The Palestinian minority in Israel has endured sociopolitical stressors (e.g., ethnonational racism, discrimination, oppression, and political violence) throughout the decades, which have adverse psychological and behavioral outcomes. In this study, we examine the association between interpersonal racism (IPR) among Palestinian parents in Israel and their child neglect, the mediating role of psychological distress on this relationship, and the moderating role of perceived social support (PSS) on the mediated effect of psychological distress on this relationship. A systematic sample of 770 parents (500 mothers and 270 fathers) aged 21–66 was recruited to fill out a self-administered questionnaire composed of several instruments. The results indicate that parents’ IPR experiences are associated with an increased risk of child neglect, and this relationship is mediated by psychological distress. Results also show that in low or medium levels of PSS, psychological distress reports in relation to racism exposure are the highest. Yet, surprisingly, this effect strengthens at high levels of PSS. In comparison, the positive effect of psychological distress on child neglect strengthens in lower levels of PSS, showing a protective role of PSS. Finally, PSS moderates the mediation model’s indirect effect; IPR is related to increased psychological distress, and in turn, to a greater risk of child neglect when perceiving low or medium levels of social support. The study underlines the negative consequences of IPR on child neglect and contributes new knowledge to the literature. Longitudinal research is needed to confirm and extend these findings, which could have important clinical implications for treating parents facing racism and potential child neglect.
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Introduction
Palestinian-Arab citizens of Israel are native-born individuals who lived under military administration for many years following the establishment of the Israeli state in 1948. This had a major impact on their economic development and hindered their political and social integration (e.g., residential segregation, financial limitation, social exclusion, and inadequate infrastructure; Okun & Friedlander, 2005). Palestinians in Israel, also known as Arab citizens of Israel, are an ethnonational minority group who constitute about 20% of Israel’s population. This group has historically experienced ethnonational racism, exclusion, and discrimination across key domains, including housing, employment, the justice system, education, welfare, and health services (Abu-Saad, 2004; Daoud et al., 2018; Herzog, 2006). They are treated as a marginalized group with limited participation in the Israeli economy and political decision-making (Ghanem & Khatib, 2019). They suffer from both formal and informal discrimination in the labor market, whereas Jews are over-represented in higher-status occupations. Due to this, Palestinian-Arabs have been subjected to poor outcomes in education and socioeconomic status compared to Jews (Okun & Friedlander, 2005). Additionally, child maltreatment rates in Israel, including child neglect, were found to be higher among Palestinians than among Jews (Ben-Natan et al., 2013; Lev-Wiesel et al, 2018).
In recent years, there has been a concerted effort in Israel to undermine the rights and status of Palestinian citizens. This has manifested in discriminatory actions and policies on the ground, as well as in governmental statements and legislation, such as the 2018-nation-state-law, which increased discrimination and racism against them (Ghanem & Khatib, 2019). These experiences include devaluation and lack of control which represent threats to mental health and well-being (Schmitt et al., 2014). Further, the experience of ethnicity- and race-related stress resulting from racism, microaggressions, and discrimination can devastatingly affect interpersonal relations and the functioning of the family, such as parenting and parent-child relations (Sanders-Phillips, 2009). Research has shown that mothers’ experiences of discrimination are directly related to greater psychological distress (e.g., depression and anxiety), but also indirectly related to negative parenting and low quality of the parent-child bond, via mothers’ psychological functioning (Murry et al., 2022). Experience with and responses to racism and discrimination may harm parenting and children’s well-being, by limiting the parents’ ability to provide optimal care, treatment, and support to promote their children’s development, leading to child maltreatment (Bécares et al., 2015; Caughy et al., 2004; Sanders-Phillips, 2009; Shonkoff et al., 2021).
Based on Lazarus and Folkman’s (1984) Stress and Coping Theory, coping with stress, including racism-related stress, entails the interplay between an individual and their environment, as well as the efforts they make to manage the demands of a stressful situation. Stress is experienced when the demands exceed the individual’s capacity to cope. This theory identifies certain factors (including seeking and receiving social support) that may serve as moderators of stressors and subsequent outcomes. Social support plays a prominent role in improving individuals’ mental health and behavioral performance. Research has demonstrated that social support can protect against depressive symptoms and psychological distress, particularly in minority populations facing discrimination (Seawell et al., 2014; Steers et al., 2019). However, the existing research on social support as a protective factor against racism is limited and inconsistent. In addition, there is a dearth of empirical studies examining the mechanism by which racism relates to child neglect. Therefore, this study aims to address these gaps in the literature by examining the role of psychological distress and social support in this process.
Interpersonal Racism (IPR)
Racism is defined as a form of oppression based on racial or ethnic classifications and systems of domination that designate one group as superior and the other group(s) as inferior. Such classification creates inequity, exclusion, or domination (Bulhan, 1985). According to Bulhan, oppression is a form of violence involving interpersonal, institutional, and structural violence. The violence of racism may be internalized and turned against the self and others of one’s oppressed group (Bulhan, 1985). This definition demonstrates a possible conceptual link between ethnonational racism and potential mental health and behavioral effects.
IPR is experienced or perceived in discriminatory interactions between individuals in their institutional roles or public and private spheres (Krieger, 1999). Interpersonal stressors (e.g., IPR and discrimination) are associated with psychopathology, such as depressive symptoms and anxiety. Such stressors may contribute to developing discrimination-related schemas (e.g., concerns about being abandoned or rejected by others, mistrust of others, and vulnerability to harm), which are linked to psychopathology (Mikrut et al., 2022). Thus, they may affect the individual’s interpersonal functioning, including the parent-child bonds.
