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Daily stress, family functioning and mental health among Palestinian couples in Israel during COVID-19: A moderated mediation model

The COVID-19 pandemic created a range of stressors, among them difficulties related to work conditions, financial changes, lack of childcare, and confinement or isolation due to social distancing. Among families and married individuals, these stressors were often expressed in additional daily hassles, with an influence on mental health. This study examined two moderated mediation models based on Bodenmann’s systemic-transactional stress model. Specifically, the models tested the hypothesis that intra-dyadic stress mediates the association between extra-dyadic stress and mental health, while two measures of family functioning, cohesion and flexibility, moderate the relationship between extra and intra-dyadic stress. Participants were 480 Palestinian adults in Israel who completed self-report questionnaires. All were in opposite-sex marriages and identified as either cisgender women or cisgender men. The results showed partial mediation patterns supporting both models, indicating that family cohesion and flexibility weakened the mediating effect of intra-dyadic stress on the relationship between extra-dyadic stress and mental health. These findings increase our understanding of the variables that affected mental health during the pandemic, and suggest that when faced with extra-dyadic stress, married individuals with good family environments are less likely to experience high levels of intra-dyadic stress, which is in turn associated with preserved mental health. Limitations and implications for planning interventions for couples and families during the pandemic are discussed.

Furthermore, according to the STM, external stress affects mental health not only directly but also indirectly by increasing intra-dyadic stress (Bodenmann et al., 2016;Falconier et al., 2015;Neff & Karney, 2017). Namely, when extra-dyadic stress spills over into the dyad, the couple's dynamics can be negatively affected, which also contributes to decreased mental health (Falconier et al., 2015). In this context, Neff and Karney (2017) have argued that stressful contexts undermine marital well-being through two routes. In the first route, external stressors create additional problems by diverting time and attention away from activities that promote intimacy between partners in the marriage. In the second, external stress can make it difficult for spouses to cope with the increased problems by draining them of the energy and resources necessary for responding constructively. When individuals have to cope with greater external demands, they report being more distracted and less responsive when interacting with their partners (Story & Repetti, 2006), and when they do manage to make time for interacting, they often allocate that time to resolving their stressors (Randall & Bodenmann, 2009). In an example provided by Neff and Karney (2017), a couple experiencing serious financial strains might spend their limited time together negotiating the household budget, instead of more pleasurable pursuits that foster intimacy.
It follows that when extra-dyadic stress does not increase intra-dyadic stress, better outcomes can be expected. According to the STM, there are mechanisms that prevent extra-dyadic stress from increasing intra-dyadic stress, for example, provision of support and joint efforts to deal with common stressors (Bodenmann et al., 2016). Accordingly, we can assume that additional characteristics of family functioning interact with extradyadic stress in determining intra-dyadic stress. The current study therefore examined the possibility that two family functioning measures, cohesion and flexibility, would influence the association between extra-dyadic stress and intra-dyadic stress. This analysis was part of a broader model examining the ways in which extra-dyadic stress from daily hassles affects individual mental health through increased intra-dyadic stress. Essentially, family functioning is considered a potential protective factor that can buffer the adverse effects of extra-dyadic stress on intra-dyadic stress.
The family functioning measures examined here, cohesion and flexibility, are broadly discussed in the Circumplex Model of Marital and Family Systems (Olson et al., 1979), as central variables that define family interactions (Olson, 2000). Cohesion, which involves emotional bonding between family members, is positively correlated to the provision of functional and emotional support (Wang et al., 2015). Flexibility relates to the quality and expression of the family's leadership, organization, roles, and rules. It has been associated with effective adaptation to life changes and stressful events among families (García-Huidobro et al., 2012;Koutra et al., 2016;Wang et al., 2015). Together, cohesion and flexibility have been shown to create a balance between stability and adaptation to change, leading to optimal functioning (Olson, 1993;Olson & Gorall, 2006). The theoretical premise of the current study is that families that adapt to change while remaining close experience less perceived stress.
Various studies examining family functioning during times of distress support this premise. For example, earlier work on the family environments of patients with traumatic brain injuries shows that positive family functioning improves coping and enables thriving Sander et al., 2002;Stevens et al., 2013). Studies have also shown that better family functioning encouraged effective coping processes during major epidemics (Chang et al., 2015;Neo et al., 2016) and when a family member had a lifethreatening medical condition (Harris & Zakowski, 2003). Berryhill et al. (2018) also found that cohesive-flexible family functioning was associated with better coping resources, including positive communication and self-compassion.
Other work has shown direct relationships between measures of family functioning and perceived daily stress. Pollock et al. (2015) found that cohesion and flexibility were directly and negatively related to perceived stress from daily hassles. Sheidow et al. (2014) showed that youths from struggling families, which were low in family cohesion, positive communication, support, and organization, were less resilient to stress from daily hassles.
Studies specifically addressing the COVID-19 pandemic have also shown family functioning to be associated with perceived stress, both directly and as presumably moderated by coping. Salin et al. (2020) showed that agreement regarding everyday practices, sharing responsibilities, and confidence in managing life pressures promoted better coping with lockdown-related stressors, with flexibility emerging as a crucial facilitator. Goldberg et al. (2021) showed that use of strategies aimed at maintaining or enhancing relationship health decreased relationship and parenting stress. Similarly, both Hu et al. (2020) and Mohindra et al. (2020) showed that healthy family environments were associated with the provision of family support, which encouraged effective coping among individual family members. Finally, Ye et al. (2022) showed a direct negative association between family cohesion and perceived stress during the pandemic.

