Elsevier

Child Abuse & Neglect

Volume 24, Issue 2, February 2000, Pages 291-298
Child Abuse & Neglect

Original Articles
Post traumatic stress disorder reactions in children of war: a longitudinal study

https://doi.org/10.1016/S0145-2134(99)00127-1Get rights and content

Abstract

Objective: To establish rates of posttraumatic stress disorder (PTSD) reactions and general mental health problems in children who had experienced war trauma.

Method: A longitudinal study in the Gaza strip with 234 children aged 7 to 12 years, who had experienced war conflict, at 1 year after the initial assessment, that is, during the peace process. Children completed the Child Post Traumatic Stress Reaction Index (CPTS-RI), while the Rutter A2 and B2 Scales were completed by parents and teachers.

Results: The rate of children who reported moderate to severe PTSD reactions at follow-up had decreased from 40.6% (N = 102) to 10.0% (N = 74). 49 children (20.9%) were rated above the cut-off for mental health problems on the Rutter A2 (parent) Scales, and 74 children (31.8%) were above the cut-off on the Rutter B2 (teacher) Scales. The total scores on all three measures had significantly decreased during the 1-year period. The total CPTS-RI score at follow-up was best predicted by the number of traumatic experiences recalled at the first assessment.

Conclusions: PTSD reactions tend to decrease in the absence of further stressors, although a substantial proportion of children still present with a range of emotional and behavioral problems. Cumulative previous experience of war trauma constitutes a risk factor for continuing PTSD symptoms.

Introduction

THE HIGH PREVALENCE of posttraumatic stress disorders (PTSD) in children traumatized by exposure to community violence or war trauma is well established. Previous research has investigated the course and prognosis of PTSD and other mental health disorders, particularly in young populations who experienced natural disasters. Most studies have found a gradual improvement of posttraumatic symptoms, but with a high risk of relapse (American Association of Child and Adolescent Psychiatry Official Action, 1998). Children’s prognosis has often been mediated by the degree of exposure to trauma and its impact on parents (e.g., Swenson et al 1996, Winje and Ulvik 1998). Longitudinal studies have followed-up children who had been exposed to violence, usually within the school environment. A gradual decrease of PTSD symptoms following a sniper attack was demonstrated by Nader, Pynoos, Fairbanks, and Frederick (1990) at 1–6- and 14-month assessments.

More recent research has addressed the short-term impact of war on children, often within refugee populations. In a series of studies of Cambodian refugees, Savin, Sack, Clarke, Meas, and Richart (1996) found PTSD to persist over time, although the intensity of symptoms dropped. There was marked decrease in depression. Full PTSD was associated with experience of earlier war trauma, while development of depression was more related to recent stressors.

Macksoud and Aber (1996) found PTSD rates of 43% in Lebanese children up to 10 years after exposure to war trauma. Among displaced Kurdish children in Iraq following the Gulf war, all had PTSD symptoms and 20% had PTSD, with significant improvement when they returned to their home regions (Ahmad, 1992). Israeli pre-school children, who had also been displaced during the Gulf war and exposed to scud missile attacks, had high stress symptoms in the first 6 months (Laor et al., 1997). Children’s stress levels subsequently decreased, but persisted in their mothers. Servan-Schreiber, Le Lin, and Birmaher (1998) reported a 30% rate of PTSD reactions in Tibetan refugee children in India. These findings are obviously based on different ethnic groups, as well as different types of traumatic experiences.

The aim of this study was to investigate the outcome of PTSD reactions in Palestinian children who had experienced longstanding military conflict throughout their childhood. The children of this study had been brought up during the military conflict in the area between 1987 and 1993, that is, until the peace process was initiated by the Middle East Oslo agreement. They were selected and assessed for the first time 6 months after the start of the peace process. The hypothesis was that continuing PTSD reactions would be best predicted by the degree of initial trauma.

Section snippets

Sample

The Gaza strip in the Middle East has a general population of 860,000 in an area of 360 km2. There are several socio-economic adversity factors (Thabet & Vostanis, 1998) which have been repeatedly associated with child psychopathology, such as overcrowding (population density of 2,150 people per km2), 62.6% of the population living in refugee camps, a proportionately large young population (51% of the general population are under the age of 15 years, with an annual growth of 6%), and high rate

Results

There was a trend of improvement according to parent ratings of “caseness” (Rutter A2 Scales) from 26.9% (N = 63) at the initial assessment to 20.9% (N = 49) at follow-up, although this did not reach a statistically significant level (McNemar non parametric test for paired observations: χ2 = 2.91, p = .08 Table 1). In contrast, children above the cut-off score on the Teacher Rutter B2 Scales significantly decreased from 43.6% (N = 102) to 31.8% (N = 74)—McNemar test: χ2 = 9.85, p = .0017. The

Discussion

This longitudinal study found a decrease in rates and severity of PTSD reactions in a sample of children who had experienced earlier war trauma. Continuing PTSD symptoms were predicted by the amount of traumatic experiences, which confirmed the main hypothesis of the study. At the time of follow-up, there was peace in the region, although socioeconomic adversities remained, particularly for children living in refugee camps. One characteristic of this population was its geographical stability,

Acknowledgements

The authors are grateful to all families and teachers who participated in this project. We wish to thank Professor R. Pynoos and Professor M. Rutter for their permission and support in using the CPTSD-RI and the Rutter Scales, respectively, as well as Dr. Saeed Haque for advice on the statistical analysis.

References (18)

There are more references available in the full text version of this article.

Cited by (180)

  • Post-traumatic stress disorder among victims of great march of return in the Gaza Strip, Palestine: A need for policy intervention

    2022, Archives of Psychiatric Nursing
    Citation Excerpt :

    Studies within the Palestinian context related to trauma are limited. They were limited to studying PTSD among children and adolescents (Abdelaziz et al., 2013; Al Ghalayini & Thabet, 2017; Blanc et al., 2015; Khamis, 2015; Punamäki et al., 2015; Thabet et al., 2014; Thabet, Tawahina, et al., 2015; Thabet & Thabet, 2015; Thabet & Vostanis, 2000; Thabet, 2018; Thabet & Thabet, 2017; Thabet et al., 2016), health care providers (N. I. Abu-El-Noor et al., 2018; N. I. Abu-El-Noor et al., 2016; Alhajjar, 2014; Shamia et al., 2015) and a few number of studies about adults (Hall et al., 2015; Thabet, Elheloub, & Vostanis, 2015). Up to the researchers' knowledge, there were no studies conducted in the Gaza Strip to assess PSTD among victims of GMR.

  • Psychological effects of collective political traumas and post-traumatic growth

    2024, Journal of Aggression, Conflict and Peace Research
View all citing articles on Scopus
View full text