Predictors of psychological distress and positive resources among Palestinian adolescents: trauma, child, and mothering characteristics

OBJECTIVE: The aim was to examine how traumatic and stressful events, responses to violence, child characteristics, and mothering quality, as measured in middle childhood predict psychological distress and positive resources in adolescence. METHOD: The participants were 65 Palestinian adolescents (17+/-.85 years; 52% girls), who had been studied during the First Intifada (T1), during the Palestinian Authority rule (T2) and before the Second Al Aqsa Intifada (T3) in Gaza. Psychological distress was indicated by PTSD, and depressive symptoms and positive resources by resilient attitudes and satisfaction with quality of life, all measured at T3. The predictors that were measured at T1 were exposure to military violence, active coping with violence and children's intelligence, cognitive capacity, and neuroticism. Mothering quality and stressful life-events were measured at T2, the former reported by both the mother and the child, and the latter by the mother. RESULTS: Adolescents' PTSD symptoms were most likely if they had been exposed to high levels of traumatic and stressful experiences and had poor cognitive capacity and high neuroticism in middle childhood. Only high levels of childhood military violence and stressful life-events predicted high depressive symptoms and low satisfaction with quality of life in adolescence. CONCLUSIONS: Military violence in childhood forms risks for both increased psychological distress and decreased positive resources. However, child characteristics such as cognitive capacity and personality are important determinants of psychological vulnerability in military trauma.     

“We must cooperate with one another against the Enemy”: Agency and activism in school-aged children as protective factors against ongoing war trauma and political violence in the Gaza Strip

This exploratory qualitative study investigated self-perceived risk and protection factors that may reinforce the ability of children living in refugee camps on the Gaza Strip to adjust to a traumatic and risky life context characterized by loss and dispossession. The sample comprised 200 Palestinian children recruited at primary schools in four refugee camps in the Gaza Strip following the Israeli military operation “Pillar of Defence” in 2012. Thematic content analysis was applied to written materials and narratives produced by the children. Environment, friends, emotions, family, play, self, sociality, health, school, and spirituality were the dimensions that emerged from the narrative texts. Palestinian children’s psychological adaptability and ability to reposition themselves along the continuum between ease and disease is underpinned by constant political agency and activism – a dimension that guides sense-making activities in a traumatizing environment marked by continuous uncertainty, loss and bereavement. We therefore recommend a politically-informed focus, both when assessing children and when designing intervention for them in contexts of chronic political violence and war.     

Teaching Clinical Social Work Under Occupation: Listening to the Voices of Palestinian Social Work Students

The authors were invited to teach clinical social work in the Palestinian West Bank. In order to teach, we designed a study exploring how 65 Palestinian social work students described the psychological and social effects of working under occupation. Students described social stressors of poverty, unemployment, lack of infrastructure, violence, imprisonment, separation of families, and severe constraints on travel. They identified depression, suicide, anxiety, and war-related trauma as emerging from these conditions. Many experienced the same psychosocial problems as their clients in coping with harassment and delays at checkpoints. Implications for teaching social work theory and practice are discussed.     

Maltreatment and coping strategies among male adolescents living in the Gaza Strip

OBJECTIVE: To establish the nature and extent of maltreatment experiences, coping strategies, and behavioral/emotional problems, and their relationships, in a sample of Palestinian adolescents. METHOD: A study of 97 male adolescents aged 15-19 years, and attending a vocational training center based in the Gaza Strip. Adolescents completed the Child Maltreatment Schedule and the Ways of Coping Scale (WAYS). The Strengths and Difficulties Questionnaire (SDQ) was completed by adolescents and by their teachers. RESULTS: Findings revealed high rates of emotional and physical maltreatment. Reliance on emotion-focused or avoidant coping strategies was associated with exposure to maltreatment. Use of maladaptive coping also predicted emotional difficulties in the respondents. CONCLUSIONS: Coping strategies are an important indicator of psychosocial functioning in adolescents who have experienced maltreatment. Identification of coping styles can augment the assessment of at-risk adolescents. Emotion-focused strategies, in particular, appear to be widely used by young people from non-Western cultural backgrounds.     

Prevalence and determinants of post-traumatic stress disorder,anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti,four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD = 2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.     

