Trauma-related psychological disorders among Palestinian children and adults in Gaza and West Bank, 2005-2008

Background  

Trauma from war and violence has led to psychological disorders in individuals living in the Gaza strip and West Bank. Few reports are available on the psychiatric disorders seen in children and adolescents or the treatment of affected populations. This study was conducted in order to describe the occurrence and treatment of psychiatric disorders in the Palestinian populations of the Gaza strip and Nablus district in the West Bank.     

The psychological impact of the Intifada on Palestinian children in the occupied West Bank and Gaza: an exploratory study

The mental health of 796 Palestinian children living in the occupied West Bank and Gaza Strip was assessed in terms of reported psychological status and behavioral symptoms. Results, interpreted within the context of the 1987 uprising (Intifada), indicate that exposure to political and military violence may be associated with the onset of conduct problems and fears, although active participation in the conflict may enhance self-esteem and shield children from development of psychological symptoms.     

The impact of political violence on psychosocial functioning of individuals and families: the case of palestinian adolescents

Background: The impact of political violence on the psychosocial functioning of adolescents and their families was compared for surveyed populations from two regions of Palestine. Method: A randomly‐selected sample of 971 adolescents (521 from the West Bank and 450 from the Gaza Strip regions, 42% male/57% female) completed scales measuring traumatic event, post‐traumatic stress disorder (PTSD), peer relations, mental health, aggression, and family functioning. Results: (1) West Bank participants reported a significantly higher level of exposure to political violence and significantly more aggression, mental health symptoms, problems in family and social functioning; (2) Participants exposed to greater political violence reported higher levels of depression, hostility, paranoid ideation, and PTSD; (3) Economic status and level of parental education were related to reduced levels of mental health symptoms and greater family functioning; (4) There were gendered differences. Conclusions: The study provides a starting point to begin to compare the experiences and outcomes between Palestinian adolescents in the West Bank and Gaza Strip and a basis for considering implications for service delivery and policy makers concerned with the well being of Palestinian communities.     

Psychological Symptomatology Among Palestinian Adolescents Living with Political Violence

Background:  The study examined the impact of the level of exposure to political violence on the psychological symptomatology of Palestinian adolescents in the West Bank, an area affected by the ongoing political violence between Israel and the Palestinian Authority.
Method:  A random sample of 1775 participants (54.1% males, 45.9% females) between the ages of 12–18 was administered a self-report questionnaire consisting of three measures: demographic variables, domestic violence, political violence events and psychological symptomatology (BSI).
Results:  Results indicated that the average psychological symptomatology was higher among those who were exposed to political violence events compared to those who were not; the level of hostility was significantly higher in those who were exposed to each of the political violence events. However, the factors that contributed most to psychological symptomatology were parental violence toward children and violence among siblings.     

Psychiatry and the Palestinian population

Some key issues pertaining to Palestinian psychiatry are described. Bearing in mind the geographical location and history of the Palestinian population, the development of psychiatry needs to be seen in the context of the Arab world, on the one hand, and of Israel, on the other. In the Middle Ages, Arab culture and medicine were more developed than in Europe. Aspects of general and forensic psychiatry on the West Bank and Gaza are outlined. Issues pertaining to the death penalty, suicide and suicide bombers are also discussed. The biblically-described relationship between the Arab and Jewish peoples has its resonance today with regard to cohabitation and conflict.     

Behavioural and emotional symptoms in 8–9-year-old children

We present epidemiological data from a multi-centre study on psychiatric symptoms among 6017 8–9-year-old children representing a total annual birth cohort (N=60007) in Finland. The results are based on three questionnaires: the Rutter Parent Scale (RA2), the Rutter Teacher Scale (RB2), the Children’s Depression Inventory (CDI). The proportion of children that scored above the cutoff points, indicating probable psychiatric disturbance, were 11.2% for the RA2, 13.9% for the RB2 and 6.9% for the CDI. Twenty-four percent of the subjects scored above the cutoff point on at least one of the questionnaires. Low family social status and disrupted family relations correlated strongly with high rates of symptoms in the children.     

