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  During pandemics, minorities may experience high stress levels, which could harm their health. This study explores stress among the Arab minority in Israel during the first wave of the COVID-19 outbreak, and its association with the population's perceived COVID-19 threat, trust in the healthcare system, adherence to guidelines, and perceived discrimination. The study analyzed a cross-sectional online survey of 626 Israeli Arabs. Most participants (65%) reported moderate levels of stress, and 10% reported severe levels. The Bedouin population reported significantly higher levels of stress compared to other minority groups. The participants also reported a high degree of perceived threat, a moderate-to-high level of discrimination, a moderate level of trust in the healthcare system, and very high adherence to guidelines. Structural equation modeling (SEM) revealed that the participants' perceived threat and trust mediated the association between their perceived discrimination and stress [indirect effect=0.13, SE = 0.03 CI = (0.08, 0.18)], whereby discrimination was negatively associated with trust (β=-0.52), which, in turn, was negatively associated with stress (β=-0.10). Furthermore, discrimination was positively associated with perceived threat (β = 0.21), which, in turn, was positively associated with stress (β = 0.35). Discrimination is an important social determinant of health - especially during health emergencies when trust in healthcare systems and perceived threats are crucial. Our findings could assist policymakers in developing fair policies, that are tailored to various population groups and that may reduce stress levels among minorities, thereby improving their mental and physical health. Key messages The results highlight the relationships between discrimination, trust, perceived threat and stress. To reduce minorities’ stress, it is vital to create a credible and fair atmosphere during pandemics.

Stress and perceived discrimination among Israeli Arabs: the mediation role of threat and trust