Ways of coping and sense of belonging in the face of a continuous threat

The prevalence of PTSD and coping strategies among Palestinian mental health professionals during political violence and wartime

Background

In times of war, mental health professionals are at an increased risk of developing psychological problems, including posttraumatic stress disorder (PTSD). The effects of conflicts or wars on mental health professionals in Palestine and their coping methods of dealing with these challenges remain unknown. This study aimed to assess the prevalence of PTSD symptoms and strategies for coping among mental health professionals in Palestine, in light of the ongoing Gaza war and political violence.

Methods

The study utilized a cross-sectional research design. Self-reported questionnaires, including the PCL-5 and Brief COPE scales, were used to gather data. The relationship between the research variables and PTSD symptoms was investigated using frequencies, percentages, bivariate analysis, Pearson correlation, and Pearson's chi-square test.

Results

A total of 514 participants were recruited, with an estimated prevalence of PTSD of 38.7%. Furthermore, the multivariate analysis revealed that having a prior history of trauma and feeling disabled or unable to deal with your patients during the current Gaza war and Israeli-Palestinian political violence increases the likelihood of developing PTSD symptoms. In addition, using venting, self-blame, and behavioral disengagement as coping strategies increases the likelihood of developing symptoms of PTSD. Moreover, using acceptance and substance use as coping strategies reduces the risk of developing PTSD symptoms.

Conclusion

The findings revealed a high prevalence of PTSD symptoms among mental health professionals during wartime and political violence. As a result, mental health professionals need immediate assistance in enhancing their mental wellbeing through supervision, psychotherapy, and comprehensive and continuous training.

Peer Teasing and Restrained Eating among Chinese College Students: The Chain Mediating Role of Negative Coping Styles and Negative Physical Self

This study aimed to determine whether negative coping styles and negative physical self sequentially mediate the relationship between peer teasing and restrained eating among Chinese university students. In total, 1127 participants (66.9% women, average age = 18.43 years; age range, 14-26 years) completed the Perception of Teasing Scale, Coping Style Questionnaire, Negative Physical Self Scale, and the Chinese version of the Restraint Scale. The mediational analysis showed that, after controlling for age, sex, and body mass index (BMI), peer teasing was related to restrained eating behaviors through (a) the mediating effect of negative coping styles, (b) the mediating effect of negative physical self, and (c) the chain-mediating effect of negative coping styles and negative physical self. This study showed for the first time that negative coping styles and negative physical self may chain mediate the association between peer teasing and restrained eating. It also provides suggestions for clinical practices as to strategies for controlling restrained eating.

Political violence and posttraumatic stress symptoms among Palestinians: The mediating roles of sense of belongingness and loneliness

The current study investigated the correlation between political violence and posttraumatic stress symptoms (PTSS) and whether the sense of belongingness (SOB) and loneliness mediate the correlation between the two variables among Palestinians living in a society characterised by high political violence and prolonged traumatic events. The study sample consisted of 590 Palestinian adults, consisting of 360 men and 230 women, and were recruited using non-probabilistic convenience sampling methods from a village in the northern region of the occupied Palestinian territories. This study suggests a positive correlation between political violence and PTSS, a positive correlation between loneliness and PTSS, and a negative correlation between SOB and PTSS. SOB and loneliness mediated the correlation between political violence and trauma-related symptoms.

Exposure to continuous political violence: rational and experiential thinking styles, coping styles and post traumatic stress symptoms

Cognitive style is considered an important determinant of individual behavior. The aim of the present study was to examine the relations between rational and experiential thinking styles, coping styles and Post Traumatic Stress (PTS) symptoms among civilians exposed to continuous and ongoing exposure to political violence. Three-hundred and thirty-two Israeli adult citizens living in the south region of Israel reported on their experiences of exposure to political violence as well as level of PTS, coping styles, and preference toward rational and experiential processing style. Results showed that low rational thinking was related with elevated PTS, both directly and indirectly through the mediation of high emotion-focused coping. The findings suggest that rational thinking may serve as a protective factor against stress related to chronic exposure to political violence; conversely, a preference for low rationality may be a risk factor.

