Adverse Political Events and Psychological Adjustment:Two Cross-Cultural Studies

MICHELLE SLONE, PH.D. , MICHAL ADIRI, M.A., AN D AVIV ARIAN, M.A.

ABSTRACT

ObJective: The life events model was extended to the political arena to enable the comparison of children's adjustment

reactions to political stress. The cross-cultural impact of adverse political events on psychological adjustment was

examined for two closely matched research samples, Arab and Jewish children and Palestinian and Israeli children .

Method: All children completed the Political Life Events scale and the Brief Symptom Inventory in their home languages.

Results: The hypothesis of a linear relation between adverse events and psycholog ical distress was not confirmed in

both studies. In study 1, a direct relation emerged for both Jewish and Arab Israeli children. However, in study 2, when

separated by nationality, results revealed opposite trends for each nation. For Israelis there was a linear relation, but for

Palestinians there was a consistent inverse relation between increased severity of political life events exposure and

distress, both for the global index and for specific symptomatology. Conclusion: It is proposed that these cross-cultural

results stem from differential mediating coping mechanisms, specifically pass ive versus active strategies, which

intervene between the stressor-adjustment link. The need to address short- and long-term consequences of political

stress on children's mental health is discussed. J. Am. Acad. Child Ado/esc. Psychiatry, 1998, 37(10):1058-1069. Key

Words: political life events, adjustment , cross-cultural , Middle East.

The consequences of war and sociopolitical stress onchildren's adjustment have raised considerable concerns(Jensen and Shaw, 1993 ; Ladd and Cairns, 1996) .Despite recognition of the need for controlled investi­gation in this domain, research is daunted by inevitablemethodological pitfalls due to the sporadic and unpre­dictable nature of the eruption of stressful events andthe rapid transformations that characterize sociopoliticalphenomena. Most studies have been restricted to qual­itative evidence or clinical-descriptive designs with focion post hoc examination of consequences of acute trau­matic events on narrow symptomological indicators,such as anxiety or depressive reactions (Cicchetti andToth, 1992) or posttraumatic stress disorder (Eth andPynoos, 1985). The two studies reported here attempt to

Acupud May 8. /998.Dr. Slone and M s. Adi ri are with the Psychology Departmen t, Ttl Aviv

Uniuenity. Israel. M r. A rian is with thr Psychology Department, Haift Uniuer­siry. Israel.

This research wasfu nded by a grnrrous grant fro m Jonathan Kolber and tbrKareu Fund. to whom the authors rxprm their appreciation.

Reprint rrqums to Dr. Slone, Department of Psychology. Ttl Aviv University.Ramat Aviv 69978, Israel; e-mail: mich@wg.tau.ac.il

0890-85671981371O-10581$03 .0010~ 1998 by the American Academy ofChild and Adolescent Psych iatry.

address some of these difficulties by extending the quan­titative study of psychological developmental processesto the political arena. The basis of this attempt is theapplication of the life events model to the investigationof children's adjustment to adverse political events.

The life events paradigm seeks to study the conse­quences of adverse events by separating precipitantstressor from response by means of the quantification ofsocial experiences measured by questionnaire meth­odology (Monroe and Peterman , 1988). In general, theoccurrence of life events has been conceptualized as anindependent variable in the prediction of various indicesof psychological functioning (Cohen, 1988). The tradi­tional paradigm reflects a linear model of cause and effectwhich, therefore , has failed to take cognizance of thecultural, socioeconomic, and sociopolitical context onthe appraisal and response to stress (Parkes, 1986).

Within this framework, adverse political events couldbe conceptualized as representing a special category of lifeevents as they are located within a particular histor icaland cultural context and result in collective experience.Application of the life events model to the examinationof adverse political events could release research fromdependence on acute stressors and address some of the

1058 J. A M . AC A D. CHI l.D A D O L ESc:. PSYCHIATRY. 37: 10. O C T O BER 1998

methodological difficulties that hamper the researchdomain. The lack of an across-group standard restrictsstudy to a descriptive comparison of adjustment indicesof samples of children from different groups. Thus, theneed for a life event standard, against which differentialgroup adjustment processes can be compared, is situ­ated at the base of any quantitative cross-group study inthe political domain. However, the standard must beapplicable transculturally such that it provides a com­mon denominator of group-specific meanings andappraisals attributable to events. This could potentiatethe investigation of children's adjustment under condi­tions of social upheaval, with cross-cultural compari­sons enabling the development of an interactionistmodel which could account for the mediation of thesociocultural framework.

The baseline of the current two studies involved theutilization of the Political Life Events (PLE) scale forthe measurement of exposure to adverse political events,which is as inclusive as possible, but interpretable fromdifferent points of cultural reference (M . Slone, K.Durrheim, D. Kaminer, unpublished, 1997). Since theconstruction of a meaning-free life events scale presentsa thorny problem (Cohen, 1988), the scale marked anattempt to pare off the cross-cultural content specificityof the political life events within a specific geographicalregion. Further supporting this formulation is the notionthat since a completely meaning-free instrument is unten­able in general life events research, the leap of utilizing aPLE scale is smaller than it may appear at first glance.

An additional issue is the question of applying anexistent, assumedly universal, political trauma measure­ment scale, such as the Childhood War Trauma Ques­tionnaire (Macksoud and Aber, 1996), as opposed to thedevelopment of an ecologically sensitive scale. This isprobably a moot point, as assets may be located in each.The use of an existent scale ensures its psychometricproperties and its comparative utility. However, thatwhich is gained by generality may be lost for ecologicaland cultural sensitivity. Given the particular liquidityand specificity of many political environments, the uti­lization of an ecologically sensitive tool would appear tobe a legitimate endeavor. In line with this assumption,the aim of the two studies reported here was to use anecologically appropriate PLE scale against which psycho­logical adjustment could be examined. The two studiesdeal with Jewish and Arab Israeli children and Palestinianchildren growing up under the tensions surrounding the

J. AM . ACAD . CHIl.D ADOl.E SC. PSYCHIATRY. '>7:10 . O C T OB ER 19 98

ADVERS E POLITI CAL EVENTS AND ADJUSTM EN T

Israeli-Palestinian conflict in the Middle East. Therefore,this scale standard aimed to examine children's psycho­logical adjustment to political stressful events within thisarena and, additionally, to extend the investigation to across-cultural comparison of possibly differential adjust­ment processes of children.

