COVID-19 specific anxiety, perceived stress related to missile attacks, and anxiety “episodes”.

This article aimed to examine the prospective effects of anxiety related to the COVID-19 pandemic (virus-specific anxiety, VSA) and perceived stress related to a missile attack in predicting general anxiety episodes during the first wave of COVID-19 in Israel. Nine hundred ninety-one Israeli adults completed online self-report questionnaires over 7 weeks. The total number of anxiety episodes (defined as an average score of 4 or 5 on two state anxiety items) was predicted by VSA and perceived stress related to missile attacks at Wave 1, controlling for anxiety episodes at baseline (Wave 0) and Wave 1. A zero-inflated negative binomial model was used to analyze the count data. The number of anxiety episodes was positively correlated with VSA and perceived stress related to missile attacks. The zero-inflated negative binomial model revealed that (a) higher VSA (b = -0.46, p < .001) and perceived stress (b = -0.41, p < .001) at Wave 1 predicted a lower probability of having no anxiety episodes. (b) Only higher levels of VSA at Wave 1 (b = 0.13, p < .001) prospectively predicted the number of anxiety episodes, controlling for anxiety episodes at baseline and Wave 1. Findings support an additive pattern, whereby perceived stress from missile attacks contributed to the onset of an anxiety episode over and above the effect of VSA, while VSA predicted the total number of such episodes. Focusing solely on a single, highly salient stressor may hinder clinicians and policymakers' ability to identify the adverse effect of multiple stressors. (PsycInfo Database Record (c) 2025 APA, all rights reserved).