Social capital,affect balance and personal well-being among teachers in Israel and Palestine

Informed by a perspective centred on psychological health and well-being, the present research investigated whether teachers’ overall well-being was influenced by their affect balance, as well as the extent to which both affect and well-being are influenced by social capital, in conflict-ridden areas such as the occupied Palestinian Territories (Gaza Strip and West Bank). The study involved three cohorts of Palestinian teachers working in Israel, Gaza and the West Bank, respectively (N = 153). Dynamics of social exclusion, religious difference, educational disparity, poor educational standards and a lack of opportunity are factors affecting Palestinian teachers in both Israel and the occupied Palestinian territories. The results supported the hypothesis that emotional balance directly influences teachers’ well-being. Teachers with higher levels of positive affect reported greater personal well-being than those with higher levels of negative affect. Social capital also positively influenced teachers’ personal well-being, both directly, and indirectly by fostering positive emotions. These results suggest that availability of community resources plays a key role in promoting teachers’ well-being.     

Factors associated with the type of violence perpetrated against adolescents in the state of Pernambuco,Brazil

To analyze the factors associated with the types of violence against adolescents reported in Pernambuco, Brazil, from 2009 to 2012. Prevalence study conducted through an electronic database from the Violence Surveillance Official System in a population of 5259 adolescents (aged 10–19 years). Poisson regression was used, with significance level at 5%. There was a significant increase of 204% in the number of violence reports, and the number of reporting units increased by 92.6%. When separately evaluated, physical violence was the most prevalent type, accounting for 44.7% of the reports. Taking as independent variables the age range of 15–19 years, female, having no disability, and public roads as place of occurrence, the positively and independently associated factors were: male gender (OR 1.5, 95% CI 1.4–1.6) with physical violence; having deficiency (OR 1.7, 95% CI 1.5–2.0) with psychological violence; age range of 10–14 years (PR 2.4, 95% CI 2.2–2.6) with sexual assault; and male (OR 3.9, 95% CI 2.0–7.5), having disabilities (PR 4.6, 95% CI 2.7–9.7), and occurrence in residence (PR 2.8, 95% CI 1.3–6.1) with neglect. Age between 10 to 14 years was associated with the occurrence of sexual assault; male with the occurrence of physical violence and neglect; having disabilities with psychological violence and neglect; and occurrence in the residence was associated with neglect.     

Society,individual, family,and school factors contributing to child mental health in war: The ecological-theory perspective

Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers’ practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10–13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children’s mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.     

Educational Attitudes and Trends in Palestine

This paper reports the findings of a study of 7000 Palestinian ninth-grade students living in the West Bank and Gaza Strip. Information is presented concerning educational aspirations, school performance and suggestions for strengthening the Palestinian school system. The impact of the intifada, the popular uprising which resulted in the Oslo Agreement, on the students' performance is also ascertained. The data were collected in 1994 and 1995 from ninth-grade students attending all 64 United Nations Relief and Works Agency (UNRWA) schools in the West Bank. UNRWA schools only offer education up to the ninth grade. In addition, information was collected from a sample of 2000 ninth-grade students attending UNRWA schools in Gaza. Finally, a sample of 2000 ninth-grade students attending schools operated by the Palestinian Authority was also surveyed. We were unable to obtain access to PA schools in the West Bank. The response rate among students in completing the Arabic questionnaire was 95%. Questionnaires were also obtained from over 90% of the students' mothers and fathers. The results demonstrate that Palestinian students have exceptionally high educational aspirations in spite of living under Israeli occupation and in dire poverty. We discovered the students work hard in school and are supported by their parents. Interestingly, intifada participation was not related to school performance as those who were heavily involved in the conflict earned just as good grades as those who did not participate. Sadly, these youth realize that their lofty educational aspirations are not likely to be fulfilled because of their families' poverty and the disruptive influence of the Israeli occupation.     

The rates of child sexual abuse and its psychological consequences as revealed by a study among Palestinian university students.

