Children exposed to violent war-like and repeated political violence often experience a continued threat to life and their sense of safety, as well as a disruption of daily functioning. The purpose of the study was to examine the psychological impact of exposure to Israeli occupation on Palestinian school children in the West Bank and Gaza, Palestine. We assessed the association between exposure to occupation and the severity of posttraumatic symptoms and the inter-relationship between posttraumatic symptoms, functional impairment, somatic complaints, and coping strategies in school children. Palestinian students (n = 2100) from grades 9—11 were screened from both the West Bank (n = 1235) and Gaza (n = 724) and responded to self-report questionnaires. Results showed that extensive exposure to violence was associated with higher levels of posttraumatic distress and more somatic complaints in both the West Bank and Gaza regions. More Gaza than West bank students reported symptoms meeting the criteria for PTSD, and more girls than boys in both groups reported somatic complaints. Thus, school-based screening can be an effective method for case identification of students showing PTSD symptoms as a result of exposure to political violence.
Abdeen Z., & Qasrawi R. (2004). CHERISH report on school-based screening, Section A: Palestinian schools. Unpublished report.
2.
Abdel-Khalek, A.M. (1997). A survey of fears associated with Iraqi aggression among Kuwaiti children and adolescents. A factorial study 5.7 years after the Gulf War. Psychological Reports, 81, 247-255.
3.
Abu-Hein, F., Qouta, S., Thabet, A., & El Sarraj, E. (1993). Trauma and mental health of children in Gaza. British Medical Journal, 306, 1129.
4.
Allen, M., Burt, K., Bryan, E., Carter, D., Orsi, R., & Durkan, L. (2002). School counselors' preparation for and participation in crisis intervention. Professional School Counseling, 6, 1096-2409.
5.
American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
6.
B'Tselem (2002). Landgrab: Israel's settlement policy in the West Bank. Comprehensive report. The Israeli Information Centre for Human Rights in the Occupied Territories , B'Tselem, Jerusalem.
7.
Baker, A. (1990a). Psychological responses of Palestinian children to the environmental stress associated with military occupation. Journal of Refugee Studies, 4, 237-247.
8.
Baker, A. (1990b). The psychological impact of the Intifadah on Palestinian children in the occupied West Bank and Gaza: An exploratory study . American Journal of Orthopsychiatry, 60, 496-505.
9.
Baker, A., El-Husseini, S., Arafat, C., & Ayyoush, D. (1991). The Palestinian child in the West Bank and Gaza Strip. Jerusalem: El Tawin Institute (Arabic).
10.
Barber, B.K. (1999). Political violence, family relations, and Palestinian youth functioning. Journal of Adolescent Research, 14, 206-230.
11.
Barber, B.K. (2001). Political violence, social integration, and youth functioning: Palestinian youth from the Intifada. Journal of Community Psychology, 29, 259-280.
12.
Brander, T. (1941). Kinderpsychiatrische Beobachtungen während des Krieges in Finnland 1939-1940. Zeitschrift für Kinderpsychiatrie , 7, 177-187.
13.
Brent, D.A., Perper, J.A., Moritz, G., Liotus, L., Richardson, D., Canobbio, R., Schweers, J., & Roth, C. (1995). Posttraumatic stress disorder in peers of adolescent suicide victims: Predisposing factors and phenomenology. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 209-215.
14.
Bryce, J.W., Walker, N., Ghorayeb, F., & Kanj, M. (1989). Life experiences, response styles and mental health among mothers and children in Beirut, Lebanon. Social Science and Medicine, 28, 685-695.
15.
Buka, S., Stichick, T., & Earls, F.J. (2001). Children's exposure to community violence. American Journal of Orthopsychiatry, 71(3), 298-310.
16.
Carver, C.S., Scheier, M.F., & Weintraub, J.K. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267-283.
17.
Cohen, J.A., Berliner, L., & Mannarino, A.P. (2001). Treating traumatized children: A research review and synthesis. Trauma, Violence, and Abuse , 1, 29-46.
