Abstract
BackgroundResearch on children's responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). However, PTSD is only one aspect of a complex set of responses. This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of well-being beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health.MethodsIn 2007, we used a cross-sectional random sample of kindergartens to examine factors associated with HRQOL, as measured by the PedsQL 4.0, in 350 preschoolers in the Gaza Strip, Palestine, where political violence and deprivation are widespread.ResultsAbout 65% of the mothers reported severely impaired psychosocial and emotional functioning in their children. Preschoolers had lower HRQOL than the US reference sample and samples of children in other low income countries with large effect size. HRQOL was comparable to those of US children with several chronic diseases. Factors associated with lower HRQOL were older child age, male gender, and more exposures to traumatic events. Factors associated with HRQOL subscales were for lower psychosocial health: older child age, history of food, water, and electricity deprivation during incursion, and witnessing assassination of people by rockets. For lower physical health: older child age, history of food, water, and electricity deprivation during incursion, and having heard of a killing of a friend by soldiers.ConclusionsHRQOL, including psychosocial health and emotional functioning is often severely impaired among preschoolers in the Gaza Strip. Exposure to both violent and non-violent negative events was associated with HRQOL in preschoolers.
Highlights
Research on children’s responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD)
Direct and indirect exposure to violence is common among children in Palestine, and especially among those living in the Gaza Strip [1-3]
Most studies of health-related quality of life (HRQOL) were among children with chronic diseases [7-11]
Summary
Research on children’s responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of wellbeing beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health. These restrictions have seriously compromised household welfare, resulting in loss of income, decreased quantity and quality of food, and impeded access to health care [4]. Since this time, poverty has risen dramatically, with more than 57% of the Palestinians (47% in the West Bank, 77% in the Gaza Strip) currently living below the poverty line (less than $2/person/day) [5]. Availability of data on HRQOL in children will help identify subgroups at risk, but may assist in the evaluation of health care needs and in the allocation of resources [12]
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