Stress Reactions and Coping Resources Mobilized by Children under Shelling and Evacuation

The Australasian Journal of Disaster
and Trauma Studies
ISSN:  1174-4707
Volume : 2004-2

Stress Reactions and Coping Resources
Mobilized by Children under Shelling and Evacuation

Dr. Miri Shacham Ort Braude College, Karmiel, Israel

Prof. Mooli Lahad Community Stress Prevention Centre, Tel-Hai College, Kiryat Shmona, Israel

Abstract

Stress Reactions and Coping Resources
Mobilized by Children under Shelling and Evacuation

Introduction

Evacuation of civilian population is not an unusual phenomenon. However the opportunity to study in vivo what are the reactions of the evacuees and how did they coped immediately and in a follow up study is rather scarce.

The research was conducted when hostilities broke out in the north of Israel lasting seventeen days and leading to mass evacuation. Hundreds of missiles fell on the settlements; about 150 houses were hit and fifty four residents were injured.
As a result of military forecast that retaliation will end up with massive bombardment of the area, a short term evacuation of residents to safer places was decided upon. This research studied the effect of exposure to shelling prior to the evacuation and the effect of evacuation on children in real time, during their stay in an evacuation center.

The study evaluates the impact of shelling and evacuation as well as the impact of age and gender on stress reactions, coping resources and future preferences of the children. The heart of this study was based on Lahad`s Model of Coping and Resiliency that suggests that every person has internal powers - coping resources - which he or she can mobilize in stressful situations. This approach perceives the efforts to survive and cope with the complex situation from a health rather than the pathological approach. Our basic assumption is that stress reactions are normal reactions to an abnormal situation. Thus, the focus of this study is on the following questions: What helps children cope with war situations, shelling and evacuation, and how does it affect their future preferences.

The research examined these questions while using this Model (the "BASIC PH") for understanding the individual's mental strength in stressful situations, which was developed in Israel by Lahad (1993; 2000). The "BASIC PH" model is based on the Applied Psychology Approach, developed over 22 years of studies, observations and interviews with variety of population world wide who live under the shadow of constant threat to their lives (Ayalon& Lahad & Cohen 1999, 2000, Shacham & Lahad et al 2000, Lahad & Niv, 2000). It relates to six major coping modalities at the core of an individual’s coping style: Beliefs and Values, Affect, Social, Imagination, Cognition and Physiology.

Exposure to stressful situations – both natural and man-made – enhances four types of stress reactions according to Mitchell, 1986: Emotional, Cognitive, Behavioral, and Physiological immediately after the disaster and in the period to follow (Pynoos et. al. 1987; Hobfoll et. al. 1991; Bat-Zion & Levy-Shiff 1993; Levynson et. al. 1994; Wisenberg et. al. 1994; Niv, 1997; Pfefferbaum, 1997). Trauma response usually correlates with exposure, measured by both physical and emotional proximity to the threat ((McFarlane 1987; Chimietny & Alunasr 1993; Vogel & Verenberg, 1993; Shacham & Lahad, 2000).

There is a wide and consistent body of research indicating that females exhibit higher levels of distress than male in relation to stressful situations (Kessler & McLeod, 1984; Witkin-Lanoil, 1989; Farhood et. al 1993, Landau, Beit Hallachmi and Levy, 1997; Niv, 1996; Pfefferbaum, 1997; Awaldh et. al. 1998). Researchers do not agree as to the question whether male and female differ in reports of stress reactions or in feelings? This question was examined in our research in real time during shelling and evacuation.

As for the effect of age on stress reactions and coping, there is a discrepancy in the literature regarding the question whether there is a positive or negative correlation between age and stress reactions (Lahad, 1993; Vogel & Vernberg, 1993; Klingman, Sagi & Raviv, 1993). This contradiction in the findings of numerous studies led us to a rather new assumption, which had not been assessed in previous studies. Our new assumption was that the correlation between age and stress reactions is not linear but rather a "bell shaped phenomenon", and that one must distinguish three childhood periods: young childhood (up to age 9), pre-adolescence (9 – 12) and adolescence (12+).

Examining the physiological, emotional, cognitive and behavioural characteristics of each age group, led to the assumption that: at a very young age, characterized by children being close to their parents at all times, and a strong family support, the level of stress reactions is rather low. The pre-adolescent age, which is the transition between childhood and adolescence is characterised by the child not being so physically close to the parents, but still not independent or experienced enough to have a variety of sufficiently developed coping resources, as the cognitive mechanisms are not fully developed. That is why at this age, there will be an increase of stress reactions. Adolescence is characterised by having previous experience and cognitive development, which enable adolescents to assess the situation and mobilize active resources in order to cope. That is why at this age, there will be a decrease in the level of stress reactions.