Cultural context
The main goal of the current study was not cultural comparison. Indeed, the literature supporting the proposed models is not limited to a particular cultural group. However, it is noteworthy that the study sample comprised married individuals from the Palestinian society in Israel, a population that has rarely been studied. A short description of broad sociocultural characteristics is therefore provided, with a focus on stress and family functioning, to contextualize the study.
At 21% of Israel's total population, Palestinian society constitutes a minority (Israeli Central Bureau of Israel Central Bureau of Statistics, 2019) and is therefore subjected to the stress involved in balancing the ubiquitous demands of the dominant and minority cultures (Hennon et al., 2008;Peterson, 2017). This stress has been shown to affect family relationships and functioning (Peterson, 2017). While Palestinian society in Israel tends to have traditional attitudes toward marriage and gender roles, with an unequal division of labor in the home and family (Abu-Baker, 2003), its proximity to the more modern views of the majority population has led to demographic, social, and economic changes, including the educational and economic empowerment of women. In addition, Palestinian society, like other Arab cultures, is largely collectivistic, and thus often characterized by close relationships between relatives, friends, and neighbors (Azaiza, 2008a). Furthermore, the Palestinian population has more limited access to professional mental healthcare services (Al-Krenawi & Graham, 2005), though as an ethnic minority they have a greater need for such services (Azaiza, 2008b). Due in part to this increased vulnerability, we might expect the limitations on extended family support experienced during the COVID-19 pandemic to affect the Palestinian population disproportionately, making cohesion and flexibility in the nuclear family particularly important.

Current study and hypotheses
Based on the aforementioned findings, the current study addressed the interplay between extra-dyadic stress, intra-dyadic stress, family functioning, and mental health among married individuals during the COVID-19 pandemic. Specifically, the study examined whether intra-dyadic stress mediated the relationship between extra-dyadic stress and mental health, and whether family functioning, as measured by cohesion and flexibility, moderated the relationship between extra-dyadic and intra-dyadic stress. Two models were tested, one for each of the moderator variables (family cohesion and family flexibility). The hypotheses were as follows: (1) extra-dyadic stress would be negatively associated with mental health, (2) intra-dyadic stress would partially mediate the relationship between extra-dyadic stress and mental health, and (3) family functioning (cohesion and flexibility) would moderate the relationship between extra-dyadic stress and intra-dyadic stress.

Participants and procedure
Data for this study were taken from a larger survey on family coping during the COVID-19 pandemic among 480 Palestinian adults in opposite-sex marriages, who identified as either cisgender women or cisgender men (see Table 1), from different regions in Israel. Participants were recruited through social media to complete an online survey. To be included, participants had to be married and living with their spouse (divorced, separated, and widowed individuals were excluded), have at least one child, and have access to a smartphone, personal computer, or laptop and an Internet connection. An attempt was made to represent a broad sociodemographic range, with respect to age, gender, years of marriage, number of children, place of residence, and socioeconomic status. The sociodemographic characteristics of the sample are presented in Table 1.
The COVID-19 pandemic began to spread in Israel in January 2020. Between March 15 and May 7, 2020, the Israeli government implemented an overall lockdown policy and required the entire population, with the exception of essential service providers, to leave their homes only for necessary provisions. Data for this study were collected just after the general lockdown was lifted, when the public was gradually allowed to resume routine functioning. Participants were asked to complete self-report questionnaires that addressed coping and stress since the outbreak of the pandemic, including the first lockdown.
The study was approved by the institutional Ethics Committee at the college where it was conducted. Participants received a brief explanation regarding the study and were assured that anonymity and confidentiality would be maintained. All participants signed an informed consent form before completing the study questionnaire.