Perceived discrimination has adverse outcomes on psychological well-being, depressive symptoms, and psychiatric distress for women and men across ethnicities. The consequences of discrimination and racism, which include rejection and exclusion from positions of power, can go beyond the consequences of the negative treatment itself. It can harm the person’s social place and threaten their self-concept (Schmitt et al., 2014). Several studies, including those conducted among Palestinians in Israel, have supported the well-established correlation between experiencing national/ethnic racism and psychological distress, including depression and anxiety (Daoud et al., 2018; Mikrut et al., 2022; Mossakowski & Zhang, 2014; Schmitt et al., 2014). Researchers have suggested that the effects of racism and discrimination go beyond the direct recipient and may influence the people surrounding the victim, such as friends and family (Brondolo et al., 2009). Other works have shown that discrimination and racism affect parental depression, parenting, and child development (Anderson et al., 2015; Bécares et al., 2015; Caughy et al., 2004; Sanders-Phillips, 2009).
Child Neglect
Child neglect is defined as the caregiver’s failure to provide supervision and care for a child’s development in fields of health, education, emotional development, nutrition, shelter, and safe living conditions despite the caregiver having the ability and resources to do so. Child neglect also occurs when a caregiver causes harm or has a high probability of causing harm to the child’s health or physical, mental, spiritual, moral, or social development (World Health Organization, [WHO], 1999). A study found that neglect was higher among the Palestinian population in Israel at 84% than among the Jewish population at 16% (Ben-Natan et al. 2013). Palestinian children in Israel, compared to their Jewish counterparts, reported higher rates of child maltreatment, including physical and emotional neglect (Lev-Wiesel et al., 2018). The authors suggest that the Palestinian population in Israel has less access to social and welfare services as they tend to live in segregated areas, far from the center of Israel, while others have pointed out the discrimination in providing services (Abu-Saad, 2004; Daoud et al., 2018). Racist and discriminatory policies and practices have been associated with poor child health and development. These policies limit access to education, employment, healthcare, and housing, which can perpetuate economic disparities and poverty rates. As a result, persistent health and social inequalities among ethnic groups can be created (Bécares et al., 2015), increasing the risk of child neglect. Scholars (e.g., Slack et al., 2011) have discussed the link between poverty and neglect. They argue that poverty can impact parents’ ability to provide basic necessities for their children, which can be interpreted as neglectful behavior. However, it’s essential to recognize that being a low-income family does not necessarily reflect neglectful parenting. Slack et al. (2011) reviewed several risk factors for child neglect, including parental education and employment status (which were controlled for in this study), income and poverty, parents’ mental health and substance abuse, domestic violence, and social support. Shalhoub-Kevorkian (2005) posited that child maltreatment and protection are generally investigated and discussed from a personal pathology framework rather than considering the sociopolitical context and inferiority-oppression frameworks. Ignoring the social and political factors increases inequality among societies in Israel and disregards potential resources in a child’s family that may help reduce child abuse (Shalhoub-Kevorkian, 2005). Sociopolitical risk factors (e.g., ethnonational racism), have not yet been adequately investigated in relation to child neglect in Israel.
Parental Psychological Distress as a Risk Factor for Child Neglect
Raising a mentally and physically healthy child with affection and consistency might be difficult for parents dealing with their own mental health risk factors. Parenting might be challenging for those affiliated with ethnic or racial minority groups, given that they are exposed to both daily hassles and sociopolitical stressors, such as racism, microaggression, and discrimination (Anderson et al., 2015). The growing research in this field has indicated a positive relationship between such stressors and psychological distress (Daoud et al., 2018; Mossakowski & Zhang, 2014; Murry et al., 2022; Schmitt et al., 2014), which in turn, was found related to child maltreatment (Murry et al., 2022).
Some researchers have suggested that parental psychological distress plays a critical role in the parents’ risk of child neglect (Errázuriz Arellano et al., 2012; Lee et al., 2012; Venta et al., 2016). For example, parental depressive symptoms were correlated with dysfunctional discipline, including laxness, overreactivity, less warmth, and hostility (Errázuriz Arellano et al., 2012; Venta et al., 2016). Increased parental stress affected this correlation (Venta et al., 2016). Lee et al. (2012) have argued that parenting stress and depression disturb the parent’s ability to supervise, monitor, and positively interact with children. They also suggested that depression increases the risk of the parent’s rejection of the child, which correlates with child neglect, in addition to unhealthy behaviors such as alcohol abuse.
Perceived Social Support as a Stress Buffer
Perceived social support (PSS) refers to an individual’s feeling of respect, support, understanding, and satisfaction in society and to the belief that others (e.g., parents, teachers, friends) would provide help when needed (Klasen et al., 2010). Social support was found to enhance mental health and behavioral performance. It protects against depressive symptoms and psychological distress, especially among minority populations experiencing racism and discrimination (Seawell et al., 2014; Steers et al., 2019). According to Lazarus and Folkman (1984), coping with stress, with the help of social support from family and friends, involves reevaluating the stressor and its meaning to minimize the threat or the significance of the stress to the individual’s well-being and thus decrease distress.
The Palestinian family and society in Israel have strengths characterized by social solidarity and collective psychological and instrumental support from family, neighbors, and friends (Shalhoub-Kevorkian, 2005). The interconnectedness that characterizes collective cultures, such as the Arab Palestinian one, enables individuals to use social support as a resilience factor when facing racism (Odafe et al., 2017; Osman et al., 2018; Steers et al., 2019). Supportive social networks help by promoting a sense of security and connectedness, reinforcing the understanding that racism is a collective experience, and providing guidance and advice for coping with racism. Lastly, social support enhances participation in social activities as a distraction and a positive experience that may mitigate the negative effects of racism (Brondolo et al., 2009).
The existing research on social support as a protective factor against racism is limited, and its results are inconsistent. For example, certain aspects of social support have a protective function against race-related stress, whereas some aspects do not (Odafe et al., 2017). Tailored social support to cope with racial discrimination (rather than general support) has been shown to reduce depressive symptoms over time (Seawell et al., 2014), while perceived emotional support from family for a severe problem buffers the stress of high levels of everyday discrimination. However, neither perceived nor received social support from friends provides a buffer from the stress of any level of discrimination (Mossakowski & Zhang, 2014). Similarly, Ajrouch et al. (2010) found that instrumental social support somehow protects against the impact of everyday discrimination on a person’s psychological distress, whereas emotional social support does not. They indicated that instrumental support offered protection among those who perceived moderate levels of everyday discrimination, but its effect was minimal among those perceiving excessive everyday discrimination. Similarly, Brondolo et al. (2009) suggested that seeking social support may be helpful with low levels of racism exposure but exacerbates difficulties at high levels of racism exposure.
