Palestinian children living amidst political and military violence deploy active protection strategies against psychological trauma: How agency can mitigate traumatic stress via life satisfaction

Abstract

This exploratory study assessed the association between agency and life satisfaction, as well as the potential for life satisfaction, in its turn, to alleviate trauma symptoms and reduce negative emotion in a group of children exposed to war and military violence in Palestine. Two hundred and fifty Palestinian children, who had been recruited at primary schools in urban and rural areas, and refugee camps, completed the Multilevel Student’s Life Satisfaction Scale, Children’s Hope Scale (CHS), Children’s Impact of Event Scale (CRIES) and Positive and Negative Affect Scales. We performed structural equation modelling to evaluate the effects of agency on negative emotions and trauma symptoms via life satisfaction. The participants appeared to play an agentic role in mobilizing their own life satisfaction, and the more satisfied they were with their lives, the less they suffered from trauma symptoms. In terms of clinical practice, we advocate more active and participatory approaches to fostering children’s agency, a complex construct in need of further investigation via mixed-method quanti-qualitative and ethnographic studies.

Keywords

Agency children life satisfaction military violence negative affect trauma symptoms

Introduction

Numerous studies have quantitatively assessed the association between children’s exposure to violence and negative mental health outcomes (Punamäki et al., 2015; Rabaia et al., 2014). However, more recently, researchers have been seeking to identify positive outcomes of exposure to potentially traumatic events, including personal growth, life satisfaction and the development of positive coping styles (Barber and Schluterman, 2009; Veronese and Pepe, 2017a, 2017b; Veronese et al., 2017b).

Huebner (1994) conceptualized life satisfaction in children as a multifaceted individual cognitive state concerning multiple ecological domains, such as family, school, living environment, peer relationships and personal satisfaction, which contribute to personal well-being and quality of life. In the Palestinian context, life satisfaction and positive affect balance have been identified as factors that can help to mitigate stress symptoms, enhance children’s well-being and improve their overall mental health (Veronese et al., 2012; Veronese and Pepe, 2018). Veronese and Pepe (2017b) developed and tested a conceptual model in which life satisfaction was an antecedent of trauma via negative emotions. More specifically, these authors found that perceived life satisfaction played a role in reducing negative emotions and mitigating the impact of potentially traumatic events. Furthermore, a recent study carried out in South Africa with a group of adolescents showed that the more the participants perceived themselves to be competent in mobilizing personal and relational resources following traumatic experiences, the more they were satisfied with their lives (Botha and van den Berg, 2016). Finally, life satisfaction and traumatic response were found to be discriminating factors between non-clinical (greater satisfaction) and clinical subjects (more intense trauma symptoms) in a group of children exposed to war and political violence in Palestine (Veronese and Pepe, 2017b).

Agency in children

The concept of agency – understood as children’s ability to mobilize the individual and collective resources present in their environment – might be expected to shed light on how children boost their life satisfaction, thereby protecting themselves from traumatic stress, when exposed to military violence and political oppression (Gilligan, 2009; Veronese et al., 2019). Human ‘capability to act’ has been studied under the umbrella of the agency concept. The broad construct of agency has prompted a revisiting of the mainstream framing of children exposed to violence as defenceless victims and a shift towards a new conceptualization of young people as active, empowered subjects (Alexander et al., 2015; Brown and Westaway, 2011; Veronese et al., 2017a). Several qualitative studies have explored the positive relationship between self-perceived self-control/agency and the capacity to recover from traumatic experiences (Benight and Bandura, 2004). The ability to actively exert some sort of control over the multiple domains of their lives enhances children’s sense of competence and psychological well-being (Marshall, 2014; Veronese et al., 2018).

While there is a significant body of qualitative research on agentic behaviours in children living amidst war and military violence (Denov and Akesson, 2016; Marshall, 2014), to the best of our knowledge, the literature offers few quantitative assessments of this construct and its interrelationships with life satisfaction and trauma (Veronese et al., 2017b, 2018, 2019).

