Acute posttraumatic stress symptoms but not generalized anxiety symptoms are associated with severity of exposure to war trauma: A study of civilians under fire

War-Related Stress among Israeli College Students Following 7 October 2023 Terror Attack in Israel

BACKGROUND

Warfare represents a significant source of stress in contemporary times, with enduring implications beyond the immediate casualties, fostering a pervasive atmosphere of danger and anxiety within affected populations. The Israel-Hamas war, marked by ongoing armed incursions and missile attacks, stands as a recent example of such turmoil, inflicting widespread trauma and disruption.

METHODS

This study, conducted among students at the Ashkelon Academic College in southern Israel, aimed to investigate the stress levels and associated factors amidst the ongoing conflict. Utilizing a cross-sectional survey design, data were collected from 625 participants between January and February 2024, approximately four months after the commencement of the initial attack. The survey encompassed demographic information, perceived stress levels, sleep quality, and social media usage.

RESULTS

The findings revealed moderate to high stress levels among participants, with significant differences observed based on gender, parental status, and residency in conflict zones. Moreover, poorer sleep quality was reported among students residing in conflict-affected areas. Regression analysis identified several predictors of elevated stress, including gender, parental status, sleep quality, residency in conflict zones, and social media usage.

CONCLUSIONS

These findings underscore the profound impact of ongoing conflict on college students' mental well-being, highlighting the need for tailored interventions and support services within higher education institutions. The limitations include the study's focus on a specific college population and the timing of the data collection relative to the onset of the war. Nonetheless, this research contributes valuable insights concerning the stress dynamics within the unique context faced by Israeli students amidst ongoing warfare.

Stress exposure, perceived stress, protective psychosocial factors, and health status in Ukraine after the full-scale invasion

The concept of stress as a cause of ill health has received much attention in social sciences. The distinction between stress exposure and perceived stress emphasizes the importance of cognitive dimension of stress. This quantitative study (N = 213) conducted in Ukraine in November 2022 collected self-reported cognitive data on stress exposure, perceived stress, and self-rated heath. The goals of the study included (1) testing if stress exposure and perceived stress differ in terms of breadth and depth of their impact; (2) isolating psychosocial factors that reduce stress; and (3) testing if individuals who have relocated within Ukraine or abroad to escape the war had worse health outcomes than those who remained at their domiciles. The results suggest that while perceived stress was a stronger predictor of negative health outcomes, optimism and social support served as protective psychosocial factors. Having moved abroad predicted higher stress levels and more adverse health symptoms.

Traumatic stress, active engagement and resilience in first responders and civilians in the outbreak of war

Background: The outbreak of war in Israel on 7 October and the unique events of that day have presented unprecedented challenges to first responders (FRs), who are professionally trained to engage in providing assistance in such circumstances. Moreover, while research demonstrates the long-term psychological consequences of FRs, little is known regarding how FR's engagement in providing assistance relates to stress and resilience levels as events continue to unfold.Objective: The current study examined the relationship between traumatic stress symptoms (TSS) and resilience levels among FRs and controls during the first weeks of the Iron Swords war, while focusing on the moderating role of active engagement in providing assistance.Method: Data were collected during the first month of the Iron Swords war from 374 participants living in Southern Israel, of whom 77 (20.6%) were FRs. All participants filled out scales assessing TSS and resilience and provided relevant background information.Results: High TSS levels were associated with reduced resilience in FRs and non-FRs. Moreover, both the study group and active engagement were significant moderators for the TSS-resilience link, which was insignificant among FRs who provided assistance and for civilians who did not provide assistance. However, the TSS-resilience association remained significant for FRs who did not engage in providing assistance and for civilians who did.Conclusions: Our findings highlight the importance of examining the extent to which FRs act in line with their duties during times of adverse stress. Clinical interventions aimed towards FRs who did not engage in providing assistance are needed and should focus on the extent to which their moral values, beliefs and expectations are met, as these appear critical parameters in preserving resilience.

Six months into the war: a first-wave study of stress, anxiety, and depression among in Ukraine

Objective

This study examines the prevalence and predictors of mental health issues, specifically anxiety, depression, and stress, among Ukrainians during the military conflict with Russia.

Method

A cross-sectional correlational study was conducted six months after the beginning of the conflict. Sociodemographic factors, traumatic experiences, anxiety, depression, and stress were assessed. The study included 706 participants, both men and women, from different age groups and living in various regions of Ukraine. The data were collected from August till October 2022.

Results

The study found that a large portion of the Ukrainian population shows increased levels of anxiety, depression, and stress due to the war. Women were found to be more vulnerable to mental health issues than men, and younger people were found to be more resilient. Worsened financial and employment statuses predicted increased anxiety. Ukrainians who fled the conflict to other countries exhibited higher levels of anxiety, depression, and stress. Direct exposure to trauma predicted increased anxiety and depression, while war-related exposure to "other stressful events" predicted increased acute stress levels.

Conclusion

The findings of this study highlight the importance of addressing the mental health needs of Ukrainians affected by the ongoing conflict. Interventions and support should be tailored to address the specific needs of different groups, particularly women, younger individuals, and those with worsened financial and employment statuses.

Factors associated with critical care nurses' acute stress disorder after patient death

BACKGROUND

In intensive care units, patient death can have a negative psychological influence on the patient's nurse. However, how the frequency of events and factors contributed to acute stress among nurses remains unknown.