OBJECTIVES: The study aimed to achieve the following two objectives: First, it sought to examine the rates of sexual abuse in Palestinian society at three ages (12 years or less, 12-16 years, and 16 + years) by three perpetrators (a family member, a relative, and a stranger). Second, the study sought to assess some psychological implications of sexual victimization. METHOD: A cross-sectional survey was conducted among 652 Palestinian undergraduate students from the Palestinian Authority. A revised version of Finkelhor's scale was utilized to measure sexual abuse, and a revised and culturally adjusted version of Derogatis and Melisaratos' Brief Symptoms Inventory was used to measure nine psychological symptoms. RESULTS: The rates of sexual abuse among Palestinian students fall within the range of the problem in many other societies. Similar rates of abuse were found among female and male students. Moreover, sexually abused participants expressed significantly higher levels of psychoticism, hostility, anxiety, somatization, phobic anxiety, paranoid ideation, depression, obsessive-compulsiveness, and psychological distress compared with their nonabused counterparts. Sexual abuse by different perpetrators at different ages significantly explained between 20.7% and 35.8% of the variance in these psychological symptoms. CONCLUSIONS: The results provide strong support for the argument that sexual abuse exists in Palestinian society, as well as for the hypothesis that sexual abuse has a strong psychological impact on victims. Furthermore, the results highlight the need for further research into different aspects and dimensions of the problem in Arab societies.     

Depression,anxiety and PTSD in sexually abused adolescents: Association with self-efficacy,coping and family support

Sexual abuse has the potential to generate serious emotional consequences for its victims, but there is high variability in the symptoms reported by different victims. Therefore, it is necessary to ascertain the factors associated with the symptoms presented by sexual abuse victims. The aim of the study was to use a single model to evaluate the relationship between sexual abuse characteristics (frequency, violence, relation with the aggressor and physical commitment), cognitive and behavioral factors (self-efficacy, active coping and perceived family support) and internalizing symptoms (anxiety, depression and posttraumatic stress) in a group of sexually abused adolescents. The participants included 106 female adolescent victims of sexual abuse (M = 14.25 years, SD = 1.74). The results of a path analysis indicated that sexual abuse characteristics were unrelated to symptomatology. Only a negative relationship was observed between the victim’s relationship with the aggressor and PTSD symptomatology. The violence of the sexual abuse was negatively related to self-efficacy, and self-efficacy was positively related to active coping and negatively related to symptomatology. Finally, the perception of family support was positively related to self-efficacy and negatively related to symptomatology. These results suggest the need to consider the studied factors in the process of psychotherapy with victims of sexual abuse.     

Physical violence and psychological aggression towards children: five-year trends in practices and attitudes from two population surveys

OBJECTIVE: To present prevalence rates of child psychological aggression and physical violence from a population survey conducted in 2004 and to compare the rates with the rates obtained in the 1999 edition of the survey. METHODS: The survey used a randomly generated telephone number methodology. Interviews were conducted using a computer-assisted telephone interview system with a representative sample of 3,148 mothers living in Quebec province, Canada. Responses relating to psychological aggression, minor and severe physical violence were collected using the Parent-Child Conflict Tactics Scales. RESULTS: Eighty percent of the mothers reported the use of psychological aggression towards a child by an adult living in the household, 43% reported at least one episode of minor violence, and 6% reported at least one episode of severe physical violence. When compared to the 1999 surveys, mothers reported 5% less minor physical violence in 2004, a result that is counterbalanced by a similar significant increase in the report of repeated psychological violence towards children in a year. Results also reveal a significant decrease in attitudes favoring the use of violence for discipline purpose between 2004 and 1999. CONCLUSIONS: The trends observed in violence towards children over the 5-year period may partly be attributed to a change in mother's attitudes concerning methods of disciplining children. Findings support the need to promote alternative methods of firm discipline that do not involve violence.     

Socialization of coping with community violence: influences of caregiver coaching, modeling, and family context

A socialization model of coping with community violence was tested in 101 African American adolescents (55% male, ages 9-13) and their maternal caregivers living in high-violence areas of a mid-sized, southeastern city. Participants completed interviews assessing caregiver coping, family context, and child adjustment. Caregiver-child dyads also discussed a film clip depicting community violence. Parental coaching (caregivers' strategies suggesting how to cope) and child-reported coping were coded from the discussion. Coaching, modeling (caregivers' own coping), and family context each contributed to children's coping with violence. Children's problem-focused coping in response to violence had the strongest associations with changes in their adjustment 6 months later. Implications for interventions with youth and families are discussed.     