18.
Cook-Cottone, C. (2004). Childhood post-traumatic stress disorder: Diagnosis, treatment, and school reintegration. School Psychology Review , 33, 127-139.
19.
Dunsdon, M.I. (1941). A psychologist's contribution to air raid problems . Mental Health, 2, 37-41.
20.
Dyregrov, A., Gjestad, R., & Raundalen, M. (2002). Children exposed to warfare: A longitudinal study . Journal of Traumatic Stress, 15, 59-68.
21.
Ford, J.D., Racusin, R., Ellis, C.G., Davis, W.B., Reiser, J., Fleischer, A.M., & Thomas, J. (2000). Child maltreatment, other trauma exposure and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. Journal of the American Professional Society on the Abuse of Children, 5, 205-217.
22.
Freud, A., & Burlingham, D.T. (1943). War and children. New York: Medical War Books.
23.
Friedman, R.M. (2003). A conceptual framework for developing and implementing effective policy in children's mental health. Journal of Emotional and Behavioral Disorders, 11, 11-18.
24.
Garbarino, J., & Kostelny, K. (1996). The effects of political violence on Palestinian children's behavior problems: A risk accumulation model. Child Development, 67, 33-45.
25.
Hadi, F.A., & Llabre, M.M. (1998). The Gulf crisis experience of Kuwaiti children: Psychological and cognitive factors. Journal of Traumatic Stress, 11, 45-56.
26.
Haj-Yahia, M.M. (2004). Political Violence Inventory. Unpublished, The Hebrew University of Jerusalem Paul Baerwald School of Social Work and Social Welfare.
27.
Herberg, M., & Övensen, G. (1993). Palestinian society in Gaza, the West Bank and ArabJerusalem. Oslo, Norway: FAFO.
28.
Khamis, V. (1993). Post-traumtic stress disorder among the injured of the Intifada. Journal of Traumatic Stress, 6, 555-559.
29.
Khamis, V. (1995). Coping with stress: Palestinian families and Intifada-related trauma. Unpublished manuscript. Palestine: Bethlehem University.
30.
Khamis, V. (2000). Political violence and the Palestinian family . New York: The Haworth Press.
31.
Kuterovac-Jagodić, G. (2003). Posttraumatic stress symptoms in Croatian children exposed to war: A prospective study. Journal of Clinical Psychology , 59, 9-17.
32.
Laor, N., Wolmer, L., & Cohen, D.J. (2001). Mother's functioning and children's symptoms 5 years after Scud missile attack. American Journal of Psychiatry , 158, 1020-1026.
33.
Laor, N., Wolmer, L., Mayes, L.C., Gershon, A., Weizman, R., & Cohen, D.J. (1997). Israeli preschools under Scuds: A 30-month follow-up . Journal of the American Academy of Child and Adolescent Psychiatry, 36, 349-356.
34.
Lavee, Y., & Ben-David, A. (1993). Families under war: Stresses and strains of Israeli families during the Gulf war. Journal of Traumatic Stress , 6, 239-254.
35.
Lavi, T., & Solomon, Z. (2005). Palestinian youth of the intifada: PTSD and future orientation. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1176-1183.
36.
Llabre, M.M., & Hadi, F.A. (1994). Health-related aspects of the Gulf crisis experience of Kuwaiti boys and girls. Anxiety, Stress and Coping, 7, 217-228.
37.
Lucas, C.P., Zhang, H., Fisher, P.W., Shaffer, D., Regier, D.A., Narrow, W.E., Bourdon, K., Dulcan, M.K., Canino, G., Rubio-Stipec, M., Lahey, B.B., & Friman, P. (2001). The DISC Predictive Scales (DPS): Efficiently screening for diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 443-449.
38.
Luthar, S. (1993). Annotation: Methodological and conceptual issues in research on childhood resilience. Journal of Child Psychology and Psychiatry, 34(4), 441-453.
39.
