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

Abstract

There is a well-established body of knowledge on the impact of community violence exposure (ECV) on mental health (MH). Yet little is known about the protective role of individual and social factors on this association, particularly among women in ethnic minority groups. This cross-sectional study aims to fill this void by investigating the moderating roles of perceived self-efficacy and perceived social support on the association between ECV and poor MH among a sample of 377 Palestinian women. The findings indicate that ECV is a significant environmental risk factor for developing poor MH outcomes. However, enhancing social support spaces helps women to cope better in this context.

Keywords

mental health women community violence social support

Get full access to this article

View all access options for this article.

References

Abi-Habib

Kheir

Yaktine

Maouch

M. E.

Tohme

(2025). The psychological outcomes of direct and indirect exposure to trauma: The Lebanese experience. Psychiatric Quarterly, 1, 1–16. https://doi.org/10.1007/s11126-025-10149-3

Abraham Initiatives. (2023). Crime and violence in Arab society: Mid-year monitoring report. Available at: https://abrahaminitiatives.org/crime-and-violance-in-the-arab-society-2023-mid-year-monitoringreport.

Abu-Kaf

Braun-Lewensohn

(2015). Paths to depression among two different cultural contexts. Journal of Cross-Cultural Psychology, 46(4), 612–630. https://doi.org/10.1177/0022022115575738

Ali-Saleh Darawshy

(2024). The correlation between exposure to violence and parental monitoring: Differences between mothers and fathers from Palestinian–Israeli families. Child & Family Social Work, 30(4), 657–668. https://doi.org/10.1111/cfs.13211

Ali-Saleh Darawshy

(2025). Experiences and challenges of Arab social workers in Israel with community violence. International Social Work, 68(4), 667–680. https://doi.org/10.1177/00208728251331792

Ali-Saleh Darawshy

Haj-Yahia

M. M.

(2018a). Self-efficacy and collective efficacy as moderators of the psychological consequences of exposure of Palestinian parents in Israel to community violence. International Journal of Offender Therapy and Comparative Criminology, 62(13), 4236–4256. https://doi.org/10.1177/0306624X18757616

Ali-Saleh Darawshy

N. A. S.

Haj-Yahia

M. M.

(2018b). Internalizing and externalizing symptoms among Palestinian adolescents from Israel as consequences of their exposure to community violence: Are they moderated by their self-efficacy and collective efficacy? Child Abuse & Neglect, 79(1), 61–73. https://doi.org/10.1016/j.chiabu.2018.01.021

Altman

C. E.

Gorman

B. K.

Chávez

(2018). Exposure to violence, coping strategies, and diagnosed mental health problems among adults in a migrant-sending community in central Mexico. Population Research and Policy Review, 37(1), 229–260. https://doi.org/10.1007/s11113-018-9460-x

Assari

Lankarani

(2018). Violence exposure and mental health of college students in the United States. Behavioral Sciences, 8, (53), 1–14. https://doi.org/10.3390/bs8060053

10.

Bandura

(1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191–215.

11.

Bandura

Wessels

(1997). Self-efficacy (pp. 4-6). Cambridge University Press.

12.

Barcelona de Mendoza

Harville

E. W.

Savage

Giarratano

(2018). Experiences of intimate partner and neighborhood violence and their association with mental health in pregnant women. Journal of Interpersonal Violence, 33(6), 938–959. https://doi.org 10.1177/0886260515613346https://doi.org/10.1177/0886260515613346

13.

Benight

C. C.

Bandura

(2004). Social cognitive theory of posttraumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42(1), 1129–1148. https://doi.org/10.1016/j.brat.2003.08.008

14.

Bentes

Comini César

Coelho

Teixeira

Proietti

F. A.

(2017). Self-rated health and perceived violence in the neighborhood is heterogeneous between young women and men. BMC Public Health, 17(2), 1–9. https://doi.org 10.1186/s12889-017-4969-1

15.

Blackburn

Owens

G. P.

(2015). The effect of self-efficacy and meaning in life on posttraumatic stress disorder and depression severity among veterans. Journal of Clinical Psychology, 71(10), 219–228. https://doi.org/10.1002/jclp.22133

16.

Chen

W. Y.

Corvo

Lee

Hahm

H. C.

(2017). Longitudinal trajectory of adolescent exposure to community violence and depressive symptoms among adolescents and young adults: Understanding the effect of mental health service usage. Community Mental Health Journal, 53(1), 39–52. https://doi.org/10.1007/s10597-016-0031-5

17.