A cohort study of behavioral problems and intelligence in children with high prenatal polychlorinated biphenyl exposure

BACKGROUND: In 1978, about 2000 persons in Taiwan were poisoned when their cooking oil was contaminated during manufacture with heat-degraded polychlorinated biphenyls, which are toxic, very widespread pollutant chemicals. The chemicals cannot be metabolized or excreted, and 8 of the first 39 children born to affected women died. When examined in 1985, 117 surviving children were found to have ectodermal defects, developmental delay, and disordered behavior. We have continued to observe the children. METHODS: From 1992 through 1995, 118 children born between 1978 and 1985 (during or after their mothers' exposure) and 118 matched neighborhood control children had cognitive function measured yearly with the Wechsler Intelligence Scale for Children-Revised and behavioral problems measured with the Achenbach Child Behavior Checklist and the Rutter Child Behavior Scale A. RESULTS: The exposed children scored 3 points (P =.05) lower than control children for IQ; 3 points (P =.002) higher on the Child Behavior Checklist (an effect size similar to the sex difference); and 6 points (P<.001) higher on the Rutter scale (3 times the sex difference). Birth year x exposure interactions, testing whether children born long after the exposure were as affected as those born soon after, were small and not significant. Age x exposure interactions, testing whether the children improved relative to control children as they got older, were significant only for the Rutter scale. CONCLUSIONS: Prenatal exposure to these compounds produces long-lasting cognitive and behavioral damage, but there is some evidence of recovery.     

Changes in psychiatric problems and service use among 8-year-old children: a 16-year population-based time-trend study

OBJECTIVE: To study differences in children's psychiatric symptoms and child mental health service use at three time points: 1989, 1999, and 2005. MethoD: Three cross-sectional representative samples of 8-year-old children were compared from southern Finland. The sampling, procedure, and methods were similar at all three time points. Information was gathered from parents and teachers using Rutter questionnaires and other related determinants of service use and from children using the Children's Depression Inventory. The participation rate at the three time points was 96% in 1989, 86% in 1999, and 84% in 2005. RESULTS: Overall, parent and teacher reports of children's problems did not show a significant increase during the 16-year period. Parent reports of boys' conduct symptoms decreased from 1989 to 1999. However, self-reported depressive symptoms among girls increased from 1989 to 2005. Low parental education level, broken family, and negative life events were associated with depressive symptoms among girls. Although 4% of boys and 1% of girls had used child mental health services in 1989, the respective figures in 2005 were 12% and 4%. The majority of children who were screen positive on either parent or teacher ratings of emotional and behavioral problems using Rutter scales had received some educational support from school in 2005. CONCLUSIONS: Reports of depressive symptoms increased among girls, and this finding merits further studies. Use of services has continuously increased. School services play an important role in providing support and early detection of children who need to be referred to child mental health services.     

The persistence of behavioural symptoms and symptom groups in children: A study of the stability of parental reported symptoms

The investigation assessed psychiatric symptoms in children at two time points and the persistence of symptom groups over an interval of 4 years. We studied 1128 children by using parental questionnaires (Rutter Scale A2) in both studies (mean age of the children was 8.5 years in Study 1 and 12.5 years in Study 2). There was a tendency for the frequency of symptoms to decrease over the 4-year period. Most of the symptoms reported in Study 1 were also found in Study 2. Sex differences were similar in both studies. Four factors were constructed out of the items on Rutter Scale A2, reflecting externalizing, hyperactive, internalizing, and poorly socialized behaviours. Externalizing, hyperactive, and internalizing behaviours were moderately persistent in the sample studied. The stability of externalizing and internalizing behaviour was high among deviant children. Hyperactivity was not persistent among deviant boys but highly persistent among deviant girls. Poorly socialized behaviour was not persistent in the sample studied, but girls scoring high in this factor in Study 1 scored high on the externalizing factor in Study 2.     

Children of a cohort of depressed patients 25 years on: identifying those at risk

OBJECTIVE: Factors associated with psychological outcome in children of patients with depression have been examined piecemeal, with emphasis on young rather than adult children. We hypothesized that psychological morbidity in adult children of patients with depression would be associated with characteristics of the children, their parents and their family relationships. METHOD: Factors predicting psychopathology in children (n = 94) of a cohort of patients with depression, admitted to a teaching hospital 25 years earlier, were examined using logistic regression. RESULTS: Psychological morbidity in children was predicted by their being younger at parent's admission, their perception of the depressed parent as more controlling and chronicity of the parent's depression. Correlations between child characteristics, parent illness and family relationship variables showed systemic interactions between parental illness, child psychopathology and family relationships. CONCLUSION: Chronicity (though neither recurrence nor severity) of parent depression and younger children's age at the time of parental admission for depression were associated with psychological morbidity in the children in adulthood. The interaction between child psychopathology, parental illness and family relationships emphasizes the need for a systemic, family focus in the treatment of depression.     

