The indirect role of perceived survival expectations in the association between perceived hope and suicidal thoughts among palestinians amid war in Gaza

Understanding how hope can be protective against suicide may improve prevention efficiency by helping identify and target those most at risk for suicide, and develop individualized treatment strategies. However, no studies have yet focused on the processes underlying the relationship between hope and suicidality in war-affected populations. The objective of this study was to explore the direct and indirect effects of hope on suicidal ideation through perceived survival expectations in Palestinian adults who currently live in Gaza in the midst of war. This is a cross-sectional study that has adopted the snowball sampling method and used an Internet-based survey that was distributed during the month of September 2024. The target population consisted of 534 adult Gazan people from the general population who were aged over 18 years and were living in Gaza Strip at the time of data collection. 44.6% of participants had suicidal ideation. A total of 43%, 44% and 45% of participants perceived < 50% chances of living for the next year, the next 5 years, and the next 10 years, respectively. After adjusting for covariates (age, education status, and living arrangements), perceived survival expectations at 5 years (indirect effect: Beta = -0.004; Boot SE = 0.002; Boot CI -0.01; -0.001) and 10 years (indirect effect: Beta = -0.01; Boot SE = 0.004; Boot CI -0.02; -0.003) mediated the association between hope and suicidal ideation. Higher hope was significantly associated with higher perceived survival expectations at 5 years, and directly with lower suicidal ideation. Finally, higher perceived survival expectations at 5 and 10 years were significantly associated with lower suicidal ideation. Our findings contend that hope might confer protection against suicide through the indirect effect of perceived survival expectations in individuals living in a constantly life-threatened state. Future experimental research is warranted to test whether intervening on low perceived survival expectations can be successful in mitigating related psychopathological outcomes, including suicidal ideation.