A social-cognitive-ecological framework for understanding the impact of exposure to persistent ethnic-political violence on children's psychosocial adjustment

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 (β = 0.219; ** p < .01, social agency; β = 0.11; ** p < .01, with agency in education) and hope (β = 0.07; ** p < .05, agency on free movement), while mental difficulties (conduct problems, β = -0.09; ** p < .01; hyperactivity, β = -0.07; ** p < .05; β = -0.15; ** p < .01 with life satisfaction) (conduct problems, β = -0.06; ** p < .05, and difficulties in pro-social behaviour, β = -0.21; ** p < .01 with hope), traumatic events (β = -0.16; ** p < .01, with life satisfaction; β = -0.15; ** p < .01, with hope) and trauma symptoms (β = -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.

Exposure to violence predicts callous-unemotional traits and aggression in adolescence in the context of persistent ethnic-political conflict and violence

According to social-cognitive ecological theory, violence exposure increases emotional factors-such as callous-unemotional (CU) traits-which then contribute to engagement in aggressive behavior. However, previous research has generally not tested this mediational pathway, particularly in the context of persistent ethnic-political violence exposure. The present study examined associations among violence exposure, CU traits, and aggression in a sample of 1051 youth in the Middle East (Palestine and Israel), using youth- and parent-reported data in a cohort-sequential design with three age cohorts (starting ages 8, 11, and 14 years) assessed over four waves spanning 6 years. Results from structural equation models with latent variables indicated that cumulative violence exposure in childhood and adolescence (measured annually for 3 years, and comprising exposure across multiple settings including political, community, family, and school) predicted later CU traits and aggression in adolescence and early adulthood, even after controlling for earlier levels of aggression and CU traits and demographic characteristics (child age and sex and parental socioeconomic status). Additionally, in mediation analyses, CU significantly mediated the association from earlier cumulative violence exposure to concurrent aggression, while aggression did not significantly mediate the association from earlier exposure to concurrent CU traits. The results of this study suggest that violence exposure leads to both aggressive behavior and a constellation of traits that place youth at greater risk for subsequent aggressive behavior, and that CU traits could partially explain the increased risk of aggression after violence exposure.

Consequences of Exposure to War Violence: Discriminating Those with Heightened Risk for Aggression from Those with Heightened Risk for Post-Traumatic Stress Symptoms

Chronic exposure to ethnic-political and war violence has deleterious effects throughout childhood. Some youths exposed to war violence are more likely to act aggressively afterwards, and some are more likely to experience post-traumatic stress symptoms (PTS symptoms). However, the concordance of these two outcomes is not strong, and it is unclear what discriminates between those who are at more risk for one or the other. Drawing on prior research on desensitization and arousal and on recent social-cognitive theorizing about how high anxious arousal to violence can inhibit aggression, we hypothesized that those who characteristically experience higher anxious arousal when exposed to violence should display a lower increase in aggression after exposure to war violence but the same or a higher increase in PTS symptoms compared to those low in anxious arousal. To test this hypothesis, we analyzed data from our 4-wave longitudinal interview study of 1051 Israeli and Palestinian youths (ages at Wave 1 ranged from 8 to 14, and at Wave 4 from 15-22). We used the 4 waves of data on aggression, PTS symptoms, and exposure to war violence, along with additional data collected during Wave 4 on the anxious arousal participants experienced while watching a very violent film unrelated to war violence (N = 337). Longitudinal analyses revealed that exposure to war violence significantly increased both the risk of subsequent aggression and PTS symptoms. However, anxious arousal in response to seeing the unrelated violent film (measured from skin conductance and self-reports of anxiety) moderated the relation between exposure to war violence and subsequent psychological and behavioral outcomes. Those who experienced greater anxious arousal while watching the violent film showed a weaker positive relation between amount of exposure to war violence and aggression toward their peers but a stronger positive relation between amount of exposure to war violence and PTS symptoms.

Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers' perceptions

In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients' most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.

A Developmental Psychopathology Perspective on Political Violence and Youth Adjustment

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Factors Associated with Willingness toward Organ Donation in China: A Nationwide Cross-Sectional Analysis Using a Social–Ecological Framework

Improving public willingness toward organ donation is an important solution to the low organ donation rate. This study aimed to explore factors impacting public willingness for organ donation in China from a multi-agent perspective and further explore the impact of these factors on high or low willingness, using a social–ecological framework. Data from a total of 11,028 (effective rate, 94.18%) participants were analysed. Generalised linear model (GLM) and quantile regression were used to explore factors associated with willingness and high/low willingness toward organ donation, respectively. The mean willingness toward organ donation was 56.9 (range, 0–100) points. GLM regression revealed that age, family health, males, lower educational levels, and agricultural hukou were negatively associated with willingness. For personality, conscientiousness was negatively associated with willingness, whereas openness was positively associated with willingness. Health literacy perceived social support, and media utilisation were positively associated with willingness. Quantile regression further indicated that educational levels of college, bachelor, master’s, and PhD, openness, health literacy, perceived social support, and media utilisation were positively associated with organ donation willingness at all percentiles. It is necessary to adopt more targeted and diversified publicity, education, and guidance for different types of individuals. Meanwhile, social support needs to be strengthened. To enhance the willingness of the residents to donate organs, media publicity should be strengthened, particularly by using modern ways to improve their health literacy.

