|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
“Prevalence of PTSD among Palestinian children in
Gaza Strip” Samir Qouta, PhD - Eyad El Sarraj, MD Gaza Community Mental Health Programme |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
q Full text / Texte entier |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Abstract This research study aimed
to get acquainted with the prevalence of PTSD, and other psychological suffering
among Palestinian children living under severe conditions during the last two
and half years of the Al-Aqsa
Intifada. The sample consists of 944 children whom age ranged between 10-19
years. The group excluded those with previous mental health problems. In this
research, trauma scale, PTSD scale, the Child Posttraumatic Stress Index, the
Children’s PTSD-symptoms, The CPTS-RI and open questions had been used
as tools. The results indicated that 32.7% of the children started to develop
acute PTSD symptoms that need psychological intervention, while 49.2% of them
suffered from moderate level of PTSD symptoms. Also the results showed that
the most prevalent types of trauma exposure for children are for those who
had witnessed funerals (94.6%), witnessed shooting (83.2%), saw injured or
dead who were not relatives (66.9%), and saw family members injured or killed
(61.6%). Key words: PTSD In September, 2000, a new
Palestinian uprising began against the now 36-year old Israeli military
occupation. The immediate cause was the visit of then Israeli Knesset Member
Ariel Sharon accompanied by over 1000 fully armed Israeli riot police to what
Jews call the Temple Mount and Muslims, the Noble Sanctuary (“El-Haram
A-Sharif”) on which sits Al-Aqsa Mosque. Palestinians’ protest of the
violation of their holy place resulted in Israeli police shooting several
unarmed protesters. This event provided the immediate spark for Palestinian
protests throughout the West Bank and Gaza Strip, as well as the name for an
uprising that continues at this writing, “The Al-Aqsa Intifada.” The more
distant cause for this second and more violent Intifada was the evident
failure of the Oslo peace process. Instead of a lasting peace between
Israelis and Palestinians, Oslo agreement has followed by a 50% increase in
Israeli settlement building and land confiscation (KUKA), a decrease in
Palestinian freedom of movement and lack of civil liberties (KUKA), and
economic de-development including high unemployment. As the “Al–Aqsa
Intifada” continues into its fourth year, the Israeli army frequently shells
and destroys the Palestinian homes. Since October 2000 until 31 of January
2004, 3062 homes have been completely and partially demolished and 2524 homes
need to be repair in Gaza Strip (UNRWA, 2004). The army uses a variety of
methods to destroy homes, including tank shells, bulldozing, helicopter
gunship, and fighter aircraft. As homes have been bombarded and made
uninhabitable, many Palestinian families have found themselves living in
tents. When families
witness the destruction of their own homes by enemy soldiers, the
psychological effects can be serious. Loss of home can be a traumatic
experience for not only material loss but for psychological meaning. The home
means a shelter and heart of family life. It contains memories of joy and
pain as well as attachment to the families’ objects. Home is associated with
feelings of security and consolation. As in all modern wars,
the victims of the latest Middle Eastern war are mainly civilians. We have an
accumulated knowledge about the children’s responses to air raids,
bombardment, shelling, loss of family members and being target and witnessing
killing and destruction. It involves research on acute responses during the
II World war (Brander, 1941; Dunsdon, 1941; Freud & Burlingham, 1943),
mental health Middle Eastern children during military attacks (Bryce &
Walker,1986; Baker, 1990; Macksoud & Aber, 1996; Milgram & Milgram,
1976; Ziv & Israeli, 1973; Saigh, 1991), as well as military violence and
persecution in Africa (Dawes, 1992; Cliff, 1993) and Europe (Smith, Perrin,
Yule, & Rabe-Hasketh, 2001). Children’s responses to danger and
life-threat include anxiety, somatization and withdrawal symptoms, and
