The development and validation of the Palestinian children's traumatic events checklist in a war-torn environment.

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.

Positive and negative effects of child's agency on trauma symptoms and psychological difficulties in war-like conditions. The mediating role of hope and life satisfaction.

BACKGROUND: Children affected by war and political violence deploy agentic competencies to cope with trauma symptoms and psychological difficulties. However, it does not always act as a protective factor to help them adjust to potentially traumatic events. AIMS: We expected to explore the association between agency, trauma symptoms and psychological difficulties and the mediating role of hope and life satisfaction in a group of child victims of military violence in Palestine. METHODS: 965 children aged 8 to 14 were assessed with self-reported measures, War Child Agency Assessment Scale, Children Revised Impact of events scale, Strengths and difficulties scale, Child Hope Scale and Brief Multidimensional Students Life Satisfaction Scale. Structural Equation Modelling was performed having Agency as a predictor, trauma symptoms, psychological difficulties as an outcome variable and life satisfaction and hope as a mediator. RESULTS: We found a direct and positive effect of agency on trauma symptoms, psychological difficulties, and life satisfaction and hope on the two dependent variables. Life satisfaction and hope mediated the association between agency and the outcome variables. CONCLUSION: Agency can help defend children from trauma and psychological maladaptation when it acts on life satisfaction and hope. At the same time, it might worsen psychological dysfunctions when working directly on trauma symptoms and difficulties. Clinical interventions must help children to foster agentic resources in activating hope and life satisfaction.

Hope and life satisfaction in Palestinian children victim of military violence: The predictive role of agency, potentially traumatic experiences and symptoms of trauma.

BACKGROUND: Children exposed political violence deploy resources to maintain functioning, hope and life satisfaction. OBJECTIVE: We sought to explore whether or not children promote hope and life satisfaction trough agency, psychological difficulties, potentially traumatic experiences and symptoms in Palestine. PARTICIPANTS AND SETTING: 965 children (494 males and 471 females) in multiple geographical contexts, and areas were involved. METHODS: We administered the War Child Agency Assessment Scale, Child Hope Scale, Multilevel Students'Life Satisfaction Scale-Bref, the Strength and difficulties scale, the Child Revised Impact of events Scale, and Trauma Checklist, and performed regression analysis; hope and life satisfaction were dependent and agency, strength and difficulties, trauma symptoms and traumatic events independent variables. RESULTS: Specific forms of agency predicted life satisfaction (ß = 0.219; ** p < .01, social agency; ß = 0.11; ** p < .01, with agency in education) and hope (ß = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, ß = -0.09; ** p < .01; hyperactivity, ß = -0.07; ** p < .05; ß = -0.15; ** p < .01 with life satisfaction) (conduct problems, ß = -0.06; ** p < .05, and difficulties in pro-social behaviour, ß = -0.21; ** p < .01 with hope), traumatic events (ß = -0.16; ** p < .01, with life satisfaction; ß = -0.15; ** p < .01, with hope) and trauma symptoms (ß = -0.09; ** p < .05, with hope) were negatively associated with the dependents variables. CONCLUSIONS: We found a positive role of social, educational, and freedom of movement agentic behaviours in fostering hope and life satisfaction.

Trajectories of quality of life and mental health during the Covid-19 lockdown and six months after in Italy. A longitudinal exploration.

Aim: Covid-19 pandemic and its relative containment measures have affected populations' quality of life and psychological well-being worldwide. The fear related to the pandemic and the imposed containment measures has acted as a trigger causing a global increase in negative mental health states. Thus, we aimed to explore the relationship between fear of covid-19 and mental health via QoL (the first and the second lockdown in Italy, 2020). Subject and methods: Through a quantitative cross-lagged path model research design, the study investigates people's fear of Covid-19, quality of life, and negative mental states in a population of 444 Italian adults (Mean=40.7; Standard Deviation=16.9; 80% women), in the period between the first and the second waves of the pandemic. Results: Results show that participants' Covid-19 fear decreased between waves, contributing to a decrease in negative mental states (stress, anxiety and depression), thus improving the perceived quality of life. Furthermore, quality of life emerged as able to buffer the impact of fear of Covid on people's psychological distress in short and medium terms, confirming its central role in regulating mental distress. Conclusion: The study suggests important guidelines for developing interventions to support the populations' well-being and mental health.

Impact of COVID-19 Pandemic on Mental Health and Quality of Life. An Exploratory Study During the First Outbreak in Italy.