The environment of sociopolitical transition in theMiddle East, interspersed with violence, provides thebackdrop against which children undertake the usualtasks of development, leading to additive levels of psy­chosocial stress. Traumatic experiences have been foundto manifest in a variety of affective and behavioral reac­tions (Cicchetti and Toth, 1992) and chronic stressorshave been reported to compromise emotional adjust­ment (Garmezy and Rutter, 1985). This necessitates adevelopmental approach to trauma-related psychopa­thology (Pynoos, 1996). Stress reactions lie on a spectrumranging from the mild and transient to psychopathology,at the base of which lie diverse symptoms, althoughsome common characteristics of responses to childhoodtraumatic experiences have been delineated (Terr, 1991).Prevalence rates of psychopathology are sufficiently ele­vated to warrant concern about adverse life events assevere risk factors for children's adjustment (Martinezand Richrers, 1993), indicating that the ambit of con­cern should extend beyond direct violence victimizationto encompass a range of stressors associated with threat,insecurity, and loss of control. This need heightens sincechronic insecurity imposes a requirement for develop­mental adjustment and potentiates age-related vulnera­bilities, particularly when it stems from a transformationof social reality (Garbarino et al., 1991).

Investigations of sociopolitical stress reactions haveyielded contradictory evidence. In the main, findingsfor children exposed to war and other social crises pointto profiles of developmental impairment, psychiatricsymptomatology, and emotional reactions (Garmezyand Rutter, 1985; Punamaki and Suleiman, 1990),including posttraumatic stress disorder (Erh and Pynoos,1985). Studies emerging from countries besieged byprotracted conflict, such as Israel (Hoffman and Bizman,1996) and Northern Ireland (Cairns, 1987), have reportedvarying symptom patterns as a function of adjustmentdomains and stressors targeted, and demographics of re­search samples.

However, some political stress research has yieldedevidence of early maturation and precocious moral sen­sibility (Coles, 1987) and an increased capacity for moral

1059

SLONE ET AL.

and, by extension, abstract reasoning (Straker, 1993).Studies of children in Northern Ireland suggest that chil­dren are often surprisingly resilient in the face of chronicviolence, tending to normalize daily living conditions(Cairns, 1987). This inconsistent evidence suggests thatthe effects of political stress on children's psychologicaladjustment warrants further systematic investigation.

Rationale

These studies represent two cross-cultural investiga­tions of children's reactions to their experienced politi­cal life events. One study investigated responses ofJewishand Arab Israeli children residing in Israel, and theother study investigated responses of Palestinian chil­dren residing in Gaza and a matched sample of Israelichildren. The motivation underlying these studies wasto provide an indication of adjustment reactions to

adverse political events and their possible differentialimpact and culturally specific patterns. This assumptionwas based on an interactive model of adjustment whichnecessitates cognizance of the transaction between thespecific sociopolitical context and collective response.The ability of the life events model to reflect this trans­action extends the model beyond its traditional bound­aries. Thus, in a sense, although it is not the prime aim,the current investigation represents an indirect evalua­tion of the flexibility of the life events model to encom­pass political phenomena.

STUDY 1

The two aims of the first study were to determinestressful political life events exposure among Jewish andArab Israeli children living in Israel and to use this mea­sure to examine the relation between political life eventsexposure and psychological adjustment.

Within Israel of the pre-June 1967 borders, Arabs andJews are citizens who enjoy formal civic and legal equal­ity.The Arabs, who were granted citizenship when Israelwas established in 1948, constitute approximately 16%of its citizens (Rouhana and Fiske, 1995). However, con­stellations of religious, cultural, and political differenceshave given rise to complex difficulties and the relationbetween Jewish and Arab citizens is permeated with coop­eration in some areas and conflict in others (Kretzrner,1990). Confiictual areas include land ownership rights,power sharing, and the distribution of resources, com­plicated further by the Israeli-Palestinian conflict. Arab

1060

citizens identify closely with Palestinians in the territo­ries, although they have not shown readiness to join inthe uprisings or to move to a Palestinian state if one isestablished. Although these conflictual areas have beenalmost completely devoid of physical violence, relationshave often been strained (Smooha, 1992).

In terms of this unequal alliance, it would be expectedthat the political experiences and concomitant psycho­logical adjustment of Arab and Jewish Israeli childrenwould be different. They are separated along a religious,ethnic, cultural, residential, and national identity dividethat could influence both political event exposure and itstranslation into psychological distress. Thus, the under­lying assumption of the first study suggested that ArabIsraeli children would be exposed to more political lifeevents than matched Jewish children. This was postu­lated on the thesis that an Arab minority group living incentral Israel would be more intimately involved in, andmore aware of, the intricacies involved in the politicallycentral Israeli-Palestinian conflict, possibly leading togreater political activity than their relatively insulatedIsraeli counterparts. In addition to the significance ofthis investigation, support would strengthen the cre­dence of the PLE scalein this context. The central hypoth­esis predicted, in line with basic assumptions underlyinggeneral life events research, that there would be a linearrelation between exposure to political life events andpsychological distress indices.

METHOD

Subjects

Subjects were 259 Jewish and Arab sixth- and seventh-grade chil­dren between ages 13 and 14 years (mean age 13.6). Subject demo­graphics are presented in Table 1.

