Talya Greene

The relationship between posttraumatic stress disorder symptoms and paternal parenting of adult children among ex-prisoners of war: a longitudinal study.

The aversive impact of combat and combat-induced posttraumatic stress disorder (PTSD) on parenting of young children has been examined in a few studies. Nevertheless, the toll of war captivity on parenting and the long-term relations between posttraumatic symptoms and paternal parenting of adult children remains unknown. This longitudinal study examined paternal parenting of adult children among war veterans, some of whom were held in captivity. Furthermore, we examined the mediating role of PTSD symptoms in the association between captivity and parenting. The sample included two groups of male Israeli veterans from the 1973 Yom Kippur War: ex-prisoners of war (ex-POWs) and comparable veterans who had not been held captive. Both groups were assessed via self-report measures of PTSD at three time points: Time 1 (18 after the war), Time 2 (30 after the war), and Time 3 (35 after the war) years after the war. Results shows that ex-POWs reported lower levels of positive parenting compared to comparison group veterans at Time 3. Furthermore, PTSD symptoms at Time 1, Time 2, and Time 3 mediated the association between captivity experience and parenting at Time 3. In addition, it was found that increases in the levels of PTSD symptom clusters over time were associated with lower levels of positive parenting at Time 3.

Secondary traumatization and self-rated health among wives of former prisoners of war: The moderating role of marital adjustment

We investigated the relationships between secondary traumatization, marital adjustment, and self-rated health among wives of former prisoners of war. Participants were Israeli wives of former prisoners of war (N = 116) and a matched control group of wives of combat veterans (N = 56). Wives of former prisoners of war reported worse self-rated health compared to the control group of wives of combat veterans. Wives of former prisoners of war also reported higher levels of secondary traumatization, and marital adjustment moderated the relationship between wives’ secondary traumatization and their general health. The experience of living with former prisoners of war who might also suffer from posttraumatic stress disorder is associated with wives’ own psychological and self-rated health outcomes.

Loneliness Trajectories: The Role of Posttraumatic Symptoms and Social Support

This study prospectively examines the longitudinal course of loneliness, social support, and posttraumatic symptoms (PTS) among Israeli war veterans. Two groups of veterans with and without antecedent combat stress reaction (CSR) were assessed at three points of time during a 20-year period. Veterans with CSR reported higher levels of loneliness compared with veterans without CSR. Loneliness remained stable among veterans with CSR but decreased among veterans without CSR. Baseline level of social support predicted the trajectory of change in loneliness. Finally, higher levels of PTS and lower levels of social support were associated with more loneliness among veterans with CSR.

Improving mental health is key to reduce violence in Israel and Gaza

1 Manduca P, Chalmers I, Summerfi eld D, Gilbert M, Ang S. An open letter for the people in Gaza. Lancet 2014; published online July 22. http://dx.doi.org/10.1016/S01406736(14)61044-8. 2 Council of the European Union Foreign Aff airs. EU Council conclusions on the Middle East Peace Process (22 July 2014, Brussels). http:// www.eu-un.europa.eu/articles/en/ article_15300_en.htm (accessed July 30, 2014). 3 UNRWA. UNRWA condems placement of rockets, for a second time, in one of its schools. http://www.unrwa.org/newsroom/pressreleases/unrwa-condemns-placement-rocketssecond-time-one-its-schools (accessed July 30, 2014). 4 Schwartz M, Abdelaziz S, Levs J. Israel drops leafl ets warning Gaza residents to evacuate ahead of strikes. CNN, July 13, 2014. http:// www.cnn.com/2014/07/13/world/meast/ mideast-tensions/ (accessed July 30, 2014) 5 McCoy T. How Hamas uses its tunnels to kill and capture Israeli soldiers. The Washington Post, July 21, 2014. http://www. washingtonpost.com/news/morning-mix/ wp/2014/07/21/how-hamas-uses-itstunnels-to-kill-and-capture-israeli-soldiers/ (accessed July 30, 2014). 6 WHO press release. Access to essential medicines and disposables in the Gaza Strip, 2012. http://www.emro.who.int/palestinepress-releases/2012/access-essentialmedicinesgaza.html (accessed July 30, 2014). 7 Hamas Covenant 1988. The Covenant of the Islamic Resistance Movement. http://avalon. law.yale.edu/20th_century/hamas.asp (accessed July 30, 2014).

