Abstract Background Marginalization of intersecting racial, sex, and rural identities heightens the vulnerability of African American women in rural South Carolina (SC) during the COVID-19 pandemic, leading to psychological distress. Social support, positive coping, and resilience may serve as protective factors, enhancing individuals' ability to cope with stress. Methods A cross-sectional online survey of 328 African American women (Mean age = 48.03 ± 16.75) in rural SC from January to February 2024 was conducted. Structural equation modeling was used to test direct, indirect, and total effects of social support on PTSD and hopelessness, mediated by resilience and coping. We also examined moderation by age and caretaker status. Results All model fit indices were acceptable (CFI = 0.99, TLI = 0.98, RMSEA = 0.034, SRMR = 0.031, χ 2 = 11.02, p = 0.2). Social support was positively associated with resilience (β = 0.463, p < 0.001), while resilience was negatively correlated with negative coping (β = -0.329, p < 0.001). Negative coping was linked to PTSD (β = 0.325, p < 0.001) and hopelessness (β = 0.321, p < 0.001). Resilience and positive coping mitigated hopelessness, and social support offered protection against PTSD. Resilience mediated the relationship between social support and hopelessness (β = -0.197, p < 0.001). The moderation analysis showed that single caretaker status negatively moderated the association between social support and resilience (β = -0.227, p = 0.006), while age positively moderated the association between resilience and hopelessness (β = 0.162, p = 0.001). Findings revealed that greater social support was associated with higher resilience and increased use of positive coping strategies. These, in turn, were linked to lower levels of hopelessness and PTSD symptoms. Moderation analysis indicated that the protective effect of social support is stronger among older women but weaker among single caretakers. Conclusions Findings highlight the need for strategies tackling structural barriers to mental health equity in rural African American communities while considering individual factors like age and caretaker status, ensuring social support interventions yield positive outcomes.
Pasha et al. (2025) studied this question.