Adults Exposed to Terror Feel Distress and a Diminished Sense of Safety, but Are Able to Cope
Studies show that people who experience catastrophic events such as a terrorist attack or school shooting show a wide range of reactions. Some suffer from “normal” after-effects including worries and bad memories, which fade with emotional support and time. Others are more deeply affected and experience long-term problems including ]]>post-traumatic stress disorder]]> (PTSD) and ]]>depression]]> . Experts believe that the more direct exposure a person has to a traumatic event, the higher the risk he or she has of serious emotional harm.
To date, little research has been done to assess the impact of modern forms of terrorism on a national scale. In a new study, however, researchers examined the psychological impact of the ongoing terror in Israel. The results are published in the August 6, 2003 issue of the Journal of the American Medical Association (JAMA)—devoted entirely to violence and human rights. The researchers show that although about half of the study participants had experienced a terrorist attack either personally or through a friend or family member since September 2000, they have not developed a high frequency of psychiatric illness.
About the Study
The researchers conducted a telephone survey of 512 randomly selected participants using a structured questionnaire. Trained telephone-survey professionals carried out the interviews on April 30 and May 1, 2002—by which time Israelis had experienced 19 months of terrorism from the start of the intifada (the uprising by Palestinians against Israel). The questionnaires measured:
Traumatic stress-related (TSR) symptoms, including:
- symptoms of acute stress disorder (ASD), such as panic attacks or obsessive thoughts
- symptoms of posttraumatic stress disorder (PTSD), such as flashbacks or emotional numbness
- Means of coping
- Sense of safety
- Attitude regarding the future
Participants represented a cross-section of Israel’s heterogeneous population and included Jews and Arabs and men and women with a variety of educational and socioeconomic backgrounds.
Exposure to terrorism was assessed by asking participants whether:
- They or a friend or family member had witnessed a terrorist attack
- They or a friend or family member were injured or died in the attack
Of the 512 survey participants, 16.4% had been directly exposed to a terrorist attack and 37.3% had a family member or friend who had been wounded or killed by terrorists. Of the 510 participants who responded to questions about traumatic stress-related (TSR) symptoms, 76.7% had at least 1 symptom. Symptom criteria for PTSD were met by 9.4% of participants while less than one percent met symptom criteria for ASD. More than half (58.6%) reported feeling depressed or gloomy. No association was seen between level of exposure and the number or intensity of any type of symptom.
In addition, 22.7% reported that their work or social functioning was impaired and 60.4% declared they felt their lives were in danger. The most frequently used modes of coping were checking on whereabouts of family and friends, instrumental support (talking to others about what could be done), and emotional support (talking to others about their feelings).
At the same time, the majority of participants (82.2%) felt optimistic about their future and two-thirds (66.2%) felt optimistic about the future of Israel. Furthermore, nearly three-quarters (74.6%) agreed they would know what to do in the event that they were caught in an attack. Only 5.3% stated they felt a need for professional treatment.
The study has a number of limitations including the absence of psychiatric data prior to September 2000, and the fact that the responses of those who were exposed to terrorism were not directly compared to responses of those who weren’t exposed. Consequently, the researchers could not properly measure the emotional impact of the terrorism. Moreover, since the researchers focused on adults, there is no information regarding the effect of terrorism on Israelis under age 18.
How Does This Affect You?
This study confirms that ongoing terrorism has a substantial emotional impact, even on those members of a society only indirectly exposed to an attack (e.g., through the media). Although it is not clear why, most Israeli adults appear to be adapting to the situation—despite the high levels of distress and concerns about safety.
While this study did not focus on children, another study from the same issue of JAMA investigated the effect of cognitive-behavioral group therapy on children exposed to violence in Los Angeles. After 10 sessions, students who had been exposed to violence prior to the study showed significantly fewer symptoms of PTSD and depression compared to students who had also been exposed to violence but who had not participated in the group therapy program. When the comparison group of students received the therapy three months later, they too showed a significant reduction in PTSD and depression symptoms.
Violence, in its many forms (terror, gang related, physical abuse, isolated crimes, etc.), is sadly a prevalent feature in many societies today, leaving almost no one untouched. While many people seem to pull together and function after a violent experience, others may develop serious mental health disorders like depression and PTSD. It is encouraging to find that people are able to cope in such difficult situations and that programs can be developed to reduce symptoms of mental illness.
U.S. Department of Health and Human Services: Substance Abuse and Mental Health Services Administration (SAMHSA)
National Institute of Mental Health
Bleich A, Gelkopf M, Solomon Z. Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. JAMA . 2003;290(5):612-20.
Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, Fink A. A mental health intervention for schoolchildren exposed to violence. JAMA . 2003;290(5):603-11.
Silver RC, Holman A, McIntosh DN, Poulin M, Gil-Rivas V. Nationwide longitudinal study of psychological responses to September 11. JAMA . 2002;288(10):1235-44.
Last reviewed August 7, 2003 by ]]>Richard Glickman-Simon, MD]]>
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