Trauma exposure, perceived stress and morning cortisol levels among Palestinian boys in the Gaza Strip and West Bank.

Millions of children worldwide grow up under conditions of war and armed conflict, yet the risks associated with data collection in such highly adverse contexts mean that very few cortisol datasets are available from these regions. This descriptive study aimed to document salivary morning cortisol levels (MCL), trauma exposure and perceived effects, as well as perceived stress in Palestinian boys (N = 115), ages 9-11, living in the Gaza Strip (n = 62) and the West Bank (n = 53). Salivary cortisol was sampled at awakening and 30 min post-awakening over three consecutive days, and mean values were used to compute MCL as an index of basal hypothalamic-pituitary-adrenal (HPA) activity. Results show that in both groups, self-reported perceived stress levels were descriptively higher relative to a published U.S. reference sample. Children in both regions reported substantial exposure to traumatic events and associated perceived effects. When descriptively compared with published normative cortisol awakening response values, salivary MCL showed divergent patterns across regions, with markedly higher values in the Gaza Strip and considerable variability in the West Bank. Exploratory correlational analyses suggested region-specific associations: in the West Bank, greater perceived effect of trauma was associated with higher MCL, whereas in the Gaza Strip, no association was found with perceived stress or trauma. These findings provide rare descriptive data on salivary cortisol among children growing up under chronic war exposure and underscore the importance of building comparative datasets to better understand how adverse environments shape stress physiology.