Modelling life satisfaction and adjustment to trauma in children exposed to ongoing military violence: An exploratory study in Palestine

Abstract

Exposure to war and ongoing political violence increases mental health risks among children, especially in terms of posttraumatic stress disorder (PTSD), and depressive or somatic symptoms. However, an exclusive focus on negative functioning can lead to underestimating the coping abilities and natural potential for adjusting to trauma of war-affected children at different developmental phases. Using structural equation modelling, we tested the extent to which data gathered in a predominantly nonclinical sample of Palestinian children (N = 1276) living in refugee camps supported a conceptual model in which the relationship between subjective wellbeing and the effects of trauma is mainly top-down in direction. The cross-sectional design adopted showed that feelings of life satisfaction contributed to better affect balance in children (aged 6–11 years), which in turn, mitigated the impact of traumatic events. These findings point up the importance of dimensions of subjective well-being in children involved in traumatic events and may inspire intervention and treatment focused on the ability to activate positive emotions as a crucial resource for dealing with traumatic reactions.

Introduction

A huge number of researchers have reported that exposure to war and ongoing political violence increase mental health risks among children. Specifically, posttraumatic stress disorder (PTSD), depressive, and somatic disorders are the most common diagnoses in such contexts (Attanayake et al., 2009, Dimitry, 2012). Studies have found an exceptionally – and controversially – high incidence (58–80%) of PTSD among war-affected children in the Middle East (Dyregrov, Gjestad, & Raundalen, 2002; Elbedour, Onwuegbuzie, Ghannam, Whitcome, & Hein, 2007) and Africa (Betancourt, Speelman, Onyango, & Bolton, 2009; Schaal & Elbert, 2006). The severity of post-traumatic stress disorder is mainly associated with personal experiences of traumatic events. Cumulative exposure to traumatic events is especially strongly associated with a broad range of psychological problems in individuals exposed to violence during war. For example, a study by Lai, Hadi, and Llabre (2014) on psychological impairment in parents and children after the 1990–1991 Gulf Crisis, identified multiple domains of distress among children after exposure to traumatic events, such as PTS, anxiety, and depression symptoms. However, an exclusive focus on traumatic reactions and negative functioning can lead to underestimating the natural adaptive resources of war-affected children at different developmental phases, such as a natural potential to adjust to trauma, or the ability to cope (Barber, 2013, Veronese and Castiglioni, 2015).

In the following sections, we review a recent paradigm shift from perspectives focused on negative functioning and pathology to approaches with a greater focus on children’s adjustment to extreme trauma that is specific to a Palestinian context characterized by ongoing conflict and political violence (Barber, 2009a, Barber, 2009b).

In this study, war trauma is understood as exposure to extremely traumatic events in the context of war (Khamis, 2015). We adopt the APA (2000) definition of extreme trauma as directly experiencing, witnessing, or learning about events that involve actual or threatened death or serious injury, or other threat to physical integrity. This understanding of war trauma fully corresponds to the reality of Palestinian children’s everyday experience. Children living in contexts of chronic warfare such as in Palestine undergo an ongoing and complex form of trauma that pervades all dimensions of their lives and subjects them to dehumanising and abnormal conditions of existence (Nguyen-Gillham, Giacaman, Naser, & Boyce, 2008). More specifically, Palestinian children are constantly and directly exposed to a dangerous and unpredictable environment characterised by poverty, war-related destruction and episodes of military and political violence such as drone strikes, military incursions and internal fighting among families and factions (Barber, McNeely, Olsen, Belli, & Doty, 2016).

In this section, we present our rationale for conducting our study within a paradigmatic framework that advocates a focus on the constructs of wellbeing and life satisfaction in promoting the psychological functioning of war-affected children and questions the relevance of more frequently researched constructs (such as resilience) to protracted conflict scenarios (Barber, 2013, Nguyen-Gillham et al., 2008). Palestinians in general are required to deal with severe social suffering and extreme cumulative trauma in a context of ongoing occupation and violence (Barber et al., 2016). Children thus face constant threat across multiple dimensions of their wellbeing, with negative consequences for their psychological functioning and coping abilities (Veronese and Castiglioni, 2015, Veronese and Pepe, 2014). The fact that for Palestinian children “being steadfast neither precludes nor excludes feelings of emotional distress or sheer boredom” (Nguyen-Gillham et al., 2008) brings to light the episodic nature of other constructs (such as resilience), and explains why they may fail to capture the complex traumatic experience of children in Palestine. A study by Veronese, Castiglioni et al. (2012) found Palestinian children living in refugee camps to display higher levels of optimism, life satisfaction and perceived quality of life than Palestinian children living in Israel. The study showed that environmental factors such as freedom of movement and safety at home, as well as individual factors such as positive emotions, a feeling of competence and life satisfaction can help children to cope with extreme trauma. Finally, Palestinian children who presented a moderate degree of trauma, have been shown to display resources for functioning including satisfaction with their families, school and environment (Fazel, Reed, Panter-Brick, & Stein, 2012).