Evaluating the Role of Maternal and Paternal Trauma Exposure, Emotional Security, and Mental Health in Predicting Psychological Adjustment among Palestinian Adolescents

Previous research has established a strong relationship between family system functioning and child adjustment outcomes. However, within the context of Gaza, an evaluation of both maternal and paternal factors associated with adolescent psychological adjustment has not yet been thoroughly evaluated. The current study examines how maternal and paternal trauma exposure, emotional security, and mental health are related to parent-reported scores of adolescent psychological adjustment, while controlling for adolescent trauma exposure and security in the family. The sample included N = 68 family units living in the Gaza Strip, with two parents and one adolescent surveyed within each unit (adolescent Mage = 14.03 years). The regression model examining maternal factors was significant overall (F = 7.44, R2 = 42.70%, p < 0.001), with increased maternal depression associated with greater adolescent adjustment difficulties (β = 0.31, p = 0.011) and greater maternal emotional security in the family associated with fewer adolescent adjustment difficulties (β = −0.36, p = 0.004). The regression model examining paternal factors was also significant (F = 4.57, R2 = 31.00%, p < 0.001), with increased paternal trauma exposure associated with greater adolescent adjustment difficulties (β = 0.32, p = 0.012). Understanding family-level factors associated with adolescent adjustment is an important step in conceptualizing the mental health needs of conflict-affected youth within the context of Gaza and more broadly.

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.

Well-being and Life Satisfaction in Children Living in Contexts of Political Violence: A Narrative Literature Review

Background

Children and youth growing up in contexts characterized by political violence are at high risk of developing mental health impairments. In recent years, a growing interest has been directed to the study of children’s well-being after being exposed to political violence in order to develop interventions aimed at preserving and enhancing it.

Objective

This study provides a synthetic overview of studies that have explored or implemented interventions aimed at improving well-being and life satisfaction in conflict-affected children.

Methods

We identified peer-reviewed studies relating to children’s well-being in conflict-affected environments through a narrative literature review. An ecological framework was used to organize the studies in relation to the individual, family, social and community factors playing a role in promoting and preserving participants’ well-being. Implications for practices, policies and research were summarized to highlight areas in which they need strengthening.

Results

Of 1221 unique studies returned from online searches of the literature, 70 qualified for full review, with a total of 22 peer-reviewed studies included in the final synthesis. Results indicate a range of domains and dimensions that mutually interact to either enhance or diminish children’s well-being and life satisfaction. Four studies explicitly focused on assessing the effectiveness of interventions aimed at promoting and assessing children’s well-being and health.

Conclusions

Researchers were able to identify several dimensions that were contributing to the children’s well-being in situations of significant adversity. The concept of well-being emerged as a combination of personal resources and supportive contexts—such as family, peers, and community—that vary over time or across contexts. Well-being and life satisfaction in children living in contexts of political violence: a narrative literature review.

A Social-Ecological Framework to Understand Barriers to HIV Clinic Attendance in Nakivale Refugee Settlement in Uganda: a Qualitative Study

The social-ecological model proposes that efforts to modify health behaviors are influenced by constraints and facilitators at multiple levels. We conducted semi-structured interviews with 47 clients in HIV care and 8 HIV clinic staff to explore how such constraints and facilitators (individual, social environment, physical environment, and policies) affect engaging in HIV clinical care in Nakivale Refugee Settlement in Uganda. Thematic analysis revealed that participants were motivated to attend the HIV clinic because of the perceived quality of services and the belief that antiretroviral therapy improves health. Barriers to clinic attendance included distance, cost, unemployment, and climate. Those that disclosed their status had help in overcoming barriers to HIV care. Nondisclosure and stigma disrupted community support in overcoming these obstacles. Interventions to facilitate safe disclosure, mobilize social support, and provide more flexible HIV services may help overcome barriers to HIV care in this setting.

Exposure to community violence and depressive symptoms: Examining community, family, and peer effects among public housing youth

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n = 320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.

A socio-ecological analysis of risk, protective and promotive factors for the mental health of Burundian refugee children living in refugee camps

Children and adolescents' mental health risk and resilience arise from a complex interplay of factors on several socio-ecological levels. However, little is known about the factors that shape the mental health of refugee youth living in refugee camps close to ongoing conflict. We conducted a cross-sectional study with a representative sample of 217 Burundian refugee children aged 7-15 and their mothers residing in refugee camps in Tanzania to investigate associations between risk, protective and promotive factors from various ecological levels (individual, microsystem, exosystem), and children's post-traumatic stress disorder (PTSD) symptoms, internalizing and externalizing problems, and prosocial behavior. Data were collected using structured clinical interviews and analyzed using multiple regression models. Exposure to violence across all contexts and engagement coping were risk factors for PTSD symptoms and internalizing problems, while only violence by mothers seemed to increase children's vulnerability for externalizing problems. A differential impact of violence exposures on prosocial behavior was observed. Higher-quality friendships appeared to protect youth from PTSD symptoms and externalizing problems, while they also promoted children's prosocial behavior, just as mothers' social support networks. Prevention and intervention approaches should integrate risk, protective and promotive factors for refugee youth's mental health across multiple ecological contexts and take into account context-specific and adaptive responses to war and displacement.

