title: Trajectories of posttraumatic stress symptoms (PTSS) after major war among Palestinian children: Trauma, family- and child-related predictors.
abstract: 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.
  
  
  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).
authors.affiliation: University of Tampere, Finland. Electronic address: Raija-leena.punamaki@uta.fi.
authors.forename: Raija-Leena
authors.initials: RL
authors.lastname: Punamäki
authors.affiliation: University of Tampere, Finland; Aalto University, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Palosaari
authors.affiliation: University of Tampere, Finland; Gaza Community Mental Health Programme, Gaza, Palestine.
authors.forename: Marwan
authors.initials: M
authors.lastname: Diab
authors.affiliation: University of Tampere, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Peltonen
authors.affiliation: Islamic University of Gaza, Palestine.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Qouta
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003071:Cognition; D005190:Family; D005220:Fathers / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D011237:Predictive Value of Tests; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology*; D000067453:War Exposure; D014857:Warfare
keywords: Children; Palestinian; Posttraumatic stress symptoms (PTSSs); Trajectories; War