Risk factors for DSM–5 posttraumatic stress symptoms (PTSS) among Israeli civilians during the 2014 Israel-Hamas war.

Abstract

In light of current modifications in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for posttraumatic stress disorder (PTSD), this study aimed to revalidate well-known PTSD risk factors related to terrorism and war in Israel, namely, proximity to the Gaza Strip, dissociative symptoms, acute stress disorder (ASD) symptoms, and social support. One hundred and sixty Israeli civilians were assessed during the 2014 Israel-Hamas war at 2 time points: 1 week after the beginning of the operation (t1) and 1 month after initial evaluation (t2), using the DSM-5 PTSD Symptom Levels Scale (PSLS; Gil, Weinberg, Or-Chen, & Harel, 2015). A paired t test analysis showed significant reduction in the respondents' posttraumatic stress symptoms (PTSS) 1 month after the initial assessment point. A structural equation model (SEM) showed that higher ASD symptoms at t1 and higher dissociative symptoms at t2 increased the risk for PTSS at t2. Conversely, higher peritraumatic dissociation at t1 decreased the risk for PTSS at t2. Proximity to the Gaza Strip, and social support, failed to demonstrate significant association with PTSS at t2. DSM-5 PTSS 1 month after prolonged traumatic exposure are strongly associated with high ASD symptoms at 1 week as a risk factor; high levels of peritraumatic dissociation at 1 week as a protective factor; and high levels of dissociative symptoms at 1 month as a risk factor. Theoretically and clinically the findings of the study further suggest that ongoing massive terrorism and war cannot be viewed or treated as identical to other traumas.

PTSD, ASD, Secondary-Traumatization, and Death-Anxiety among Civilians and Professionals as Outcomes of On-Going Wars, Terror Attacks and Military Operations: An Integrative View

“…Israeli civilians living in Israel's Southern region. This sample was divided into three groups, based on proximity to the Gaza strip: a) lived 4-25 miles from the border; b) lived 25-50 miles and c) lived more than 51 miles away from the border (Gil et al, 2015). The study's findings confirmed the significance of ASD symptoms identified a week after traumatic exposure as the hallmark risk factor for a subsequent development of PTSD at one month.…”

“…The study's findings confirmed the significance of ASD symptoms identified a week after traumatic exposure as the hallmark risk factor for a subsequent development of PTSD at one month. Previous studies showed that approximately 70% of trauma survivors who initially met criteria for ASD also met criteria for PTSD (Brewin, Andrews, & Valentine, 2000;Frans, Rimma, Aberg, & Fredrikson, 2005;Johnson, Maxwell, & Galea, 2009 (Gil et al, 2015).…”

The relationships between on-going terror attacks, military operations and wars and the well-being of Jewish and Arab three generations civilians in Israel

“…Fortunately, geographically proximity to Gaza did not show any association with PTSD. Conceivably, the war condition and the reality that large areas of Israel that were under constant missile attacks, created uncertainty regardless of the variations in distance (Gil et al 2015).…”

“…Th e defi nition of national terrorism suggests some of its consequences for the targeted population: loss of life, injuries and increased anxiety and fear. Studies conducting with victims of direct national terror attacks (i. e., survivors, witnesses and close relatives of those who were killed) confi rm that these individuals are at high risk of suff ering from a distress reaction (Solomon, Mikulincer, Waysman, Marlowe 1991;Gidron 2002;Shalev, Tuval-Mashiach 2005;Ron, Shamai 2015). Th e distress symptoms include generalized fear and anxiety, recurrent thoughts about the terror attack, avoidance behavior, physiological symptoms, depression, problems in daily functioning, and diffi culties in relating to trusting others.…”

“…Social support refers to perceived assistance provided by other persons, such as emotional, informational, and tangible assistance (Rosario, Salzinger, Feldman, Ng-Mak 2008). It is a primary interpersonal resource that has been consistently found to be associated with psychological well-being in times of stress, and is generally considered to be a protective factor for individuals who experienced a disaster (Norris et al 2002), terror attack (Hobfoll, Canetti-Nisim, Johnson 2006;Weinberg 2015), or other potentially life-threatening situations (e.g., Norris, Kaniasty 1996;Shalev et al 2006). Research indicates that higher levels of social support serve a protective role, and have also been linked to resilience and recovery with respect to traumatic events (Besser, Priel 2010;Gilbar, Plivazky, Gil 2010;King, King, Foy, Keane, Fairbank 1999).…”