Multiple Traumas, Maternal Depression, Mother-Child Relationship, Social Support, and Young Children's Behavioral Problems

This study examined whether maternal depression, mother-child relationships, and maternal perceived social support mediate the associations between child's exposure to multiple traumatic events and behavioral problems. We recruited a representative sample of 904 Israeli (Jewish and Arab) mothers and their 2- to 6-year-old children. Data collection was conducted through structured face-to-face interviews with the mothers between July and November 2011. All measures were completed by the mothers. We used the child's and mother's exposure to political violence questionnaires, Child Behavior Checklist (CBCL), a short version of the Parental Acceptance-Rejection Questionnaire (PARQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Medical Outcomes Study (MOS) Social Support Survey. The research study model was tested using path analysis. The model showed a very good fit to the data, suggesting that maternal rejection, maternal depression, and social support play an important role in child's behavioral problems in the context of multiple traumatic events. Higher levels of maternal rejection were significantly associated with greater children behavior problems. Maternal rejection mediated the associations between maternal depressive symptoms and child's behavioral problems. Maternal perceived social support mediated the associations between child's exposure to multiple traumatic events and child's behavioral problems; child's exposure to multiple traumatic events was associated with lower levels of maternal perceived social support. In turn, lower levels of perceived social support were associated with higher levels of behavioral problems. In conclusion, in accordance with the "social stress framework," social support has a mediation role in the association between exposure to traumatic events and child's behavioral problems. Thus, enhancing social support to mothers to young children in the context of multiple traumatic events is essential for children resiliency.

Social Expectations, Violence and Social-Moral Knowledge: Considerations for Developmental Research

Violence associated with gangs known as maras in Honduras is an impetus for why people flee and migrate out of the country. Based on fieldwork with youth between the ages of 10 and 18 in San Pedro Sula, Honduras, I discuss (a) that prevailing views of violence in developmental research need further elaboration in understanding the illicit and legal forms and functions of violence in a society that children and adolescents grow up in and (b) that a domain model of social-moral thinking offers more insight about violence and morality than a current model informing violence prevention in Honduras. Lastly, I conclude with a few implications for violence prevention efforts and future directions for developmental research.

Supportive Relationships in Children and Adolescents Facing Political Violence and Mass Disasters

PURPOSE OF REVIEW

We identify trends and gaps in the literature on the role of social support in the psychopathology and risky behavior of youths exposed to political violence and mass disasters. We also discuss the implications of recent research's findings and suggest directions for future research.

RECENT FINDINGS

Political violence and natural disasters inflict serious blows to adolescents' mental and physical health and may have reverberating, negative impacts throughout the nested social systems in which youths develop. However, many adolescents are not adversely affected, suggesting the presence of resilience. While the beneficial effects of social support from close others are well documented, along with situations under which perceived support may even increase stress, the exact mechanisms behind social support's protective effects have not been thoroughly studied. Different personality attributes and/or different concepts of the self may possibly contribute to-or harm-youths' resilience. There is considerable variability in research on adolescents' social support in the context of political violence and mass disasters, stressors that may erode social support. Thus, further investigation of social support's protective effects via longitudinal studies is highly important.

Does violence beget violence? The role of family ethnic socialization and intergroup bias among youth in a setting of protracted intergroup conflict

Does violence beget violence among youth in a setting of protracted conflict? Framed by a developmental intergroup approach, this paper examines the mediating roles of family ethnic socialization and intergroup bias. Two time points from 466 (50% female/50% male, 51% Catholic/49% Protestant) 14- to 16-year-olds in Northern Ireland were analyzed. Bootstrapped chain mediation found that previous experience with sectarianism, or intergroup violence, was positively related to family ethnic socialization, which predicted later intergroup bias, which was related to higher levels of adolescent participation in sectarian antisocial behavior. Findings identify the importance of family processes in the link from experiencing to committing sectarian acts. Implications for preventing youth participation in sectarianism are discussed.

Serious violent behavior and antisocial outcomes as consequences of exposure to ethnic-political conflict and violence among Israeli and Palestinian youth

We examine whether cumulative-past and concurrent exposure to ethnic-political violence among Israeli and Palestinian youth predict serious violent behavior and antisocial outcomes toward the in-group and the out-group. We collected four waves of data from 162 Israeli Jewish and 400 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents. The first three waves were consecutive annual assessments, and the fourth was conducted 4 years after the third wave, when the three age cohorts were 14, 17, and 20 years old, respectively. Based on social-cognitive-ecological models of the development of aggression (Dubow et al., 2009, Clinical Child and Family Psychology Review, 12, 113-126; Huesmann, 1998) and models of the development of beliefs about the "other," (Bar-Tal, 2004, European Journal of Social Psychology, 34, 677-701; Tajfel & Turner, 1986), we predicted that serious violent outcomes directed toward both the in-group and the out-group would be related to both concurrent and to persistent-past exposure to ethnic political violence. Bivariate regression models (prior to including covariates) indicated that both early cumulative exposure to ethnic-political violence during childhood and adolescence and concurrent exposure during late adolescence/early adulthood predicted all six serious violent and antisocial outcomes. When we added to the models the covariates of ethnic subgroup, age, sex, parents' education, and youths' prior physical aggression, concurrent exposure to ethnic-political violence was still significantly associated with a greater likelihood of concurrently perpetrating all six serious violent and nonviolent forms of antisocial behavior, and earlier cumulative exposure remained significantly related to three of these: severe physical aggression, participating in violent demonstrations, and our overall index of violent/antisocial behavior.

Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective

Mental health problems are common in war-affected areas, but children have different levels of vulnerability. Based on ecological theory (Bronfenbrenner, 2005), this study analyses how factors related to the child (cognitive capacity), their family (parental depression and parenting styles), and their school (teachers' practices and peer relations) mediate the association between traumatic stress (traumatic war experiences and stressful life-events) and child mental health (posttraumatic stress and psychological distress symptoms). The participants were 303 Palestinian children (51.2% girls) of 10-13 years (M = 10.94 ± 0.50) and their parents from the Gaza Strip. The children filled in questionnaires during school classes and the parents did so at their homes. The results of structural equation modeling substantiated the hypothesis that parental depression, poor parenting and low-quality peer relations mediated between traumatic stress and children's mental health problems. Contrary to the hypothesis, child-related factors did not mediate that association. To conclude, parents and peers provide important age-salient social resources for children in war conditions, and psychosocial interventions should therefore enhance their beneficial functions.

Psychological Aspects of the Israeli-Palestinian Conflict: A Systematic Review

Despite ongoing local and international peace efforts, the Jews, Arabs, and other residents of Israel and the Palestinian territories (i.e., the West Bank and Gaza) have endured decades of political, social, and physical upheaval, with periodic eruptions of violence. It has been theorized that the psychological impact of the Israeli-Palestinian conflict extends beyond the bounds of psychiatric disorders such as posttraumatic stress disorder (PTSD). Exposure to the ongoing conflict may lead to changes in the way Israelis and Palestinians think, feel, and act; while these changes may not meet the thresholds of PTSD or depression, they nonetheless could have a strong public health impact. It is unclear whether existing studies have found associations between exposure to the conflict and nonclinical psychological outcomes. We conducted a systematic review to synthesize the empirical research on the Israeli-Palestinian conflict and its psychological consequences. As a whole, the body of literature we reviewed suggests that exposure to regional political conflict and violence may have detrimental effects on psychological well-being and that these effects likely extend beyond the psychiatric disorders and symptoms most commonly studied. We found evidence that exposure to the conflict informs not only the way Israelis and Palestinians think, feel, and act but also their attitudes toward different religious and ethnic groups and their degree of support for peace or war. We also found that Palestinians may be at particularly high risk of experiencing psychological distress as a result of the conflict, though more research is needed to determine the extent to which this is due to socioeconomic stress. Our review suggests the need for more studies on the nonclinical psychological aspects of the Israeli-Palestinian conflict as well as for longitudinal studies on the impact of the conflict on both Israelis and Palestinians.

Heterogeneity in Perceptions of Parenting Among Arab Refugee Adolescents in Jordan

Heterogeneity in parenting was examined in 883 Arab refugee adolescents in Jordan (M_age  = 15.01 years, SD = 1.60). Latent profile analyses of five parenting dimensions rated separately for mothers and fathers yielded authoritative, authoritarian, indifferent, punitive, and for mothers, permissive profiles, with most mothers (60%) and fathers (66%) classified as authoritative. Parenting was more often authoritative for women than men and punitive (for fathers) or permissive (for mothers) of boys than girls. Authoritative fathers and authoritarian mothers were better educated than punitive parents, whose offspring reported more norm breaking and internalizing symptoms and lower academic achievement than other youth. Adjustment was better when adolescents had at least one authoritative parent than when parents were either consistent or discrepant but nonauthoritative.

Examining Bidirectional Pathways Between Exposure to Political Violence and Adolescent Adjustment in Northern Ireland

Research on social ecologies of political violence has been largely confined to cross-sectional tests of the impact of political violence on child adjustment, limiting perspectives on more nuanced causal pathways, including tests of reciprocal relations between exposure to political violence and child adjustment. Based on a four-wave longitudinal study, this research breaks new ground in assessing bidirectional relations between exposure to political violence in the form of experience with sectarian antisocial behavior and adolescents' adjustment problems. The study included 999 mother-adolescent dyads selected from working-class neighborhoods in Belfast ranked in the bottom quartile in terms of social deprivation in Northern Ireland, with approximately 35-40 families recruited to participate from each neighborhood. Across the four annual waves of data, adolescents (52% female) were 12.18 (SD = 1.82), 13.24 (SD = 1.83), 13.62 (SD = 1.99), and 14.66 (SD = 1.96) years old. Cross-lagged path models were tested through R package lavaan with full information maximum likelihood. Reflecting a reciprocal pathway, adjustment problems related to higher reports of experience with sectarian antisocial behavior 1 year later. Boys' experience with sectarian antisocial behavior related to greater adjustment problems 1 year later, but this reciprocal path did hold for the girls. These findings offer promising directions toward better modeling of dynamic relations between exposure to political violence and adolescent adjustment over time.

Serious physical violence among Arab-Palestinian adolescents: The role of exposure to neighborhood violence, perceived ethnic discrimination, normative beliefs, and, parental communication

This study adopted a social-ecological perspective to exploring perpetration of serious physical violence against others among Arab-Palestinian adolescents. A total of 3178 adolescents (aged 13-18) completed anonymous, structured, self-report questionnaire, which included selected items from several instruments that measured variables relating to the constructs examined in the study. We explored the association of individual characteristics (age, gender, normative beliefs about violence, and perceived ethnic discrimination), familial characteristics (parent-adolescent communication and socioeconomic status), and contextual characteristics (exposure to community violence in the neighborhood) with perpetration of serious physical violence against others. A moderation-mediation model was tested, and 28.4% of the adolescents reported that they had perpetrated serious physical violence against others at least once during the month preceding the study. The findings also show that exposure of youth to violence in their neighborhood correlated significantly and positively with their perpetration of serious physical violence against others. A similar trend was revealed with respect to personal perceptions of ethnic discrimination. These correlations were mediated by the adolescents' normative beliefs about violence. Furthermore, the correlation of direct exposure to violence in the neighborhood and normative beliefs about violence with perpetration of serious physical violence against others was stronger among adolescents who have poor communication with their parents than among those who have strong parental communication.

