Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Anita J. Hunter, PhD, CPNP, FAAN, Chairperson; Lois Howland, DPH, MS, RN; Joseph F. Burkard, DPNC, CRNA; Jane M. Georges, RN, PhD


children & youth, Diurnal rhythm, nursing, Palestinian, Psychology, resilience, Salivary Alpha-Amylase, Salivary cortisol, Stress, traumatic exposure, war violence


Political violence, war, and genocide exist across the world and often the innocent children and civilians become victims. War and long-term violence have potentially harmful psychological and physiological effects on children. There are limited studies on the effect of prolonged armed conflict on the child's physiologic and psychologic stress responses. The purpose of this study is to investigate the relationships between level of trauma, stress and resilience with salivary cortisol and salivary alpha-amylase (sAA) diurnal patterns in Palestinian children, ages 10-12, living in a long standing war zone. Salivary cortisol, a surrogate marker of hypothalamic-pituitary-adrenal axis (HPA) activity, and salivary alpha-amylase, a surrogate marker of sympathetic nervous system (SNS), have been used to explore relationships of studies psychoneurobiological factors and processes related to stress. This study is exceptional in its examination of stress-related processes in a Palestinian child population. Factors as resilience, and stress biomarkers may serve as predictors in identifying children at greatest risk for physical and mental health problems in the face of actual or perceived stress and trauma. Exploring the effects of trauma exposure on perceived stress, resilience, and HPA and SNS markers provided for an examination of biological and behavioral relationships to in developing a theoretical framework and an explanatory model that might provide a guideline for clinical assessment and intervention models among traumatized children.

Document Type

Dissertation: Open Access



Included in

Nursing Commons