The challenge of estimating PTSD prevalence in the context of ongoing trauma: the example of Israel during the Second Intifada

Many studies attempt to gauge population prevalence of post traumatic stress disorder (PTSD) following a major catastrophe. However, little is known about the validity of these estimates in the increasingly common situation of ongoing trauma. During the period of the Second Intifada in Israel, which involved frequent and widespread terrorist attacks, several studies generated estimates of PTSD prevalence in the Israeli population, but yielded widely discrepant findings. A number of focused surveys using symptom checklists estimated population prevalence of PTSD or probable PTSD diagnosis at about 9%. However a large population health study conducted during this same time period using a structured diagnostic interview yielded a very low estimated prevalence of PTSD (0.5%). We examine methodological differences that might account for these striking discrepancies. Inherent limitations of both checklist and structured interview methods may be especially problematic in the context of ongoing trauma. Findings regarding PTSD and associated factors obtained during ongoing trauma should be interpreted with caution.     

Selecting and implementing evidence-based practices in psychiatric rehabilitation services in Israel: a worthy and feasible challenge

Major recent conceptual and legal advancements in Israel have generated a profound shift in the services provided for people with severe mental illness. Perhaps the most influential development has been the passage of the act for the rehabilitation of persons with a psychiatric disability in the community in the year 2000. In this paper we argue that the psychiatric rehabilitation services defined by the recent legislation lack explicit standards or criteria for selection, and thus could benefit from incorporating interventions that evidence has shown to be effective in assisting clients to achieve desirable outcomes. We propose a practical five-step plan to facilitate the implementation of these evidence-based practices including creating demand, selecting the EBPs, preparing practitioners and agencies, monitoring and feedback, and ensuring sustainability. The importance of an ongoing dialogue between stakeholders to facilitate the integration of research evidence, clinical expertise and rehabilitation values to improve the quality of service is discussed.     

The Spiritualities of Therapists' Lives

Summary

We situate how the personal spiritual quests of our own lives have influenced our work as family therapists, particularly influencing our chosen theories of change. We provide a definition of and approach to spirituality that centers its ethical, moral, and deeply relational nature, and propose that therapists' own spirituality can be a beneficial resource in the relationships they build and foster with those who consult them. Careful attention is given to how God calls us into relationships with others. Narrative therapy and spirituality are both defined as inherently relationalist practices and ways of being. Drawing on narrative therapy ideas, we describe a four step process we have used to explore therapists' spirituality in supervisory contexts specifically focusing on the relational nature of their work, and illustrate this process by giving supervision dialogues from some of our experiences.     

Handedness in Israel.

The handedness scores in 1171 Israeli high school students were found to be independent of ethnic origin, socio-economic class and reading direction. Contrary to other reports, sex differences were found neither between the mean handedness scores nor between the distribution of scores. The trends were in the expected direction—males were slightly less right handed than females—which was probably due to a higher percentage of males in the weak right handed range. The Israeli distribution was found to be significantly different from Taiwanese [1] and British [2] populations reported in the literature. Cultural and genetic factors giving rise to the differences in the distribution are discussed.     

Measuring Recurring Stigma in the Lives of Individuals with Mental Illness

We present an exploratory factor analysis of the 8-item Daily Indignities of Mental Illness (DIMI) scale, created to measure the detection and perceptions of recurring stigma among individuals with recent psychiatric hospitalizations. Structured in-person interviews were conducted with individuals with recent psychiatric hospitalizations in metropolitan New York. The 8-item DIMI scale’s internal consistency for the sample (n?=?65), measured by Cronbach’s alpha, was 0.869. Statistically significantly higher DIMI scale scores were observed among individuals with more than 2 psychotic episodes and those reporting seeing relatives less often after hospitalization. The DIMI scale possesses good internal consistency for research contextualizing perceptions around the occurrence or recurrence of mental illness-related stigma among individuals with recent psychiatric hospitalizations.     

Presenile dementia in Israel

A nationwide epidemiologic study of presenile dementia of the Alzheimer type (PDAT) with onset through age 60 years was carried out in Israel. The Israeli National Neurologic Disease Register and clinical records of all patients discharged from hospitals between 1974 and 1983 with a neurologic or psychiatric diagnosis suggestive of dementia were reviewed. A total of 71 Jewish patients with onset of PDAT between 1974 and 1978 was ascertained. The age at onset in these patients ranged from 43 to 60 years. The median survival was 8.1 years, with slightly longer survival if onset occurred before age 55 years, even after correction for expected mortality according to age and sex. The average annual incidence rate per 100,000 population at risk was 2.4 in the population aged 40 through 60 years. Although the incidence rates were slightly greater for women, the difference between the rates by sex was not statistically significant. The age- and sex-adjusted incidence of PDAT per 100,000 population was significantly higher in those born in Europe or America (2.9) than in those born in Africa or Asia (1.4). No significant difference in survival was found between these two groups. The curve of the incidence rates by age for PDAT in Israel is continuous with that for senile dementia of the Alzheimer type collected by similar methods elsewhere, which suggests that one disease process may account for both conditions.     

Down syndrome in Israel

The incidence of Down syndrome was studied in Jerusalem for the years 1964-1970 showing an overall incidence rate of 2.43 per 1,000 live births. A National Down Syndrome Register was established in 1978 and data on annual incidence and mortality rates from 1979-1997 is presented. The incidence in 1997 was 1.0 per 1,000 live births, but 2.32 per 1,000, when live births and terminated pregnancies are summed. Infant mortality has generally decreased in the past 20 years in Israel, and a decrease in infant mortality in Down syndrome has also been noted. This is due to better medical treatment and increased parental involvement in the care for infants with Down syndrome.