especially younger children may regress into the earlier stages of
development (Yule, 2002). While almost all children respond with excessive
fear, sleeping difficulties and clinging to parents in acute trauma, only a
smaller minority develop posttraumatic disorders. A substantial amount of
research is available on the severity of PTSD symptoms and predictive factors among Middle Eastern
children, especially of Kuwaiti children during the nine-months of Iraqi occupation (Hadi, & Llabre,
1998; Llabre & Hadi, 1994; Macksoud & Aber, 1996; Nader, & Pynoos,
1993; Pynoos, 1994; Nader & Fairbanks, 1984) and Israeli children during the Iraqi
scud missile bombardment (Klingman, 1992; Lavee & Ben-David, 1993; Laor,
Wolmer, & Cohen, 2001; Laor, Wolmer, Mayers, Gershon, Weitzman, &
Cohen, 1997; Weisenberg, Schwarzwald, Waysman, Solomon,
& Klingman, 1993; Rahav & Ronen, 1994; Rosenthanl & Levy-Shiff,
1993). The percentages of PTSD diagnosis vary from 22% among Israeli
(Laor et al., 1997, 27% among Lebanese (Saigh, 1991) 41% among Palestinian
children from Gaza exposed to shelling, (Thabet & Vostanis, 1999) 48%
among Cambodian refugee children (Kinzie, Sack, Angell, Manson, & Rath,
1996; Sack, Clarke, & Seeley, 1995), 52% among children from
Bosnia-Hercegovina (Smith, Perrin, Yule, Hacam, & Stuvland, 2002), and 78-88%
among Iraqi children exposed to bombardment (Dyregrov, Gjestad, &
Raundalen, 1993). Longitudinal studies on the PTSD are rare, and they reveal
that once the fighting and danger are over, the posttraumatic symptoms
decrease considerable (Laor et al., 2001; Punamäki, Qouta, & El Sarraj,
2001). Among Kuwaiti children, the share of severe level of PTSD was 4% after
one year of traumatic events, among Iraqi children and among Israeli children
0% after five years (Laor, et at. 2001). Dyregrow et al (2002) followed
shelled children at six months, one year and two years, and showed first
increase from 84% to 88%, and then decrease to 78% of PTSD. The physical and
emotional proximity, severity and nature of the traumatic event prescribe the
nature and severity of psychological problems (Macksoud & Aber, 1996;
Qouta, Punamäki, & El-Sarraj, 1996; Punamaki, 1998; Pynoos, 1987;
Klingman, 1992). For example, Bryce et al. (1989) found that especially
displacement from home increased depression among Lebanese children and women
during the 1982 Israeli invasion. Laor
et al., (1997; 2001) found among Israeli children that while posttraumatic
stress symptoms decreased generally after the Iraqi shelling, the symptoms
increased among displaced children. The present study
examines the levels of PTSD among Palestinian children during the current
Intifada. We further study how the nature of trauma (personal exposure to and
witnessing military violence) correlates with the children vision to their
future, and we guess that these
traumatic experiences will affect the way, in which the child see his
perspectives and solving problems. Method
-
The Sample The
sample consisted of 944 children ranging between 10-19 years, randomly
selected from all part of Gaza Strip with Arithmetic mean (15.1±1.5). 49.7%
of the sample were boys while 50.3% were girls. Refugee children represented
76.8% of the sample and the rest were citizen’s residents. Seven field
workers had participated in the field work, which done at schools, with
co-operation of the teacher and headmasters, -
Measurements 1. Trauma
questionnaire scale: This was developed for this study by
the Gaza Community Mental Health Programme. It consists of 12 traumatic
events frequently experienced by Palestinian children during the “Al-Aqsa
Intifada” (Box 1). Seven events refer to direct exposure to the traumatic
events (e.g., tear gas, shooting, or deprivation of medical help), while five
events refer to witnessing military violence, (e.g. witnessing killing and
injuring). Reliability by Alpha Cronbach was .82
Box 1. Trauma questionnaire scale The following are a
number of questions related to difficult events that you were exposed to. It
has nothing to do with a disorder or a normal event.
Witnessing traumatic events: The following questions are related
to events that you may have witnessed or heard about. Now I would like you to
answer them.
