To our knowledge, this study is the first to assess the factors related to psychological distress among Lebanese women during the COVID-19 confinement. The results showed that marital conflicts and financial difficulties were associated with high stress, anxiety, and depression, while higher violence was related to higher depression among women. Also, violence was a mediating factor between pregnancy status and anxiety and between marital conflict and depression.
In this study, marital conflicts were related to higher depression, anxiety, and stress among women. Consistently, previous findings have also associated high levels of psychological distress with marital dissatisfaction (45–48). A recent study conducted in China during the COVID-19 pandemic showed that emotional well-being in married people was lower than in unmarried people (49). Evidence suggests that stressful or life-threatening events, such as natural disasters, can lead to a decline in the quality of relationships due to stress and conflict or, instead, improve the quality of relationships and intimacy (50–52). Also, during the COVID-19 confinement, several factors can lead to increased tension between romantic partners confined together, such as disturbed everyday activities, the fear of the pandemic, loss of physical activity, loss of outside social networks, lack of access to non-essential health services, and reduced physical interaction in overcrowded households (53). Previous studies have shown that the persistence of tense verbal or non-verbal exchanges between partners can lead to physiological and psychological changes, eventually progressing to disease states (54, 55). Once health conditions develop or intensify, they can be experienced as a traumatic life occurrence or persistent stress, resulting in adverse mental health consequences, such as depression and anxiety (56). Our results also showed that marital conflicts were associated with higher violence, consistent with those of previous studies (57–59). The severity of marital conflicts ranges from minor disagreements to disputes that partners cannot overcome, which harms their relationship and could lead to violence (60).
This study showed that violence was associated with higher depression among women, in agreement with previous studies showing that women subject to behavioral, physical, and sexual violence by an intimate partner were more likely to exhibit signs of depression (61–63). The core mechanisms that explain why violence can cause subsequent depression in women are traumatic and psychological stress reactions (64). Sustained psychological stress due to social threats or rejection can affect women’s cognition, mood, and behavior, leading to symptoms of depression (65). Also, domestic environments have become a suitable place for intimate partner abuse because of lockdown restrictions (66). Abusive individuals may use the confinement to exert power over the vulnerable ones, especially women (66). Lockdown restrictions can contribute to increased stress and further lead to exacerbation of anxiety, depressive symptoms, and violence (67). Thus, the perpetrator disturbed psychological health could adversely affect that of abused individuals (67). The persistent exposure of vulnerable persons to abusive individuals constrains the victim to cope with the situation, which further aggravates depressive symptoms (68).
Our findings revealed that financial difficulties were associated with higher depression, stress, and anxiety, consistent with those of a recent study showing a correlation between financial hardship and emotional impact due to the pandemic (69). Other studies have also reported that financial difficulties due to the lockdown might impair mental health and increase the incidence of psychological stress (70–72). During times of crisis and confinement, women face plenty of problems, including high risks of economic poverty. Also, they are over-represented in health services, continue to do most unpaid household care jobs, and face increased risks of violence, assault, or harassment (73). Additionally, their employment, businesses incomes, and living conditions could be more vulnerable than men to the predicted systemic economic effects of the pandemic, placing them at greater risk of financial instability. All these issues have a considerable impact on the health and psychological well-being of women (73). Psychological difficulties expected by financial pressures include higher psychological distress and intensified issues and relations with family members, friends, and in the workplace (74).
Our results showed that a higher number of pregnancies and abuse by a family member were related to higher violence against women. Similarly, other studies found that a large family is a risk factor for frequent domestic violence, empowered by lower socioeconomic status, deprivation of maternal care, neglect of children, lack of family planning, and parenteral conflict (75–78). Furthermore, a history of child abuse was related to higher depression among women, consistently with other findings (79–82). Hence, the loss of attachment and the absence of a secure life were the main features for women to experience depression (83, 84). Moreover, women victims of childhood abuse are more likely to endure violence later in their life (85–87). Identifying women with a history of childhood abuse and assaults would provide efficient maternal care and increase awareness against domestic violence.
Our results showed that violence mediated the association between pregnancy status, marital conflicts, financial difficulties, and depression and anxiety but did not mediate between these factors and stress. Contrary to our findings, a recent study conducted in Lebanon during the COVID-19 lockdown among 502 adults found that female gender and physical violence at home were associated with higher stress during the pandemic (88). It also showed that a previous higher socioeconomic status was associated with higher stress, while current financial wellness was correlated with lower stress (88). However, a previous study among 215 mothers found that stressful life events were directly linked to psychological distress, particularly depression through domestic violence, while marital and pregnancy statuses were not related to the presence of domestic violence (29). Several other studies found that dissatisfied married women would present a high risk of mental distress (89–91). The sudden disruption of routine due to the COVID-19 outbreak has affected the populations globally, leading to exacerbation of stress in the majority of people. However, the Lebanese people exhibited psychological resilience during the confinement, as they had faced and continue to endure political instabilities, a decline of essential services, in addition to several types of violence (92); they adapt to abuse and work through it more than they oppose it (92). Regarding gender equality in Lebanese society, women continue to face discrimination at numerous levels, such as decision-making structures, socio-cultural values, and security issues. Men are raised in a manner that gives them a sense of authority over women and makes them expect women to recognize their superiority. Thus, unhappy marriages, marital conflicts, and economic insecurity make women more vulnerable to mental problems (48, 60, 80). Future studies are necessary to determine the psychological distress faced by Lebanese married women, particularly during confinement.