Continuous Traumatic Situations in the Face of Ongoing Political Violence: The Relationship Between CTS and PTSD

This article presents a literature review of the concept of continuous traumatic situations (CTS), which relates to residents living in ongoing situations of political violence and national security threats. The first aim of this review is to narrow the gap regarding knowledge about the concept of CTS by presenting findings from studies that have assessed the effects of CTS on civilian populations. The second aim is to describe CTS in a way that highlights the differences and similarities between posttraumatic stress disorder and responses to CTS. This distinction is a necessary precondition for examining CTS, as is a careful clinical analysis of the development and course of symptoms. This literature review also highlights the importance of adopting a supplementary perspective for understanding the psychological impact of ongoing exposure to real threats, which can be used as a basis for developing intervention strategies that are appropriate for coping with life in the context of persistent violence. CTS can be manifested as emotions, behaviors, and perceptions among individuals, families, communities, and societies. The nature of the proposed model of CTS is a circular one, combining past and future perceptions and emotional reactions that have resulted from continuous and repeated traumatic experiences over an extended period of time. This wider understanding reflects the complexity of the CTS phenomenon. Various micro and macro interventions relating to CTS as the result of political violence situations and national security threats are presented, and recommendations for practice, policy, and future research are offered.

Conducting longitudinal, process-oriented research with conflict-affected youth: Solving the inevitable challenges

The reader might get the impression that the four projects described in this Special Section proceeded in a systematic and predictable way. Of course, those of us engaged in each research project encountered pitfalls and challenges along the way. A main goal of this Special Section is to provide pathways and encouragement for those who may be interested in advancing high-quality research on this topic. In this paper, we describe a set of practical and ethical challenges that we encountered in conducting our longitudinal, process-oriented, and translational research with conflict-affected youth, and we illustrate how problems can be solved with the goal of maintaining the internal and external validity of the research designs. We are hopeful that by describing the challenges of our work, and how we overcame them, which are seldom treated in this or any other literature on research on child development in high-risk contexts, we can offer a realistic and encouraging picture of conducting methodologically sound research in conflict-affected contexts.

Developmental and social-ecological perspectives on children, political violence, and armed conflict

An increasing number of researchers and policymakers have been moved to study and intervene in the lives of children affected by violent conflicts (Masten, 2014). According to a United Nations Children's Fund (2009) report, over 1 billion children under the age of 18 are growing up in regions where acts of political violence and armed conflict are, as Ladds and Cairns (1996, p. 15) put it, "a common occurrence-a fact of life." In recent years, the United Nations Children's Fund, advocacy and human rights groups, journalists, and researchers have drawn public attention to the high rates of child casualties in these regions, and to the plights of those children still caught in the crossfire. It has thus become clear that both the challenges and the stakes are higher than ever to promote the safety and well-being of affected children around the world (Masten & Narayan, 2012; Tol, Jordans, Kohrt, Betancourt, & Komproe, 2012).

Children's exposure to violent political conflict stimulates aggression at peers by increasing emotional distress, aggressive script rehearsal, and normative beliefs favoring aggression

We examine the hypothesis that children's exposure to ethnic-political conflict and violence over the course of a year stimulates their increased aggression toward their own in-group peers in subsequent years. In addition, we examine what social cognitive and emotional processes mediate these effects and how these effects are moderated by gender, age, and ethnic group. To accomplish these aims, we collected three waves of data from 901 Israeli and 600 Palestinian youths (three age cohorts: 8, 11, and 14 years old) and their parents at 1-year intervals. Exposure to ethnic-political violence was correlated with aggression at in-group peers among all age cohorts. Using a cross-lagged structural equation model from Year 1 to Year 3, we found that the relation between exposure and aggression is more plausibly due to exposure to ethnic-political violence stimulating later aggression at peers than vice versa, and this effect was not moderated significantly by gender, age cohort, or ethnic group. Using three-wave structural equation models, we then showed that this effect was significantly mediated by changes in normative beliefs about aggression, aggressive script rehearsal, and emotional distress produced by the exposure. Again the best fitting model did not allow for moderation by gender, age cohort, or ethnic group. The findings are consistent with recent theorizing that exposure to violence leads to changes both in emotional processes promoting aggression and in the acquisition through observational learning of social cognitions promoting aggression.

