{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T18:23:49Z","timestamp":1787250229699,"version":"build-2736575974"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>\n                    Home destruction is a severe traumatic event strongly associated with psychological distress, particularly in conflict settings. Hemodialysis patients face heightened vulnerability due to chronic illness and dependence on continuous medical care. This study examined whether anxiety mediates the relationship between home destruction and post-traumatic stress disorder (PTSD) among hemodialysis patients in Gaza following the military assault on October 7, 2023. A cross-sectional study was conducted across five dialysis centers in Gaza. Anxiety symptoms were measured using the Depression Anxiety Stress Scale (DASS-21), and PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Structural equation modeling with bootstrapped confidence intervals evaluated mediation effects. Among 383 participants, 83.6% reported moderate-to-extreme anxiety, and 58% met the PTSD cutoff. Home destruction was highly prevalent, affecting 66.1%, with 53.5% experiencing total loss of residence. Significant positive correlations were found among home destruction, anxiety, and PTSD. Mediation analysis showed that anxiety fully accounted for the association between home destruction and PTSD (significant indirect effect, non-significant direct effect after adjustment). In adjusted models controlling for gender and current residency, the total effect was no longer significant, consistent with full statistical mediation. The model explained 42% of the variance in PTSD scores, almost entirely through anxiety (R\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.02 for anxiety from home destruction alone). Given the cross-sectional design, this mediation should be interpreted as a statistical association rather than evidence of a causal pathway, and longitudinal studies are needed to confirm temporal relationships. Although causality cannot be determined from this cross-sectional study, the observed indirect association suggests that integrating anxiety-focused mental health support into dialysis services may help reduce PTSD symptoms among conflict-affected hemodialysis patients. Pilot intervention studies are needed to test this hypothesis.\n                  <\/jats:p>","DOI":"10.1371\/journal.pmen.0000682","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:27:08Z","timestamp":1787246828000},"page":"e0000682","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring anxiety as a potential mediator of the association between home destruction and PTSD symptoms among hemodialysis patients in Gaza after 7th Oct 2023"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3637-6221","authenticated-orcid":true,"given":"Maha","family":"AbuZarifa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5108-3692","authenticated-orcid":true,"given":"Yaser","family":"Hamam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2394-5491","authenticated-orcid":true,"given":"Mohammed","family":"Hamam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5380-8108","authenticated-orcid":true,"given":"Salah Wajdi","family":"Alaloul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8310-5281","authenticated-orcid":true,"given":"Khalil Mostfa","family":"Alinaby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5808-1601","authenticated-orcid":true,"given":"Mohammed Wajdi","family":"Alaloul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara M.","family":"Hijazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed B.","family":"AbuZarifa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"AbuZarifa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Veronese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"pmen.0000682.ref001","doi-asserted-by":"crossref","first-page":"978703","DOI":"10.3389\/fpsyt.2022.978703","article-title":"Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis","volume":"13","author":"ICZY Lim","year":"2022","journal-title":"Front Psychiatry"},{"issue":"1","key":"pmen.0000682.ref002","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13031-025-00681-1","article-title":"Prevalence and correlates of anxiety, depression, and symptoms of trauma among Palestinian adults in Gaza after a year of war: a cross-sectional study","volume":"19","author":"MR Zughbur","year":"2025","journal-title":"Confl Health"},{"key":"pmen.0000682.ref003","unstructured":"Action by UN System and Intergovernmental Organizations Relevant to the Question of Palestine (June 2025 Monthly