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This study was designed to evaluate the dimensionality, internal consistency, and validity of scores on the Arabic Post-Traumatic Growth Inventory--Short Form (PTGI--SF). This brief 10-item form of the PTGI self-report measure was administered to a sample of Arabic-speaking professional helpers (N = 338) working in Israel, Gaza, and the West Bank. Scores were assessed using confirmatory factor analysis. The findings suggest that the psychometric properties of the Arabic version of the PTGI--SF make it appropriate for assessing posttraumatic growth in the broader Arabic-speaking population.

Informed by a perspective centred on psychological health and well-being, the present research investigated whether teachers' overall well-being was influenced by their affect balance, as well as the extent to which both affect and well-being are influenced by social capital, in conflict-ridden areas such as the occupied Palestinian Territories (Gaza Strip and West Bank). The study involved three cohorts of Palestinian teachers working in Israel, Gaza and the West Bank, respectively (N = 153). Dynamics of social exclusion, religious difference, educational disparity, poor educational standards and a lack of opportunity are factors affecting Palestinian teachers in both Israel and the occupied Palestinian territories. The results supported the hypothesis that emotional balance directly influences teachers' well-being. Teachers with higher levels of positive affect reported greater personal well-being than those with higher levels of negative affect. Social capital also positively influenced teachers' personal well-being, both directly, and indirectly by fostering positive emotions. These results suggest that availability of community resources plays a key role in promoting teachers' well-being.

Traumatic experiences in childhood can lead to trauma symptoms and impaired mental health, especially when children are exposed to war and political violence. Despite significant attention to child's exposure to traumas, few instruments to detect potentially traumatic events have been validated psychometrically. Our study aimed to develop, adapt and validate a user-friendly traumatic events checklist in Palestinian children living in three areas affected by low-intensity war and ongoing political and military violence. 965 Palestinian children (494 males and 471 females) living in the Gaza Strip, West Bank and East Jerusalem were administered with a tailor-made Traumatic Events checklist, Children Impact of Events scale, and Strengths and Difficulties Scale. Exploratory and Confirmatory factor analysis was run to detect the factorial structure of the checklist. Furthermore, ANOVA was performed to identify statistically significant demographic differences among participants. A three factors structure emerged with Political violence-related traumatic experiences (PVTE), military violence against individuals (MVI), and military violence against individuals and families (MVF). Gaza children and adolescents resulted in being the most exposed to potentially traumatic events. The instrument can clearly portray potentially traumatic experiences in children exposed to violent events and adverse childhood experiences. [ABSTRACT FROM AUTHOR]

The ongoing occupation in Palestine involves structural colonial oppression over the native population, depriving Palestinians of fundamental human rights. The set of political, social, economic, and environmental factors that result from the occupation has a lasting direct and indirect effect on the well-being of the children exposed to systematic violence. In this study, we explored the effect of systematic violence and military oppression in a group of 22 school-aged youths (M = 12.2; SD = 2.69, 45.5% girls) living in the West Bank. We identified factors associated with children's maladjustment to potentially traumatic environments and survival skills following a socio-ecological lens. Data were collected through biographical participative interviews. The TCA identified six themes: the pervasiveness of the Israeli violence; the unexpected costs of the pandemic; victims and perpetrators of intra-community violence; everyday acts of happiness (or normalcy); support from families, peers, and community; subverting negative situations, and fighting back. Children emerged as continuously engaged in adjustment and readjustment to inhuman living conditions, making normal what is abnormal in their development. The study draws attention to the political antecedent and determinants of the Palestinian children's actions and reactions to violence, highlighting the impossibility of exploring children's growth while avoiding political and human rights implications. [ABSTRACT FROM AUTHOR]

The main goal of this study was to examine the psychometric properties of the COVID Stress Scales (CSS) in the Palestinian context and the factorial structure of the instrument. The CSS, a newly emerging internationally standardized measure of stress related to being exposed to or contracting COVID-19, was translated and validated for a Palestinian context to ensure that it can be used to measure COVID-19 stress. The sample of the study consisted of 860 Palestinian adults living in the West Bank of Palestine. Participants' age ranged from 20 to 48 years old (M = 34.7, SD =13.46). They were all recruited from online advertisements, e-mail campaigns, blogs, social media, and SMS campaigns. The CSS was found to be valid in the Arabic language within a Palestinian context. The confirmatory factor analysis yielded six factors: (1) Fears about the dangerousness of COVID-19, (2) fears about the personal social, and economic consequences of COVID-19, fears of disruption in the supply chain, fears of looting or rioting, (3) COVID-19-xenophobia, fears that foreigners are sources of COVID-19, (4) fears about sources of COVID-19-related contamination,(5) traumatic stress symptoms related to COVID-19, and (6) COVID-19-related checking which is consisting with the ordinal structure the scale. The CSS demonstrated a high level of validity and reliability in a Palestinian context and therefore can be considered for future studies as the COVID-19 pandemic persists. Further investigations using the Arabic Language of CSS may have far-reaching implications for measuring and combating the stress of COVID-19 at a personal and societal level for uniquely at-risk populations such as in the occupied territories of Palestine. [ABSTRACT FROM AUTHOR]