Cohen-Cline

Beresford

S. A.

Barrington

Matsueda

Wakefield

Duncan

G. E.

(2018). Associations between social capital and depression: A study of adult twins. Health & Place, 50(1), 162–167. https://https://doi.org/10.1016/j.healthplace.2018.02.002

18.

Corno

Villani

de Montigny

Pierce

Bouchard

Molgora

(2023). The role of perceived social support on pregnant women’s mental health during the COVID-19 pandemic. Journal of Reproductive and Infant Psychology, 41(5), 488–502. https://doi.org/10.1080/02646838.2022.2042799

19.

Crapolicchio

Vezzali

Regalia

(2021). I forgive myself”: The association between self-criticism, self-acceptance, and PTSD in women victims of IPV, and the buffering role of self-efficacy. Journal of Community Psychology, 49(2), 252–265. https://doi 10.1002/jcop.22454 https://doi.org/10.1002/jcop.22454

20.

Dahlberg

L. L.

Krug

E. G.

(2006). Violence: A global public health problem. Ciência & Saúde Coletiva, 11(1), 277–292. https://doi.org/10.1590/S1413-81232006000200007

21.

Daoud

Alfayumi-Zeadna

Tur-Sinai

Geraisy

Talmud

(2020). Residential segregation, neighborhood violence and disorder, and inequalities in anxiety among Jewish and Palestinian-arab perinatal women in Israel. International Journal for Equity in Health, 19(1), 21. https://doi.org/10.1186/s12939-020-01339-5

22.

Daoud

Gao

Osman

Muntaner

(2018). Interpersonal and institutional ethnic discrimination, and mental health in a random sample of Palestinian minority men smokers in Israel. Social Psychiatry and Psychiatric Epidemiology, 53(10), 1111–1122. https://doi.org/10.1007/s00127-018-1531-0

23.

Daoud

Sergienko

O'campo

Shoham-Vardi

(2017). Disorganization theory, neighborhood social capital, and ethnic inequalities in intimate partner violence between Arab and Jewish women citizens of Israel. Journal of Urban Health, 94(5), 648–665. https://doi.org/10.1007/s11524-017-0196-4

24.

Epstein-Ngo

Maurizi

L. K.

Bregman

Ceballo

(2013). In response to community violence: Coping strategies and involuntary stress responses among Latino adolescents. Cultural Diversity & Ethnic Minority Psychology, 19(1), 38. https://doi.org/10.1037/a0029753

25.

Fiori

K. L.

Denckla

C. A.

(2012). Social support and mental health in middle-aged men and women: A multidimensional approach. Journal of Aging and Health, 24(3), 407–438. https://doi.org/10.1177/0898264311425087

26.

Folkman

Lazarus

R. S.

Dunkel-Schetter

DeLongis

Gruen

R. J.

(1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(1), 992–1003. https://doi.org/10.1037/0022-3514.50.5.992

27.

Fowler

P. J.

Tompsett

C. J.

Braciszewski

J. M.

Jacques-Tiura

A. J.

Baltes

B. B.

(2009). Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Development and Psychopathology, 21(1), 227–259. https://https://doi.org/10.1017/S0954579409000145

28.

Gallagher

M. W.

Long

L. J.

Phillips

C. A.

(2020). Hope, optimism, self-efficacy, and posttraumatic stress disorder: A meta-analytic review of the protective effects of positive expectancies. Journal of Clinical Psychology, 76(3), 329–355. https://doi.org/10.1002/jclp.22882

29.

Gharrah

(2015). Arab society in Israel: Population, society, economy. Van Leer Institute.

30.

Guterman

N. B.

Cameron

Staller

(2000). Definitional and measurement issues in the study of community violence among children and youths. Journal of Community Psychology, 28(6), 571–587. https://doi.org/10.1002/1520-6629(200011)28:6<571::AID-JCOP3>3.0.CO;2-Q

31.

Haden

S. C.

Scarpa

(2008). Community violence victimization and depressed mood: The moderating effects of coping and social support. Journal of Interpersonal Violence, 23(9), 1213–1234. https://doi.org/10.1177/0886260508314297

32.

Haj-Yahia

M. M.

Leshem

Guterman

(2011). Exposure to community violence among Arab youth in Israel: Rates and characteristics. Journal of Community Psychology, 39(2), 136–151. https://doi.org/10.1002/jcop.20423

33.