Method

Participants
The participants were 102 children evacuated from their shelled town: 37 (36.3%) boys and 65 (63.7%) girls. The average age of the children in the sample is 12.9 years (Standard deviation = 2.5 years, mean =13 years). The youngest is 7 years old, and the oldest is 19 years old.

Design and Methodology
The research design stemmed from the rare opportunity to obtain data in real time, from the will to understand the issue of coping and resiliency and from the belief that it is important to learn from the children themselves what their stress reactions were and what helps them cope. For this reason it was decided to use self-report measures of stress reactions and coping resources.

The research tools were structured individual interviews with open-ended questions devised by the researcher with the staff of the Community Stress Prevention Centre in Israel. (Note: The Community Stress Prevention Center is the oldest and most established field center studying and developing methods to enhance coping of individuals groups and communities.) The first question related to the proximity to the threat – the time the child spent in the bombed area and the details of the evacuation – with or without the family. Coping resources were measured according to the "BASIC PH" Coping and Resiliency Model, by asking the children to describe what helped them cope with the situation. The children were also asked to grade the extent to which they mobilized each coping resource on a scale of 1 (helped very little) to 4 (helped the most). In order to analyse the respondents’ answers to the open-ended questions and overcome reliability problems, the answers were submitted to three "expert judges", psychologists from the emergency team, to be analysed according to the "BASIC PH" model. After the three judges analysed the data and reached a consensus, the analysis was registered as a basis for the database of this research.

Stress Reactions were tested by asking the children to describe unusual things they had experienced. The children stated the extent to which these stress reactions bothered them. Future preferences were tested by asking about the child’s preference regarding the future need of evacuation and the wish to live in a safer place following the shelling (leaving their hometown for good).

Procedure
Interviews with the children were conducted in the last week of their stay in the evacuation center. The researcher conducted the interviews with each child separately. The children were guaranteed confidentiality, anonymity and that the findings would serve only for research purposes.

Results

A. Stress Reactions

Stress Reactions -Examples of children's answers :

Gender and Stress Reactions

Table 1 and Figure 1 present stress reactions according to gender.

Table 1: Comparison of boys’ and girls’ stress reactions – mean, standard deviation and t values.

t	Boys (N=37)		Girls (N=65)		Stress Reaction
	S.D.	Mean	S.D.	Mean
-0.71	1.60	2.35	2.22	2.62	Physiological
-3.48**	1.74	2.27	2.95	4.12	Emotional
-2.04*	2.01	2.21	3.05	3.25	Cognitive
-1.15	1.48	1.27	1.84	1.65	Behavioral

* P <0.05    ** P<0.01

Table 1 and Figure 1 reveal that girls report more stress reactions (for all types of reactions) than boys. Themost significant difference between boys and girls is in Emotionaland Cognitive stress reactions.

Age and Stress Reactions

In order to examine the new hypothesis, the children were divided into three age groups: up to 9 years old; 9 – 12 years old and 12+ years old. Figure 2 presents stress reactions in the various age groups.

From this figure, it seems that "bell shaped" phenomenon exists for Behavioral, Emotional and Physiological stress reactions: a rather low intensity of stress reactions in the youngest age group (6 – 9 ), a rise in the intensity of stress reactions among the middle group (9 –12), a decrease in stress reactions among adolescents (12 – 18).
ANOVA of stress reactions in the three age groups revealed that the "bell shape" tendency was found to be significant for Physiological stress reactions only (F=3.88, P<. 05).

Proximity to the Threat and Stress Reactions

Table 2 presents stress reactions according to the distance from the family at the time of the evacuation.

Table 2: Mean, Standard Deviation and Z values of stress reactions
according to distance from the family (N=102)

Z	Evacuation with the family (N=88)		Evacuation without the family (N=88)		Stress Reaction
	S.D.	Mean	S.D.	Mean
-.74	2.37	2.35	1.96	2.55	Physiological
-2.16*	1.41	2.00	2.81	3.67	Emotional
-2.17*	1.90	1.71	2.83	3.05	Cognitive
-.79	1.60	1.43	1.76	1.53	Behavioral

* p<.05

Table 2 reveals that children evacuated without their families reported more Emotional and Cognitive stress reactions than children evacuated with their families.

Figure 3 reveals that:
A. The most common resource is the Social resource (S).
B. A significant mobilising of Cognition (C) and Physiological (PH) resources were found, but to a lesser extent.
C. The resource that the children hardly ever reported is the Beliefs and Values (B) resource.

Gender and Coping Resources

Table 3: Comparison between boys and girls regarding coping resources.
(Means, Standard Deviations, t values N=102)

Table 3 reveals that:
1. Girls mobilize the Affect (A) resource and the Social (S) one more than boys. The difference yielded significance only for the Affect (A) coping resource.
2. Boys mobilize the Physiological (PH), the Imagination (I) and the Cognition (C) resources more than girls, but the difference between boys and girls is insignificant.

