 30, 1544–1545. https://doi.org/10.1111/sms.13....
 
14.
Cortez, P. A., Joseph, S. J., Das, N., Bhandari, S. S., & Shoib, S. (2020). Tools to measure psychological impact of COVID-19 pandemic: What do we have in the platter? Asian Journal of Psychiatry, 53, 102371. https://doi.org/10.1016/j.ajp.....
 
15.
Dashraath, P., Jeslyn, W. J. L., Karen, L. M. X., Min, L. L., Sarah, L., Biswas, A., Choolani, M., Mattar, C., & Su, L. L. (2020). Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. American Journal of Obstetrics and Gynecology, 222, 521–531. https://doi.org/10.1016/j.ajog....
 
16.
Dong, M., & Zheng, J. (2020). Letter to the editor: Headline stress disorder caused by netnews during the outbreak of COVID‐19. Health Expectations: An International Journal of Public Participation in Health Care and Health Policy, 23, 259–260. https://doi.org/10.1111/hex.13....
 
17.
Freire, C., Ferradás, M. D. M., Valle, A., Núñez, J. C., & Vallejo, G. (2016). Profiles of psychological well-being and coping strategies among university students. Frontiers in Psychology, 7, 1554. https://doi.org/10.3389/fpsyg.....
 
18.
Friborg, O., Hjemdal, O., Rosenvinge, J. H., & Martinussen, M. (2003). A new rating scale for adult resilience: What are the central protective resources behind healthy adjustment? International Journal of Methods in Psychiatric Research 12, 65–76. https://doi.org/10.1002/mpr.14....
 
19.
Gao, J., Tian, Z., & Yang, X. (2020). Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience Trends, 14, 72–73. https://doi.org/10.5582/bst.20....
 
20.
Giacaman, R., Rabaia, Y., Nguyen-Gillham, V., Batniji, R., Punamäki, R. L., & Summerfield, D. (2011). Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Global Public Health, 6, 547–559. https://doi.org/10.1080/174416....
 
21.
Ghandour, R., Ghanayem, R., Alkhanafsa, F., Alsharif, A., Asfour, H., Hoshiya, A., Masalmeh, A., Nadi, M., Othman, L., Ryahe, S., Wahdan, Y., Wahsh, S., Yamani, A., & Giacaman, R. (2020). Double burden of COVID-19 pandemic and military occupation: Mental health among a Palestinian university community in the West Bank. Annals of Global Health, 86, 131. https://doi.org/10.5334/aogh.3....
 
22.
Gunzler, D., Chen, T., Wu, P., & Zhang, H. (2013). Introduction to mediation analysis with structural equation modeling. Shanghai Archives of Psychiatry, 25, 390–394. https://doi.org/10.3969/j.issn....
 
23.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis. Pearson Education Inc.
 
24.
Hambleton, R. K., Merenda, P. F., & Spielberger, C. D. (Eds.) (2004). Adapting educational and psychological tests for cross-cultural assessment. Psychology Press.
 
25.
Hammoudeh, W., Jabr, S., Helbich, M., & Sousa, C. (2020). On mental health amid COVID-19. Journal of Palestine Studies, 49, 77–90. https://doi.org/10.1525/jps.20....
 
26.
Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., Ford, T., John, A., Kabir, T., King, K., Madan, I., Michie, S., Przybylski, A. K., Shafran, R., Sweeney, A., … Bullmore, E. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry, 7, 547–560. https://doi.org/10.1016/S2215-....
 
27.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. https://doi.org/10.1080/107055....
 
28.
Islam, S. D. U., Bodrud-Doza, M., Khan, R. M., Haque, M. A., & Mamun, M. A. (2020). Exploring.
 
29.
COVID-19 stress and its factors in Bangladesh: a perception-based study. Heliyon, 6, e04399. https://doi.org/10.1016/j.heli....
 
30.
Kavčič, T., Avsec, A., & Kocjan, G. Z. (2021). Psychological functioning of Slovene adults during the COVID-19 pandemic: Does resilience matter? Psychiatric Quarterly, 92, 207–216. https://doi.org/10.1007/s11126....
 
