Skip to main content

Exposure to war trauma and PTSD among parents and children in the Gaza strip

European Child & Adolescent Psychiatry volume 17, pages 191–199 (2008)Cite this article

Abstract

Objective

Exposure to war trauma has been independently associated with posttraumatic stress (PTSD) and other emotional disorders in children and adults. The aim of this study was to establish the relationship between ongoing war traumatic experiences, PTSD and anxiety symptoms in children, accounting for their parents’ equivalent mental health responses.

Methods

The study was conducted in the Gaza Strip, in areas under ongoing shelling and other acts of military violence. The sample included 100 families, with 200 parents and 197 children aged 9–18 years. Parents and children completed measures of experience of traumatic events (Gaza Traumatic Checklist), PTSD (Children’s Revised Impact of Events Scale, PTSD Checklist for parents), and anxiety (Revised Children’s Manifest Anxiety Scale, and Taylor Manifest Anxiety Scale for parents).

Results

Both children and parents reported a high number of experienced traumatic events, and high rates of PTSD and anxiety scores above previously established cut-offs. Among children, trauma exposure was significantly associated with total and subscales PTSD scores, and with anxiety scores. In contrast, trauma exposure was significantly associated with PTSD intrusion symptoms in parents. Both war trauma and parents’ emotional responses were significantly associated with children’s PTSD and anxiety symptoms.

Conclusions

Exposure to war trauma impacts on both parents’ and children’s mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Ager A (1997) Tensions in the psychosocial discourse: implications for the planning of interventions with war-affected populations. Dev Pract 7:402–427

    Article  Google Scholar 

  2. Ajdukovic M (1998) Displaced adolescents in Croatia: a source of stress and post traumatic stress reaction. Adolescence 33:209–217

    PubMed  CAS  Google Scholar 

  3. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (4th ed). American Psychiatric Association, Washington DC

    Google Scholar 

  4. Banyard V, Rozelle D, Englund D (2001) Parenting the traumatized child. Psychother: Theor, Res, Pract, Train 38:74–87

    Article  Google Scholar 

  5. Barenbaum J, Ruchin V, Schwab-Stone M (2004) The psychosocial aspects of children exposed to war: practice and policy initiatives. J Child Psychol Psychiatry 45:41–62

    Article  PubMed  Google Scholar 

  6. Basoglu M, Livanou M, Crnobaric C, Franciskovic T, Suljic E, Duric D, Vranesic M (2005) Psychiatric and cognitive effects of war in former Yugoslavia. JAMA 294:580–590

    Article  PubMed  CAS  Google Scholar 

  7. Berg-Nielsen TS, Vikan A, Dahl A (2002) Parenting related to child and parental psychopathology: a descriptive review of the literature. Clin Child Psychol Psychiatry 7:529–552

    Article  Google Scholar 

  8. Blanchard E, Jones-Alexander J, Buckley T, Forneris C (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673

    Article  PubMed  CAS  Google Scholar 

  9. Bronfman E, Biron-Campis L, Koocher G (1998) Helping children to cope: clinical issues for acutely injured and medically traumatized children. Profess Psychol: Res Pract 29:575–581

    Google Scholar 

  10. Browne A (1993) Family violence and homelessness: the relevance of trauma histories in the lives of homeless women. Am J Orthopsychiatry 63:370–384

    Article  PubMed  CAS  Google Scholar 

  11. De Jong J, Komproe I, Van Ommeren M, Masri M, Araya M, Khaled N et al. (2001) Lifetime events and posttraumatic stress disorder in four postconflict settings. J Am Acad Child Adol Psychiatry 286:555–562

    Google Scholar 

  12. Dirkzwager A, Bramsen I, Ader H, Van der Ploeg H (2005) Secondary traumatization in partners and parents of Dutch peacekeeping soldiers J Fam Psychology 19:217–226

    Article  Google Scholar 

  13. Dybdahl R (2001) Children and mothers in war: an outcome study of a psychosocial intervention programme. Child Dev 72:1214–1230

    Article  PubMed  CAS  Google Scholar 

  14. Dyregrov A, Yule W (2006) A review of PTSD in children. Child Adoles Ment Health 11:176–184

    Article  Google Scholar 

  15. Farhood L, Zurayk H, Chaya M, Saadeh F, Meshefedjian G, Sidani T (1993) The impact of war on the physical and mental health of the family: the Lebanese experience. Soc Sci Med 12:1555–1567

