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A study of the link between food-water insecurities and self-reported psychotic experiences among young adults in Gaza Strip: What role does social support play under conditions of war and extreme suffering?

Feten Fekih-Romdhane·Kamel Jebreen·Tasnim Swaitti·Mohammed Jebreen·Eqbal Radwan·Wafa Kammoun-Rebai·Mahmoud A Abu Samra·Asmaa Abusamra·Sahar Obeid·Souheil Hallit
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Abstract

BACKGROUND: The war in Gaza, coupled with severe restrictions on humanitarian access and assistance, have led to a rapid and large-scale exacerbation of food insecurity (FI) and water insecurity (WI) in Gaza, which can cause a myriad of deleterious effects on both physical and mental health. Previous evidence suggests that environmental stressors (such as FI and WI), coupled with lack of support, can compromise coping ability and trigger psychosis. Elucidation of these pathways can inform efforts to reduce the incidence of psychosis in war settings in particular, and in global communities more generally. This study aimed to assess the mediating role of social support on the association between food-water insecurities and psychotic experiences (PEs). METHODS: This study was carried-out over a period of one month (September 2024) by using a free online form builder. Data were collected at a single time point using snowball sampling. A total of 476 adults aged 18–35 years and living in Gaza at the time of the survey took part in this study. The Prodromal Questionnaire- Brief, the Food Insecurity Experience Scale, the Four-Item Household Water Insecurity Experiences Scale, and the Single Item Measure of Social Supports have been administered to participants. RESULTS: A total of 110 participants (23.1%) reported low tangible social support (i.e., having no or 1 person in the social support network), 27.3% were classified as moderately-to-severely food insecure and 41% were categorized as water-insecure. The mediation analysis was adjusted for the following covariates: marital status, living arrangement and age. Higher food-water insecurity experiences were significantly associated with lower social support. Higher food-water insecurity experiences were also significantly associated with higher PEs. Higher social support was significantly associated with lower PEs. The results of the mediation analysis showed that social support mediated the link of FI (indirect effect: Beta = 0.06; Boot SE = 0.03; Boot CI 0.01; 0.12) and WI (indirect effect: Beta = 0.04; Boot SE = 0.02; Boot CI 0.01; 0.08) to PEs. CONCLUSION: Our findings support the case for bolstering social support networks in war-affected communities facing survival challenges such as FI and WI. This study points to the urgent need for increased food aid and improved water supplies in the short term, and sustainable food and water systems in the long term, to support mental health. In times of war, mental health prevention and interventions strategies might do well to increase social support and resources in order to help buffer such intense environmental stressors and prevent the emergence of psychosis. CLINICAL TRIAL NUMBER: Not applicable.

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HumansSocial SupportAdultMiddle EastFood InsecurityFemaleMaleWarfareYoung AdultPsychotic DisordersAdolescentSelf ReportWater InsecuritySurveys and QuestionnairesFood SupplyFood insecurityPsychotic experiencesSocial supportWarWater insecurityJournal Article

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Feten Fekih-Romdhane, Kamel Jebreen, Tasnim Swaitti, Mohammed Jebreen, Eqbal Radwan, Wafa Kammoun-Rebai, Mahmoud A Abu Samra, Asmaa Abusamra, Sahar Obeid, Souheil Hallit. 2025-11-17. A study of the link between food-water insecurities and self-reported psychotic experiences among young adults in Gaza Strip: What role does social support play under conditions of war and extreme suffering?. https://doi.org/10.1186/s12939-025-02699-6

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