31.
Kteily-Hawa, R., Khalifa, D. S., & Abuelaish, I. (2020). Resilience among a large sample of adult Palestinians in the Gaza Strip: Examining contextual sociodemographic factors and emotional response through a social-ecological lens. Public Health, 182, 139–142. https://doi.org/10.1016/j.puhe....
 
32.
Layous, K., Chancellor, J., & Lyubomirsky, S. (2014). Positive activities as protective factors against mental health conditions. Journal of Abnormal Psychology, 123, 3–12. https://doi.org/10.1037/a00347....
 
33.
Liu, C. H., Zhang, E., Wong, G. T. F., & Hyun, S. (2020). Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for US young adult mental health. Psychiatry Research, 290, 113172. https://doi.org/10.1016/j.psyc....
 
34.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343. https://doi.org/10.1016/0005-7....
 
35.
Mahamid, F. A., & Berte, D. Z. (2019). Social media addiction in geopolitically at-risk youth. International Journal of Mental Health and Addiction, 17, 102–111. https://doi.org/10.1007/s11469....
 
36.
Mahamid, F. A., & Berte, D. Z. (2020). Portrayals of violence and at-risk populations: Symptoms of trauma in adolescents with high utilization of social media. International Journal of Mental Health and Addiction, 18, 980–992. https://doi.org/10.1007/s11469....
 
37.
Mahamid, F., & Bdier, D. (2020a). The association between positive religious coping, perceived stress, and depressive symptoms during the spread of coronavirus (COVID-19) among a sample of adults in Palestine: a cross-sectional study. Journal of Religion and Health, 60, 34–49. https://doi.org/10.1007/s10943....
 
38.
Mahamid, F., & Bdier, D. (2020b). Fear of COVID-19 and mental health outcomes among psychosocial service providers in Palestine: The mediating role of well-being. Retrieved from https://concurrentdisorders.ca....
 
39.
Mahamid, F., Bdier, D., & Berte, D. Z. (2020a). Psychometric properties of the Fear of COVID-19 Scale (FCV-19S) in a Palestinian context. Manuscript submitted for publication.
 
40.
Mahamid, F., Veronese, G., & Bdier, D. (2020b). Fear of coronavirus COVID-19 and mental health outcomes in Palestine: The mediating role of social support. Manuscript submitted for publication.
 
41.
Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s (1999) findings. Structural Equation Modeling, 11, 320–341. https://doi.org/10.1207/s15328....
 
42.
Montano, R. L. T., & Acebes, K. M. L. (2020). COVID stress predicts depression, anxiety, and stress symptoms of Filipino respondents. International Journal of Research in Business and Social Science, 9, 78–103. https://doi.org/10.20525/ijrbs....
 
43.
Moss, D., & Majadle, G. (2020). Battling COVID-19 in the occupied Palestinian territory. The Lancet Global Health, 8, e1127–e1128. https://doi.org/10.1016/S2214-....
 
44.
Muhareb, R., & Giacaman, R. (2020). Tracking COVID-19 responsibly. The Lancet. https://doi.org/10.1016/S0140-....
 
45.
PeConga, E. K., Gauthier, G. M., Holloway, A., Walker, R. S., Rosencrans, P. L., Zoellner, L. A., & Bedard-Gilligan, M. (2020). Resilience is spreading: Mental health within the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12, S47–S48. https://doi.org/10.1037/tra000....
 
46.
Pfefferbaum, B., & North, C. S. (2020). Mental health and the COVID-19 pandemic. New England Journal of Medicine, 383, 510–512. https://doi.org/10.1056/NEJMp2....
 
47.
Poyiadji, N., Shahin, G., Noujaim, D., Stone, M., Patel, S., & Griffith, B. (2020). COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology, 296, 201187. https://doi.org/10.1148/radiol....
 
48.
Schermelleh-Engel, K., Moosbrugger, H., & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8, 23–74.
 
49.
Spinelli, A., & Pellino, G. (2020). COVID-19 pandemic: Perspectives on an unfolding crisis. The British Journal of Surgery, 107, 785–787. https://doi.org/10.1002/bjs.11....
 
