Mediating effect of intolerance of uncertainty between fear of war and mental health in adults during the Israel-Palestine war of 2023.

Background: The Israel-Palestine war of 2023 has exposed many individuals to prolonged fear and uncertainty, contributing to significant psychological and behavioral consequences. Fear of war has been shown to exacerbate negative mental health outcomes such as anxiety, depression, aggression and suicidal ideation and reduce overall wellbeing. Intolerance of uncertainty is a trait characterized by difficulty coping with ambiguous situations. It was regarded as a potential mediator in the association between fear of war and these outcomes. Therefore, this study's aim is to investigate the mediating effect of intolerance of uncertainty between fear of war and mental health including anxiety, depression, aggression, suicidal ideation and wellbeing in adults during the Israel-Palestine war of 2023.

Methods: This study employs a cross-sectional design; it included a total of 484 Lebanese participants. A snowball sampling method via Google forms was employed by the research team to collect data. They were assessed with self-reported measures using The War-related Media Exposure Scale (WarMES), the Buss Perry Aggression Questionnaire-Short Form (BPAQ-SF), Columbia-Suicide Severity Rating Scale (C-SSRS), Intolerance of Uncertainty Scale (IUS) and The World Health Organization 5-item Well-Being Index (WHO-5).

Results: Higher fear of war was significantly associated with more inhibitory and prospective anxiety. More prospective anxiety and inhibitory anxiety were significantly associated with more aggression, higher suicidal ideation, higher depression, lower wellbeing and higher anxiety. Fear of war was directly associated with depression, anxiety and lower wellbeing. Whereas the results did not show a direct association with aggression and suicidal ideation. The mediation analysis revealed that inhibitory anxiety and prospective anxiety fully mediated the relation between fear of war and aggression and partially mediated the relation between fear of war and depression, anxiety and wellbeing. Whereas the association between fear of war and suicidal ideation was fully mediated by prospective anxiety but not by inhibitory anxiety.

Conclusion: Understanding the role of intolerance of uncertainty is crucial to developing interventions aimed to reduce mental health challenges in populations affected by conflict.