Palestinian youth of the Intifada: PTSD and future orientation

Psychological health benefits of focusing on the 'here and now' versus a limited future during the COVID-19 pandemic

Objective: College students' psychological health has been negatively impacted by the COVID-19 pandemic (e.g., 1). We investigated whether students' psychological health was related to their orientation toward the future and mindfulness while considering previously-identified correlates of psychological health such as perceived risks of COVID-19. Participants: Participants were 278 college students at a mid-Atlantic US university in November and December 2020. Method: Using a self-report survey, we measured three aspects of psychological health (depression, anxiety, and stress) and future orientation, mindfulness, perceptions of risk, and the personal impact of COVID-19 on students' lives. Results: Multiple linear regression analyses showed that greater mindfulness and focusing less on a limited future were related to less depression, anxiety, and stress. Conclusions: Encouraging students to be mindful and focus on the present instead of focusing on a limited future may be beneficial for their psychological well-being during the COVID-19 pandemic.

Growing Up on the Edge: A Community-Based Mental Health Intervention for Children in Gaza

The Gaza Strip is a notoriously high-conflict area, but few large-scale studies have examined the rates of psychiatric distress and emotional/behavioral problems among Gaza youth, and there are few trauma-informed, scaleable intervention options. Studies in existence have used smaller samples or have examined focal problems such as posttraumatic stress disorder (PTSD) or aggression. Here, we examine the mental health burden of young individuals (ages 8-13) in Gaza across a broad range of symptoms, and demonstrate the impact of a community-based, trauma-informed program, Eye to the Future. At the outset of this supportive youth program, over 2000 children and adolescent youth and their parents reported on child well-being using standardized measures with established global norms (the Child Behavior Checklist and Youth Self Report). These measures examine symptoms broadly (e.g. anxiety, depression, social problems, attention problems, aggression, etc.). Relative to U.S. population estimates, children in Gaza had between 2.5- and 17-times higher point prevalence of clinical mental health problems. The most significant clinical concern was anxiety, but overall, their symptoms were not confined to posttraumatic stress as a disorder and were instead broadly dispersed. However, these concerns were responsive to intervention: over the course of a six-month community psychosocial program, symptoms ameliorated, with approximately 50-70% showing reliable improvement at post-program (varying by measure). These gains were maintained in a 9-month follow-up. Future work should consider the broader mental health impact, beyond PTSD and aggression, and incorporate community supports into addressing mental health among children in the region.

Children's Resilience to Ongoing Border Attacks: The Role of Father, Mother, and Child Resources

To understand children's resilience to ongoing violent border attacks (low PTSD symptoms and internalizing/externalizing behavior problems, and high sense of coherence-SOC), this study examined a multidimensional model of protective resources. This model comprised factors at the family level (fathers'/mothers' coping strategies and SOC) and at the individual level (children's coping strategies and attachments with father/mother). Participants were 251 Israeli father-mother-child triads living near the border with Gaza (children ages 9-12 years). Preliminary analyses indicated children's prevalence of clinical PTSD was 6%. SEM analyses revealed the theoretical model's high fit with empirical data, χ2(1) = .00, p = .99, CFI = 1, TLI = 1, SRMR = .00, RMSEA = .00 [90% CI (.00, .00)]. More significant paths emerged between fathers' coping resources and children's resilience measures than for mothers' coping resources. Results also pinpointed the significant role of children's parental attachments and coping strategies. Discussion focused on the unique value of father, mother, and child risk/protective factors for explaining well-adjusted functioning among children living in conflict areas.

The association between callous-unemotional traits and suicide ideation among youth: A conditional process analysis

BACKGROUND

The relationship between callous-unemotional (CU) traits (the affective facet of psychopathy and the psychopathy that occurs during childhood and adolescence) and suicide ideation (SI) remains unclear. The mechanisms underlying this association still have a gap in the literature. The aims of this study were to determine whether and how callous-unemotional traits were associated with suicide ideation, and to evaluate the mediating effect of negative affect (includes irritability, depression, and anxiety) and the moderating effect of future orientation on the association.

METHODS

Data were extracted from a longitudinal study involving middle and high school students, with 1,913 students (55.3% girls) aged 11 to 19 years (14.9 ± 1.6 years) completing a self-reported online survey. The conditional process analysis was examined using Mplus 8.3.

RESULTS

We found that callous-unemotional traits positively predicted youths' current suicide ideation, with the observed positive relationship partly mediated by negative affect. However, callous-unemotional traits did not predict the worst-point suicide ideation, which indicated the connection fully mediated by negative affect. Furthermore, future orientation moderated these indirect effects.

LIMITATIONS

Use of self-report measures and cross-sectional design.

CONCLUSIONS

These findings provided evidence for current debates and conflicting conclusions, and set the foundation for future research, as well as implied the important intervention goals for reducing suicide ideation in youth.

Impact of COVID-19 and lockdown on mental health and future orientation among young adult asylum seekers in Italy: A mixed-methods study

The COVID-19 outbreak caused a worldwide health emergency which disproportionately affected migrants and ethnic minorities. Yet, little is known about the psychosocial effects of the pandemic among refugees and asylum seekers. This study used a convergent parallel mixed-method design to explore knowledge and opinions concerning COVID-19 and the impact of lockdown on perceived mental health and future orientation among 42 young adult asylum seekers residing in northeastern Italy. Participants took part in individual interviews comprising both qualitative and quantitative questions. Qualitative reports were analyzed using thematic content analysis, whereas descriptive statistics and paired sample t-tests were computed on quantitative data. Results indicated that most participants were correctly informed about the nature, origin, and spread of COVID-19, expressed moderate or high satisfaction concerning the clarity of communication about safety measures, and followed them most of the time. Worries about family in the home country, loneliness, fear for own and loved ones' health, and concerns about delays in the asylum application were the most frequently mentioned stressful events. Psychological and physical distress significantly increased, and positive future orientation significantly decreased during the lockdown. However, participants also emphasized the usefulness of instrumental support from social workers and exhibited a resilient attitude characterized by the acceptance of uncertainty, sense of connectedness, and positive outlook. Overall, findings suggest that the current emergency may exacerbate psychological vulnerabilities of asylum seekers due to continued existential uncertainty. Thus, individual and contextual assets should be strengthened to promote psychosocial adjustment and coping resources in the context of the pandemic.