The Arab children resided in and attended school in Jaffa. whichis one of the cities in Israel consisting of a mixed Arab and Jewishpopulation. The Arabs residing in this area live an urban lifestyle.and the children were all from Moslem families who were traditionalto secular in their religious orientation. The Jewish children werefrom a neighborhood in Tel Aviv approximating the low middle to

middle class socioeconomic status from which the Arab childrenwere sampled. Post hoc analyses of the demographic characteristicsof the Arab and Jewish samples showed no significant differencesbetween the two groups on parental educational level or reportedstrength of self or familial religious commitment.

Instruments

All children responded to a battery of questionnaires in their homelanguage; Jewish children in Hebrew and Arab children in the Arabicdialect used in the area. The Arabic version of the questionnaires wastranslated professionally by a translation company. countertranslared

]. AM. ACAD, CHILD ADOLESC. PSYCHIATRY. 37:10. OCTOBER 1998

TABLE1Study I: Subject Demographic Characteristics

back into Hebrew by two psychologists independently, and thenassessed for equivalence and reformatted accordingly.

The research battery was composed of the following two ques­tionnaires:

Political Life Events Scale. The PLE scale is conceptualized as apolitical life events checklist. constructed to measure exposure to thebroad spectrum of regional Israeli-Palestinian political life events(Slone er al., unpublished. 1997) . Only negative events are includedin this scale. circumscribing the difficulty of balancing positive andnegative events at this earl y research stage. The checklist consists of20 items originally derived from event exposure reported in in-depthinterviews with Israeli adolescents. The original scale yielded goodinternal consistency (Cronbach a =.83) and criterion validity.

Children are requested to note their exposure to the events, with apositive response receiving a score of I and a negative response receiv­ing a score of O. Since items are not equivalent in their severity. itwould be erroneous to score the scale on the basis of the sum of expe­rienced items. The original scale used item weightings based on chil­dren's categorizations of item severity (Slone et al., unpublished,1997) , which is an acceptable sco ring system for life events scaleswith adequate predictive value for psychological adjustment indices(Zuckerman er al., 1986).

Despite original weightings, it was considered necessaty to reestab­lish the validity of the weightings for the different populations cur­rently under investigation . Therefore. a pretest was conducted inwhich 20 Jewish. 20 Arab Israeli . and 20 Palestinian children betweenthe ages of 12 and 15 years were requested to categorize items accord­ing to severity. For example. events categorized as mild included"Participation in a political demonstration" and "Exposure to politi­cal violence via the media." Item s such as "Prolonged period spent ina bomb shelter" and "Damage to property as a result of politicallybased activity" were categorized as moderate events. Finally. severeevents included items such as "Injury to a family member as a resultof political or military events" and "Death of a friend as a result o fpolitical or military events." To reflect increases in severity. itemswere attributed d ifferent weightings according to children's catego­rizations on the pretest, with items categorized as mild multiplied by0.5, items categorized as moderate multiplied by 1.0. and items cate­gorized as severe multiplied by 1.5 . The final PLE score is a globalmeasure derived by summing weighted items across the entire ques­tionnaire which, in the present study, yielded a Cronbach a coeffi­cient of .90 .

For statistical analyses, subjects were divided into four quarr ilcs to

reflect different levels of sever ity of exposure on the weighted scores.The four quartiles rellecred low, moderate, high, and very h ighexposure.

BriefSymptom Inventory. The Brief Symptom Inventory (BSl)(Derogaris and Spencer. 1982) is the abbreviated version of the Symp­tom Checklist-90-R. comprising 53 self-report items rated on a 5­point distress scale and providing distress indices and an assessmentof symptom load interpreted along nine dimensions-Somatization.Obsessive-Compulsive. Interpersonal Sensitivity. Depression. Anxiety,Hostility. Phobic Anxiety, Paranoid Ideation. and Social Aliena-

Males Females Total

JewsArabs

5668

6272

118140

ADVERSE POLITI CAL EVENTS AND ADJUSTMENT

tion-and one additional miscellaneous symptom subscale. Amongthe psychological distress indices, Derogaris and Spencer (1982) rec­ommend the utilization of the Global Severity Index (GSl) in mostinstances in which a single summaty measure of depth of distress isrequired. The GSI is a weighted frequency score calculated as theaverage of the sum of distress ratings that the subject has assigned toeach symptom. In the present study, the distress measure was basedon the GSI and symptom load was calculated along each of the sub­scales. excluding the additional scale, which does not represent a uni­fied index. providing a profile of global distress and specificsymptomatology for each subject.

The BSI has yielded high reliability and validity measures(Cronbach a coefficients of between .71 and .81). high test-retestreliability (correlations between .78 and .90). and relatively high con­current validity with the MMPI. Norms for the English version havebeen demarcated for adolescents. nonreferred adults, and psychiatricpatients. The inventory has been translated into Hebrew (Canettiet al., 1994) with good internal consistency and concurrent valid ity(correlations between GSI and the General Well Being Scale r =-0.62). The Hebrew version of the scale is reported to have no signif­icant sociodemographic effect (Canerri et al., 1994) . The current studyyielded a Cronbach a coefficient of .95 for internal consistency.

Procedure

Questionnaires were pre sented in a randomly counterbalancedorder to minimize response set. For both samples. the questionnaireswere administered in the classroom in their instructional languageby teachers who had received prior instructions. This was consideredpreferable to administration by the Jewish Israeli experimenter inone or both samples, which may have produced response biases. Per­mission to conduct the study was obtained from relevant officialauthorities and from the schools. Children were informed that theywere participating in a research program. and anonymity and confi­dentiality were assured. To restrict bias maximally, the institutionunder whose auspices the research was conducted was not disclosedto the children.

