title: Mental Suffering in Protracted Political Conflict: Feeling Broken or Destroyed.
abstract: OBJECTIVE
  This mixed-methods exploratory study identified and then developed and validated a quantitative measure of a new construct of mental suffering in the occupied Palestinian territory: feeling broken or destroyed.
  
  
  METHODS
  Group interviews were conducted in 2011 with 68 Palestinians, most aged 30-40, in the West Bank, East Jerusalem, and the Gaza Strip to discern local definitions of functioning. Interview participants articulated of a type of suffering not captured in existing mental health instruments used in regions of political conflict. In contrast to the specific difficulties measured by depression and PTSD (sleep, appetite, energy, flashbacks, avoidance, etc.), participants elaborated a more existential form of mental suffering: feeling that one's spirit, morale and/or future was broken or destroyed, and emotional and psychological exhaustion. Participants articulated these feelings when describing the rigors of the political and economic contexts in which they live. We wrote survey items to capture these sentiments and administered these items-along with standard survey measures of mental health-to a representative sample of 1,778 32-43 year olds in the occupied Palestinian territory. The same survey questions also were administered to a representative subsample (n = 508) six months earlier, providing repeated measures of the construct.
  
  
  RESULTS
  Across samples and time, the feeling broken or destroyed scale: 1) comprised a separate factor in exploratory factor analyses, 2) had high inter-item consistency, 3) was reported by both genders and in all regions, 4) showed discriminate validity via moderate correlations with measures of feelings of depression and trauma-related stress, and 5) was more commonly experienced than either feelings of depression or trauma-related stress.
  
  
  CONCLUSIONS
  Feeling broken or destroyed can be reliably measured and distinguished from conventional measures of mental health. Such locally grounded and contextualized measures should be identified and included in assessments of the full impact of protracted political conflict on functioning.
authors.affiliation: University of Tennessee, Knoxville, Tennessee, United States of America.|New America, Washington, DC, United States of America.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Barber
authors.affiliation: University of Tennessee, Knoxville, Tennessee, United States of America.
authors.forename: Clea A
authors.initials: CA
authors.lastname: McNeely
authors.affiliation: Gaza Community Mental Health Programme, Gaza Strip, Palestine.
authors.forename: Eyad
authors.initials: E
authors.lastname: El Sarraj
authors.affiliation: Independent Consultant, Gaza Strip, Palestine.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Daher
authors.affiliation: Birzeit University, Birzeit, West Bank, Palestine.
authors.forename: Rita
authors.initials: R
authors.lastname: Giacaman
authors.affiliation: Save the Children Foundation, Ramallah, West Bank, Palestine.
authors.forename: Cairo
authors.initials: C
authors.lastname: Arafat
authors.affiliation: Georgetown University, Washington, DC, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Barnes
authors.affiliation: Al-Qattan Foundation, Gaza Strip, Palestine.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Abu Mallouh
mesh_terms: D000328:Adult; D018912:Arabs / Q000523:psychology; D000068337:Armed Conflicts / Q000523:psychology; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011057:Politics; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology; D055815:Young Adult