Stress of COVID-19 and mental health outcomes in Palestine: the mediating role of well-being and resilience

BACKGROUND 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). PARTICIPANTS AND PROCEDURE 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 wellbeing 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.