The study was conducted in mid-year 1995 after the spate ofsuicide bombings in the heart of Israel and prior to the assassinationof Prime Minister Rabin. To minimize the chances of acute eventoccurrence. data collection was completed within I week. Fortui­tously, none occurred during that week.

ln addition to the test battery, all children responded to a series ofquestions assessing recent nonsociopolitical traumatic experiences.There were 23 children who met certain preset criteria of significantadditional stress , and they were removed from the study, leaving 258participants. This was considered preferable to partialing out a gen­erallife events scale which would increase the difficulty of controllingfor culture specificity and translation of an additional instrument.

RESULTS

The underlying assumption of the study that Arabchildren would report greater exposure to political lifeevents than Jewish children was confirmed (t243 = -2.73,P < .01). suggesting the criterion validity of the PLEscale. The central hypothesis of the study posited thatthere will be a direct relation between level of exposureto political life events and psychological distress. Meansfor the GSI according to the four PLE levels are pre­sented in Figure 1.

J. AM . ACAD . CHILD AD O l.E SC. PSYCHIATRY. 37 :10 . O CTOB ER 1998 1061

SLONE ET AL.

0....1...-....----.,..-----..----r--

Fig. 1 Global Severity Index (GSI) means according ro political life events(PLE) exposure for Jewish and Arab population.

In line with the hypothesis, Figure 1 indicates thatthere was a significant linear relation between exposureto increasing levels of severiry of political life events andhigher levels of psychological distress (F3 ,24 1 =6.39, P <

.00l). No significant interaction was found betweennation and levelsof political life events on the GSI, indi­cating that this direct relation held both for the entirepopulation and for each nation. In addition, three-wayanalyses of variance yielded no significant main effects

The second study used the same research design asthe first study; however, it targeted sociopolitical stressresponsesof Palestinian children living in Gaza and Israelichildren. Equivalently to the first study, the second study

STUDY 2

for nation on the relation between high and low PLEand BSI subscales.

Since there was no main effect for nation, t tests wereconducted to examine the effect of high and low expo­sure to political life events on the BSI profiles for the en­tire population. These data are presented in Table 2.

Significant differences emerged for the GSI and forall the subscales for low and high exposure to politicallife events, indicating that high exposure to political lifeevents is associated with significantly higher levels ofglobal distress and symptomatology on all subscales.

An examination of differences between Jewish andArab children for specific symptom profiles yielded nosignificant differences on the specific symptom subscalesexcept for Social Alienation (t256 = 4.28, P < .001), forwhich Arab children manifested higher levels than Jewishchildren.

A highly significant effect emerged for sex on the GSIand all the subscales, with girls exhibiting higher levelsthan boys. Means, standard deviations, and t values forthe difference between boys and girls on the GSI andsubscales are presented in Table 3.

No significant effect emerged for sex on the relationbetween level of exposure to polit ical life events and theGSI.

2.33

very high

2.21

high

PLE exposure

low moderate

2

1.5

0.5

2.5

TABLE 2Means. Standard Deviations. and t Values of GSI and Subscales for High and Low Exposure to PLE

Low PLE High PLE

BSI Mean SO Mean SO t (df= 243) P

GSI 104.88 28.45 120.40 33.36 - 3.92 .001Soma 12.03 4.22 14.24 5.02 -3.72 .001Obsessive 12.83 4.01 14.39 5.04 -2.67 .01Inrerper Sen 8.09 3.05 9.31 3.59 -2.88 .005Depression 10.81 4.04 12.38 5.24 -2.64 .01Anxiety 12.20 4.09 14.13 4.78 - 3.40 .001Hostility 10.13 3.85 11.39 4.13 - 2.45 .05Phobic 9.21 3.38 10.47 3.91 -2.69 .01Paranoid 11.51 3.62 12.71 4.25 -2.39 .05Soc Alien 10.14 3.70 12.27 4.27 -4.17 .001

Note: PLE = political life events; BSI = Brief Symptom Inventory; GSI = Global Severity Index; Soma = Somatization;Obsessive =Obsess ive-Compulsive; Interper Sen =Interpersonal Sensitivity; Phobic =Phobic Anxiety; Paranoid =ParanoidIdeation; Soc Alien = Social Alienation.

1062 J. AM . ACAD . CHILD ADOL ESC . PSYCHIATRY, 3 7:10 , OCTOBER 1998

aimed to identify adverse political life events exposurelevels for Israeli and Palestinian children and their effectson psychological adjustment.

Despite the enormity of the peace initiative in the Mid­dle East, the fabric of society for Israelis and Palestiniansremains beset by radical political views, high levels ofviolence, and social, community, security, and pragmaticdifficulties. Despite residential proximity and comple­mentary concerns for security and autonomy, Israelisand Palestinians have been exposed to differential experi­ences throughout their protracted and complex conflict.

Since the establishment of the state, Israeli life hasbeen punctuated by opposition to its autonomous exist­ence, war, threats of war, and terrorist attacks (Harkabi,1988). The unstable status of the peace process betweenIsrael and the Palestinians and the spates of suicidebombings in the heart of the country have produced ageneralized sense of insecurity that has intensified ideo­logical and political divisions.

On the other side of the conflict is the Palestinian na­tion who live in Gaza, which was conquered by Israelfrom Egypt during the Six-Day War, and in the WestBank, which was conquered from Jordan. The Palestinianshave historically lived under foreign occupation, a situa­tion that has stunted the establishment of autonomoussocietal and economic infrastructures, resulting in gen­eral socioeconomic disadvantage. Despite an intact cul­tural and religious framework, the societal and politicalbase is frail. Tensions peaked during the Intifada, a pro­tracted uprising that began in 1987, during which theyouth acted against the Israeli occupation by means ofdemonstrations, marches, and stone-throwing. Despite

ADVERSE POLITICAL EVENTS AND ADJUSTMENT

recent initiatives toward a peaceful settlement in theregion, the Palestinians remain in a position of insecurityabout their national destiny, frequently divided amongthemselves regarding aspirations for its final form(Shikaki, 1996).