Age and Coping Resources The results were assessed according to the three age groups (under 9 years old, 9 – 12, from 12+ years old). No significant correlation was found between age and mobilizing coping resources.

C. Future Preferences

Gender and Future Preferences

In order to test the difference between boys and girls regarding their future preferences χ2 tests were carried out.
The main difference was found between boys and girls in the wish for the family to move to live in a safer place following the shelling and evacuation: boys prefer to move to a safer place more than girls (χ2=8.21, P<. 05).

Age and Future Preferences
In order to test these correlations between age and future preferences, correlation coefficients between age and future preferences were calculated and are presented in Table 4.

Table 4: The correlation between age and future preferences (N=102)

Correlation to age	Future preference
.244*	Wishing to stay at in the home town in case of a future emergency
-.199*	Preferring to stay with the family in a future emergency
-.263*	Wishing to move to live in a safer place

* P<.05

Table 4 reveals that younger children prefer to stay with their families in a similar future emergency and they prefer to move to live in a safer place. Older children prefer to stay in their hometown, in a similar future emergency. The results were also tested according to gender.

Figure 4 reveals that boys of all age groups express a stronger desire than girls to move to live in a safer place. ANOVA analysis of future preferences by gender with age revealed that both age (F=8.81, P<. 01) and gender (F=10.74, P<. 001) contribute to the effect.

In conclusion, boys prefer more than girls to change their living place and move to live in a safer place. This preference is higher with the younger children (age <9) and it decreases - both for boys and girls - in the older age groups.

Proximity to Threat and Future Preferences

Table 5: Comparison of children who were evacuated without their families
and those evacuated with their families regarding future preferences (N=102; Z values)

χ2	Evacuation with the family	Evacuation without the family		Future Preferences
-0.06	13 14.0	80 86.0	No	Staying in the home town
	1 11.1	.8 88.9	Yes
-8.56 **	8 30.8	18 69.2	No	Staying with the family
	6 7.9	70 92.1	Yes
4.14	3 7.7	36 92.3	Not at all	Moving to stay in a safe place
	1 10.0	9 90.0	No
	3 33.3	6 66.7	Yes
	7 15.9	37 84.1	Very much

** P < .01

Table 5 teaches us that children who were separated from their families in the evacuation prefer to stay with their families in case of a future emergency, more than children who were evacuated with their families.

Discussion

This research provided a rare opportunity to investigate children reactions and coping whilst they were staying in an organized evacuation centre, while their town was being shelled. Unlike other places in the world, in Israel children are repetitively exposed to terrorists' acts. This constant exposure to terror, does not correspond with many disaster research axiom that the end of the event is clear, and if an event reoccurs, its boundaries are clear (for example, a hurricane zone). Therefore, it is clear that our research population is not "free" of prior experience. At the same time based on the prevailing assumption in the world today is that knowledge of natural disaster is not to be immediately applied to terror acts this study helps to shed light on the particular incident that is so unstudied.

"Much of what is used to determine how individuals and communities may react to terrorism is derived from broader trauma literature, including that which examines disasters. Although there may be some similarities between other types of disasters and terrorism, the malicious intent and unpredictable nature of terrorism may carry a particularly devastating impact for those directly or indirectly affected." (IQM Report, 2003: 4)

Gender Differences in Stress Reactions, Coping Resources and Future Preferences

This study found that girls report more stress reactions than boys for all kinds of tested stress reactions: Emotional, Physiological, Behavioural and Cognitive. The difference is significant for the Emotional and Cognitive stress reactions.
A significant interesting gender difference was found in the desire to leave and to move to a safer place: boys report more desire to move to a safer place than do girls. This finding is contrary to the expectations, as boys manifest less stress reactions than girls.

The explanation seems to lie in the fact that feelings of stress and anxiety are the same for boys and girls whose town under constant enemy shelling, but girls seem to express their fears more frankly, and report stress reactions such as pains, worrying thoughts, fears and stressed behaviour openly (Witkin-Lanoil, 1989; Diamant, 1994; Landau et. al. 1998).

Girls need less acting-out. Boys do not admit their stress reactions openly, and they are looking for more practical solutions. Perhaps this is their legitimate way of saying "I want to move to another place" instead of "I am scared".

These findings regarding stress reactions and gender differences might support, in our opinion, the assumption that these differences found between boys and girls are the result of different ways of expressing feelings, but do not necessarily reflect true differences in real inward feelings of anxiety.

It is possible that these differences derive from the differences in social messages typical of the state of Israel, where society suggests "Macho" norm that is: men fight, women stay behind waiting for the men. Men find it difficult to admit that they have fears. Children might internalise reactions according to these messages.

