Exposure to war traumatic experiences, post traumatic growth and resilience among university students in Gaza

Aim: This study aimed to establish the association between war traumatic experiences, post traumatic growth and resilience among universities students in the Gaza Strip after war on Gaza. Method: The sample consisted of 381 randomly selected student's representing the four major universities in Gaza Strip. Students completed the following self-rated questionnaires: Gaza Traumatic Events Checklist, Resilience scale, and Posttraumatic Growth Inventory. Data collection was done on March -April 2015. Results: Participants reported a range of traumatic events; the highest frequencies reported traumatic events were watching mutilated bodies in TV (94.5%), hearing shelling of the area by artillery (92.4%), hearing the loud voice of drone’s motors (87.4%), and inhalation of bad smells due to bombardment (78.7%). While, the least common traumatic experiences were: hearing killing of a friend (11%), and being arrested during the land incursion witnessing (18.9%). Mean traumatic events reported by universities students were 10 events. While, 6% reported mild, 36% moderate and 58% severe traumatic events. Male students reported more traumatic events than females. Mean post traumatic growth was 67.34, appreciation of life was 7.17, new possibilities were 12.25, the personal strength was 10.62, and spiritual change was 6.82. Males had significantly more post traumatic growth than females and females had significantly more spiritual changes than males. For resilience, mean resilience was 55, personal competence was 22.32, positive acceptance was 13.49, trust in one's instincts was 16.30, control was 7.96, and spiritual influences were 7.31.There were gender differences on resilience subscale. Males had significantly more positive acceptance than females, trust in others, control, spiritual influences, and females had significantly more spiritual changes than males. Traumatic events had no association with post traumatic growth and total resilience. However, resilience was positively correlated with post traumatic growth. Conclusion: Universities students still experienced high levels of distress few months following war on Gaza, although they remained reported trauma. Trauma was not related to resilience and post traumatic growth. This finding highlights the need for establishing special community centers at the universities to help students to overcome the impact of trauma. New programs for psychosocial support and second level intervention for students, and these should continue beyond the end of hostilities. More training courses in the impact of trauma and ways of coping must be conducted for students in the universities

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict‐affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi‐structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as ‘on hold’. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised

Identifying and addressing conflicting results across multiple discordant systematic reviews on the same question: protocol for a replication study of the Jadad algorithm

Introduction An increasing growth of systematic reviews (SRs) presents notable challenges for decision-makers seeking to answer clinical questions. In 1997, an algorithm was created by Jadad to assess discordance in results across SRs on the same question. Our study aims to (1) replicate assessments done in a sample of studies using the Jadad algorithm to determine if the same SR would have been chosen, (2) evaluate the Jadad algorithm in terms of utility, efficiency and comprehensiveness, and (3) describe how authors address discordance in results across multiple SRs. Methods and analysis We will use a database of 1218 overviews (2000-2020) created from a bibliometric study as the basis of our search for studies assessing discordance (called discordant reviews). This bibliometric study searched MEDLINE (Ovid), Epistemonikos and Cochrane Database of Systematic Reviews for overviews. We will include any study using Jadad (1997) or another method to assess discordance. The first 30 studies screened at the full-text stage by two independent reviewers will be included. We will replicate the authors' Jadad assessments. We will compare our outcomes qualitatively and evaluate the differences between our Jadad assessment of discordance and the authors' assessment. Ethics and dissemination No ethics approval was required as no human subjects were involved. In addition to publishing in an open-access journal, we will disseminate evidence summaries through formal and informal conferences, academic websites, and across social media platforms. This is the first study to comprehensively evaluate and replicate Jadad algorithm assessments of discordance across multiple SRs

Parent and child agreement for acute stress disorder, post-traumatic stress disorder and other psychopathology in a prospective study of children and adolescents exposed to single-event trauma

Examining parent-child agreement for Acute Stress Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) in children and adolescents is essential for informing the assessment of trauma-exposed children, yet no studies have examined this relationship using appropriate statistical techniques. Parent-child agreement for these disorders was examined by structured interview in a prospective study of assault and motor vehicle accident (MVA) child survivors, assessed at 2-4 weeks and 6 months post-trauma. Children were significantly more likely to meet criteria for ASD, as well as other ASD and PTSD symptom clusters, based on their own report than on their parent's report. Parent-child agreement for ASD was poor (Cohen's κ = -.04), but fair for PTSD (Cohen's κ = .21). Agreement ranged widely for other emotional disorders (Cohen's κ = -.07-.64), with generalised anxiety disorder found to have superior parent-child agreement (when assessed by phi coefficients) relative to ASD and PTSD. The findings support the need to directly interview children and adolescents, particularly for the early screening of posttraumatic stress, and suggest that other anxiety disorders may have a clearer presentation post-trauma

Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka

Catani C, Jacob N, Schauer E, Kohila M, Neuner F. Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008;8(1): 33.BACKGROUND: The consequences of war violence and natural disasters on the mental health of children as well as on family dynamics remain poorly understood. Aim of the present investigation was to establish the prevalence and predictors of traumatic stress related to war, family violence and the recent Tsunami experience in children living in a region affected by a long-lasting violent conflict. In addition, the study looked at whether higher levels of war violence would be related to higher levels of violence within the family and whether this would result in higher rates of psychological problems in the affected children. METHODS: 296 Tamil school children in Sri Lanka's North-Eastern provinces were randomly selected for the survey. Diagnostic interviews were carried out by extensively trained local Master level counselors. PTSD symptoms were established by means of a validated Tamil version of the UCLA PTSD Index. Additionally, participants completed a detailed checklist of event types related to organized and family violence. RESULTS: 82.4% of the children had experienced at least one war-related event. 95.6% reported at least one aversive experience out of the family violence spectrum. The consequences are reflected in a 30.4% PTSD and a 19.6% Major Depression prevalence. Linear regression analyses showed that fathers' alcohol intake and previous exposure to war were significantly linked to the amount of maltreatment reported by the child. A clear dose-effect relationship between exposure to various stressful experiences and PTSD was found in the examined children. CONCLUSION: Data argue for a relationship between war violence and violent behavior inflicted on children in their families. Both of these factors, together with the experience of the recent Tsunami, resulted as significant predictors of PTSD in children, thus highlighting the detrimental effect that the experience of cumulative stress can have on children's mental health