Samir Qouta

Resiliency factors predicting psychological adjustment after political violence among Palestinian children

The effects of cognitive capacity, perceived parenting, traumatic events, and activity, which were ” rst measured in the midst of the political violence of the Intifada in 1993, were examined on post-traumatic stress disorder (PTSD), emotional disorders, school performance, and neuroticism three years later in more peaceful conditions among 86 Palestinian children of 14.04 ± 0.79 years of age. The results showed, ” rst, that PTSD was high among the children who had been exposed to a high level of traumatic events and had responded passively (not actively) to Intifada violence. Discrepant perceived parenting was also decisive for adjustment: Children who perceived their mothers as highly loving and caring but their fathers as not so showed a high level of PTSD. High intellectual but low creative performance was also characteristic of the children suffering from emotional disorders. Second, the hypothesis that cognitive capacity and activity serve a resiliency function if children feel loved and nonrejected at home was confirmed. Third, neuroticism decreased significantly over the three years, especially among the children who had been exposed to a high number of traumatic events.

Prevalence and determinants of PTSD among Palestinian children exposed to military violence.

Abstract.The prevalence and determinants of PTSD were assessed among 121 Palestinian children (6–16 years; 45% girls and 55% boys) living in the area of bombardment. The mothers (21–55 years) and the children themselves reported their exposure to military violence (being personally the target of violence or witnessing it towards others) and symptoms of posttraumatic stress disorders (PTSD: intrusion, avoidance and hypervigilance). The results showed that 54% of the children suffered from severe, 33.5 % from moderate and 11 % from mild and doubtful levels of PTSD. Girls were more vulnerable; 58% of them suffered from severe PTSD, and none scored on the mild or doubtful levels of PTSD. The child’s gender and age, mother’s education and PTSD symptoms were significant, and the exposure to traumatic experiences marginally significant determinants of children’s PTSD symptoms. The most vulnerable to intrusion symptoms were younger girls whose mothers showed a high level of PTSD symptoms, whereas those most vulnerable to avoidance symptoms were children who had personally been targets of military violence and whose mothers were better educated and showed a high level of PTSD symptoms. The results are discussed in the context of military violence interfering with the protective function of family and home.

Child development and family mental health in war and military violence: The Palestinian experience

The article reviews developmental research among Palestinians living in Gaza. The aims are, first, to analyze how exposure to traumatic events associates with childrens mental health and their cognitive, emotional and social development. Second, we aimed to model familial and symbolic processes that can either harm or protect the mental health of children. Third, we wanted to learn who the resilient children are in conditions of war and military violence. The reviewed research has been conducted in the context of a Palestinian non-governmental organization, the Gaza Community Mental Health Programme, during the political upheavals involving hopes for peace and intensive war and violence: the First Intifada (1987—1993), the Palestinian Authority rule (1994— ) and the Second Al Aqsa Intifada (2001— ). The results show that life threat, violence and losses form a risk for increased psychological distress. There are, however, a myriad of child, family and society related factors and psycho-socio-physiological processes that protect child development and mental health. They include, e.g. loving and wisely guiding parenting, childrens flexible and high cognitive capacity, flexible and multiple coping strategies and narrative and symbolic nocturnal dreaming, as well as social support and good peer relations. Different models explain psychological distress and positive resources, including child resilience. Exposure to trauma is crucial in predicting distress, while familial and developmental issues are important in building resilience. Childrens conscious and unconscious cognitive-emotional processes are crucial for underlying mental health and knowledge about them is important in tailoring evidence-based preventive interventions among war victims.

