Ruth Pat-Horenczyk

Adolescent exposure to recurrent terrorism in Israel: posttraumatic distress and functional impairment.

This study examines the impact of exposure to ongoing terrorism on 695 Israeli high school students. Exposure was measured using a questionnaire developed for the security situation in Israel. Posttraumatic symptoms were measured using the UCLA PTSD Index for DSM-IV--Adolescent Version (N. Rodriguez, A. Steinberg, & R. S. Pynoos, 1999), functional impairment and somatic complaints were assessed using items derived from the Diagnostic Interview Schedule for Children (C. P. Lucas et al., 2001), and depression was measured with the Brief Beck Depression Inventory (A. T. Beck & R. W. Beck, 1972). According to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), the prevalence of probable posttraumatic stress disorder was 7.6%. Girls reported greater severity of posttraumatic symptoms, whereas boys exhibited greater functional impairment in social and family domains. School-based screening appears to be an effective means of identifying adolescents who have been exposed to terror and are experiencing posttraumatic stress symptomatology and psychosocial impairment.

Post-Traumatic Distress in Israeli Adolescents Exposed to Ongoing Terrorism: Selected Findings from School-Based Screenings in Jerusalem and Nearby Settlements

Summary This article examines the impact of exposure of ongoing terrorism on post-traumatic stress disorder (PTSD) symptoms, functional impairment, somatization, and depression among Israeli adolescents in the context of the Al Aqsa Intifada. An in-school screening of 1,010 adolescents was conducted in Jerusalem and nearby settlements that were subjected to intensive terrorist attacks. The screening procedure proved effective in identifying posttraumatic distress and triaging students for school-based treatments. The relationship between level of exposure and gender and the psychological sequelae, the differences between adolescents in Jerusalem and the settlements, and the role of spirituality and community are discussed.

COPING FLEXIBILITY AND COMPLICATED GRIEF: A COMPARISON OF AMERICAN AND CHINESE SAMPLES

The ability to process a death and the ability to remain optimistic and look beyond the loss are both thought to be effective means of coping with loss and other aversive events. Recently, these seemingly contrary dimensions have been integrated into the idea of coping flexibility.

Association of Direct Exposure to Terrorism, Media Exposure to Terrorism, and Other Trauma with Emotional and Behavioral Problems in Preschool Children

Abstract:  This study examined the differential impact of various types of trauma exposure on emotional and behavioral problems in preschool children. Participants were 95 mothers of 1‐ to 4‐year‐old children in Israel. Results suggested a differential pattern of associations between the types of trauma exposure (i.e., direct exposure to terrorism, media exposure to terrorism, and other trauma) and childrens internalizing and externalizing problems. This line of research is important for the identification of risk factors and the development of effective prevention and intervention strategies to promote resilience in preschool children exposed to specific type(s) of trauma.

Are Community Studies of Psychological Trauma's Impact Accurate? A Study Among Jews and Palestinians

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.

Posttraumatic Growth in Breast Cancer Survivors: Constructive and Illusory Aspects.

This study investigated the impact of a building-resilience intervention on coping and posttraumatic growth (PTG) in a convenience sample of 94 breast cancer survivors. PTG was divided into constructive and illusory components, based on the two-sided Janus face model (Maercker & Zoellner, 2004). We operationalized constructive PTG as an improvement in both PTG and coping, and illusory PTG as an improvement in PTG only. An 8-session group intervention was delivered to 49 women (mean age = 51.5 years, SD = 10.7) who completed self-report questionnaires at baseline and at 6 months follow-up; a control group of 45 women only completed questionnaires. More than half the participants (n = 53; 56.38%) reported increased PTG at 6 months (mean change = 0.56, SD = 0.48, η(2) = .58). The increase in both PTG and positive coping was significantly greater in the intervention group than the control group (B = 0.23 for PTG, and B = 0.35 for positive coping). Further, a higher proportion of constructive PTG (vs. illusory PTG) was reported by the participants in the intervention group (89.3%), as compared to the control group (56.3%; z = 2.57). The distinction between constructive and illusory PTG has clinical implications for interventions promoting coping and growth among cancer survivors.