    Article  Google Scholar 

  16. Ford J, Racusin R, Daviss W, Ellis C, Thomas J, Rogers K, Reiser J, Schiffman J, Sengupta A (1999) Trauma exposure among children with oppositional defiant disorder and attention deficit – hyperactivity disorder. J Consult Clin Psychol 67:786–789

    Article  PubMed  CAS  Google Scholar 

  17. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adol Psychiatry 40:1337–1345

    Article  CAS  Google Scholar 

  18. Henry D, Tolan P, Gorman-Smith D (2004) Have there been lasting effects associated with the September 11, 2001, terrorist attacks among inner-city parents and children? Profess Psychol 35:542–547

    Article  Google Scholar 

  19. Horowitz M, Wilner N, Alvapez W (1979) Impact of events scale: a measure of subjective stress. Psychosom Med 41:209–218

    PubMed  CAS  Google Scholar 

  20. Jones L, Rrustemi A, Shahini M, Uka A (2003) Mental health services for war-affected children. Br J Psychiatry 183:540–546

    Article  PubMed  Google Scholar 

  21. Karim K, Tischler V, Gregory P, Vostanis P (2006) Homeless children and parents: short-term mental health outcome. Int J Soc Psychiatry 52:447–458

    Article  PubMed  Google Scholar 

  22. Khamis V (2005) Post-traumatic stress disorder among school age Palestinian children. Child Abuse Neglect 29:81–95

    Article  PubMed  Google Scholar 

  23. Kuterovac G, Dyregrov A, Stuvland R (1994) Children in war: a silent majority under stress. Br J Med Psychol 67:363–375

    PubMed  Google Scholar 

  24. Laor N, Wolmer L, Cohen D (2001) Mothers’ functioning and children’s symptoms five years after a scud missile attack. Am J Psychiatry 158:1020–1026

    Article  PubMed  CAS  Google Scholar 

  25. Laor N, Wolmer L, Mayes L, Golomb A, Silverberg D, Weizman R, Cohen D (1996) Israeli preschoolers under scud missile attack: a developmental perspective of risk-modifying factors. Arch Gen Psychiatry 53:416–423

    PubMed  CAS  Google Scholar 

  26. Leinonen J, Solantaus T, Punamaki RL (2003) Parental mental health and children’s adjustment: the quality of marital interaction and parenting as mediating factors. J Child Psychol Psychiatry 44:227–241

    Article  PubMed  Google Scholar 

  27. Lonigan C, Shannon M, Taylor C, Finch J, Sallee F (1994) Children exposed to disaster: II. Risk factors for the development of post traumatic symptomatology. J Am Acad Child Adol Psychiatry 33:94–105

    Article  CAS  Google Scholar 

  28. Nader K, Pynoos R, Fairbanks L, Al-Ajeel M, Al-Asfoor A (1993) A preliminary study of PTSD and grief among the children of Kuwait following the Gulf crisis. Br J Clin Psychol 32:407–416

    PubMed  Google Scholar 

  29. Palestinian Central Bureau of Statistics: http://www.pcbs.gov/ps/ Checked June 2007

  30. Perrin S, Meiser-Stedman R, Smith P (2005) The children’s revised impact of events scale (CRIES): validity as a screening instrument for PTSD. Beh Cogn Psychotherapy 33:487–498

    Article  Google Scholar 

  31. Pham P, Weinstein H, Longman T (2004) Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation. JAMA 292:602–612

    Article  PubMed  CAS  Google Scholar 

  32. Pynoos R, Frederick C, Nader K (1987) Life threat and posttraumatic stress in school-age children. Arch Gen Psychiatry 44:1057–1063

    PubMed  CAS  Google Scholar 

  33. Qouta S, Punamaki R, El Sarraj E (1997) House demolition and mental health: victims and witnesses. J Soc Distress Homeless 6:203–211

    Article  Google Scholar 

  34. Qouta S, Punamaki R, El Sarraj E (2003) Prevalence and determinants of PTSD among Palestinian children exposed to military violence. Eur Child Adol Psychiatry 12:265–272

    Article  Google Scholar 

  35. Qouta S, Punamaki R, El Sarraj E (2005) Mother–child expression of psychological distress in war trauma. Clin Child Psychol Psychiatry 10:135–156

    Article  Google Scholar 

  36. Reynolds C, Richmond B (1978) What I think and feel: a measure of children’s manifest anxiety. J Abn Child Psychol 6:271–280

    Article  CAS  Google Scholar 

  37. Reynolds C, Richmond B (1997) What I think and feel: a revised measure of children’s manifest anxiety. J Abn Child Psychol 25:15–20