Emotional insecurity about the community: A dynamic, within-person mediator of child adjustment in contexts of political violence

Over 1 billion children worldwide are exposed to political violence and armed conflict. The current conclusions are qualified by limited longitudinal research testing sophisticated process-oriented explanatory models for child adjustment outcomes. In this study, consistent with a developmental psychopathology perspective emphasizing the value of process-oriented longitudinal study of child adjustment in developmental and social-ecological contexts, we tested emotional insecurity about the community as a dynamic, within-person mediating process for relations between sectarian community violence and child adjustment. Specifically, this study explored children's emotional insecurity at a person-oriented level of analysis assessed over 5 consecutive years, with child gender examined as a moderator of indirect effects between sectarian community violence and child adjustment. In the context of a five-wave longitudinal research design, participants included 928 mother-child dyads in Belfast (453 boys, 475 girls) drawn from socially deprived, ethnically homogenous areas that had experienced political violence. Youth ranged in age from 10 to 20 years and were 13.24 (SD = 1.83) years old on average at the initial time point. Greater insecurity about the community measured over multiple time points mediated relations between sectarian community violence and youth's total adjustment problems. The pathway from sectarian community violence to emotional insecurity about the community was moderated by child gender, with relations to emotional insecurity about the community stronger for girls than for boys. The results suggest that ameliorating children's insecurity about community in contexts of political violence is an important goal toward improving adolescents' well-being and adjustment. These results are discussed in terms of their translational research implications, consistent with a developmental psychopathology model for the interface between basic and intervention research.

Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study

This study explored how coping with war-related traumatic events in Sierra Leone impacted mental health outcomes among 529 youth (aged 10–17 at baseline; 25% female) using longitudinal data from three time points (Time 1 in 2002, Time 2 in 2004, and Time 3 in 2008). We examined two types of coping items (approach and avoidance); used multiple regression models to test their relations with long-term mental health outcomes (internalizing behaviors, externalizing behaviors, adaptive/prosocial behaviors, and posttraumatic stress symptoms); and used mediation analyses to test whether coping explained the relation between previous war exposures (being raped, death of parent(s), or killing/injuring someone during the war) and those outcomes. We found that avoidance coping items were associated with lower internalizing and posttraumatic stress behaviors at Time 3, and provided some evidence of mediating the relation between death of parent(s) during the war and the two outcomes mentioned above. Approach coping was associated with higher Time 3 adaptive/prosocial behaviors, whereas avoidance coping was associated with lower Time 3 adaptive/prosocial behaviors. Avoidance coping may be a protective factor against mental illness, whereas approach coping may be a promotive factor for adaptive/prosocial behaviors in war-affected societies. This study has important implications for designing and implementing mental health interventions for youth in postconflict settings.

Growing Up Amid Ethno-Political Conflict: Aggression and Emotional Desensitization Promote Hostility to Ethnic Outgroups

Ethno-political violence impacts thousands of youth and is associated with numerous negative outcomes. Yet little research examines adaptation to ethno-political violence over time or across multiple outcomes simultaneously. This study examines longitudinal patterns of aggressive behavior and emotional distress as they co-occur among Palestinian (n = 600) youth exposed to ethno-political violence over 3 years in three age cohorts (starting ages: 8, 11, and 14). Findings indicate distinct profiles of aggressive behavior and emotional distress, and unique joint patterns. Furthermore, youth among key joint profiles (e.g., high aggression-emotional desensitization) are more likely to endorse normative beliefs about aggression toward ethnic outgroups. This study offers a dynamic perspective on emotional and behavioral adaptation to ethno-political violence and the implications of those processes.

Adolescents' Exposure to Disasters and Substance Use

This paper reviews the impact of exposure to man-made or natural disasters on adolescent substance use. It covers empirical studies published from 2005 to 2015 concerning (a) the scope of the problem, (b) vulnerable groups and risk and protective factors, and (c) evidence-based interventions. The review suggests a strong link between adolescent substance use and exposure to either man-made or natural disaster. Vulnerable groups include adolescents with previous exposure to traumatic events, living in areas that are continually exposed to disasters, and ethnic minorities. Risk and protective factors at the individual, familial, community, and societal levels are described based on the bioecological model of mass trauma. Given that mass trauma is unfortunately a global problem, it is important to establish international interdisciplinary working teams to set gold standards for comparative studies on the etiology for adolescent substance use in the context of disasters.

Negative Stereotypes of Ethnic Out-groups: A Longitudinal Examination Among Palestinian, Israeli Jewish, and Israeli Arab Youth

Ethno-political conflict impacts thousands of youth globally and has been associated with a number of negative psychological outcomes. Extant literature has mostly addressed the adverse emotional and behavioral outcomes of exposure while failing to examine change over time in social-cognitive factors in contexts of ethno-political conflict. Using cohort-sequential longitudinal data, the present study examines ethnic variation in the development of negative stereotypes about ethnic out-groups among Palestinian (n=600), Israeli Jewish (n=451), and Israeli Arab (n=450) youth over three years. Age and exposure to ethno-political violence were included as covariates for these trajectories. Findings indicate important ethnic differences in trajectories of negative stereotypes about ethnic out-groups, as well as variation in how such trajectories are shaped by prolonged ethno-political conflict.

Childhood maltreatment and violence: mediation through psychiatric morbidity

Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21-34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.

Emotional insecurity in the family and community and youth delinquency in Northern Ireland: a person-oriented analysis across five waves

BACKGROUND

Over one billion children are exposed worldwide to political violence and armed conflict. Currently, conclusions about bases for adjustment problems are qualified by limited longitudinal research from a process-oriented, social-ecological perspective. In this study, we examined a theoretically-based model for the impact of multiple levels of the social ecology (family, community) on adolescent delinquency. Specifically, this study explored the impact of children's emotional insecurity about both the family and community on youth delinquency in Northern Ireland.

