Health Perception and Anxiety Among Internally Displaced and Non-Displaced Israeli Adults: The Mediating Role of Emotional Well-Being and Functioning

Abstract

Background: Forced displacement is a significant public health challenge associated with deteriorated mental and physical health outcomes. Following the outbreak of Israel's 'Iron Swords' war on 7 October 2023, more than 250,000 citizens were evacuated from their homes. Previous research has consistently documented elevated anxiety and poor health perception among displaced populations; however, the extent to which displacement itself contributes to anxiety has not been directly examined or established. Objective: The objective was to compare levels of anxiety and health perception between internally displaced and non-displaced Israeli adults and examine the mediating roles of emotional well-being and emotional functioning within the framework of Hobfoll's Conservation of Resources (COR) theory. Methods: A cross-sectional, comparative quantitative study was conducted using validated self-report questionnaires to assess health perception (SF-36) and anxiety (GAD-7). The study sample comprised 98 adults, including 46 displaced individuals and 52 participants from the general population. Differences in health dimensions and anxiety levels were analyzed using t-tests, correlation analyses, and regression models. To advance understanding beyond previous research, mediation analysis based on the Conservation of Resources (COR) theory was employed, enabling identification of the psychological mechanisms through which displacement influences anxiety. Results: Displaced participants reported significantly lower scores across all SF-36 dimensions and significantly higher anxiety levels compared to the general population. Regression analyses indicated that emotional well-being and emotional functioning were significant predictors of anxiety, whereas displacement status alone was not a direct predictor once mediators were included. Mediation analysis further demonstrated that both emotional well-being and emotional functioning fully mediated the relationship between displacement and anxiety Conclusions: Forced displacement has lasting negative effects on mental health, primarily through the erosion of emotional and functional resources. These findings highlight the importance of interventions aimed at strengthening psychological resilience and continuity of care. Study limitations include a cross-sectional design, reliance on self-reported data, and relatively small sample, which may limit generalizability.

Keywords: anxiety; displaced persons; mediating model.

Figure 1

The COR Model for Predicting Anxiety.

Figure 2

Mediation Model to predict anxiety. Note: Paths marked with β indicate standardized regression coefficients. p < 0.001 ***.