A Person-centered Approach to Violence Exposure in Postwar Colombian Youth: Demographic Covariates and Positive Youth Development Outcomes

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth's postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.

“In the Middle, between Anxiety Victims and PTSD, There Are People That Have Some Kind of a Disorder That Has No Name Yet” Insights about the Traumatic Stress Consequences of Exposure to Ongoing Threat

Current diagnostic criteria for post-traumatic stress disorder (PTSD) do not include symptoms resulting from exposure to ongoing traumatic stress. Thus, existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. We aimed to enumerate the symptoms associated with ongoing exposure to stress and to evaluate the need for a new comprehensive tool designed to assess traumatic stress in these situations. Study methods included focus group sessions, interviews, and a content expert’s workshop. Thematic analysis yielded three main themes: 1. PTSD in its current definition does not capture the whole “traumatic picture” observed in ongoing exposure to threat, 2. Some DSM-5 criteria are not applicable in ongoing exposure to threat, 3. The need for a new tool or modifications of commonly used assessment tools. This study supports the notion that PTSD assessment practices are lacking when assessing traumatic stress in ongoing exposure to threat and highlights the need for a new tool specifically designed for these situations.

Trajectory of post-traumatic stress and depression among children and adolescents following single-incident trauma

OBJECTIVE

Post-traumatic stress disorder and depression have high comorbidity. Understanding their relationship is of clinical and theoretical importance. A comprehensive way to understand post-trauma psychopathology is through symptom trajectories. This study aims to look at the developmental courses of PTSD and depression symptoms and their interrelationship in the initial months post-trauma in children and adolescents.

METHODS

Two-hundred-and-seventeen children and adolescents aged between eight and 17 exposed to single-event trauma were included in the study. Post-traumatic stress symptoms (PTSS) and depression symptoms were measured at 2 weeks, 2 months and 9 months, with further psychological variables measured at the 2-week assessment. Group-based trajectory modelling (GBTM) was applied to estimate the latent developmental clusters of the two outcomes. Logistic regression was used to identify predictors associated with high symptom groups.

RESULTS

The GBTM yielded a three-group model for PTSS and a three-group model for depression. PTSS trajectories showed symptoms reduced to a non-clinical level by 9 months for all participants (if they were not already in the non-clinical range): participants were observed to be resilient (42.4%) or recovered within 2 months (35.6%), while 21.9% experienced high level PTSS but recovered by 9 months post-trauma. The depression symptom trajectories predicted a chronic non-recovery group (20.1%) and two mild symptom groups (45.9%, 34.0%). Further analysis showed high synchronicity between PTSS and depression groups. Peri-event panic, negative appraisals, rumination and thought suppression at 2 weeks predicted slow recovery from PTSS. Pre-trauma wellbeing, post-trauma anxiety and negative appraisals predicted chronic depression.

CONCLUSIONS

Post-trauma depression was more persistent than PTSS at 9 months in the sampled population. Cognitive appraisal was the shared risk factor to high symptom groups of both PTSS and depression.

Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis

Objective

We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population.

Methods

PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted.

Results

The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I² 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures.

Conclusion

We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.

Food insecurity, state fragility and youth mental health: A global perspective

Youth in fragile settings face disproportionate risks of experiencing food insecurity and poor mental health. Cross-national evidence is lacking on the association between food insecurity and mental health in youth populations, and on state fragility as a social determinant of these experiences. We analysed data from six cycles of the Gallup World Poll (2014-2019), an annual survey that contains multi-item scales of food insecurity, mental health problems and positive wellbeing. The analytic sample included 164,118 youth aged 15-24 years in 160 states. We linked individual responses to state-level data from the Fragile States Index-an aggregate measure of state vulnerability to collapse or conflict (coded: sustainable, stable, warning, or alert) and estimated adjusted relative risk (RR) of food insecurity as a function of state fragility. We then used linear regression to examine associations of state fragility and food insecurity with mental health and wellbeing. The prevalence of moderate or severe food insecurity rose from 22.93% in 2014 to 37.34% in 2019. State fragility (alert vs. sustainable) was related to an increased risk of food insecurity (RR = 2.28 [95% CI 1.30 to 4.01]), more mental health symptoms (b = 6.36 [95% CI 1.79 to 10.93]), and lower wellbeing (b = -4.49 [95% CI -8.28 to -0.70]) after controlling for state wealth and household income. Increased food insecurity (severe vs. none or mild) was uniquely related to more mental health symptoms (b = 18.44 [95% CI 17.24 to 19.64]) and reduced wellbeing (b = -9.85 [95% CI -10.88 to -8.83]) after state fragility was also controlled. Globally, youth experience better mental health where states are more robust and food access is more secure. The findings underscore the importance of strong governance and coordinated policy actions that may improve youth mental health.

Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats

BACKGROUND

Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria.

OBJECTIVES

To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties.

METHOD

We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS).

RESULTS

On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct.

CONCLUSIONS

These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.

Youth in Northern Ireland: Linking Violence Exposure, Emotional Insecurity, and the Political Macrosystem

Growing up in the aftermath of armed conflict puts youth at a higher risk for psychopathology—particularly in societies like Northern Ireland which continue to be characterized by intergroup tension and cyclical violence. This risk may be heightened during adolescence, when youth are beginning to explore their identities and are becoming more aware of intergroup dynamics in both their immediate communities and the broader society. It is also during this stage when youth increasingly witness or engage in antisocial behavior and sectarian activities. A series of studies in Belfast conducted by Cummings et al. (2014, Child Dev Perspect, 12(1), 16–38; 2019, J Clin Child Adolesc Psychol, 48(2), 296–305) showed that adolescents’ exposure to sectarian violence resulted in heightened emotional insecurity about the community and subsequent adjustment problems. Though the impact of direct exposure to violence is well documented, few studies have accounted for the influence of sectarianism that occurs outside of one's immediate environment. These influences may include the general climate surrounding events that are not experienced firsthand but are nonetheless salient, such as the overarching levels of tension between groups or societal discourse that is threatening to one's identity. These higher‐level influences, often referred to collectively as the macrosystem, are a necessary component to consider for adequately assessing one's socio‐developmental environment. Yet, measurement at this level of the social ecology has proven elusive in past work. The current study advances research in this area by using newspaper coding as a method of measuring the political macrosystem in Northern Ireland and assessing whether a tense or threatening climate serves as an added risk factor for youth living in Belfast.

