Palestinian Adolescents' Prolonged Exposure to Political Violence, Self- Esteem, and Post-Traumatic Stress Symptoms

Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: occurrence and correlates

The present study sought to examine the occurrence and correlates of depression, PTSD, and insomnia in a cohort of Palestinian refugees residing in camps located in Jordan during the outbreak of the War on Gaza on Oct.7th.This is a cross-sectional cohort study that employed the convenient sampling method to recruit Palestinian refugees residing in Irbid and Azmi Almufti camps for Palestinian refugees. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. The self-reported PTSD symptoms were evaluated using the brief PTSD scale, and insomnia severity was assessed using the Insomnia Severity Index -Arabic scale (ISI-A). The data analysis from 258 participants showed that severe depression was reported in 178 participants (69%). Additionally, 127 participants (49.2%) reported severe PTSD symptoms, and 156 participants (60.5%) reported severe insomnia symptoms. Regression analysis revealed that "Residents of Azmi Almufti camp" was a significant correlate for severe depression (OR = 2.22, 95% 1.28-3.85, p = 0.004) and severe PTSD (OR = 1.81, 95% CI = 1.10-2.99, p = 0.02). The use of over-the-counter antihistamines as a sleep aid was a significant correlate severe insomnia (OR = 3.19, 95%CI = 1.17-8.71, p = 0.02) and PTSD (OR = 3.32, 95% CI = 1.34-8.21, p = 0.01). The conflict in Gaza has been observed to correlate with mental health challenges, particularly among Palestinian refugees residing in Jordan.

The role of personal, relational, and collective self-esteem in predicting acute salivary cortisol response and perceived stress

Personal self-esteem (PSE) has been well recognized as a buffer against stress; however, the effects of other types of self-esteem, such as relational self-esteem (RSE) and collective self-esteem (CSE), on stress have not been adequately explored. This study investigated the roles of PSE, RSE, and CSE in reducing stress response. The Rosenberg, Relational, and Collective Self-Esteem Scales were adopted to assess PSE, RSE, and CSE, respectively. Participants underwent an acute social stress paradigm, and their acute stress response was assessed using subjective stress reports and salivary cortisol levels. Chronic stress level was estimated using the Perceived Stress Scale and hair cortisol concentration. The results showed that PSE was negatively correlated with salivary cortisol response during acute social stress; however, no significant associations were found between any type of self-esteem and subjective stress reports. For chronic stress, all types of self-esteem were negatively associated with perceived stress level, but not with hair cortisol concentration. Further hierarchical regression analyses suggested that only PSE negatively predicted acute salivary cortisol response and perceived stress level. Overall, the findings suggest the essential role of PSE in predicting acute salivary cortisol responses and perceived stress.

Political violence and posttraumatic stress symptoms among Palestinians: The mediating roles of sense of belongingness and loneliness

The current study investigated the correlation between political violence and posttraumatic stress symptoms (PTSS) and whether the sense of belongingness (SOB) and loneliness mediate the correlation between the two variables among Palestinians living in a society characterised by high political violence and prolonged traumatic events. The study sample consisted of 590 Palestinian adults, consisting of 360 men and 230 women, and were recruited using non-probabilistic convenience sampling methods from a village in the northern region of the occupied Palestinian territories. This study suggests a positive correlation between political violence and PTSS, a positive correlation between loneliness and PTSS, and a negative correlation between SOB and PTSS. SOB and loneliness mediated the correlation between political violence and trauma-related symptoms.

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.