Note: the trauma scale is answered by the child not
the mother 2. PTSD
Scale (Posttraumatic Stress Disorder Scale) (DSMIV, American Psychiatric
Association, 1994). For the purposes of this study, PTSD refers to chronic
and not acute PTSD since the events described by the youths were associated
with lifetime trauma exposures. The scale was based the Clinician
Administered PTSD published in the Journal of Traumatic Stress. The
Child Posttraumatic Stress Reaction Index (CPTS-RI): this
follows DSMIV
criteria, developed by Nader and used to measure PTSD in youths aged 12 and
over(1)
Children’s PTSD-symptoms were assed by the Child Posttraumatic Stress
Disorder Reaction Index (CPTS_RI).(2) The
20-symptom scale is used to assess the degree of a child’s reactions to a
selected traumatic event, and covers the intrusive re-experiencing of the
event, avoiding related memories and numbing feelings and increased
hyper-arousal. The older children (13-16) reported themselves and the
interviewer estimated together with younger children the occurrence of the
symptoms on a five-point scale: (0) none of the time, (1) little of the time,
(2) some of the time, (3) much of the time, and (4) most of the time. The maximum
sum score is 80 and minimum 12, and in our sample the range was 11-68. Averaged sum variables were
constructed for intrusive (9 items, a =.80), avoidance (7 items, a =.77) and
hyperarousal (4 items, a =.66) symptoms. The CPTS_RI has been fond reliable and valid in predicting
trauma impacts among Arab children in Palestine (Punamäki et al., 2001;
Qouta, et al., 2001) and Kuwait (Nader et. al., 1993; Nader, & Pynoos,
1993; Hadi, & Llabre, 1998).
3. Open questions. We presented a picture of “Fatima”, a 15 year old sitting by herself
and looking out into empty space. We asked children to imagine what kinds of
problems Fatima might be thinking of and how they, the children, could help
solve them. In an effort to avoid suggestibility, the researcher provided the
children with no additional information regarding “Fatima.” rESULTS: Research on the "Prevalence of
PTSD among Palestinian Child during in Gaza Strip” showed the results of the
psychological suffering among Palestinian children living under severe
conditions during of Al-Aqsa
Intifada in hot and community areas of the Gaza Strip. The most prevalent
types of trauma exposure for children in the community areas is for those who
had witnessed funerals 94.6%, witnessed shooting 83.2%, witnessed shooting, 66.9
%; saw a friend or a neighbor being injured or killed 61.6% and were tear
gassed 36.1%. (see table 1). TABLE 1
Prevalence rate of the traumatic experiences among children in the community
areas
It was found
that 32.7% of the children in the community areas suffered from acute level
of PTSD while 49.2.1% children suffered from moderate level of PTSD at the
same time 15.6% children suffered low level of PTSD and we can say that 2.5%
children had no symptoms while in hot areas 54.6% of the children suffered
from acute level of PTSD (see table 2). While 34.5% children suffered from
moderate level of PTSD at the same time 9.2% children suffered low level of
PTSD and we can say that 1.7% children had no symptoms. TABLE 2 The
severity of PTSD according to the child’s gender PTSD score
The study found
significant differences between boys and girls. In the acute level of PTSD,
57.9% girls developed such symptoms while the percentage among the boys was
42.1% (see table 3). TABLE
3 The severity of
PTSD according to the child’s gender PTSD score
In this research we were
eager to explore how children are being coped with their problems, so the
researcher presented a picture of "Fatma", 15 years old student,
who engage in thinking, and we asked children how "Fatma" can solve
her problems. We found out that 66% of the children would like to concentrate
their effort on the school issue, 24.7% would like to be martyrs, 8.7% would
like to encourage the peace process, 0.1% would like to involved in national
struggle, 0.5% would like to be concentrating on the religion issue. In
addition to the "Fatma" picture it was discovered that some
differences between boys and girls. 67.8% of boys would like to be martyrs,
while 32.2% of girls go at the same direction. DISSCCUSION This article
reports the level of PTSD among Palestinian children currently exposed to war
and bombardment, and the role of children trauma perspective to the future
outlook. The results revealed a high level of PTSD: more than a half (32.7%)
of the children suffered from severe level of PTSD symptoms. The percentage
corresponds with the levels of PTSD among the Cambodian (Kinzie, et al.,
1996; Sack et al., 1995), and South American (Cervantes, et al., 1989) and
Bosnia-Herzegovian (Smith et al., 2002) refugee children fleeing atrocities
in their home countries. The level of PTSD was considerably higher than was
reported among Lebanese and Israeli children, 22% (Laor et al., 1997), but
lower than was reported among Iraqi children, 84% (Dyregrov et al., 1993). There are some context-specific characteristic of the current trauma