Macksoud, M., Aber, J.L., & Cohn, I. (1996). Assessing the impact of war on children. In R.J. Apfel & B. Simon (Eds.), Minefields in their hearts:The mental health of children in war and communal violence (pp. 218-230). New Haven, CT: Yale University Press.
40.
Milgram, R., & Milgram, N. (1976). The effect of the Yom-Kippur war on anxiety level in Israeli children. Journal of Psychology, 94, 107-113.
41.
Motta, R.W. (1995). Childhood posttraumatic stress disorder and the schools. Canadian Journal of School Psychology, 11, 65-78.
42.
Nader, K.O., & Pynoos, R.S. (1993). The children of Kuwait after the Gulf crisis. In L.A. Leavitt & N.A. Fox (Eds.), The psychological effects of war and violence on children (pp. 181-195). Mahwah, NJ: Lawrence Erlbaum.
43.
Nader, K.O., Pynoos, R.S., Fairbanks, L., Al-Ajeel, M., & Al-Asfour, A. (1993). Preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis. British Journal of Clinical Psychology, 32, 407-416.
44.
Pat-Horenczyk, R. (2005). Post-traumatic distress in adolescents exposed to ongoing terror: Findings from a school-based screening project in the Jerusalem area. In Y. Danieli, D. Brom, & J. Sills (Eds.), The trauma of terrorism: Sharing knowledge and shared care: An international handbook (pp. 335-347). Binghamton, NY: Haworth Press.
45.
Pat-Horenczyk, R., Abramovitz, R., Peled, O., Brom, D., Daie, A., & Chemtob, C.M. (2007). Adolescent exposure to recurrent terrorism in Israel: Posttraumatic distress and functional impairment. Journal of Orthopsychiatry, 77(1), 76-85.
46.
Pat-Horenczyk, R., Peled, O., Miron, T., Villa, Y., Brom, D., & Chemtob, C.M. (2007). Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism. American Journal of Psychiatry , 164(1), 66-72.
47.
Pfefferbaum, B., North, C.S., Doughty, D.E., Gurwitch, R.H., Fullerton, C.S., & Kyula, J. (2003). Posttraumatic stress and functional impairment in Kenyan children following the 1998 American Embassy bombing. American Journal of Orthopsychiatry, 73, 133-140.
48.
Pfefferbaum, B., Seale, T.W., McDonald, N.B., Brandt, E.N., Rainwater, S.M., Maynard, B.T., Meierhoefer, B., & Miller, P.D. (2000). Posttraumatic stress two years after the Oklahoma City bombing in youths geographically distant from the explosion. Psychiatry, 64, 358-370.
49.
Punamäki, R.L. (1987). Psychological stress of Palestinian mothers and their children in conditions of political violence. The Quarterly Newsletter of the Laboratory of Comparative Human Cognition, 9, 116-119.
50.
Punamäki, R.L., Qouta, S., & El Sarraj, E. (1997). Models of traumatic experiences and children's psychological adjustment: The roles of perceived parenting and children's own resources and activity. Child Development, 68, 718-728.
51.
Punamäki, R.L., Qouta, S., & El Sarraj, E. (2001). Resiliency factors predicting psychological adjustment after political violence among Palestinian children. International Journal of Behavioral Development, 25, 256-267.
52.
Qouta, S., Punamäki, R.L., & El Sarraj, E. (1995). Impact of peace treaty on psychological well-being: A follow-up study on Palestinian children. Child Abuse & Neglect, 19, 1197-1208.
53.
Qouta, S., Punamäki, R.L., & El Sarraj, E. (1998). House demolition and mental health: Victims and witnesses. Journal of Social Distress and the Homeless, 7, 279-288.
54.
Qouta, S., Punamäki, R.L., & El Sarraj, E. (2003). Prevalence and determinants of PTSD among Palestinian children exposed to military violence. Child and Adolesescent Psychiatry, 12, 265-272.
55.
