PTSD and Risk Factors Facing Palestinian Teenage Girls Dr. Rasmya Hannoun Professor of Clinical Psychology An-Najah National University West Bank, Palestine

Post Traumatic Stress Disorder PTSD Definition: Mental disorder that can develop after a person is exposed to a traumatic event.

According the World health Organization, the PTSD world rates were between 0.5- 1%. In war-torn areas such as the Middle East countries, however, these rates are higher. One estimate suggests that children and adolescents having PTSD in developed countries may be 1% as opposed to 1.5-3% of adults.

It’s usually not possible or easy to know why one person develops PTSD and another doesn’t. Research has shown that certain risk factors may increase a person’s chances of developing PTSD.

There are factors that are linked to lower risk of PTSD called protective risk factors or protection factors. A risk factor : refers to anything that increases a person’s chance of developing PTSD . Risk factors are some of them can be avoided but others can’t because they are beyond control of the person.

Risk Factors Facing Palestinian Adolescents Poor social services and educational system. Poverty and impaired nutrition. Restricted access to health care. Home demolition. Political violence.

Common symptoms of PSTD Nightmares. Flashbacks, severe anxiety. Somatoform disorders. Uncontrollable fear thoughts about the event.

Participants and Procedures: The final sample comprised 522 teen age girls:12-18. The study sample was drawn randomly from schools in Palestinian refugee camps , villages and towns in the northern West Bank. The researchers developed a 51-item questionnaire distributed among six domains: occupation violence, poverty, community violence, social phobia, poor school achievement and family neglect.

In addition to questionnaire we conducted two interviews with PTSD victims. Example of case study:

Result and Discussion

Total score for study domains Table 1: Arithmetic means, standard deviation and percentages for study domains and total score. Level % S.D. Average Domain High 50.8 0.64 2.54 Occupation violence 1 Low 36.2 0.62 1.81 Community violence 2 48.2 0.96 2.41 poverty 3 45.2 0.88 2.26 Poor school achievement 4 Very low 27.0 0.48 1.35 Family neglect 5 43.0 0.72 2.15 Social phobia 6 42.0 0.54 2.10 Total score for study domains

Trauma is tied to several risk factors The most significant risk factor was the violence of the occupation while the lowest significant risk factor was family neglect , as Palestinian parents overprotect their female daughters .

female teens which could be attributed to place of living. Table (2)of One-way. Anova to test significant differences in PTSD domains among female teens which could be attributed to place of living. =0.05 F.value Average of squares Degrees of freedom Total squares Source of variance Domain 0.810   0.211 0.088 2 0.176 Between groups Occupation violence 0.416 519 216.138 Within groups 521 216.314 Total 0.227 1.488 0.570 1.140 Community violence 0.383 198.758 198.898 0.0001 21.556 18.232 36.463 Poverty 0.846 438.950 475.413 32.992 22.927 45.854 Poor school achievement    0.695 360.668 406.522 0.002 6.553 1.450 2.900 Between groups Family neglect 0.221 114.839 117.739 12.856 6.428 Social phobia 0.500 259.507 272.364 13.174 3.660 7.321 Total score 0.278 144.201 151.522

In the refugee camps ,the most significant factors were poverty , Poor school achievement, family neglect, social phobia and the least significant were occupation violence and community violence this could attributed to over crowdedness in camps ,and lack of privacy ,lacked of governmental facilities ,overcrowded classes

Poor school achievement Table 3 : Independent t-test for two independent groups to test significant differences between averages of PTSD risk factors according to age variable. Significant level Computed 16-18 N=200 13-15 N=300 Domain SD Mean 0.025 2.246 0.65 2.38 0.54 2.51 Occupation violence 0.055 1.920 0.60 1.75 0.63 1.85 Community violence 0.529 0.631 0.97 2.44 0.94 2.39 Poverty 0.870 0.164- 0.89 2.26 0.88 2.27 Poor school achievement    0.026 2.238 0.44 1.30 0.50 1.39 Family neglect 0.876 0.156 0.71 2.14 0.74 2.15 Social phobia 0.266 1.114 0.53  2.07 0.55 2.12 Total score

Occupation violence and family neglect were found to be the most significant risk factors among age group 13-15 the others were the least significant ,this is due to the feeling of insecurity ,and lack of attention from family

Table 4 : Results of One Way Anova to test significance of differences in PTSD risk domains among female teens according to school grade Level of significance Value F Average of squences Freedom score Total squares Source of variance Domain 0.502 0.869 0.361 5 1.806 Between groups Occupation violence 0.416 516 214.508 Within groups   521 216.314 Total 0.542 0.810 0.312 1.558 Community violence 0.384 198.341 199.898 0.220 1.408 1.280 6.399 Poverty 0.909 469.014 475.413 *0.007 3.259 2.489 12.445 Poor school Achievement 0.764 394.077 406.522

Poor school performance was found to be the most significant risk factor among 11th and 12th grades as school class get higher girls start worrying about their future .They become more serious and mature.

Recommendations To set up support programs and resilience training courses for girls . To hold workshops for their families on PTSD and strategies to use to provide protection to their daughters.

Training counsellors on cognitive, behavioural and counselling program by organizing courses and workshops in order to develop their performance and abilities on reducing the effects of trauma on adolescent girls. There must be specialized centres and specialized people to treat adolescents who are suffering from the effects of post-traumatic stress on north region.

Activating the role of the family doctor and psycho-social worker in hospitals and clinics to detect the problems at the beginning and properly diagnose and treat .