that may explain the children’s high level of PTSD. First, the long duration
for the conflict means more than an acute disaster for Palestinians as the
children exposed to on going traumatic experiences, and that means the
continuation of the stress for long periods, which damage the child psyche,
and increased the rate of PTSD. With regard to the
source of trauma for the Palestinian people, many researches indicated that
Israeli authorities were held responsible for the majority of direct trauma
exposure, an attribution that has face validity since tear gassing, home
demolitions and injuries due to bullet wounds have been widely reported by
news agencies, Israeli and Palestinian human right organizations and an UNRWA
field investigator (PCHR 2001, Palestinian National Authority, State
Information Services, 2001). Not surprising under the circumstances,
researches found a high level of behavioral problems and neurotic symptoms
among the children, who had an average level of 6 PTSD symptoms. Again, this
confirms the fact that a safe home fulfills a basic need and makes it
possible to establish secure and adaptive human relationships. Tragically,
the protective shield that is essential for children’s mental health is
dramatically destroyed when their families are faced with the shelling and
demolition of their homes. Our knowledge about the effect of
violent trauma on children’s mental health derives from the experience of
both human-made and natural disasters. Studies on the effect of war on
civilians come from the experience of the Second World War, contemporary
conflicts in the Middle East, South Africa, Ireland and Bosnia, as well as
the effect of urban violence targeted at American children. Traumatic
experiences and conflicts are the reality of many people throughout the
world. All of us have imagines of the civilians victims of contemporary
conflicts and what happened for the Palestinian since 1948 uprooting, is a
serious of disaster. As in all
modern wars, the victims of the latest Middle East war are mainly civilians.
Palestinian uprising and Israeli military attach to suppress are mainly
children. We have an accumulated knowledge about the human being’s responses
to air raids, bombardment shelling, loss of family member and being target
and witnessing killing and destruction. Children’s and adult’s responses to
danger and life-threat include anxiety, somatization and withdrawal symptoms,
and especially among younger children regression to the earlier stages of
development and clinging to parents. Family's ties are considered one of the
most important protectors of the child mental health in war conditions. Children
living in conditions of political violence and war have been described as
"growing up too soon", "losing their childhood", and
taking political responsibilities ample maturation (Boothby, Upton, &
Sultan, 1992). This development is predicting to result in negative
psychological consequences (Garbarino, Kostelny, & Dubrow, 1991). It is tragic
fact that Israeli and Palestinian children have become laboratories for the
study of the relationship between trauma and violence, conflict, and
children’s well being during war. Wars and battles have been fought without
interruption in the region for fifty years. None of these wars, however, have
brought a solution to the conflict between Jaws and Arabs. Palestinian
children have not known a day of real peace. Since the war area is small it
is difficult to protect children from sights of destruction, the dangers of
war and insecurity. Many of these children have taken part in their national
struggle. Even if they were not actively fighting on the streets, as so may
were they still could not help but experience the national struggle on an emotional
level. The atmosphere of insecurity, danger, violence, and hostility that
prevailed during the Intifada inevitably left scars on the mental health of
the Palestinians children. Mental
health professionals show increasing concern about developmental risks for
children who fall victims to political violence and war. Family and
parent-child attachment are considered important in providing a protective
shield for children's psychological well-being in dangerous conditions (Freud
& Burlingham, 1943; Garbarino, Kostelny & Dubrow, 1991). Researchers
assume that experiences related to political violence and war indeed
constitute a serious risk for the well-functioning family (Garbarino,
Kostelny, 1993). War and political conflict therefore disrupt some of the
basic parental functions, such as protecting children and enhancing trust in
security and human virtues. Palestinian
families in the Gaza Strip are large, and people show strong affiliation to
them. “El Hamula” (the extended family) continues to play an important
protective role in modern life too. Traditionally, children submit to the
authority of their parents, and older members of the family enjoy special
respect. The constant on their security threat and the collective trauma of
losing their homeland in 1948 have further increased social cohesion in
Palestinian society. However, the