Conversely, other researchers have not found any evidence that social support protects a person against racism and discrimination’s harmful effects (Prelow et al., 2006). In their review, Schmitt et al. (2014) found that the majority of studies (77%) on social support—whether perceived or received from friends, family, and others—did not reveal a significant moderating effect on the relationship between racism and well-being. Furthermore, the significant effects of social support on these relationships showed similar evidence for buffering and exacerbating effects. Similarly, Brondolo et al. (2009) also observed that some studies did not find positive buffering effects of seeking social support in terms of addressing the relationship between racism and distress. Some of these studies, however, found that social support had an effect on alleviating symptoms of depression.
Notably, studies of racism, its consequences on mental health, parental functioning, and possible buffers such as social support have implications for clinical interventions and public health awareness intended to reduce racism and mitigate its adverse effects on the personal and familial context.
Research Objectives
Considering the relationship between parental mental health, parenting styles, and child development, and the influence of sociopolitical stressors on parental functioning (Bécares et al., 2015; Caughy et al., 2004; Sanders-Phillips, 2009; Shonkoff et al., 2021), the primary objective of this study was to examine how the interpersonal experiences of Palestinian parents with ethnonational racism and psychological distress are related to child neglect. A second objective of this study was to evaluate this process (i.e., by which IPR is associated with child neglect) by examining psychological distress and PSS as possible mediators and moderators in a moderated mediation model (see Fig. 1).
Fig. 1
The Proposed Model. Figure 1 depicts a moderated mediation model of the relationship between interpersonal racism and child neglect through psychological distress and perceived social support (Andrew Hayes’s moderation-mediation Model 59). Notes: a, the effect of interpersonal racism on psychological distress; b, the effect of psychological distress on child neglect; c’, the direct effect of interpersonal racism on child neglect
×
The Study’s Hypotheses
The hypotheses of this study were as follows:
1.
Increased experiences of Palestinian parents with IPR and psychological distress will be associated with greater rates of child neglect.
2.
Psychological distress among Palestinian parents will mediate the relationship between their experience of IPR and neglecting their children. More specifically, experiencing IPR will be associated with increased levels of psychological distress, which in turn will be associated with greater rates of child neglect.
3.
PSS will moderate the mediating effect of psychological distress in the relationship between IPR and child neglect, including PSS will mitigate (a) the effect of IPR on psychological distress, (b) the effect of psychological distress on child neglect, and (c) the effect of IPR on child neglect.
Method
Participants
A cross-sectional survey was conducted of 770 Palestinian parents of children ages 5 to 18 years living in Israel. Each participant was asked to provide their gender, age, religion, level of religious observance, name of their city or town and its size, level of education, employment and occupation, and their family’s average monthly income. 64.9% (n = 500) were women, and 35.1% (n = 270) were men, whose ages ranged from 21–66 (M = 38.7, SD = 7.84). The majority of participants (83.4%) were Muslim, 8.8% were Christian, and the rest were Druze (7.7%). Among the participants, 57% had completed postsecondary education, and 43% had completed high school or lower. A total of 70.5% of the participants were employed, and 29.5% were not.
Measures
Interpersonal Racism
IPR was measured using the Daily Life Experience (DLE) scale, a subscale of Harrell’s instrument, Racism and Life Experiences Scales (RaLES; Harrell, 1997). This subscale assesses one’s experience with racial aggression and consists of 20 items, such as, “You have been treated rudely or disrespectfully because of your racial, national, or religious affiliation.” The participants gave their responses using a 6-point Likert-type scale ranging from 0 (has not happened to me) to 5 (has happened more than 20 times). We then reassigned the scores for each anchor, apart from has not happened to me, which remained 0; 1–3 times was assigned the score 2; 4–6 times was given the score 5; 7–10 times received the score of 8; 11–20 times was given the score 15, and more than 20 times received the score 25. The values of Cronbach’s alpha ranged from .903 to .908 for the 12 months preceding the administering of the scale and the time prior to that, respectively, as reported by the participants.
Psychological Distress
We used a subscale of 24 items of the Mental Health Inventory (MHI-38) by Veit and Ware (1983) to measure psychological distress over the previous 12 months. This subscale included aspects of depression, anxiety, and loss of control, such as “To what extent did you feel disturbed and restless?” The participants gave their responses using a 6-point Likert scale, ranging from 1 (all the time) to 6 (never). Some positively formulated items were reversed. The mean score was calculated, and higher scores reflected higher distress. The value for Cronbach’s alpha for psychological distress was 0.94.
Child Neglect
Child neglect was measured using the neglect subscale of the Conflict Tactics Scale Parent-Child (CTSPC; Straus et al., 1998), which measures five types of physical or psychological neglect. For example, “I left my child unattended by an adult” and “I was unable to ensure the child had medical attention when needed.” To prevent parents from reporting on a specific child, which could bias the results, they were instructed to report on the child whose birthday was the most recent. Parents completed the CTSPC items for the previous 12 months on a 6-point Likert scale ranging from 1 (never) to 6 (more than 20 times). We rescored these responses based on Straus et al. (1996) as follows: 0 for never; 2 remained the same for rarely (1–2 times); 4 for often (3–5 times); 8 for a lot (6–10 times); 15 for very much (11–20 times); and 25 for more than 20 times. Higher scores indicated more child neglect. Cronbach’s alpha for the internal consistencies of the neglect subscale was 0.69.
Perceived Social Support
The Provision of Social Relations (PSR; Turner et al., 1983) questionnaire was utilized to measure PSS. The tool consists of 15 items that include five components of social support: attachment, social integration, reassurance of worth, reliable alliance, and guidance. The tool examines two dimensions: family support (6 items) and friends’ support (9 items), as perceived by the participants. For example, “I know my family will always stand by me”; “When I am with my friends, I feel completely able to relax and be myself”; “People in my family have confidence in me”; “People in my family provide me with help in finding solutions to my problems.” The statements were rated on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Based on Turner et al. (1983), the score was obtained by summing the average scores of the two dimensions, after reversing two items that were negatively formulated. Higher scores reflected more social support. The tool was found to be valid and had high internal consistency. Cronbach’s alpha was 0.89.