A Model for Predicting Fear of Terrorism through Fear of Crime, Gender, Locus of Control and Coping Strategies

This study examines the assumption that aspects of fear of crime (fear of rape and sense of insecurity) predict fear of terrorism. The online survey included 754 Israeli respondents, who answered questions about their demographic characteristics, fear of terrorism, fear of crime indicators (fear of rape and sense of insecurity), locus of control (LOC; internal and external), and coping strategies. The findings indicate that for women, higher belief in chance and fate, and powerful others (external LOC), higher sense of insecurity, and higher fear of rape were related to a higher fear of terrorism. For men, higher belief in chance and fate (external LOC), higher sense of insecurity, and higher fear of rape were related to a higher fear of terrorism. Furthermore, the effect of fear of rape on fear of terrorism was mediated by sense of insecurity. Our findings support the assumption that fear of crime shadows and affects fear of terrorism for men as well as women. Therefore, fear of rape should be addressed as a significant issue for both genders.

Suicide Ideation, Distress, and Peer Perceptions as Predictors of Substance Use

BACKGROUND

Substance use and suicide ideation are common behaviors that often overlap among college students. However, clues about their temporal relationship, as well as moderating factors (e.g., distress, peer perceptions of substance use), are understudied. Indeed, those with a history of suicide ideation may use avoidance coping (including substance use) to manage distress, underscoring the possibility of substance use as a response to suicide ideation, an oft-stressful experience in and of itself. Further, as a low sense of belongingness confers risk for suicide ideation, distress may increase compliance with perceived cultural norms, thus increasing substance use behavior. This study examined the effect of the suicide ideation-distress-peer perception interaction on substance use.

METHOD

Participants were 3,608 undergraduate students across eleven college campuses. Measures of past month substance use frequency, general distress, peer perceptions of substance use, and past year suicide ideation were utilized.

RESULTS

Suicidal ideation was associated with e-cigarette, marijuana, and illicit drug use. There were main effects of suicide ideation (on e-cigarette and marijuana use) and peer perceptions of substance use (on tobacco, alcohol, e-cigarette, and marijuana use), but not distress, on past 30-day substance use. Further, the three-way interaction of suicide ideation, distress, and peer perceptions of substance use predicted frequency of past month tobacco and illicit drug use.

CONCLUSIONS

Suicide ideation may be temporally linked to use of specific substances. Peer perception and distress may strengthen the suicide ideation-substance use relationship. These factors should be carefully considered when treating individuals with substance use.

A Model for Predicting Post-Traumatic Stress Disorder due to Exposure to Chronic Political Violence: Big Five Personality Traits, Ego-Resiliency, and Coping

Research on psychological effects of exposure to political violence has focused mainly on the effect of environmental factors whereas the effect of individual differences is understudied. The present study offers an integrative model of the contribution of personality traits, ego-resiliency, and coping styles to post-traumatic stress (PTS) symptomatology of civilians exposed to chronic political violence. Three-hundred and thirty-two Israeli citizens living in the south region of Israel were asked to report their experience with different types of political violence incidents, their coping strategies, and PTS symptoms. The participants were also asked to complete the Big Five personality Inventory and Ego-Resiliency Scale. Structural Equation Modeling (SEM) analysis indicated that ego-resiliency and emotion-focused coping mediate the relationship between big five personality traits and levels of stress symptoms. It is suggested that neurotic people are more vulnerable to PTS due to low levels of ego-resiliency and a preference to use emotion-focused coping strategies.

COVID-19 vs. terrorism: Contribution of the COR theory to the process of coping with invisible threats

Two years have passed since the outbreak of the COVID-19 pandemic. The entire world is still struggling with the virus and its mutations, and governments have been imposing various restrictions, including social distancing and quarantine. This paper leans on the Conservation of Resources (COR) theoretical model in comparing the impact of COVID-19 with that of an ongoing threat of terror attacks, allowing us to understand the similarities and differences between them. Such exploration could result in an understanding that may guide devising psycho-social interventions to minimize the negative psychological consequences of a continuous life-threatening situation. By applying the extensive available literature on the aftermath of terrorist attacks to the little-known long-run consequences of the COVID-19 pandemic, this paper comes up with several guidelines such as increasing online social support and enhancing adaptive coping with stress, that are applicable on the individual, community, and societal levels.

Social support, resilience, and mental health in a low-intensity warfare context: the effects of siege on university students in Gaza

BACKGROUND

Gaza has long been enduring a quasi-total siege that significantly undermines quality of life in the region. Gazan youth are particularly affected by the ongoing economic recession, a disrupted environment, and health and food insecurity. These critical circumstances are worsened by the ongoing conflict between Palestine and Israel, which is a cause of death and destruction.

AIMS

This cross-sectional study investigated the effects of living under protracted siege conditions on mental distress, resilience, and social support among a sample of Palestinian university students living on the Gaza Strip.

