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Item Open Access Trauma, PTSD, anxiety and coping strategies among Palestinian adolescents exposed to war in Gaza(Arab Journal of Psychiatry, 2014-05) thabet, abdelaziz; EL-Buhaisi, Omar; Vostanis, PanosAim: The present study investigated types of traumatic events experienced by Palestinian adolescents exposed to war in Gaza in relation to PTSD, anxiety and coping strategies. Methods: The sample comprised 358 adolescents aged 15 to 18 years; 158 boys (44.1%) and 200 girls (55.9%). Self-administrated questionnaires included Gaza Traumatic Events Checklist, Spence Children’s Anxiety Scale, Posttraumatic Stress Disorder according to DSM-IV scale, and the Adolescent-Coping Orientation for Problem experiences Scale. Results: The mean number of traumatic events reported by adolescents was 13.34 with 90.8% witnessing mutilated bodies on TV, 88.5% exposed to heavy artillery shelling, 86.6% seeing evidence of shelling, and 86.0% hearing sonic sounds from jetfighters. The mean total anxiety was 41.18, obsessive compulsive subscale was 8.90, generalized anxiety subscale was 4.46, social phobia was 6.99, separation anxiety was 6.16, physical injury fears was 5.48, and panic/Agoraphobia was 5.4. Girls reported more anxiety problems than boys; 11.8% of all participants reported no PTSD while 24.2% reported fewer than two symptom clusters. Criterion for partial PTSD was met by 34.31% while 29.8% reported symptoms meeting DSM-IV-TR criteria for full PTSD. Girls also reported more PTSD symptoms than boys. Participants reported coping by developing social support, investing in close friends, and/or engaging in demanding activities. Those reporting traumatic experiences developed less social support and requested more professional support while participants with PTSD coped by ventilating feelings, developing social support, avoiding problems. Participants with fewer PTSD symptoms tended towards solving their family problems while those with anxiety reported ventilating feelings, developing social support, and engaging in demanding activities. Participants with less anxiety sought more spiritual support.Item Open Access Social Support of Palestinian Adults with Disabilities in the Gaza Strip(Arab Journal of Psychiatry, 2018-11) thabet, abdelaziz; Vostanis, Panos; Qama, Kamal AbuAim: The present study aimed to determine the social support levels perceived by Palestinian adults with disabilities and to compare the data with socio-demographic variables. Method: N=416 participants (n=263 men, n=53 women); ages ranged from 19-70 years (M= 33.56 years) were selected randomly from the databases of two NGOs for people with disabilities. Instruments: Demographic data were collected via questionnaire for gender, age, class, and place of residence and attitudes and perceptions about social adaptation, life status, social role, self-esteem and self-concept were via the Social Support Scale. Results: The most commonly reported items in the Social Support Scale included feeling the need for security (69.6%), not feeling satisfied about quality of life (39%), understanding the demands of a new life (53.3%), feeling the need for love and social recognition (69.4%), and being aware of personal potential and ability (69.4%). Men with disabilities reported higher self-esteem than women with disabilities. Those who had no income had less social adaptation, less life status, less social role, and less self-concept. Conclusion and clinical implications: The importance of focus for improving the social support, self-esteem, and well-being of disabled Palestinian adults and families. Self-esteem enhancement interventions offered in this context might well have an increased effect when combined with the other services available through independent living. Culturally sensitive interventions need to be developed to further enable people in all strata of the social hierarchy to understand their own worth and bring about changes in their lives and communities. Psychosocial interventions can play a useful role in supporting awareness and the development of accurate and positive appraisals of the self, alongside the process of adjusting to life of disabled people.Item Open Access Resilience and Psychological Problems among Palestinians Victims of Community Violence(Arab Journal of Psychiatry, 2013-11) Anwar, Abadsa; thabet, abdelazizAim: The present study examined the relationship between psychological problems in families' of victims of community violence and resilience in the Gaza Strip. Method: 255 participants were selected; 120 were males (47.1%) and 135 were females (52.9%). Participants were interviewed using a socio-demographic scale and Arabic versions of the Symptom Checklist-90-Revised and the Resilience Attitude Scale. Results: Participants’ mean psychological symptoms were 121.48. Females reported more somatization, obsessive compulsive, anxiety and phobic anxiety symptoms than males. Hostility was greater