History of Trauma
Participants were given seven questions assessing their lifetime exposure to stressful events and their history of trauma (HoT). These included serious accidents, natural disasters, and physical and sexual abuse, relying upon a variation of the first part of the Posttraumatic Diagnostic Scale (PDS; Foa et al., 1997). The scale’s reliability was reasonable (α = 0.58), as participants were not expected to be exposed to each type of traumatic event. Participants recorded their responses according to a yes-no dichotomy scale, and the score for traumatic events was totaled.
HoT was associated with psychological distress (Foa et al., 1997) and child maltreatment (Slack et al., 2011), and, thus, was controlled for in the analysis. In addition to HoT, gender, employment status, and educational level were also treated as control variables.
Procedures
Development of Measures
A self-administered questionnaire was prepared, which consisted of scales that were originally developed and validated in Western societies but were also validated among Arab societies. The scales were translated into Arabic and back-translated into English by a professional translator. To ensure their face and content validity, the scales were adapted to fit the sociocultural context of Palestinian society, particularly, they were reviewed by an expert researcher in the field of family violence in Arab societies. We further refined the questions, items, and instructions, based on a pilot study among 25 married parents. After receiving approval from the research ethics committee of the author’s institute, the data collection process proceeded.
Data Collection
Given that a sampling framework was unavailable, a systematic semi-random sample was generated, comprising participants representing different sectors of the Palestinian population in Israel (urban, rural, and Bedouin) and all three religious affiliations (Muslim, Christian, and Druze). We aimed to obtain a heterogeneous sample that is representative, to the extent possible, of the population. Cities and villages were not chosen randomly, but rather by clusters that fit the population’s characteristics and geographical distribution. Each city or village was sectioned into a central area, a mid-center (between the center and periphery) area, and a peripheral area, from which at least one main street was sampled. Beginning with the first building on each selected street, we canvassed every seventh building (for smaller-sized settlements) or every tenth building (for larger-sized settlements), systematically, for the length of the street. Only one parent was recruited per building. In the event that nobody in a given building was willing to participate in the study, we moved on to the adjacent building to canvas there, continuing thus until the desired sample was recruited. Participants were asked to sign a consent form, complete a self-administered questionnaire, and place them in a sealed envelope, which we then collected. We gave the participants a list of phone numbers for social services and mental health institutions where they could get counseling and psychological assistance to cope with any difficult feelings that the questionnaire might have caused.
Data Analysis
We first used the expectation-maximization algorithm to impute missing values (Allison, 2001). Then we conducted the analyses of descriptive statistics and correlation with SPSS 26.0. To estimate the associations between the study variables, we analyzed all pairwise Pearson’s correlations. Then, we utilized Hayes’ (2009, 2017) PROCESS macro (Version 3.5.2) models 4 and 59 to examine the study hypotheses. In a preliminary analysis, we used Model 4 to test mediation as proposed in Hypothesis 2. After confirming the mediation model, we used Model 59 to test the moderated mediation model as proposed in Hypothesis 3 (see Fig. 1). Specifically, for testing the mediating role of psychological distress and the moderating effect of PSS on the relationship between IPR (independent variable) and child neglect (dependent variable). Participants’ educational level, gender, employment status, and HoT were treated as covariates in all analyses. We used the bootstrapping method to test the significance of the effects. The bootstrapping method produced 95% bias-corrected confidence intervals of these effects from 5,000 resamples of the data. Confidence intervals not including zero means effects were significant at α = 0.05 (Hayes, 2009). In model 59, we initially examined the significance of interaction terms, such as the effect of IPR × PSS on psychological distress, the effect of IPR × PSS on child neglect, and the effect of psychological distress × PSS on child neglect. Also, the significance of conditional indirect effects at three different levels of the moderator, namely, at low (SD = −1), mean (SD = 0), and high (SD = +1) was further analyzed according to the 95%CI.
Results
Correlation Analysis
For an initial examination of the study’s hypotheses, we conducted a Pearson correlation analysis to examine the correlations between the study variables (see Table 1). We found that increased rates of child neglect significantly correlated with higher rates of IPR (r = 0.14, p < 0.001) and higher levels of psychological distress (r = 0.17, p < 0.001). Additionally, increased rates of IPR significantly correlated with higher levels of psychological distress (r = 0.22, p < 0.001). Moreover, to test PSS as a moderator, we initially tested its correlation with the outcome variables; psychological distress and child neglect. We found that PSS negatively correlated with psychological distress (r = −0.40, p < 0.001) and child neglect (r = −0.10, p = 0.004). Beyond these correlations, we also found that IPR was negatively correlated with PSS (r = −0.19, p < 0.001), history of trauma (HoT) (r = −0.16, p < 0.001), and with education level (r = −0.11, p = 0.002; see Table 1).