Aims

The aim of our exploratory study was to investigate agency as a potential determinant in activating life satisfaction and alleviating trauma symptoms in a group of children exposed to war and military occupation. We set out to investigate the association between agency and life satisfaction and, more specifically, to explore how – and to what degree – the construct of agency is associated with life satisfaction and in turn whether life satisfaction is negatively associated with trauma-related symptoms. Does children’s ability to mobilize positive resources improve their life satisfaction and, in so doing, mitigate their traumatic responses? Our starting hypothesis was that expressing a stronger sense of agency would be associated with enhanced life satisfaction (H1). Second, we predicted that greater life satisfaction would be associated with fewer traumatic symptoms. More specifically, in keeping with the model proposed by Veronese and Pepe (2017b), we expected that life satisfaction would predict trauma via negative emotions (H2). Finally, we predicted that the relationship between agency and trauma symptoms would be mediated by self-reported life satisfaction, such that enhancing children’s life satisfaction and agency might contribute to mitigating the impact of trauma (H3).

Methods

Written informed consent was obtained from all the participants’ families. The children’s verbal consent was sought directly in the classroom. Furthermore, the significance of each questionnaire item was fully explained to them. The International Review Board (IRB) at the University of Milano-Bicocca reviewed and approved the research protocol (N.368).

Population

Convenience sampling was used to select schools for the respective areas both in West Bank and Gaza Strip.

Instruments and procedures

Measures were completed by the children in the classroom, with the help of a local research partner and two social workers who had previously been given ad hoc training by the researcher. In addition, each child was asked to write or draw something that had frightened him/her during the previous couple of months. This step was necessary to verify fulfilment of the inclusion criteria and, thus, to select children who had been directly exposed to or witnessed episodes of violence.

The researchers asked the children to comment on and explain their drawings. These narratives were recorded, transcribed and translated into English by a local bilingual assistant researcher, and the content was analysed to extract the main potentially traumatic events that had affected the children over the prior 2-month period. Data were collected between November 2017 and April 2018 during a relatively calm period for Palestine. However, it should be noted that due to the ongoing occupation, children in the Palestinian territories are continuously exposed to a traumatic situation marked by violence and political oppression (Giacaman et al., 2007).

Multidimensional Student’s Life Satisfaction Scale (MSLSS) (Huebner, 1994): This instrument provides a measure of an individual’s subjective evaluation of life (Pavot et al., 1991), assessing life satisfaction as an ecological construct comprising multiple contextual levels. The scale’s 40 items explore life satisfaction across five specific domains: family, friends, school, living environment and self (Huebner, 2004; Veronese and Pepe, 2018). The responses are rated on a Likert scale: never = 1, sometimes = 2, often = 3 and almost always = 4.

The Positive and Negative Affect Scale for Children (PANAS-C) is a two-dimensional instrument that taps into positive and negative affect, modelled as distinct constructs (Huebner and Dew, 1996). In our study, the scale adopted was the brief child version of the Positive and Negative Affect Schedule (Watson et al., 1988). It comprises 10 separate items, five measuring the child’s level of positive affect and five measuring negative affect. Children are invited to express how much they have experienced each of the represented emotions using a 5-point Likert scale, ranging from 1 (not at all) to 5 (very much). Negative and positive affectivity are conceptualized as broad temperamental factors, the former relating to feelings of sadness, fear, guilt and anger (Ebesutani et al., 2011), and the latter ‘reflect[ing] the extent to which a person feels enthusiastic, active and alert’ (Watson et al., 1988: p.1063). The literature emphasizes that these two dimensions are independent of one another: an increase in positive affect does not necessarily correspond to a decrease in negative affect (Veronese et al., 2012). The psychometric proprieties and factor structure of the PANAS-C, as well as its cross-cultural adaptation, had been previously evaluated within the Palestinian context (Veronese and Pepe, 2017a).