Bulletin). https:\/\/www.un.org\/unispal\/document\/june-2025-monthly-bulletin\/"},{"issue":"1","key":"pmen.0000682.ref004","doi-asserted-by":"crossref","DOI":"10.1186\/s43045-025-00545-7","article-title":"Prevalence and risk factors of depression among people who attended the Gaza war in 2024 and who fled Palestine \u2014 a cross-sectional study","volume":"32","author":"M AbuZarifa","year":"2025","journal-title":"Middle East Curr Psychiatry"},{"issue":"1","key":"pmen.0000682.ref005","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13031-025-00744-3","article-title":"A mediation model on how PTSD symptoms are related to psychotic experiences in survivors of the ongoing Gaza war 2023-2024","volume":"20","author":"F Fekih-Romdhane","year":"2025","journal-title":"Confl Health"},{"issue":"2","key":"pmen.0000682.ref006","doi-asserted-by":"crossref","first-page":"89","DOI":"10.26719\/2025.31.2.89","article-title":"A narrative review of mental health and psychosocial impact of the war in Gaza","volume":"31","author":"I Aqtam","year":"2025","journal-title":"East Mediterr Health J"},{"issue":"1","key":"pmen.0000682.ref007","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1038\/s41598-025-31757-w","article-title":"A cross-sectional study of screened depression prevalence among Gaza war survivors who fled versus those who remained","volume":"16","author":"M AbuZarifa","year":"2026","journal-title":"Sci Rep"},{"issue":"1","key":"pmen.0000682.ref008","doi-asserted-by":"crossref","first-page":"23404","DOI":"10.1038\/s41598-026-53197-w","article-title":"Sociodemographic and clinical characteristics of Palestinian patients with chronic pain: a cross-sectional study from Al-Shifa Hospital, Gaza","volume":"16","author":"A AbuJlambo","year":"2026","journal-title":"Sci Rep"},{"issue":"1","key":"pmen.0000682.ref009","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13033-021-00472-0","article-title":"Mental health consequences of home demolition policy towered Palestinians: Literature review","volume":"15","author":"M Marie","year":"2021","journal-title":"Int J Ment Health Syst"},{"issue":"1","key":"pmen.0000682.ref010","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.socscimed.2009.09.029","article-title":"War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks","volume":"70","author":"KE Miller","year":"2010","journal-title":"Soc Sci Med"},{"key":"pmen.0000682.ref011","doi-asserted-by":"crossref","first-page":"1443374","DOI":"10.3389\/fpsyt.2024.1443374","article-title":"Post traumatic stress disorder and co-morbid psychological disorders after Palestinians\u2019 home demolition: a comparative study","volume":"15","author":"AL Sarhan","year":"2024","journal-title":"Front Psychiatry"},{"key":"pmen.0000682.ref012","unstructured":"Gaza\u2019s largest hospital forced to end dialysis services amid fuel crisis. Middle East Eye. https:\/\/www.middleeasteye.net\/news\/gaza-largest-medical-complex-forced-shut-dialysis-services-amid-fuel 2026. 2026 January 6."},{"key":"pmen.0000682.ref013","unstructured":"Dialysis patients struggle to get treatment in blockaded Gaza. Hundreds have died, officials say. PBS News. https:\/\/www.pbs.org\/newshour\/world\/dialysis-patients-struggle-to-get-treatment-in-blockaded-gaza-hundreds-have-died-officials-say 2026 January 6."},{"issue":"1","key":"pmen.0000682.ref014","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1186\/s12882-025-04322-w","article-title":"Quality of life and access to healthcare among hemodialysis patients during wartime: cross-sectional insights from Gaza","volume":"26","author":"B Aldabbour","year":"2025","journal-title":"BMC Nephrol"},{"key":"pmen.0000682.ref015","doi-asserted-by":"crossref","first-page":"102857","DOI":"10.1016\/j.janxdis.2024.102857","article-title":"Relationship between anxiety sensitivity and post-traumatic stress symptoms in trauma-exposed adults: A meta-analysis","volume":"103","author":"HTS Chiu","year":"2024","journal-title":"J Anxiety Disord"},{"key":"pmen.0000682.ref016","doi-asserted-by":"crossref","first-page":"1544289","DOI":"10.3389\/fpsyt.2025.1544289","article-title":"Post-traumatic stress disorder, depression, anxiety, and their predictors among internally displaced persons in a conflict-affected area of Metekel Zone, Northwest Ethiopia: structural equation modeling","volume":"16","author":"SD Bekeko","year":"2025","journal-title":"Front Psychiatry"},{"key":"pmen.0000682.ref017","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/s10862-019-09731-4","article-title":"Anxiety Sensitivity Moderates the Effect of Posttraumatic Stress Disorder Symptoms on Emotion Dysregulation among Trauma-Exposed Firefighters","volume":"41","author":"KC Paltell","year":"2019","journal-title":"J