Anxiety Disorders: Hobfoll SE

Foa EB, Cahill SP, Boscarino JA, Hobfoll SE, Lahad M, McNally RJ, Solomon Z. · Department of Psychiatry, University of Pennsylvania, 3535 Market Street 6th Floor, Philadelphia, PA 19104, USA. · Neuropsychopharmacology. · Pubmed #16012536 links to  free full text

Abstract: The terrorist attacks of September 11, 2001, and the constant threat of imminent terrorist activity have brought into the forefront the urgent need to prepare for the consequences of such attacks. Such preparation entails utilization of existing knowledge, identification of crucial gaps in our scientific knowledge, and taking steps to acquire this knowledge. At present, there is little empirical knowledge about interventions following terrorism and absolutely no available empirical knowledge about interventions following bioterrorism. Therefore, this paper reviews knowledge about (1) reactions following the September 11 terrorist attacks in New York City and other places, (2) the practical experiences accumulated in recent years in countries (eg, Israel) that have had to cope with the threat of bioterrorism and the reality of terrorism, and (3) interventions for acute and chronic stress reactions following other types of traumatic events (eg, rape, war, accidents). Our review found several treatments efficacious in treating individuals for acute and chronic post-traumatic stress disorder (PTSD) related to other traumatic events that will likely be efficacious in treating PTSD related to terrorist attacks. However, there were significant gaps in our knowledge about how to prepare populations and individuals for the possibility of a terrorist attack and what interventions to apply in the immediate aftermath of such an attack. Accordingly, we conclude the paper with several questions designed to guide future research.

Hobfoll SE, Watson P, Bell CC, Bryant RA, Brymer MJ, Friedman MJ, Friedman M, Gersons BP, de Jong JT, Layne CM, Maguen S, Neria Y, Norwood AE, Pynoos RS, Reissman D, Ruzek JI, Shalev AY, Solomon Z, Steinberg AM, Ursano RJ. · Summa-Kent State University, Center for the Treatment and Study of Traumatic Stress, Akron, OH 44310, USA. · Psychiatry. · Pubmed #18181708 No free full text.

Abstract: Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

Banou E, Hobfoll SE, Trochelman RD. · University of Florida, Gainesville, Florida, USA. · J Health Psychol. · Pubmed #19237487 No free full text.

Abstract: We hypothesized that loss of interpersonal, financial and work resources would mediate the relationship between physical and sexual abuse, cancer-related Posttraumatic Stress Disorder (PTSD) symptoms, noncancer-related PTSD symptoms and depressive mood among women with cancer. Participants were 64 women with heterogeneous cancers (64.1% breast cancer) seeking outpatient treatment. Structured interviews were conducted to assess for pre-cancer interpersonal trauma, recent loss of interpersonal, financial and work resources, cancer-related PTSD symptoms, noncancer-related PTSD symptoms and depressive mood. Only interpersonal loss mediated the relationship between earlier interpersonal trauma and current PTSD symptoms and depressive mood. Implications of the findings are discussed.

Hobfoll SE, Palmieri PA, Johnson RJ, Canetti-Nisim D, Hall BJ, Galea S. · Department of Behavioral Sciences, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612-3244, USA. · J Consult Clin Psychol. · Pubmed #19170460 No free full text.

Abstract: This is the 1st longitudinal examination of trajectories of resilience and resistance (rather than ill-being) among a national sample under ongoing threat of mass casualty. The authors interviewed a nationally representative sample of Jews and Arabs in Israel (N = 709) at 2 times during a period of terrorist and rocket attacks (2004-2005). The resistance trajectory, exhibiting few or no symptoms of traumatic stress and depression at both time points, was substantially less common (22.1%) than has previously been documented in studies following single mass casualty events. The resilience trajectory, exhibiting initial symptoms and becoming relatively nonsymptomatic, was evidenced by 13.5% of interviewees. The chronic distress trajectory was documented among a majority of participants (54.0%), and a small proportion of persons were initially relatively symptom-free but became distressed (termed delayed distress trajectory; 10.3%). Less psychosocial resource loss and majority status (Jewish) were the most consistent predictors of resistance and resilience trajectories, followed by greater socioeconomic status, greater support from friends, and less report of posttraumatic growth.

Palmieri PA, Canetti-Nisim D, Galea S, Johnson RJ, Hobfoll SE. · Summa Health System, Psychiatry, St. Thomas Hospital, 4th Floor, Ambulatory Care Building, 444 North Main Street, Akron, OH 44310, USA. · Soc Sci Med. · Pubmed #18667263 No free full text.

Abstract: Although there is abundant evidence that mass traumas are associated with adverse mental health consequences, few studies have used nationally representative samples to examine the impact of war on civilians, and none have examined the impact of the Israel-Hezbollah War, which involved unprecedented levels of civilian trauma exposure from July 12 to August 14, 2006. The aims of this study were to document probable post-traumatic stress disorder (PTSD), determined by the PTSD Symptom Scale and self-reported functional impairment, in Jewish and Arab residents of Israel immediately after the Israel-Hezbollah War and to assess potential risk and resilience factors. A telephone survey was conducted August 15-October 5, 2006, following the cessation of rocket attacks. Stratified random sampling methods yielded a nationally representative population sample of 1200 adult Israeli residents. The rate of probable PTSD was 7.2%. Higher risk of probable PTSD was associated with being a woman, recent trauma exposure, economic loss, and higher psychosocial resource loss. Lower risk of probable PTSD was associated with higher education. The results suggest that economic and psychosocial resource loss, in addition to trauma exposure, have an impact on post-trauma functioning. Thus, interventions that bolster these resources might prove effective in alleviating civilian psychopathology during war.