The Children’s Impact of Event Scale (CRIES-13) (Horowitz et al., 1979) in its Arabic version (Veronese and Pepe, 2021) measures traumatic responses in individuals who have experienced distressing events, mainly by assessing the extent to which they re-experience or avoid thinking about the traumatic event itself. Four items measure intrusion (when the traumatic event is persistently re-experienced via unwanted perturbing memories, thoughts, images and flashbacks), four items evaluate avoidance (i.e. avoidance of trauma-related stimuli after the traumatic episode, such as staying away from reminders of the event or denying the meaning and consequences of the event) and five items assess hyperactivation (arousal). All items are rated on a 4-point scale (not at all, rarely, sometimes, often; scores 0, 1, 3 and 5).

Children’s Hope Scale (CHS): This instrument taps into the construct of hope by assessing two distinct dimensions: individuals’ belief in their ability to initiate and sustain actions to achieve a certain goal (agency) and their self-perceived ability to generate ways of achieving those goals (pathways). Indeed, agency is conceptualized as children’s ability to harness their motivation, resulting in enhanced well-being and greater ability to cope with hardship and adversity (Snyder et al., 1991, 1996). The scale comprises three items assessing agentic thoughts (reflecting a child’s self-perceived capacity to initiate and sustain movement towards their goals: I think I’m doing pretty well; I am doing just as well as other kids my age and I think the things I have done in the past will help me in the future) and three items detecting pathway thoughts (reflecting the respondent’s self-perceived ability to produce the means to achieve these goals: I can think of many ways to get the things in life that are most important to me; When I have a problem, I can come up with lots of ways to solve it and Even when others want to quit, I know that I can find ways to solve the problem) (Snyder et al., 1997). In the present study, items were rated on a 5-point ordinal scale for frequency (none of the time, a little of the time, some of the time, most of the time and always) (Haroz et al., 2017). The translation–back translation method was used to develop an Arabic version of the CHS.

Data analysis

All scales obtained acceptable internal consistency coefficients (α > 0.60). Scores for all variables were preliminarily assessed by computing Mahalanobis distances (p < 0.001) so that multivariate outliers could be identified and skipped. There were no extreme multivariate values, and no variables displayed multicollinearity. Next, the data were assessed to verify whether the scores for each of the study variables were normally distributed. Significantly, none of the score sets displayed kurtosis or skewness values exceeding the recommended limits [−2, +2; George and Mallery, 2010] (see Supplementary Table 4).

In order to evaluate the potential direct association between the children’s demographic profiles (age and gender) and the study variables, we calculated zero-order correlations and descriptive statistics (means and standard deviations).

Finally, we adopted a structural equation modelling (SEM) technique to obtain a more comprehensive understanding of the relationships between the study variables. Structural equation modelling enabled us to evaluate the network of direct and indirect effects among these variables and to create latent – or unobserved – variables, thereby decreasing the bias caused by measurement error (Merrilees et al., 2013). We assessed the tested models’ fit with the observed data via the ratio of chi-square to degrees of freedom (χ²/df), normed fit index (NFI; Morin et al., 2013), Tucker–Lewis Index (TLI; Morin et al., 2013), comparative fit index (CFI; Bentler, 1990) and root mean square error of approximation (RMSEA; Browne and Cudeck, 1993). An acceptable fit was defined as a χ²/df ratio of at least 5 (Marsh and Hocevar, 1985); an NFI, TLI and CFI equal to or greater than 0.95 and a RMSEA of under 0.08 (Browne and Cudeck, 1993). Analysis of Moment Structures (AMOS) software was used to simultaneously model and analyse the interrelationships among the constructs.

In light of previous research (Veronese et al., 2017b) and our expected outcomes for the present study, we tested a conceptual model of pathways that comprised three latent variables (children’s sense of agency, life satisfaction and trauma symptoms) and 10 measured indicators (see Figure 1).

Figure 1.

Conceptual model of pathways connecting latent variables and observed indicators.

Findings

Two hundred and fifty Palestinian children were purposively recruited at primary schools (rural areas, urban areas and refugee camps).