In the current study, we measured sectarian violence at the level of the macrosystem by systematically collecting and coding newspaper articles from Northern Ireland that were published between 2006 and 2011 (N = 2,797). Each article was coded according to its level of overall political tension between Catholics and Protestants, threat to Catholics, and threat to Protestants. When aggregated, these assessments reflected the overarching trends in Catholic–Protestant relations during this period. In order to assess the association between these sociopolitical trends and the direct experiences of adolescents, the newspaper coding was linked with five waves of survey data from families (N = 999) in socioeconomically disadvantaged areas of Belfast. Using a series of multilevel moderation analyses, we then tested whether intergroup tension and ingroup threat moderated the relation between adolescents’ direct exposure to violence and their emotional insecurity. These analyses were followed by a thematic analysis of the coded newspaper articles in order to provide further context to the findings.

The results indicated that adolescents’ response to direct exposure to sectarian violence varied based on the political climate at the time of their interview. Overall, the adolescents’ emotional insecurity about the community increased with exposure to sectarian violence. During periods when the sociopolitical climate was characterized by high levels of intergroup political tension, this relation was slightly weaker—regardless of the adolescents’ ingroup (i.e., Protestant vs. Catholic). During periods when the sociopolitical climate was coded as threatening, this relation was weaker for Catholic adolescents. That is, high levels of macro‐level threat—particularly events coded as threatening for Protestants—seemed to be a protective factor for Catholic adolescents. Group differences were also found based on the adolescents’ cumulative amount of exposure to sectarian violence. As threat in the macrosystem increased, Catholic adolescents who were directly exposed to higher than average levels of sectarian violence became more emotionally secure, while Catholics with little to no exposure to violence became more insecure. Contrastingly, Protestant adolescents directly exposed to higher than average levels of sectarian violence were more insecure than Protestants with little to no violence exposure.

A thematic analysis of the newspaper articles revealed the categories of events that were viewed by coders as politically tense and threatening. Five primary themes emerged: ineffective policing and justice, family and community unrest, memories of violence, destabilized leadership, and organized paramilitary activity. Many of the articles coded as most threatening reported on a spike in attacks organized by dissident republican groups—that is, members of the Catholic community with, particularly hardline views. This may be pertinent to the finding that associations between sectarian violence exposure and emotional insecurity were exacerbated during this time for Protestants but not for Catholics. Findings from the thematic analysis provide a deeper examination of the context of events taking place during the study period, as well as their potential bearing on interpretation of the macro‐level effects.

In conclusion, these findings illustrate how one's response to the immediate environment can vary based on shifts in the political macrosystem. The current study thus contributes conceptually, empirically, and methodologically to the understanding of process relations between multiple levels of the social ecology and adolescent functioning. These results may further inform the design of future interventions and policies meant to lessen the impact of political violence. The methods used here may also be useful for the study of other contexts in which macrosystem effects are likely to have a salient impact on individual wellbeing.

Polyvictimization and Psychological Distress in Early Adolescence: A Mediation Model of Defense Mechanisms and Coping Styles

In the current study, we aim to examine the link between exposure to multiple traumatic events (polyvictimization), posttraumatic stress disorder (PTSD) symptoms (PTSS), and psychiatric symptomatology in early adolescence. Furthermore, we aim to explore the mediating roles of defense styles and coping styles in the associations between polyvictimization, PTSS, and psychiatric symptomatology. Data from a Danish national representative sample of 390 eighth-grade students with a mean age of 13.95 (SD = 0.37) years were used. Participants responded to validated self-report questionnaires in 2001. The dimensions of immature defense styles and emotional and avoidance coping mediated the positive associations between polyvictimization, PTSS, and psychiatric symptomatology. Serial multiple mediation indicated that the sum of exposure to traumatic events was significantly associated with more immature defense styles, associated with both high levels emotional and avoidance coping, which, in turn, were associated with high levels of PTSS and psychiatric symptomatology. Polyvictimization is related to adverse outcomes in early adolescence. Both immature defense styles and emotional and avoidance coping styles should be considered as risk factors for the development of psychological distress following exposure to multiple traumas.

The Role of Gender in the Associations Among Posttraumatic Stress Symptoms, Anger, and Aggression in Russian Adolescents

Symptoms of posttraumatic stress disorder (PTSD) have been linked to anger and aggressive behavior in adult and veteran populations. However, research on the associations among anger, aggression, and PTSD in adolescents is lacking, particularly regarding differences between the sexes. To address this research gap, we used self-report data from Russian adolescents (N = 2,810; age range: 13-17 years) to perform a full path analysis examining the associations between PTSD symptoms and the emotional (anger traits) and cognitive (rumination) components of anger as well as physical/verbal and social aggression, after adjusting for depressive symptoms. We also examined the interaction effects between PTSD symptoms and sex on anger and aggression. The results indicated that girls scored higher on measures of anger and PTSD symptoms, ds = 0.20-0.32, whereas boys scored higher on measures of physical and verbal aggression, d = 0.54. Clinical levels of PTSD symptoms were associated with anger rumination, β = .16, and trait anger, β = .06, and an interaction effect for PTSD symptoms and sex was found for aggression, whereby boys with clinical levels of PTSD symptoms reported more physical/verbal and social aggression, βs = .05 and .20, respectively. Our findings suggest that PTSD symptoms may have an important impact on anger, anger rumination, and aggression during adolescence. In particular, boys seem to have an increased risk for aggressive behavior in the presence of PTSD symptoms. The present results highlight the importance of taking anger and aggression into account when evaluating PTSD.