Psychosocial Adjustment in Middle Eastern Adolescents: The Relative Impact of Violent vs. Non-Violent Social Disorganization

The relationship between extreme social changeand the psychological adjustment of adolescentsundergoing such change was examined. The impact ofextreme social change relative to other conditions ofcatastrophic social disorganization such as chronic socialconflict and violent war-like conditions was alsoconsidered. The results indicate that Bedouinadolescents in Israel, members of a community that hasexperienced drastic social upheaval, show elevated rates ofpsychopathology. Comparisons of Bedouin adolescents toPalestinian adolescents from the West Bank and Gazasuggest that for older adolescents the impact of extreme social change on mental healthadjustment generally parallels that of both chronicsocial conflict (West Bank) and that of violent war-likeconditions (Gaza). However, this pattern did not hold for younger adolescents. In the Bedouincommunity, younger adolescents demonstratedsignificantly less adverse impact on adjustment thanolder adolescents, while such differences did not holdin the West Bank and Gaza. Thus the findings suggest acontinuum of adverse impact of the types of socialdisorganization examined and a possible interactionbetween type of social disorganization and organismicvariables such as age and gender.     

Internet Use among University Students in South West Bank: Prevalence,Advantages and Disadvantages,and Association with Psychological Health

University students are frequently using the Internet for educational purposes and for other purposes. Recently, there is a debate on advantages and disadvantages of Internet use and its effects on the students’ psychological health. This study examines the prevalence of Internet use, its advantages and disadvantages, and its relationship with the psychological health of university students in the southern part of the West Bank. Mixed methods employing sequential exploratory design were used. Three focused groups were included to inform the development of the cross-sectional survey. Then, a convenience sample of 144 students from three universities in the south West Bank completed the survey. The results revealed that 96 % of university students reported using the Internet. Different advantages and disadvantages of using the Internet among students were emphasized. A high rate of Internet use was associated with students’ poor psychological health. Internet use has negative and positive educational, social and psychological consequences for students. However, advantages of Internet use were shown to be more than its disadvantages.     

Psychiatric disturbances among prepubertal children in Southern Finland

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis. Accepted: 3 December 1997     

Emotional and behavioural symptoms in 8–9-year-old children in relation to family structure

The association between family structure and behavioural and emotional symptoms in prepubertal children was studied in an epidemiological survey conducted in Finland. Five thousand eight hundred thirteen children aged 8 and 9 years were screened using the Rutter Parent Questionnaire (RA2) for parents and the Rutter Teacher Questionnaire (RB2) for teachers. Information concerning family type, birth order and sibship size were obtained from the parents. The majority of the children (84%) in the sample lived with both their biological parents, 10% with a single parent, and around 5% with a biological parent and a stepparent. Around 1% of the children lived outside their original home. The prevalence of behavioural and emotional symptoms was lowest in children living with both their biological parents and highest among children living outside their original home according to both parents’ and teachers’ reports. Children living with a parent and a stepparent had problems more often at home, but less often at school than children living with a single parent. Living with a single father was associated with having more externalising, school-related problems, while living with a stepfather was associated with having more internalising, home related problems. Having younger siblings seemed to be associated with fewer problems at school, and being the youngest child with having less problems both at home and at school.     

Symptoms and deviant behavior among eight-year-olds as predictors of referral for psychiatric evaluation by age 12

OBJECTIVE: This study examined whether psychiatric symptoms and deviant behavior among eight-year-old children predicted referral for a psychiatric consultation by age 12. METHODS: A total of 1,268 children in Finland were assessed at age eight and again four years later. Three questionnaires-the Rutter A2 Scale for parents, the Rutter B2 Scale for teachers, and the Children's Depression Inventory (CDI)-were used at both time points. Other variables were socioeconomic status, family structure, and residence in an urban, rural, or semirural environment. One-way analysis of variance was used, and risk ratios were calculated to assess the extent to which children who were later referred for evaluation or for whom referral was considered were likely to have had scale scores in the deviant range at age eight. RESULTS: Only 3.3 percent of the children had been referred for an evaluation by age 12. Referral had been considered for another 2.9 percent of the children. The deviance scores of the referred children and those considered for referral were significantly higher on all scales at both time points. When the analysis controlled for gender and the other variables, the referred children were more likely than those not referred or considered for referral to have had high scores four years earlier on the teachers' scale and on the CDI. Children considered for referral were more likely than those not referred or considered for referral to be male and to have scored high on the CDI four years earlier. CONCLUSIONS: Psychiatric problems of younger children predict referral for psychiatric evaluation years later.     

