Methods-Sample Using the population registry of the Ministry of Interior to ensure the best sample frame Large sample size- 904 mothers with at least one child between the ages of 2-6 205 Arab (22.7%) 699 Jewish (77.3%) 478 boys (52.9%) 426 girsl (47.1%) 1
Sample- Cont. Using a complex sampling methods: stratified by geographical areas (north, south, central Israel and Jerusalem); nationality (Jewish/Arab), religiosity level (secular, traditional, orthodox and ultra-orthodox), and socio-economic status. Within each stratum- cluster sampling Within each cluster- random sampling of mothers Random sampling of the child within the family 2
Challenges Given the escalation in south Israel: should we enlarge our sample size there? A terror attack occurred during data collection. Should we stop interviewing the day of the attack? Should we continue interviewing under fire or let things cool down a bit? 3
What are we asking? About the child Trauma history -TESI (Traumatic Events Screening Inventory) Exposure to political violence- Exposure Questionnaire specially designed for this study including media exposure Distress- Scheeringa- Post traumatic distress; CBCL- child's behavioral and emotional problems Regulatory ability - Emotional intensity Health status- Questionnaire specially designed for this study 4
Examples of items: Child aggressive behavior (sub-scale of Externalizing behavior CBCL) Your child: Destroys things belonging to his/her family or others Gets in many fights Physically attacks people Threatens people 5
Your child: Examples of items: Child: Anxious/Depress (sub-scale of Internalizing behavior CBCL) Cries a lot Unhappy, sad or depressed Too fearful or anxious Worries 6
What are we asking? Mother Trauma history and PTS- PDS- Post traumatic distress scale (including exposure) Stressors during pregnancy Depression- CES-D (Center for Epidemiological Studies Depression Scale) Emotional regulation- DERS (Difficulties in Emotion Regulation scale) Flexibility- PACT scale (Perceived ability to cope with trauma) Parental-child relationship- PARQ- Parental Acceptance-Rejection Questionnaire 7
Examples of items: Emotional regulation of the mother I experience my emotions as overwhelming and out of control When I m upset, I become out of control When I m upset, I take time to figure out what I m really feeling When I m upset, I have difficulty controlling my behaviors. 8
What else are we asking? Mother cont d Neighborhood safety- Questionnaire from the Israel bureau of statistics Community services utilization - Questionnaire specially designed for this study Needing and seeking help- Questionnaire specially designed for this study Social support- MOS- Medical outcomes study social support scale Demographics -Demographic Questionnaire
Preliminary findings
Children s Exposure to Trauma (in %)
Children who were Exposed to Trauma 50 49 48 47 46 45 48.95 46.01 49.43 46.34 48.31 45.67 50 49 48 47 46 45 44.99 44.08 46.28 44.98 44 44 43.26 43.16 43 43 42 41 42 41 Exposed no 40 Total Boys Girls Expose d no 40 Total Boys Girls
Children who were Exposed to Trauma 50 49 48 47 46 45 44 43 42 41 40 46.78 45.89 44.45 44.71 43.87 43.27 Total Boys Girls Exposed no
Mothers
Mothers Exposure to Trauma 80 70 60 61.1 (by %) Total Political violence 50 40 30 41 Physical/sexual/other trauma 20 10 5.9 12.5 8.6 5 4.8 0 Total Exposure Heard or felt the shrieking of falling missiles Someone who Left home during was very close to attack you was injured or killed Accident Physical assault Sexual assault
Mothers Posttraumatic Distress by % 30 25 25.5 20 15 10 8.1 15.5 Full PTSD Partial PTSD Depression- met criteria 5 0
Associations Between Maternal distress and child s distress (Spearman) Child s exposure Mothers symptom severity (PTSS) Mothers Depressive symptoms Child s aggressive symptoms.04.23***.10** Child s internalizing symptoms.13***.30***.26*** Child s externalizing symtoms.05.23***.11** Child s total symptoms.10**.28***.22***
Mothers report on needing help due to the political insecurity ( by %) 90 80 70 60 50 40 30 20 10 0 13.2 Yes 6.7 Maybe a little 80.1 No Need help
Needing help and mother s distress (Means) 14 13.26 12 11.14 10 9.88 8 6 4 6.75 Need help No need 2 0 PTS (Mean) Depression Mothers who need at least some help (19.9%) are more distressed
Needing help and child s distress (Means) 60 50 40 53.01 52.17 51.55 48.13 49.16 45.87 43.48 43.5 30 20 Mother need help No need 10 0 Aggressive symptoms Internalizing Externalizing Total Problems Children of Mothers who need at least some help (19.9%) are more symptomatic
Summary Young children are not shielded from traumatic experiences Preliminary indications show that children s higher exposure is associated with greater emotional and behavioral symptoms Mothers distress is even more highly associated with child s emotional and behavioral symptoms Mothers call for help is associated not only with their own distress but with their children's distress Listen to the mothers!
Bridging Research and Practice: What will we gain from this study? Research informed practice Identify populations at risk for increased emotioanl and behavioral symptoms due to political trauma Identify protective factors which will lead the way to developing effective interventions for parents and children It will Inform policy makers regarding planning and tailoring appropriate cultural sensitive interventions and services Create a benchmark for evaluating future program and services for pre-school children and their mothers aimed at reducing violence 22
Thank you! Michal Achituv and Raana Assed Atoosa Khodabakhsh Dr. Anat Oren from Cohen Institute Yuval Ziv 23