Multiple risk behaviors and suicidal ideation and behavior among Israeli and Palestinian adolescents.

Based conceptually on Problem Behavior Theory, Normalization Theory and theories of adolescent ethnic identity formation this study explores relationships between individual and cumulative multiple risk behaviors and suicidal ideation and behavior among mid-adolescents in three different populations in the Middle East. Data from the 2004 Health Behavior in School-Aged Children in the Middle-East (HBSC-ME) study included 8345 10th-grade pupils in three populations: Jewish Israelis (1770), Arab Israelis (2185), and Palestinians in Gaza and the West Bank (4390). We considered risk behaviors and factors including tobacco use, bullying, medically-attended injuries, excessive time with friends, parental disconnectedness, negative school experience, truancy and poor academic performance. Substantial population differences for suicidal tendency and risk behaviors were observed, with notably high levels of suicidal ideation and behavior among Arab-Israeli youth and higher levels of risk behaviors among the Jewish and Arab-Israeli youth. For all populations suicidal tendency was at least 4 times higher among adolescents reporting 4+ risk behaviors, suggesting that similar psychosocial determinants affect patterns of risk behaviors and suicidal tendency. Results highlight the importance of understanding cultural contexts of risk behaviors and suicidal ideation and behavior.

Psychosocial outcomes related to subjective threat from armed conflict events (STACE): Findings from the Israeli-Palestinian cross-cultural HBSC study.

OBJECTIVE: This study investigates the relationship between exposure to armed conflict and terror events, and an array of mental and behavioral outcomes within a large cross-cultural scientifically representative sample of 24,935 Palestinian (7,430 West Bank and 7,217 Gaza) and Israeli (5,255 Jewish and 6,033 Arab) 11-, 13-, and 15-year-old school children. The children of the Middle East have been subjected to exposure from armed conflict and terrorism repeatedly with no adequate research or interventions aimed at shielding them from the hazards of such exposure to their mental and social well-being. METHOD: This paper studies the relationship between a newly developed scale (STACE) measuring levels of subjective perceptions of threat/fear due to exposure to armed conflict events and its predicting association with six psychosocial and behavioral outcomes covering (1) poor mental health, (2) positive well-being, and (3) risk behaviors. It also examines the role of parental support in "buffering" the effects of exposure to armed conflict events within the four target populations. RESULTS: Results showed that STACE has significant and strong effects on all six dependent variables representing (1) mental post trauma, (2) diminished well-being, and (3) elevated risk behaviors. STACE strongly affects all four populations with the greatest impact among the Jewish Israeli population and the least impact shown for the Arab Israeli youth. Parental support ("significant adult") has both a direct main effect on the outcomes of all six variables as well as a significant "buffering" effect on the impact of STACE on certain outcome variables (posttraumatic symptoms, life satisfaction, positive life perceptions, and tobacco use). CONCLUSIONS AND PRACTICE IMPLICATIONS: Regardless of the type of armed conflict events, the perception of threat and fear that a child experiences has a universal significant negative impact on mental, social, and behavioral well-being. The importance of the existence of a supporting significant adult in exposed children's lives is also emphasized. The findings show major implications for the development of community-based interventions focusing on enhancing parental, and other adult support in the lives of children living in armed conflict regions of the world.