哈马斯欢庆胜利，声称“解放”了加沙地带

巴勒斯坦伊斯兰抵抗运动——哈马斯，宣布控制了加沙地区的主要安全武装力量，解放了加沙地区。受西方国家支持的巴勒斯坦民族权力机构主席阿巴斯和他的法塔赫政府，如今仍有忠心耿耿的武装力量控制着加沙地区其它三个包括总统府在内的重要基地。但一名哈马斯高官仍然认为持续六天的武装冲突对哈马斯来说是一个胜利。哈马斯加沙地区发言人萨米·阿布·祖里告诉路透社：     

Internalizing and externalizing symptoms among Palestinian adolescents from Israel as consequences of their exposure to community violence: Are they moderated by their self-efficacy and collective efficacy?

This article presents the findings of a study that examined the rates and the consequences of exposure to community violence (ECV) as reflected in witnessing and experiencing such violence, among Palestinian adolescents from Israel. In particular, it examined the extent to which these adolescents exhibit high levels of internalizing and externalizing symptoms as consequences of such exposure, and the extent to which self-efficacy and collective efficacy moderate these consequences. A systematic random sample of 760 Palestinian adolescents in Israel (320 boys, and 440 girls) filled out a self-administered questionnaire. The results show that most of the adolescents had witnessed community violence during the last year and during lifetime, and more than one third had directly experienced such violence during their lifetime compared with 19.6% during the last year. Boys were exposed to community violence more often than girls. Moreover, participants' ECV predicted high levels of externalizing and internalizing symptoms. Hierarchical regression analysis revealed that collective efficacy moderated the correlation between experiencing community violence and internalizing symptoms, whereas self-efficacy moderated the correlation between witnessing community violence and externalizing symptoms. There is a need for providing support for youth from close adults as well as from formal and informal resources in the community before and after their ECV.     

Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors

OBJECTIVE:This research examines the understudied issue of gender differences in disclosure, social reactions, post-abuse coping, and PTSD of adult survivors of child sexual abuse (CSA). METHOD:Data were collected on a cross-sectional convenience sample of 733 college students completing a confidential survey about their demographic characteristics, sexual abuse experiences, disclosure characteristics, post-abuse coping, and social reactions from others. RESULTS:Female students reported greater prevalence and severity of CSA, more distress and self-blame immediately post-assault, and greater reliance on coping strategies of withdrawal and trying to forget than male students. Women were more likely to have disclosed their abuse to others, to have received positive reactions, and to report greater PTSD symptom severity, but were no more likely to receive negative reactions upon disclosure than men. Women delaying disclosure had greater PTSD symptom severity, whereas men's symptoms did not vary by timing of disclosure. Additional regression analyses examined predictors of PTSD symptom severity and negative and positive social reactions to abuse disclosures. CONCLUSIONS:Several gender differences were observed in this sample of college students in terms of sexual abuse experiences, psychological symptoms, coping, PTSD, and some aspects of disclosure and social reactions from others.     

Posttraumatic stress disorder and emotion dysregulation among Syrian refugee children and adolescents resettled in Lebanon and Jordan

BackgroundSince the outbreak of the conflict in Syria, many people, including children and adolescents, have fled their homes into neighboring countries. Little research exists on the psychosocial adjustment of refugee children and adolescents resettled in Lebanon and Jordan.ObjectiveThis study investigated the prevalence and predictors of PTSD and emotion dysregulation in Syrian refugee children and adolescents who resettled in Lebanon and Jordan. It was hypothesized that a combination of pre-trauma variables (age and gender), trauma-specific variables (traumatic events and time spent in host country, and host country), and post-trauma variables (coping strategies, family relationships, and school environment) would be associated with PTSD and emotion dysregulation.Participants and SettingParticipants were 1000 Syrian refugee children and adolescents aged 7–18 years attending formal and non-formal schools representing various governorates in Lebanon and Jordan.MethodsThe trauma exposure scale, DSM-IV criteria for the assessment of PTSD, the Difficulties in Emotion Regulation Scale Short Form, Kidcope, Family relationship scales, and school environment scale were administered in an interview format with children and adolescents at school by two trained psychologists. Multivariate binary logistic regression was used to predict PTSD whereas hierarchical multiple regression was used to predict emotion dysregulation.ResultsResults indicated that 45.6% of the refugees have developed PTSD with excessive risk for comorbidity with emotion dysregulation. Emotion dysregulation was reported by older refugee children and adolescents. The prevalence of PTSD was higher in refugee children and adolescents who had resettled in Lebanon than for those who had resettled in Jordan. Refugee children and adolescents who were exposed to higher levels of war atrocities evidenced the greatest prevalence of PTSD and emotion dysregulation. PTSD symptomatology and emotion dysregulation in children and adolescents varied according to coping styles, family relationships, and school environment. Both decreased significantly with the passage of time spent in host country.ConclusionsThe results may be used to formulate cognitive–behavioral coping interventions that can lead to optimal developmental outcomes in the posttrauma environment.     