Although the conflict has different meanings for eachnation, there exists a common denominator of politicallybased adverse life events in the two populations. On bothsides of the conflict, children may have experienceddemonstrations, confrontation, family separation or loss,damage to their homes, community insecurity, and otherpolitical stressful events.

In light of the nature of the conflict and differentialliving conditions, the underlying assumption of the sec­ond study stated that Palestinian children will reportgreater exposure to adverse political events than Israelichildren. In addition to its quantitative value, this prem­ise provides a further criterion validity test of the PLEscale. Again, in view of general life events research, thecentral hypothesis of the second study stated that forboth Palestinian and Israeli children, there will be a lin­ear relation between severity of exposure to political lifeevents and psychological distress . However, a cross­cultural comparison of the two groups may yield differ­ential patterns of adjustment mechanisms.

METHOD

Subjects

Subjects were 209 Palestinian and Israeli sixth-grade childrenbetween the ages of 12 and 13 years (mean age 12.10). Subjectdemographics are presented in Table 4.

TABLE 3Means . Standard Deviations. and t Values of GSI and Subscales by Sex

Males Females

BSI Mean SD Mean SD t (df= 232) P

GSI 98.88 26.99 119.28 32.73 -5 .12 .001Soma 12.06 4.29 13.59 4.97 -2.48 .05Obsessive 11 .87 3.94 14.66 4.65 -4.88 .001Interper Sen 7.33 3.00 9.55 3.49 -5 .14 .001Depression 10.27 3.98 12.09 4.84 -3.09 .005Anxiery 11.44 3.66 14.08 4.78 -4.66 .001Hostiliry 9.80 3.54 lUI 4.28 -2.51 .05Phobic 8.54 3.05 10.49 3.94 -4.16 .001Paranoid 10.53 3.56 12.82 4.12 -4.47 .001Soc Alien 9.56 3.67 12.02 4.12 -4.77 .001

Note: BSI = Brief Symptom Inventory; GSI = Global Severiry Index; Soma = Somatization; Obsessive = Obsessive­Compulsive; Inrerper Sen = Interpersonal Sensitivity: Phobic = Phobic Anxiety: Paranoid = Paranoid Ideation; Soc Alien =Social Alienation.

J. AM . ACAD. CHILD ADOLESC . PSYCHIATRY. 37:10 , OCT O BER 1998 1063

SLONE ET AL.

Instruments

TABLE 4Study 2: Subject Demographic Characteristics

All children responded to the PLE scale and the BSI in theirhome language. Israeli children in Hebrew and Palestinian childrenin the exact dialect of Arabic used in the region. The Arabic versionof the questionnaires was counterrranslared twice by two indepen­dent translators to ensure compatibility with the Hebrew versionand then assessed for equivalence with the Hebrew version by threeindependent bilingual raters.

Access to Palestinian subjects was extremely complicated. therebylimiting controlled selection of this sample. Therefore. the Israelisample was matched on the basis of the criteria of the Palestiniansample. The Palestinian children all resided in Gaza in a reportedlyupper middle class socioeconomic area with reference to local stan­dards. and representing a sector of the population with heterogeneouspolitical orientations. They attended an academically competitiveand relatively prestigious school. The Israeli children were selectedfrom areas in Tel Avivapproximating as closelyas possible the reportedsocioeconomic status and political heterogeneity of the Palestinianchildren. In an attempt to equalize residential conditions. parentaleducational level. and school characteristics. this was considered com­patible with middle class socioeconomic status for Israeli children.Post hoc findings revealed no significant differences between paren­tal educational level for the two samples.

confirmed (t207 = -8.43, P < .0001). While most of theIsraeli children (74.2%) reported low to moderate expo­sure to political life events and only 3% reported veryhigh exposure, most Palestinian children reported highto very high levels of exposure (71.5%), among whom43.8% reported very high exposure. These findingsextend the criterion validity of the PLE scale.

The central hypothesis of the study stated that therewill be a direct relation between level of exposure to

adverse political events and psychological distress. Meansfor GSI according to PLE levelsare presented in Figure 2.

Figure 2 indicates that there is a relation betweenexposure to political life events and psychological dis­tress, which was significant (Fi ,189 = 3.14,P< .05). How­ever, in opposition to the hypothesis, this is not a linearrelation; rather, an inverted U curve is produced.

To explore the effect of nationality within the overallpicture, the means of GSI according to PLE levels foreach nation are presented in Figure 3.

A significant effect emerged for the interaction be­tween level of exposure and nationality on the GSI (F3.189

= 2.70, P < .05). When the interaction was examined,two significant simple effects emerged, one for theIsraelis (F1.86 = 3.48, P < .05) and one for the Palestin­ians (Fi .101 =' 3.59, P < .05). Post hoc Tukey comparisonsrevealed that for the Israelis, there was a significant dif-

97112

4558

5254

Males Females Total

IsraelisPalestinians

O...L.._~---~--.....,r----~--

Procedure

Except for administration logistics related to entry into Gaza, theprocedure was equivalent to that of study I. Questionnaires wereadministered in the classroom. in a randomly counterbalanced order.for the Israeli children by an experimenter and for the Palestinianchildren by a teacher who had received administration instructions.Permission to conduct the study was obtained from the relevantauthorities and schools. Anonymity was assured and the childrenwere informed that they were participating in a research project.However. because of the sensitivity of the situation. and to limit self­presentational biases. none of the children were aware of the specificinstitution under whose auspices the research was being conducted.The data were collected in 1995. prior to the granting of autonomyto Gaza and in close succession to the data collection for the firststudy. No acute political events occurred either in Israel or in Gazaand the West Bank over the data collection period of both studies.

