Effect of chronic exposure to humiliation on wellbeing in the occupied Palestinian territory: an event-history analysis

Background Investigation of the long-term effects of political violence is needed. Patterns of past exposure to political violence since the first intifada were identified in a large sample of adults in the occupied Palestinian territory (oPt) and assessed for associations with current adult functioning. Methods In 2011, fieldworkers from the Palestinian Center for Policy and Survey Research, Ramallah, West Bank, oPt, undertook household interviews in Arabic of a representative sample of 1800 individuals (aged 30–40 years; 50% men) in the oPt. The interviews consisted of a culturally-grounded inventory of current wellbeing or quality of life along with an event-history calendar, which through its design and mode of administration has been shown to enhance memory. For every year from 1987 to 2011, participants indicated the degree from 0 (never) to 3 (frequently) to which they had been shot at, hit or kicked, verbally abused, saw other individuals humiliated, and had their homes raided. Latent profile (MPlus, version 7.0) and general linear regression analyses (SPSS, 21.0) were used for the statistical analyses. All participants provided written informed consent. The Palestinian Center for Policy and Survey Research and the University of Tennessee, Knoxville, TN, USA, provided institutional review board approval for the study. Findings Data were evaluable for 1758 people. For analyses, yearly scores for violence exposure were averaged within four periods: first intifada, Oslo period, second intifada, and post-second intifada. For men, there were three patterns of past exposure to political violence: 519 (60%) of 872 men reported moderate exposure during the first and second intifadas and very little or no exposure between the intifadas and after the second intifada (group 1); 250 (29%) had the same periodic pattern but with higher exposure during the intifadas (group 2) than did group 1; and 103 (12%) indicated chronic exposure to humiliation (verbal abuse and observing others being humiliated) for all the periods (group 3). For women, there were two patterns of exposure: 745 (84%) of 886 women had the same pattern of low, periodic exposure as did the men in group 1; and 141 (16%) reported high exposure to observing others being humiliated for all the periods, similar to that reported by the men in group 3. Results from the general linear regression models showed that chronically humiliated men and women, compared with other patterns of exposure, had less access to basic resources; higher insecurity or fear; higher feelings of depression; higher feelings of being broken or destroyed; higher trauma-related stress; higher community belonging; and higher marital quality. Chronically humiliated women also reported less personal freedom and poorer health. Post-hoc analyses showed that most of the chronically humiliated participants (85 [83%] of 103 men and 93 [66%] of 141 women) were living in distinct neighbourhoods in East Jerusalem and Hebron—two oPt cities that have a particularly strong presence of Israeli forces, and have frequent and several constraints (including checkpoints and barriers) on the Palestinian population's mobility. Interpretation The results of this study show that, methodologically, the assessment of the patterns of exposure over time (instead of commonly aggregating exposure) is a useful way to capture the long-term effect of political violence exposure. Substantively, they show the particular risks to long-term wellbeing of individuals with chronic exposure to humiliation. Funding Jacobs Foundation, Zurich, Switzerland.