Exposure to Terrorism, Stress-Related Mental Health Symptoms, and Coping Behaviors Among a Nationally Representative Sample in Israel

Abstract

ContextThe terrorist attacks on Israeli society have been ongoing since September 2000. However, few studies have examined the impact of terrorism on nationally representative population samples, and no study has examined the psychological impact of ongoing terrorism in Israel.Objectives To determine the level of exposure to terrorist attacks and the prevalence of traumatic stress-related (TSR) symptoms, symptoms of posttraumatic stress disorder (PTSD), and sense of safety after 19 months of terrorism in Israel, and to identify correlates of the psychological sequelae and the modes of coping with the terrorism. Design, Setting, and ParticipantsTelephone survey conducted April-May 2002, using a strata sampling method, of 902 eligible households and a representative sample of 742 Israeli residents older than 18 years (82% contact rate) and a final participation of 512 (57%).Main Outcome Measures Number of TSR symptoms, rates of those with symptom criteria for PTSD and acute stress disorder assessed by the Stanford Acute Stress Reaction Questionnaire, self-reported feelings of depression, optimism, sense of safety, help-seeking, and modes of coping. ResultsOf 512 survey participants, 84 (16.4%) had been directly exposed to a terrorist attack and 191 (37.3%) had a family member or friend who had been exposed. Of 510 participants who responded to questions about TSR symptoms, 391 (76.7%) had at least 1 TSR symptom (mean, 4.0 [SD, 4.5]; range, 0-23; mean intensity, 0.8; range, 0-4). Symptom criteria for PTSD were met by 48 participants (9.4%) and criteria for acute stress disorder, by 1 participant; 299 (58.6%) reported feeling depressed. The majority of respondents expressed optimism about their personal future (421/512 [82.2%]) and the future of Israel (307/509 [66.8%]), and expressed selfefficacy with regard to their ability to function in a terrorist attack (322/431 [74.6%]). Most expressed a low sense of safety with respect to themselves (307/509 [60.4%]) and their relatives (345/507 [67.9%]). Few reported a need for professional help (27/ 506 [5.3%]). Female sex, sense of safety, and use of tranquilizers, alcohol, and cigarettes to cope were associated with TSR symptoms and symptom criteria for PTSD; level of exposure and objective risk were not. The most prevalent coping mechanisms were active information search about loved ones and social support. ConclusionsConsidering the nature and length of the Israeli traumatic experience, the psychological impact may be considered moderate. Although the survey participants showed distress and lowered sense of safety, they did not develop high levels of psychiatric distress, which may be related to a habituation process and to coping mechanisms.

Association between feeling threatened by a terrorist attack and subjective health: a web survey a week after the attacks of 22 March 2016 in Belgium

“…People working or living in the region of the attacks felt more threatened, which is in line with most other studies (Hansen et al, 2013). However, some studies only found a weak association between perceived threat and level of exposure (Bleich et al, 2003; Cohen et al, 2006). …”

“…Although they were only a very small subgroup in our study, this finding is in line with other studies after terrorist attacks (Rubin et al, 2005; Schuster et al, 2001; Stein et al, 2004). Studies in Israel showed that populations associated with the offenders do not suffer less than the populations that are the explicit target of terrorists (Bleich et al, 2003; Cohen & Eid, 2007). It is however remarkable that violence ‘in the name of religion’ affects religious people the most.…”

“…Rather than objective factors, such as proximity to the terrorist attack, the perception of threat has a psychological effect (Ford et al, 2007; Hansen, Nissen, & Heir, 2013; Nissen, Birkeland Nielsen, Solberg, Bang Hansen, & Heir, 2015). Although several studies have found an association between exposure and post-traumatic symptoms (Hansen et al, 2013; Heir, Blix, & Knatten, 2016), other studies did not find such association (Bleich et al, 2003; Ford et al, 2007). Subjective perception of threat is a good predictor of probable PTSD (Cukor et al, 2011).…”

“…Furthermore, when people are anticipating disasters, their fears can worsen existing symptoms (Schuster et al, 2001). In contrast, some studies suggest that habituation may occur, due to continuous exposure to threat, as in Israel (Bleich, Gelkopf, & Solomon, 2003). …”

“…Some categories of people such as women (Bleich et al, 2003; Schuster et al, 2001; Stein et al, 2004), ethnic minorities (Schuster et al, 2001; Stein et al, 2004), people of lower socioeconomic status (Rubin, Brewin, Greenberg, Simpson, & Wessely, 2005), children and people already suffering from chronic disease or pre-existing psychiatric disorders (Schuster et al, 2001) proved to be more vulnerable. A meta-analysis showed that PTSD due to terrorist attacks was more prevalent in Western Europe than in North America (DiMaggio & Galea, 2006).…”