Instruments
As part of the larger study, participants completed a self-administered multi-component questionnaire addressing a range of family-related issues. The components used in the current study are described below. Apart from the sociodemographic variables, which were originally written in Arabic, all the measures were translated from English into Arabic using the following method. In the first phase, the questionnaire was translated into Arabic by the author. In the second stage, another professional in the field was asked to compare the Arabic version with the English version, to assess the questionnaire with respect to overall clarity and the clarity of specific words and instructions. In the third stage, the author prepared the final Arabic version of the questionnaire based on comments received from the additional professional.

Family functioning
The third edition of the Family Adaptability and Cohesion Evaluation Scale (FACES III, 1985), developed by Olson et al. (1985), provided the two measures of perceived family functioning: cohesion and flexibility. The 20-item scale includes 10 items for each of the two factors. Family cohesion items address perceived within-family connectedness, unity, and emotional bonding (e.g., "we ask each other for help"; "we feel close to each other"; "togetherness is a top priority"). Family flexibility items address the perceived ability of the family to adjust its rules, provide structure, and adjust relationship patterns in response to changes (e.g., "it is hard to identify the leaders in our family"; "we shift household responsibilities from person to person"; "we try new ways of dealing with problems"). Participants rated the relative truth of each statement on a 5-point Likert scale ranging from 1 (Almost never) to 5 (Almost always). The scale was analyzed as a linear measure, with high scores in cohesion and flexibility indicating more functional family relationships (Olson, 1991). In the current study, Cronbach's alpha values for cohesion and flexibility were .92 and .85, respectively.

Extra-dyadic and intra-dyadic stress from daily hassles
The basis for the daily stress measure used in the current study was the Hassles Scale developed by Kanner et al. (1981), which includes 118 items that assess various aspects of perceived daily stress. Bodenmann et al. (2006) previously employed a shortened version of the original Hassles Scale, called the Multidimensional Stress Questionnaire for Couples (MSQ-C; see also Falconier et al., 2015). Of the 37 items, they defined 29 as representing stress "external to the dyad" and 8 as representing stress "internal to the dyad." In the current study, 8 items from each of the two categories proposed by Bodenmann et al. (2006) were employed. The intra-dyadic stress items addressed issues such as problems with the partner, overload with family responsibilities, not enough time for family, task sharing in the household, and feeling bothered by some of partner's habits. The extra-dyadic stress items were chosen for their relevance to the COVID-19 pandemic period, and included concerns about events in the news, concerns about health in general, financial security, troublesome neighbors, too many things to do, concerns about job security, and dissatisfaction with work duties. Participants were asked if they had experienced each item during the lockdown period. If they had not, they were instructed to choose "0"; if they had, they rated the perceived severity of the item on a 3-point scale: 1 "somewhat stressful," 2 "moderately stressful," or 3 "extremely stressful." Cronbach's alpha for extra-dyadic and intra-dyadic stress were .71 and .74, respectively. Three summary scores each were generated for extra-dyadic and intra-dyadic stress: (1) frequencya simple count of the number of items checked, which could range from 0 to 8; (2) cumulated severitythe sum of the 3-point severity ratings, which ranged from 0 to 24; and (3) intensitycumulated severity divided by frequency, which ranged from 0 to 3. The latter scores, which provided an index of how intensely the average hassle was experienced regardless of the number (frequency) of hassles experienced, were used as the outcome measures for extra-dyadic and intra-dyadic stress.

General mental health
The MHI-18 (henceforth, MHI), a shortened version of the original 36-item Mental Health Inventory developed by Veit and Ware (1983), was used to assess the general mental health. It includes four subscales: anxiety (e.g., "Have you been a very nervous person?"), depression (e.g., "Have you been in low or very low spirits?"), behavioral/ emotional control (e.g., "Have you been in firm control of your behavior, thoughts, emotions, feelings?"), and positive affect and emotional ties (e.g., "Has your daily life been full of things that were interesting to you?"; "Have you felt loved and wanted?"; "Have you felt cheerful, light-hearted?"). Participants were asked to indicate how often they had experienced various emotions during the lockdown period, using a 6-point scale ranging from 1 (all of the time) to 6 (none of the time).
The MHI has four subscale scores and one total score. The subscale and total scores range from 0-100. Before computing the total MHI score, 8 of the items were converted to make negative and positive scores consistent. Mean MHI score was then computed based on all 18 items, yielding a range from 1 to 6. Next, total MHI total score (a transformation score) was computed as follows: [(Mean MHI -1) * 100]/5. Thus, the range for total MHI score was from 0 (based on a mean MHI score of 1) to 100 (based on a mean MHI score of 6), with higher scores indicating better mental health. In the current study, Cronbach's alpha for general mental health was .75.