Psychopathol Behav Assess"},{"issue":"8","key":"pmen.0000682.ref018","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.chiabu.2014.01.017","article-title":"Comorbidity of PTSD in anxiety and depressive disorders: prevalence and shared risk factors","volume":"38","author":"P Spinhoven","year":"2014","journal-title":"Child Abuse Negl"},{"key":"pmen.0000682.ref019","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1186\/s13031-019-0245-6","article-title":"Trauma in the Kashmir Valley and the mediating effect of stressors of daily life on symptoms of posttraumatic stress disorder, depression and anxiety","volume":"13","author":"T Housen","year":"2019","journal-title":"Confl Health"},{"key":"pmen.0000682.ref020","author":"AF Hayes"},{"issue":"3","key":"pmen.0000682.ref021","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s11126-025-10130-0","article-title":"Longitudinal Serial Mediation Study after the 2023 Earthquake in T\u00fcrkiye: Associations Between Difficulties in Emotion Regulation, Psychological Distress, Resilience and Mental Well-Being","volume":"96","author":"S Okur","year":"2025","journal-title":"Psychiatr Q"},{"key":"pmen.0000682.ref022","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","author":"Association American Psychiatric","year":"2013","journal-title":"Diagnostic and Statistical Manual of Mental Disorders"},{"issue":"6","key":"pmen.0000682.ref023","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations","volume":"51","author":"RM Baron","year":"1986","journal-title":"J Pers Soc Psychol"},{"key":"pmen.0000682.ref024","doi-asserted-by":"crossref","first-page":"1272909","DOI":"10.3389\/fpubh.2024.1272909","article-title":"Post-traumatic stress and depression following disaster: examining the mediating role of disaster resilience","volume":"12","author":"JM First","year":"2024","journal-title":"Front Public Health"},{"issue":"4","key":"pmen.0000682.ref025","doi-asserted-by":"crossref","first-page":"1542","DOI":"10.1017\/S0033291721003123","article-title":"Coping strategies as a causal mediator of the effect of loss-related memory characteristics and negative loss-related appraisals on symptoms of PGD, PTSD and depression","volume":"53","author":"KV Smith","year":"2023","journal-title":"Psychol Med"},{"issue":"8","key":"pmen.0000682.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003262","article-title":"Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis","volume":"17","author":"PA Coventry","year":"2020","journal-title":"PLoS Med"},{"key":"pmen.0000682.ref027","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.jad.2025.02.022","article-title":"Reducing posttraumatic stress symptoms by mitigating anxiety sensitivity through a computerized intervention","volume":"376","author":"C El Jamal","year":"2025","journal-title":"J Affect Disord"},{"issue":"1","key":"pmen.0000682.ref028","doi-asserted-by":"crossref","first-page":"2331613","DOI":"10.1080\/0886022X.2024.2331613","article-title":"Effectiveness of psychoeducational interventions on psychological distress and health-related quality of life among patients with maintenance hemodialysis: a systematic review and meta-analysis","volume":"46","author":"L Zhang","year":"2024","journal-title":"Ren Fail"},{"issue":"11","key":"pmen.0000682.ref029","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1001\/jama.2021.14075","article-title":"A Guideline for Reporting Mediation Analyses of Randomized Trials and Observational Studies: The AGReMA Statement","volume":"326","author":"H Lee","year":"2021","journal-title":"JAMA"},{"issue":"1","key":"pmen.0000682.ref030","doi-asserted-by":"crossref","first-page":"1855902","DOI":"10.1080\/20008198.2020.1855902","article-title":"Mediating role of post-traumatic growth in the relationship between inadequate disaster recovery and mental health outcomes: long-term evidence from the Wenchuan earthquake","volume":"12","author":"M Fu","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"pmen.0000682.ref031","article-title":"Home destruction, anxiety and PTSD in Gaza","volume":"1","author":"M Abu zarifa","year":"2026"}],"container-title":["PLOS Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000682","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:27:13Z","timestamp":1787246833000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000682"}},"subtitle":[],"editor":[{"given":"Karli","family":"Montague-Cardoso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":31,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmen.0000682","relation":{},"ISSN":["2837-8156"],"issn-type":[{"value":"2837-8156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}