Modeling quality of life, primary traumatization and positive and negative affect in a large sample of primary school students resident in Gaza Strip

Background: A huge number of researchers have reported that exposure to war and ongoing political violence increase mental health risks among children. Specifically, posttraumatic stress disorder (PTSD), depressive, and somatic disorders are the most common diagnoses in such contexts. Studies have found an exceptionally – and controversially – high incidence (58–80%) of PTSD among war-affected children in the Palestine. The aim of the present exploratory study was to estimate the direct and indirect effects of perceived life satisfaction on the consequences of children’ primary traumatization, and to assess how both of these variables affect positive and negative affect in children. Sample and method: The sample was composed of Palestinian children (N=1,276) recruited at primary schools located in four different refugee camps (Bureij, Gaza Beach Camp, Jabalia, Rafah), in the aftermath of the Israeli military operation “Pillar of Defence” conducted in the Gaza Strip in 2012. All children had been directly involved in or witnessed one (or more) episodes of violence involving other people in the two months prior to the study. Participants completed the Multidimensional Students’ Life Satisfaction Scale (MSLSS) (satisfaction with family, school, myself, living environment, social relationships) , Impact of Event Scale (IES-R-13) (intrusion and avoidance symptoms) and Positive and Negative Affect Schedule (PANAS-C-20) (positive emotions and negative emotions). The relationships among variables and robustness of the model were assessed via structural equation modeling (SEM) and commonly used goodness-of-fit indices. Results: The model was found to be robust, displaying both statistical (χ2 =4.16, p = .12) and practical significance (RMSEA=.029, NNFI=.99, SRMR=.012, AGFI=.99). Specifically, children’s life satisfaction influenced both the intrusion (β = -.48, p < .001) and avoidance (β =-11, p < .001) effects of primary traumatization. The consequences of primary traumatization –intrusion (β =.34, p < .001) and avoidance (β = .27, p < .001) – contributed to increasing negative affect. Finally, perceived life satisfaction had direct effects on affective experience, specifically increasing positive (β = .45, p < .001), and diminishing negative (β = -.15, p < .001), affect. Interpretation: The findings support the hypothesis that perceived quality of life in children plays a role in controlling traumatic reactions in the aftermath of war . In fact, the role of perceived life satisfaction in mitigating the consequences of primary traumatization in pupils who experience warfare has been confirmed. Life satisfaction contributes both directly and indirectly to raising positive, and lowering negative, affectivity. In sum, our findings suggest that when children perceive themselves to be highly satisfied with their home and school environment, living conditions and relationships with peers and parents, the effects of trauma are less severe. In term of clinical implications, narrative and community-oriented programs empowering children to advocate for their right to dignity and life satisfaction, and giving them the opportunity to condemn the war atrocities to which they are witnesses, may be more effective than developing clinical programs focused exclusively on alleviating symptoms.