Mediating Effect of Depression and Anxiety on the Relationship Between Grief Reaction and Post-Traumatic Stress Symptoms in Lebanese Volunteers

Abstract

Objective The Lebanese people have endured through several disasters, such as the Beirut explosion, coronavirus pandemic, and cholera outbreak. However, volunteers who have tried to overcome such national disasters develop emotional stress after witnessing people’s death. This study was conducted to explore whether volunteers’ depression or anxiety mediates the relationship between grief response and post-traumatic stress disorder (PTSD) symptoms.Methods We conducted an anonymous online survey study and collected responses from 270 volunteers in Lebanon from March 20–26, 2023. Demographic information and responses to the questionnaires, which included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Public Service Motivation scale (PSM scale), Connor-Davidson Resilience Scale-2, and Prolonged Grief Disorder (PG-13) were collected. Variables were compared between volunteers who did and did not witness people’s death. Furthermore, we explored the relationships among variables in volunteers who witnessed people’s death (n=72).Results Among 270 participants, 72 (26.67%) witnessed people’s death. The regression model demonstrated that scores for PG-13 (β= 0.31, p<0.001), PHQ-9 (β=0.21, p=0.011), and GAD-7 (β=0.44, p<0.001) were predictors of the PCL-5 score. Mediation analysis showed that grief reaction directly influenced PTSD symptoms (Z=6.19, p<0.001), whereas depression (Z=1.99, p=0.047) and anxiety (Z=2.79, p=0.005) individually mediated the relationship between grief reaction and PTSD symptoms.Conclusion Our study helps understand the mediating effects of volunteers’ depression or anxiety on the relationship between grief reactions and PTSD symptoms.