Participants’ ages ranged from 7 to 13 years (median age = 12; interquartile range = 12), 113 were men (45.2%) and 137 were women (54.8%). All participants were Muslim.

To be included in the study, participants were required not to have been previously diagnosed with physical or psychological syndromes and to be in good health. A further key inclusion criterion was having been directly exposed to one or more episodes of violence or having witnessed violent acts over the 2 months prior to commencement of the research. Specialized psychologists working with local institutions and associations in the selected areas assessed the children’s status with respect to the inclusion and exclusion criteria during clinical interviews.

In Table 1, we summarize the distribution of our sample across different geographical settings in the occupied Palestinian territories.

Table 1.

Breakdown of the sample by geographical area.

Setting		Female	Male	Total
West Bank	Nablus	17 (12%)	14 (12%)	31 (12%)
	Fasayil/Al-Jiftiik village	30 (22%)	19 (17%)	49 (20%)
	Dheisheh refugee camp	26 (19%)	14 (12%)	40 (16%)
Gaza Strip	Gaza City	19 (14%)	25 (23%)	44 (18%)
	Beit Hanoun/Khan Yunis village	31 (23%)	19 (17%)	50 (20%)
	Jabalya refugee camp	14 (10%)	22 (19%)	36 (14%)
	Total	137	113	250

Children were recruited both in the West Bank [31 (12%) from Nablus City, 49 (19.6%) from Fasayil and Al-Jiftiik villages, and 40(16%) from the Dheisheh refugee camp] and on the Gaza Strip [44 (17.6%) from Gaza City, 50 (20%) from Beit Hanun and Khan Yunis villages, and 36 (14.4%) from Jabalya refugee camp].

Potential traumatic experiences described by the children themselves are categorized and summarized in Table 2.

Table 2.

Traumatic event checklist.

Traumatic event	n
War and war-related events	62
Military violence	39
Shootings, Israeli army incursions and raids, tear gas and sound bombs
Israeli occupation	15
Presence of settlements, arrests, demolition of homes and displacement
Unsafe environment	11
Road, streets, cars and empty houses
Community and/or family violence	25
Physical violence, sexual harassment, theft and kidnapping
Children’s fears	40
Demons, ghosts and darkness
Wild animals	33
Snakes, mice, dogs, hyenas and scorpions
Death of someone significant	20
Death or risk of dying
Horror movies	21
Future aspirations	21
Failing exams and losing the conflict

Approximately half of the interviewees reported having been exposed to more than one event related to political violence. More specifically, about one-fourth of the children (n = 62; 24.8%) described having been exposed to war experiences (such as bombing and shelling – in person or on television). Fifty four of them reported having undergone potentially traumatic experiences as a result of the ongoing Israeli occupation: 6% (n = 15) of the children had experienced at least one episode of demolition of homes, incarceration of a family member, or displacement caused by the presence of settlers, while 15.6% (n = 39) reported experiences involving military violence (e.g. incursions and attack by the Israeli army, sound bombs, tear gas and shootings). Twenty children identified the death – or risk of dying – of a significant other as terrifying (60% of these cases were attributable to either the Israeli military or settlers). Furthermore, a considerable percentage of children mentioned that they had been terrified by an encounter with wild animals (13.2%, n = 33 reported a fear of snakes, mice, dogs, hyenas or scorpions) or by the unsafe environment they lived in (4.4%, n = 11). In addition, 25 children (10%) had experienced episodes involving community and/or family violence, such as sexual harassment, threats or physical violence. 40 children reported a fear of darkness – and the ghosts and demons inhabiting it – or of having nightmares due to watching horror movies (8.4%). Finally, 21 children (8.4%) reported feelings of anxiety and concern about their futures due to academic failure or the incurring of losses in their community’s struggle against occupation.