Girls mobilized the Affect (A) and Social (S) coping resources more than boys. This finding reaffirmed the findings of previous studies assessing coping resources according to the "BASIC PH" model (Shacham & Lahad, 1996; Niv & Lahad, 1996). Boys had a nearly significant tendency (p<. 06) to mobilize the Imagination (I) resource more than girls, and they had a tendency, though insignificant to mobilize the Cognitive (C) and Physiological (PH) coping resources more.

The Impact of Age on Stress Reactions, Coping Resources and Future Preferences

The novel assumption in this research was that correlation between age and stress reactions is not linear, but rather a "bell shaped phenomenon", and that one must distinguish three childhood periods: young childhood (up to age 9), the pre-adolescent age (9 – 12) and adolescence (12+).

It was found that the "bell-shaped phenomenon" exists with the correlation between age and Emotional, Physiological and Behavioural stress reactions. With both boys and girls there is the "bell shaped phenomenon" tendency with the Physiological stress reactions. That is to say that at the age group 6 – 9 there is a low level of Physiological stress reactions, which increases at the 9 – 12 age group, and decreases at adolescence.

No correlation was found between children’s age and the mobilization of coping resources. This finding is in accordance with the Lahad's findings(1984) suggesting there is no difference between younger and older children as far as mobilizing coping resources is concerned.

As for future preferences, findings confirm that the younger the child, the more he or she prefers to stay with the family in a similar future emergency. The older the child, he or she expresses more desire to stay in his/her hometown during a future similar emergency. Moreover, it was found that the younger the child, the stronger the desire to leave the hometown altogether and move to live in a safer place. This will is extremely strong with the 6 – 9 age group, and it decreases in the older age groups (9 – 12 and 12+). This finding contradicts the fact that the anxiety level found in this study increases at the 9 – 12 age group, and decreases only at the 12+ ages.

The contradiction may be explained by assuming that very young children are more open in reporting their preferences to move to live in a safer place, while those of the 9 – 12 age groups and the adolescents are more inhibited thus expressing attitudes which suit the adults around them and the myth of having to stay in their home town despite the danger (Malkinson, Robin & Witztum, 1993). Part of it may be attributed to the direct interview method, which may have enhanced the "demand characteristics phenomenon"(Orne, 1962). Orne believes that participants are very willing to give researchers whatever results the researchers want that it is possible that the adolescents in this study thought that what they said was what the interviewer wanted to hear.

We also assume that for pre adolescents and adolescents the meaning of leaving hometown is parting from their friends, a very important aspect of their life at this developmental stage. And so they are "willing" to pay the price of staying in their town and not missing their peers.

The Effect of Physical and Emotional Proximity to the Threat on Stress Reactions

The findings support the hypothesis that geographical and emotional proximity to the threat of shelling and evacuation enhanced children’s stress reactions: children evacuated without their families reported more stress reactions of all kinds (Emotional, Cognitive, Physiological and Behavioural) than children evacuated with their families. The difference was significant for the Emotional (Fears, sadness, anger etc.) and Cognitive stress reactions (Negative thoughts, confusion, distressing dreams etc.); i.e.. it was realised that evacuation without parents intensified children's fear, worries and negative thoughts.

An interesting finding was that children evacuated without their families expressed a clear preference to remain with their families in a similar future emergency, even if this meant staying in the bombed area, a finding that corresponds with Shacham & Lahad (1996). In our study it may suggest that although children evacuated without their families reported more Emotional and Cognitive stress reactions, they still prefer to stay with their families, even under shelling.

A possible explanation is that children prefer the psychological confidence they get by being close to their parents, and they want to share their "destiny" with their loved ones. They do not prefer being evacuated without their families, which removes the danger, but also removes them from their families and friends.

The finding that evacuation of children without their family enhances stress reactions, although physically removed from the danger, is in accordance with the findings of Freud and Burlingham (1943), Ressler (1992) Shacham & Lahad (1996) and others.

The practical conclusion drawn from this finding reaffirms UNICEF’s recommendations (1992: 29) to prefer the evacuation of children with their families, and if that is not possible, it might be advisable to keep the children near their close families and not send them away.

As much as one would be hesitant in generalizing from a single research we believe that with the world growing concern of the impact of terrorism and wars on civilians the research findings do shed light on this under researched topic. Recent research indicate that the children who were evacuated from lower Manhattan area following the WTC disaster in September 2001 are still manifesting post traumatic symptoms. Stith, A. (2003) . It is therefore of great importance that more specific studies of the short and long term effects of evacuation be made mainly to inform and enlighten decision makers of the needed services and for professionals to be better informed of the best practice to support these children and their families.

References

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