Israeli adolescents with ongoing exposure to terrorism: Suicidal ideation, posttraumatic stress disorder, and functional impairment

In this study, we examined the relationships among terrorism exposure, functional impairment, suicidal ideation, and probable partial or full posttraumatic stress disorder (PTSD) from exposure to terrorism in adolescents continuously exposed to this threat in Israel. A convenience sample of 2,094 students, aged 12 to 18, was drawn from 10 Israeli secondary schools. In terms of demographic factors, older age was associated with increased risk for suicidal ideation, OR = 1.33, 95% CI [1.09, 1.62], p < .01, but was protective against probable partial or full PTSD, OR = 0.72, 95% CI [0.54, 0.95], p < .05; female gender was associated with greater likelihood of probable partial or full PTSD, OR = 1.57, 95% CI [1.02, 2.40], p < .05. Exposure to trauma due to terrorism was associated with increased risk for each of the measured outcomes including probable partial or full PTSD, functional impairment, and suicidal ideation. When age, gender, level of exposure to terrorism, probable partial or full PTSD, and functional impairment were examined together, only terrorism exposure and functional impairment were associated with suicidal ideation. This study underscores the importance and feasibility of examining exposure to terrorism and functional impairment as risk factors for suicidal ideation.

Growing Up Under Fire: Building Resilience in Young Children and Parents Exposed to Ongoing Missile Attacks

This article presents data from a project in Sderot, Israel designed to build resilience for 255 young children and their families. During the time of the project, the area was under continual exposure to missile attacks and resulting traumatic events. The phenomenology of living under continual exposure to missiles attacks, as well as the impact of the ongoing fear and uncertainty on both the children and their parents, are presented through voices of the parents. The clinical picture for young children and their parents coping with ongoing terrorism indicated a high level of posttraumatic distress for children (33%) and for mothers (28%). An integrative model was developed and implemented with three major components: clinical screening and treatment with an adjusted dyadic therapy for peritraumatic and posttraumatic circumstances; building resilience intervention by workshops for both parents and teachers; and building local capacity and sustainability by training local therapists, parents, and teachers.

The Role of Social Support for Israeli Adolescents Continually Exposed to Terrorism: Protective or Compensatory Factors?

This study investigated the role that social support plays in posttraumatic stress (PTS) and depressive symptoms among Israeli adolescents with high or low exposure to terrorist acts. Participants were 585 Jewish students (221 girls and 364 boys) in grades 7 to 12 from areas extensively versus slightly exposed to terrorist attacks. Results found that PTS levels and depressive symptoms were higher among adolescents residing in areas highly exposed to terrorism. Adolescents in high exposure areas reported lower perceived levels of support than adolescents in low exposure areas when gender, age, and religiosity were controlled. Social support was found to be a significant predictor for PTS and depressive symptoms, but no evidence for a buffering role of social support was obtained. We conclude that social support has a positive effect on a person’s mental health regardless of the type and level of the stressor the individual is exposed to.

Stability and transitions in posttraumatic growth trajectories among cancer patients: LCA and LTA analyses.

OBJECTIVES The objectives of the current study were to identify (a) different post cancer treatment adaptation profiles; (b) factors that predict these adaptation profiles; and (c) transitions in post cancer-treatment adaptation profiles and trajectories in a sample (N = 198) of female breast cancer patients over a 2-year period. METHOD Latent class analysis (LCA) was used to idenitfy profiles of post cancer treatment adaptation, based on a combined pattern of responses to observable indicators of distress, coping strategies, and posttraumatic growth. latent transition analysis (LTA) was used to track trajectories, based on the probabilities of transitions among latent classes. RESULTS Four postcancer treatment adaptation profiles were found: (a) distressed, (b) resistant, (c) constructive growth, and (d) struggling growth. CONCLUSIONS The majority of transitions between different adaptation profiles occurred between 6 and 12 months after treatment. These findings offer theoretical and practice implications regarding posttraumatic growth in breast-cancer patients by distinguishing between profiles of adaptation and highlights a previously unidentified profile-struggling growth. These results contribute to the theoretical understanding of the complex relationship between growth, distress, and coping. (PsycINFO Database Record