METHODS

Five hundred fifty Palestinian university students were recruited at four universities in Gaza. They completed a battery of instruments, including the Gaza Siege Checklist, Depression, Anxiety and Stress Scale (DASS), Resilience Scale (RS), and Berlin Social Support Scales (BSSS). We used structural equation modelling (SEM) to test a conceptual model of social support and resilience as protective factors against the impact on mental distress of living under siege.

RESULTS

Our findings indicate that living under siege has direct adverse effects, leading to increased mental distress in the form of anxiety, depression, and acute stress. Enduring siege conditions compromises resilience and sources of social support, thereby increasing subjects' risk of developing psychological distress.

Don't Downplay "Play": Reasons Why Health Systems Should Protect Childhood Play

Much research has studied the importance of play for children's development. However, questions of its political importance and our public institutions' duties to protect it have been largely neglected. This article argues that childhood play is politically important due to having both intrinsic and instrumental value, and it suggests that the duty to protect the capability for play in childhood falls especially on the public health system. If this argument succeeds, it follows that we have stronger duties toward our children than we currently believe.

Sexual assault, sense of belonging, depression and suicidality among LGBQ and heterosexual college students

To compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among lesbian, gay, bisexual, queer and questioning (LGBQ) and heterosexual students. Participants: A total of 60,194 students from 60 US campuses who participated in the 2017-2018 Healthy Minds Study. Methods: Three-way interaction effects were analyzed using PROCESS macro models in SPSS. Results: Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b = -0.06, p= 0.042, CI: -0.12 to -0.00), and suicidality (b = -0.10, p= 0.004, CI: -0.01 to -0.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health. Conclusion: Enhancing sense of belonging may represent a strategy to mitigate depression and promote suicide prevention, particularly among LGBQ students.

Spousal Coping Strategies in the Shadow of Terrorism

The present study focuses on spousal differences in reaction to ongoing exposure to terror and security threats. Sixty-eight married couples with children living in a region exposed to ongoing security threats were evaluated. All participants completed questionnaires on objective exposure (number of incidents) and subjective exposure (sense of fear) to terrorism and security threats, posttraumatic stress disorder (PTSD) symptoms, and their coping strategies with this ongoing exposure. Mothers reported higher levels of fear and PTSD symptoms, although their objective levels of exposure did not differ from those of their husbands. Similarities were found in coping strategies adopted by mothers and fathers to cope with life in the shadow of terrorism. Both mothers and fathers integrated emotion- and problem-focused coping strategies, with greater use of the latter. These similarities partially contradict research findings suggesting gender differences in coping with exposure to security threats. The results support the need for further research into investigating the role of dyadic coping in the context of prolonged exposure to security threats.

Continuous Traumatic Stress and the Life Cycle: Exposure to Repeated Political Violence in Israel

PURPOSE OF REVIEW

Millions of individuals and families live under continual exposure to threat such as protracted socio-political conflict or community violence facing current and future danger. The construct of continuous traumatic stress (CTS) was suggested as a supplement perspective for the understanding of the specific impact of living under both current and realistic future threat. Yet, the unique parameters, utility, and validity of the construct CTS are underexplored.

RECENT FINDINGS

Currently, CTS describes both the exposure and the unique clinical conglomerate of distress. In this paper, we first elaborate on the rationale for the construct of CTS. Then, we present evidence on the consequences of exposure to CTS in the Israeli context of continual ongoing and prolonged political violence. Research on CTS is presented across the life cycle with an emphasis on risk and protective factors from a developmental perspective. We conclude with implications for research, assessment, and interventions.

Risk perception of a chronic threat of terrorism: Differences based on coping types, gender and exposure

High levels of risk perception of terrorism (RPT) may impair an individual's quality of life and welfare. To understand the mechanisms responsible for RPT, this study investigated the association of gender and coping styles with individual differences in two key elements of RPT: perceived control and perceived vulnerability. A convenience sample of 400 Israelis (181 men and 219 women) filled out questionnaires on sociodemographic background, RPT and coping. Employing a multidimensional approach for coping, we divided participants into four coping types: problem-focused (n = 65), emotion-focused (n = 70), mixed (n = 122) and minimal (n = 142). The results indicate that problem-focused coping is associated with higher levels of perceived control than other types of coping and mixed coping is associated with higher levels of perceived vulnerability than other coping strategies. Also, interactions between gender and exposure to terrorism contributed to understanding the differences in perceived control. The discussion addresses gender differences in RPT and coping in the context of traditional gender roles. The study concludes with implications for risk management and therapeutic interventions regarding high levels of fear of terrorism.