Contextualizing Cognitions: the Relation Between Negative Post-traumatic Cognitions and Post-traumatic Stress Among Palestinian Refugees

Negative post-traumatic cognitions (PTC) are a relevant factor in the development, persistence, and treatment of post-traumatic stress disorder (PTSD). Palestinian refugees live under challenging circumstances and have negative future prospects, so negative cognitions might be expected to prevail. It is uncertain whether findings on the relation between PTC and PTSD in other (non-refugee) populations can be generalized to the Palestinian refugee context. The first objective was to examine the degree to which endorsement of PTC in this sample differed from the endorsement observed in other samples. The second objective was to investigate whether PTC explain variance in PTSD symptomatology and are predictive of PTSD diagnostic status. In Palestinian refugees (N = 85, 51.8% female), PTSD symptoms and negative cognitions were assessed. One sample t tests and multiple logistic regression analyses were performed. Total PTC scores were significantly higher in the Palestinian sample than in reference samples. Negative cognitions explained significant variance in PTSD symptoms and probable diagnostic status. Findings support the relevance of PTC for PTSD symptoms and diagnosis in a Palestinian refugee sample, in line with the cognitive model for PTSD. This is especially relevant for researchers and clinicians working with refugees in conflict areas.

Positive School Climate as a Moderator of Violence Exposure for Colombian Adolescents

In Colombia, many adolescents have experienced violence related to the decades-long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence-affected youth through enhancements to school safety, connectedness, and services.

Dispositional orientation to the present and future and its role in pro-environmental behavior and sustainability

With our attitudes and behavior, which aim at promoting sustainable behavior, we face a temporal dilemma – a temporal conflict between short-term and long-term interests. Accordingly, psychological time is an essential variable in understanding how people decide between options of short-term self-interest, which can be experienced at present, and long-term common interest, such as sustainable development with an outcome that lies far in the future. Present feelings are often so powerful that considerations of future events are neglected. Individuals differ in their emphasis on present and future dimensions. A stronger future orientation and a mindful present orientation are positive predictors of sustainable behavior; hedonistic and impulsive present orientations are negative predictors. We discuss the concept of the balanced time perspective as the propensity to consciously switch among the time orientations of past, present, and future. Fitting with their overall psychological profile, individuals with a balanced time perspective might display a range of sustainable attitudes and behaviors.

Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review

This article provides a quantitative and conceptual review of emotion regulation difficulties in trauma-exposed young people, and informs future directions in the field. Despite long-standing interest in the influence of emotion regulation difficulties on different internalizing and externalizing psychiatric disorders in childhood, several questions remain unresolved with respect to children and adolescents with PTSD (post-traumatic stress disorder). Meta-analytic data from adult victims suggest that emotion regulation problems are associated with PTSD, but this has never been studied in children and young people. We therefore provide a conceptual review of features related to the phenomenology, assessment, severity and treatment of emotion regulation difficulties in trauma-exposed children and young people. We combine this with a meta-analysis of published literature. We searched studies in Medline, PsychINFO, and Embase databases based on pre-selected criteria. Eight hundred and eighty-six papers were identified and 41 were included. We found that children and adolescents with a diagnosis of PTSD reported more emotion regulation difficulties than those who did not develop PTSD, and that the overall association between the two symptom dimensions was moderately strong. We identify a number of research priorities: the development of instruments to assess emotion regulation difficulties in children, the design of studies that describe its prevalence in young epidemiological traumatized samples, its predictive role in the onset, severity and persistence of post-traumatic symptoms, and its relevance as a moderator, outcome or treatment target for young survivors.

Differences in posttraumatic stress characteristics by duration of exposure to trauma

Ongoing exposure of civilian populations to war and terror is associated with adverse responses beyond those specified in DSM-5 for PTSD. Current PTSD assessment practices are not fully sensitive to the complex symptomatic picture observed among individuals exposed to ongoing stress and are therefore limited for use in these situations. The current survey aimed to portray the posttraumatic characteristics most salient to ongoing exposure to political conflict. A questionnaire enquiring about various aspects of the posttraumatic consequences of ongoing exposure to political conflict as compared with those associated with a single exposure to trauma was disseminated to therapists throughout the country. Participants were asked to rank 75 posttraumatic characteristics for their relevance to each trauma type (about the symptom frequency and severity) and item mean scores were compared. The sample consisted of 66 responses valid for analysis. Our findings pinpoint some of the posttraumatic characteristics most salient to ongoing exposure to political conflict and highlight the complexity of the posttraumatic picture observed in these situations. Incorporating these in post trauma assessment tools will allow for the development of standardized, reliable definitions, which in turn will allow for more accurate diagnosis and more effective treatment protocols.

Psychological Aspects of the Israeli-Palestinian Conflict: A Systematic Review

Despite ongoing local and international peace efforts, the Jews, Arabs, and other residents of Israel and the Palestinian territories (i.e., the West Bank and Gaza) have endured decades of political, social, and physical upheaval, with periodic eruptions of violence. It has been theorized that the psychological impact of the Israeli-Palestinian conflict extends beyond the bounds of psychiatric disorders such as posttraumatic stress disorder (PTSD). Exposure to the ongoing conflict may lead to changes in the way Israelis and Palestinians think, feel, and act; while these changes may not meet the thresholds of PTSD or depression, they nonetheless could have a strong public health impact. It is unclear whether existing studies have found associations between exposure to the conflict and nonclinical psychological outcomes. We conducted a systematic review to synthesize the empirical research on the Israeli-Palestinian conflict and its psychological consequences. As a whole, the body of literature we reviewed suggests that exposure to regional political conflict and violence may have detrimental effects on psychological well-being and that these effects likely extend beyond the psychiatric disorders and symptoms most commonly studied. We found evidence that exposure to the conflict informs not only the way Israelis and Palestinians think, feel, and act but also their attitudes toward different religious and ethnic groups and their degree of support for peace or war. We also found that Palestinians may be at particularly high risk of experiencing psychological distress as a result of the conflict, though more research is needed to determine the extent to which this is due to socioeconomic stress. Our review suggests the need for more studies on the nonclinical psychological aspects of the Israeli-Palestinian conflict as well as for longitudinal studies on the impact of the conflict on both Israelis and Palestinians.