Background: In a geopolitically at-risk environment, such as Palestine, gender-based violence (GBV) is still a crucial problem rooted in discriminatory laws and traditional habits exacerbated by the ongoing Israeli military occupation. Moreover, the lack of updated data makes it difficult to grasp the magnitude of the phenomenon entirely; the purpose of the current study was to explore mental health professionals' perceptions and concerns on GBV among Palestinian women during the COVID-19 pandemic. Methods: Participants in the study were 30 Mental Health Professionals (MHP) selected using convenience and snowball sampling techniques from among MHP in northern West Bank, Palestine. Results: A thematic content analysis revealed seven main themes of GBV during the pandemic. Palestinian MHP reported that the increased number of GBV cases among women during the COVID-19, quarantine, physical distancing measures, and closure of non-essential services significantly heightened the risks of GBV among Palestinian women. Moreover, Palestinian women involved with or married to older men or married at a very young age were at risk of GBV more than others. Results of qualitative analysis also showed that Israeli occupation and the political violence characterizing the area for decades (including restriction of movement, house demolitions, separation of family members, etc.) have also exacerbated and increased GBV in the occupied Palestinian territories. Conclusions: Improving intervention skills and supervision services among Palestinian MHP to help women who face GBV is recommended. Moreover, additional research should be conducted to explore the risk and potential factors of GBV, agency, and coping strategies to deal with GBV. [ABSTRACT FROM AUTHOR]

Through a mixed-method design, the study investigated gender and context differences within the domains of agency, life satisfaction, affectivity, and symptoms of trauma. Two-hundred-fifty Palestinian children from cities, villages, and refugee camps (M = 11.58, SD = 1.49) completed four self-reported measures, Multilevel Student's Life Satisfaction Scale, Children's Hope Scale, Children's Impact of Event Scale, and Positive and Negative Affect Scales. Based on drawings and walk-along interviews with 75 children (M = 10.27, SD = 1.38), thematic analysis was performed to detect gender and context-specific differences regarding all the variables, which assisted in the interpretation of quantitative findings. Findings showed higher girls' satisfaction in the dimension of school (MD = 1.497, p<.05) and higher values of negative affect (MD = 1.192, p<.05). Correlation analysis revealed that older girls displayed lower levels of life satisfaction, positive emotions, arousal symptoms, and agency (p<.05). Children living in the West Bank reported higher levels of agency (MD = 1.898, p<.05) in comparison to those in Gaza. The comparison of urban, rural, and refugee camp participants yielded significant differences concerning children's satisfaction with their lives (MSLSS: F (2, 245) = 10.69, p <.001) and positive emotions (F (2, 245) = 6.49, p =.002). Six themes emerged from the TA: girls' feelings of insecurity and uncertainty; gender gaps in mobility and accessibility to public spaces; education as a mean for equal rights; perceived gender inequality; environmental unpredictability in the context of Gaza; unstable social and environmental conditions in the refugee camps. We explored participants' strategies of resistance to endure adverse living conditions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore mental health workers' perceptions and concerns about the psychosocial interventions provided to third-generation Palestinian refugee children. Our sample comprised 30 mental health practitioners aged 26–35 years, who were purposively selected at five Palestinian refugee camps in the West Bank of Palestine. Thematic content analysis was applied to transcripts of interviews with the practitioners, with a view to identifying key themes. It emerged that psychosocial service providers typically deliver consultation, group, and individual counselling, debriefing, and life skills training to children in Palestinian camps. The main challenges faced by the psychosocial service providers in the camps include a lack of qualified specialist staff, insufficient funding, the political conflict, and poor community awareness of psychosocial services, as well as low salaries and unemployment among psychosocial practitioners. The participants suggested that improving psychosocial services in the future will require investment in the sector, working alongside families and schools, establishing permanent psychosocial centres, and offering professional development opportunities to Palestinian psychosocial service providers. [ABSTRACT FROM AUTHOR]