War episodes were only reported by children living on the Gaza Strip (31% of the Gaza Strip sub-sample; n = 40). Furthermore, although potentially traumatic experiences related to military violence and the Israeli occupation recurred across all settings, some differences emerged. For example, children from across urban, rural and refugee camp settings described experiencing military incursions by the Israeli army, sound bombs or arrests but such incidences were most frequently cited by participants from the Dheisheh refugee camp, West Bank (65%) and in the two villages in the West Bank (23%) with fewer or no mentions coming from Nablus and Gaza, respectively. Likewise, experiences related to the Israeli occupation, such as the demolition of homes, the presence of settlers and displacements, were predominantly reported by the children living in the rural areas of the West Bank (15 children in the villages and two in the refugee camp). Finally, dogs emerged as frightening for children across all of Palestine, while snakes and scorpions were reported solely by children living in rural areas (in both Gaza and the West Bank), and a fear of rats was only reported by children at the Dheisheh refugee camp in the Bethlehem area where sanitary conditions are an issue.

The participating children reported a relatively high level of life satisfaction, as reflected in their scores on the MSLSS, which generally fell at around 3 (3 = often and 4 = always). Out of the four different domains, the most favourable marks were obtained for family life (M = 3.56), while the greatest variability (SD = 0.30) was registered on the Friends and Living Environment subscales. In keeping with the positive findings for life satisfaction, on the PANAS-C, our participants obtained lower scores for negative affect (M = 2.16; SD = 0.8) than for positive emotion (M = 4.22; SD = 0.7). With regard to the CRIES, mean scores on individual items generally fell at around 2 (between rarely and sometimes). Notably, the literature suggests that a combined score of 30 for all CRIES scales, and of 17 or over on the eight items relating to intrusion and avoidance is a valid marker for cases of post-traumatic stress disorder (Perrin et al., 2005). The mean global score obtained by our sample was 31.07, which is above the cut-off score (≥30), thus demonstrating the relative severity of these children’s traumatic symptoms. The mean intrusion score was slightly above the cut-off level for posttraumatic stress disorder (PTSD) (8.2 as opposed to 7.5), while the children reported extremely high levels of avoidance of traumatic events (cut-off ≥ 4, M = 11.84). Finally, with regard to the CHS, higher scores were obtained on the agency subscale (M = 4.17; SD = 0.9) than on the pathways subscale (M = 4.05; SD = 0.8), which also displayed the greatest variability (0.3).

The zero-order correlations among the study variables are reported in Table 3. The data concerning girls are presented above the diagonal and those concerning boys, below the diagonal.

Table 3.

Zero-order correlations among the study variables; means (M) and standard deviations (SD) by gender.

	1	2	3	4	5	6	7	8	9	M	SD
Life satisfaction (1)	—	−0.37**	0.47**	−0.19*	−0.26**	NS	−0.17*	0.35**	−0,29**	134	13.9
Negative affect (2)	−0.47**	—	−0.31**	0.56**	0.47**	NS	0.46**	−0.18*	NS	11.3	3.90
Positive affect (3)	0.46**	−0.47**	—	NS	NS	NS	NS	0.47**	−0.29**	21.2	3.37
Intrusion (4)	−0.43**	0.36**	−0.32**	—	0.62**	0.37**	0.83**	NS	NS	7.86	5.43
Arousal (5)	−0.52**	0.41**	−0.31**	0.67**	—	0.30**	0.82**	NS	−0.20*	10.3	6.06
Avoidance (6)	NS	NS	NS	0.45**	0.32**	—	0.70**	NS	NS	11.3	5.70
Trauma total (7)	−0.46**	0.39**	−0.29**	0.88**	0.84**	0.71**	—	NS	NS	29.4	13.5
CHS (8)	0.35**	NS	0.44**	−0.20*	−0.32**	NS	−0.22*	—	−0.17*	24.9	4.62
Age (9)	NS	NS	NS	NS	NS	NS	NS	NS	—	11.6	1.42
M	132	10.1	21.1	8.65	11.3	12.5	32.5	24.4	11.5
SD	14.0	3.88	3.70	6.08	6.69	5.72	15.0	4.94	1.58

Note: CHS: Children’s Hope Scale.

N = 250, * = p < .05, ** = p < .01.

