Predictors of National and Community Resilience of Israeli Border Inhabitants Threatened by War and Terror

Resilience, sense of danger, and reporting in wartime: a cross-sectional study of healthcare personnel in a general hospital

BACKGROUND AND AIMS

Maintaining healthcare services and ensuring the presence of healthcare personnel (HCP) during periods of conflict and high-intensity warfare in Israel including the significant security event that occurred on May 2021, pose significant challenges for hospitals in the range of missile attacks. The May 2021 event, marked by intense hostilities and military actions, brought about heightened security escalations and increased risks in the region. Despite the prevailing threat of missile attacks and ongoing security concerns, hospitals in the affected areas were required to sustain their services and uphold care standards. In light of these circumstances, this study aims to identify the factors that influence the percentage of HCP reporting for work during these intense periods of security escalations and wartime in Israel. Specifically, it explores the relationships between resilience, sense of danger, and HCP absenteeism in the context of the ongoing conflict. The findings of this study can provide valuable insights for designing interventions aimed at decreasing HCP absenteeism during security escalations, wartime, and emergency situations, ultimately contributing to the resilience and effectiveness of healthcare delivery in this challenging environment.

METHODS

During a relative calm period from December 2021 to January 2022, a cross-sectional study was conducted at a southern Israeli general hospital, situated within the range of missile attacks in the midst of a longstanding conflict. The study focused on HCP who were employed before May 21, which marked the end of the last war state at that time. The questionnaire, consisting of measures for resilience using the Conor-Davidson scale (CD-RISC 10) and the sense of danger assessed with the Solomon & Prager inventory, was administered online to all hospital employees at Assuta Ashdod Hospital, located in the southern city of Ashdod, Israel. This approach was chosen due to the challenging nature of conducting a study during an existing war, making it impractical to carry out the research during such periods of active war.

RESULTS

In total, 390 employees completed the survey (response rate of 24%). Of this sample, 77.4% reported fully to work during the last security escalations in May 2021. Most of the sample (84.1%) felt insecure on the way to work. The HCP who reported fully to work had a higher level of resilience than employees who reported partially or did not come to work at all (p = .03). A higher sense of danger in the workplace correlated with a 73% increase in absenteeism (p < .01). Absenteeism (partial or full) was higher among HCP with children who require supervision (p < .01). Hospital preparedness for emergencies as perceived by the employees increased HCP attendance at work (p = .03).

CONCLUSIONS

Hospital management should consider designing programs aimed at potentially strengthening the level of resilience and fostering a greater sense of security among hospital personnel, which might encourage greater attendance at work during wartime, crises, or emergencies.

The 'welcomed lockdown' hypothesis? Mental wellbeing and mobility restrictions

The COVID-19 pandemic and its mobility restrictions have been an external shock, influencing mental wellbeing. However, does risk exposure to COVID-19 affect the mental wellbeing effect of lockdowns? This paper examines the 'welcomed lockdown' hypothesis, namely the extent to which there is a level of risk where mobility restrictions are not a hindrance to mental wellbeing. We exploit the differential timing of exposure the pandemic, and the different stringency of lockdown policies across European countries and we focus on the effects on two mental health conditions, namely anxiety and depression. We study whether differences in the individual symptoms of anxiety and depression are explained by the combination of pandemic mortality and stringency of lockdown. We draw on an event study approach, complemented with a Difference-in-Difference (DiD), and Regression Discontinuity Design (RDD). Our estimates suggest an average increase in depression (3.95%) and anxiety (10%) symptoms relative to the mean level on the day that lockdown took effect. However, such effects are wiped out when a country's exhibits high mortality ('pandemic category 5'). Hence, we conclude that in an environment of high mortality, lockdowns no longer give rise to a reduction in mental wellbeing consistent with the 'welcome lockdown' hypothesis.