Objective: We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods: PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results: The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion: We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine. [ABSTRACT FROM AUTHOR]

Health-care workers operating in conflict zones are at severe risk of psychological consequences, given their extended exposure to traumatic events under conditions of stress and violence. This quantitative, cross-sectional study was designed to explore the relationships between personal resources (sources of functioning)-operationalized as sense of coherence, posttraumatic growth, and perceived well-being-psychological distress, and trauma symptoms in a specific population of health workers exposed to war and violence. Palestinian health professionals (N = 181) completed quantitative measures of well-being, posttraumatic growth, sense of coherence, psychological distress, and traumatic response. The data were analyzed using structural equation modeling (SEM). The outcomes suggest that sources of psychological functioning consistently play a role in the mental health of different types of health professionals. Health-care workers in an environment characterized by instability and ongoing risk need to protect their own mental health by mobilizing sources of resistance and resilience, such as a sense of coherence, subjective well-being, and growth. We discuss the clinical implications of these findings and offer recommendations for training and supervision. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

In light of critical psychology and socio-constructionist theories, the present work aims at analyzing attitudes of political agency, psychological adjustment to trauma, and resistance, as protective factors against political violence in 122 children living in refugee camps in Palestine: Aida and Dheisheh camps in the West Bank and Jabalia camp on the Gaza Strip. Data were collected over 3 months, during summer camps that lasted at least 6 days. We conducted a comparative analysis of the use of drawing as a diagnostic tool for children who have experienced severe trauma and its use as a narrative instrument. Two strikingly different portraits emerge from a diagnostic perspective on the inner states of trauma-impacted children versus a narrative child-centered perspective that values children's own efforts to construct meaning. The former type of analysis is underpinned by an image of vulnerable children, afflicted by symptoms and at risk of losing emotional and behavioral control. In contrast, the analysis of children's narratives reveals abundant sources of functioning, coping abilities and agency in facing adversity. We discuss the fact that the first of these approaches fails to capture the protective and functioning factors underlying aspects of dysfunction and maladaptation. Diagnosis-oriented approaches risk to victimize and pathologize children living in contexts of ongoing trauma. The results of this preliminary survey on children's activism and agency show and confirm the crucial role of context in shaping children's suffering and reactions to war and ongoing violence. [ABSTRACT FROM AUTHOR]

Background: In Palestine, the ongoing Israeli occupation shapes and endangers all spaces that are used by children in their everyday lives. In this study, Palestinian children were considered active agents in their lives, both affecting and being affected by the world around them. Our research aimed to explore the role of resources, competencies, and attitudes of spatial agency in the lives of children in the occupied Palestinian territory. Specifically, we investigated how children use domestic and social spaces to actively maintain positive function and wellbeing despite an environmental backdrop of military violence.Methods: A convenience sample of 29 children aged 7-13 years (mean 9·66, SD 1·63) attending the primary school in Dheisheh refugee camp, West Bank, was selected. 17% (5 of 29) were boys and 83% (24) were girls. All children were asked to draw and describe a map of safe and unsafe places in the camp. Ten children were asked to continue the conversation outdoors using a "walk-along" technique, showing familiar places and narrating their experiences. Data were collected in April, 2018. All of the children's narratives were audiotaped, transcribed, and translated by a local bilingual researcher. Thematic content analysis was applied. Children who have been diagnosed with a physical or psychological disease were excluded from the sample. The study was approved by the ethical board of the University of Milano-Bicocca. Written informed consent was obtained from children and their families, who were informed of the scope of the research.Findings: Five themes emerged: using the mosque and the school to access spiritual and educational resources for subjective wellbeing; internal spaces as a safe place for growth and development (including domestic spaces to experience a sense of protection and security); community spaces to have fun and play an active part in the social and political life of the camp; enjoying the outdoor spaces of the camp despite environmental dangers and the violence of the occupation. Some children perceived risks and lack of safety in their lives. Children's narratives made plain the ways in which their ability to mobilise functioning resources (such as playing and socialising) were constrained by military and community violence, and environmental degradation. Overall, social and external places as spaces to restore a sense of normality and happiness were valorised more by boys than by girls, and girls were more active in internal spaces than in external spaces.Interpretation: Spatial agency is a key factor that potentiates wellbeing in children. Psychosocial interventions should aim to promote children's participation in transforming and reshaping spaces and places for their own protection and to improve the psychological wellbeing of the community.Funding: None. [ABSTRACT FROM AUTHOR]

