Mental Health Outcomes Among Palestinian Women in the Context of Community Violence: The Moderating Roles of Perceived Social Support and Self-Efficacy

Background and purpose: The exposure to community violence has become a major public health concern due to its negative impacts on their well-being. Despite the growing body of knowledge in the field of community violence as a public health concern, less attention has been given to the impact of exposure to community violence (ECV) on women's mental health (MH) outcomes. The main objective of this study is to investigate the association between ECV and MH outcomes (depression, anxiety and psychological distress) among a sample of Palestinian women, and to explore the moderating role that perceived self-efficacy (PSE) and perceived social support (PSS) have on the association between ECV and MH.

Method: The study was conducted on a sample of 377 Palestinian women (aged 28 and 60); (M = 40.2; SD = 9.96). Data were collected through an online snowball sampling method by using different social media platforms, including Facebook and WhatsApp groups, to distribute the questionnaire of the study via a link shared among Palestinian women who reside in Israel. Participants were asked to participate in the study by completing an online anonymous structured self-administered questionnaire using Qualtrics software via their phones or computers.

Findings: Confirming our hypothesis, the findings of the study indicate that overall ECV (direct and indirect ECV) was positively and significantly associated with overall poor MH outcomes (r = .380, P <.000); thus, the more women reported being exposed to violent incidents in their community, the more they reported poor MH, including depression, anxiety and stress, respectively (r = .298; P <.000; r = .373, P <.000; r = .351, P <.000). The findings demonstrate that the association between ECV and poor MH was stronger among women who reported lower levels of PSS. In other words, PSS was a significant moderator of the association between ECV and MH outcomes, while PSE, in contrast, was not found to be a significant moderator of this association. The results were significant after controlling for the women's age, SES, level of education and marital status.

Conclusion and implications of the study: In light of the findings of the study, there is an urgent need to deploy effective strategies and policies aimed to protect women against community violence. This is particularly true of women from ethnic minority groups, who are at risk of suffering from multiple socio-economic adversities, which exacerbates their psychological vulnerability and increases the mental health costs associated with community violence. It is also vital to develop group interventions to enhance social support among women who are exposed to community violence, whether directly and/or indirectly, and to help them establish and strengthen their social relationships. Promoting social support spaces for women will contribute positively to their emotional empowerment and to their ability to better cope with their exposure to traumatic incidents of violence in their immediate surroundings. Community-based interventions that support the enhancement of various dimensions of social support in the lives of Palestinian women could help mitigate their psychological burden in this context.