Prediction of Somatic Symptom Severity from Post-Traumatic Stress Symptom Severity, Difficulties in Emotion Regulation, Alexithymia, and Sleep Quality in War-Affected Adolescents
Downloads
Objective: This study aimed to examine the predictive contribution of post-traumatic stress symptom severity, difficulties in emotion regulation, alexithymia, and sleep quality to somatic symptom severity in war-affected adolescents aged 13–18.
Methods and Materials: A cross-sectional predictive design was employed. Sixty adolescents exposed to the recent Iran–Israel conflict were recruited through purposive sampling in Tehran. Participants completed the Somatic Symptom Scale-8 (SSS-8), Child Post-Traumatic Stress Reaction Index (CPTSD-RI), Difficulties in Emotion Regulation Scale (DERS), Toronto Alexithymia Scale (TAS-20), and Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using Pearson correlation coefficients and hierarchical multiple regression. Significance was set at p < .05.
Findings: Somatic symptom severity was positively correlated with post-traumatic stress symptom severity (r = .61, p < .001), difficulties in emotion regulation (r = .58, p < .001), alexithymia (r = .49, p < .001), and poor sleep quality (r = .46, p < .001). Hierarchical regression analysis revealed that post-traumatic stress symptoms significantly predicted somatic symptoms (β = .61, t = 7.02, p < .001), followed by difficulties in emotion regulation (β = .34, t = 3.60, p = .001), alexithymia (β = .27, t = 2.80, p = .007), and sleep quality (β = .25, t = 2.95, p = .005). The overall model explained 58% of the variance in somatic symptom severity (Adjusted R² = .56, F(4, 55) = 18.45, p < .001).
Conclusion: Post-traumatic stress symptoms, emotional regulation difficulties, alexithymia, and poor sleep quality are significant predictors of somatic symptom severity in adolescents affected by war.
Downloads
American Psychiatric Association, D., & American Psychiatric Association, D. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5). American Psychiatric Association, Washington, DC. https://doi.org/10.1176/appi.books.9780890425596
Bagby, R. M., Parker, J. D., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of psychosomatic research, 38(1), 23–32. https://doi.org/10.1016/0022-3999(94)90005-1
Burchell, B., Miller, J., Brewin, C., Soffia, M., & Wang, S. (2023). The association between job quality and the incidence of PTSD amongst police personnel. Policing: a journal of policy and practice, 17, paac054. https://doi.org/10.1093/police/paac054
Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research, 28(2), 193-213. https://doi.org/10.1016/0165-1781(89)90047-4
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage Publications.
Gierk, B., Kohlmann, S., Kroenke, K., Spangenberg, L., Zenger, M., Brähler, E., & Löwe, B. (2014). The somatic symptom scale–8 (SSS-8) a brief measure of somatic symptom burden. JAMA internal medicine, 174(3), 399-407. https://doi.org/10.1001/jamainternmed.2013.12179
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Gross, J. J., & Thompson, R. A. (2007). Emotion regulation: conceptual foundations. In: Gross JJ, editor. Handbook of emotion regulation, 3–26. https://www.researchgate.net/publication/303248970_Emotion_Regulation_Conceptual_Foundations
Kobayashi, I., Pereira, M. E., Jenkins, K. D., Johnson III, F. L., & Pace-Schott, E. F. (2023). Assessing the role of sleep in the regulation of emotion in PTSD. In Translational Methods for PTSD Research (pp. 51-96). Springer. https://doi.org/10.1007/978-1-0716-3218-5_4
Lewis, C., Lewis, K., Kitchiner, N., Isaac, S., Jones, I., & Bisson, J. I. (2020). Sleep disturbance in post-traumatic stress disorder (PTSD): a systematic review and meta-analysis of actigraphy studies. European Journal of Psychotraumatology, 11(1), 1767349. https://doi.org/10.1080/20008198.2019.1709709
Morina, N., Schnyder, U., Klaghofer, R., Müller, J., & Martin-Soelch, C. (2018). Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims. BMC psychiatry, 18(1), 92. https://doi.org/10.1186/s12888-018-1680-4
Organization, W. H. (2025). Guideline for the prevention, diagnosis, and treatment of infertility. World Health Organization. https://www.who.int/publications/i/item/9789240115774
Pineros-Ortiz, S., Moreno-Chaparro, J., Garzon-Orjuela, N., Urrego-Mendoza, Z., Samaca-Samaca, D., & Eslava-Schmalbach, J. (2021). Mental health consequences of armed conflicts in children and adolescents: An overview of literature reviews. Biomedica, 41(3), 5447. https://doi.org/10.7705/biomedica.5447
Pynoos, R. S., Ritzmann, R. F., Steinberg, A. M., Goenjian, A., & Prisecaru, I. (1996). A behavioral animal model of posttraumatic stress disorder featuring repeated exposure to situational reminders. Biological psychiatry, 39(2), 129-134. https://doi.org/10.1016/0006-3223(95)00088-7
Sharma, M., Fine, S. L., Brennan, R. T., & Betancourt, T. S. (2017). Coping and mental health outcomes among Sierra Leonean war-affected youth: Results from a longitudinal study. Development and Psychopathology, 29(1), 11-23. https://doi.org/10.1017/S0954579416001073
Taylor, G. J., & Bagby, R. M. (2021). Examining proposed changes to the conceptualization of the alexithymia construct: The way forward tilts to the past. Psychotherapy and psychosomatics, 90(3), 145-155. https://doi.org/10.1159/000511988
Thabet, A. A. M., & Ghannam, R. T. (2014). Effect of trauma due to war on dissociative symptoms and resilience among Palestinian adolescents in the Gaza Strip. The Arab Journal of Psychiatry, 25(2), 107-118. https://doi.org/10.12816/0006760
Weissman, D. G., Bitran, D., Miller, A. B., Schaefer, J. D., Sheridan, M. A., & McLaughlin, K. A. (2019). Difficulties with emotion regulation as a transdiagnostic mechanism linking child maltreatment with the emergence of psychopathology. Development and Psychopathology, 31(3), 899-915. https://doi.org/10.1017/S0954579419000348
Copyright (c) 2025 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