The coronavirus pandemic has been sweeping the world for more than a year. As physical health begins to stabilize in the western world, an increasing concern is related to the impact of the virus and its containment measures on people's mental health. This work aimed to explore the effect of demographic factors (age, gender, level of education, and socioeconomic status) and variables such as fear of COVID-19 and social support in predicting the quality of life and mental health of adults during the first wave of the pandemic in Italy. Through an online survey with 1087 Italian adults (M = 39.7, SD = 16.39; 74.4% women), gender and socioeconomic status emerged as crucial factors in determining differences regarding people's responses and reactions to the pandemic. In addition, the results highlighted the importance of perceived social support and a moderate fear of COVID-19 in predicting people's quality of life and mental health. The study suggests important guidelines for the development of interventions to support the population's well-being and mental health.

When Agency Turns Into a Risk Factor: A Literature Review of the Negative Consequences of Children's Agentic Behaviors on Their Physical and Psychological Well-Being.

Background: Research has widely documented how, even in conditions of extreme poverty, deprivation, or oppression, children are competent and situated actors, capable of actively mobilizing internal, external, or social resources to protect themselves from their environments and safeguard their everyday lives. Yet, the ways in which their agency might support their well-being or instead increase their own vulnerability has remained underexplored. Aims: The present study aims to provide an assessment of all those contributions which, over the past 20 years, have focused on both the positive and negative consequences of children's actionability, revealing children's self-destructive acts alongside their self-empowering and protective ones. In the process, it highlights several major theoretical breakthroughs and findings in this area of research. Method: We provide an assessment of peer-reviewed studies that have focused on both positive and negative consequences of children's actionability, through a qualitative narrative literature review. Results: Of the 168 studies identified from online searches of the literature and the three additional sources gathered through bibliography mining, 76 qualified for full review, with 12 studies included in the final synthesis. Overall, the literature explored the different conditions in which children's agentic practices expose them to trauma symptoms and to dangerous or self-harmful situations, thereby failing to safeguard their health and overall well-being. Conclusion: The review highlights the need to focus on the dangerous effect of the agentic practices activated by children in terms of their physical and psychological health.

Alternative Ways of Capturing the Legacies of Traumatic Events: A Literature Review of Agency of Children Living in Countries Affected by Political Violence and Armed Conflicts.

BACKGROUND: It has been revealed that the construct of agency plays a crucial role in contributing to children's positive functioning and well-being despite their traumatic contexts. Yet there is little agreement within the literature about the definition of agency, how agency is displayed by children, or how it should be investigated. AIMS: This study provides a synthetic overview of studies that have analyzed the agency of children living in contexts affected by political violence and armed conflict. In the process, it highlights major theoretical breakthroughs and findings in this area of research. The aim was to review research investigating the different ways in which children's agency manifests itself within their everyday lives, as well as possible policy implications. METHOD: We identified published peer-reviewed studies relating to children's agency in conflict-affected environments through a narrative literature review. An ecological framework was used to organize studies according to the different settings (personal, familial, cultural, or contextual) within which the children's agency was displayed. RESULTS: Of 682 studies identified from online searches of the literature and the three additional sources gathered through bibliography mining, 63 qualified for full review, with 15 studies included in the final synthesis. Overall, the literature focused mostly on the ways in which children's ability to mobilize resources emerged in order to cope with their challenging contexts. CONCLUSION: Scholars advocated for community-oriented and child-centered programs that are aimed not only at promoting recovery from symptoms but also at fostering advocacy and a sense of agency in children.

Palestinian children living amidst political and military violence deploy active protection strategies against psychological trauma: How agency can mitigate traumatic stress via life satisfaction.

This exploratory study assessed the association between agency and life satisfaction, as well as the potential for life satisfaction, in its turn, to alleviate trauma symptoms and reduce negative emotion in a group of children exposed to war and military violence in Palestine. Two hundred and fifty Palestinian children, who had been recruited at primary schools in urban and rural areas, and refugee camps, completed the Multilevel Student's Life Satisfaction Scale, Children's Hope Scale (CHS), Children's Impact of Event Scale (CRIES) and Positive and Negative Affect Scales. We performed structural equation modelling to evaluate the effects of agency on negative emotions and trauma symptoms via life satisfaction. The participants appeared to play an agentic role in mobilizing their own life satisfaction, and the more satisfied they were with their lives, the less they suffered from trauma symptoms. In terms of clinical practice, we advocate more active and participatory approaches to fostering children's agency, a complex construct in need of further investigation via mixed-method quanti-qualitative and ethnographic studies.

Human (in)security and psychological well-being in Palestinian children living amidst military violence: A qualitative participatory research using interactive maps.

