Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates.

BACKGROUND: Adverse Childhood Experiences have been associated with poor health outcomes later in life. OBJECTIVE: The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi. PARTICIPANTS AND SETTING: A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi. METHODS: The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors. RESULTS: Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk. CONCLUSIONS: The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.

Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed.

PURPOSE: This mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed. METHODS: Group interviews were conducted in 2011 with 68 Palestinians, most aged 30-40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one's spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items-along with standard survey measures of mental health-to a representative sample of 1,778 32-43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct. RESULTS: Across samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress. CONCLUSIONS: Feeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.

Political Imprisonment and Adult Functioning: A Life Event History Analysis of Palestinians.

Political imprisonment is a traumatic event, often accompanied by torture and deprivation. This study explores the association of political imprisonment between 1987 and 2011 with political, economic, community, psychological, physical, and family functioning in a population-based sample of Palestinian men ages 32-43 years (N = 884) derived from a dataset collected in 2011. Twenty-six percent (n = 233) had been politically imprisoned. Men imprisoned between 1987 and 2005 reported functioning as well as never-imprisoned men in most domains, suggesting that men imprisoned as youth have moved forward with their lives in ways similar to their nonimprisoned counterparts. In an exception to this pattern, men imprisoned during the Oslo Accords period (1994-1999) reported higher levels of trauma-related stress (B = 0.24, p = .027) compared to never-imprisoned men. Men imprisoned since 2006 reported lower functioning in multiple domains: human insecurity (B = 0.33, p = .023), freedom of public expression (B = -0.48, p = .017), perceived government stability (B = -0.38, p = .009), feeling broken or destroyed (B = 0.59, p = .001), physical limitations (B = 0.55, p = .002), and community belonging (B = -0.33, p = .048). Findings pointed to the value of examining the effects of imprisonment on functioning in multiple domains.

Politics drives human functioning, dignity, and quality of life.

Too little is known about human functioning amidst chronic adversity. We addressed that need by studying adult Palestinians in the occupied Palestinian territories (oPt), a population that has experienced longstanding economic and political hardships. Fourteen group interviews were conducted in February, 2010 in Arabic by local fieldworkers with 68 participants representing the main stratifications of Palestinian society: gender, region, refugee status, and political affiliation. Interview tasks included each participant: describing someone doing well and not well, free listing domains of functioning, and prioritizing domains to the three most important. Thematic analyses highlighted the dominating role of the political domain of functioning (e.g., political structures, constraints, effects, identity, and activism) and the degree to which political conditions impacted all other realms of functioning (economic, education, family, psychological, etc.). The discussion links the findings to relevant theory and empirical work that has called attention to the need to include the political in frameworks of quality of life. It also emphasized that values, such as justice, rights, dignity and self-determination, that underlie political structures and policies, are key elements of human functioning. This is the case not only in the oPt, but in any society where power imbalances marginalize segments of the population.

Human insecurity, chronic economic constraints and health in the occupied Palestinian territory.

Research on the effects of political conflict has focused predominantly on the association between violence exposure and psychological trauma. This paper expands that focus. We broaden the assessment of health beyond the conventional spotlight on trauma-related stress to include culturally derived measures of health, and we assess the association between a broad array of political and economic conditions and health. Household interviews were conducted in 2011 with a representative sample of 508 30-40 year olds in the occupied Palestinian territory (oPt; response rate = 97%). The four dependent variables were limits on functioning due to health, feeling broken or destroyed (both culturally derived measures of health), feelings of depression and trauma-related stress. Twenty-four predictor variables assessed multiple dimensions of political conflict and background characteristics. All four measures of health and suffering were associated with human insecurity and resource adequacy. Exposure to political violence was associated only with trauma-related stress. These findings support the increasing recognition that human insecurity and chronic economic constraints in the oPt broadly threaten health, perhaps more so than direct exposure to violence. Ultimately, a political solution is required, but in the meantime, efforts to reduce insecurity and improve economic conditions may improve health and reduce suffering in the oPt.