Haj-Yahia

M. M.

Leshem

Guterman

N. B.

(2021). The relationship between exposure of Palestinian youth to community violence and internalizing and externalizing symptoms: Do gender and social support matter? Child Abuse & Neglect, 112(1), 104906. https://doi.org/10.1016/j.chiabu.2020.104906

34.

Hammack

P. L.

(2010). Narrative and the politics of identity: The cultural psychology of Israeli and Palestinian youth. Oxford University Press.

35.

Harandi

T. F.

Taghinasab

M. M.

Nayeri

T. D.

(2017). The correlation of social support with mental health: A meta-analysis. Electronic Physician, 9(9), 5212–5222. https://doi.org/10.19082/5212

36.

Hobfoll

S. E.

(1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513. https://doi.org/10.1037/0003-066X.44.3.513

37.

House

J. S.

Umberson

Landis

K. R.

(1988). Structures and processes of social support. Annual Review of Sociology, 14(1), 293–318. https://doi.org/10.1146/annurev.so.14.080188.001453

38.

Howell

D. M.

Metcalfe

Kong

Stephen

Olivotto

I. A.

Baxter

Quan

M. L.

(2022). Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: A national multicentre cohort study. Breast Cancer Research and Treatment, 194(1), 91–102. https://doi.org/10.1007/s10549-022-06576-6

39.

Huang

King

McAtee

(2018). Exposure to violence, neighborhood context, and health-related outcomes in low-income urban mothers. Health & Place, 54(1), 138–148. https://doi.org/10.1016/j.healthplace.2018.09.008

40.

Israel Bureau of Statistics. (2019). Israel in numbers: On its 70th anniversary (Hebrew).

41.

Jabareen

Y. T.

(2021). Linguistic rights for minorities and the quest for equality: The case of Arab-Palestinians in Israel. U. Pa. JL & Soc. Change, 25(1), 259.

42.

Jocson

R. M.

Alers-Rojas

Ceballo

Cranford

J. A.

(2022, October). Examining mothers’ exposure to community violence: How does it influence young adolescents? In Child & youth care forum (pp. 1–18). Springer.

43.

Jocson

R. M.

Alers-Rojas

Ceballo

Cranford

J. A.

(2022). Examining mothers’ exposure to community violence: How does it influence young adolescents? Child & Youth Care Forum (pp. 1–18). Springer.

44.

Johnson

S. L.

Solomon

B. S.

Shields

W. C.

McDonald

E. M.

McKenzie

L. B.

Gielen

A. C.

(2009). Neighborhood violence and its association with mothers’ health: Assessing the relative importance of perceived safety and exposure to violence. Journal of Urban Health, 86(4), 538–550. https://doi.org/10.1007/s11524-009-9345-8

45.

Kaynak

Lepore

S. J.

Kliewer

W. L.

(2011). Social support and social constraints moderate the relation between community violence exposure and depressive symptoms in an urban adolescent sample. Journal of Social and Clinical Psychology, 30(3), 250–269. https://doi.org/10.1521/jscp.2011.30.3.250

46.

Khatib

Abo-Rass

(2022). Mental health literacy among Arab university students in Israel: A qualitative study. International Journal of Social Psychiatry, 68(7), 1486–1493. https://doi.org/10.1177/00207640211036167

47.

Khazaeian

Kariman

Ebadi

Nasiri

(2017). The impact of social capital and social support on the health of female-headed households: A systematic review. Electronic Physician, 9(12), 6027. https://doi.org/10.19082/6027

48.

Krug

E. G.

Mercy

J. A.

Dahlberg

L. L.

Zwi

A. B.

(2002). The world report on violence and health. The Lancet, 360(9339), 1083–1088. https://doi.org/10.1016/S0140-6736(02)11133-0

49.

Lazarus

R. S.

Folkman

(1984). Stress, Appraisal, and Coping. Springer publishing company.

50.

Lee

J. S.

(2019). Perceived social support functions as a resilience in buffering the impact of trauma exposure on PTSD symptoms via intrusive rumination and entrapment in firefighters. PloS one, 14(8), e0220454. https://doi.org/10.1371/journal.pone.0220454

51.

Leibbrand

Rivara

Rowhani-Rahbar

(2021). Gun violence exposure and experiences of depression among mothers. Prevention Science, 22(4), 523–533. https://doi.org/10.1007/s11121-020-01202-7

52.

Leibbrand

Rivara

Rowhani-Rahbar

(2021). Gun violence exposure and experiences of depression among mothers. Prevention Science, 22(4), 523–533. https://doi.org/10.1007/s11121-020-01202-7

53.