Impact of the war in Ukraine on resilience, protective, and vulnerability factors

War or armed conflict is one of the most severe human-made adversities. The current study examines the resilience, protective, and vulnerability factors of a sample of Ukrainian civilians, during the current Russian-Ukrainian war. The level of resilience and coping indicators were compared with the responses of an Israeli sample following an armed conflict in May 2021. The data were collected by an internet panel company. A representative sample of Ukrainian residents (N = 1,001) responded to an online questionnaire. A stratified sampling method was employed regarding geographic distribution, gender, and age. The data concerning the Israeli population (N = 647) were also collected by an internet panel company during a recent armed conflict with Gaza (May 2021). Three notable results emerged in this study: (a) The Ukrainian sample reported significantly higher levels of the following: Distress symptoms, sense of danger, and perceived threats, compared with the Israeli sample. However, despite these harsh feelings, the Ukrainian respondents reported substantially higher levels of hope and societal resilience compared, to their Israeli counterparts, and somewhat higher individual and community resilience. (b) The protective factors of the respondents in Ukraine (level of hope, wellbeing, and morale), predicted the three types of resilience (individual, community, and social) better than the vulnerability factors (sense of danger, distress symptoms, and level of threats). (c) The best predictors of the three types of resilience were hope and wellbeing. (d) The demographic characteristics of the Ukrainian respondents hardly added to the prediction of the three types of resilience. It appears that a war that threatens the independence and sovereignty of a country may, under certain conditions, enhance the societal resilience and hope of the population under risk, despite a lower sense of wellbeing and higher levels of distress, sense of danger, and perceived threats.

What does community resilience mean in the context of trauma-informed communities? A scoping review

Several communities are implementing trauma-informed, community-level approaches focused on addressing/preventing adverse childhood experiences (ACEs), yet most community resilience definitions from published articles are based on acute traumas. This scoping review aims to determine how community resilience is defined and operationalized within the context of chronic/complex traumas.

METHODS

We performed a rigorous, comprehensive literature search using multiple databases.

RESULTS

The 38 included articles addressed multiple types of chronic traumas, including historical trauma, poverty, minority stress, mass incarceration, and ACEs. A variety of definitions of community resilience were cited, several of which stressed the ability to thrive despite risk factors and the safety and wellbeing of residents. Few articles operationalized community resilience within the context of ACEs, suggesting significant gaps in the literature.

CONCLUSION

This review can serve as an important building block to develop expanded definitions of community resilience for chronic traumas and assist communities in promoting community-wide responses to ACEs.

A multi-level examination of nursing students' resilience in the face of the COVID-19 outbreak: A cross-sectional design

AIMS

To examine nursing students' stress and coping with the coronavirus disease 2019 (COVID-19) pandemic through an ecological model of resilience. Specifically, to examine the relative contribution of different resilience levels in decreasing nursing students' strain symptoms: at the individual level, resilience trait; at the relational level, students' coping strategies; at the university level, nursing students' perceptions on their university's readiness to handle the virus outbreak; and at the national level, nursing students' trust in policymakers' decisions.

DESIGN

The study used a cross-sectional design.

METHODS

Undergraduate students of five universities were recruited via an electronic link sent to their emails during the first months of the COVID-19 outbreak: May-July 2020. Of them, 492 participants completed the research questionnaire.

RESULTS

Hierarchical Regression Analysis revealed that nursing students' resilience, as a multi-level factor, decreased the students' level of strain symptoms above and beyond their stress levels and control variables. Specifically, the nursing students' trait resilience, perceptions of their university's positive response to the pandemic and trust in their national policymakers were negatively associated with their strain symptoms. Conversely, disengagement-in-emotion coping strategies was positively associated with the students' strain symptoms.

CONCLUSIONS

Nursing students' resilience should be seen as a flexible resource that can be developed and influenced by their academic and clinical training, and by the intentions and actions of their university and the nursing administration at the Ministry of Health (MOH).

IMPACT

The findings call for the nursing administration at the MOH and for the university deans and department heads to prepare in advance a crisis plan that could be rapidly and effectively implemented when needed. Furthermore, topics such as developing flexible coping strategies should be integrated into the nursing curricula. These would allow students to prepare and cope better with adversity in their routine and in times of crisis.