in low income families, paranoia was greater in people from moderate income families, psychosis was greater in those from low income families. While mean resilience was 60.84, males had more resilience than females, were more committed, more able to control, and more challenging than females. People living in north Gaza were less resilient and less challenging than people living in Gaza or Khan Younis. Psychological problems, obsessive compulsive, depression, anxiety, phobic anxiety, paranoia, and psychosis were correlated negatively with resilience. Also, total psychological problems, sensitivity, and phobic anxiety were correlated negatively with commitment. Sensitivity, anxiety and phobic anxiety were negatively correlated with control. With total psychological problems, obsessive compulsive, sensitivity, depression, anxiety, paranoia and psychosis were correlated negatively with challenge. Conclusion: Palestinians in the Gaza Strip reported more psychological problems due to long-standing stress and trauma arising from community violence. Resilience was an outcome of experiences of stress and trauma and coping strategies; social support was affected by the presence of psychological problems among Palestinians whereby people with more psychological problems showed less resilience. This study highlights the need for community reconciliation between the factions and increased effort in social reconciliation. More psychoeducational programs may help increase coping and resilience. Also, families affected directly by such community violence should be targeted with their children by programs including psychological intervention, social and community support group, stress management, and parenting training.Item Open Access The Relationship between War Trauma and Anxiety and Posttraumatic Stress Disorder among Preschool Children in the Gaza strip(Arab Journal of Psychiatry, 2017-05) Al Ghalayini, Heba; thabet, abdelazizAim: The current study investigated the relationship between war trauma and anxiety and posttraumatic stress disorder (PTSD) among preschool children in the Gaza Strip. Methods: N=399 mothers and their preschool children who were enrolled in kindergartens in the Gaza Strip. Child ages ranged from 3-6 years with mean age of 4.48 years. Mothers were interviewed using a sociodemographic questionnaire, Gaza Traumatic Events Checklist, Child PTSD Symptom Scale-parent form, and Spence Children’s Anxiety Scale. Results: The most commonly reported traumatic experiences by mothers for their children were: hearing shelling of the area by artillery (95.5%), hearing loud noises from drones (89.2%) and seeing mutilated bodies on TV (81.2%). The mean number of traumas experienced by preschool children was 8.3. PTSD prevalence was 6% with scores higher in children aged five and older. The mean for total anxiety was 49.84, generalized anxiety was 10.7, social anxiety was 8.4; specific phobia was 21.1, and separation anxiety was 9.65. There were significant associations between trauma and PTSD and anxiety as well as a significant association between PTSD and anxiety. Conclusion: Preschool children exposed to war-related incidents are at risk of developing PTSD and anxiety problems, which highlights the need to establish programs for preschool children affected by traumatic events associated with war.Item Open Access Relationship between Stressors Due to Siege of Gaza Strip on Anxiety, Depression and Coping Strategies among University Students(Arab Journal of Psychiatry, 2015-05) thabet, abdelaziz; Joma’a, AbeerAim: The present study assessed siege related stressors and their impact on the depression, anxiety and coping strategies among university students in the Gaza Strip. Method: It is descriptive analytic study comprised of 399 randomly selected university students from the four main universities in Gaza Strip (Al-Aqsa, Al-Azhar, Al-Quds Open and Islamic University). Five questionnaires were used: sociodemographic questionnaire, the Gaza Stressful Situations Checklist, the Hamilton Anxiety Rating Scale, the Beck Depression Inventory and the Carver Brief Coping Scale. Results: The most frequently reported stressors were: sharply increased prices due to closure (92% of students), studies being affected so much due to cut-off of electricity (83.5%), and shortage of gas. Results showed that mean stressors in men were 12.38 and 10.33 in women. The study showed 9.5% of men and 12% of women had severe depression although no gender differences were found. In addition, 10.3% of men and 13.8% of women had anxiety. There was a statistically significant positive relationship between total stress due to siege and depression symptoms and anxiety. The most frequent coping strategies were finding comfort in religious beliefs (78.2%), thinking about what steps to take (71.4%), and learning to live with the situation (67.7%). A significant negative relationship was found between total score of stress due to siege and total coping strategies. Conclusion: The Gaza siege has had lasting negative effects on Palestinians, which has led to increased mental health problems among and to them using fewer positive coping strategies. Humanitarian organizations should play a more positive role to protect the Palestinian community from the negative consequences of siege. Further research is recommended to evaluate the impact of siege on Palestinian people in all aspects of life and to provide therapeutic interventions for university students with moderate and severe depression.Item Open Access The relationship between mothers’ mental health and the prevalence of depression and anxiety of preschool children after the war on Gaza Strip(Arab Journal of Psychiatry, 2014-05) thabet, abdelaziz; Ashraf, Abu bakar; Vostanis, PanosObjective: The present study investigated the prevalence of depression and anxiety among preschool children and relationship to mothers’ mental health. Participants: A sample of 380 preschool children aged 4-6 years with their mothers were selected from 24 kindergartens in the Gaza Strip. Method: Children were assessed by maternal reports for depression and anxiety; their mothers were assessed using the General Health Questionnaire-28. Results: Results showed the mean anxiety score for preschool children was 27.46, generalized anxiety mean was 3.42, social anxiety was 3.94, obsessive compulsive disorder was 4.92, physical injury fear was 10.47, and separation anxiety 4.94. No gender differences in showing anxiety symptoms except for physical injury fear which was greater in girls than boys. Anxiety problems were greater in children with low family income; no significant differences between the means of preschoolers’ anxiety problems according to type of residence or number of siblings. Mean depression was 33.10, mean lack of vitality and worthlessness was 12.98, mean loneliness and anxiety was 9.03, and mean anger and aggression 7.37. There were significant differences in depression for children with low family income although no significant differences according to type of residence. For mothers, mean total GHQ scale was 6.54, somatic symptoms was 1.80; mean anxiety and insomnia was 2.18, mean social dysfunction was 1.26, and severe depression was 1. Using 4/5 cut-off points, cases of mothers according to GHQ-28 were 185 (53.6%) and 160 (46.3%) were not cases. Conclusion: There was a significant positive correlation between mental health problems of mothers and subscales and depression and anxiety and subscales of their children.Item Open Access Posttraumatic Stress and Growth among War-Exposed Orphans in the Gaza Strip(Arab Journal of Psychiatry, 2018-11) thabet, abdelaziz; ElRabbaiy, AlaaAim: The present study explored the impact of trauma on war-exposed orphans in the Gaza Strip reporting symptoms of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). Participants: N=83 children attending the orphanage, El-Amal Institute, in Gaza city were included. Method: Measures were The Gaza Traumatic Events Checklist, Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI), Posttraumatic Growth Inventory (PTGI), and a demographic questionnaire. Results: Participants experienced 3 to 28 traumatic events (M=11.19). Those aged 12-14 years reported more traumatic events than younger and older children; 49.4% reported no PTSD symptoms, 32.5% reported partial PTSD, and 18.1% reported full criteria of PTSD. Children in the middle age group (12-14 years) reported higher levels of PTSD than younger and older groups. The PTGI scale found 78.31% reported they had a stronger religious faith with 70.7% stating they learned a great deal about how wonderful people are. Total posttraumatic growth among orphan children mean was 25.27. There was a statistically significant positive relationship between total traumatic events due to war and PTSD, numbness symptoms, and arousal symptoms. While, there was no correlation with PTG nor was there a correlation between PTSD and PTG. Conclusion: Orphaned children reported significant trauma and PTSD symptom levels, which suggests the need for governmental and non-governmental organizations to identify therapeutic programs to improve their daily functioning and productivity in future. Training is needed for caregivers in different institutions to ensure early detection of children with mental health problems and identify best ways to support.Item Open Access Prevalence of attention deficit hyperactivity disorder and conduct disorder among a school-based sample of Palestinian children in the Gaza Strip(Arab Journal of Psychiatry, 2014-11) thabet, abdelaziz; Elumour, IkramAim: The present study investigated prevalence of attention deficit hyperactivity disorder (ADHD) and conduct disorders among Palestinian children in the south Gaza Strip. Methods: Three hundred and eighty eight participants (194 boys, 194 girls), aged 12 to 15 years (M=13.5 years), were selected from eight governmental and United Nations Relief and Works Agency (UNRWA) preparatory