Intifada created a situation that apparently shook traditional parent-child
relations and family hierarchy. First, the increased influence of political
parties decreased the social role of the extended family. Second, children
and youths played a very active role in the national struggle. They were an
essential element in the initiation, planning, and organizing of
demonstrations against and confrontations with Israeli soldiers (Kuttab,
1988). Palestinians
have expressed serious concern about the future consequences of these
shattered parental bonds. Some believe that children who threw stones
("children of the stones") and fought against the occupation army
also challenge their parents' authority. Parents face difficulties to protect
their children from sights of destruction, violence, and abuse. Many
Palestinian children have taken active part in their national struggle. Even
if they were not actively fighting on the streets, as so may were, they still
could not help but experience of
the national struggle on an emotional level interact dynamically
inside the child psyche as we see that ( 24.7%) expressed that
"Fatma" can be a martyr in order to solve her concerns . Researchers
studied Palestinian children’s and adult’s vulnerability to trauma and
resiliency from the first Intifada through seven years of practicing peace
and building national institutes and currently during the three years of
Al-Aqsa Intifada (Quota, Punamaki, & El Sarraj, 1995; Punamaki, Quota,
& El Sarraj, 1997; Qouta, Punamaki, & El Sarraj, 2003). We found that
family could function as a protective shield and secure base despite of the
violence predicted children’s resiliency. Loving and wise parenting
associated with children’s creativity and active participation, which then,
once peace was there predicted good mental health. We as a professionals had some questions about
future of the Palestinian children and we asked ourselves at that time what
kind of teachers, mothers and fathers they will be. We are very afraid to
have next lost generation but unfortunately the Palestinian children started
their wounds when the Al-Aqsa Intifada broke up the peace treaty and those
children inter to the new stage and their psyche goes on. This time the
Israeli violence is even more aggressive than during the first Intifada so
that why the psychological consequences of traumatic experiences are negative
influence of good children development, as those children did not know a day
of real peace as their grandparents had been uprooted in 1948 and from that
time their suffering had been started. The memory of Palestine is still alive
in their mind and they try to keep it alive by telling stories to their sons,
daughters and grandchildren about Palestine, about their own country and
about their own land. In each home map of Palestine is on the wall to remind
about their own country. So because the Palestine is all the time in the
concise of the Palestinian children their grow up in high political
environment and they grow too soon. Those children lost their right to have
normal childhood they gradually stared to be involved in Palestinian-Israeli
conflict. It is strange that such young children can carry such responsibility
but this is the real characteristics for all area of conflict around the
world. The biggest tragedy is that the children whom grow up in such
environment can perceive their parents as unable to protect them. Some
questions came to their mind; “if my father is unable to protect me who
can protect me?". So when the chills had witnessed parent’s
humiliation his trust and his psychology development had been complete
destroyed. Our study
has many faults and can be generalized only to the children living in acute
danger to life and military destruction. First, our study focused on the
epidemiological conclusions, but we need to gain a genuine view of how
families survive extreme life endangering situations, also the responses of
the parents are essential. Also a more comprehensive setting including family
resiliency and vulnerable factors could have been more informative. References 1.
Baker, A.,
(1990). Psychological
Responses of Palestinian Children to the Environmental Stress Associated with
Military Occupation, Journal of Refugee Studies, 4, 237-247. 2.
Brander, T. (1941). Kinderpsychiatrische Beobachtungen wahrend
des Krieges in Finland 1939-1940.
Zeitschrift fur Kinder Psychiatrie, 7,177-187. 3.
Boothby, N., Upton, P., & Sultan, A. (1992). Children of
Mozambique: The cost of survival (Special issue paper). Washington, DC: U.S.
Committee for Refugees. 4.
Bryce, J., & Walker, N. (1986) Family functioning and
child health: A study of families in West Beirut (Final report submitted to
UNICEF, December 31, 1986). New York: UNICCEF. 5.
Bryce, J., & Walker, N., Ghorayed, F., and Kanj, M.
(1989). “Life Experiences, Response Styles and Mental Health Among Mothers
and Children in Beirut, Lebanon”. Social Science and Medicine, 28 (7),
685-695. 6.
Cervantes (1989) 7.
Cliff, J. (1993).
The Impact of War on Children: Health in Mozambique. Social Science Medicine, 36,
7,843,848. 8.