    Article  CAS  Google Scholar 

  38. Smith P, Perrin S, Dyregrov A, Yule W (2003) Principal components analysis of the impact of events scale with children in war. Personality Indiv Diff 34:315–322

    Article  Google Scholar 

  39. Smith P, Perrin S, Yule W, Rabe-Hesketh S (2001) War exposure and maternal reactions in the psychosocial adjustment of children from Bosnia-Herzegovina. J Child Psychol Psychiatry 42:395–404

    Article  PubMed  CAS  Google Scholar 

  40. Souife A (1976) Social psychology. El Anglo, Cairo (in Arabic)

    Google Scholar 

  41. Taylor J (1953) A personality scale of manifest anxiety. J Abn Soc Psychol 48:285–290

    Article  CAS  Google Scholar 

  42. Thabet AA, Abdulla T, El Helou M, Vostanis P (2006) Effect of trauma on children’s mental health in the Gaza Strip and West Bank. In: Greenbaum C, Veerman P, Bacon-Shnoor N (eds) Protection of children during armed political conflict: a multidisciplinary perspective. Intersentia, Antwerp, pp 123–1241

    Google Scholar 

  43. Thabet AA, Abed Y, Vostanis P (2002) Emotional problems in Palestinian children living in a war zone: a cross-sectional study. Lancet 359:1801–1804

    Article  PubMed  Google Scholar 

  44. Thabet AA, Abed Y, Vostanis P (2004) Comorbidity of post-traumatic stress disorder and depression among refugee children during war conflict. J Child Psychol Psychiatry 45:533–542

    Article  PubMed  Google Scholar 

  45. Thabet AA, Stretch D, Vostanis P (2000) Child mental health problems in Arab children: application of the strengths and difficulties questionnaire. Int J Soc Psychiatry 46:266–280

    Article  PubMed  CAS  Google Scholar 

  46. Thabet AA, Vostanis P, Karim K (2005) Group crisis intervention for children during ongoing war conflict. Eur Child Adol Psychiatry 14:262–269

    Article  Google Scholar 

  47. Thienkrua W, Cardozo B, Chakkraband S, Guadamuz T, Pengjuntr W, Tantipiwatanaskul P, et al. (2006) Symptoms of posttraumatic stress disorder and depression among children in Tsunami-affected areas in Southern Thailand. Am Med Assoc 296:549–559

    Article  CAS  Google Scholar 

  48. Tischler V, Vostanis P (2007) Homeless mothers: is there a relationship between coping strategies, mental health and goal achievement? J Comm Appl Soc Psychol 17:85–102

    Article  Google Scholar 

  49. Vostanis P (2004) Impact, psychological sequelae and management of trauma affecting children. Curr Opinon Psychiatry 17:269–273

    Article  Google Scholar 

  50. Vostanis P (2006) The strengths and difficulties questionnaire: research and clinical applications. Curr Opinion Psychiatry 19:367–372

    Article  Google Scholar 

  51. Weine S, Raina D, Zhubi M, Delesi M, Huseni D, Feetham S, et al. (2003) The TAFES multi-family group intervention for Kosovar refugees. J Nerv Ment Dis 191:100–107

    Article  PubMed  Google Scholar 

  52. Wolmer L, Laor N, Gershon A, Mayes L, Cohen D (2000) The mother–child dyad facing trauma: a developmental outlook. J Nerv Ment Disease 188:409–415

    Article  CAS  Google Scholar 

  53. Zahr L (1996) Effects of war on the behaviour of Lebanese preschool children: influence of home environment and family functioning. Am J Orthopsychiatry 66:401–408

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are grateful to the families and children who participated in this study, for their openness in sharing such difficult issues. Also, we wish to thank the team that collected the data under shelling and enormous difficulties.

Author information

Authors and Affiliations

  1. Gaza Community Mental Health, Programme, El Rasheed Street, P.O Box 1049, Gaza, Palestine, Israel

    A. A. Thabet, A. Abu Tawahina & Eyad El Sarraj

  2. University of Leicester, Greenwood Institute of Child Health, Westcotes House, Westcotes Drive, Leicester, LE2 OQU, UK

    Panos Vostanis

Authors
  1. A. A. Thabet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Abu Tawahina
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eyad El Sarraj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Panos Vostanis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panos Vostanis.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Thabet, A.A., Tawahina, A.A., El Sarraj, E. et al. Exposure to war trauma and PTSD among parents and children in the Gaza strip. Eur Child Adolesc Psychiatry 17, 191–199 (2008). https://doi.org/10.1007/s00787-007-0653-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-007-0653-9

Key words

  • war
  • trauma
  • parents
  • child
  • PTSD