Trajectories of resilience, resistance, and distress during ongoing terrorism: The case of Jews and Arabs in Israel.

Abstract

This is the 1st longitudinal examination of trajectories of resilience and resistance (rather than illbeing) among a national sample under ongoing threat of mass casualty. The authors interviewed a nationally representative sample of Jews and Arabs in Israel (N = 709) at 2 times during a period of terrorist and rocket attacks (2004)(2005). The resistance trajectory, exhibiting few or no symptoms of traumatic stress and depression at both time points, was substantially less common (22.1%) than has previously been documented in studies following single mass casualty events. The resilience trajectory, exhibiting initial symptoms and becoming relatively nonsymptomatic, was evidenced by 13.5% of interviewees. The chronic distress trajectory was documented among a majority of participants (54.0%), and a small proportion of persons were initially relatively symptom-free but became distressed (termed delayed distress trajectory; 10.3%). Less psychosocial resource loss and majority status (Jewish) were the most consistent predictors of resistance and resilience trajectories, followed by greater socioeconomic status, greater support from friends, and less report of posttraumatic growth. Research on terrorism and war and other mass casualty events has overwhelmingly focused on pathological responding, most typically symptoms related to traumatic stress (Bleich, Gelkopf, & Solomon, 2003;Galea et al., 2002;Hobfoll, Canetti-Nisim, & Johnson, 2006;Punamäki, Komproe, Qouta, Elmasri, & de Jong, 2005) and, to a lesser extent, depression (Hobfoll, Tracy, & Galea, 2006). However, emerging research has suggested that in the aftermath of mass casualty, the majority of persons do not report psychological distress and may be termed resistant (Bonanno, Galea, Bucciarelli, & Vlahov, 2006. Because we have only begun to study resistance, and in limited contexts, we know little about its prevalence or predictors (Bonanno, 2005;Bonanno, Rennicke, & Dekel, 2005).We longitudinally studied symptoms related to traumatic stress and depression among a national sample of Israeli Jews and Arabs during the latter period of the Second Intifada, when there was ongoing terrorism and likelihood of war because mass casualty exposure weighs heavily on such populations (Shalev, Tuval, Frenkiel-Fishman, Hadar, & Eth, 2006;Somer, Ruvio, Soref, & Sever, 2005). Our aim was to estimate the prevalence of resistance, resilience, chronic distress, and a failure to remain resistant (i.e., delayed symptom onset) and to predict these outcomes. We believe this is the first longitudinal study of resilience and related trajectories in the face of terrorism and war during a period of ongoing conflict.Building on the work of Bonanno et al. (2007);Layne, Warren, Shalev, and Watson (2007); and Norris, Stevens, Pfefferbaum, Wyche, and Pfefferbaum (2007), we outline four key symptom trajectories, over time, after traumatic event exposure. In the first trajectory, termed the resistance trajectory (Layne et al., 2007), individuals never develop symptoms of disorder. A se...

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