Mental Toughness and Prenatal Depression Among Pregnant Women in Gaza

During pregnancy, psychologically the stage is very vulnerable and this vulnerability can be highly compounded in a place where there has been conflict like Gaza where women are vulnerable through displacement, insecurity, bereavement, financial hardship, disrupted healthcare and constant exposure to violence. There is evidence that has been seen in the Gaza Strip that prenatal symptoms of depression are very prevalent. A randomized sample of 400 pregnant women visiting primary healthcare systems reported moderate depressive symptoms in 33.3% and severe depressive symptoms in 18.5% and a study in a West Bank refugee-camp reported some level of depressive symptoms in 59.5% of 327 pregnant women. Protective psychological resources might be blue ocean of mental toughness, which is a sense of perceived control, commitment, challenge appraisal and confidence but it is not directly studied in pregnant Gazan women. This is a critical review which compiles the evidence regarding prenatal depression in Gaza and Palestine, mental toughness and depressive symptoms, resilience, coping, social support and pregnancy under conflict. Independent-of-pregnancy evidence repeatedly supports more depressive symptoms correlated with higher mental toughness and stress-focused-depression correlations; a recent community study revealed that there was a significant interaction between stress and mental toughness on depressive symptoms (b = -0.16, p = .004). There is also supportive perinatal evidence based on adjacent constructs: the stronger the social support and resilience, the lower the level of perinatal depression, and the avoidance of coping is related to a higher level of depressive symptoms. But the substitution of constructs, cross-sectional designs, dissimilar screening instruments and harsh contextual deficiency restrict causal inference. Available evidence thus shows that mental toughness is a potential/testable stress-buffering determinant as opposed to an established protective determinant of prenatal depression in Gaza. Future Gaza-based, validated Arabic measure studies are needed.