Youth from Fundamentalist Societies: What are Their Attitudes Toward War and Peace and Their Relations with Anxiety Reactions?

The present study was conducted during "Protective Edge," a long-lasting military operation between the State of Israel and Hamas in Gaza, during which hundreds of rockets were fired from Gaza into various regions across the country. At the same time, Israeli forces bombed Gaza and sent in ground forces. The military operation ended after 50 days of fighting, with a cease-fire between the warring sides. The aim of this study was to compare attitudes and perceptions of youth from different religious fundamentalist societies, toward the war and their readiness for peace during this specific violent struggle, and attitudes toward the Israeli-Palestinian (I-P) conflict in general. Furthermore, we wanted to examine the links between these attitudes, personal sense of coherence and state anxiety. We compared two groups of adolescents who belong to religious minorities in Israel: ultra-Orthodox and national religious. The sample included a total of 107 subjects from both groups. The young people responded to a questionnaire, distributed during the military operation, while they were still under rocket fire from the Gaza Strip. The questionnaire included: socio-demographic characteristics; attitudes toward the military operation; ways to resolve the Israeli-Palestinian conflict; sense of coherence and state anxiety. Results indicate that both groups thought that the I-P conflict would not be resolved peacefully and that there were more wars to come. Furthermore, both national religious and ultra-Orthodox adolescents thought that this operation would have limited success for only a limited time. Regarding the differences between the groups, sense of coherence was higher among the ultra-Orthodox and this group also believed more than their counterparts that everything was in God's hands. Interesting results emerged with peaceful resolution being linked to more anxiety among the national religious group, while among the ultra-Orthodox group no relationships were indicated on these two variables. The results of the study underscore the implications of ongoing political conflicts, alongside the growing global power of religion, which minimizes opportunities for world peace.

Facilitating mental health screening of war-torn populations using mobile applications

BACKGROUND

War-torn populations are often hard to screen for mental health disorders. Classical data collection approaches, such as paper-based, online, or SMS-operated, are either infeasible or lack accuracy due to a variety of challenges associated with dynamics and consequences of war.

METHODS

In this paper, we introduce a novel approach for accurate and fast screening using free open-source software, Open Data Kit (ODK) mobile application. This approach was developed by the Palestine Children's Relief Fund (PCRF) to assess the mental health symptoms of 986 Palestinian children (age 6-18) in the aftermath of Israel's Operation Protective Edge (OPE) in 2014. The organization developed assessment questionnaires and trained local field workers on the use of the mobile application, and on recruiting and interviewing war victims.

RESULTS

War-affected children were found to suffer from several alarming symptoms associated with post-traumatic stress disorder (PTSD), depression, and somatic symptoms. Children with highest number of psychological symptoms were referred for further evaluation and treatment.

CONCLUSIONS

The use of ODK mobile technologies facilitated efficient screening of affected children in war zones. The offline data collection capability was crucial for handling the difficult conditions associated with war-torn areas, enabling timely intervention for urgent cases. Further applications of the novel mobile technology are to be explored.

Children's Mental Health in the Context of Terrorist Attacks, Ongoing Threats, and Possibilities of Future Terrorism

Over the past two decades, the field has witnessed tremendous advances in our understanding of terrorism and its impacts on affected youth. It is now well established that a significant proportion of exposed youth show elevated PTSD symptoms in the months following a terrorist attack. In more recent years, research has expanded beyond confirming our understanding of the association between direct terrorism exposure and child PTSD symptoms by elucidating (a) links between terrorism exposure and non-PTSD clinical outcomes (e.g., externalizing problems, substance use), (b) individual differences associated with divergent patterns of risk and resilience, (c) the clinical correlates of media-based contact with terrorism, (d) clinical outcomes associated with exposure to recurrent terrorist attacks, and (e) exposure to extended contexts of uncertainty and the possibilities of future terrorism. Researchers studying the effects of terrorism and political violence on youth have increasingly examined a much broader range of regions in the world, affording needed opportunities to consider the generalizability of prior findings to youth living in different political contexts, in less developed regions of the world, and/or in regions with different rates of recurrent terrorism. In order to understand and, in turn, best meet the clinical needs of the majority of terrorism-affected youth across the globe, more targeted research on exposed youth is needed in developing regions of the world and regions enduring more recurrent terrorist attacks.

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

OBJECTIVE

Adolescents living in Israel and the Palestinian authority are exposed to political violence. This review examines psychosocial risk factors for posttraumatic stress disorder (PTSD) organized within an ecological framework.

METHOD

Relevant articles were identified through PubMed and PsycINFO. Studies measuring risk and/or protective factors for PTSD in the Palestinian and/or Israeli adolescent populations because of conflict exposure from 1990 to present were included.

RESULTS

A total of 20 studies met inclusion criteria. Greater violence exposure, poor economic resources, living in rural compared with urban areas, poor family and peer relations, and poor coping skills were associated with PTSD symptoms.

CONCLUSIONS

The ecological framework is a useful approach to understanding factors affecting adolescent PTSD. Future research should focus on socioecological levels that have received limited attention. (PsycINFO Database Record

The Moderating Effect of State Anger on Treatment Outcome in Female Adolescents With PTSD

Trauma experienced in childhood and adolescence negatively affects the development of adaptive regulation of emotions and is associated with greater symptoms of anger. Prior research has suggested that high levels of anger may impede the outcome of treatment in adults with posttraumatic stress disorder (PTSD). The current study investigated whether high levels of anger resulted in poorer treatment outcomes in adolescent girls with PTSD. Participants included 61 female adolescent survivors of sexual abuse or assault who were randomized to either prolonged exposure for adolescents (PE-A) or client-centered therapy (CCT) for traumatized children for 8-14 weekly sessions. Participants were followed for 12 months posttreatment. High levels of state anger at baseline were associated with less improvement in PTSD symptoms in the CCT group than the PE-A group (d = 0.62). The moderating effects of state anger on improvement in PTSD symptoms was significant with emotion regulation difficulties, which may underlie anger symptoms (d = 0.58) in the model. The results of this study suggessted that high state anger was less of an impediment to treatment of PTSD for those receiving PE-A than those receiving less differentiated approaches such as CCT.