METHODS

In the context of a five-wave longitudinal research design, participants included 999 mother-child dyads in Belfast (482 boys, 517 girls), drawn from socially-deprived, ethnically-homogenous areas that had experienced political violence. Youth ranged in age from 10 to 20 and were 12.18 (SD = 1.82) years old on average at Time 1.

FINDINGS

The longitudinal analyses were conducted in hierarchical linear modeling (HLM), allowing for the modeling of interindividual differences in intraindividual change. Intraindividual trajectories of emotional insecurity about the family related to children's delinquency. Greater insecurity about the community worsened the impact of family conflict on youth's insecurity about the family, consistent with the notion that youth's insecurity about the community sensitizes them to exposure to family conflict in the home.

CONCLUSIONS

The results suggest that ameliorating children's insecurity about family and community in contexts of political violence is an important goal toward improving adolescents' well-being, including reduced risk for delinquency.

Iraqi, Syrian, and Palestinian Refugee Adolescents' Beliefs About Parental Authority Legitimacy and Its Correlates

This study examined intra- and interindividual variations in parental legitimacy beliefs in a sample of 883 Arab refugee adolescents (M(age) = 15.01 years, SD = 1.60), 277 Iraqis, 275 Syrians, and 331 Palestinians in Amman, Jordan. Confirmatory factor analyses showed distinct latent factors for moral-conventional, prudential, and personal legitimacy items. Older adolescents rated legitimacy lower for personal issues, but higher for prudential issues. Beliefs were associated with socioeconomic status (fathers' education, family size), particularly for personal issues, but were more pervasively associated with displacement-related experiences. Greater war trauma was associated with less prudential legitimacy for all youth and more authority legitimacy over moral-conventional issues for Syrian youth. Greater hopefulness was associated with more authority legitimacy over all but personal issues.

The Longitudinal Effects of Chronic Mediated Exposure to Political Violence on Ideological Beliefs About Political Conflicts Among Youths

This study examines the effects of chronic (i.e., repeated and cumulative) mediated exposure to political violence on ideological beliefs regarding political conflict. It centers on these effects on young viewers, from preadolescents to adolescents. Ideological beliefs refers here to support of war, perception of threat to one's nation, and normative beliefs concerning aggression toward the out-group. A longitudinal study was conducted on a sample of Israeli and Palestinian youths who experience the Israeli-Palestinian conflict firsthand (N = 1,207). Two alternative hypotheses were tested: that chronic exposure via the media increases support for war and aggression and elevates feeling of threat, or that chronic exposure via the media strengthens preexisting beliefs. Results demonstrated that higher levels of exposure were longitudinally related to stronger support for war. Regarding normative beliefs about aggression and threat to one's nation, mediated exposure reinforced initial beliefs, rendering the youths more extreme in their attitudes. These results mostly support the conceptualization of the relation between media violence and behaviors as "reciprocally determined" or "reinforcing spirals." The results are also discussed in light of the differences found between the effect of exposure to political violence firsthand and exposure via the media.

Effectiveness of psychosocial intervention enhancing resilience among war-affected children and the moderating role of family factors

The study examines, first, the effectiveness of a psychosocial intervention based on Teaching Recovery Techniques (TRT) to increase resiliency among Palestinian children, exposed to a major trauma of war. Second, it analyses the role of family factors (maternal attachment and family atmosphere) as moderating the intervention impacts on resilience. School classes in Gaza were randomized into intervention (N=242) and control (N=240) groups. The percentage of girls (49.4%) and boys (50.6%) were equal, and the child age was 10-13 years in both groups. Children reported positive indicators of their mental health (prosocial behaviour and psychosocial well-being) at baseline (T1), post-intervention (T2) and at a six-month follow-up (T3). At T1 they accounted their exposure to war trauma. Mothers reported about their willingness to serve as an attachment figure, and the child reported about the family atmosphere. Resilience was conceptualized as a presence of positive indications of mental health despite trauma exposure. Against our hypothesis, the intervention did not increase the level of resilience statistically significantly, nor was the effect of the intervention moderated by maternal attachment responses or family atmosphere.

A Social-Ecological, Process-Oriented Perspective on Political Violence and Child Development

Youths' risk for adjustment problems in contexts of political violence is well-documented. However, outcomes vary widely, with many children functioning well. Accordingly, moving beyond further documenting the risk for many negative outcomes associated with living in contexts of political violence, a second generation of research is moving towards identifying the mechanisms and conditions that contribute to children's adjustment. Increasing support is emerging for understanding effects on children in terms of changes in the social contexts in which children live, and in the psychological processes engaged by these social ecologies. Selected themes are considered, including (a) the need to study multiple levels of the social ecology, (b) differentiating between the effects of exposure to contexts of political versus non-political violence, and (c) theories about explanatory processes. Selected research pertinent to these directions is reviewed, including findings from a six-wave longitudinal study on political violence and children in Northern Ireland.

Relations between political violence and child adjustment: a four-wave test of the role of emotional insecurity about community

This study further explored the impact of sectarian violence and children's emotional insecurity about community on child maladjustment using a 4-wave longitudinal design. The study included 999 mother-child dyads in Belfast, Northern Ireland (482 boys, 517 girls). Across the 4 waves, child mean age was 12.19 (SD = 1.82), 13.24 (SD = 1.83), 13.61 (SD = 1.99), and 14.66 years (SD = 1.96), respectively. Building on previous studies of the role of emotional insecurity in child adjustment, the current study examines within-person change in emotional insecurity using latent growth curve analyses. The results showed that children's trajectories of emotional insecurity about community were related to risk for developing conduct and emotion problems. These findings controlled for earlier adjustment problems, age, and gender, and took into account the time-varying nature of experience with sectarian violence. Discussion considers the implications for children's emotional insecurity about community for relations between political violence and children's adjustment, including the significance of trajectories of emotional insecurity over time.