Sociodemographic variables
The following sociodemographic variables were examined: gender, age, religion, level of education, marriage duration, number of children, employment, average family income before the pandemic, and COVID-19-related financial damage.

Statistical analysis
Data were analyzed using SPSS 26. First, descriptive statistics and bivariate correlations (see Table 2) were calculated for the study variables, including extra-dyadic stress, intradyadic stress, family cohesion, family flexibility, mental health, and the sociodemographic variables (age, education, marriage duration, number of children, average family income before the pandemic, and financial damage due to the pandemic). Next, to address the main study objective and test the proposed models, moderated mediation analysis was conducted in SPSS version 26 using the PROCESS macro (model 7; Hayes, 2018). The macro regressed the dependent variable, mental health, on the following variables: (a) the independent variable, extra-dyadic stress; (b) the mediating variable, intra-dyadic stress; and (c) any sociodemographic covariates that were significantly correlated with at least one of the study variables (these included age, marriage duration, number of children, family income before the pandemic, and financial damage due to the pandemic). The mediator was also regressed on the independent variable and on the covariates. The moderators were also regressed on the independent variable and on the covariates. This procedure was run for each of the moderator variables (cohesion and flexibility).
To assess mediation and determine whether it was partial or complete, direct effects and indirect effects were estimated. Direct effects represent the direct pathways from an independent variable (e.g., extra-dyadic stress) to a dependent variable (mental health). Indirect effects represent the pathway from the independent variable (extra-dyadic stress) to the dependent variable (mental health) through a mediator (intra-dyadic stress). To determine the significance of the mediation effects, a bootstrapping technique was used (Preacher & Hayes, 2004), which resamples the existing dataset at least 5000 times to estimate the confidence intervals of the mediated effect.

Results
As a greater percentage of women participated in the study, t-tests were conducted to assess differences between women and men for all the study variables. As no significant differences were found, all the analyses were conducted on the entire sample.

Bivariate correlations
The results presented in Table 2 reveal a positive correlation between extra-dyadic stress and intra-dyadic stress, both of which were negatively correlated with mental health. In addition, a positive correlation between cohesion and flexibility, both of which were .21** .21** À.13** À.14** À.29** .17** À.13** À.33** À.01 .06 À.37** Note. Mean scores could range from 0 for low stress to 3 for high stress for extra-dyadic and intra-dyadic stress, from 1 for low levels to 5 for high levels for family cohesion and flexibility, and from 0 for low levels to 100 for high levels for mental health. Gender: 0 = male (n = 141), 1 = female (n = 339). Age ranged from 18 to 86. Education: scores could range from 1 for low education to 5 for high education. Marriage duration could range from 1 to 54. Number of children could range from 1 to 10. Average family income before the pandemic: scores could range from 1 for very low income to 5 for very high income. Financial damage due to the pandemic: scores could range from 1 for no damage to 5 for great damage. *p < .01; **p < .001.
negatively correlated with intra-dyadic stress and positively correlated with mental health.
Cohesion also negatively correlated with extra-dyadic stress. Average family income before the pandemic was negatively correlated with extra and intra-dyadic stress, and positively correlated with mental health. COVID-19-related financial damage was negatively correlated with cohesion, flexibility, mental health, and positively correlated with extra and intra-dyadic stress. Finally, age, marriage duration and number of children were negatively correlated with cohesion and flexibility. Overall, correlations between the study variables were as expected, enabling further examination of direct and indirect effects on mental health in the moderated mediation models. Note. a 1i = The effect of perceived extra-dyadic stress on intra-dyadic stress; a 2i = The effect of family functioning (cohesion or flexibility) on intra-dyadic stress; a 3i = The interaction effect of extra-dyadic and family functioning on intra-dyadic stress. *p < .05; **p < .01; ***p < .001.  Figure 1 presents the standardized coefficients of each pathway of the two models, after controlling for age, marriage duration, number of children, family income before the pandemic, and COVID-19-related financial damage. As shown in Table 3, the results demonstrated a significant direct effect of extra-dyadic stress on mental health (β = À.14, SE =.05, p = .005), supporting the first hypothesis. Furthermore, extra-dyadic stress demonstrated a significant effect on intra-dyadic stress (β = .55, SE = .04, p < .001; β = .56, SE = .04, p < .001, in Models A and B, respectively). In turn, intra-dyadic stress demonstrated significant direct effects on mental health (β = À.34, SE =.05, p < .001). Furthermore, the indirect effects, which are described below, were significant. In addition, after controlling for intra-dyadic stress, the direct effect of extradyadic stress on mental health was significant, suggesting partial mediation by intradyadic stress. These findings support the second hypotheses regarding the partial mediating effect of intra-dyadic stress on the relationship between extra-dyadic stress and mental health. Both extra-and intra-dyadic stress and the covariates accounted for 21.51% of the variance in mental health (F (7,473) = 18.52, p < .001).