Patterns in response to chronic terrorism threats: A construct of emotional, cognitive, and behavioral responses among Israeli citizens

Israeli citizens are exposed to unpredictable and chronic terrorism threats that significantly jeopardize their personal sense of safety. The purpose of the present study is to present how Israeli discourse is structured with regard to emotional, cognitive, and behavioral responses to chronic terrorism threats and to understand the range of responses as well as map the risk and protective factors of this existential threat. Semistructured in-depth interviews were conducted with 40 Israeli adults (22 women and 18 men). Qualitative analysis revealed three patterns of responses to ongoing terrorism: emotional, cognitive, and behavioral. Emotional responses include fear, worry, sense of empathy, and detachment. Cognitive responses include situational assessment and pursuit of solutions, the use of traumatic imagining, beliefs in fate and luck, and optimism. Behavioral responses include looking for information, alertness, and habituation. The findings also revealed another response, which combines cognitive and behavioral responses. Some of the responses are innovative and unique to the threat of terrorism. Mapping the responses revealed mental health risk factors, as well as protective factors that can help structure personal and national resilience. These findings have implications on the treatment and prevention of personal and social pathologies, and how to effectively cope with terrorism threats.

Children and adolescents facing a continuous security threat: Aggressive behavior and post-traumatic stress symptoms

There is extensive research evidence indicating that children and youth are the most vulnerable population for developing psychological symptoms relating to war and terror. Although studies have documented a wide range of detrimental emotional and behavioral effects of such exposure, much less is known about the effects of exposure to a continuous security threat for children and adolescents. Against this background, the current article examined the implications of continuous exposure to missile attacks among 1096 children and adolescents enrolled in public schools near the Israeli border with Gaza. Participants filled out quantitative questionnaires, which relate to the pathological consequences of continuous exposure to security threats, and to the role of the school and the community as a protective environment against disruptive behavior resulting from such exposure. The findings revealed that PTSS responses were mainly related to the security threat, whereas interpersonal aggression resulted from other types of traumatic events. Significant differences were found between aggression and posttraumatic symptoms, by age and gender. PTSS was found to be lower for older participants and higher for girls, whereas aggression was higher for boys and higher for older participants. Furthermore, the sense of belonging to the place of residence was negatively associated with PTSS as well as with aggressive behavior: the higher the participants' sense of belonging, the lower their levels of PTSS and aggressive responses. In contrast, the sense of belonging to the school was negatively associated only with aggressive behavior: the higher the participants' sense of belonging to the school, the lower their aggressive responses. The findings are discussed in the light of trauma theories and in light of the results of previous research. The study contributed to knowledge about the differential consequences of exposure to a security threat, and highlighted the importance of differential interventions with children who show post-traumatic symptoms versus those who show aggressive behavior. Accordingly, the security situation should not overshadow social issues that need to be addressed, such as family violence and aggression among school children.

Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis

OBJECTIVE

To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD).

METHODS

402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life.

RESULTS

The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (β = 0.39) and SIBDQ (β = 0.12), number of children impacted SWLS (β = 0.10), emotion-focused coping impacted SWLS (β = 0.11), dysfunctional coping impacted SWLS (β = -0.25). In an indirect path, economic status impacted dysfunctional coping (β = -0.26), dysfunctional coping impacted SIBDQ (β = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (β = 0.43) more than women (β = 0.26); emotional coping impacted SWLS in women (β = 0.36) more than men (β = 0.14).

CONCLUSIONS

Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.

Simple pain measures reveal psycho-social pathology in patients with Crohn’s disease

AIM

To determine whether pain has psycho-social associations in adult Crohn’s disease (CD) patients.

METHODS

Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.

RESULTS

The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.

CONCLUSION

Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Continuous Traumatic Situations in the Face of Ongoing Political Violence: The Relationship Between CTS and PTSD

This article presents a literature review of the concept of continuous traumatic situations (CTS), which relates to residents living in ongoing situations of political violence and national security threats. The first aim of this review is to narrow the gap regarding knowledge about the concept of CTS by presenting findings from studies that have assessed the effects of CTS on civilian populations. The second aim is to describe CTS in a way that highlights the differences and similarities between posttraumatic stress disorder and responses to CTS. This distinction is a necessary precondition for examining CTS, as is a careful clinical analysis of the development and course of symptoms. This literature review also highlights the importance of adopting a supplementary perspective for understanding the psychological impact of ongoing exposure to real threats, which can be used as a basis for developing intervention strategies that are appropriate for coping with life in the context of persistent violence. CTS can be manifested as emotions, behaviors, and perceptions among individuals, families, communities, and societies. The nature of the proposed model of CTS is a circular one, combining past and future perceptions and emotional reactions that have resulted from continuous and repeated traumatic experiences over an extended period of time. This wider understanding reflects the complexity of the CTS phenomenon. Various micro and macro interventions relating to CTS as the result of political violence situations and national security threats are presented, and recommendations for practice, policy, and future research are offered.

