Predictors of bereaved parents' satisfaction with group support: an Israeli perspective

This study evaluates various aspects of groupwork with bereaved parents who lost a child during military service. More specifically, it assesses the unique and cumulative contributions of various features of groupwork to the participants' satisfaction with the group support. One hundred and thirty-eight bereaved parents, who participated in 16 support groups, answered a battery of questionnaires tapping 3 aspects of the groupwork: their motives for joining the group, the interpersonal relations among the group members, and the group leadership style. In addition, the participants were asked to evaluate the contribution of the intervention to their adjustment. The findings indicate that the supportive elements of the intervention were associated with the groups' perceived contribution. The clinical implications of these results are discussed.     

Exposure to terrorism,stress-related mental health symptoms,and coping behaviors among a nationally representative sample in Israel

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.      

PTSD and social functioning

This longitudinal study assessed long term social functioning among two groups of Israeli soldiers: (a) front line soldiers who had been treated for combat stress reaction (CSR) during the 1982 Lebanon war (n = 213); and (b) matched controls who were front line soldiers participating in the same battles, but did not sustain a CSR (n = 116). Subjects were screened one, two, and three years after the war for PTSD and social functioning. Results indicated that CSR and PTSD casualties reported more problems in social functioning than controls. The link between PTSD and social functioning was stronger among PTSD veterans who had suffered an antecedent CSR episode. Time had a differential effect on the social functioning of CSR and control subjects.     

A 3-year prospective study of Post-traumatic Stress Disorder in Israeli combat veterans

This study attempted to trace the long-term psychiatric sequelae of combat in a large representative sample of combat stress reaction (CSR) Israeli casualties and matched controls. Employing DSM-III criteria for Post-traumatic Stress Disorder (PTSD) subjects were assessed 1, 2, and 3 years after their participation in the war. Results show that CSR casualties had dramatically higher rates of PTSD than controls at all three points of time. In both groups a decline in prevalence and breadth of PTSD was observed over time. The passage of time had a differential effect on the symptom profile of the CSR casualties and controls. Theoretical, methodological, and treatment implications are discussed.     

A Relational Model for the Intergenerational Transmission of Captivity Trauma: A 23-Year Longitudinal Study

Objectives: The aversive, long-term toll of war captivity and fathers’ combat-induced posttraumatic stress disorder (PTSD) on adult offspring’s secondary traumatization (ST) has been recently exemplified. However, the study of potential mechanisms of the intergenerational transmission of trauma to offspring is still lacking. This prospective study aimed to assess the role of fathers’ PTSD symptoms (PTSS), paternal parenting, and adult offspring’s attachment insecurities in adult offspring’s PTSS. Method: A sample of 124 Israeli father–child dyads (80 ex-POW dyads and a comparison group of 44 veteran dyads) completed self-report measures. The fathers participated in three waves of measurements following the Yom Kippur War (T1: 1991, T2: 2003, T3: 2008), while the offspring took part in T4 (2013). Results: Offspring of ex-POWs with PTSD at T3 reported more PTSS and higher levels of attachment insecurities than offspring of ex-POWs without PTSD and controls at T4. Fathers’ proximity to the children and sensitivity to the children’s needs were negatively related. Offspring’s attachment insecurities were positively related to offspring’s PTSS. Importantly, serial multiple mediation model results show that war captivity increased the level of the fathers’ PTSD at T2 and T3, which in turn decreased the level of the fathers’ parenting at T3, and thereby increased the level of offspring’s attachment avoidance at T4, which by its own merit was related to higher levels of adult offspring’s PTSS. Conclusions: The mechanisms of the intergenerational transmission of captivity-related trauma of veterans’ PTSD and paternal parenting, through offspring’s attachment insecurities and offspring’s PTSS, was exemplified.     

Posttraumatic Growth and Shattered World Assumptions Among Ex-POWs: The Role of Dissociation

Objective: The controversy regarding the nature of posttraumatic growth (PTG) includes two main competing claims: one which argues that PTG reflects authentic positive changes and the other which argues that PTG reflects illusionary defenses. The former also suggests that PTG evolves from shattered world assumptions (WAs) and that the co-occurrence of high PTG and negative WAs among trauma survivors reflects reconstruction of an integrative belief system. The present study aimed to test these claims by investigating, for the first time, the mediating role of dissociation in the relation between PTG and WAs. Method: Former prisoners of war (ex-POWs; n = 158) and comparable controls (n = 106) were assessed 38 years after the Yom Kippur War. Results: Ex-POWs endorsed more negative WAs and higher PTG and dissociation compared to controls. Ex-POWs with posttraumatic stress disorder (PTSD) endorsed negative WAs and a higher magnitude of PTG and dissociation, compared to both ex-POWs without PTSD and controls. WAs were negatively correlated with dissociation and positively correlated with PTG. PTG was positively correlated with dissociation. Moreover, dissociation fully mediated the association between WAs and PTG. Conclusion: These findings imply that PTG might reflect illusory defenses and raise questions regarding the integration between the co-occurrence of high PTG and negative WAs among trauma survivors.     

Changes in diagnostic criteria of PTSD: implications from two prospective longitudinal studies

This study assesses differences in PTSD rates according to different sets of diagnostic criteria. Two samples have been studied: one comprised of 286 combat stress reaction (CSR) casualties and 218 non-CSR veterans from the Lebanon war (Study 1); the other of 95 ex-POWs and 101 non-POWs from the Yom Kipur war (Study 2). Participants were administered two versions of the PTSD inventory based on different Diagnostic and Statistical Manual of Mental Disorders (DSM) editions: DSM-III and DSM-IV in Study 1 and DSM-III-R and DSM-IV in Study 2. PTSD rates declined when criteria of more recent DSM editions were applied. In addition, findings clearly demonstrate the importance of the dysfunction criterion (F) in PTSD. The highly complex nature of the PTSD diagnosis is discussed, as well as the important role of dysfunction and distress.