Discussion
Two moderated mediation models based on the systemic-transactional model (STM; Bodenmann, 1995;1997) were used to examine the relationship between stress from daily hassles and mental health among married individuals during the early stages of the COVID-19 pandemic. The results showed that alongside a direct relationship between the extra-dyadic stress and mental health, intra-dyadic stress played a mediating role and family functioning played a moderating role. Specifically, extra-dyadic-stress was positively associated with intra-dyadic stress, which in turn was negatively associated with mental health, indicating partial mediation. Furthermore, a significant interaction effect was found between extra-dyadic stress and both family cohesion and flexibility, indicating that these family functioning variables moderate the association between extra-dyadicstress intra-dyadic stress. Participants with lower levels of family cohesion and flexibility demonstrated a greater effect of extra-dyadic stress on intra-dyadic stress, compared to participants with higher levels of family cohesion and flexibility. The overall moderated mediation model was supported, as intra-dyadic stress mediated the effect of extra-dyadic stress on mental health, and family cohesion and flexibility weakened the mediating effect of intra-dyadic stress. The results support the distinction between stressors that are external to and internal to the intimate dyad (see Bodenmann, 2000;2005;Bodenmann et al., 2007;Neff & Karney, 2004) and suggest that extra-dyadic stress influences mental health both directly and indirectly through intra-dyadic stress (Bodenmann et al., 2016;Falconier et al., 2015;Neff & Karney, 2017). Family functioning can therefore be considered a protective factor that provides a buffer from the adverse effects of extradyadic stress on intra-dyadic stress.
The COVID-19 pandemic brought on a range of stressors, among them environmental stressors, such as increased workloads and financial difficulties (Pietromonaco & Overall, 2021), disrupted family routines and responsibilities (Goldberg et al., 2021), and increased burden of unpaid work and childcare (Craig & Churchill, 2020). These stressors were often expressed in additional daily hassles, with corresponding decreases in mental health (Goldberg et al., 2021;Gray et al., 2020;Reizer et al., 2020). The current findings contribute to our understanding of the mechanisms through which pandemic stressors disrupted mental health.

The relationship between extra-dyadic stress and mental health
The results support previous findings indicating that stress from daily hassles plays an important role in understanding the mental health of married individuals. Several researchers have shown that high levels of daily stress are associated with greater anxiety and depression and lower mental health (D'Angelo & Wierzbicki, 2003;Parrish et al., 2011;Schönfeld et al., 2019;Serido et al., 2004). Specifically regarding extra-dyadic stress from daily hassles, previous work shows a direct negative impact on individual mental health (Bodenmann, 1997). This claim has been supported in several studies with a range of outcome measures (Falconier et al., 2015;Serido et al., 2004;Ledermann et al., 2010).