Mother-Child Expression of Psychological Distress in War Trauma

The aims of this study were, first, to examine how exposure to war trauma, maternal neuroticism and psychological distress are associated with child psychological distress, and, second, whether good maternal mental health and low neuroticism can moderate the negative impact of war trauma on child mental health. Third, we examined whether mother-child dyads’ psychological distress was dependent on who was the main war trauma victim in the family: the mother, the child or both. Fourth, we tested whether mother-child dyads express similar or different symptoms. The sample consists of 121 Palestinian children (aged 6-16 years; 45% girls and 55% boys), and their mothers (aged 21-55 years) living under conditions of military violence and war in Gaza. Child psychological distress was measured using the CPTS-RI (child-reported) and Rutter Parent Questionnaire (mother-reported), and mothers’ mental health was measured using the SCL-90-R. The results failed to show any moderating effect of good maternal mental health or low neuroticism in protecting child mental health from negative impact of war trauma. The main effects showed that the child’s young age, war trauma and poor maternal mental health were associated with children’s internalizing symptoms, and male gender, maternal neuroticism and poor mental health with children’s externalizing symptoms. There were gender differences in psychological distress depending on whether the mother, the child or both were the main war trauma victim in the family: girls showed particularly high psychological distress when their mothers were exposed to war trauma (family systems model), whereas boys showed high levels of distress when both they themselves and their mothers were exposed to war trauma (accumulative impact model). Similarities were confirmed in dyadic symptom expression: significant associations were found between mothers’ depressive and children’s internalizing symptoms, and between mothers’ hostile and children’s externalizing symptoms.

Adult attachment, posttraumatic growth and negative emotions among former political prisoners

Abstract Although traumatic events are generally associated with negative psychosocial consequences, trauma survivors also report positive changes in themselves, human relationships and spirituality. Our aims are, first to study associations between exposure to torture and ill-treatment and posttraumatic growth and negative emotions, and second, to examine the role of adult attachment in moderating the association between exposure and positive growth. The participants were 275 Palestinian men imprisoned in a political context. They completed the Posttraumatic Growth Inventory (PTGI), adult attachment questionnaire (AAQ) and reported exposure to traumatic events. The results show that a high level of torture and ill-treatment was associated with a low level of posttraumatic growth and a high level of negative emotions. However, adult attachment style moderated that association, among men with secure attachment exposure to torture and ill-treatment was associated with a high level of posttraumatic growth, whereas among insecure-avoidant men exposure was associated with relatively higher level of negative emotions. Main effects show that men with secure attachment reported generally more posttraumatic growth, i.e., personal strength, positive affiliation to others and spiritual change, while insecure-preoccupied attachment was associated with negative emotions. Finally, favourable socio-economic characteristics were associated with posttraumatic growth: men with high professional position, steady employment, and good economic situation reported more personal strength and positive affiliation to others. Of demographic factors, only education was associated with attachment, secure men being more educated.

The Relations Between Traumatic Experiences, Activity, and Cognitive and Emotional Responses Among Palestinian Children

Abstract The relations between the level of traumatic experiences, degree of active participation in the Intifada, and cognitive and emotional responses were studied among 108 Palestinian children of 11–12 years of age in the Gaza Strip. The results showed that the more traumatic experiences the children had and the more they participated in the Intifada, the more concentration, attention, and memory problems they had. Traumatic experiences also increased neuroticism and risk-taking, and Intifada participation decreased self-esteem. Childrens active participation in the Intifada could not protect children from developing emotional problems, as was originally assumed. The highest level of neuroticism was found among active boys who were exposed to many traumatic experiences.

Trauma and mental health of children in Gaza.