schools. A self-report questionnaire, including sociodemographic scale, was completed. Teachers and parents completed the Structured Clinical Interview for DSM-IV diagnosis of ADHD while parents and their children completed a conduct disorder scale. Results: Parents reported 4.4% of children fulfilled the full criteria of ADHD combined type. According to teachers, 9.8% fulfilled the full criteria of ADHD combined type. ADHD combined type symptoms were higher in boys than girls. Children in governmental schools had more ADHD combined type than in UNRWA schools according to teachers who also rated children living in families with low family monthly income as having more ADHD. Parents reported 15.7% of children had conduct disorder while 17.5% of children self-reported the condition. Boys self-reported had higher levels of conduct disorder than girls, which supported parent ratings. Regarding comorbidity, 6.7% of children rated by parents had inattentive disorder and conduct; 5.2% of children had both conduct and hyperactivity-impulsivity disorder; and, 3.4% had both combined ADHD and conduct disorder. Conclusion: Findings confirmed a strong relationship between ADHD and conduct disorder and provided specific data on the prevalence in Palestinian children in the Gaza Strip. Such findings highlight the need to establish psychosocial rehabilitation programs in schools and community-based centers so children and their families can learn to overcome the adverse impact of such disorders on psychosocial development and academic achievement. Psychoeducation for parents and teachers should focus on early detection of behavioral problems and of alternatives approaches such as behavior modification to deal with such problems.Item Open Access Posttraumatic Stress Disorder and Resilience among Palestinian Adolescents in the Gaza Strip(Arab Journal of Psychiatry, 2019-11) Alibwaini, Issa; thabet, abdelazizObjective: The current study investigated posttraumatic stress disorder and resilience among adolescents in the Gaza Strip after the 52-day war in 2014. Method: N=408 adolescents, aged between 13 and 18 years, were recruited from the five governorates of the Gaza Strip with the help of local community-based organizations. Four self-report questionnaires were completed, including a sociodemographic questionnaire, the Gaza Traumatic Events Checklist, the PTSD Scale-DSM-IV, and Child and Youth Resilience Measure. Results: The most frequently reported traumatic experience was seeing mutilated bodies on television. Nearly half of the participants had experienced at least 10 traumatic events and 19.1% showed full criteria of PTSD. Getting an education was recorded as the most influential factor in the development of resilience. The total number of experienced traumatic events was positively correlated with PTSD and negatively correlated with resilience. PTSD was negatively correlated with resilience factors. Conclusion: Adolescents living in armed conflict zones are at risk of experiencing traumatic events, which can lead to PTSD. Resilience plays a significant role in reducing the negative effect of trauma and PTSD. Further investigation, particularly on resilience factors, is required.Item Open Access The Relationship between Mental Health of Palestinian Mothers Due to Siege and Child Attachment(Arab Journal of Psychiatry, 2019-05-01) thabet, abdelazizAim: The current study investigated the relationship between mothers’ stressors due to siege, their mental health and the attachment styles of their children. Methods: Participants were recruited from a list of previously studied Palestinian families in the Gaza Strip, which was part of a three-stage prospective study of 184 households. N=140 mothers were recruited to the study. Ages ranged from 18 to 64 years with a mean age of 41.53 years. Participants completed selfreport questionnaires, which included a sociodemographic scale, the Gaza Siege Checklist, the Hopkins Symptoms Checklist (HSCL-25), and the Parent/Child Reunion Inventory (P/CRI). Data were collected from October to November 2008. Results: Mothers reported from 2-20 stressors due to siege (M=10.83, SD=4.07). Those with monthly income of less than $350 US reported experiencing more stressors than mothers whose families had a monthly income of $351 US or more. Results identified 16.8% of mothers met the criteria for psychiatric conditions; 19.0% reported anxiety and 15.2% reported depression. Mothers living in cities reported fewer mental health problems compared with those living in villages and camps. Further, insecure attachment of children was positively associated with total stressors and mothers’ anxiety, and depression. Conclusion: Maternal depression and anxiety was associated with insecure attachment styles in children. Maternal depression and anxiety were also associated with experiences of siege stressors and an insecure attachment style in children. The study highlights potential targets for future intervention.