Table 1
Descriptive statistics and correlations for the research variables (N = 748–770)
Variable
M
SD
1
2
3
4
5
6
7
1. Child neglect
0.38
1.15
–
2. IPR
3.44
4.13
0.14 ***
–
3. Psychological distress
3.04
0.86
0.17 ***
0.22 ***
–
4. Perceived social support
3.86
0.68
−0.10 **
−0.19 ***
−0.40 ***
–
5. HoT
12.61
1.38
−0.05
−0.16 ***
−0.12 **
0.08 *
–
6. Education
0.57
0.50
−0.07 *
−0.11 **
−0.16 **
0.11 **
0.06
–
7. Employment
0.70
0.46
−0.06
0.03
−0.06
0.06
0.07
0.38 **
–
8. Gender
0.35
0.48
0.01
0.10 **
−0.06
−0.06
−0.03
−0.05
0.34 **
M and SD are used to represent the mean and standard deviation, respectively; IPR interpersonal racism; HoT history of trauma; Gender: 1 = male, 0 = female
*p < 0.05, **p < 0.01, ***P < 0.001
Testing Mediation
We examined whether psychological distress would mediate the relationship between IPR and child neglect. The results of the mediation analysis are presented in Fig. 2. After controlling for covariates (gender, education, employment, and HoT), the analyses revealed a significant positive association between IPR and child neglect (path c), (β = 0.13, se = 0.04, p < 0.001), and a significant positive effect of IPR on psychological distress (path a), (β = 0.22, se = 0.04, p < 0.001). Additionally, the effect of psychological distress on child neglect (path b) was found significant (β = 0.14, se = 0.04, p < 0.001). The direct positive effect of IPR on child neglect, after controlling for psychological distress, was still significant (c’), (β = 0.10, se = 0.04, p < 0.01). The indirect effect of IPR on child neglect via psychological distress was (β = 0.03, 95%CI = [0.02, 0.05]). Taken together, psychological distress partially mediated the relationship between IPR and child neglect. These results indicate that higher levels of IPR and psychological distress are associated with increased rates of child neglect, thus supporting Hypothesis 1. Further, results showed that increased IPR experiences are related to greater distress, and in turn to high rates of child neglect, hence, Hypothesis 2 was supported.
Fig. 2
The Standardized Coefficients of the Mediation Model. Figure 2 depicts the mediation role of psychological distress in the relationship between IPR and child neglect. Note: The mediation analysis was conducted using PROCESS (Hayes’s mediation Model 4). a, b, c, and c′ are standardized coefficients. c = total effect, which includes the direct effect of IPR on child neglect and the indirect effect of IPR on child neglect via psychological distress; c′ = direct effect of IPR on child neglect. ***p < 0.001; **p < 0.01
×
Testing the Moderated Mediation Model
The moderated mediation analysis, proposed in Hypothesis 3, examined the mediating role of psychological distress and the moderating effect of PSS on the relationship between IPR and child neglect. As shown in Table 2, the results revealed that increased rates of IPR experiences were significantly associated with greater psychological distress (β = 0.18, p < 0.001, 95% CI [0.11, 0.25]). In addition, both increased rates of IPR (β = 0.11, p = 0.005, 95% CI [0.03, 0.19]) and psychological distress (β = 0.13, p = 0.001, 95% CI [0.05, 0.21]) were significantly associated with greater child neglect. Moreover, higher levels of PSS were associated with decreased psychological distress (β = −0.38, p < 0.001, 95% CI [−0.44, −0.31]); however, they were not significantly associated with child neglect (β = −0.02, P = 0.55, 95% CI [−0.10, 0.06]). The results also show initial support to Hypotheses 3(a) and 3(b), but not to Hypothesis 3(c). The interaction effect of IPR and PSS on psychological distress (Path a) was significant (β = 0.08, p = 0.02, 95% CI [0.01, 0.14]). Additionally, the interaction effect of psychological distress and PSS on child neglect (Path b) was also significant (β = −0.09, p = 0.03, 95% CI [−0.16, −0.01]). However, the interaction effect of IPR and PSS on child neglect (Path c’) was not significant (β = 0.05, p = 0.22, 95% CI [−0.03, 0.12]), indicating that Hypothesis 3c was not supported (see Table 2), therefore it was not further examined.
Table 2
The Moderated Mediation Effect of Interpersonal Racism on Child Neglect Mediated by Psychological Distress and Moderated by Perceived Social Support
Mediation model outcome: PSD
Dependent variable model outcome: Child Neglect
Independent Variables
Beta
se
p
CI
Beta
se
p
CI
Gender
−0.13 ***
0.04
< 0.001
[−0.19, −0.06]
−0.01
0.04
0.92
[−0.08, .07]
Education
−0.13 ***
0.04
< 0.001
[−0.19, −0.06]
−0.02
0.04
0.70
[−0.10, .06]
Employment
0.05
0.04
0.16
[−0.02, 0.13]
−0.03
0.04
0.50
[−0.11, .05]
HoT
−0.08 *
0.03
0.02
[−0.14, −0.02]
−0.01
0.04
0.70
[−0.09, .06]
IPR
0.18 ***
0.04
< 0.001
[0.11, .25]
0.11 **
0.04
0.005
[.03, .19]
PSS
−0.38 ***
0.03
< 0.001
[−0.44, −0.31]
−0.02
0.04
0.55
[−0.10, .06]
IPR * PSS
0.08 *
0.03
0.02
[0.01, 0.14]
0.05
0.04
0.22
[−0.03, .12]
PSD
0.13 **
0.04
0.001
[.05, .21]
PSD * PSS
−0.09 *
0.04
0.03
[−0.16, −0.01]
Constant
0.01
0.03
0.84
[−0.06, 0.07]
−0.03
0.04
0.46
[−0.11, .05]
R2
0.23
0.05
ANOVA
F(7727) = 30.81, p < 0.001
F(9725) = 4.30, p < 0.001
Bootstrap sample size n = 5000. Standardized regression coefficients reported are based on bias-corrected and accelerated 95% confidence intervals (CIs). CIs that do not include zero indicate significant effects
IPR interpersonal racism, PSS perceived social support, PSD psychological distress, HoT history of trauma, Gender: 1= male, 0 = female
*p < 0.05, **p < 0.01, ***p < 0.001
The Impact of IPR on Psychological Distress at Different Levels of PSS (Path a)
To further examine Hypothesis 3(a) regarding the interaction found between IPR and PSS in predicting psychological distress, simple slope analyses were performed. Effects were plotted at low (SD = −1), mean (SD = 0), and high (SD = +1) levels of PSS (see Fig. 3). The results of the simple slope test suggested that IPR had a positive effect on psychological distress in all levels of social support. When social support was perceived to be low, IPR was positively associated with greater psychological distress (β = 0.10, p = 0.01, 95% CI [0.03, 0.18]). When social support was perceived as medium and high, the association between IPR and psychological distress was also positive and significant (β = 0.18, p < 0.001, 95% CI [0.11, 0.25]) and (β = 0.26, p < 0.001, 95% CI [0.15, 0.36]), respectively. These results contradicted Hypothesis 3(a). Thus, to further explore the weakening effect of PSS in mitigating the effect of racism on psychological distress, we tested the interaction between IPR and PSS at different levels of IPR exposure. Results indicated that when exposure to IPR was low, the effect of PSS on psychological distress (β = −0.44, p < 0.001, 95% CI [−0.53, −0.35]) was negative and significant. The effect was weaker when IPR exposure was medium (β = −0.38, p < 0.001, 95% CI [−0.44, −0.31]) and weaker still when IPR exposure was high (β = −0.30, p < 0.001, 95% CI [−0.39, −0.21]).