Religiosity as a Moderator of Self-Efficacy and Social Support in Predicting Traumatic Stress Among Combat Soldiers

Based on a sample of 54 Israeli soldiers (51 % non-religious, 49 % religious) surveyed upon their return from combat, this study investigates the moderating role of religiosity as a factor that may strengthen cognitive processing tied to the belief in oneself to persevere (i.e., self-efficacy) after trauma and/or as a factor tied to enhanced external social support that religious individuals in particular may benefit from by their involvement in a religious community. Findings revealed (1) social support was tied to greater resilience within the general sample; (2) religious soldiers were less susceptible to traumatic stress than non-religious soldiers; and (3) religiosity moderated the relationship between self-efficacy and traumatic stress but not the relationship between social support and traumatic stress. Implications of findings are discussed.

Youth Exposed to Terrorism: the Moderating Role of Ideology

The present review examines the moderating role of ideology on the effects of war, armed conflict, and terrorism on youth. Ideology is an important factor given the central role played by religio-political ideology and nationalism in present-day conflicts. Ideologies or worldviews represent cognitive frameworks that imbue the traumatic situation with meaning and order. Analysis of the pool of studies identified three categories of ideologically based moderating factors, each representing an aspect of social construction of traumatic events, namely, religion, political ideology, and self-concept. The two closely related categories of religion and politico-religious beliefs showed both positive and negative effects on psychological and psychiatric outcomes among youth. The third category of different aspects of self-concept yielded consistently positive moderating effects. The mechanisms by which each category of ideology moderates effects of exposure to war, armed conflict, and terrorism are discussed, and research and clinical implications are presented.

Life under occupation: citizenship and other factors influencing the well-being of university students living in the West Bank

There is substantial evidence that individuals affected by conflict suffer poor physical and mental outcomes, particularly in indicators of well-being. This study assesses the health-related quality of life (HRQoL), perceived stress and insecurity of Palestinian young adults in the West Bank. We surveyed 398 university students from Nablus (mean age = 20.1) using the SF-36 to measure HRQoL, the PSS-4 to assess stress and a context-specific insecurity instrument. A third of participants reported Israeli citizenship, and the results indicated better outcomes in these individuals in several outcomes, with the noteworthy exception of insecurity. This study is one of the first to assess citizenship of West Bank Palestinians as a potential covariate to predict measures of well-being. Because citizenship is such a meaningful issue for Palestinians and is related to individual freedom and access to resources, this study suggests that there are complex dynamics outside of typical demographic variables that contribute to well-being.

Adolescents on the Front Line: Exposure to Shelling Via Television and the Parental Role

OBJECTIVES

Research suggests that exposure to traumatic content via television inadvertently increases posttraumatic stress symptoms (PTSS) as well as psychological distress, especially among adolescent viewers. The aim of the current study was to assess the effect of news consumption on PTSS and general distress among adolescents who live in a war area, as well as to examine the role of parents as intermediaries of news broadcasting.

METHOD

A total of 65 adolescents who live in a war zone filled out the Child Post Traumatic Stress Reaction Index, the Brief Symptoms Inventory, and a scale measuring the level of real-life exposure, news broadcast consumption, and parents as intermediaries of news broadcasting.

RESULTS

A main effect for real-life exposure on both PTSS and general distress was revealed. Interestingly, a three-way interaction between real-life exposure, television exposure, and parents as intermediators was found for general distress. Only under low real-life exposure did parents as intermediaries buffer the effect of television exposure on general distress.

CONCLUSIONS

Parental intermediation of news broadcasting of traumatic events, especially in situations of continuous, real-life exposure, is essential.

Regional research priorities in brain and nervous system disorders

The characteristics of neurological, psychiatric, developmental and substance-use disorders in low- and middle-income countries are unique and the burden that they have will be different from country to country. Many of the differences are explained by the wide variation in population demographics and size, poverty, conflict, culture, land area and quality, and genetics. Neurological, psychiatric, developmental and substance-use disorders that result from, or are worsened by, a lack of adequate nutrition and infectious disease still afflict much of sub-Saharan Africa, although disorders related to increasing longevity, such as stroke, are on the rise. In the Middle East and North Africa, major depressive disorders and post-traumatic stress disorder are a primary concern because of the conflict-ridden environment. Consanguinity is a serious concern that leads to the high prevalence of recessive disorders in the Middle East and North Africa and possibly other regions. The burden of these disorders in Latin American and Asian countries largely surrounds stroke and vascular disease, dementia and lifestyle factors that are influenced by genetics. Although much knowledge has been gained over the past 10 years, the epidemiology of the conditions in low- and middle-income countries still needs more research. Prevention and treatments could be better informed with more longitudinal studies of risk factors. Challenges and opportunities for ameliorating nervous-system disorders can benefit from both local and regional research collaborations. The lack of resources and infrastructure for health-care and related research, both in terms of personnel and equipment, along with the stigma associated with the physical or behavioural manifestations of some disorders have hampered progress in understanding the disease burden and improving brain health. Individual countries, and regions within countries, have specific needs in terms of research priorities.

A time to be stressed? Time perspectives and cortisol dynamics among healthy adults

Perceptions of past, present, and future events may be related to stress pathophysiology. We assessed whether Time Perspective (TP) is associated with cortisol dynamics among healthy adults (N=61, Ages=18-35, M=22.9, SD=4.1) exposed to the Trier Social Stress Test (TSST). TP was measured according to two profiles: maladaptive Deviation from Balanced TP (DBTP) and adaptive Deviation from Negative TP (DNTP). Eight salivary cortisol samples were analyzed using area under the curve with respect to ground (AUCg) and to increase (AUCi). Statistic analyses involved partial correlations controlling for depressive symptoms. Results for both sexes showed that higher DBTP scores were associated with lower cortisol AUCg scores, while higher DNTP scores were associated with higher cortisol AUCg scores. These novel findings suggest that maladaptive TP profiles influence hypocortisolism, whereas adaptive TP profiles influence hypercortisolism. Thus, TP profiles may impact conditions characterized by altered cortisol concentrations.

