Assessment of mental health and coping mechanisms among adolescents in Palestine: a cross-sectional study

Adolescence is a sensitive developmental period characterized by rapid physical and psychosocial changes, making adolescents particularly vulnerable to mental health challenges. In Palestine, students may also be exposed to socio-political stressors such as conflict, displacement, and economic hardship, which may further compromise psychological well-being. Despite these pressures, limited data are available on mental health status and coping patterns among Palestinian adolescents. This study aimed to assess mental health status and coping mechanisms among Palestinian adolescents, and to examine how coping styles relate to sociodemographic factors and psychological well-being. A cross-sectional study was conducted from February to August 2025 among students aged 12–18 years in grades 7–12 from 12 public and private schools across Palestine. Data were collected using a structured, self-administered Arabic questionnaire developed through literature review and expert consultation. The tool included: (1) sociodemographic characteristics; (2) perceived stress and mental health-related characteristics; (3) a 28-item coping strategies scale adapted from prior Palestinian research; and (4) the validated Strengths and Difficulties Questionnaire (SDQ). Parental e-consent and student assent were obtained. Analyses were performed using SPSS v26 with Mann–Whitney U, Kruskal–Wallis H tests, and hierarchical multivariable linear regression; statistical significance was set at p < 0.05. A total of 560 students participated (57% aged 12–15 years; 53.6% female). Most reported moderate socioeconomic status (84.8%), and 88.2% had never used mental health services. Regarding stress, 42.7% reported feeling stressed sometimes and 34.3% felt stressed frequently or most of the time. Based on SDQ total difficulties, 58.0% were in the normal range, 17.3% borderline, and 24.6% abnormal. Problem-focused coping was the most commonly used style (mean 2.8 ± 0.67), followed by emotion-focused coping (2.48 ± 0.50), while avoidant coping was least used (1.97 ± 0.48). Females reported higher emotion-focused and avoidant coping scores than males ( p ≤ 0.024), while problem-focused coping did not differ by gender. Age, smoking status, and socioeconomic status showed no significant associations with coping styles. Higher stress was associated with greater use of all coping styles ( p < 0.05), and avoidant coping was higher among students using mental health services, reporting a mental illness diagnosis, or classified as borderline/abnormal on SDQ domains. Problem-focused coping was higher in normal SDQ categories and with better prosocial behavior. In adjusted analysis, problem-focused coping was associated with lower Total Difficulties (B = − 3.29, 95% CI − 4.11 to − 2.47), whereas emotion-focused (B = 2.24, 95% CI 1.04–3.45) and avoidant coping (B = 4.46, 95% CI 3.51–5.42) were associated with higher scores. Nearly one-quarter of Palestinian adolescents demonstrated abnormal SDQ total difficulties. While problem-focused coping was the dominant strategy, avoidant coping clustered among students with higher psychological difficulties, greater stress, and lower paternal education. These findings highlight the need for school-based mental health promotion, early screening, and resilience-building interventions tailored to the Palestinian socio-political context. Not applicable.