Fig. 3
The Impact of Interpersonal Racism on Psychological Distress at Different Levels of Perceived Social Support (Path a) – Standardized Coefficients. Figure 3 indicates that interpersonal racism is positively associated with greater psychological distress at all levels of perceived social support
×
Altogether, the results indicate that high levels of PSS are significantly related to decreased levels of psychological distress. We also found that PSS’s protective effect occurred at all IPR exposure levels. It seems that PSS is a protective social component that can mitigate the adverse effect of IPR on psychological distress, but its protective effects are lessened when exposure to IPR increases. Indeed, the relationship between IPR and psychological distress becomes stronger (and not weaker, as we expected in Hypothesis 3[a]) in high levels of PSS.
The Impact of Psychological Distress on Child Neglect at Different Levels of PSS (Path b)
To further examine Hypothesis 3(b) concerning the interaction between psychological distress and PSS in predicting child neglect. The simple slope test results, shown in Fig. 4, revealed that psychological distress had a significant positive effect on child neglect only at low and medium levels of PSS. When social support was perceived as low or medium, an increase in psychological distress was associated with greater rates of child neglect (β = 0.22, p = 0.01, 95% CI [0.10, 0.33]) and (β = 0.13, p = 0.001, 95% CI [0.05, 0.21]), respectively. For parents with high levels of PSS, the effect of psychological distress on child neglect was not significant (β = 0.05, p = 0.42, 95% CI [−0.06, .15]). These results indicate that the relationship between psychological distress and child neglect became stronger when levels of PSS were lower. Thus, parents who experience high psychological distress are at higher risk of neglecting their children when they perceive decreased social support, as expected in Hypothesis 3(b).
Fig. 4
The Impact of Psychological Distress on Child Neglect at Different Levels of Perceived Social Support (Path B) – Standardized Coefficients. Figure 4 shows that psychological distress is positively associated with high rates of child neglect at low and medium levels of perceived social support
×
Conditional Direct and Indirect Effects of Interpersonal Racism on Child Neglect
As presented in Table 3 and Fig. 5, the results supported our hypotheses, indicating that IPR was significantly associated with increased child neglect. This relationship was mediated by psychological distress at low and medium levels of PSS with a significant indirect effect (β = 0.02, 95% CI [0.004, 0.05]), (β = 0.02, 95% CI [0.01, 0.04]) respectively. Though there was a significant, positive direct effect of IPR on child neglect at high levels of PSS, there was no mediation effect of psychological distress on this relationship (β = 0.01, 95% CI [−0.02, 0.04]). Importantly, the direct effects of IPR on child neglect (Path c’) indicated that the mediation effects of psychological distress were full when PSS was low (β = 0.07, se = 0.05, p = 0.15, 95% CI [−0.02, 0.16]) and partial when PSS was medium (β = 0.11, se = 0.04, p = 0.005, 95% CI [0.03, 0.19]).
Table 3
Conditional direct and indirect effects of interpersonal racism on child neglect
Levels of moderator
β
Boot SE
95% Boot CI
Conditional direct effect
M −SD
0.07
0.05
[−0.02, 0.16]
M
0.11
0.04
[0.03, 0.19]
M + SD
0.16
0.06
[0.04, 0.28]
Conditional indirect effect
M − SD
0.02
0.01
[0.004, 0.05]
M
0.02
0.008
[0.01, 0.04]
M + SD
0.01
0.01
[−0.02, 0.04]
Bootstrap sample size n = 5000. Standardized coefficients (β) are based on bias-corrected and accelerated 95% confidence intervals (CIs). CIs that do not include zero indicate conditional significant direct or indirect effects. M and SD are used to represent the mean and standard deviation
PSS perceived social support, low (M − SD), Medium (M), and high (M + SD)
Fig. 5
The Standardized Coefficients of the Moderated Mediation Model. Figure 5 depicts a moderated mediation model of the relationship between interpersonal racism and child neglect through psychological distress at different levels of perceived social support (Andrew Hayes’s moderation-mediation Model 59). *p < 0.05, **p < 0.01, ***p < 0.001
×
Overall, we found evidence for the positive effect of IPR and psychological distress on child neglect (supporting Hypothesis 1) and for the mediating role of psychological distress in the relationship between IPR and child neglect (supporting Hypothesis 2). More specifically, the results indicated that a greater number of IPR experiences is significantly related to increased psychological distress (Path a), and in turn, higher levels of psychological distress are linked to high rates of child neglect (Path b). Beyond that, our moderated mediation model regarding Hypothesis 3 was partially supported. Results indicated that an increase in PSS levels strengthened the effect of IPR on psychological distress (as shown in Fig. 3) against our expectations in Hypothesis 3a. At the same time, however, the lower the levels of PSS were, the more exacerbated the effect of psychological distress on child neglect was (see Fig. 4), as we expected in Hypothesis 3b. Finally, the indirect effect of the relationship between IPR and child neglect via psychological distress was stronger at low and medium levels of PSS. Notably, the more parents experience IPR, the more they report psychological distress, and in turn, the risk of neglecting their children becomes greater when perceiving low or medium levels of social support.