The correlation analysis revealed a consistent pattern of relationships among the key variables under study. With regard to age, a negative correlation was identified in the female group only, in relation to life satisfaction, positive affect, arousal symptoms and sense of agency. Specifically, older girls tended to score lower on all four of these dimensions. In general, this preliminary analysis suggested that agency was more strongly associated with life satisfaction and only weakly associated with trauma symptoms.

In order to evaluate the main research hypotheses and analyse the associations between variables in greater depth, we applied a SEM technique (Bollen, 1989).

As a latent variable, sense of agency was assessed via the observed variables of agency and pathways. The target latent variable – trauma symptoms – was measured via the observed variables of intrusion and arousal in CRIES-13. The observed variable avoidance was dropped from the final model because it was not significantly related to any of the other variables. This finding was not surprising, however, given the contradiction inherent in viewing avoidance as a symptom in contexts of ongoing and constant threats of violence. This issue has been acknowledged in the literature, and some authors have suggested that avoidance behaviours may actually represent effective protective strategies for dealing with ongoing threats to one’s personal safety and welfare (Punamäki et al., 2015; Veronese et al., 2017b). Next, as recommended in the literature (Stiglitz et al., 2009), the third latent variable – life satisfaction – was estimated based on the children’s reported levels of satisfaction with four key life domains, namely, family, friends, school and living environment. Finally, the manifest variable of negative affect (as measured by the five related items of the PANAS-C) was also included in the final model. Given that the three dimensions of positive affect, negative affect and global life satisfaction have been conceptualized as forming a multidimensional model of children’s subjective well-being (Diener, 1984; Huebner and Dew, 1996), positive affect was also entered in the first model evaluated, but then excluded from the final model given that it was not significantly related to any of the other variables. This finding is in keeping with Israel-Cohen and colleagues, who in a study with youth exposed to war in Israel found that life satisfaction and negative affect mediated PTSD symptoms, while positive affectivity was a non-significant factor (Israel-Cohen et al., 2015). Similarly, Veronese et al. (2017b) reported that negative affect amplified the effects of trauma in Palestinian children, whereas positive affectivity did not seem to be related in any way to either intrusion or arousal symptoms.

We also controlled for the effects of age and gender in the final model (see Figure 2).

Figure 2.

Structural equation modelling outcomes for the relations between agency, life satisfaction, negative emotions, and trauma symptoms.

Discussion

Our results suggest that the children who participated in the study appeared to be satisfied with their lives despite their dangerous and uncertain living environment. Our preliminary analysis identified agency and positive emotions as key factors in children’s general life satisfaction (Veronese et al., 2019). On the contrary, and as expected, high levels of fear and anxiety were found to be strongly correlated with increased severity of trauma symptoms.

The model revealed that the children’s agency was positively associated with their life satisfaction. Furthermore, agency also appeared to indirectly predict both reduced negative affect and lower levels of trauma symptoms. Life satisfaction on the other hand was directly associated with decreased levels of negative emotion and trauma. The results of the final model (Figure 2) suggest that it offered a good fit for the empirical data (χ²/df = 1.93; NFI = .914; TLI = .951; CFI = .96; RMSEA = .060; Akaike’s information criterion: 103.535). The fit indexes confirmed both the conceptual and statistical robustness of the relationships among the variables. With regard to the pathway analysis, children’s sense of agency was found to have positive standardized effects on reported life satisfaction (β = .41, p < .001). In contrast, there was no statistically significant relationship between agency and either trauma symptoms or negative affectivity. However, life satisfaction had a statistically significant and negative effect on both trauma and negative affect (β = −.34, p < .001 and β = −.46, p < .001; respectively). Finally, negative affect positively and directly predicted traumatic response (β = .37, p < .001), suggesting that negative emotions amplify the effects of trauma. Regarding the children’s demographic characteristics, age had direct, significant and negative effects on both agency and trauma symptoms (β = −.17, p < .05 and β = −.15, p < .05; respectively) but was not significantly related to either life satisfaction or negative affect.