Dawes, A. (1992). Mental Health in South Africa. South African Journal of Psychology,
22, 28-33. 9.
Dunsdon, M.I. (1941). A Psychologist’s Contribution to Air Raid
Problems. Mental Health, 2, 37-41. 10. Dyregrove, A., &
Raundalen, M. (1993). A longitudinal Study of War-Exposed Children in Iraq,
Presented at the International GCMHP Conference Mental Health and the
Challenge of Peace, 13-15 September 1993.KS. 11. Dyregrove, A.,
Gjestad, R., & & Raundalen, M. (2002). Children exposed to warfare: A
longitudinal study. Journal of Traumatic Stress, 15, 59-68. 12. Freud, A. &
Burlingham, D.T. (1943). War and Children. New York: Medica War Books, Ernest
Willard. 13. Garbarino, J., Kostelny,
K. and Dubrow, N. (1991). No Place to Be a Child: Growing Up in a War
Zone. Lexington, Mass.:
Lexington Books. 14. Garbarino, J.,
Kostelny, K. (1993). Children's response to war: what do we know? In L.A.
Leaved & N.A. Fox (Eds.). The Psychological Effects of War and Violence
on Children (pp. 23-39). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc. 15. 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. 16. Kinzie, J. D.,
Sack,W.H., Angel, R.H., Manson, S, & Rath, B. (1996). The psychiatric
effect of massive trauma on Cambodian children: I the children. Journal of
the American Academy of Child Psychiatry, 25, 370-376. 17. Klingman, A.(1992).
Stress Reaction of Israeli Youth during the Gulf War: A Quantitative Study.
Professional Psychology, Research Practice, 23(6), 521-527. 18. Kuttab, D. (1988). A
profile of the stonethrowers.
Journal of Palestinian Studies, 17, 14-23. 19. 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 American
Academy of Child and Adolescence Psychiatry, 36, 349-356. 20. 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. 21. Lavee, Y., & Ben-David, A. (1993).
Families under war: stress and strains of Israeli families during the Gulf
war. J. Traumtic Stress 6: 239-254 22. Llabre, M.M., &
Hadi, F.A. (1994). Health related aspects of the Ggulf crisis experience of
Kuwaiti boys and girls. Anxiety, Stress and Copying 7:217-228. 23. Macksoud, M., & Aber, J. (1996). The War Experience and Psychological
Development of Children in Lebanon. Child Development, 67, 72-88. 24. Milgram, R., Milgram, N.(1976). The Effect of the
Yom-Kippur War on Anxiety Level in Israeli Children, Journal of Psychology,
94, 107-113. 25. Nader, K.O., &
Fairbanks, Punamäki, R.L., (1984) Reactions of Palestinian and Israeli
Children to War and Violence. Arab Studies Institute. 26. Nader, K.O., &
Pynoos, R.S. (1993). Preliminary Study on Grief Among the Children of Kuwait
Following the Gulf Crisis, British Journal of Clinical Psychology, 32,
407-416. 27. Punamäki, R.L., Qouta,
S., & El Sarraj, E. (1997) Models of Traumatic Expereinces and Children’s
Psychological Adjustment: The Role of Perceived Parenting and the Children’s own
Resources and Activity. Child Development, 64 (4), 718-728. 28. Punamaki, R., Qouta,
S., & El Sarraj. E. (1997). Models of experiences and children’s
psychological adjustment: the roles of perceived parenting and the children’s
own resources and activity. Child Development, 64 (4), 718-728. 29. Punamaki, R., Qouta,
S., & El Sarraj, E. (1997). Relationships between traumatic events,
children’s gender, and political activity, and perceptions of parenting
styles. International Journal of Behavioral Development, 2l, 91-109. 30.
Punamäki, R.L. (1998). The role of dreams in protecting
psychological well-being in traumatic conditions. International Journal of
Developmental Behaviour, 22, 559-588. 31.
Punamäki, R. L., Qouta, S., & El
Sarraj, E. (2001). Resiliency factors predicting psychological adjustment
after political violence among Palestinian children. International Journal of
Developmental Behaviour ,25, 256-267. 32.
Pynoos, R.S., Frederick, C. and Nader, K. (1987). Life Threat and Post-Traumatic Stress
in School-Age Children. Archives
of General Psychiatry, 44, 1057-1063. 33. Pynoos, R. S. (1994).