Discussion
This study investigated the mechanisms underlying the relationship between IPR and child neglect in a sample of Palestinian parents in Israel. The results support our first hypothesis that increased experiences of Palestinian parents with IPR and psychological distress are associated with a greater risk of neglecting their child. Results also supported our second hypothesis, showing that the relationship between IPR and child neglect was significantly mediated by psychological distress; increased IPR was, directly and indirectly, related to child neglect. Finally, PSS moderated the indirect effect of IPR on child neglect via psychological distress, showing support for our third Hypothesis. Namely, PSS reduced the indirect effect of IPR on child neglect, which was greater among parents with medium and low levels of PSS.
Our findings could be explained by the notion that greater exposure to race-related stress may worsen daily-life stress and have severe physical and psychological consequences, as posited by Steers et al. (2019). Thus, this increased cognitive and emotional burden on parents as a result consequently puts their parenting quality at risk and increases the risk of child neglect (Anderson et al., 2015; Bécares et al., 2015; Sanders-Phillips, 2009; Murry et al., 2022). Racism and discrimination also can limit the provision of services and affect parents’ ability to care optimally, treat, and support their children’s development, consequently leading to child maltreatment (Bécares et al., 2015; Caughy et al., 2004; Sanders-Phillips, 2009; Shonkoff et al., 2021).
In addition, these results show that parents’ experiences with IPR are related to high levels of psychological distress and, in turn, may put them at greater risk of child neglect. These results align with our second hypothesis suggesting that psychological distress (i.e., depression and anxiety) mediates the relationship between IPR and child neglect. The results are consistent with previous research, underscoring the severe consequences of racism on mental health, including depressive symptoms and anxiety (Daoud et al., 2018; Mikrut et al., 2022; Mossakowski & Zhang, 2014; Murry et al., 2022; Schmitt et al., 2014). The results also strengthen previous research that found that parents’ exposure to racial discrimination may increase their mental health symptoms and irritability and provoke quick-tempered and harsh parenting practices (Anderson et al., 2015; Bécares et al., 2015; Murry et al., 2022). Furthermore, the results indicate that the greater the psychological distress experienced, the more that child neglect is observed among Palestinian parents in Israel. Research in other contexts has provided similar evidence for the positive association between parental depressive symptoms and dysfunctional discipline, including laxness, over-reactivity, lower warmth, and hostility, which was found related to an increased risk of child maltreatment and neglect (Errázuriz Arellano et al., 2012; Lee et al., 2012; Slack et al., 2011; Venta et al., 2016). Moreover, depression disturbs a parent’s ability to supervise, monitor, and positively interact with children. Depression also correlates with child neglect by increasing the risk of the parent rejecting the child and engaging in unhealthy behaviors such as alcohol abuse (Lee et al., 2012).
This study also explored the effect of PSS on the relationship between IPR and child neglect through psychological distress. PSS was related to lower levels of psychological distress, regardless of the amount of racism experienced, which is also consistent with previous research (Ajrouch et al., 2010; Odafe et al., 2017; Prelow et al., 2006; Steers et al., 2019). This finding underscores the importance of social support for successfully adapting to stress. Our moderated mediation analysis revealed that PSS had a conditional effect on the mediated relationship between IPR and child neglect among Palestinian parents in Israel (supporting Hypothesis 3). Importantly, our analysis showed that not all parents who experienced IPR and reported high psychological distress were at high risk of neglecting their children. Namely, PSS moderated the strength of the mediating effect of psychological distress on the relationship between IPR and child neglect. This result indicates that parents exposed to IPR are at higher risk of experiencing psychological distress and, in turn, at increased risk of neglecting their children when they perceive medium and lower levels of social support. Aligning with previous research (Steers et al., 2019), individuals with lower social support who reported higher levels of perceived discrimination were found to experience high psychological distress. This finding is critical as psychological distress is associated with numerous adverse outcomes (Steers et al., 2019), including harsh parenting and child neglect (Anderson et al., 2015; Bécares et al., 2015).
However, PSS played a different moderating role in moderating the effects of IPR. Namely, increased IPR was found related to greater psychological distress at all levels of PSS. The higher the perceptions of social support were; the less psychological distress was reported. When perceiving low or medium levels of social support, the reports of psychological distress in relation to racism exposure are the highest. Yet, this effect was stronger at high levels of PSS. Although this result contradicts the study’s hypothesis 3(a), it was to some degree confirmed by previous studies, which did not yield any evidence that perceived or received social support from family and friends protects against racism and discrimination effects (e.g., Ajroush et al., 2010; Brondolo et al., 2009; Schmitt et al., 2014). Literature has even shown the exacerbating effects of social support on the relationship between racism and its outcomes (Schmitt et al., 2014). In their review, Schimitt et al. discuss social constraints to explain the moderating role of social support, arguing that receiving messages that contain blame or tend to minimize and deny aspects of a support seeker’s experience with racism might turn social support ineffective and be associated with increased distress.
To further understand this unexpected finding, we explored the weakening effect of PSS in mitigating the effect of IPR on psychological distress. We found that the protective effect of PSS occurred at all levels of IPR exposure. It seems that PSS can protect against the adverse effect of IPR on psychological distress, but its protective effect is weakened when exposure to IPR increases. Indeed, previous research suggests that social support may be helpful at low or moderate levels of exposure to racism but exacerbates difficulties at higher levels of exposure (Ajrouch et al., 2010; Brondolo et al., 2009). The provision of social support is inadequate and not guaranteed among populations who have been exposed to lifelong experiences of racism and discrimination, which in turn harm their trust in others and consequently affect social support dynamics (Ajrouch et al., 2010; Mikrut et al., 2022). Other explanations for such an unexpected finding may be that discussions of racism among stigmatized group members may evoke recollections that feel uncontrollable and stressful (Richeson & Shelton, 2007), rendering the group members as potentially less mentally available to support others, which may explain why increased PSS is not so protective. It should also be noted that we only measured general perceptions of social support and did not measure whether this support was actually received. Further, the participants did not associate this support with specific events such as the racism experiences examined here.