In this study. Cronbach a coefficients were. 90 for the PLE and.94 for the BSI, supporting their internal consistency. As for study I.children responded to a series of questions regarding recent traumaexperiences outside of the sociopolitical context; 19 children whomet preset criteria of additional stress were removed from the study.leaving the remaining 209 subjects.

1.5

0.5

low

1.22

moderate

1.19

high very high

RESULTS

The underlying assumption that Palestinian childrenwould report greater exposure to political stressors was

PLE exposure

Fig. 2 Global Severity Index (GSI) meansaccording to political lifeevents(PLE) exposure for Israeli and Palestinian population.

1064 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY. 37:10. OCTOBER 1998

ADVERSE POLITI CAL EVE NTS AND ADJUSTMENT

[]

1 .52

tivity (F3•189 = 3.85,p < .05), Somatization (F.~ ,183 = 2.98,P < .05), and Hostility (F3•194 = 4.13,p < .01) . Each oneof these scales shows an inverted U curve.

The results show a consistent trend. For the Israelis,on all the scales, the symptom load is lowest at the low­est level of exposure and rises with increases in politicallife events , until the third quartile of exposure. Thefourth quartile, representing the highest level of expo­sure, has only three subjects in the Israeli sample and,therefore, is not meaningful. For the Palestinian chil­dren, for the nine scales, the symptom load on each scaleis highest when the level of exposure is moderate, andlowest at the highest levels of exposure. These trendswere significant for two of the scales, the Somatization(F3•183 = 4.03, P < .01) and Interpersonal Sensitivity(F3•189 = 2.72 , P < .05) scales, and tended toward signifi­cance for the Depression scale (F3•193 = 2.25 ,P < .10). Nosignificant interaction was found between nation andsex or between political life events and sex in their effecton the GSI. Therefore, no further examination was con­ducted for the sex variable.

very highhigh

PLE exposure

low moderate

2

0.5

0 ,8

O"'&"'-T"""--"""---"'T"'"---r---

1.5

Fig. 3 Global Severity Index (GSI) means accord ing to polirical life events(PLE) exposure for Israeli and Palestinian children by nation.

ference between distress at the low (mean = 0.80) andhigh levels (mean = 1.26), while for the Palestinians,there was a significant difference between distress at themoderate (mean = 1.52) to very high (mean = 0.97) lev­els. This difference reflects a different pattern for eachnationality. For the Israelis, at high levels of exposure,psychological distress is highest. For the Palestinians, atthe very high levels of exposure, psychological distress islowest. No main effect was found for nationality.

In addition to the examination of the effect of polit­icallife events and nationality on the GSI , differencesbetween Israelis and Palestinians for symptom load wereexamined for the nine symptom scales. The Anxietyscale was significantly higher for the Israelis (mean =

1.15) than for the Palestinians (mean = 0.86) (t l'>6 =

2.57,P < .05) , and the Hostility scale was significantlyhigher for the Israelis (mean = 1.17) than for thePalestinians (mean = 0.90) (t200 = 2.14, P < .05). Forthree subscales, the Palestinians showed significantlyhigher load than the Israelis: Phobic Anxiety, Israelis mean= 0.92, Palestinians mean = 1.30 (f202 = 3.09. P < .005);Social Alienation, Israelis mean = 0.83, Palestiniansmean = 1.47 (t199 = 5.82, P < .00 1); and Obsessive­Compulsive, Israelis mean = 1.28, Palestinians mean =

1.63 (f200 = 3.02, P < .005).Main effects for exposure to political life events were

found for three of the subscales: Interpersonal Sensi-

DISCUSSION

The studies yielded two major sets of findings. Thefirst set relates to the excellent psychometric propertiesof the PLE scale which increase the confidence withwhich it may be used as a measure of regional politicallife events and as an adequate standard against which toexamine the adjustment of Palestinian and Jewish andArab Israeli children. Its conceptualization provides aframework of response to some of the inherent method­ological difficulties in the research domain. In addition,the scale was fertile in yielding consistent and interestingdata which would have been untenable without somestandard for between-group comparison. However,extension of this type of research necessitates the devel­opment of a taxonomy both of political event exposureand its impact and the addressing of their generalizabil­iry to other contexts.

The second set of findings relates to the relation be­tween political life events and psychological distress. Forthe first study, both Jewish and Arab children reportedexposure to a significant array of measurable political lifeevents which , in line with the hypothesi s, were relateddirectly to distress reactions. Despite differences inresearch designs and the specific positioning of variablesunder investigation, these results concur with the broad

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consensus of findings from other Israeli and Middle Eastresearch (Garbarino and Kostelny, 1996; Punamaki,1996). Our findings showed that children are affectednot only by acute, dramatic stressors, but also by chroniccumulative forms of political tensions. Reactions are notlimited to singular symptoms such as anxiety or post­traumatic stress disorder, but they manifest in a varietyof symptom profiles. There were no significant differ­ences between Jewish and Arab children both for theamount and type of symptomological reactions, exceptfor social alienation. This could be interpreted to meanthat the variables along which the two groups differ,such as culture and religion, do not intervene in theresponse to adverse political events.

In the first study, a direct relation also held for bothsexes across both samples, although the effect for sex onthe GSI and all subscales was higher for girls than forboys. This aligns with studies that show greater emo­tionality and expression of distress in girls than boys(Eagly and Wood, 1991).

In the second study, which investigated Israeli andPalestinian children, the central hypothesis of a linearrelation between PLE and GSI was not confirmed andthe relation assumed an inverted U curve. However, thispattern reflected the overall effect for both nations to­gether. When the relation was separated for each nation,results showed a linear relation for the Israelis and aninverse relation for the Palestinians.

