Occupational Balance and Meaning Mediate Higher Education Students' Mental Health During War: A Structural Equation Modeling Analysis.

Abstract

Importance: Exposure to trauma and extensive changes in daily life circumstances and occupations as a result of an ongoing armed conflict can significantly affect mental health.

Objective: To examine factors related to the mental health status of Israeli students during the Swords of Iron war.

Design: A cross-sectional study.

Setting: Online survey.

Participants: Students in higher education institutions across Israel (N = 863).

Outcomes and measures: Self-report validated questionnaires were used to assess students' mental health status, resilience, satisfaction with life, executive functions, environmental factors, and occupations.

Results: Moderate levels of depression (Mdn = 18, interquartile range [IQR] = 10-28), anxiety (Mdn = 10, IQR = 4-20), and stress (Mdn = 24, IQR = 14-34) were found for 50% of participants, along with extensive changes in daily life occupations, occupational balance, and meaning. Using structured equation modeling, χ2(15) = 15.969, p = .384, the authors found that satisfaction with life, psychological resilience, religious status, executive functions, occupational balance, and variability in occupational change were directly associated with mental health status, whereas occupational balance and occupational change mediated these connections.

Conclusions and relevance: The modifiable factors related to reduced mental health after exposure to traumatic threat included change in occupational patterns, occupational balance, and sense of belonging, which may all serve as goals for occupation-based interventions and contribute to better coping mechanisms with traumatic events. This study used a cross-sectional design and an online survey with self-reported data, which may limit the generalizability of the findings. Plain-Language Summary: Higher education students in Israel were exposed to traumatic events and changes in daily life because of war. This study aimed to understand their mental health, resilience, executive functions, environments, and changes in their occupational patterns and the complex interplay between these factors. An online survey showed a notable decline in the students' mental health status, with around 50% experiencing at least moderate levels of depression, anxiety, and stress. Changes in occupations, occupational meaning, and balance were also common. The study found that satisfaction with life, mental resilience, occupational balance, religious status, executive functions, and variability in occupational change all contributed directly to the students' mental health status. The findings suggest that modifiable factors such as occupational balance and belongingness could be addressed through interventions to enhance mental health and coping mechanisms of students facing trauma and stressful life events.