Leshem

Haj-Yahia

M. M.

Guterman

N. B.

(2015). The characteristics of help seeking among Palestinian adolescents following exposure to community violence. Children and Youth Services Review, 49(1), 1–10. https://doi.org/10.1016/j.childyouth.2014.12.022

54.

Lin

(1986). Conceptualizing social support. In Lin

Dean

Ensel

W. M.

(Eds.), Social support, life events, and depression (pp. 17–30). Academic Press.

55.

Lopes

C. S.

Moraes

C. L.

Junger

W. L.

Werneck

G. L.

Ponce de Leon

A. C.

Faerstein

(2015). Direct and indirect exposure to violence and psychological distress among civil servants in Rio de Janeiro, Brazil: A prospective cohort study. BMC Psychiatry, 15(1), 109. https://doi.org/10.1186/s12888-015-0487-9

56.

Lovibond

P. F.

Lovibond

S. H.

(1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. https://doi.org/10.1016/0005-7967(94)00075-U

57.

Luszczynska

Benight

C. C.

Cieslak

(2009). Self-efficacy and health-related outcomes of collective trauma: A systematic review. European Psychologist, 14(1), 51–62. https://doi.org/10.1027/1016-9040.14.1.51

58.

Massarwi

A. A.

Khoury-Kassabri

(2016). Serious physical violence among Arab-Palestinian adolescents: The role of exposure to neighborhood violence, perceived ethnic discrimination, normative beliefs, and parental communication. Child Abuse & Neglect, 63, 233–244. https://doi.org/10.1016/j.chiabu.2016.11.002

59.

Miliauskas

C. R.

Faus

D. P.

da Cruz

V. L.

do Nascimento Vallaperde

J. G. R.

Junger

Lopes

C. S.

(2022). Community violence and internalizing mental health symptoms in adolescents: A systematic review. BMC Psychiatry, 22(253), 1–23. https://doi.org/10.1186/s12888-022-03873-8

60.

Mitchell

K. J.

Jones

L. M.

Turner

H. A.

Beseler

C. L.

Hamby

Wade Jr

(2021). Understanding the impact of seeing gun violence and hearing gunshots in public places: Findings from the Youth Firearm Risk and Safety Study. Journal of Interpersonal Violence, 36(17-18), 8835–8851. https://doi.org/10.1177/0886260519853393

61.

Motley

Sewell

Chen

Y. C.

(2017). Community violence exposure and risk-taking behaviors among black emerging adults: A systematic review. Journal of Community Health, 42(5), 1069–1078. https://https://doi.org/10.1007/s10900-017-0353-4

62.

Nagar

Shani

Poria

(2022). “You feel like a second-class guest”: Customer discrimination against arab guests in Israeli hotels. International Journal of Hospitality Management, 103(103216), 1–9. https://doi.org/10.1016/j.ijhm.2022.103216

63.

Pearlin

L. I.

Menaghan

E. G.

Lieberman

M. A.

Mullan

J. T.

(1981). The stress process. Journal of Health and Social Behavior1(1), 337–356. https://doi.org/10.2307/2136676

64.

Pickover

A. M.

Bhimji

Sun

Evans

Allbaugh

L. J.

Dunn

S. E.

Kaslow

N. J.

(2021). Neighborhood disorder, social support, and outcomes among violence-exposed African American women. Journal of Interpersonal Violence, 36(7-8), NP3716–NP3737. https://https://doi.org/10.1177/0886260518779599

65.

Preacher

K. J.

Hayes

A. F.

(2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. https://https://doi.org/10.3758/BRM.40.3.879

66.

Qadir

Khalid

Haqqani

Medhin

(2013). The association of marital relationship and perceived social support with mental health of women in Pakistan. BMC Public Health, 13(1), 1–13. https://doi.org/10.1186/1471-2458-13-1150

67.

Liu

Meng

Zhao

(2022). Effects of family relationship and social support on the mental health of Chinese postpartum women. BMC Pregnancy and Childbirth, 22(65), 1–10. https://doi.org/10.1186/s12884-022-04392-w

68.

Raman

Bonanno

P. A.

Sachdev

Govindan

Dhole

Salako

Kennedy

C. A.

(2021). Community violence, PTSD, hopelessness, substance use, and perpetuation of violence in an urban environment. Community Mental Health Journal, 57(4), 622–630. https://doi.org/10.1007/s10597-020-00691-8

69.

