This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Llabre, M. M. Articles by Hadi, F. PubMed PubMed Citation Articles by Llabre, M. M. Articles by Hadi, F. Related Collections Pediatrics PTSD Sleep and Biological Rhythms

War-Related Exposure and Psychological Distress As Predictors of Health and Sleep: A Longitudinal Study of Kuwaiti Children

From the Department of Psychology, University of Miami, Coral Gables, Florida (M.M.L.); and Department of Educational Psychology, Kuwait University, Kuwait City, Kuwait (F.H.).

Address correspondence and reprint requests to Maria M. Llabre, PhD, Department of Psychology, University of Miami, PO Box 248185, Coral Gables, FL 33124. E-mail: mllabre{at}miami.edu

Objectives: To determine whether exposure to war-related trauma during childhood predicted posttraumatic stress, self-reported health, sleep, and obesity in adulthood, and whether psychological distress mediated the relationships.

Methods: We assessed 151 Kuwaiti boys and girls aged 9 to 12 years in 1993 to determine their level of exposure to war-related trauma during the Iraqi occupation and Gulf war, health complaints, and psychological distress. In 2003, 120 (79%) of the initial participants reported on their posttraumatic stress, general health, body mass index (BMI), and sleep quality. We tested a structural model where exposure to war-related trauma predicted psychological distress and health complaints 2 years after the war, and posttraumatic stress, self-reported health, BMI, and sleep quality and duration 10 years later, controlling for intermediary life events. We also tested effects of exposure to war-related trauma on self-reported health and sleep factors mediated by psychological distress.

Results: Results indicated a direct effect of exposure on poor sleep quality and BMI. Exposure also predicted poor sleep quality through its association with concurrent posttraumatic stress. The effect of exposure on self-reported health was mediated by health complaints and psychological distress, which included symptoms of depression, anxiety, and posttraumatic stress.

Conclusion: Exposure to war-related events during childhood is associated with posttraumatic stress, poor sleep quality, high BMI, and poor self-reported health in adulthood.

Key Words: war-related trauma • health related • posttraumatic stress • children

Abbreviations: BMI = body mass index; PTSD = posttraumatic stress disorder; PTSDS = Posttraumatic Stress Disorder Symptom Scale; RCMAS = Revised Children's Manifest Anxiety Scale; CSI = crisis structured interview; RMSEA = root mean squared error of approximation; SRMR = standardized root mean squared residual; OR = odds ratio.