These findings raise two pivotal questions: Whatunderlies the counterintuitive decline in reported distressand symptomatology for Palestinian children at high lev­els of political life events exposure, and why does this notoccur among two samples of Israeli children, includingboth Arab and Jewish Israelis? The inverse relationamong Palestinian children would not be explicable interms of a cross-cultural difference according to whichPalestinian and Israeli children expressdifferent amountsof distress, since for both nationalities, global distress andsymptom indices initially increase with rising politicallife events exposure from the low to moderate levels.

A second proposition that may be considered is thepossible differential consequence of qualitatively differ­ent types of symptom profiles characteristic for eachnationality. Some types of symptom load could resolvespontaneously or change in certain ways, resulting indifferent patterns of psychological distress. However,there were no grounds to suggest that the symptom loadfor Israeli children tends toward passivity, such as may be

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the case with constellations along a depression axis,while the symptomatology of Palestinian children tendstoward activity or "acting-out," such as could be the casewith clustering around a hostility axis. The randomspread of symptom profiles across both populations doesnot constellate in a way that is clearly divisible, obviatingexplanations of qualitatively different patterns of pre­dominant symptomatology that produce opposite out­comes. Also this explanation is implausible because itwould not account for the similar initial increases insymptomatology in both groups, nor for the illogicalconsequence of resolution of symptomatology at higherlevels of political life events exposure. The failure ofthese interpretations suggest that different copingstrategies are used to regulate distress, and these arerooted in the cross-cultural variable.

The activation of mediating coping mechanisms thatintervene to ameliorate distress under stress circum­stances is consistent with views that traumatic eventsand psychological responses frequently cannot be accom­modated within the traditional linear model of causeand effect (Parkes, 1986). In this context, psychologicalcoping may be perceived as the factor by which socialstress is translated into individual psychological func­tioning and mental health (Lazarus and Folkman, 1984).

In the sociopolitical sphere, this construal is supportedby studies of children exposed to prolonged social up­heaval, such as responses to conflict in Northern Ireland,which connote the mechanisms of denial and repressionin alleviating subjective distress and aiding in normaliz­ing life routines (Cairns, 1987). In light of the nature ofthe Middle East conflict, a possible mediating copingmechanism is the transformation of the experience fromthat of passivity to activity.

Active efforts to relieve a stressful situation are con­sidered effective coping strategies in providing masteryand control over unpredictable or dangerous environ­ments, frequently resulting in alleviation of perceiveddistress and enhanced mental health, whereas passivecoping strategies are considered ineffective modes thatdo not ameliorate distress (Billings and Moos, 1981).The Palestinian experience of violence, personal threat,blocked national aspirations, and economic hardshipscould produce a pathogenic constellation of negativeevents that culminate in helplessness. The potential foradaptation and self-sufficiencylies in the transformationof helplessness into self-help and competence. However,the confluence of a particular sociocultural requisite sit-

J. AM. ACAD. CHIl.D ADOl.ESC. PSYCHIATRY, 37:10, OCTOBER 1998

uation and the ability to mobilize active participationwould add the counrertorce of control to an otherwiseunpredictable situation. Previous research on the reactionsof Palestinian children to the conflict has indicated thattraumatic experiences increased risk-taking (Punamakiand Suleiman, 1990) and that active participation inconfrontation produced feelings of increased impor­tance, pride, and self-esteem (Baker, 1990).

For the Palestinians, there may be a unique con­gruence between traditional cultural and collectivemodes of response and particular sociohistorical circum­stances enabling the transition to active coping modes.The Palestinians perceive the conflict in terms of theneed to create an autonomous state out of a situationthat could be described as a national void, exacerbatedby the experience of living as a conquered nation. To thisend, Palestinian national aspirations require the chan­neling of activity to one clear target. In addition, under­lying social frameworks enhance the potential foraction-based strategies (Nixon, 1990) . Densely popu­lated residential areas and the traditional extended Elm­ily produce high concentrations of people living in closeproximity, and community structure and cultural andreligious norms promote the formation of cohesivegroups. When daily routines are disrupted by politicalevents, such as closure of schools or curfews, childrentend to constellate and rapidly form into united groups.

Individuals are not passive recipients of life events,and adolescents in particular may actually expose them­selves to political violence to varying degrees. Cultural,familial, and individual factors would contribute to thedetermination of which children become political activ­ists, and the related mechanisms of displaying strengthand power may additionally influence the underreport­ing of the influence between political events and psy­chological symptoms. There is also the possibility of abidirectional influence between political events and psy­chological symptoms in which exposure to political lifeevents may lead to symptomatology, and psychologicalsymptoms could motivate political involvement or influ­ence political exposure.

Finally, it is also plausible to invoke an explanation interms of a specific buffering hypothesis. There may bespecific resilience-enhancing environmental circum­stances , such as emotional or community support, for asection of the Palestinian population. However, it isimprobable that this would exist for only one sector ofthe entire research population, and specifically for that

ADVERS E POLITI CAL EVENTS AND ADJUSTM ENT

segment in one culture exposed to the highest politicallife events levels. It is possible that this segment is char­acterized by a specific ideology which activates somealleviating mechanism. If this is so, it suggests that notall Palestinian children are protected by ideology fromdistress and symptomatology, only those intimatelyinvolved with severely stressful political experiences.

However, these premises raise the second question ofthe inability of Israeli children to modulate subjectivedistress. Israeli children, both Jewish and Arab, find them­selves in a different set of sociopolitical circumstances.The uncertainty of the peace process and the vulnerabil­ity of the country to internal and external attack havebeen reported to produce high levels of anxiety and dis­tress reactions both among adults (Arian, 1996) andchildren (Klingman et al., 1993). Surveys indicate thatover the period of 1993 through 1996, between 76%and 85% of sampled Israelis expressed deep concern forpersonal safety (Arian , 1996). As opposed to Palestinianchildren, for Israelis there is no clear enemy against whomthey can direct personal action. Although public opin­ion plays a crucial role in the sociopolitical theater,national policy is mediated via official channels, and thepeace process is spearheaded at the democratically electedgovernmental level. In addition, cultural and religiousnorms encourage discussion and intellectual strategies indealing with social issues.