Qouta, S., Punamäki, R.L., & El Sarraj, E. (2005). Mother-child expression of psychological distress in war trauma. Clinical Child Psychology and Psychiatry, 10, 135-156.
56.
Rahav, G., & Ronen, T. (1994). Children's perceptions of their behavior problems during the Gulf war. Anxiety, Stress and Coping, 7, 241-252.
57.
Rodriguez, N., Steinberg, A., & Pynoos, R.S. (1999). UCLA PTSD index for DSM IV instrument information: Child version, parent version, adolescent version. UCLA Trauma Psychiatry Services.
58.
Rosenthal, M.K., & Levy-Shiff, R. (1993). Threat of missile attacks in the Gulf war: Mothers' perceptions of young children's reactions. American Journal of Orthopsychiatry, 63, 241-249.
59.
Rosner, R., Powell, S., & Butollo, W. (2003). Posttraumatic stress disorder three years after the siege of Sarajevo. Journal of Clinical Psychology, 59, 42-57.
60.
Rutter, M. (1985). Resilience in the face of adversity: Protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598-611.
61.
Saigh, P.A., Green, B.L., & Korol, M. (1996). The history and prevalence of posttraumatic stress disorder with special reference to children and adolescents. Journal of School Psychology, 34, 107-131.
62.
Saltzman, W., Pynoos, R.S., Layne, C., Steinberg, A., & Ainsenberg, E. (1999). School-based trauma-grief focused psychotherapy program for youth exposed to community violence. Unpublished manuscript.
63.
Schwarzwald, J., Matisyhu, W., Waysman, M., Solomon, Z., & Klingman, A. (1993). Stress reaction of school-age children to the bombardment by SCUD missiles. Journal of Abnormal Psychology , 102, 404-410.
64.
Shaffer, D., Fisher, P., Lucas, C.P., Dulcan, M., & Schwab-Stone, M. (2000). NIMH Diagnostic Interview Schedule for Children, Version IV (NIMH DISCIV): Description, differences from previous version, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28-38.
65.
Shaw, J.A. (2003). Children exposed to war/terrorism. Clinical Child and Family Psychology Review, 6, 237-246.
66.
Smith, P., Perrin, S., Yule, W., Hacam, B., & Stuvland, R. (2002). War exposure among children from Bosnia-Hercegovina: Psychological adjustment in a community sample. Journal of Traumatic Stress, 15, 147-156.
67.
Smith, P., Perrin, S., Yule, W., & Rabe-Hesketh, S. (2001). War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina . Journal of Child Psychology and Psychiatry and Allied Disciplines , 42, 395-404.
68.
Stein, B. (1997). Community reactions to disaster: An emerging role for the school psychologist. School Psychology International , 18, 99-118.
69.
Stein, B.D., Jaycox, L.H., Kataoka, S.H., Wong, M., Tu, W.T., Elliott, M.N., & Fink, A. (2003). A mental health intervention for schoolchildren exposed to violence. JAMA, 6, 603-611.
70.
Stichick, T. (2001). The psychosocial impact of armed conflict on children: Rethinking traditional paradigms in research and intervention. Child and Adolescent Psychiatric Clinics of North America, 10(4), 797-814.
71.
Strein, W., Hoagwood, K., & Cohn, A. (2003). School psychology: A public health perspective . Journal of School Psychology, 41, 23-48.
72.
Thabet, A.A., & Vostanis, P. (1999). Posttraumatic stress reactions in children of war. Journal of Child Psychology and Psychiatry, 40, 385-391.
73.
Thabet, A.M., Abed, Y., & Vostanis, P. (2002). Emotional problems in Palestinian children living in a war zone: A cross-sectional study. The Lancet, 359, 1801-1804.
74.
Unicef (2005). State of the World's Children 2005. New York: United Nations Children's Fund.
75.
Ziv, A., & Israeli, R. (1973). Effects of bombardment on the manifest anxiety levels of children living in the Kibbutz. Journal of Consultative and Clinical Psychology, 40, 287-291.
