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. 2025 Apr 19;15(1):13570.
doi: 10.1038/s41598-025-98417-x.

The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety in a sample of Lebanese adults

Elie Mattar  1 , Toni Sawma  2 , Rabih Hallit  3   4   5 , Diana Malaeb  6 , Fouad Sakr  7 , Mariam Dabbous  7 , Souheil Hallit  1   8   9 , Feten Fekih-Romdhane  10   11 , Sahar Obeid  12
Affiliations

The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety in a sample of Lebanese adults

Elie Mattar et al. Sci Rep. .

Abstract

Childhood maltreatment is a widespread issue worldwide and has a significant impact on the society at multiple levels, as it affects children. Numerous studies have shown the relationship between various forms of child abuse and the development of adverse outcomes in affected individuals. This study aims to assess the mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety among a sample of Lebanese adults. This cross-sectional study was conducted between March and April 2024; 507 participants were recruited using a snowball sampling method. The results of the mediation analysis were adjusted over sex and physical activity. Distress tolerance partially mediated the association between child abuse and anxiety (indirect effect: Beta = 0.01; Boot SE = 0.01; Boot CI 0.001; 0.02). Higher child abuse was significantly associated with less distress tolerance and directly associated with more anxiety. Higher distress tolerance was significantly associated with less anxiety. The mediating role of distress tolerance in the relationship between childhood maltreatment and anxiety as a mental health outcome was established in this study. Thus, this study highlights the importance of enhancing distress tolerance through therapeutic means including Cognitive and Behavioral Therapies and Dialectical Behavioral Therapy. By doing so, individuals can learn to cope with anxiety caused by childhood maltreatment.

Keywords: Anxiety; Childhood maltreatment; Distress tolerance; Mediation.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The Lebanese International University’s School of Pharmacy ethics committee granted this study ethics permission. When filling out the online form, each participant provided written informed consent, as did their parents or legal guardian(s) if they were study participants under the age of sixteen. All methods were performed in accordance with the relevant guidelines and regulations (in accordance with the Declaration of Helsinki).

Figures

Fig. 1
Fig. 1
(a) Relation between total child abuse and distress tolerance (R2 = 0.012); (b) Relation between distress tolerance and anxiety (R2 = 0.120); (c) Total effect of total child abuse on anxiety (R2 = 0.049); (c') Direct effect of total child abuse on anxiety. Numbers are displayed as regression coefficients (standard error). *p < .05; ***p < .001.
Fig. 2
Fig. 2
(a) Relation between psychological child abuse and distress tolerance (R2 = 0.003); (b) Relation between distress tolerance and anxiety (R2 = 0.196); (c) Total effect of psychological child abuse on anxiety (R2 = 0.180); (c') Direct effect of psychological child abuse on anxiety. Numbers are displayed as regression coefficients (standard error). **p < .01; ***p < .001.
Fig. 3
Fig. 3
(a) Relation between child neglect and distress tolerance (R2 = 0.046); (b) Relation between distress tolerance and anxiety (R2 = 0.035); (c) Total effect of child neglect on anxiety (R2 = 0.013); (c') Direct effect of child neglect on anxiety. Numbers are displayed as regression coefficients (standard error). ***p < .001.
Fig. 4
Fig. 4
(a) Relation between physical child abuse and distress tolerance (R2 = 0.002); (b) Relation between distress tolerance and anxiety (R2 = 0.140); (c) Total effect of physical child abuse on anxiety (R2 = 0.122); (c') Direct effect of physical child abuse on anxiety. Numbers are displayed as regression coefficients (standard error). **p < .01; ***p < .001.
Fig. 5
Fig. 5
(a) Relation between sexual child abuse and distress tolerance (R2 = 0.002); (b) Relation between distress tolerance and anxiety (R2 = 0.123); (c) Total effect of sexual child abuse on anxiety (R2 = 0.105); (c') Direct effect of sexual child abuse on anxiety. Numbers are displayed as regression coefficients (standard error). **p < .01; ***p < .001.
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