BACKGROUND The aim of this study was to investigate the effect of exposure to war-traumatic events on mental health in children and adolescents in the presence of other stressors such as stressful life events, exposure to traumatic events (not related to war trauma; eg, being in a car accident or having a serious illness), and poverty. METHODS Participants were chosen from the Gaza Strip using a stratified random sampling method. The data were collected in October, 2013, 1 year after the Gaza War on Nov 14–26, 2012. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh), which includes three categories: personal trauma; witnessing trauma to others; and seeing demolition of property. Stressful life events were measured using the Stressful Life Events Scale. Exposure to traumatic events (not related to war-trauma) was measured using the University of California at Los Angeles post-traumatic stress disorder (PTSD) reaction index for the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV (child version). PTSD was measured using the PTSD Symptoms Scale. Finally, depression was measured using the Child Depression Inventory. FINDINGS The sample consisted of 1029 students aged 11–17 years. 496 (48%) participants were boys, and 533 (52%) participants were girls. 909 (88%) students had experienced personal trauma, 861 (84%) had witnessed trauma to others, and 908 (88%) had seen demolition of property during the war. Boys reported more exposure to personal trauma, witnessing trauma to others, seeing demolition of property, and overall traumatic events compared to girls. Girls reported more exposure to stressful life events, exposure to trauma (not related to war-trauma), PTSD, and depression. 549 (54%) students had a diagnosis of PTSD diagnosis. We found a positive correlation between the age and exposure to war-traumatic events and stressful life events and between family size and exposure to war-traumatic events and PTSD. By contrast, we found a negative correlation between family income and stressful life events, exposure to traumatic events not related to war trauma, PTSD, and depression. Finally, exposure to war-traumatic events, experience of stressful life events, and exposure to traumatic events not related to war-trauma were positively correlated with PTSD and depression. INTERPRETATION Socioeconomic status such as big family size and low family income increased the severity of effects of stressful life events, exposure to war-traumatic events, and exposure to traumatic events not related to war-trauma. Consequently, the possibility of PTSD and depression was high. The findings also show that stressful life events, exposure to war-trauma, and exposure to traumatic events not related to war-trauma could be considered as risk factors for PTSD and depression. FUNDING Qatar National Research Fund (QNRF), a member of Qatar Foundation Doha, Qatar, National Priority Research Programs under grant NPRP 7-154-3-034 to MS.
El-khodary, B., & Samara, M. (2018). The effect of exposure to war-traumatic events, stressful life events, and other variables on mental health of Palestinian children and adolescents in the 2012 Gaza War. The Lancet, 391, S6. https://doi.org/10.1016/s0140-6736(18)30331-3