We prospectively examined predictors of engagement in life tasks in a large sample of Palestinians in three waves during a period of high exposure to traumatic stress and major economic challenge. It is a central tenet of positive psychology that understanding psychopathology does not necessarily offer the fullest picture of functional aspects of people’s behavior (Seligman & Csikszentmihalyi, 2000
). The results of this first study of engagement in the face of traumatic stress partially supported our proposed model. The deviations from the hypothesized model are also of great interest and potentially inform an understanding of what predicts remaining more fully engaged in life tasks, despite an environment of omnipresent threat of violence, political unrest, and marked economic challenge that characterizes the occupied Palestinian Authority.
Beginning with traumatic exposure, we found that those who were more exposed to trauma had reduced engagement, mediated by their greater depressive symptoms, and greater resource loss, but also increased engagement as a direct effect of exposure. Loss of psychosocial resources was the best predictor of engagement through its combined direct negative association with engagement and through its indirect association with engagement as mediated by depressive symptoms. Social support was also both directly and indirectly associated with greater engagement, through its negative relationship with depressive symptoms.
There are several remarkable findings regarding the associations, and lack thereof, between depressive symptoms, PTS symptoms and engagement. Foremost of these findings is that engagement and psychological distress in the form of either depressive or PTS symptoms were only moderately related as predicted in hypothesis 4. In fact, PTS symptoms had no independent association with engagement. We know so little about the relationship between psychological distress and functioning in any domain (Seligman & Csikszentmihalyi, 2000
). Nevertheless, this finding reflects the several studies in the organizational psychology literature that show that psychological distress and engagement are negatively related, but not strongly so (Schaufeli et al., 2002
) and also mirrors a similar finding among caregivers of dying partners (Folkman, 1997
). This would be consistent with more basic research on personality that finds that a state of high energy, full concentration, and pleasurable engagement is relatively independent of sadness and lethargy (Watson & Tellegen, 1985
This means that people continue to strive toward functioning even when they are feeling psychological distress, which was remarkably high in this sample. Second, it is notable that when all variables are simultaneously considered, that it is the depressive symptoms, not the PTS symptoms that are significantly associated with engagement. Other studies have also noted that depressive symptoms are associated with withdrawal and more passive behavioral response (Jacobson et al., 1996
). It must also be stressed that PTS symptoms include depressive affect, so this finding does not mean that PTS symptoms per se are not associated with engagement. Rather, it suggests that it may be the depressive component of PTS that is associated with reduced engagement.
The finding that exposure to trauma contributes both to lower engagement through its association with depressive symptoms, and through its direct positive association with engagement is important and consistent with several stress theories, although it was not predicted in our model. In this regard, Lazarus and Folkman’s stress appraisal theory (1984
) and Hobfoll’s COR theory (1988 (1998
) both predict that stressful challenges activate people’s coping efforts and mobilization of resources, at the same time as they might contribute to psychological distress. More engagement in life tasks in the face of trauma is also consistent with self-regulation theory (Carver & Scheier, 1998
), which posits that when people are faced with even significant life challenges such as these, that they are motivated to act in ways to improve their circumstances at the same time as they attempt to regulate their emotions. Likewise, Frederickson’s (1998)
broaden and build theory suggests that many individuals sustain positive affect (which we did not study, but which we must assume also occurs for many) and that these emotions, in turn, are linked to efforts toward exploration, curiosity, commitment, and adaptation. On another level, confrontation with traumatic circumstances of violence and political unrest may actually motivate some individuals to increase the value they place on family, work, and other things in life that are important to them as a counteragent in their search for positive meaning and meaningfulness (Tedeschi & Calhoun, 2004
), which would likely motivate further investment in these life domains that might be reflected in engagement. As others have noted, exposure to conflict-related violence could, in certain conditions, have a positive long-term effect, such as receiving external assistance and gaining new lifestyle and values (Pedersen, Tremblay, Erra’zuriz, & Gamarra, 2008
Among the demographic variables, a number of findings were notable. Women were less engaged then men, through their being more likely to have depressive symptoms than men, which, in turn, was related to lower engagement. Being older was related to lower engagement through its direct effect on engagement and indirectly, as older individuals were more likely than younger individuals to report depressive symptoms. Education also was both directly and indirectly related to engagement, as more educated individuals reported being more engaged and experienced less resource loss, which in turn was related to lower engagement. Finally, being religious was indirectly related to higher engagement, through it being significantly related to less resource loss. Marital status and income were not independently related to engagement.
