Cumulative Effects of Exposure to Violence on Posttraumatic Stress in Palestinian and Israeli Youth

Abstract

Objective We examine cumulative and prospective effects of exposure to conflict and violence across four contexts (ethnic-political, community, family, school) on post-traumatic stress (PTS) symptoms in Palestinian and Israeli youth. Method Interviews were conducted with 600 Palestinian and 901 Israeli (Jewish and Arab) children (ages 8, 11, and 14) and their parents once a year for three consecutive years. Results Palestinian children, males, and older youth were generally at greatest risk for exposure to conflict/violence across contexts. Regression analysis found unique effects of exposure to ethnic-political (Palestinian sample), school (Palestinian and Israeli Jewish samples), and family conflict/violence (Israeli Arab sample) during the first two years on PTS symptoms in year 3, controlling for prior PTS symptoms. Cumulative exposure to violence in more contexts during the first two years predicted higher subsequent PTS symptoms than did exposure to violence in fewer contexts, and this was true regardless of the youth’s level of prior PTS symptoms. Conclusions These results highlight the risk that ongoing exposure to violence across multiple contexts in the social ecology poses for the mental health of children in contexts of ethnic-political violence. Researchers and mental health professionals working with war-exposed youth in a given cultural context must assess both war- and non-war-related stressors affecting youth. Based on this assessment, interventions may not be limited to individual-based, war-trauma-focused approaches, but also may include school-based, community-based, and family-level interventions.

An application of an ecological framework to understand risk factors of PTSD due to prolonged conflict exposure: Israeli and Palestinian adolescents in the line of fire.

“…Each of the seven studies found a positive relationship between political violence exposure to and increased risk of PTSD in both populations (Al-Krenawi et al, 2009; Dubow, Boxer, et al, 2012; Dubow, Huesmann, et al, 2012; Hamama-Raz, Solomon, Cohen, & Laufer, 2008; Lavi & Solomon, 2005; Pat-Horenczyk et al, 2009; Schiff et al, 2012). …”

“…Three studies examined the importance of school, peer and family relations as protective factors against PTSD symptom severity (Elbedour et al, 2007; Punamäki et al, 2001; Thabet et al, 2009). Three studies showed that school and family violence was associated with greater PTSD symptoms (Al-Krenawi, Graham, & Sehwail, 2007; Dubow et al, 2009; Dubow, Boxer, et al, 2012). One study noted that higher maternal love and caring was associated with PTSD symptom severity (Punamäki et al, 2001) .…”

“…One study showed that among Palestinians, greater school violence was related to PTSD symptom severity (Dubow, Boxer, et al, 2012). …”

Family quality of life and child psychological well-being in Palestine: A pilot case study

“…Numerous studies highlight the risk of poor mental health outcomes among children growing up amidst military and political violence, particularly within the diagnostic category of posttraumatic stress disorder (PTSD) (Barber & Schluterman, 2009a, 2009bDubow, Huesmann, et al, 2012;Kohrt et al, 2008).…”

Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study

“…In the Occupied Palestinian Territories and Jerusalem, a cohort of 600 children in 3 initial age cohorts (8,11, and 14 years old) has been followed over 3 years to study the relationship of exposure to political conflict with violence in the family, community, and school to posttraumatic stress (PTS) symptoms and aggressive behavior. 4,5 Findings have documented both the cumulative effects of exposure to political violence and the need to examine and understand the full spectrum of violence exposure and the dynamics underway between community and familial violence and stress that shape mental health and adjustment in war-affected youth. In Northern Ireland, a study of 700 mother-child dyads in both Protestant and Catholic neighborhoods found that sectarian community violence was associated with elevated family conflict as well as children's reduced security about multiple aspects of their social environment (family, parent-child relations, and community).…”