Giacaman Rita, Abu-Rmeileh Niveen M E, Husseini Abdullatif, Saab Hana, Boyce William
Institute of Community and Public Health, Birzeit University, Box 154, Ramallah, West Bank, Occupied Palestinian Territory.
Public Health. 2007 Aug;121(8):563-71; discussion 572-7. doi: 10.1016/j.puhe.2006.10.021. Epub 2007 Jun 12.
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.
A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District.
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.
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.
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.
调查在类似战争的环境中遭受羞辱对居住在巴勒斯坦被占领土约旦河西岸拉马拉地区的十年级和十一年级学生健康状况的影响。
从拉马拉地区的城市、城镇、村庄和难民营中抽取3415名学生作为分层单阶段整群样本。
调查问卷源自世界卫生组织的学龄儿童健康行为调查、加沙社区心理健康项目创伤事件清单，以及与年轻人的焦点小组讨论。调查问卷由学生在教室中，在一名经过培训的现场工作人员监督下完成。
大量主观健康问题与人口统计学变量之间存在显著关联，尤其是女性与男性相比，以及难民营居民与乡村居民相比。此外，遭受羞辱与主观健康问题数量增加显著相关。发现经历三种形式羞辱的学生报告大量主观健康问题的可能性是从未遭受羞辱学生的2.5倍（52%对21%），而经历四种形式羞辱的学生报告大量主观健康问题的可能性是从未遭受羞辱学生的三倍（62%对21%）。多元逻辑回归模型显示，即使在对性别、居住情况和其他暴力事件暴露指标进行调整后，羞辱仍与大量主观健康问题显著相关。报告大量主观健康问题的比值比随着羞辱形式数量的增加而增加，与从未遭受羞辱的人相比，暴露于一种、两种、三种或四种羞辱形式时报告大量主观健康问题的比值分别为1.69、2.67、4.43和7.49。
本研究结果表明，冲突和类似战争的环境所导致的羞辱本身构成一种独立的创伤性事件，与负面健康结果相关，而不论是否暴露于其他暴力/创伤性事件。基于这些发现，建议在调查战争和冲突对人群健康影响的研究中，应将羞辱纳入心理健康状况指标。
