Household hunger and depression, anxiety, and stress symptoms among online survey respondents in gaza during the 2023–2025 war: a cross-sectional study

Résumé fourni par la source

Protracted armed conflict in the Gaza Strip has severely disrupted household food access, potentially amplifying the population’s mental health burden. This study examined the relationship between household hunger and symptoms of depression, anxiety, and stress among Palestinian respondents during the 2023–2025 war. An online cross-sectional survey was conducted among Palestinian respondents living in the Gaza Strip from 15 July to 25 August 2025 ( n = 250 individual respondents). Participants were recruited using convenience and snowball sampling through WhatsApp and Telegram networks. The unit of analysis was the individual respondent: household hunger was assessed as a respondent-reported household-level exposure using the Household Hunger Scale, while depression, anxiety, and stress symptoms were assessed at the individual level using the Arabic DASS-21. Three multivariable linear regression models were used to estimate associations between household hunger categories and DASS-21 depression, anxiety, and stress scores, adjusting for sociodemographic and war-related variables. Among online survey respondents, 87.6% reported household hunger scores in the moderate-to-severe range (48.8% moderate; 38.8% severe). Based on DASS-21 screening thresholds, 98.8% of respondents scored above the cutoff for depressive symptoms, 98.8% scored above the cutoff for anxiety symptoms, and 92.0% scored above the cutoff for stress symptoms, with many respondents classified in the severe or extremely severe symptom categories. Compared with respondents reporting little-to-no household hunger, moderate and severe respondent-reported household hunger were associated with higher DASS-21 symptom scores across all domains: depression (B = 4.55, 95% CI 0.71–8.39; B = 8.43, 95% CI 4.55–12.32), anxiety (B = 5.42, 95% CI 1.80–9.05; B = 9.71, 95% CI 6.05–13.37), and stress (B = 4.11, 95% CI 0.66–7.55; B = 8.27, 95% CI 4.79–11.76). In this online non-probability sample of war-affected respondents in Gaza, respondent-reported household hunger was high and showed a graded association with higher DASS-21 depression, anxiety, and stress symptom scores. These findings support integrated emergency responses that combine food-security interventions with scalable mental health and psychosocial support, with priority given to respondents reporting moderate-to-severe household hunger.

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