Trajectories of traumatic stress symptoms during conflict: A latent class growth analysis

BACKGROUND The ways in which traumatic stress symptoms unfold under situations of ongoing threat and trauma exposure are poorly understood. The current study aims to identify traumatic stress symptom trajectories during conflict, as well as potential risk factors. METHODS Experience sampling methods were used to study traumatic stress symptoms during the 2014 Israel-Gaza conflict in 100 Israeli civilians exposed to rocket fire. Summary reports of traumatic symptoms were made twice-daily for 30 days via mobile phone. RESULTS Latent class growth analysis revealed four distinct classes (low, reducing, moderate, and high) characterised by their trajectory of traumatic stress symptoms during the conflict. Female gender, not being in a relationship, and higher prior trauma exposure were identified as potential risk factors. LIMITATIONS Data were not collected in the early phase of the conflict, the sample was relatively small, and only traumatic stress symptoms were investigated as outcomes. CONCLUSIONS This study identified heterogeneous traumatic stress symptom trajectories among civilians during a conflict, with different subgroups showing distinct response patterns over time, associated with various risk factors. Investigating responses to ongoing trauma, and identifying predictors of different stress symptom trajectories has clinical implications for the targeted delivery of interventions. Further exploration of heterogeneous trajectories could potentially elucidate mechanisms that drive resilience and recovery, including in situations of ongoing exposure such as during conflict.

A Longitudinal Study of Secondary Posttraumatic Growth in Wives of Ex-POWs

Objective: The current study aimed to investigate (a) “secondary” posttraumatic growth (PTG) in wives of former prisoners of war (ex-POWs) and its association to husbands’ captivity, husbands’ posttraumatic stress disorder (PTSD), and husbands’ PTSD trajectories; and (b) the bidirectional relationships over time between wives’ posttraumatic stress symptoms (PTSS) and PTG. Method: The study compared 116 wives of Israeli ex-POWs from the 1973 Yom Kippur War with 56 wives of a matched control group of non-POW combat veterans. Wives were divided into groups according to husbands’ captivity status, husbands’ PTSD status, and husbands’ PTSD trajectories; and ANOVAs and MANOVAs were conducted to assess group differences in PTSS and PTG, both cross-sectionally and longitudinally. Autoregressive cross-lag modeling was also used to assess bidirectional relationships between wives’ PTSS and PTG over time. Results: Wives of ex-POWs with PTSD reported significantly higher PTG compared with wives of ex-POWs without PTSD and wives of controls. While PTG and PTSS remained stable over time, importantly, the Time 1 (T1) level of PTG predicted avoidance symptoms at Time 2 (T2); the higher the wives’ PTG at T1, the higher their avoidance symptoms at T2, but not vice versa. Conclusions: These findings support the notion that “secondary PTG” exists. They also strengthen the theory that growth and distress can co-occur. Finally, the finding that PTG predicted subsequent avoidance symptoms suggests that PTG does not prevent the future development of distress.

Secondary Traumatization and Marital Adjustment among Former Prisoners of War Wives

We aimed to assess the associations between secondary traumatization (ST) and perception of husbands’ posttraumatic stress symptoms (PTSS) and marital adjustment among wives of former prisoners of war (POWs). Wives of Israeli ex-POWs and wives of a matched control group of combat veterans were assessed using self-report measures. Ex-POWs’ wives reported higher levels of ST and perception of their husbands PTSS and lower levels of marital adjustment compared with veterans’ wives. Both attachment avoidance and family boundaries were associated with marital adjustment. In addition, family boundaries moderated the relationship between wives’ attachment anxiety and marital adjustment. Implications for research and practice are discussed.

