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Ellenberg E, Yakir A, Bar-On Z, Sasson Y, Taragin M, Luft-Afik D, Cohen O, Lavenda O, Mahat-Shamir M, Hamama-Raz Y, Ben Ezra M, Frueh BC, Ostfeld I. Naturalistic Study of Posttraumatic Stress Disorder Among Israeli Civilians Exposed to Wartime Attacks. Psychiatr Serv 2021; 72:1026-1030. [PMID: 33882689 DOI: 10.1176/appi.ps.201900313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Civilians who survive wartime attacks commonly experience substantial psychological distress, including acute stress reactions (ASRs) and posttraumatic stress disorder (PTSD). The authors sought to determine the level of Israeli civilian exposure to wartime attacks, prevalence of posttraumatic stress disorder (PTSD) and physical injuries, and associated medical costs over a 7-year period. METHODS Data from the National Insurance Institute of Israel on civilian survivors of wartime attacks in the 2009-2015 period were retrospectively examined. RESULTS Overall, 11,476 civilians were affected by 243 wartime attacks during the study period. Of these individuals, 7,561 (65.9%) received early intervention (EI) psychological treatment for ASRs, 1,332 (11.6%) were subsequently adjudicated as having a disability (all causes), and 519 (4.5%) were adjudicated as disabled by PTSD through the end of 2016. Individuals who received immediate ASR treatment were less likely to be disabled by PTSD (p=0.001). Among those without physical injuries, the EI was associated with decreased PTSD disability (2.6% of those receiving the EI developed PTSD, whereas 7.2% of those who did not receive the EI developed PTSD); however, for those with physical injuries, the PTSD rate was higher among those who received the EI (30.4%) than among those who did not receive the EI (5.2%). Individuals having a disability other than PTSD incurred higher medical costs ($7,153 in 2016 U.S. dollars) than individuals with PTSD ($1,960). CONCLUSIONS An approach of providing case management, medical care, behavioral health screening, and EI for ASRs in the wake of wartime attacks on civilians minimized long-term PTSD-related disability.
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Affiliation(s)
- Eytan Ellenberg
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Avi Yakir
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Zvia Bar-On
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Yehuda Sasson
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Mark Taragin
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Danielle Luft-Afik
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Osnat Cohen
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Osnat Lavenda
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Michal Mahat-Shamir
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Yaira Hamama-Raz
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Menahem Ben Ezra
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - B Christopher Frueh
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
| | - Ishay Ostfeld
- Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh)
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