Background: Professional helpers working in adverse circumstances are at risk of developing psychosocial stress and signs of primary and secondary trauma (eg, anxiety and hyperarousal). We used modelling to investigate whether and to what extent personal resources (ie, post-traumatic growth, sense of coherence, and wellbeing) of Palestinian helpers affected their experience of psychological distress and trauma symptoms.Methods: Eligible participants were professional health-care providers working in Gaza and the West Bank, occupied Palestinian territory, between June and October, 2018. We used the following quantitative measures: WHO Well Being Index (WHO-5), General Health Questionnaire (GHQ-12), Impact of Event Scale (IES-13), Sense of Coherence Scale (SOC-3), and Post-traumatic Growth Index (PTGI-10). Data were analysed by multivariate structural equation modelling with latent and empirical indicators to test the fit of these constructs to the empirical data. The model was specified to evaluate whether and to what extent mental resources may be interpreted as a set of protective factors mitigating risk factors. The study was approved by the ethics board of the University of Milano-Bicocca, Milan, Italy. Written consent was obtained from participants.Findings: 181 participants were enrolled, ranging in age from 18 to 65 years (mean 31·1, SD 8·7). 135 (75%) were men. The mean GHQ-12 score was 17·7 (SD 7·5), revealing a medium to high degree of psychological trauma. 60 (33%) participants reported low mood (although not necessarily depression) on WHO-5. The structural model showed an excellent fit (χ2 [24] 31·8, p=0·132, root mean square error of approximation 0·043, 90% CI 0·019-0·077). Stronger personal resources were associated with lower levels of both psychological distress (β=-0·25, p<0·01) and trauma (β=-0·16, p<0·01). Personal resources were especially associated with reduced levels of anxiety (β=-0·23, p<0·01) and intrusion symptoms (β=-0·22, p<0·01).Interpretation: Our integrated model showed that, despite heavy psychological burden, perceptions of post-traumatic growth, coherence, and wellbeing are associated with reduced psychological distress. Targeted training of health-care providers focused on self-awareness of their personal skills and survival resources could improve their psychological health. The study was limited by the cross-sectional research design, and the outcomes of the structural model should be read in terms of probabilistic associations rather than cause-effect relationships. A second limitation concerns the kind of data collected. All the research instruments yielded self-reported quantitative scores, meaning that the standardised β weights in the model could potentially be an artifact of common method variance (ie, attributable to the measurement method rather than to the constructs themselves.Funding: None. [ABSTRACT FROM AUTHOR]

Background: Subjective wellbeing can be defined in terms of good mental state, including positive and negative evaluations that people make of their affect and lives. The aim of this study was to identify specific domains of wellbeing that are salient to Palestinian teachers living in three different contexts (West Bank, Gaza Strip, and Israel) and to map how components of subjective wellbeing vary between the three cohorts.Methods: Data were gathered from interviews of teachers participating in 16 focus groups and from 36 key informants (including psychologists, counsellors, school principals, lawyers). Participants were divided into three groups according to their working locations. Data were analysed by using a mixed-method approach. We used thematic textual analysis, and data were cross-validated with results of statistical significance of lexical specificities (ie, domain-specific terms extracted from specific participants' lexicon) and semantic network analysis.Findings: We interviewed 104 teachers. First-order hierarchical categorisation of thematic analysis revealed four dimensions of subjective wellbeing: psychosocial, professional-related, economic issues, and contextual factors. Some second-order subcategories were quality of teaching work, personality aspects, emotional dimensions, political dimensions, and psychological dimensions. Analysis of lexical specificities and results of semantic network analysis revealed that the importance of different components of subjective wellbeing varied across geographical cohorts. Overall, the results of qualitative and quantitative data analysis showed a clear relationship between the teachers' subjective wellbeing and the places they lived.Interpretation: General themes were common in all populations, but the three cohorts differed in terms of the relative salience of each theme. The prominent themes for the Gazan group were quality of teaching, social dimensions, and religion. The key themes for the West Bank group were economic, social dimensions, and recognition. Salient themes for the Arab-Israeli group were professional, emotional, and social dimensions. Despite some differences between the diasporic Palestinian populations in the occupied Palestinian territories and Israel, the categories of wellbeing are supported in all cohorts.Funding: None. [ABSTRACT FROM AUTHOR]