BACKGROUND: Research has widely evidenced the effects of war and political violence on the functioning of children, with a great accord in diagnosing children's psychological burdens related to their exposure to violence. Yet, within this literature, the influence of the chronic sense of insecurity on their psychological functioning during and after hostilities remains unexplored. METHODS: The present study aimed at exploring interrelated relationships between the perceived insecurity and the children's psychological well-being and their adjustment to trauma. Based on drawings and walk-along interviews with 75 Palestinian children, residents of both the West Bank and Gaza Strip, we offer an analysis of human security-related risks and protective factors that contribute to either promoting or undermining the child's psychological functioning in a context characterized by chronic instability and political violence. RESULTS: A complex network of sources of security and insecurity emerged from the narratives depicting an ecological portrait encompassing the determinants of children's mental health and psychological functioning. The TCA led to the identification of eight main themes: school and associativism; social relations and house as a source of security/insecurity; military occupation as a source of insecurity; national and political identity as a source of safety; mosque and spirituality as a source of safety/unsafety; environment as a source of security/insecurity; and mental health. DISCUSSION: An approach encompassing human security as an explicative model can help in exhaustively portraying the complexity of the Palestinian children's suffering and their competence in adjusting to their traumatic reality. The study draws attention to social, political, environmental and economic determinants of children psychological well-being.

Measuring agency in children: The development and validation of the War Child Agency Assessment Scale - Palestinian version (WCAAS-Pal).

In the present article, we aimed at construing a new quantitative measure of children's agency in Palestine. Within a socio-ecological and culturally and contextually informed perspective, the study introduces the development of a new instrument to investigate and evaluate children's agentic practices within their living contexts and their daily lives. First, we evaluated the model of measurement of WCAAS-Pal using a sequential exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Following the principles of testing a quantitative measure in the context of the dual-frame sampling method, the process of validating the quantitative measure was conducted on a group of 1166 Palestinian children aged 9 to 14 years (m = 11.58, sd = 1.54). Second, a sample of 251 Palestinian children aged between 9 and 14 years (m = 11.82, sd = 1.53) was used to compute the reliability of the instrument along with both convergent and divergent validity using the Children Hope Scale and the Children Revised Impact of Event Scale-Arabic Version measures, respectively. The results of the EFA suggested a baseline seven-factor structure to be further assessed via CFA. a complex web of agency domains that might contribute to the child psychological functioning when forced to leave in conditions of ongoing threat and military violence emerged from the analysis.

Spatial agency among children living in the Dheisheh refugee camp in the West Bank: a qualitative investigation of space and place as risk and protection factors from political and military violence.

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.

Wellbeing, symptoms of trauma, and personal resources in Palestinian professional helpers: a cross-sectional quantitative survey.

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 (ß=-0·25, p<0·01) and trauma (ß=-0·16, p<0·01). Personal resources were especially associated with reduced levels of anxiety (ß=-0·23, p<0·01) and intrusion symptoms (ß=-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 ß 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.

Risk and Protective Factors Among Palestinian Women Living in a Context of Prolonged Armed Conflict and Political Oppression.

Research has widely documented the effects of war and political violence on the functioning and well-being of adults and children. Yet, within this literature, women's agency in the face of war-related adversity and political violence remains underexplored. The present study was conducted in the Gaza Strip in the aftermath of the most recent war on Gaza in 2014, with the aim of investigating the consequences of war and political violence for women's mental health and psychological functioning. Based on interviews with 21 Palestinian women exposed to extreme war-related traumatic events, the article offers an analysis of the risk and protective factors affecting their well-being and enhancing (or diminishing) their agency. Human Security, Family Ties, Psychosocial Resources, Individual Resources, and Motherhood emerged from the women's narratives as key factors contributing to the maintenance of positive psychological functioning and the ability to adjust to traumatic war events in the aftermath of acute armed conflict. These exploratory findings suggest that Palestinian women display a high level of functioning and resources for adjustment that is preserved after periods of devastating armed conflict. The study draws attention to a set of protective factors for the well-being of women and their families when living with chronic political violence.

Survival and Resilience Among Palestinian Women: A Qualitative Analysis Using Individual and Collective Life Events Calendars.

Responding to the need for more information concerning the mental health and psychological well-being of women living amid political oppression and war, this study aimed to explore specific factors that contribute to women's individual and collective perceptions about war and the associated traumatic life events that occurred during their lives. Moving from a socioecological and culture-informed perspective, we used narrative timelines elicited from 21 Palestinian women in Gaza, both individually and collectively, as a tool for both data collection and intervention. A deductive, top-down, thematic content analysis procedure was used to categorize data. The main events outlined by the women in their historical accounts, both individual and collective, were linked to political events in and surrounding Palestine. The life events' calendars reflect a constant attempt in balancing and compensating traumatic events with sources of well-being related to social support and family. Individual and collective narrative activities contributed to generate a significant reframing in the attribution of meaning and emotional perceptions of the participants. Women articulated how they build resilience through transgenerational and daily practices of resistance that encompass indigenous strategies of coping and skills of survival.