Given this background, the present study focused on life satisfaction, positive affect, negative affect and wellbeing, which we consider to be the most comprehensive and clearly defined constructs for describing children’s ability to adjust to war (Barber, 2009a, Barber, 2009b; Veronese, Castiglioni, & Said, 2010). Investigation has long been underway into the contribution of each of these constructs to overall quality of social and personal life (Strack, Argyle, & Schwarz, 1991). With regard to how they relate to one another, the work of Andrews and Withey (1976) established that life satisfaction (LS), positive affect (PA) and negative affect (NA) may be viewed as three distinct components making up subjective wellbeing (SWB).

Life satisfaction is defined as the individual’s cognitive appraisal of the quality of his or her life circumstances (Diener, 1984). Recent research has borne out the key role of life satisfaction in children’s and adolescents’ psychological wellbeing and ability to adjust to adversity (Gilman & Huebner 2003; Huebner, 2004; Leversen, Danielsen, Birkeland, & Samdal, 2012). Huebner (2004) examined two major conceptual frameworks for this construct, one of which views life satisfaction as unidimensional (global life satisfaction) and the other as multidimensional. The unidimensional framework assumes that a single total score can represent different levels of life satisfaction. In contrast, the multidimensional approach assesses satisfaction with a number of key life domains in order to build up overall profiles of life satisfaction. Huebner (2004) proposed evaluating five specific second-order domains under a general life-satisfaction umbrella: satisfaction with family, school, friends, self and living environment. In this regard, the present study conceptualized life satisfaction as an unidimensional construct, on the grounds that most of the existing research on life satisfaction has used unidimensional indicators, offering limited information about the subcomponents of life satisfaction in children (Park, Peterson, & Seligman, 2004). We advocate the idea that if the components of life satisfaction are not specifically under investigation, a unidimensional measure may be more useful in evaluating the effects of life satisfaction on other constructs. In fact, life satisfaction is a crucial component of mental health that is directly related to an array of psychological, behavioural, social, interpersonal, and intrapersonal outcomes.

Nonetheless, life satisfaction is only one dimension of the broader construct of subjective wellbeing (Diener, Suh, & Oishi, 1997): a positive affect balance (relatively more positive affect than negative affect) represents a second layer (Arthaud-Day, Rode, Mooney, & Near, 2005). Within affect balance, positive affect as the frequency with which positive emotions such as happiness or tenderness are experienced. On the contrary, negative affect is understood as the frequency of negative feelings such as sadness or anxiety. These two dimensions are independent, meaning that an increase in positive affect does not necessarily correspond to a decrease in NA (Watson & Tellegen, 1985). A recent study conducted in the Palestinian context (Veronese, Barola et al., 2012) found that positive emotions contribute to children’s wellbeing, acting as buffering factors in dealing with traumatic experiences (Johnson & Cronister, 2010). The children displayed a range of personal resources facilitated above all by the functioning community structure supporting them.

Research on subjective well-being has typically had to address uncertainty about what variables “cause” subjective well-being and, on the contrary, what variables may be viewed as consequences of it (Heady, Veenhoven, & Wearing, 1991). This debate is crucial given that one of the key aims of investigating wellness in the first place is to identify factors that can enhance people’s perceived quality of life. Subjective wellbeing has been studied from two different perspectives: the hedonic view is related to emotions and life satisfaction (Kahneman et al., 2003) and the eudaimonic view to self-fulfillment and purposeful engagement (Delle Fave, 2006). From the hedonic perspective, the assessment of subjective wellbeing should include both an emotional component and a cognitive component, or life satisfaction judgment (Diener, 2009).

Traditionally, studies of wellbeing (Diener, 1984) have followed one of two competing models: top-down and bottom-up. Bottom-up perspectives suggest that multiple (personal and environmental) variables contribute to determining an individual’s overall level of subjective wellbeing. From this perspective, subjective well-being is viewed as the ultimate outcome of a constellation of life circumstances. This approach assumes that people’s judgments about their lives are constructed following a “bottom-up” path: their assessments of life conditions across different domains feed into a final overall evaluation.

In contrast, top-down models propose that the variables often described as “causes” of subjective wellbeing should be viewed as correlates at most, and might even be defined as consequent on a certain level of subjective well-being. From a top-down perspective, therefore, subjective well-being is itself seen as “producing” certain outcomes. More specifically, people form their judgments via a “top-down” process: they first evaluate their general life satisfaction and then draw on this feeling when assessing specific life domains. It should be noted that, in both models, the notion of causality typically denotes lawlike certainty (Pearl, 2000), whereas, in the field of subjective wellbeing, it would be more appropriate to adopt the notion of “probability”, which leaves room for doubt and accommodates any potential lack of regularity.