Contextual Positive Coping as a Factor Contributing to Resilience After Disasters

OBJECTIVE

Strategy-situation fit, or contextual coping, posits that the physical and psychological demands associated with stressors are determined in part by the characteristics of each stress situation and may therefore require the use of different coping strategies. In this review, we discuss strategy-situation fit in the context of both natural and manmade disasters as it pertains to positivity and, ultimately, resilience after disasters.

METHOD

We reviewed the relevant literature on positivity and coping with disasters using a contextual approach.

RESULTS

We identified several disaster-related characteristics (i.e., cause of disaster, temporal characteristics of disasters, and degree of resource loss) that might influence the efficacy of positive coping strategies. We then discussed strategies that could be useful for promoting resilience with regard to these different characteristics.

CONCLUSION

This work represents an initial step in conceptualizing disaster resiliency within the framework of contextual positive coping. Recommendations for future avenues of research are discussed.

Continuous traumatic stress as a mental and physical health challenge: Case studies from South Africa

This article discusses the condition of continuous traumatic stress as common on the African continent and in other international settings characterised by very high levels of ongoing violence and threat of community, political or war-related origin. Through consideration of three case studies from South Africa, contexts of continuous traumatic stress are described, and the mental health and physical health effects of living in such contexts are elaborated. Cautions are raised about attempting to transpose existing posttraumatic stress models onto individuals exposed to situations of continuous traumatic stress, and guidelines for optimal interventions with such cases are proposed.

Community resilience and sense of coherence as protective factors in explaining stress reactions: comparing cities and rural communities during missiles attacks

Based on the salutogenic theory, the aim of this study was to examine sense of coherence and communal resiliency as related to stress reactions during missile attacks. Data were gathered in August 2011 while missiles were being shot from Gaza to the Negev communities in Israel from approximately 150 participants, aged 15-85. Participants lived in cities and different types of small rural villages. Self reported questionnaires were administered via the internet and included demographic data, coping resource of sense of coherence and community resiliency as coping resources, as well as state anxiety, state anger and psychological distress as stress reaction outcomes. Overall, the participants in our study reported strong personal and communal resources and relatively low levels of stress reactions. Personal and communal resources were linked negatively to the different stress reactions. However, some differences emerged when we compared participants from different types of communities. The most resilient group was composed of people who lived in the rural and communal communities. Differences also emerged on patterns of relationships between the community resource and state anxiety. While among the rural citizens, community resilience was strongly linked to anxiety, no relationships were revealed in the urban citizens group.

Development and Validation of the Coping With Terror Scale

Terrorism creates lingering anxiety about future attacks. In prior terror research, the conceptualization and measurement of coping behaviors were constrained by the use of existing coping scales that index reactions to daily hassles and demands. The authors created and validated the Coping with Terror Scale to fill the measurement gap. The authors emphasized content validity, leveraging the knowledge of terror experts and groups of Israelis. A multistep approach involved construct definition and item generation, trimming and refining the measure, exploring the factor structure underlying item responses, and garnering evidence for reliability and validity. The final scale comprised six factors that were generally consistent with the authors’ original construct specifications. Scores on items linked to these factors demonstrate good reliability and validity. Future studies using the Coping with Terror Scale with other populations facing terrorist threats are needed to test its ability to predict resilience, functional impairment, and psychological distress.

Social factors and mental health symptoms among women who have experienced involuntary job loss

The growing proportion of women in the labor force and the current economic crisis has made women a target population for job loss. In that situation, they are likely to experience recurrent layoffs, which force them to cope with multiple job loss and with unemployment. The present study aimed to examine sociodemographic factors that help women succeed in coping with single or multiple experiences of job loss, and that even enhance their self-efficacy in returning to work. The population of participants consisted of 134 Israeli women aged 30-45 who had been laid off. The findings indicate that the women who had experienced multiple job loss expressed a stronger desire to return to work than did those who had been laid off only once. Married women showed a greater tendency to become accustomed to stress after being laid off than did never-married women. However, even though multiple job loss might be a forced solution to home-work conflict, never-married women were found to be at risk for distress responses after being laid off. There is a need to develop responses for women who are at risk for multiple job loss, and to enhance employers' awareness of the situation faced by women who are laid off.