The model showed that the total impact of the exogenous variable (agency) on the target variable (trauma symptoms) was entirely composed of mediated effects. Children’s sense of agency ultimately had a statistically significant, negative total effect on trauma symptoms (β = −.256, p < .01). The network of indirect and direct effects among the variables – including the cumulative effect of agency – is summarized in Figure 3.

Figure 3.

Indirect and total effects.

The total effect of children’s life satisfaction on their trauma symptoms was found to be both significant and negative (β = −.51, p < .01). Breaking down total effects allows us to observe whether the effect of one variable on another is transferred (at least partially) via a third/intervening variable. In our case, for example, life satisfaction had a robust effect on the relationship between agency and trauma symptoms (green pathway, β = −.14, p < .01), while the indirect effect of negative affectivity was smaller (blue pathway, β = −.004, p < .01). Agency also impacted indirectly on negative affect via life satisfaction (red pathway). On the whole, the indirect effect of the children’s agency on their life satisfaction and negative affectivity was both negative and statistically significant (β = .21, p < .01), suggesting that a sense of agency may mitigate the consequences of trauma by impacting children’s emotions and life satisfaction. Indeed, our participants’ feelings of agency had positive indirect effects on all the various domains of their life satisfaction, with values ranging from β = .28 (satisfaction with family, p < .01) to β = .19 (satisfaction with school, p < .01).

Structural equation modelling assessment of the relationships and effects among variables appeared to partially confirm our research hypotheses. As described, children’s sense of agency was consistently and positively correlated with life satisfaction and its sub-domains. More specifically, the SEM revealed that agency directly impacted life satisfaction, mainly in the domains of family, friends and living environment (H1). Second, the results offered support for the notion that feeling satisfied with their lives helps children to control their reactions to trauma as well as reducing their levels of negative emotion (H2). Indeed, higher levels of global life satisfaction were associated with less negative affect and thus with less intense trauma symptoms, despite our participants’ continuously dangerous and unpredictable life contexts. In other words, the results of the SEM model confirmed a robust negative association between life satisfaction and both trauma symptoms and negative emotions (see Varela et al., 2018; Veronese et al., 2012; Veronese and Pepe, 2017a; Veronese et al., 2017b; Veronese et al., 2019). In addition, children who perceived themselves as satisfied with their social relationships, school and living environment also reported experiencing less negative emotion and engaging in fewer intrusion and arousal behaviours. Therefore, life satisfaction appears to play a key role in buffering children against adverse mental health outcomes.

Palestinian children are daily exposed to conditions of fear, insecurity and danger that make their adjustment to avoidance symptoms peculiar. In fact, as scholars have already noted, viewing avoidance as a symptomatic response in such contexts needs to be called into question (Cairns and Wilson, 1984; Veronese et al., 2017b). Indeed, distancing and avoidance tactics may even function as adaptive and protective strategies, helping children to mitigate the impact of the threats that they routinely face in the course of their everyday lives (Punamäki et al., 2015; Veronese et al., 2017b). Finally, the association between agency and life satisfaction suggests that a sense of agency might be viewed as a means of enhancing children’s satisfaction with their lives. It follows that agency may play a key role in protecting children from trauma-related symptoms (H3). While we did not find agency to wield a significant direct effect on measures of trauma, we showed it to strongly and directly impact life satisfaction and its related domains. Hence, while agency alone is not able to protect children, it can still significantly contribute to reducing negative affect and trauma symptoms. In other words, by enhancing life satisfaction, agency may indirectly mitigate traumatic response.

Study limitations

Turning now to the limitations of the present study, our operationalization of agency via the CHS, as reflected in the low albeit acceptable alpha coefficients obtained for this measure (see Supplementary Table 4), failed to capture the full complexity and nuance of the construct. For example, no differences were found between the various life contexts (urban, rural and refugee camp) included in the sample, suggesting that the instrument is insensitive to setting-specific dimensions of agency and its sources in environments of political and military violence. Also, this measure does not offer any insight into the many ways in which children mobilize resources to cope with traumatic experiences or survive in adverse conditions.