Anticipatory stress in the population facing forced removal from the Gaza Strip

The Israeli government decided in March 2005 to remove the settlers of the Gaza Strip, a process known as "disengagement." One person per household residing in 13 settlements was randomly selected for a telephone interview that included the Demoralization Scale of the Psychiatric Epidemiology Research Interview. Women respondents and those with fewer years of education, higher risk perception, greater alienation from government, poorer perceived health, no social support outside the West Bank or Gaza, worse religious coping, and residence in a secular settlement had enhanced risk for higher emotional distress. Positive current satisfaction with life was associated with greater place attachment, less risk perception, stronger ideological stand, less feeling of alienation from the government, a more positive view of the future, and plans to return to Gaza. This population, as others in transitional states, may be at risk for emotional distress compared with some but not all stable Israeli groups.     

Psychiatric disorders in adopted children: a profile from the Ontario Child Health Study.

Studies of clinical populations suggest that adopted children are overrepresented among children using mental health facilities, whereas studies using non clinical populations of adopted children have reached mixed conclusions about whether or not there is an increased psychological risk associated with adoption. Data from the Ontario Child Health Study, a community survey of children aged four to 16 years, which included a subpopulation of adopted children, were used to: 1. profile the characteristics of adoptive families; 2. examine the strength of adoptive status as a marker for psychiatric and educational morbidity; and 3. determine the extent to which adoptive status has an independent relationship with psychiatric and educational morbidities. The findings were: 1. adoptive mothers were significantly older than non adoptive mothers, but otherwise adoptive families did not differ significantly from non adoptive families, 2. adoption in boys, but not in girls, was a significant marker for psychiatric disorder and poor school performance; adoption in adolescent girls was a significant marker for substance use; and 3. multivariate analyses demonstrated no independent effect of adoption on psychiatric disorder or poor school performance; for adolescents, adoptive status did have an independent relationship with substance use for girls. The implications of these findings will be discussed.     

An update on mental health services in the West Bank

The continuing development of the mental health services provided in the West Bank over the last fifty years is described. The hospital in Bethlehem was supplemented by the first community clinic in 1974, followed by clinics opening up in all 10 regions of the West Bank. The first Intifada brought actions from many international non-governmental organizations (NGOs). From 1993 the Palestine Authority's Ministry of Health has organized services, although the main addition initially was school counsellors from the Education Ministry. The second Intifada brought a further flurry of disorganized and well-intentioned interventions. A proposal for the reorganization of services from 2004 is in the course of implementation and should influence the training of personnel and structure of services.     

Family environment of children and adolescents with bipolar parents

Objectives: The effect of family environment on the development of bipolar disorder (BD) in children is not known. We sought to characterize families with children at high risk for developing BD in order to better understand the contributions of family environment to the development of childhood BD. Methods: We collected demographic data and parental ratings on the Family Environment Scale (FES) for 56 children (aged 6–18 years) from 36 families with at least one biological parent with BD. The cohort had previously been psychiatrically diagnosed according to semi-structured interviews. Results: Statistical comparisons with normative data indicated that parents' ratings were significantly lower on the FES Cohesion and Organization scales and were significantly higher on the FES Conflict scale. Multivariate analyses of variance indicated that families with both parents having a mood disorder had no significantly different FES scores than families with only one parent with a mood disorder (BD). Diagnostic data indicated that while 54% of the children in the sample had an Axis I disorder and 14% had BD, FES scores did not differ significantly for subjects with or without an Axis I disorder, or with or without BD. Conclusions: Families with a bipolar parent differ from the average family in having less cohesion and organization, and more conflict. Despite this difference, it does not appear that the environment alone of families with a bipolar parent determines the outcome of psychopathology in the children, or that the psychopathology of the children determines the family environment.