Sense of Threat as a Mediator of Peritraumatic Stress Symptom Development During Wartime: An Experience Sampling Study

Exposure and sense of threat have been associated with stress symptoms, yet these relationships have not been clarified during the peritraumatic period. We investigated the mediating role of sense of threat in the link between exposure to rocket warning sirens and stress symptoms during wartime, and the effect of severe mental illness (SMI) status and gender on this mediation. A 30-day twice-daily smartphone-based intensive assessment of exposure to sirens, sense of threat, and peritraumatic stress symptoms was performed during the 2014 Israel-Gaza conflict. Participants included 182 highly exposed individuals with or without SMI. Multilevel structural equation modeling analysis was performed, with SMI status and gender as confounders. Exposure affected the level of peritraumatic stress symptoms both directly, b = 1.07, p < .001, 95% CI [0.32, 1.82], and indirectly, b = 0.78, p < .001, 95% CI [0.24, 1.33], through sense of threat. The effect of sense of threat on stress symptoms was larger in the SMI group, b = 0.86, p < .001, 95% CI [0.31, 1.40]. Gender did not have a significant effect. Sense of threat has a key role in symptom development during the peritraumatic timeframe. Intervention and prevention efforts should start early and focus on promoting a sense of safety, particularly with people with SMI.

Peritraumatic Reaction Courses During War: Gender, Serious Mental Illness, and Exposure

Objective: We assessed in vivo symptom courses of early psychological responses during war and investigated the influence of exposure, gender, and a prior diagnosis of severe mental illness (SMI). Method: Participants were 181 highly exposed individuals from the general population and community psychiatric rehabilitation centers. A 30-day twice-daily Internet-smartphone-based intensive assessment two weeks into the 2014 Israel–Gaza war estimated peritraumatic symptom clusters, sense of threat, negative emotions and cognitions, and siren exposure during two periods that varied in exposure level. Piecewise growth curve modeling procedures were performed. Results: We found different courses for most variables, gender, and SMI status. Women were more reactive two weeks into the war but reduced their reactivity level at a faster pace than males, reaching lower symptom levels one month later. Women’s courses were characterized by arousal, negative emotionality, sense of threat, and reactivity to siren exposure. No-SMI men had a stable course followed by a significant reduction in arousal, negative emotions, avoidance, and perceived threat during a “return to routine” lower-level intensity period of the war. Individuals with SMI had higher reactivity levels at study onset; but while women with SMI improved over time, men with SMI worsened. SMI reactivity was characterized by negative cognitions, intrusions, and avoidance. Conclusions: Early reactions during prolonged exposure to war are variable, dynamic, and affected by exposure context. Symptoms, emotions, and cognitions develop differentially over time and are affected by gender and mental health status. The identification of various early stress courses should inform primary intervention strategies.

Blame, PTSD and DSM-5: an urgent need for clarification

ABSTRACT DSM-5 substantially revised the PTSD criteria relating to exposure, redrawing symptom clusters and introducing additional symptom criteria, among them a newly defined criterion of persistent distorted blame of self or others. This commentary argues that there are fundamental problems with the current DSM-5 formulation of the blame criterion for PTSD. Most critically, there is conflation of self-blame and other-blame, which are two distinct phenomena, and there is heterogeneity in the research findings regarding the association between both kinds of blame and PTSD. Secondly, distortion of blame may be complex to determine. Finally, standard assessment tools fail to accurately represent the criteria as currently formulated. Despite the conceptual ambiguity in the diagnostic criteria and the lack of clarity regarding the assessment of this item in commonly-used measures, there is also evidence that blame is associated with other PTSD symptoms, is clinically relevant and may be an important intervention target in therapy. It is crucial, therefore, to clarify the blame criterion, differentiating aspects of self-blame and other-blame and, even more importantly, delineating the boundaries between normal and pathological blame.