Prevalence of depressive symptoms, anxiety symptoms, and stress and associated factors among Palestinian nurses in the Gaza Strip during the war

The ongoing war in the Gaza Strip has profoundly affected the psychological well-being of healthcare workers, particularly nurses, who provide frontline care amid continuous violence, displacement, and resource scarcity. Understanding the mental health consequences of these extreme working conditions is essential for developing targeted interventions and institutional support mechanisms. This study aimed to assess the prevalence of depressive symptoms, anxiety symptoms, and stress, and to examine associated factors among Palestinian nurses during the 2023–2025 war in the Gaza Strip. A cross-sectional descriptive study was conducted between August 15 and September 15, 2025, involving 260 nurses recruited from public and field hospitals across the Gaza Strip. Data were collected using a self-administered questionnaire incorporating the validated Arabic version of the Depression, Anxiety, and Stress Scale-21 (DASS-21). Descriptive statistics and multiple linear regression analyses were performed using SPSS version 24 to identify factors associated with psychological symptom scores. Based on DASS-21 classifications, 81.5% of nurses reported elevated depressive symptoms, 86.9% reported elevated anxiety symptoms, and 69.2% reported elevated stress symptoms of varying severity. Notably, 67.7% of participants reported elevated symptoms across all three domains concurrently. Regression analysis showed that nurses with more than 10 years of experience had significantly higher depression (B = 6.67, 95% CI = 1.40 to 11.94, p = 0.013) and anxiety (B = 10.70, 95% CI = 5.62 to 15.76, p < 0.001) scores. In contrast, working more than 36 h per week was associated with significantly lower depression ((B = -3.71, 95% CI = − 6.44 to − 0.98, p = 0.009), anxiety scores (B = -4.89, 95% CI = -7.50 to -2.25, p < 0.001), and stress (B = -3.99, 95% CI = -6.54 to -1.43, p = 0.004) scores compared with those working ≤ 36 h/week. Additionally, nurses in supervisory or managerial roles had significantly lower anxiety (B = -7.37, 95% CI = − 13.38 to − 1.36, p = 0.016). This study found a high burden of depressive symptoms, anxiety symptoms, and stress among nurses in the Gaza Strip during the ongoing conflict, exceeding rates reported in many comparable settings. These findings suggest that occupational workload indicators were significantly associated with nurses’ psychological symptom scores in this sample. Institutional measures, including regulated working hours, psychosocial support programs, and routine mental health monitoring, are urgently needed to safeguard nurses’ well-being and support healthcare system resilience under crisis conditions. Not applicable.