The mediating role of intra-dyadic stress
The present study also examined the mediating role of intra-dyadic stress in the relationship between extra-dyadic stress and mental health. As expected, extra-dyadic-stress was positively associated with intra-dyadic stress, which in turn was negatively associated with mental health.
The first path, indicating that extra-dyadic stress was positively related to intra-dyadic stress, supports Bodenmann's theory and previous studies showing that during periods of relatively high external stress, couples are more likely to report struggling with serious problems within the relationship, such as spending less time connecting with one another, lacking intimacy, feeling neglected by their partner, and increased differences in attitude (Neff & Karney, 2017). When couples face significant external stressors, as they did during the pandemic, critical time together often becomes limited and characterized by greater disconnection (Repetti et al., 2009). The second path of the mediation model indicated that intra-dyadic stress was negatively related to mental health. This was also consistent with previous studies, which found that intra-dyadic stress is related to depression (Falconier et al., 2015) and that marital tension and negative interactions are associated with symptoms of depression (Whisman & Uebelacker, 2009) and anxiety (Addis & Bernard, 2002;Chambless et al., 2001).
Overall, this study joins previous empirical work supporting the mediating role of intra-dyadic stress in the association between extra-dyadic stress from daily hassles and psychological well-being (Falconier et al., 2015). The novel question examined here was whether family cohesion and flexibility could affect mental health by altering the relationship between extra-dyadic and intra-dyadic stress.

The moderating role of family functioning
The results further revealed that family cohesion and flexibility moderate the path between extra-dyadic and intra-dyadic stress. As expected, among participants who reported higher cohesion and flexibility, the association between extra-dyadic and intra-dyadic stress was weaker.
These novel results support the assumption that when extra-dyadic stress does not go hand in hand with intra-dyadic stress, better outcomes can be expected. In the STM, Bodenmann et al. (2016) used the term dyadic coping in reference to the mechanisms that prevent extra-dyadic stress from increasing intra-dyadic stress, specifically noting provision of support and joint efforts to deal with common stressors. The current study raises the possibility that both family cohesion and family flexibility contribute significantly to such coping, thereby preventing extra-dyadic stress from daily hassles from spilling over into the relationship. This, in turn, can reduce negative effects on mental health.

Limitations
The findings and conclusions of this study should be considered in the context of several limitations. First, the sampling method employed, in which participants had access to and were users of social media, and chose to complete an online survey, could have resulted in a selection bias. This might limit the generalizability of the results, although a large sample of participants with a broad sociodemographic range was included. Second, the study relied solely on self-report questionnaires, which are subjective by definition and affected by various biases. Third, the study was cross-sectional, making it impossible to determine causative relationships between the variables. Future studies are needed to evaluate whether the reported associations continued to be maintained longitudinally following the early stages of the pandemic, given that all the study variables could potentially be affected by increasing mortality rates, economic burdens, and other longterm effects of COVID-19.
In the context of generalizability, it should be noted that while the majority of previous work on ties between family functioning and mental health were conducted in Western societies, participants in the current study were from the Arab society in Israel. In general, this is a collectivistic culture (Haj-Yahia, 2019) that tends to differ essentially from Western societies with respect to values and norms related to all the variables addressed in this study. Though it is beyond the scope of the current work to assess the manner in which these values and norms might have affected the results, it is certainly possible that such effects would be found in a broader, cross-cultural comparison. Further work should address such cross-cultural differences, as well as differences resulting from other sociodemographic or geography-based variables, for example the extent of damage incurred and of aid offered during the COVID-19 pandemic.

Conclusions and implications
This study increases our understanding of variables related to stress processes and mental health among married individuals during the COVID-19 pandemic. In accordance with the STM (Bodenmann et al., 2016), intra-dyadic stress was shown to play a critical role in mediating the effects of extra-dyadic stress on mental health. Furthermore, family functioning was shown to moderate the relationship between extra-dyadic and intradyadic stress. These findings suggest that married individuals with cohesive and flexible family environments are protected from the negative effects of external stressors on their relationship, and in turn on their mental health.
The current work has implications for planning couple interventions during the pandemic and in general, with the dual goals of improving marital satisfaction and supporting the mental health of the partners. If stress from daily hassles is likely to decrease mental health directly and also indirectly by raising intra-dyadic stress, then couples' therapists should routinely assess both the presence of major external stressors and their effects on relationship stress. Moreover, reducing daily hassles or coping with them effectively so that they do not spill into the couple's relationship or deteriorate partners' individual well-being may become a key goal of therapy and guide therapists towards intervention methods focused on enhancing communication and joint coping.
Furthermore, the findings suggest that intervention efforts should be focused on encouraging cohesive and flexible environments, as a means of reducing the effect of external stress on relationship stress. To promote cohesion, interventions should urge families to increase interaction and communication between members and to resolve conflicts constructively. Flexibility, meanwhile, can be increased by creating viable mechanisms to adjust family rules and roles in response to environmental changes.

Ethical approval
The author confirms being the sole contributor of this study and has approved it for publication.

Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.