Spatial agency as a source of resistance and resilience among Palestinian children living in Dheisheh refugee camp, Palestine.

Research has widely documented the effects of war and political violence on the functioning and well-being of children. Yet, children's agency in the face of political violence remains underexplored. The present study aimed at exploring the sources of spatial agency that children draw on to counteract the harmful consequences of ongoing exposure to trauma. Based on drawings and walk-along interviews with 29 Palestinian children from Dheisheh refugee camp, we offer an analysis on how children use domestic and social spaces to actively maintain positive function and subjective well-being. Five themes were identified: the mosque as a place of spiritual resistance, the school as a source of happiness and personal improvement, internal spaces as a safe place for growing and developing, community spaces as places where children have fun and play an active role, and inhabiting the outdoor spaces in the camp despite environmental dangers and the Occupation. The study draws attention to spatial activities as forms of embodied resistance through which children promote their subjective well-being and maintain positive functioning.

Agency and life satisfaction in Bedouin children exposed to conditions of chronic stress and military violence: A two-wave longitudinal study in Palestine.

Bedouin children in Palestine are at risk of developing trauma-related pathologies as a result of chronic exposure to severe political and military violence. Little is known about their coping abilities and survival skills. The aim of our study was to longitudinally test the contribution of agency to predicting life satisfaction and the power of life satisfaction to mitigate traumatic stress in a group of Bedouin children exposed to prolonged military violence in West Bank, occupied Palestinian territories. We expected that children who maintained good levels of satisfaction over the time would be less at risk of developing stress- and trauma-related syndromes and that agency would act as a predeterminant of mitigated traumatic reactions. A quantitative cross-lagged path model (CLPM) research design was implemented. One hundred forty-three Palestinian children were administered with Children's Hope Scale, Multidimensional Student Life Satisfaction Scale, Children's Impact of Event Scale, and a built ad hoc traumatic checklist. The results provided support for all the study hypotheses, suggesting that in general Bedouin children draw on a considerable range of resources in adjusting to their chronically traumatic life context. Implications for clinical work and future research are discussed.

Agency via Life Satisfaction as a Protective Factor From Cumulative Trauma and Emotional Distress Among Bedouin Children in Palestine.

Adopting an ecological perspective on children's functioning and psychological well-being, we investigated the association between agency and life satisfaction, and its bearing on trauma symptoms and negative emotions in a group of Bedouin children living in the occupied Palestinian territories. Specifically, we hypothesized that the more children were agentic, the more they would be satisfied with their lives; and that greater life satisfaction would be associated with better affect balance, and reduced trauma symptoms. A sample of 286 Bedouin children attending primary schools in four different villages in the Jordan Valley completed the multidimensional students' life satisfaction scale (MSLSS), positive affect and negative affect scale for children (PANAS-C), Children's Impact of Event Scale (CRIES-13), and the children's hope scale (CHS). Structural equation modeling was performed to evaluate the cumulative network of direct and indirect effects between children's agency, life satisfaction, and trauma symptoms. The findings confirmed the key role of life satisfaction in mitigating traumatic reactions. Higher levels of life satisfaction were associated with reduced negative emotions and trauma symptoms, suggesting that agency may be viewed as a pre-determining factor with the potential to protect children from trauma symptoms. We discuss the implications for research and clinical practice.

Narrating hope and resistance: A critical analysis of sources of agency among Palestinian children living under military violence.

BACKGROUND: In light of critical and socioconstructionist theories, the aim of our research was to analyze source of agency, psychological adjustment to trauma as protective factors against political violence in children living in three different refugee camps in Palestine, as well as exploring the risks to which these children are exposed. METHODS: Thematic content analysis was applied to children's written and drawn productions in order to extract the main categories and themes. RESULTS: Four main domains of agency emerged from the analysis: personal growth, political well-being, social relationships, and geographical context. For each domain, specific dimensions are discussed. CONCLUSIONS: The results of this preliminary exploration of children's agency suggest that the children's living environment plays a key role in shaping their suffering and reactions to war and ongoing violence. Furthermore, the social nature of the children affected by war-related suffering forces practitioners and policymakers to question the effectiveness of intervention programs that are predominantly focused on symptoms.