Although our focus was on engagement, this study is also one of the first to examine the impact of trauma exposure in a developing “nation” during a period of significant political violence from external and internal sources in other than cross-sectional surveys. As others have found examining trauma in low income regions, Palestinians’ exposure to traumatic events was found to be related to high levels of psychological distress, such as PTSD and depression symptoms (Johnson et al., 2008
; Lopes Cardozo, Vergara, Agani, & Gotway, 2000
; Scholte et al., 2004
). In addition, it has been noted that exposure to conflict-related violence concentrates its ill-effects in specific vulnerable groups, having greater impact on women, those with low education, and older individuals (Lopes Cardozo et al., 2000
; Pedersen et al., 2008
; Scholte et al., 2004
). Such study in different regions in the world increases our overall ability to speak in terms of how humans react to trauma, as opposed to how people in higher income nations react, and in so doing contributes to a more universal psychology (de Jong et al., 2001
). In this regard, it is also notable that the relationships between trauma exposure, resource loss, social support, and PTS and depression symptoms were of a magnitude that we might expect in more developed regions (Bleich et al., 2003
; Galea et al., 2002
; Miguel-Tobal, Cano-Vindel, Gonzalez-Ordi, Iruarrizaga, Rudenstine, Vlahov, 2006
), at the same time that the levels of psychological distress were quite high, as have been found in other developing and underdeveloped nations experiencing trauma exposure (de Jong et al., 2001
; Punamaki et al., 2005
Strengths and Limitations
This study had several marked strengths. The large sample size and three-wave design are themselves nearly unique in the field of traumatic stress (Kessler & Wittchen, 2008
) and lend themselves to the sophisticated statistical modeling we conducted. The theoretically derived model and pioneering exploration of the positive psychology construct of engagement are also key study strengths. Limitations include a reasonable, but still noteworthy, refusal rate for initial participation, and we cannot know how our findings might generalize to those who refused to participate. Also, even prospective study and sophisticated analyses can only be used to imply potential causal relations. Certainly these relationships are transactional and interactive. Perhaps the key thing to remember in any such study is that interpretations are limited to the constructs chosen for study and the models that are explored, and that other variables and other models not considered might have better explanatory value. Given the need not to overburden respondents, scales were necessarily brief and self-report, which reduces their reliability compared to full scales, and certainly less reliable than obtaining multiple assessments of each variable of interest or clinical assessments. Finally, there is controversy over the use of trauma-related constructs in non-Western cultures (Nicholl & Thompson, 2004
; Silove, 1999
), but we and others have found cross-cultural applicability and quite similar findings as those found in the West for PTS and depressive symptoms (Cardozo et al., 2000
; Cheung, 1994
; Hobfoll et al., 2008
; Scholte et al., 2004
Any conclusions drawn from this study must be taken in context and be cautiously generalized. First, being the pioneering study of remaining engaged and vigorous in life tasks during traumatic conditions also means that we had to extrapolate our model from a literature on positive psychology in much lower stress circumstances (Schaufeli et al., 2001). Second, the chronically threatening and traumatic conditions in which Palestinians live also means that they have had an unusual amount of time to adapt to these circumstances in a process that has been called stress recalibration (Hobfoll, 2003
). Hence, although we found only a weak relationship between trauma exposure, traumatic psychological distress and engagement, individuals who are exposed to severe acute trauma may possibly be markedly disengaged from key life tasks. Only future study can address the critical question of generalizability.
Notwithstanding these caveats, our model was nevertheless theoretically based and partially supported in a strong research design that has seldom been achieved under conditions of severe, chronic environmental threat and trauma. It is remarkable that, on one hand, we found this sample to be highly distressed, and yet that distress did not greatly disrupt their engagement and vigor in life tasks. This is very different than the conclusions of others that PTS symptoms do not necessarily follow from trauma exposure, which is a separate key point (Breslau, Kessler, Chilcoat, Schultz, Davis & Andreski, 1998
), but instead emphasizes that even when rather severe psychological distress does follow, many people remain engaged in life tasks and vigorous. Our findings also shed more light on how people react to trauma in non-Western, low income regions of the world that are in fact more likely to be exposed to such chronic environmental threat. As such, we believe it is a strong starting point for the study of the relationship between trauma exposure and engagement and provides a good heuristic base for future research. This future research is vital to our development of a fuller understanding of how people simultaneously have great emotional difficulty when they are exposed to traumatic conditions, but yet also continue to thrive and survive (Bonanno et al., 2006