Traumatic stress and developmental psychopathology in children and
adolescents. In R.S. Pynoos et al. (Eds.) Posttraumatic stress disorder. A
clinical review (pp. 65-98).
Lutherwille: Sidran press. 34. Palestinian Central
Bureau of Statistics (PCBS) 2001 35. Qouta, S., Punamaki,
R., & El Sarraj, E. (1995). The relation between traumatic experiences,
activity, and cognitive and emotional responses among Palestinian
children. International Journal
of Psychology, 30, (3), 289-304. 36. Qouta, S., Punamaki,
R., & El Sarraj, E. (1995).
The impact of the peace treaty on psychological well-being: a follow-up study of Palestinian
children. Hild Abuse and Neglect, 19 (10), 1197-1208. 37.
Qouta, S., Punamaki, R., & El Sarraj, E. (1996)
Relationships between Traumatic Experiences, Activity, and Cognitive and
Emotional responses among Palestinians. International Journal of Psychology,
30, 289-304. 38.
Qouta, Q., Punamäki, R.L., El-Sarraj, E.
(2001). Mental flexibility as resiliency factor in traumatic stress.
International Journal of Psychology, 36, 1-7. 39. Qouta S., El Sarraj
E., and Punamaki, R., (2003). Prevalence and determinants of PTSD among
Palestinian children exposed to bombardment and loss of home. Accepted to
European Journal of Child and Adolescent Psychiatry. 40. Qouta S., El Sarraj
E., and Punamaki, R., (2003). Prevalence of PTSD among Palestinian mothers
and children exposed to shelling and loss of home. 41. Rahav, G., & Ronen, T. (1994). Children’s perceptions of their
behavior problems during the Gulf war. Anxiety, Stress and Coping
7:241-252. 42.
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.
43. Sack, W.H., Clarke,
G.N., & Seeley, J. (1995). Posttraumatic stress disorder across two
generations of Cambodian refugees. Journal of American Academy of Child and
Adolescence Psychiatry, 34, 1160-1166. 44. Saigh, P.A. (1991).
The development of post-traumatic stress disorder. Behavioral Research and
Therapy, 29, 213-216. 45. Smith, P., Perrin,
S., Yule, W., & Rabe-Hasketh, S. (2001). War exposure and maternal
reactions in the psychological adjustment of children from
Bosnia-Herzegovina. Child Psychol Psychiatry & Allied Disciplines
42:395-404. 46. Smith, P., Perrin,
S., Yule, W., Hacam, B., & Stuvland, R. (2002). War exposure among
children from Bosnia-Herzegovina: psychological adjustment in a community
sample. J. Trauma Stress 15: 147-156 47. Thabet, A.A.M., &
Vostanis, Y. (1999) Posttraumatic stress reactions in children of war.
Journal of Child Psychology and Psychiatry 40, 385-391. 48. Weisenberg, M., Schwarzwald, J., Waysman, M.,
Solomon, Z., & Klingman, A. (1993). Coping of school-age children in the sealed
room during scud missile bombardment and postwar stress reactions. Journal of
Consulting and Clinical Psychology, 61, 462-467. 49. Ziv, A.& Israeli, R.(1973). Effects of Bombardment on the Manifest
Anxiety Levels of Children Living in the Kibbutz. Journal of Consulting and Clinical Psychology, 40,
287-291. 50. Yule, W. (2002).
Alleviating the Effects of War and Displacement on Children. Traumatology,
10, 1-71. (1) Nader K, Pynoos R, Fairbanks L,
Al-Ajeel M, Al-Asfour A. A preliminary study of PTSD and grief among the
children of Kuwait following the Gulf crisis. British Journal of Clinical Psychology
1993; 32: 407-416. (2) Pynoos R, Frederick
S, Nader K, Arroyo W. Life threat and posttraumatic stress in school age
children. Archives of General Psychiatry 1987: 44: 1057–1063. |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Document Code
OP.0088 |
ÊÑãíÒ
ÇáãÓÊäÏ OP.0088 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Copyright ©2004
WebPsySoft ArabCompany, www.arabpsynet.com (All Rights Reserved) |