This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (125)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Psychiatry  • Post Traumatic Stress Disorder  • World Health  • Violence and Human Rights  • Violence and Human Rights, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Avraham Bleich, MD; Marc Gelkopf, PhD; Zahava Solomon, PhD

JAMA. 2003;290:612-620.

Context  The 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 Participants  Telephone 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.

Results  Of 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 self-efficacy 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.

Conclusions  Considering 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.

Author Affiliations: Lev-Hasharon Mental Health Center, affiliated with Tel-Aviv University Sackler School of Medicine, Tel-Aviv, Israel (Drs Bleich and Gelkopf); Department of Psychiatry, Tel-Aviv Sackler School of Medicine and Israel Trauma Center for Victims of Terror and War (NATAL) (Dr Bleich); Shappel School of Social Work and Adler Research Center, Tel-Aviv University (Dr Solomon).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Analysis of trauma exposure, symptomatology and functioning in Jewish Israeli and Palestinian adolescents
Al-Krenawi et al.
Br. J. Psychiatry 2009;195:427-432.
ABSTRACT | FULL TEXT  

Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis
Steel et al.
JAMA 2009;302:537-549.
ABSTRACT | FULL TEXT  

Gender Differences in Fear of Terrorism
Nellis
Journal of Contemporary Criminal Justice 2009;25:322-340.
ABSTRACT  

Terrorism-Related Perceived Stress, Adolescent Depression, and Social Support From Friends
Shahar et al.
Pediatrics 2009;124:e235-e240.
ABSTRACT | FULL TEXT  

A New Stress-Based Model of Political Extremism: Personal Exposure to Terrorism, Psychological Distress, and Exclusionist Political Attitudes
Canetti-Nisim et al.
Journal of Conflict Resolution 2009;53:363-389.
ABSTRACT  

Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence
Hobfoll et al.
Focus 2009;7:221-242.
ABSTRACT | FULL TEXT  

Effect of 7 July 2005 terrorist attacks in London on suicide in England and Wales
Salib and Cortina-Borja
Br. J. Psychiatry 2009;194:80-85.
ABSTRACT | FULL TEXT  

Psychological interventions following terrorist attacks
Mansdorf
Br Med Bull 2008;88:7-22.
ABSTRACT | FULL TEXT  

2009 Theme Issue on Violence and Human Rights--Call for Papers
Cole and Flanagin
JAMA 2008;300:2427-2427.
FULL TEXT  

The well being of children living in chronic war zones: The Palestinian--Israeli case
Sagi-Schwartz
International Journal of Behavioral Development 2008;32:322-336.
ABSTRACT  

Predictors of symptoms of post-traumatic stress disorder after the AZF chemical factory explosion on 21 September 2001, in Toulouse, France
Riviere et al.
J. Epidemiol. Community Health 2008;62:455-460.
ABSTRACT | FULL TEXT  

Resilience of Israeli Body Handlers: Implications of Repressive Coping Style
Solomon et al.
Traumatology 2007;13:64-74.
ABSTRACT  

Social identification and post-traumatic stress symptoms in post-conflict Northern Ireland
MULDOON and DOWNES
Br. J. Psychiatry 2007;191:146-149.
ABSTRACT | FULL TEXT  

Enduring consequences of terrorism: 7-month follow-up survey of reactions to the bombings in London on 7 July 2005
Rubin et al.
Br. J. Psychiatry 2007;190:350-356.
ABSTRACT | FULL TEXT  

Terror, Barriers, and the Changing Topography of Jerusalem
Savitch and Garb
Journal of Planning Education and Research 2006;26:152-173.
ABSTRACT  

Lack of Safe Environment: Emotional Difficulties and Coping Among Clinicians Treating Traumatized Patients Within a Terrorized Society--Israel 2006
Shalvi and Luzzatto
Traumatology 2006;12:282-292.
ABSTRACT  

Impacts of media coverage on the community stress level in Hong Kong after the tsunami on 26 December 2004.
Lau et al.
J. Epidemiol. Community Health 2006;60:675-682.
ABSTRACT | FULL TEXT  

Health Services Utilization in Jerusalem Under Terrorism
Levav et al.
Am. J. Psychiatry 2006;163:1355-1361.
ABSTRACT | FULL TEXT  

Correlates of Subjective Stress Among Drug Court Clients
Garrity et al.
Int J Offender Ther Comp Criminol 2006;50:269-279.
ABSTRACT  

Psychological Responses to Continuous Terror: A Study of Two Communities in Israel
Shalev et al.
Am. J. Psychiatry 2006;163:667-673.
ABSTRACT | FULL TEXT  

The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem
Kark et al.
Int J Epidemiol 2006;35:448-457.
ABSTRACT | FULL TEXT  

Americans as Survivors
Neria et al.
NEJM 2005;353:957-958.
FULL TEXT  

PTSD Following Terrorist Attacks: A Prospective Evaluation
Shalev and Freedman
Am. J. Psychiatry 2005;162:1188-1191.
ABSTRACT | FULL TEXT  

Book Review: Group Psychotherapy for Psychological Trauma
Masalha
Group Analysis 2005;38:325-327.
 

Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients
Azoulay et al.
Am. J. Respir. Crit. Care Med. 2005;171:987-994.
ABSTRACT | FULL TEXT  

Dr. Cohen and Colleagues Reply
COHEN et al.
Am. J. Psychiatry 2005;162:398-400.
FULL TEXT  

Terror attacks influence driving behavior in Israel
Stecklov and Goldstein
Proc. Natl. Acad. Sci. USA 2004;101:14551-14556.
ABSTRACT | FULL TEXT  

Association of Fear of Terror With Low-Grade Inflammation Among Apparently Healthy Employed Adults
Melamed et al.
Psychosom. Med. 2004;66:484-491.
ABSTRACT | FULL TEXT  

Definitions of Terrorism
Lipton et al.
JAMA 2003;290:2254-2254.
FULL TEXT  

Effects of Terror and Violence Vary by Culture
JWatch Psychiatry 2003;2003:5-5.
FULL TEXT  

Posttraumatic Symptoms and the Complexity of Responses to Trauma
Kroll
JAMA 2003;290:667-670.
FULL TEXT