The results of our study also revealed that increasing psychological distress was associated with greater child neglect among parents with low or medium PSS, but was unrelated to child neglect among parents with high PSS, supporting Hypothesis 3(b). Perceptions of lack of provision of social support are devastating in coping with distress and its effect on child neglect. This result aligns with previous research indicating that social support protects against the effects of racism among Palestinians and other minority populations (Osman et al., 2018; Seawell et al., 2014; Steers et al., 2019).
Finally, the study’s results did not yield a significant mitigating role for PSS in terms of the direct relationship between IPR and child neglect and did not support Hypothesis 3(c). Similarly, other researchers have also found mixed results; remarkably, some of their results gave no evidence that social support protects against racism and discrimination’s harmful effects (Ajroush et al., 2010; Brondolo et al., 2009; Mossakowski & Zhang, 2014; Prelow et al., 2006; Schmitt et al., 2014), most likely because increased racism is associated with lower levels of PSS, as found in this study’s correlations analysis and previous research (Prelow et al., 2006). Exposure to racism deprives parents of seeking support (Sanders-Phillips, 2009), thus limiting the role of PSS in mitigating racism’s effects on child neglect. Although social support may reinforce resilience, different stressors require specific dimensions of social support (Odafe et al., 2017; Seawell et al., 2014). Our results suggest that in other contexts (IPR or psychological distress), PSS plays different roles in moderating the effects of different stress sources.
This study adds to a growing literature examining how experiences of IPR and parental psychological distress may contribute to the parents’ risk for child maltreatment by identifying the direct and indirect paths between IPR and neglectful practices against children of a disadvantageous minority group. Findings underscore the importance of distinguishing between the effects of PSS in different contexts of stress to clarify how social support influences psychological status and subsequent behavior.
Limitations of the Study and Recommendations for Future Research
This research joins other studies that have attained mixed results for the argument that social support buffers the effects of racism on mental health and parenting behavior. This inconsistency stems from variations in the conceptualization and measurement of social support, which complicate the interpretation of the results of the various studies (Brondolo et al., 2009). This study has examined general perceived support from family and friends. To better understand the notable inconsistency in the moderating role of social support, we strengthen previous research suggestions to differentiate among various dimensions of social support (e.g., perceived or received, emotional or instrumental, self-esteem or appraisal support). In addition, it is essential that future research examines both the usage of and satisfaction with social support, addressing its quality and negative aspects of support, in addition to examining racism-tailored (rather than general) social support.
The present study has additional limitations. Given our cross-sectional data, accurate temporal precedence of the independent variable cannot be assured, consequently our ability to conclude causative links was restricted. In the future, further longitudinal studies are needed to replicate and expand on these findings and to investigate temporal ordering. It is also recommended to explore additional mediators (e.g., cognitive appraisal of racism and parental stress) and moderators (e.g., coping strategies with racism and gender) for a more comprehensive perspective. Further, the sample of this study included a majority of women. While gender was controlled for in the analyses, men and women may differently perceive or utilize stress and social support (Lazarus & Folkman, 1984). Further examination of gender differences would enable a better understanding of men’s and women’s roles in the relationship between social support, racism, psychological distress, and child neglect. Furthermore, the gaps between the characteristics of the obtained sample and the characteristics of the Palestinian population in Israel in terms of gender, socioeconomic status, employment, educational level, and geographic region restrict the generalizability of the results from the sample to the general Palestinian population in Israel. These differences could potentially affect the conclusions drawn from the research findings, as they can impact individuals’ discourse on racism, their awareness of it, and the frequency and intensity of their experiences with it, which consequently may influence their responses on the research scales. Nevertheless, while these gaps do exist, it is difficult to argue that they have unique and significant onsequences on the overall findings. Additionally, it is important to note that the scales employed in this study were originally developed within Western societies. While these scales were also utilized and validated among Arab populations in previous research, they were only validated theoretically for face and content validity in our study. Empirical validation for construct validity was not carried out, as it was not within the study’s primary objectives. As such, it is advisable to conduct future research to validate these tools more comprehensively.
Clinical and Policy Implications
Understanding the risk factors of child neglect is critical to developing child maltreatment prevention programs. Addressing the risk and protective factors (IPR, psychological distress, social support) associated with parenting practices and child neglect would enable building effective socio-culturally sensitive interventions within minority groups, including Palestinians exposed to everyday racism. Simultaneously, if the results can be successfully replicated and expanded upon in longitudinal studies, they could potentially have clinical implications for parents who face racism and who are at risk of child neglect.
Based on our results, PSS seemed to help parents with low IPR exposure, this adaptive feature did not provide a buffer from increased psychological distress to those who had experienced high exposure to racism. Social support is necessary, for example, emotional support from family and friends can provide a safe space to discuss and process experiences with racism and help individuals feel validated and supported. Additionally, family and friends can offer practical support to alleviate additional challenges they may face due to racism. They may also provide positive experiences and relationships that can help to build resilience and foster a sense of belonging against the exclusion that may be experienced due to racism. However, our results suggest that social support from family and friends is not sufficient for enhancing the mental health of those facing chronic stressors such as high levels of racism. Therefore, interventions must consider resources beyond the support of family and friends, such as formal instrumental support (e.g., legal aid and access to financial resources to address discriminatory practices) and psychosocial support (e.g., therapy, counseling, and support groups). Moreover, encouraging open and honest conversations about race and ethnicity can help to raise public awareness of the psychological and behavioral sequelae of racism and promote understanding, empathy, and behavioral change among majority group members. Further, supporting anti-racism initiatives and organizations can help to create systemic change and promote equality for all. Finally, policymakers have to take action against racist policies and rules to combat social exclusion that creates disparities and barriers to services among minorities.
Acknowledgements
This article is based on a study supported, in part, by the Fay Kaufman Memorial Prize and Yad Ora Foundation for Research in Ethnography and Middle Eastern Geopolitics at the Hebrew University of Jerusalem. The author would like to extend her sincere gratitude to all parents who participated in this study and to all research assistants for their invaluable contribution to its accomplishment.
Compliance with ethical standards
Conflict of interest
The author declares no competing interests.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (the Paul Baerwald School of Social Work and Social Welfare ethical research committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
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