Does socioeconomic status moderate the association between political violence exposure and mental health in the occupied Palestinian territories?

Background/Purpose: SES is a major determinant of mental health. Although this main effect is well-established, still not known is whether SES can also buffer the negative effects of exposure to political violence on mental health. Answering this question is central to improve both our understanding of social determinants of health and applied public health programming. This paper explores this question in the occupied Palestinian territories, employing multiple measures of SES and mental health.

Methods: This paper utilized cross-sectional data collected in 2011 from a representative sample of 508 individuals ages 30-40 in the West Bank, Gaza, and East Jerusalem. Outcomes included depression, trauma-related stress, and “feeling broken or destroyed” (a locally-derived measure of emotional well-being). Five measures of current and early-life SES include education, resource adequacy, and perceptions of relative socio-economic position. Political violence exposure (PVE) was measured with five items: being hit/kicked, shot at, and verbally abused; seeing a close friend or family member humiliated; and having one’s home raided. In OLS regression models, interaction terms (SES by PVE) examine whether the effects of political violence on mental health varied by SES.

Results: All three outcomes were predicted by current but not past SES. Only trauma-related stress was predicted by PVE (hit/kicked: β = .073, p < .05; verbally abused: β = .075, p < .005; home raided: β = .074, p < .001). In 39 tests of moderation, only four interaction terms were statistically significant, with no discernible pattern.

Implications: These findings suggest that SES has direct and powerful effects on mental health but that it does not buffer against the effect of political violence exposure on trauma-related stress.