A future extension of this study will involve exploring agency to define more context-specific dimensions of this construct and build up a more detailed and nuanced picture of the various domains in children’s agency. The present quantitative phase has offered a preliminary measure of the contribution of agency to children’s life satisfaction and its indirect role in mitigating the effects of traumatic experience.

Implications for practice

The findings of this study may be of benefit to clinical practitioners, especially those working with children who are exposed to ongoing systematic violence and political oppression. Specifically, our outcomes may be used to inform programmes that seek to boost children’s agency in improving their own life satisfaction, in tandem with more traditional symptom-focused therapies. A child-centred approach implies a focus on empowering children and their communities to participate in the recovery process (Veronese and Barola, 2018). On the contrary, protocols exclusively centred on trauma reduction may fail to leverage children’s life satisfaction as an effective buffer against the consequences of trauma (Darawshy et al., 2020).

Operationalizing the construct of agency in psychology can add a valuable new dimension to clinical work with children affected by war and political oppression (Boyden, 2003). Therapeutic and psychosocial intervention needs to take account of children’s active deployment of protective strategies and competencies to defend their life satisfaction and make sense of and manage the burden of potentially traumatic experiences (Gilligan, 2009). Clinical psychology requires new client-oriented paradigms underpinning participatory interventions aimed at enhancing positive agency in war children (Denov and Shevell, 2019; Wessells, 2017).

Conclusion

Children appear to play an active role in fostering domains of life satisfaction that are of key importance in the Palestinian context. Indeed, their satisfaction with peer and family relationships suggests that these children play a significant role in their collectivist society from which, in turn, they receive essential nurturing. Their satisfaction with their school and living environment may be viewed as an attempt to re-assert control over their lives despite the traumatic conditions they are continually confronted with in their everyday lives. Ultimately, life dimensions and domains that are at risk of being undermined by disrupted living conditions are restored by the children’s continuous efforts to make sense of their lives, as well as by acts of love, decency, mutual respect and social inclusion that can all help children to survive abnormal living conditions.

Our next step moving forward will be to conduct a more comprehensive exploration of the forms, expressions and sources of childhood agency and the many ways they are used by children to reinforce their life satisfaction and manage trauma. What factors – individual, social or environmental – are sources of agency for children? And what resources – in terms of agentic actions, competencies and attitudes – do children draw on to maintain and boost their well-being, despite living in violent environments? The development of new measures and a more sophisticated operationalization of the agency construct will help to answer these and other questions of clinical and psychosocial interest.

Finally, future studies should also focus on better understanding the potential negative outcomes of agentic behaviours and consequent risk factors (Rohmann et al., 2019), as well as factors that can suppress positive agency and thus undermine resilience.

Supplemental Material

sj-pdf-1-chc-10.1177_13674935211017727 – Supplemental Material for Palestinian children living amidst political and military violence deploy active protection strategies against psychological trauma: How agency can mitigate traumatic stress via life satisfaction

Supplemental Material, sj-pdf-1-chc-10.1177_13674935211017727 for Palestinian children living amidst political and military violence deploy active protection strategies against psychological trauma: How agency can mitigate traumatic stress via life satisfaction by Guido Veronese, Federica Cavazzoni, Alaa Jaradah, Shaher Yaghi, Hania Obaid and Hala Kittaneh in Journal of Child Health Care

Footnotes

Acknowledgements

This article is a substantial rework of a doctoral thesis written by F. Cavazzoni and supervised by G. Veronese. G. Veronese planned the research design and set out data collection, planned and revised the statistical analysis and wrote the final version of the present article. F. Cavazzoni did statistical analysis and wrote the first draft of the paper. H. Kittaneh, A. Jaradah and S. Yaghi contributed to the data collection and approved the final paper. We would like to thank Dr. Alessandro Pepe for his consultancy in statistical analysis.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

ORCID iDs

Guido Veronese

Federica Cavazzoni

Supplemental Material

Supplemental material for this article is available online.

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