There is a lack of longitudinal research on the impact of prolonged exposure to militarized violence and threat on the developmental process of children the future mental health of children intellectual maturation world view and tendency to behaviors such as risk taking. This editorial refers to documentation of the impact of the intifada (uprising) on the mental health of a random sample of 1200 children aged 7-15 living in Gaza. The Gaza community mental health program which has jurisdiction over the 700000 refugees in Gaza conducted the inquiry. The findings for 1992 showed that 1044 children had been tear-gassed; 853 had been subjected to night raids on their homes by soldiers; 624 had viewed assaults on family members; 420 had been beaten; 228 had been detained; and 192 had been injured including bullet wounds and broken limbs. Their experiences included viewing soldiers shooting within school grounds. Schools had been shut down by Israeli military authorities regularly and for indefinite periods. In general children experienced a high prevalence of nervousness fears restlessness sleep disturbance nightly bedwetting and psychosomatic symptoms. Teachers reported childrens behavior as aggressive with reduced concentration and performance. Observations were made that those who identified with the intifada or confronted soldiers had higher self-esteem. These findings about self-esteem were also observed by South African psychologists on the children of Soweto. Violent and unruly acts of soldiers set a model for childrens disrespect for the traditional authority of parents and teachers. There were 70 cases of diagnosed posttraumatic stress disorder which required treatment. Almost 50% of these cases had experienced multiple exposure to the aforementioned traumatic experiences. Common symptoms were recurrent frightening memories nightmares weeping social withdrawal loss of appetite aggressive play and phobias about the dark or soldiers. There were 12 with conversion fits and a distress mode which is not uncommon in an Arab cultural setting and has been documented among children in many conflict zones.

Relationships between Traumatic Events, Children's Gender, and Political Activity, and Perceptions of Parenting Styles

The associations between traumatic events, children’s gender and political activity, and parenting styles were examined among 108 Palestinians of 11-12 years of age. The results showed that the more the children were exposed to traumatic events, the more they perceived both their parents as strictly disciplining, rejecting, and hostile, and their mothers as more negatively evaluating. The boys perceived both their parents as treating them more negatively than the girls did. Affectionate parenting, such as intimacy and love, for its part, was not associated with traumatic events, and did not vary according to the child’s gender or political activity. The gender of the child affected the association between traumatic events, political activity, and perceived parenting. Traumatic events increased perceived parental rejection and hostility only among the boys, and perceived strict disciplining only among the girls. Although politically active children perceived both of their parents as more negative in general, in the families exposed to a high level of traumatic events, passive boys perceived their fathers as more rejecting and hostile than active boys did. It is suggested that mothers and fathers rear girls restrictively and with greater attention, and boys with rejection, when the family faces traumatic events. In exposed families, fathers also tend to discourage boys’ political passivity and apparently encourage activity.

The relation of appraisal, coping efforts, and acuteness of trauma to PTS symptoms among former political prisoners

We examined how trauma-specific appraisals and coping efforts mediate between traumatic experiences, acuteness of trauma, and length of imprisonment and posttraumatic stress symptoms (PTS) among 103 Palestinian former political prisoners. The findings provide support for both direct and mediated models of trauma. The acuteness of trauma (time since release), appraisal of prison experience as harmful and involving loss, and use of both emotion- and problem-focused coping efforts were associated with high levels of PTS symptoms. Torture and ill-treatment had a direct association with intrusion, and recent release from prison with avoidance symptoms. Acuteness of trauma turned out to be important in the coping and symptom association: emotion-focused coping was associated with a low level of PTS symptoms in the long run, whereas problem-focused coping was associated with a low level of PTS symptoms in the short run.

The impact of the peace treaty on psychological well-being: A follow-up study of Palestinian children

This research examined the impact of the Israeli-Palestinian peace treaty and Palestinian childrens perception of it on their self-esteem and neuroticism. We also studied the relative importance of earlier exposure to traumatic experiences and psychosocial resources indicated by the childrens creativity, intelligence and political activity in influencing their psychological well-being after the peace treaty. The sample used was a follow-up group of 64 Palestinian children of 11-12 years of age, living in the Gaza Strip. The results showed that the level of neuroticism was significantly lower after the peace treaty than before. The childrens earlier exposure to traumatic experiences was still significantly related to high neuroticism and low self-esteem after the peace treaty. Acceptance of the treaty and participating in the subsequent festivities mitigated the negative impact of the traumatic experiences on their well-being. Increased neuroticism and decreased self-esteem were found only among children who refused to accept the peace treaty and did not participate in the festivities. Creativity and Intifada activity promoted their post-peace treaty well-being, in terms of psychosocial resources. The more creative the children were, the more their neurotic symptoms decreased because of the treaty and the higher self-esteem they had after it. The more active the children were during the Intifada, the more their self-esteem increased because of the treaty.