Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors

Raija Leena Punamäki*, Esa Palosaari, Marwan Diab, Kirsi Peltonen, Samir R. Qouta

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

56 Citations (Scopus)


Objective Research shows great individual variation in changes in posttraumatic stress symptoms (PTSSs) after major traumas of terrorist attacks, military combat, and natural disasters. Earlier studies have identified specific mental health trajectories both in children and adults. This study aimed, first, to identify potential PTSS-related trajectories by using latent class growth analyses among children in a three-wave assessment after the 2008/2009 War on Gaza, Palestine. Second, it analyzed how family- and child related factors (e.g., attachment relations, posttraumatic cognitions (PTCs), guilt, and emotion regulation) associate with the trajectory class membership. 2014 Elsevier B.V. All rights reserved.

Methods The sample consisted of 240 Palestinian children (49.4% girls and 50.6% boys) of 10-13 years of age (M=11.29, SD=0.68), who completed PTSS (CRIES) assessments at 3 (T1), 5 (T2), and 11 (T3) months after the war. Children reported their personal exposure to war trauma, attachment style, cognitive trauma processing, and emotion regulation, and their parents reported family war trauma exposure and attachment style.

Results Results revealed a three-trajectory solution, a majority of children belonging to the Recovery trajectory (n=183), and a minority belonged either to Resistant trajectory (n=29) or to Increasing symptoms trajectory (n=28). Low levels of negative posttraumatic cognitive appraisals, feelings of guilt and emotion regulation were characteristic of children in the Resistant trajectory as compared to Increasing symptoms trajectory. Father's attachment security was further associated with the Resistant trajectory membership. Children's attachment avoidance and high parental trauma were typical to children in Recovery trajectory (as compared to the Increasing symptoms trajectory).

Original languageEnglish
Pages (from-to)133-140
Number of pages8
JournalJournal of Affective Disorders
Early online date12 Nov 2014
Publication statusPublished - Feb 2015
MoE publication typeA1 Journal article-refereed


  • Children
  • Palestinian
  • Posttraumatic stress symptoms (PTSSs)
  • Trajectories
  • War


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