Morale and Perceived Threats as Predictors of Psychological Coping with Distress in Pandemic and Armed Conflict Times

The present study investigated predictors of psychological coping with adversity responses during the COVID-19 pandemic and an armed conflict. Two paired samples that represented the Israeli population that was exposed to both adversities were compared. Respondents rated five different psychological coping responses associated with the two adversities, such as anxiety or individual resilience. Perceived security, pandemic, economic, and political risks, as well as level of morale, were rated. Two major findings were disclosed by two path analyses. Morale improved the predictions of the varied coping responses in both the pandemic and conflict and was the best predictor of four out of five responses and the second-best predictor of the fifth response. Contrary to previous studies, our findings revealed that the concept of a single major predictor of coping responses under distress is an overgeneralization. In both cases, the coping responses were better explained by other perceived risks rather than by the risk of the investigated adversity. Rather than assume that a perceived security threat accounts for low levels of public moods, it is vital to study the antecedents of coping responses and to empirically examine additional potential predictors.

Fluctuations in National Resilience during the COVID-19 Pandemic

The current study measured national resilience (NR) in three different time frames during the coronavirus disease 2019 (COVID-19) pandemic in Israel (N = 804). We investigated two main issues: first, the direction and extent of NR changes during the crisis, and second, the predictors of NR. The results show the following: (a) the average NR score declined significantly across the three repeated measures, with a medium-size effect. (b) Three of the four identified NR factors declined significantly across the three measurements: belief in the government and the prime minister (large effect size); belief in civil society; and patriotism (medium effect size); while trust in Israeli national institutions was the lowest and did not weaken significantly. (c) Analyzing the prediction of NR factors indicated that the levels of the three NR factors mainly reflected one's political attitudes, sense of political and economic threats, rather than health threats. One conclusion concerns the importance of trust in leadership as the most sensitive component in the decline of national resilience following a crisis.

Recovery from the COVID-19 pandemic: Distress and resilience

The current study analyzed repeated responses to the coronavirus. Data for the first phase was gathered during the peak of the COVID-19 pandemic crisis in Israel (T1), which included the overall lock-down of the Israeli society. The repeated measurement was conducted approximately two months later, on the initial phase of lifting the lock-down (T2). The sample size was 300 people. Results indicated four significant differences between the first and the second measurements: Sense of danger, distress symptoms, and national resilience significantly decreased, while perceived well-being increased at T2. No significant differences were noted between the two measurements regarding individual and community resilience and economic difficulties. The data indicated that the highest decrease in national resilience was accounted for by low respondent trust in governmental decisions during the COVID-19 crisis. The negative impact of the COVID-19 pandemic on the participants was determined by two indicators: level of distress symptoms and sense of danger. Path analyses showed that five variables significantly predicted these two indicators. Their best predictor at T1 and T2 was well-being followed by individual resilience, economic difficulties due to the pandemic crisis, community resilience, and gender. It was concluded that psychological attributes may help in decreasing the impact of the threats of the COVID-19 pandemic.

Recovery from the COVID-19 pandemic: Distress and resilience

The current study analyzed repeated responses to the coronavirus. Data for the first phase was gathered during the peak of the COVID-19 pandemic crisis in Israel (T1), which included the overall lock-down of the Israeli society. The repeated measurement was conducted approximately two months later, on the initial phase of lifting the lock-down (T2). The sample size was 300 people. Results indicated four significant differences between the first and the second measurements: Sense of danger, distress symptoms, and national resilience significantly decreased, while perceived well-being increased at T2. No significant differences were noted between the two measurements regarding individual and community resilience and economic difficulties. The data indicated that the highest decrease in national resilience was accounted for by low respondent trust in governmental decisions during the COVID-19 crisis. The negative impact of the COVID-19 pandemic on the participants was determined by two indicators: level of distress symptoms and sense of danger. Path analyses showed that five variables significantly predicted these two indicators. Their best predictor at T1 and T2 was well-being followed by individual resilience, economic difficulties due to the pandemic crisis, community resilience, and gender. It was concluded that psychological attributes may help in decreasing the impact of the threats of the COVID-19 pandemic.

