Exposure to Prolonged Socio-Political Conflict and the Risk of PTSD and Depression among Palestinians

Little is known about the impact of traumatic experiences and stressful life conditions on people in low-income countries who live in conditions of ongoing political violence. In order to determine the prevalence and predictors of post-traumatic stress disorder (PTSD) and major depression (MD) among Palestinians subjected to chronic political violence and upheaval, we used a stratified multi-stage cluster random sampling strategy to interview a representative sample of 1,200 Palestinian adults living in Gaza, the West Bank, and East Jerusalem. Prevalence of PTSD/MD for men living in the West Bank, Gaza, and East Jerusalem was 25.4%/29.9%, 22.6%/27.6%, and 16.1%/16.1%, respectively. For women, the prevalence of PTSD/MD was 23.8%/29.0%, 23.9%/28.9%, and 19.7%/27.6%. Among men, PTSD was significantly positively associated with age group, two or more incidences of political violence (compared to none), greater intrapersonal resource loss, and loss of faith in government. MD was positively associated with experiencing exposure to one, or two or more, incidences of political violence (compared to none), and greater interpersonal and intrapersonal resource loss. Among women, PTSD was positively associated with greater interpersonal and intrapersonal resource loss, and MD was positively associated with death of a loved one, two or more socio-political stressors (compared to none) previous to the past year, one or more socio-political stressors (compared to none) in the past year, and greater interpersonal and intrapersonal resource loss. Interpersonal and intrapersonal resource losses were consistently associated with PTSD and MD, suggesting potential targets for intervention and prevention efforts and thus provide important keys to treatment in areas of ongoing conflict.

[1]  Sandro Galea,et al.  The association of exposure, risk, and resiliency factors with PTSD among Jews and Arabs exposed to repeated acts of terrorism in Israel. , 2008, Journal of traumatic stress.

[2]  S. Galea,et al.  The psychological impact of the Israel-Hezbollah War on Jews and Arabs in Israel: the impact of risk and resilience factors. , 2008, Social science & medicine.

[3]  A. Thompson,et al.  The psychological treatment of Post Traumatic Stress Disorder (PTSD) in adult refugees: A review of the current state of psychological therapies , 2004 .

[4]  B. L. Cardozo,et al.  Mental health symptoms following war and repression in eastern Afghanistan. , 2004, JAMA.

[5]  Charles S. Carver,et al.  Conservation of resources and coping self-efficacy predicting distress following a natural disaster: A causal model analysis where the environment meets the mind , 1999 .

[6]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[7]  Kerstin E. E. Schroder,et al.  The assessment of optimistic self-beliefs : Comparison of the German, Spanish, and Chinese versions of the general self-efficacy scale , 1997 .

[8]  H. Weinstein,et al.  Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation. , 2004, JAMA.

[9]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[10]  Eran Halperin,et al.  A New Stress-Based Model of Political Extremism , 2009, The Journal of conflict resolution.

[11]  S. Hobfoll.  Conservation of resources. A new attempt at conceptualizing stress. , 1989, The American psychologist.

[12]  M. Ommeren,et al.  Lifetime events and posttraumatic stress disorder in 4 postconflict settings. , 2001, JAMA.

[13]  P. Cheung.  Posttraumatic Stress Disorder Among Cambodian Refugees in New Zealand , 1994, The International journal of social psychiatry.

[14]  D. Silove,et al.  The psychosocial effects of torture, mass human rights violations, and refugee trauma: toward an integrated conceptual framework. , 1999, The Journal of nervous and mental disease.

[15]  B. Hall,et al.  The psychological impact of impending forced settler disengagement in Gaza: trauma and posttraumatic growth. , 2008, Journal of traumatic stress.

[16]  Stevan E. Hobfoll,et al.  The ecology of stress , 1988 .

[17]  Patrick Vinck,et al.  Exposure to war crimes and implications for peace building in northern Uganda. , 2007, JAMA.

[18]  S. Galea,et al.  PTSD and depression after the Madrid March 11 train bombings. , 2006, Journal of traumatic stress.

[19]  R. Punamäki,et al.  The role of peritraumatic dissociation and gender in the association between trauma and mental health in a Palestinian community sample. , 2005, The American journal of psychiatry.

[20]  B. Hall,et al.  Refining our Understanding of Traumatic Growth in the Face of Terrorism: Moving from Meaning Cognitions to Doing what is Meaningful , 2007 .

[21]  Stevan E. Hobfoll,et al.  Resource conservation as a strategy for community psychology , 1993 .

[22]  A. Lazarus,et al.  Learning theory and the treatment of depression. , 1968, Behaviour research and therapy.

[23]  B. L. Cardozo,et al.  Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo. , 2000, JAMA.

[24]  C. Peterson,et al.  War-Related Trauma and Symptoms of Posttraumatic Stress Disorder Among Adult Kosovar Refugees , 2002, Journal of traumatic stress.

[25]  R. Ursano,et al.  Five Essential Elements of Immediate and Mid–Term Mass Trauma Intervention: Empirical Evidence , 2009, Psychiatry.

[26]  A. Thompson,et al.  The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. , 2008, Clinical psychology review.

[27]  Stevan E. Hobfoll,et al.  Stress, Culture, and Community: The Psychology and Philosophy of Stress , 1998 .

[28]  J. Flaherty.  Life Events and Illness , 1991 .

[29]  S. Hobfoll,et al.  Exposure to terrorism, stress-related mental health symptoms, and defensive coping among Jews and Arabs in Israel. , 2006, Journal of consulting and clinical psychology.

[30]  A. Proroković,et al.  Psychosomatic and depressive symptoms in civilians, refugees, and soldiers: 1993-2004 longitudinal study in Croatia. , 2005, Croatian medical journal.

[31]  R. Baumeister,et al.  Ego depletion: is the active self a limited resource? , 1998, Journal of personality and social psychology.

[32]  S. Hobfoll,et al.  The relationship of self-concept and social support to emotional distress among women during war. , 1986 .

[33]  C. Carver,et al.  On the Self-Regulation of Behavior , 1998 .

[34]  Barbara O. Rothbaum,et al.  Reliability and validity of a brief instrument for assessing post‐traumatic stress disorder , 1993 .

[35]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[36]  S. Galea,et al.  Predictors of depressive symptoms among israeli jews and arabs during the Al aqsa intifada: a population-based cohort study. , 2008, Annals of epidemiology.

[37]  F. Norris,et al.  Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. , 2008, Journal of traumatic stress.

[38]  F. Klasen,et al.  Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers. , 2007, JAMA.

[39]  B. Hall,et al.  Reciprocal relationships between resource loss and psychological distress following exposure to political violence: an empirical investigation of COR theory's loss spirals , 2012, Anxiety, stress, and coping.

[40]  M. Vranesic,et al.  Psychiatric and cognitive effects of war in former yugoslavia: association of lack of redress for trauma and posttraumatic stress reactions. , 2005, JAMA.

[41]  L. Fairbanks,et al.  Prospective study of posttraumatic stress, anxiety, and depressive reactions after earthquake and political violence. , 2000, The American journal of psychiatry.

[42]  T. Hudson.  Necessary losses? , 1997, Hospitals & Health Networks.