Depression, anxiety, and stress among adults in Kuwait across pre- and post-vaccine phases of the COVID-19 pandemic: a repeated cross-sectional study

BackgroundThe COVID-19 pandemic has significantly affected mental health globally, with important implications for pandemic preparedness, yet psychological responses across pandemic phases in the Gulf region remain underexplored. This study assessed mental health outcomes among adults in Kuwait across pre- and post-vaccine phases of the COVID-19 pandemic to identify factors that can guide preparedness strategies.MethodsTwo independent web-based surveys were conducted in June 2020 (pre-vaccine phase) and August 2021 (post-vaccine phase). In total, 1,923 adults completed validated questionnaires, including the Depression, Anxiety, and Stress Scale (DASS-21). Outcomes were compared across periods using descriptive analyses, and multivariate logistic regression identified predictors of moderate-to-severe mental health symptoms.ResultsOverall, 40.9% of participants reported depression, 36.0% anxiety, and 25.0% stress. Participants surveyed during the post-vaccine phase had higher adjusted odds of moderate-to-severe anxiety (OR = 2.14, 95% CI: 1.61–2.85) and stress (OR = 2.31, 95% CI: 1.73–3.07) compared with those surveyed during the pre-vaccine phase. Females, young adults (18–29 years), and non-Kuwaitis had greater odds of adverse mental health outcomes, with non-Kuwaitis showing 50% higher odds of depression. Lower confidence in the healthcare system was also associated with greater psychological distress. In contrast, faith-based coping was associated with lower odds of stress (OR = 0.30, 95% CI: 0.20–0.45), and time management practices were linked to reduced anxiety (OR = 0.73, 95% CI: 0.55–0.96). Adherence to mask use and hand hygiene was lower during the post-vaccine phase.ConclusionSubstantial mental health challenges were observed in both pre- and post-vaccine phases of the pandemic, particularly among women, younger adults, and non-citizens. Protective coping strategies, especially faith-based and social support mechanisms, should thus be integrated into pandemic preparedness alongside biomedical responses.