Psychosocial Contradictions in Pilgrim Mental Health: A Gender-stratified Analysis of Stress Determinants During the 2024 Hajj Season in North Sumatra

Abstract Introduction: The Hajj pilgrimage, while spiritually meaningful, presents numerous psychosocial stressors that can adversely affect pilgrims’ mental health. Gender-specific vulnerabilities remain underexplored in Southeast Asian contexts. This study investigates sociodemographic, behavioral, and psychosocial determinants of stress among Indonesian pilgrims, with a gender-stratified focus. Methods: A cross-sectional survey was conducted among 5362 Hajj pilgrims from North Sumatra during the 2024 Hajj season. Data were collected at embarkation sites using structured questionnaires assessing demographic variables, health behaviors, and psychosocial factors. Stress levels were measured using the Perceived Stress Scale-10 and dichotomized as mild versus moderate to severe. Bivariate analyses and multivariable logistic regressions were conducted, including gender-stratified models. Results: Males had significantly higher odds of experiencing moderate-to-severe stress than females (odds ratio [OR] = 1.22, 95% confidence interval [CI] [1.01–1.46]). Middle-aged (40–60 years) and older (>60 years) pilgrims were at elevated stress risk, particularly among men. Among females, higher education was associated with greater stress (OR = 1.64, 95% CI [1.12–2.40]). Marriage was a protective factor, more so for males. Surprisingly, both high life satisfaction (OR = 5.97, 95% CI [4.21–8.47]) and frequent exercise (OR = 1.28, 95% CI [1.05–1.56]) were linked to higher stress levels, defying conventional assumptions. Conclusion: The study highlights the complex and gendered nature of stress among Hajj pilgrims, challenging conventional mental health paradigms. Tailored interventions addressing gender roles, age-specific needs, and culturally embedded expectations are essential. Integrating culturally sensitive, gender- and age-responsive counseling into pre-Hajj programs is crucial to enhancing pilgrim mental well-being.