Measurement and antecedents of national resilience in Filipino adults during coronavirus crisis

Resilience is a broad concept that encompasses individual and social resources to thrive from difficult circumstances. The resilience that occurs as a collective effort or country-wide phenomenon is referred to as national resilience (NR), which connotes the ability of a nation to deal with crises while keeping its social fabric intact. Like the rest of the world, the Philippines has been greatly impacted by the coronavirus pandemic and we argue that a stable and robust NR is needed to bounce back from the challenges and adversities of the crisis. This pioneering study on NR in Filipino adults was conducted to achieve two aims (1) assess the psychometric properties of the Filipino adapted National Resilience Scale (NRS-Filipino) and (2) determine demographic and psychological variables that influence NR. Data from 401 participants yielded an exploratory factor analysis with a good model fit for a four-factor solution that is similar to the original National Resilience Assessment Scale. NRS-Filipino also demonstrated acceptable reliability and convergent validity. Among the variables purported to be associated with NR, community resilience, and political attitude came out as strong predictors.

Resilience and demographic characteristics predicting distress during the COVID-19 crisis

RATIONALE

Due to lack of vaccine or cure, the COVID-19 pandemic presents a threat to all human beings, undermining people's basic sense of safety and increasing distress symptoms.

OBJECTIVE

To investigate the extent to which individual resilience, well-being and demographic characteristics may predict two indicators of Coronavirus pandemic: distress symptoms and perceived danger.

METHOD

Two independent samples were employed: 1) 605 respondents recruited through an internet panel company; 2) 741 respondents recruited through social media, using snowball sampling. Both samples filled a structured online questionnaire. Correlations between psychological/demographic variables and distress and perceived danger were examined. Path analysis was conducted to identify predictive indicators of distress and perceived danger.

RESULTS

Significant negative correlations were found between individual/community resilience and sense of danger (-0.220 and -0.255 respectively; p < .001) and distress symptoms (- 0.398 and -0.544 respectively; p < .001). Significant positive correlations were found between gender, community size, economic difficulties and sense of danger (0.192, 0.117 and 0.244 respectively; p < .001). Gender and economic difficulties also positively correlated with distress symptoms (0.130 and 0.214 respectively; p < .001). Path analysis revealed that all paths were significant (p < .008 to .001) except between family income and distress symptoms (p = .12). The seven predictors explained 20% of sense of danger variance and 34% the distress symptoms variance. The most highly predictive indicators were the two psychological characteristics, individual resilience, and well-being. Age, gender, community size, and economic difficulties due to COVID-19 further add to predicting distress, while community and national resilience do not. .

CONCLUSIONS

Individual resilience and well-being have been found as the first and foremost predictors of COVID-19 anxiety. Though both predictors are complex and may be influenced by many factors, given the potential return of COVID-19 threat and other future health pandemic threats to our world, we must rethink and develop ways to reinforce them.

Distress and Resilience in the Days of COVID-19: Comparing Two Ethnicities

The COVID-19 pandemic is an ongoing epidemic of coronavirus disease, caused by severe acute respiratory syndrome, which has spread recently worldwide. Efforts to prevent the virus from spreading include travel restrictions, lockdowns as well as national or regional quarantines throughout the international community. The major negative psychological outcome of the COVID-19 pandemic is the anxiety caused by it. The aim of the present study was to examine the level of concern and the contributions of modes of resilience, well-being and demographic attributes towards decreasing or enhancing anxiety and depression among two samples: Israeli Jews (majority group) and Israeli Arabs (minority group). These random samples included 605 Jews and 156 Arabs who participated in an internet survey. A previous study, which has been conducted in the context of terror attacks, has shown that compared to Israeli Jews, Israeli Arabs expressed a higher level of fear of war and lower levels of resilience supporting personality attributes. The results of the current study indicated a similar pattern that emerged in the context of the COVID-19 pandemic: the Israeli Arabs reported a higher level of distress and a lower level of resilience and well-being.