Scarpa

(2003). Community violence exposure in young adults. Trauma, Violence & Abuse, 4(3), 210–227. https://doi.org/10.1177/1524838003004003002

70.

Schlechter

Hellmann

J. H.

Morina

(2023). Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees. European Journal of Psychotraumatology, 14(1), 2180707. https://doi.org/10.1080/20008066.2023.2180707

71.

Selner-O'Hagan

M. B.

Kindlon

D. J.

Buka

S. L.

Raudenbush

S. W.

Earls

F. J.

(1998). Assessing exposure to violence in urban youth. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 39(2), 215–224. https://https://doi.org/10.1017/S002196309700187X

72.

Shahriar

A. Z. M.

Shepherd

D. A.

(2019). Violence against women and new venture initiation with microcredit: Self-efficacy, fear of failure, and disaster experiences. Journal of Business Venturing, 34(6), 105945. https://doi.org/10.1016/j.jbusvent.2019.06.006

73.

Sherbourne

C. D.

Stewart

A. L.

(1991). The MOS social support survey. Social Science & Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-B

74.

Sherer

Maddux

J. E.

Mercandante

Prentice-Dunn

Jacobs

Rogers

R. W.

(1982). The self-efficacy scale: Construction and validation. Psychological Reports, 51(2), 663–667. https://doi.org/10.2466/pr0.1982.51.2.663

75.

Smith

A. J.

Abeyta

A. A.

Hughes

Jones

R. T.

(2015). Persistent grief in the aftermath of mass violence: The predictive roles of post-traumatic stress symptoms, self-efficacy, and disrupted worldview. Psychological Trauma: Theory, Research, Practice, and Policy, 7(2), 179–186. https://doi.org/10.1037/tra0000002

76.

Smith

A. J.

Felix

E. D.

Benight

C. C.

Jones

R. T.

(2017). Protective factors, coping appraisals, and social barriers predict mental health following community violence: A prospective test of social cognitive theory. Journal of Traumatic Stress, 30(3), 245–253. https://https://doi.org/10.1002/jts.22197

77.

Southwick

S. M.

Sippel

Krystal

J. H.

Charney

D. S.

Mayes

L. C.

Pietrzak

R. H.

(2016). Why are some individuals more resilient than others: The role of social support. World Psychiatry, 15(1), 77–79. https://doi.org/10.1002/wps.20282

78.

Sui

Massar

Ruiter

R. A.

Reddy

P. S.

(2020). Violence typologies and sociodemographic correlates in South African adolescents: A three-wave cross-sectional study. BMC Public Health, 20(1), 221. https://doi.org/10.1186/s12889-020-8332-6

79.

Taylor

S. E.

Friedman

H. S.

(2007). Social support. Foundations of Health Psychology1(1), 145–171. https://https://doi.org/10.1558/jsrnc.v1i2.145

80.

Triandis

H. C.

Chan

D. K. S.

Bhawuk

D. P.

Iwao

Sinha

J. B.

(1995). Multimethod probes of allocentrism and idiocentrism. International Journal of Psychology, 30(4), 461–480. https://doi.org/10.1080/00207599508246580

81.

Wamser-Nanney

Walker

H. E.

Howell

K. H.

(2023). Types of community violence exposure and clinical outcomes: Evidence of differing associations among emerging adults. Psychological Trauma: Theory, Research, Practice, and Policy, 15(S1), S112. https://doi.org/10.1037/tra0001449

82.

Webermann

A. R.

Dardis

C. M.

Iverson

K. M.

(2022). The role of general self-efficacy in intimate partner violence and symptoms of posttraumatic stress disorder among women veterans. Journal of Traumatic Stress, 35(3), 868–878. https://doi.org/10.1002/jts.22794

83.

Yang

Y. C.

Schorpp

Harris

K. M.

(2014). Social support, social strain and inflammation: Evidence from a national longitudinal study of US adults. Social Science & Medicine, 107(1), 124–135. https://https://doi.org/10.1016/j.socscimed.2014.02.013

84.

Yimgang

D. P.

Wang

Paik

Hager

E. R.

Black

M. M.

(2017). Civil unrest in the context of chronic community violence: Impact on maternal depressive symptoms. American Journal of Public Health, 107(9), 1455–1462. https://https://doi.org/10.2105/AJPH.2017.303876

85.

Zimmerman

G. M.

Posick

(2016). Risk factors for and behavioral consequences of direct versus indirect exposure to violence. American Journal of Public Health, 106(1), 178–188. httpikbs://https://doi.org/10.2105/AJPH.2015.302920