50.
Staehr, J. K. (1998). The use of well-being measures in primary health care – the DepCare project. In WHO Regional Office for Europe (Ed.), Well-being measures in primary health care – the DepCare project. WHO.
 
51.
Stevenson, C., & Wakefield, J. (2020, July 14). Financial distress and suicidal behaviour during COVID-19: Family identification attenuates the negative relationship between financial distress and mental ill-health. OSF Preprints. https://doi.org/10.31219/osf.i....
 
52.
Tandon R. (2020). COVID-19 and mental health: Preserving humanity, maintaining sanity, and promoting health. Asian Journal of Psychiatry, 51, 102256. https://doi.org/10.1016/j.ajp.....
 
53.
Taylor, S., Landry, C., Paluszek, M., Fergus, T. A., McKay, D., & Asmundson, G. J. (2020). Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janx....
 
54.
Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66, 317–320. https://doi.org/10.1177/002076....
 
55.
Trzebiński, J., Cabański, M., & Czarnecka, J. Z. (2020). Reaction to the COVID-19 pandemic: The influence of meaning in life, life satisfaction, and assumptions on world orderliness and positivity. Journal of Loss and Trauma, 25, 544–557. https://doi.org/10.1080/153250....
 
56.
Veronese, G., Pepe, A., Jaradah, A., Al Muranak, F., & Hamdouna, H. (2017). Modelling life satisfaction and adjustment to trauma in children exposed to ongoing military violence: An exploratory study in Palestine. Child Abuse & Neglect, 63, 61–72. https://doi.org/10.1016/j.chia....
 
57.
Veronese, G., Pepe, A., Alzaanin, W., & Shoman, H. (2020a). Sources of functioning, symptoms of trauma, and psychological distress: a cross-sectional study with Palestinian health workers operating in West Bank and Gaza Strip. American Journal of Orthopsychiatry, 90, 751–759. https://doi.org/10.1037/ort000....
 
58.
Veronese, G., Sousa, C., & Cavazzoni, F. (2020b). Survival and resilience among Palestinian women: a qualitative analysis using individual and collective life events calendars. Violence Against Women. https://doi.org/10.1177/107780....
 
59.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020a). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17, 1729. https://doi.org/10.3390/ijerph....
 
60.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., Choo, F. N., Tran, B., Ho, R., Sharma, V. K., & Ho, C. (2020b). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity, 87, 40–48. https://doi.org/10.1016/j.bbi.....
 
61.
World Health Organization (2001) Mental health: New understanding, new hope. The world health report. WHO.
 
62.
World Health Organization (2019). Coronavirus disease 2019 (COVID-19): Situation report. WHO.
 
63.
World Health Organization (2020a). WHO coronavirus disease (COVID-19) dashboard. Retrieved from https://covid19.who.int/ [accessed July 26, 2020].
 
64.
World Health Organization (2020b). WHO coronavirus disease (COVID-19) dashboard. Occupied Palestinian territory, including east Jerusalem. Retrieved from https://covid19.who.int/region... [accessed July 26, 2020].
 
65.
Xiao, H., Zhang, Y., Kong, D., Li, S., & Yang, N. (2020). Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Medical Science Monitor, 26, e923921. https://doi.org/10.12659/MSM.9....
 
66.
Yang, H., & Ma, J. (2020). How an epidemic outbreak impacts happiness: Factors that worsen (vs. protect) emotional well-being during the coronavirus pandemic. Psychiatry Research, 289, 113045. https://doi.org/10.1016/j.psyc....
 
67.
Yıldırım, M., & Arslan, G. (2020). Exploring the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19. Current Psychology. https://doi.org/10.1007/s12144....
 
68.
Zandifar, A., Badrfam, R., Yazdani, S., Arzaghi, S. M., Rahimi, F., Ghasemi, S., Khamisabadi, S., Mohammadian Khonsari, N., & Qorbani, M. (2020). Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. Journal of Diabetes and Metabolic Disorders, 19, 1–8. https://doi.org/10.1007/s40200....
 
69.
Zolkoski, S. M., & Bullock, L. M. (2012). Resilience in children and youth: a review. Children and Youth Services Review, 34, 2295–2303. https://doi.org/10.1016/j.chil....
 
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