Making up 'national trauma, in Israel: From collective identity to collective vulnerability

We sketch a variety of institutional, discursive, professional, and personal 'vectors', dating back to the 1980s, in order to explain how 'national trauma' was able to go from a cultural into a professional category in Israeli mental health during the Al-Aqsa Intifada (2000-2005). Our genealogy follows Ian Hacking's approach to transient mental illnesses, both illustrating its fertility and expanding its horizon. Thus, we also explore the dynamics that developed in the Israeli mental health community with the advent of 'national trauma': while the vast majority of Israeli psychologists and psychiatrists did not adopt the category, they embraced much of its underlying logic, establishing a link between Israeli identity and the mental harm said to be caused by Palestinian terror. Remarkably, the nexus of national identity and collective psychic vulnerability also prompted the cooperation of Jewish and Palestinian-Israeli mental health scholars seeking to explore the psychological effect that the minority status of Israeli Palestinians had on them during the Al-Aqsa Intifada.

Career Readiness: A Potential Pathway through which Urban Youth Exposure to Stress Influences Adult Health

A growing body of research provides support for the detrimental effects of stress during childhood on future adult health, however, less is known about how stress disrupts normal developmental processes. This pathway may be particularly relevant for urban adolescents who are exposed to additional contextual stressors. This study will longitudinally explore how psychological stress from multiple domains influences urban adolescents' career readiness. Two hundred youth (ages 14-21) completed surveys assessing their school, family, neighborhood and health stress. Path analysis using a parallel process model found that school and neighborhood stress at 6 months were significantly associated with decreased career readiness at 15 months. Health stress at baseline was related to an increased report of career readiness at 15 months, which was moderated by parental closeness. These findings suggest that experiences of stress for urban youth negatively impact their planning for the future, particularly in the absence of supportive parental relationships.

Youth in contexts of political violence: A developmental approach to the study of youth identity and emotional security in their communities

Going beyond the association between youth exposure to political violence and psychopathology, the current paper examines within-person change in youth strength of identity with their ethno-political group and youth reports of the insecurity in their communities. Conceptually related but growing out of different paradigms, both group identity and emotional insecurity have been examined as key variables impacting youth responses to threats from other group members. The goal of the current study is to review previous studies examining these two key variables and to contribute new analyses, modeling within-person change in both variables and examining co-variation in their growth The current paper uses data from 823 Belfast adolescents over 4 years. The results suggest youth are changing linearly over age in both constructs and that there are ethno-political group differences in how youth are changing. The results also indicate that change in insecurity is related to strength of identity at age 18, and strength of identity and emotional insecurity are related at age 18. Implications and directions for future work in the area of youth and political violence are discussed.

Life outcomes influenced by war-related experiences during the Gulf crisis

This study examined the life outcomes of children exposed to the Gulf crisis in 1990-1991. We expected war-trauma exposure and psychological distress symptoms to predict poorer educational and occupational outcomes. Participants were 151 Kuwaiti citizens who were assessed during childhood (in 1993; M age = 10.6 years), and who were reassessed 10 years later in young adulthood (in 2003; M age = 21.2 years). Participants completed measures of intelligence, war-trauma exposure, posttraumatic stress symptoms, anxiety symptoms, depressive symptoms, intervening life events, and life outcomes. Results indicated that war-trauma exposure negatively impacted children's educational and occupational outcomes as young adults. Boys with higher levels of war-trauma exposure were less likely to attend University. Posttraumatic stress and anxiety symptoms also predicted poorer educational and occupational outcomes. However, this relationship was not significant when we accounted for children's intelligence. Depressive symptoms were not predictive of children's educational or occupational outcomes. Results suggest that war-trauma exposure may have life-altering effects on children. Tailored, early interventions are needed for children exposed to war traumas.

Surviving genocide in Srebrenica during the early childhood and adolescent personality

Aim

To examine how the experience of genocide in Srebrenica in the early childhood (ages 1-5) influences the psychological health in adolescence.

Methods

This study included 100 school-attending adolescents, age 15-16 (born in 1990-91) who were divided in two groups according to the place of residence from 1992-1995: the Srebrenica group – adolescents who lived in Srebrenica during the siege and the non-Srebrenica group who lived in the “free territory,” were not wounded, and experienced no losses. We used the socio-demographic questionnaire created for the purposes of our study and the War Trauma Questionnaire, Posttraumatic Stress Reactions Questionnaire, Self-report Depressive Scale (Zung), Freiburg Personality Inventory, and the Lifestyle Questionnaire.

Results

Srebrenica adolescents experienced significantly more traumatic experiences (14.26 ± 3.11 vs 4.86 ± 3.16, P < 0.001). Although there was no significant difference in the total score of posttraumatic stress reactions and intensity of depression between the two groups, significantly higher scores of posttraumatic stress reaction were noticed for several specific questions. The most prominent defense mechanisms in both groups were projection, intellectualization, and reactive formation. Srebrenica adolescents had higher sociability levels (34.7% vs 16.0%, χ² = 7.231, P = 0.020).

Conclusion

Srebrenica adolescents reported significantly more severe PTSD symptoms and significantly greater sociability. Our findings could be used for planning treatment and improving communication and overcoming traumas in war-affected areas.

The validity of the DSM-IV PTSD criteria in children and adolescents: a review

OBJECTIVE

DSM-V is on its way and doubts have been raised regarding the validity of pediatric PTSD. It is the goal of the current review to critically review the empirical literature on PTSD in youth.

METHOD

A search of PsycINFO, PubMed and reference lists was conducted. Empirical information considered relevant regarding the validity of the criteria was collected.

