Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel
Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel
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DOI：
10.1001/jama.290.5.612
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发表时间：
2003-08-06
影响因子：
120.7
通讯作者：
Solomon, Z
中科院分区：
文献类型：
--
作者：
Bleich, A;Gelkopf, M;Solomon, Z
自2000年9月以来，对以色列社会的恐怖主义袭击一直在进行。然而，很少有研究探讨了恐怖主义对全国代表性的人口样本的影响，也没有研究探讨了正在进行的恐怖主义在以色列的心理影响。目的为了确定暴露于恐怖袭击的水平和创伤性应激相关（TSR）症状，创伤后应激障碍（PTSD）症状的患病率，以及在以色列恐怖主义19个月后的安全感，并确定心理后遗症的相关性和应对恐怖主义的方式。设计、设置和参与者电话调查，2002年4月至5月进行，采用分层抽样方法，902个符合条件的家庭和742名18岁以上以色列居民的代表性样本（82%的接触率）和512人（57%）的最终参与。主要结果测量TSR症状的数量，具有由斯坦福大学急性应激反应问卷评估的PTSD和急性应激障碍症状标准的那些的比率，自我报告的抑郁、乐观、安全感、求助、结果在512名被调查者中，84人（16.4%）曾直接暴露于恐怖袭击，191人（37.3%）的家人或朋友曾暴露于恐怖袭击。在回答有关TSR症状问题的510名参与者中，391名（76.7%）至少有1种TSR症状（平均值，4.0 [SD，4.5];范围，0 - 23;平均强度，0.8;范围，0 - 4）。48名参与者（9.4%）符合PTSD的症状标准，1名参与者符合急性应激障碍的标准; 299名（58.6%）报告感到抑郁。大多数受访者对他们的个人未来（421/512 [82.2%]）和以色列的未来（307/509 [66.8%]）表示乐观，并对他们在恐怖袭击中的能力表示自我效能（322/431 [74.6%]）。大多数人表示对自己（307/509 [60.4%]）和亲属（345/507 [67.9%]）的安全感较低。很少有人报告需要专业帮助（27/506 [5.3%]）。女性性别、安全感、使用镇静剂、酒精和香烟与TSR症状和PTSD的症状标准相关;暴露水平和客观风险无关。最普遍的应对机制是积极的信息搜索亲人和社会support.Conclusions考虑到以色列的创伤性经验的性质和长度，心理影响可能被认为是温和的。虽然调查参与者表现出痛苦和安全感降低，他们没有发展高水平的精神痛苦，这可能与习惯化过程和应对机制有关。
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.