The mediating role of stigmatization in the mental health of adolescent victims of sexual violence in Eastern Congo

This study aims to explore the factors that explain the mental sequelae of war-related sexual violence and focuses in particular on the role of stigmatization. Drawing on a large-scale quantitative survey undertaken in the war-affected region of eastern Democratic Republic of the Congo, we analyze how stigmatization mediates the mental health impact of sexual violence on adolescent girls who were victims of rape. Twenty-two secondary schools were randomly selected out of a stratified sample in Bunia, Eastern Congo. In a cross-sectional, population-based survey, 1,305 school-going adolescent girls aged 11–23 completed self-report measures assessing war-related traumatic events, experiences of sexual violence, stigmatization, and mental health symptoms. Of the 1,305 participants, 38.2% (n = 499) reported experiences of sexual violence. Victims of sexual violence reported more war-related traumatic events and more stigmatization experiences. Several hierarchical regression analyses examined the mediating impact of stigmatization on the relationship between sexual violence and mental health outcomes, thereby controlling for sociodemographics (age, parental availability, and socioeconomic status) and war-related traumatic exposure. Our findings show that this stigmatization largely explains the mental health impact of sexual violence, in particular, on adolescent girls’ reported symptoms of depression (full mediation) and posttraumatic stress (avoidance and total PTSD: full mediation; hyperarousal: partial (40%) mediation). No evidence of mediation by stigmatization was found for symptoms of anxiety and intrusion. Stigmatization plays thus an important role in shaping the mental sequelae of sexual violence, a finding with major consequences for clinical practice.     

The rates and correlates of the exposure of Palestinian adolescents to family violence: toward an integrative-holistic approach

OBJECTIVES: First, to examine the rates of Palestinian adolescents' exposure to (i.e., witnessing and experiencing) different patterns of psychological aggression and physical violence in their families of origin; and second, to examine the correlation between this exposure and sociodemographic characteristics, parents' psychological adjustment problems, and family exposure to political stressors. METHOD: A cross-sectional survey was carried out among a sample of 1,185 Palestinian secondary school students. RESULTS: The study reveals very alarming rates of witnessing interparental and parent-to-sibling aggression and violence, and high rates of experiencing aggression and violence by parents and siblings during childhood and adolescence. In addition, these rates were found to be intercorrelated, and correlated significantly with several sociodemographic characteristics such as parents' levels of education, place of residence, family size, religious affiliation, family income, and housing conditions, as well as with parents' psychological adjustment problems and with family exposure to political stressors. CONCLUSIONS: The results of the study reveal strong evidence that emphasizes the importance of studying violence in the family from an integrative, comprehensive, and ecological perspective that incorporates intrapersonal traits, family stress theory, family resources theory, social learning theory, and sociological and environmental factors, to explain the risk factors and predictors of violence in the family.     

Course of depression and anxiety symptoms during the transition to parenthood for female adolescents with histories of victimization

The aim of the current study was to increase understanding of how victimization history impacts the longitudinal course of depression and anxiety in a sample of 55 adolescents emerging into parenthood. Adolescents were interviewed about their victimization experiences during their second trimester of pregnancy, and interviews were subsequently classified according the Maltreatment Classification Scale (Barnett, Manly, & Cicchetti, 1993). Adolescents reported on their symptoms of depression and anxiety prenatally and 6 and 12 months postpartum. Growth curve modeling revealed that, on average, there was a steady linear decline in depression and anxiety symptoms across the transition to parenthood, with a rate of change of 25% and 20%, respectively, from the prenatal assessment to 12 months postpartum. Sexual abuse history attenuated the likelihood of a decrease in depressive symptoms over time. Neglect history was associated with higher prenatal levels of anxiety, as well as a steeper decline in anxiety symptoms over time. Future research is needed to determine the role of poly-victimization in predicting the onset and change of depression and anxiety symptoms. Findings from the current study have the potential to aid in the design of preventative and intervention efforts to reduce risks of mental health difficulties in adolescent parents.