RESULTS/CONCLUSIONS

The validity of the symptom criteria and clusters varies, with the Avoidance/Numbing cluster outperforming the Re-experiencing-and Arousal cluster. Factor analytic findings suggest that Arousal criterion D4 should be placed within the Re-experiencing cluster, and that the Avoidance/Numbing cluster should be split up. Some non-DSM-IV PTSD symptoms, among which guilt, have considerable validity in trauma-exposed youth and their inclusion in DSM-V PTSD should be considered. As for preschool children, alternative criteria are recommended that are more developmentally sensitive.

Parental practices and political violence: the protective role of parental warmth and authority-control in Jewish and Arab Israeli children

Parental warmth and parental authority-control patterns have been documented as practices with highest significance for children's well-being and development in a variety of life areas. Various forms of these practices have been shown to have a direct positive effect on children and also to protect children from adverse effects of numerous stressors. However, surprisingly, few studies have examined the role of these practices as possible protective factors for children exposed to intractable conflict and political violence. Participants in this study were Jewish (n = 88) and Arab (n = 105) Israeli families, with children aged 7-12.5 (M = 10.73, SD = 0.99). Children completed questionnaires assessing political violence exposure, behavioral, psychological, and social difficulties, and perceived paternal and maternal warmth. Mothers and fathers completed questionnaires assessing parental warmth, parental authority-control, and the child's difficulties. Results showed parental warmth to be a significant moderator of political violence, related to low levels of behavioral and social difficulties of children. Parental authority-control patterns were not protectors from adverse effects of political violence exposure. Maternal authoritarian authority-control showed an effect resembling a risk factor. Differential roles of parental warmth and authority-control, fathers' versus mothers' roles, and ethnic differences are discussed, and practical clinical implications are proposed.

Factors related to posttraumatic stress disorder in adolescence

Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed.

Exposure to political conflict and violence and posttraumatic stress in Middle East youth: protective factors

We examine the role of family- and individual-level protective factors in the relation between exposure to ethnic-political conflict and violence and posttraumatic stress among Israeli and Palestinian youth. Specifically, we examine whether parental mental health (lack of depression), positive parenting, children's self-esteem, and academic achievement moderate the relation between exposure to ethnic-political conflict/violence and subsequent posttraumatic stress (PTS) symptoms. We collected three waves of data from 901 Israeli and 600 Palestinian youths (three age cohorts: 8, 11, and 14 years old; approximately half of each gender) and their parents at 1-year intervals. Greater cumulative exposure to ethnic-political conflict/violence across the first 2 waves of the study predicted higher subsequent PTS symptoms even when we controlled for the child's initial level of PTS symptoms. This relation was significantly moderated by a youth's self-esteem and by the positive parenting received by the youth. In particular, the longitudinal relation between exposure to violence and subsequent PTS symptoms was significant for low self-esteem youth and for youth receiving little positive parenting but was non-significant for children with high levels of these protective resources. Our findings show that youth most vulnerable to PTS symptoms as a result of exposure to ethnic-political violence are those with lower levels of self-esteem and who experience low levels of positive parenting. Interventions for war-exposed youth should test whether boosting self-esteem and positive parenting might reduce subsequent levels of PTS symptoms.

A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East

For many decades, the Middle East has been troubled with numerous long-standing armed conflicts and wars. Children and adolescents were not spared the trauma and its consequences. Exposure to traumatic events can result in mental, behavioural and emotional problems in children and adolescents. To date, this is the first paper that aims to systematically review the literature on the mental health of children and adolescents living in areas of armed conflict in the Middle East, specifically Israel, Palestine, Lebanon and Iraq. It explores factors that mediate between exposure to armed conflict and mental, behavioural and emotional problems and places them in a cultural context. Pubmed was searched and papers were identified using specific inclusion criteria. Seventy-one eligible studies were included. The main findings are that children and adolescents living in these conflict zones are exposed to high levels of traumatic experiences. Number of conflict-related traumatic experiences correlates positively with prevalence of mental, behavioural and emotional problems. Prevalence of post-traumatic stress disorder in children and adolescents is estimated to be 5-8% in Israel, 23-70% in Palestine and 10-30% in Iraq (insufficient data for Lebanon). The main determining factors identified were level and type of exposure, age, gender, socio-economic adversity, social support and religiosity. These findings bring to light the pressing need to provide children and adolescents living in conflict areas with help. They are useful in designing new interventions to strengthen child and adolescent resilience in areas of conflict worldwide. Specific recommendations are included.

The impact of political violence on psychosocial functioning of individuals and families: the case of palestinian adolescents

BACKGROUND

  The impact of political violence on the psychosocial functioning of adolescents and their families was compared for surveyed populations from two regions of Palestine.

METHOD

  A randomly-selected sample of 971 adolescents (521 from the West Bank and 450 from the Gaza Strip regions, 42% male/57% female) completed scales measuring traumatic event, post-traumatic stress disorder (PTSD), peer relations, mental health, aggression, and family functioning.

RESULTS

  (1) West Bank participants reported a significantly higher level of exposure to political violence and significantly more aggression, mental health symptoms, problems in family and social functioning; (2) Participants exposed to greater political violence reported higher levels of depression, hostility, paranoid ideation, and PTSD; (3) Economic status and level of parental education were related to reduced levels of mental health symptoms and greater family functioning; (4) There were gendered differences.

CONCLUSIONS

  The study provides a starting point to begin to compare the experiences and outcomes between Palestinian adolescents in the West Bank and Gaza Strip and a basis for considering implications for service delivery and policy makers concerned with the well being of Palestinian communities.

The role of religious orientations in youth's posttraumatic symptoms after exposure to terror

This study examined the effect of religiosity on youth's posttraumatic symptoms resulting from exposure to terror. Participants consisted of 1,973 Israeli high school students. Objective and subjective exposure (fear) to terror were positively associated with posttraumatic symptoms. Intrinsic religiosity was negatively associated with posttraumatic symptoms and found to decrease the effects of objective exposure. Personal extrinsic orientation and social extrinsic orientation were positively associated with posttraumatic symptoms, having no mediating effect. Theoretical implications regarding religiosity as a coping mechanism in light of exposure to terror are discussed.