Protective factors and predictors of vulnerability to chronic stress: A comparative study of 4 communities after 7 years of continuous rocket fire

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Abstract

Many communities across the world are chronically exposed to extreme violence. Responses of residents from a city and rural community in Southern Israel, both exposed to 7 years of daily mortar fire, were compared to residents from demographically, socio-economically and geographically comparable non-exposed control samples to examine protective factors and predictors of vulnerability to chronic war-related attacks. Samples from a highly exposed city (Sderot) and a highly exposed rural community region (Otef Aza), along with a demographically comparable comparison non-exposed city (Ofakim) and non-exposed rural community region (Hevel Lachish), were obtained in 2007 using Random Digit Dialing. In total, 740 individuals (81.8% participation rate) were interviewed about trauma exposure, mental health, functioning and health care utilization. In the highly exposed city of Sderot, 97.8% of residents had been in close proximity to falling rockets; in the highly exposed rural community region of Otef Aza, 95.5% were similarly exposed. Despite exposure to chronic rocket attacks, residents of Otef Aza evidenced little symptomatology: only one person (1.5%) reported symptoms consistent with probable posttraumatic stress disorder (PTSD) and functioning levels did not differ from those of non-exposed communities. In contrast, posttraumatic stress (PTS), distress, functional impairment and health care utilization were substantially higher in the highly exposed city of Sderot than the other three communities. Lack of resources was associated with increased vulnerability among city residents; predictors of PTS across all samples included being female, older, directly exposed to rockets, history of trauma, suffering economic loss, and lacking social support. Increased community solidarity, sense of belonging and confidence in authorities may have served a protective function for residents of rural communities, despite the chronic attacks to which they were exposed.

Section snippets

Participants

Respondents resided in four regions: A high exposure city (EC, Sderot), a high exposure rural community region (ERC, Otef Aza), a non-exposed city (NEC, Ofakim), and a non-exposed rural community region (NERC, Hevel Lachish). By non-exposed we mean not having been targeted directly by rocket or mortar fire. At the time of the interviews, the EC of Sderot and the ERC of Otef Aza were being fired upon at the rate of 5–10 rockets daily. The city of Ofakim and the rural region of Hevel Lachish were

Demographic comparisons within rural communities and cities

Information provided by the municipalities of the EC of Sderot and NEC of Ofakim and by local key informants within the rural communities (ERC and NERC) suggested that the cities and rural communities were roughly matched on income, education, number of children and religiosity of residents. Univariate analyses compared demographic characteristics between samples obtained from the exposed and non-exposed cities and between the exposed and non-exposed rural communities. Few differences were

Discussion

Most of the residents of the highly exposed city of Sderot and the highly exposed rural community of Otef Aza had been exposed to chronic and intense rocket attacks for many years. In the EC of Sderot, more than one half, and in the ERC of Otef Aza, about one third, of the residences had been hit by rockets, mortar fire or shrapnel. More than 70% of the EC Sderot residents and 60% of the ERC inhabitants knew people who were wounded during the attacks. Only 2% of the residents of the EC of

Acknowledgments

This work was supported by the IDB Group and The Jewish Agency for Israel. These organizations played no role in the design and conduct of the study; in the collection, management, analysis and interpretation of the data; nor in the preparation, review, or approval of the manuscript. The authors wish to thank E. Alison Holman for her expert statistical advice.

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