OBJECTIVE

The objective of this study was to explore the prevalence of and the factors affecting acute stress disorder among intensive care unit nurses after their patient death.

METHODS

Nurses from five adult intensive care units whose patient had died during the nurses' working shift were recruited from July 2018 to April 2019. Bryant's Acute Stress Disorder Scale, the Beck Anxiety Inventory, and the Beck Depression Inventory-II were used to measure acute stress, depression, and anxiety. Descriptive statistics, chi-square tests, independent sample t-tests, and stepwise logistic regression were used for data analysis.

RESULTS

In total, 119 nurses were enrolled. Nearly one in three nurses (29.4%) had suffered from acute stress disorder after their patient had died. Nurses experienced a higher risk of acute stress disorder when their patients underwent cardiopulmonary resuscitation before death (odds ratio [OR] = 13.75, 95% confidence interval [CI]: 2.59-72.95), when their patients died unexpectedly (OR = 4.88, 95% CI: 1.16-20.56), and when they experienced verbal abuse from the patient family at the patient death (OR = 4.61, 95% CI: 1.18-18.05) compared with their counterparts.

CONCLUSION

Intensive care unit nurses often experience acute stress disorder after their patient death. The nurses of patients who underwent cardiopulmonary resuscitation before death and/or who died unexpectedly and/or nurses who were subjected to verbal abuse by the patient's family were at higher risk of acute stress disorder. A comprehensive program aimed at improving the knowledge, skills, and resilience of nurses is needed.

Determinants of anxiety levels among young males in a threat of experiencing military conflict-Applying a machine-learning algorithm in a psychosociological study

Background

Anxiety could be felt even in objectively peaceful situations, but a vision of conflict could result in increased stress levels. In this article, we aimed to identify hidden patterns of mental conditions and create male profiles to illustrate the different subgroups as well as determinants of anxiety levels among them in accordance with proximity to a possibility of direct exposure to military action.

Methods

A sample of Ukrainian males, in duty as conscripts to military service (n = 392, M±SD = 22.1±5.3) participated in a survey. We used the 36-Item Short Form Health Survey, and State-Trait Anxiety Inventory. In addition to psychological indices, social-demographic data were collected. To discover the number of clusters, the k-means algorithm was used, the optimal number of clusters was found by the elbow algorithm. For validation of the model and its use for further prediction, the random forest machine-learning algorithm, was used.

Results

By performing k-means cluster analyses, 3 subgroups were identified. High values of psychological indices dominated in Subgroup 2, while lowest values dominated in Subgroup 3. Subgroup 1 showed a more even distribution among the indices. The strength of the relevance and main determinants of the prediction of the presented model mostly consisted of mental qualities, while socio-demographic data were slightly significant.

Conclusions

There is no clear relevance between proximity or even the experience of military actions and anxiety levels. Other factors, mostly subjective feelings about mental conditions, are crucial determinants of feeling anxiety.

Exposure to the 2014 Gaza War and Support for Militancy: The Role of Emotion Dysregulation

How do wars shape emotions and attitudes in intractable conflicts? In two studies conducted in the aftermath of the 2014 Gaza War in the Middle East, we tested a new theoretical model wherein the ability to regulate emotions is central in determining the influence of war exposure on emotions (i.e., group-based humiliation) and support for militancy, through posttraumatic stress symptoms (PSS). Results supported our model: (a) higher exposure to the war predicted group-based humiliation in both studies and in Study 2 also greater support for militancy; in both studies, (b) higher exposure predicted more PSS only among participants high in emotion dysregulation, and, for them, (c) higher exposure predicted greater group-based humiliation, through increased levels of PSS. Results from Study 2 suggest that (d) group-based humiliation will ultimately lead to greater support for militancy. The findings' contribution to the different literatures and their integration is discussed.

Shared trauma reality in war: Mental health therapists' experience

INTRODUCTION

Shared traumatic reality occurs when therapists are doubly exposed to a traumatic event, both through their clients' experience, along with their own direct exposure. Studies have shown that a shared traumatic reality can lead to both positive and negative outcomes for therapists. Most studies have examined these reactions sometime after the end of the traumatic event, and less is known about reactions that occur during a traumatic event. In addition, most studies have assumed, rather than examined, indirect exposure. In this study, we extend this literature by examining direct and indirect exposure of therapists during a war situation, and their psychological reactions.

METHOD

Over a period of two months in 2014, 70% of the Israeli population was exposed to rocket fire. Geographical areas differed in terms of amount of exposure, and its potential danger. 151 therapists living throughout Israel were assessed via an Internet based survey in the middle of the war, and were assessed for the effects on their professional and personal lives, degree of burnout, ways of coping and symptoms levels of PTSD and psychological distress.

RESULTS

These indicate that significant differences in direct exposure occurred depending on place of residence. PTSD levels were related to higher direct exposure, as well as prior trauma exposure, but not to indirect exposure. Indirect exposure, as measured by increased workload, was related to increased distress and emotional exhaustion.

DISCUSSION

These data shed light on the effects of direct and indirect exposure to a shared traumatic experience of war amongst therapists. The data support previous studies showing a greater effect of direct exposure on PTSD. Since indirect exposure appears to negatively impact burnout and psychological distress, rather than PTSD, this study shows that symptoms other than PTSD should be the result of in a shared traumatic reality.