This generic sociopolitical structure could hamperattempts to attain mastery over the environment. ForIsraelis and Palestinians, there seems to be a juxtaposi­tioning in the locus of control (Rotter, 1975). For thePalestinian children, who have moved from a suppressedposition of blocked national aspirations to hope forautonomous existence, the adoption of a personal senseof responsibility for resolving the conflict may have fos­tered an internal locus of control which would result inan enhanced sense of empowerment. Circumstances arealmost diametrically opposite for Israeli children, whoare faced with new political arrangements and relativelyuncontrollable threats to personal security within theboundaries of the country. These redefinitions may pro­duce an external locus of control, possibly resulting infeelings of vulnerability and lack of belief in self-abilityfor restructuring the situation. Israeli children would behard-pressed to adopt instrumental problem-solvingstrategies that could impact significantly on the situa­tion, since attempts to master the environment must befocused through indirect channels.

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This study cannot make assumptions about the spe­cific dimensions of the cultural variable responsible forthe difference, as this variable encompasses social, histor­ical, religious, and political conditions which were notdefined in the study. Complementary qualitative research,such as in the form of focus or encounter groups, may bevaluable in delineating more precisely the operative dy­namics postulated to underlie the findings. However,these considerations reinforce the thesis that it is theamount of political stressful events and the attributionof meaning within the specific cultural context thatdetermine the subjective distress outcome. Findings sug­gest the extension of the traditional life events paradigmto encompass the situational context that frames the expe­rience of stress. In addition, the resultsquestion the rradi­tionallife events linear model and support its modificationto encompass the conception of an interactionist modelbased on a mediated connection between stressor andadjustment.

Rigorously designed cross-cultural studies may provefruitful in identifying those societal mechanisms thatimpact adversely on children's mental health, althoughnot always possible due to the nature of the appraisal ofstress and the sociodemographic conditions of the verycontext under investigation. In the two studies, fewerIsraeli children reported exposure to the highest level ofpolitical life events, while most Palestinians reported thehigh to very high levels.The ability of the PLE scale to

reflect this condition reinforces its value and purpose.Future research may compare equated populations foradjustment, although this raises additional issues ofother biases, such as would exist in sample choice ofmore extreme segments of the Israeli population whoare in the front line of the struggle, for example, settlersin the West Bank. Nonetheless, the PLE scale could beused to select samples by controlling for exposure toadverse political events in studies that necessitate thisconsideration.

This investigation highlights the need for policymakersto take into consideration not only adults', but also chil­dren's differential capacities for response as a potentialforce in the region, particularly since it is these childrenwho are to inherit the conflict. Future research should bedirected toward depicting a more cohesive developmen­tal picture by investigating pathogenic sociopoliticalconditions in other age groups. In addition, the currentstudy is anchored on one specific conflict at a particularhistorical juncture. Generalizability is restricted without

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reassessment of the nature of political stress and the rela­tion between exposure and adjustment over time.

Clinical Implications

Beyond distress symptoms, much remains to be learnedabout children's responsesto chronic political stressand itsramifications. Despite differential cross-cultural reactivepatterns and the apparent reduction in symptomatologyamong Palestinian children, the long-term effects ofchronic adversepolitical events on children'smental healthstatus remain questionable. The study can serve only asan assay of limited dimensions within a stimulus-richcontext, precluding more than a cursory explanation.However, it underlines the need for a social-ecologicalperspective which highlights broad-based contextualinformation in understanding developmental adjust­ment difficulties. The findings alert to the need to addresschildren's significant distress. However, differential man­ifestations of this distress underline the importance offormulating therapeutic interventions in a culturallysensitive manner. Culture-specific patterns suggest thesuitability of group settings for this endeavor, such asclassroom or community intervention programs.

Notwithstanding the fluid and tumultuous nature ofthe sociopolitical situation and the considerable meth­odological difficulties of research in this domain, theimpact of living under chronic stresson children's adjust­ment should not be overlooked. The multidimensionalramifications of growing up under conditions of pro­tracted adverse political conditions need to be assessed,and adjustment mechanisms should be investigated inorder to disentangle short- and long-term implicationsfor children's mental health.

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represenrarive sam ple of 13.78 3 ado lesce nts were studi ed . Measurements o f weight and height co llected in the seco nd wave of th e

surv ey wer e used to study ado lesce nt obesity. M ulti vari ate logit techniq ues were used to provid e an understand ing of th e eth n ic.age. gender and int ergenerational panerns of ado lescen t obesity . C om pa risons are pre sented berween the NHAN ES III results and

those fro m th e Adolescent Health Su rvey. T he smoothed versio n o f the NHAN ES I 8 5th per centile CUI-off was used for th emeasure of obesity in th is paper. For the roral sam ple. 2(, .5% were ob ese. T he rates were as follows: wh ite non-Hispa nics, 24 .2%;black non-H ispanics, 30 .9%; all H ispanics. 30.4%; and all Asian-Amer ican s. 20 .6 % . Important variations wi th in the Hi spanic

and Asian-American su bpopu lario ns are presented. The Chinese (15.3%) and Filipino (18. 5% ) samples showed substant ially lowerobesity th an non-Hispani c whites. All groups sho wed more obesity am on g males rhan among females. except for blacks (27 .4%for males an d 34 .0% fo r females). Asian -American and H ispan ic ado lescents born in th e U .S. are more than rwice as likely to be

obese as are first gen erat ion residents of the 50 sta tes. J Nutr 1998 ; 128 :701- 706

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