Published in the open-access online academic journal PLOS ONE, the study by researchers from Ben-Gurion University of the Negev worked to identify three very distinct factors: exhaustion/detachment, rage/betrayal and fear/helplessness.
The study examined 313 adults who either were or were not exposed to ongoing security threats from the period of December 2016 to February 2017. The exposed participants lived in communities along the Gaza border area in southern Israel, a location where rocket attacks from Gaza are frequent and where there is often a window of only 30 seconds to reach a shelter.
“Exposure to ongoing life risk exists wherever people experience continuous terror, rampant crime and civil war,” lead researcher Dr. Aviva Goral, a graduate of the BGU School of Public Health, Faculty of Health Sciences, and a researcher at the PREPARED Center for Emergency Response Research (PREPARED), said in a statement.
“Current scales assess the more commonly known effects of exposure to traumatic stress, mainly post-traumatic stress disorder (PTSD). This limits patient assessment and may lead to misdiagnoses and ineffective treatment. The research was conducted to address this gap by developing a validated, comprehensive assessment tool, the Continuous Traumatic Stress Response (CTSR) Scale.”
When studying the participants, the researchers compared the CTSR validity to PTSD, and found that the CTSR measures something related to, but distinct from PTSD. This is because PTSD is traditionally associated with a single traumatic exposure. CTSR, however, involves ongoing exposure to wider and more intensive threats. As such, the effects of CTSR can in some ways be markedly different than what is often associated with PTSD.
CTSR criteria include distrust, mental exhaustion and a reduced sense of safety. Others, such as estrangement, emptiness, hopelessness and feeling constantly threatened are symptoms of ongoing trauma exposure.
“These findings imply that it is not exposure to ongoing threats per se, but rather the level of perceived threat (i.e., likelihood of injury or harm), that accounts for the difference in the prevalence and severity of CTSR stress symptoms,” Goral explained. “Compared with distant communities, border-adjacent communities are much more vulnerable to rockets and tunnel infiltration, creating an atmosphere of tension and fear.”
This is paving the way for further research in the Gaza border community populations. Other future studies will focus on more expansive international implementations and will examine other populations, such as those in Syria living constantly in civil war.
These findings come in the wake of the recent conflict between Israel and Hamas in Gaza. This 11-day period of fighting saw huge barrages of rockets fired all throughout Israel, but especially in the Gaza border area.
The potential for severe trauma due to the conflict has been noted by many experts. In the early days of the conflict, the Health Ministry released a guide to help calm people down after a rocket alert to help prevent people developing PTSD.
Another expert, Dr. Gilad Bodenheimer, head of Mental Health at Maccabi Healthcare Services and a child psychiatrist, developed a list of tips to help parents assist their children in coping.
Despite this, mental health care in Israel was slammed by the State Comptroller's Report as inadequate, with only 30 municipalities out of 257 operating mental health clinics.
Approximately 5%-8% of residents of Sderot and the Eshkol region in the South needed treatment for severe anxiety and trauma.
In addition, most of the major publicly funded mental health care centers are in Israel's South, which means there is a severe lack of an adequate emergency mental-health service for anxiety victims in the North.
In case of an emergency situation, some 25 people will suffer from anxiety for every person who is injured physically, and in the event of war, the number of victims of stress is likely to amount to several thousands, the report said.
In addition to the lack of mental-health centers, there was a lack of adequate staff at the existing structures, with a limited number of psychotherapists available, the State Comptroller Report said.
Rossella Tercatin contributed to this report.