Stress and perceived discrimination among the Arab population in Israel: the mediation role of the perceived COVID-19 threat and trust in the healthcare system

ABSTRACT

During pandemics, minorities may experience high stress levels, which could harm their mental and physical health. However, to the best of our knowledge, this has not been examined among minorities in Israel during the COVID-19 pandemic. This study, therefore, explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population’s perceived COVID-19 threat, trust in the healthcare system, adherence to preventative guidelines, and perceived discrimination.

The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines.

Hierarchical regression analysis showed that age, religion, trust in the healthcare system, perceived threat, and adherence to guidelines were all significant predictors of stress [F(11,600), p < .001]. The model explained 24% of the variance in stress. Structural equation modeling (SEM) revealed that the participants’ perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect = 0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β = −0.52), which, in turn, was negatively associated with stress (β = −0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health – especially during health emergencies when trust in healthcare systems and perceived threats are crucial. As such, our findings could assist policymakers in developing fair policies that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving both their mental and physical health.

KEYWORDS:

• Stress
• Discrimination
• Perceived Threat
• Trust in Healthcare System
• COVID-19

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 World Health Organization. (2020). WHO Timeline – COVID-19 https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19.

2 Ministry of Health, Israel: https://govextra.gov.il/ministry-of-health/corona/corona-virus-en/guidelines/.

3 Israel Ministry of Foreign Affairs publication, March 25, 2020, Cabinet approves additional emergency regulation: https://mfa.gov.il/MFA/PressRoom/2020/Pages/Cabinet-approves-additional-emergency-regulations-25-March-2020.aspx.

4 As only 10 respondents were Druze, they were included in the Muslim category due to similar characteristics.