Sense of Threat as a Mediator of Peritraumatic Stress Symptom Development During Wartime: An Experience Sampling Study

Abstract

Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30-day twice-daily smartphone-based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel-Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p < .001, 95% CI [0.32, 1.82], and indirectly, b = 0.78, p < .001, 95% CI [0.24, 1.33], through sense of threat. The effect of sense of threat on stress symptoms was larger in the SMI group, b = 0.86, p < .001, 95% CI [0.31, 1.40]. Gender did not have a significant effect. Sense of threat has a key role in symptom development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI.

Dynamic Network Analysis of Negative Emotions and DSM‐5 Posttraumatic Stress Disorder Symptom Clusters During Conflict

“…The present paper utilized data collected within a large prospective ESM study conducted during and after the Israel–Gaza conflict that took place in July and August 2014 (Gelkopf et al., ; Greene, ; Greene et al., ; Lapid Pickman, Greene, & Gelkopf, ). During the 50‐day conflict, rockets and mortar shells were fired at Israeli communities from Gaza, and the Israel Defence Forces conducted ground and air attacks on Gaza.…”

The Dynamic Relations Among Peritraumatic Posttraumatic Stress Symptoms: An Experience Sampling Study During Wartime

“…Analyses performed on the same data set as was used in the current study (Gelkopf et al., Greene et al., ; Lapid Pickman, Greene, & Gelkopf, ) have also suggested that the dynamics of P‐PTSS in civilian populations are affected by the level of objective threat (e.g., sounding of sirens at the time of incoming rocket fire). The aforementioned studies, as well as others, have also suggested gender (Freedman et al., ); a history of severe mental health problems, including poor emotional self‐regulation (Koenen, ), elevated perceived threat (Conway, Starr, Espejo, & Brennan, ), and weakened ability for contextual integration of information (Holmes & Steel, ); and trauma history (Goslin, Stover, Berkowitz, & Marans, ; Harvey & Bryant, ) as risk factors for acute stress reactions after a traumatic event.…”

“…Arousal thus may only lead to other negative symptoms if it is experienced as a threat. Indeed, studies have suggested that threat is a better predictor of PTSD than exposure (Kolkow, Spira, Morse, & Grieger, ) itself or that threat mediates the connection between exposure and symptoms (Lapid Pickman et al., ). The negative cognitions and emotions along with the memories themselves might feed the arousal by triggering the fear circuitry or simply by boosting the arousal, or both.…”

“…The current study was part of a larger study during and after the 50‐day 2014 Israel–Gaza conflict (Gelkopf et al., ; Greene et al., ; Greene, Gelkopf, Epskamp, & Fried, ; Lapid Pickman et al., ). During the conflict, over 4,500 rockets were fired from Gaza toward Israeli communities.…”

Does sense of threat in civilians during an armed conflict predict subsequent depression symptoms?

“…Threat perceptions have been found to be related both to war and terror (Bleich et al, 2003; Kutz & Dekel, 2006), as well as predicting posttraumatic psychopathology (Kolkow, Spira, Morse, & Grieger, 2007; Ozer et al, 2003; Razik, Ehring, & Emmelkamp, 2013; Vance et al, 2018). Furthermore, studies show that perceived threat plays a significant mediating role in the association between trauma exposure and both peri‐ and posttraumatic stress symptoms (Ehlers & Clark, 2000; Lapid Pickman et al, 2017). Understanding the role that peritraumatic reactions to trauma in general, and peritraumatic threat in particular, play in the development of posttraumatic psychopathology may have important implications for understanding and preventing the development of psychopathology following trauma exposure (Bovin & Marx, 2011; Ehlers & Clark, 2000).…”