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We evaluated the accuracy of posttraumatic stress disorder (PTSD) and major depression (MD) diagnoses using brief assessment instruments conducted by phone. PTSD and MD were assessed by telephone interview in a randomly selected sample of Jewish and Palestinian residents of Jerusalem (N = 150) during a period of marked threat of terrorism and war. We utilized the PTSD Symptom Scale Interview Format (Foa, Riggs, Dancu, & Rothbaum, 1993) and the Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001). We then conducted in-depth, in-person interviews within 2 weeks, assessing PTSD and MD using the Composite International Diagnostic Interview (CIDI; Kessler et al., 2004). The prevalence of PTSD and MD diagnosis ascertained by the 2 assessment modalities was similar. Indices of classification accuracy for the phone interview, using the in-person interview as the standard, ranged from modest to high. Brief phone and in-depth in-person measures of PTSD and MD also correlated similarly with other demographic, stress, and coping factors, suggesting convergent validity. Brief phone interviews appear useful for estimating the prevalence of psychological disorders in mass casualty contexts and may have a critical role in both epidemiologic work and guiding public health interventions.

The present study aimed to investigate the prevalence of self-reported impairment (Criterion F) as part of a probable DSM-IV diagnosis of posttraumatic stress disorder (PTSD) within a sample of 1001 Israeli Jews subjected to direct and indirect exposure to rocket attacks. Further, the present study aimed to investigate predictors of endorsing posttraumatic stress (PTS)-related impairment, with specific attention to the influence of resources and resource loss. Data were collected via phone surveys. Twenty-nine percent of the sample reported impairment; however, only 19% of those reporting impairment met criteria for probable PTSD. Logistic regression results indicated that psychosocial resource losses, experiencing personal injury or injury to a family member or close friend, experiencing other major life stressors in the past year, having poorer health, having significant sleep difficulty, and having traditional (moderate) religious practices, significantly predicted PTS-related impairment. Results suggest that addressing impairment only within the context of full PTSD misses many individuals experiencing significant PTS-related impairment.

Study Objectives: To estimate the prevalence of, and to identify correlates of clinically significant sleep problems in adult Israeli citizens exposed to chronic terrorism and war trauma or threat thereof., Methods: A population-based, cross-sectional study of 1001 adult Israeli citizens interviewed by phone between July 15 and August 26, 2008. The phone survey was conducted in Hebrew and assessed demographics, trauma/stressor exposure, probable posttraumatic stress disorder (PTSD), probable depression, and sleep problems. Probable PTSD and depression were assessed with the PTSD Symptom Scale (PSS) and Patient Health Questionnaire (PHQ-9), respectively, following DSM-IV diagnostic criteria. Sleep problems in the past month were assessed with the Pittsburgh Sleep Quality Index (PSQI), on which a global composite score ≥ 6 indicates a clinical-level sleep problem., Results: Prevalence of probable PTSD and depression was 5.5% and 5.8%, respectively. Prevalence of clinically significant sleep problems was 37.4% overall, but was significantly higher for probable PTSD (81.8%) and probable depression (79.3%) subgroups. Independent correlates of poor sleep included being female, older, less educated, experiencing major life stressors, and experiencing psychosocial resource loss. Psychosocial resource loss due to terrorist attacks emerged as the strongest potentially modifiable risk factor for sleep problems., Conclusions: Sleep problems are common among Israeli adults living under chronic traumatic threat and trauma exposure. Given the continuing threat of war, interventions that bolster psychosocial resources may play an important role in preventing or alleviating sleep problems in this population.

Posttraumatic growth (PTG)-deriving benefits following potentially traumatic events-has become a topic of increasing interest. We examined factors that were related to self-reported PTG, and the relationship between PTG and symptoms of post-traumatic stress (PTS) following the 2006 Israel-Hezbollah. Drawing from a national random sample of Israel, data from 806 terrorism-exposed Israeli adults were analyzed. PTG was associated with being female, lower education, greater recent terrorism exposure, greater loss of psychosocial resources, greater social support, and greater self-efficacy. PTG was a consistent predictor of PTS across hierarchical linear regression models that tested whether demographic, stress, or personal resources moderated the relationship between PTG and PTS. PTG did not relate to PTS differently for people who differed by age, sex, ethnicity, education, religiosity, degree of terrorism exposure, self-efficacy, nonterrorism stressful life events, and loss of psychosocial and economic resources. PTG was not related to well-being for any of these subgroups.

This is the 1st longitudinal examination of trajectories of resilience and resistance (rather than ill-being) 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.

Although there is abundant evidence that mass traumas are associated with adverse mental health consequences, few studies have used nationally representative samples to examine the impact of war on civilians, and none have examined the impact of the Israel-Hezbollah War, which involved unprecedented levels of civilian trauma exposure from July 12 to August 14, 2006. The aims of this study were to document probable post-traumatic stress disorder (PTSD), determined by the PTSD Symptom Scale and self-reported functional impairment, in Jewish and Arab residents of Israel immediately after the Israel-Hezbollah War and to assess potential risk and resilience factors. A telephone survey was conducted August 15-October 5, 2006, following the cessation of rocket attacks. Stratified random sampling methods yielded a nationally representative population sample of 1200 adult Israeli residents. The rate of probable PTSD was 7.2%. Higher risk of probable PTSD was associated with being a woman, recent trauma exposure, economic loss, and higher psychosocial resource loss. Lower risk of probable PTSD was associated with higher education. The results suggest that economic and psychosocial resource loss, in addition to trauma exposure, have an impact on post-trauma functioning. Thus, interventions that bolster these resources might prove effective in alleviating civilian psychopathology during war.

The Israeli government's decision to remove settlers in the Gaza Strip forcibly produced a situation of traumatic stress, resulting from confrontation and conflict for settlers. The authors examined the effects of the Gaza disengagement, that occurred following prolonged terrorist exposure, on rates of probable major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosis in a representative sample of Gaza settlers (N = 190). Predictors of probable MDD in multivariate models were being female, and experiencing greater economic and psychosocial resource loss. Predictors of probable PTSD were being older and experiencing greater psychosocial resource loss. Posttraumatic growth was significantly related to a reduction in the odds of having probable PTSD. This latter finding is interpreted within our conceptualization of action-focused growth.

Israel has faced ongoing terrorism since the beginning of the Al Aqsa Intifada in September 2000. The authors examined risk and resiliency factors associated with posttraumatic stress disorder (PTSD) among 1,117 Jews and 394 Arab adult citizens of Israel during August and September 2004 through telephone interviews. Probable PTSD was found among 6.6% of Jews and 18.0% of Arabs. Predictors of probable PTSD in a multivariate model for Jews were refusal to report income, being traditionally religious, economic and psychosocial resource loss, greater traumatic growth, and lower social support. For Arabs, predictors were low education and economic resource loss among those exposed to terrorism. Findings for only those directly exposed to terrorism were similar to those for the overall national sample.

The authors conducted a large-scale study of terrorism in Israel via telephone surveys in September 2003 with 905 adult Jewish and Palestinian citizens of Israel (PCIs). Structural equation path modeling indicated that exposure to terrorism was significantly related to greater loss and gain of psychosocial resources and to greater posttraumatic stress disorder (PTSD) and depressive symptoms. Psychosocial resource loss and gain associated with terrorism were, in turn, significantly related to both greater PTSD and depressive symptoms. PCIs had significantly higher levels of PTSD and depressive symptoms than Jews. Further, PTSD symptoms in particular were related to greater authoritarian beliefs and ethnocentrism, suggesting how PTSD may lead to a self-protective style of defensive coping., (Copyright 2006 APA)