OBJECTIVES: To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. STUDY DESIGN: A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. METHODS: Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. RESULTS: There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to humiliation. CONCLUSIONS: The results of this study demonstrate that humiliation induced by conflict and war-like conditions constitutes an independent traumatic event that is associated with negative health outcomes in its own right, regardless of exposure to other violent/traumatic events. Based on these findings, it is proposed that humiliation should be included as an indicator of mental health status in research that investigates the consequences of war and conflict on the health of populations.
OBJECTIVES: To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. STUDY DESIGN: A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. METHODS: Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. RESULTS: There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to humiliation. CONCLUSIONS: The results of this study demonstrate that humiliation induced by conflict and war-like conditions constitutes an independent traumatic event that is associated with negative health outcomes in its own right, regardless of exposure to other violent/traumatic events. Based on these findings, it is proposed that humiliation should be included as an indicator of mental health status in research that investigates the consequences of war and conflict on the health of populations.
Authors: Brian K Barber; Clea A McNeely; Eyad El Sarraj; Mahmoud Daher; Rita Giacaman; Cairo Arafat; William Barnes; Mohammed Abu Mallouh Journal: PLoS One Date: 2016-05-27 Impact factor: 3.240
Authors: Raghid Charara; Mohammad Forouzanfar; Mohsen Naghavi; Maziar Moradi-Lakeh; Ashkan Afshin; Theo Vos; Farah Daoud; Haidong Wang; Charbel El Bcheraoui; Ibrahim Khalil; Randah R Hamadeh; Ardeshir Khosravi; Vafa Rahimi-Movaghar; Yousef Khader; Nawal Al-Hamad; Carla Makhlouf Obermeyer; Anwar Rafay; Rana Asghar; Saleem M Rana; Amira Shaheen; Niveen M E Abu-Rmeileh; Abdullatif Husseini; Laith J Abu-Raddad; Tawfik Khoja; Zulfa A Al Rayess; Fadia S AlBuhairan; Mohamed Hsairi; Mahmoud A Alomari; Raghib Ali; Gholamreza Roshandel; Abdullah Sulieman Terkawi; Samer Hamidi; Amany H Refaat; Ronny Westerman; Aliasghar Ahmad Kiadaliri; Ali S Akanda; Syed Danish Ali; Umar Bacha; Alaa Badawi; Shahrzad Bazargan-Hejazi; Imad A D Faghmous; Seyed-Mohammad Fereshtehnejad; Florian Fischer; Jost B Jonas; Barthelemy Kuate Defo; Alem Mehari; Saad B Omer; Farshad Pourmalek; Olalekan A Uthman; Ali A Mokdad; Fadi T Maalouf; Foad Abd-Allah; Nadia Akseer; Dinesh Arya; Rohan Borschmann; Alexandra Brazinova; Traolach S Brugha; Ferrán Catalá-López; Louisa Degenhardt; Alize Ferrari; Josep Maria Haro; Masako Horino; John C Hornberger; Hsiang Huang; Christian Kieling; Daniel Kim; Yunjin Kim; Ann Kristin Knudsen; Philip B Mitchell; George Patton; Rajesh Sagar; Maheswar Satpathy; Kim Savuon; Soraya Seedat; Ivy Shiue; Jens Christoffer Skogen; Dan J Stein; Karen M Tabb; Harvey A Whiteford; Paul Yip; Naohiro Yonemoto; Christopher J L Murray; Ali H Mokdad Journal: PLoS One Date: 2017-01-17 Impact factor: 3.240
Authors: Ona L McCarthy; Ola Wazwaz; Iman Jado; Baptiste Leurent; Phil Edwards; Samia Adada; Amina Stavridis; Caroline Free Journal: Trials Date: 2017-10-03 Impact factor: 2.279