Longitudinal relations between sectarian and nonsectarian community violence and child adjustment in Northern Ireland

Although relations between political violence and child adjustment are well documented, longitudinal research is needed to adequately address the many questions remaining about the contexts and developmental trajectories underlying the effects on children in areas of political violence. The study examined the relations between sectarian and nonsectarian community violence and adolescent adjustment problems over 4 consecutive years. Participants included 999 mother-child dyads (482 boys, 517 girls), M ages = 12.18 (SD = 1.82), 13.24 (SD = 1.83), 13.61 (SD = 1.99), and 14.66 (SD = 1.96) years, respectively, living in socially deprived neighborhoods in Belfast, Northern Ireland, a context of historical and ongoing political violence. In examining trajectories of adjustment problems, including youth experience with both sectarian and nonsectarian antisocial behaviors, sectarian antisocial behavior significantly predicted more adjustment problems across the 4 years of the study. Experiencing sectarian antisocial behavior was related to increased adolescent adjustment problems, and this relationship was accentuated in neighborhoods characterized by higher crime rates. The discussion considers the implications for further validating the distinction between sectarian and nonsectarian violence, including consideration of neighborhood crime levels, from the child's perspective in a setting of political violence.

Understanding the impact of political violence in childhood: a theoretical review using a social identity approach

The present paper reviews the literature that has assessed the psychological impact of political violence on children. Concern for those growing up in situations of political violence has resulted in two areas of research within psychology: the first considers children as victims of conflict and considers the mental health consequences of political violence. The second considers children as protagonists or aggressors in conflict and considers related moral and attitudinal consequences of exposure to political violence. These two literatures are most often considered separately. Here the two strands of research are brought together using a social identity framework, allowing apparently divergent findings to be integrated into a more coherent understanding of the totality of consequences for children and young people growing up in situations of armed conflict.

Political violence, collective functioning and health: a review of the literature

Political violence is implicated in a range of mental health outcomes, including PTSD, depression, and anxiety. The social and political contexts of people's lives, however, offer considerable protection from the mental health effects of political violence. In spite of the importance of people's social and political environments for health, there is limited scholarship on how political violence compromises necessary social and political systems and inhibits individuals from participating in social and political life. Drawing on literature from multiple disciplines, including public health, anthropology, and psychology, this narrative review uses a multi-level, social ecological framework to enhance current knowledge about the ways that political violence affects health. Findings from over 50 studies were analysed and used to build a conceptual model demonstrating how political violence threatens three inter-related domains of functioning: individual functioning in relationship to their environment; community functioning and social fabric; and governmental functioning and delivery of services to populations. Results illustrate the need for multilevel frameworks that move beyond individual pathology towards more nuanced conceptualizations about how political violence affects health; findings contribute to the development of prevention programmes addressing political violence.

Individual and collective dimensions of resilience within political violence

Research has documented a link between political violence and the functioning of individuals and communities. Yet, despite the hardships that political violence creates, evidence suggests remarkable fortitude and resilience within both individuals and communities. Individual characteristics that appear to build resilience against political violence include demographic factors such as gender and age, and internal resources, such as hope, optimism, determination, and religious convictions. Research has also documented the protective influence of individuals' connection to community and their involvement in work, school, or political action. Additionally, research on political violence and resilience has increasingly focused on communities themselves as a unit of analysis. Community resilience, like individual resilience, is a process supported by various traits, capacities, and emotional orientations toward hardship. This review addresses various findings related to both individual and community resilience within political violence and offers recommendations for research, practice, and policy.

Coping with violence: a comprehensive framework and implications for understanding resilience

Interpersonal violence is present at all levels of influence in the social ecology and can have comprehensive and devastating effects on child and adolescent development through multiple simultaneous channels of exposure. Children's experiences with violence have been linked with a range of behavioral and mental health difficulties including posttraumatic stress disorder and aggressive behavior. In this article, we offer a conceptual framework delineating the ways in which children and adolescents might encounter violence, and a theoretical integration describing how violence might impact mental and behavioral health outcomes through short- and long-term processes. We propose that coping reactions are fundamental to the enduring effects of violence exposure on their psychosocial development and functioning. Finally, we discuss the manner in which coping efforts can support resilience among children exposed to violence and suggest new directions for research and preventive intervention aimed at optimizing outcomes for children at risk of exposure.

The protective role of group identity: sectarian antisocial behavior and adolescent emotion problems

The protective role of strength of group identity was examined for youth in a context of protracted political conflict. Participants included 814 adolescents (Mage = 13.61, SD = 1.99 at Time 1) participating in a longitudinal study in Belfast, Northern Ireland. Utilizing hierarchical linear modeling, the results show that the effect of exposure to sectarian antisocial behaviors has a stronger effect on youth emotion problems for older adolescents. The results also show that youth with higher strength of group identity reported fewer emotion problems in the face of sectarian antisocial behavior but that this buffering effect is stronger for Protestants compared to Catholics. Implications are discussed for understanding the role of social identity in postaccord societies.