Abstract summary 

Eastern Mediterranean countries, particularly Lebanon, have seen a significant rise in mental disorders, primarily driven by ongoing economic instability, political unrest, and regional conflicts. These conditions fuel feelings of unsafety, which are linked to lower psychological well-being and increased depressive symptoms. Unsafe circumstances inflate apprehension and uncertainty, leaving individuals unable to foresee a stable, secure tomorrow and often trapped in an anticipatory negative thinking state. Therefore, this study posits that in unsafe environments, Intolerance of Uncertainty (IU) may mediate the relationships between the feeling of unsafety and depression/well-being and aims to test this hypothesis among a sample of adults from Lebanon, a frequently crisis-ridden country.A one-time-point online survey was conducted among Lebanese adults from the general population (N = 905; mean age = 27.38 (SD: 9.28); 60% females), recruited anonymously via snowball sampling. The questionnaire included socio-demographic variables and the following Arabic validated scales: Feeling of Unsafety Scale- Arabic (FUSA), World Health Organization Well-Being Index (WHO-5), Patient Health Questionnaire-9 (PHQ-9), and Intolerance of Uncertainty Scale (IUS-12). Statistical analysis was performed using SPSS v.27 with mediation analysis via PROCESS MACRO v3.4 Model 4.After adjusting for potential confounders, mediation analysis showed that both prospective and inhibitory anxiety fully mediated the association between the feeling of unsafety and depression and partially mediated the association between the feeling of unsafety and well-being. Higher feeling of unsafety was significantly associated with higher prospective and inhibitory anxiety (Beta = 0.32; p < 0.001; 95% CI 0.27; 0.37 and Beta = 0.19; p < 0.001; 95% CI 0.15; 0.23 respectively), which in turn were significantly associated with higher depression (Beta = 0.42; p < 0.001; 95% CI 0.35; 0.48 and Beta = 0.62; p < 0.001; 95% CI 0.54; 0.70 respectively) and lower well-being (Beta = - 0.39; p < 0.001; 95% CI -0.44; -0.33 and Beta = - 0.39; p < 0.001; 95% CI -0.47; -0.32 respectively). It is of note that while higher feeling of unsafety did not show a direct association with higher depression (Beta = - 0.03; p = 0.187; 95% CI -0.09; 0.02 and Beta = -0.02; p = 0.399; 95% CI -0.07; 0.03 respectively), it was significantly and directly associated with lower well-being (Beta = - 0.07; p < 0.01; 95% CI -0.12; -0.03 and Beta = - 0.12; p < 0.001; 95% CI -0.17; -0.07 respectively).The hypothesis that IU mediates the relationships between the feeling of unsafety and depression/well-being is confirmed. This finding highlights a key target for interventions. Psychotherapeutic and public mental health initiatives could enhance psychological well-being by dedicating efforts to promoting uncertainty tolerance, particularly in vulnerable populations facing unstable settings.

Authors & Co-authors:  Assaf Melyssa M Malaeb Diana D Sakr Fouad F Dabbous Mariam M Fekih-Romdhane Feten F Hallit Souheil S Obeid Sahar S

Study Outcome 

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