Walter KH, Hobfoll SE. · Kent State University, Kent, OH 44242, USA. · J Interpers Violence. · Pubmed #18458352 No free full text.

Abstract: Halting the process of psychosocial and material resource loss has been theorized as being associated with the reduction of posttraumatic stress disorder (PTSD). This study examines how the limiting of resource loss is related to alleviation of PTSD symptoms among 102 inner-city women, who originally met diagnostic criteria for PTSD after experiencing interpersonal traumatic events such as child abuse, rape, and sexual assault. Participants whose PTSD symptoms improve and become nondiagnostic for PTSD are compared with those who remain diagnostic. The two groups are not significantly different at pretest. However, at the 6-month time point, those who become nondiagnostic for PTSD report less resources loss in three of four domains. This pattern suggests that as PTSD symptoms decrease, women's material and psychosocial resource loss diminishes, which in turn, may aid their recovery process.

Hall BJ, Hobfoll SE, Palmieri PA, Canetti-Nisim D, Shapira O, Johnson RJ, Galea S. · Kent State University, Kent, OH 44242, USA. · J Trauma Stress. · Pubmed #18302180 links to  free full text

Abstract: The Israeli government's decision to remove settlers in the Gaza Strip forcibly produced a situation of traumatic stress, resulting from confrontation and conflict for settlers. The authors examined the effects of the Gaza disengagement, that occurred following prolonged terrorist exposure, on rates of probable major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) diagnosis in a representative sample of Gaza settlers (N = 190). Predictors of probable MDD in multivariate models were being female, and experiencing greater economic and psychosocial resource loss. Predictors of probable PTSD were being older and experiencing greater psychosocial resource loss. Posttraumatic growth was significantly related to a reduction in the odds of having probable PTSD. This latter finding is interpreted within our conceptualization of action-focused growth.

Hobfoll SE, Canetti-Nisim D, Johnson RJ, Palmieri PA, Varley JD, Galea S. · Department of Psychology, Kent State University, Kent, OH 44242, USA. · J Trauma Stress. · Pubmed #18302179 No free full text.

Abstract: Israel has faced ongoing terrorism since the beginning of the Al Aqsa Intifada in September 2000. The authors examined risk and resiliency factors associated with posttraumatic stress disorder (PTSD) among 1,117 Jews and 394 Arab adult citizens of Israel during August and September 2004 through telephone interviews. Probable PTSD was found among 6.6% of Jews and 18.0% of Arabs. Predictors of probable PTSD in a multivariate model for Jews were refusal to report income, being traditionally religious, economic and psychosocial resource loss, greater traumatic growth, and lower social support. For Arabs, predictors were low education and economic resource loss among those exposed to terrorism. Findings for only those directly exposed to terrorism were similar to those for the overall national sample.

Tracy M, Hobfoll SE, Canetti-Nisim D, Galea S. · Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48104-2548, USA. · Ann Epidemiol. · Pubmed #18261923 links to  free full text

Abstract: PURPOSE: We sought to assess the predictors of depressive symptoms in a population-based cohort exposed to ongoing and widespread terrorism. METHODS: Interviews of a representative sample of adults living in Israel, including both Jews and Arabs, were conducted between August and September 2004, with follow-up interviews taking place between February and April 2005. Censoring weights were estimated to account for differential loss to follow-up. Zero-inflated negative binomial models with bootstrapped confidence intervals were fit to assess predictors of severity of depressive symptoms, assessed using items from the Patient Health Questionnaire. RESULTS: A total of 1613 Israeli residents participated in the baseline interview (80.8% Jewish, 49.4% male, mean age 43 years); 840 residents also participated in the follow-up interview. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for post-traumatic stress disorder were significantly associated with increased severity of depressive symptoms. CONCLUSIONS: Material deprivation is the primary modifiable risk factor for depressive symptoms in the context of ongoing terrorism. Efforts to minimize ongoing material and economic stressors may mitigate the mental health consequences of ongoing terrorism.

Dekel R, Hobfoll SE. · Bar-Ilan University, Ramat-Gan, Israel 52900. · Aging Ment Health. · Pubmed #17453549 links to  free full text

Abstract: We examined the distress level of 102 Holocaust survivors in Israel during a recent period of continuous exposure of the Israeli population to terror and the threat of missile attack. Based on the Conservation of Resources (COR) theory, we explored the contribution of losses suffered during the Holocaust and of current loss of resources due to terror attacks on their distress level. Twenty one percent of the sample had probable PTSD and high psychological distress levels in general. Current loss of psychosocial resources contributed significantly to survivors' current PTSD symptomatology and general psychological distress, above the contribution of the previous Holocaust-related loss. Our findings support COR theory, which states that traumatic events are associated with ongoing and often rapid loss of resources. Resource loss, in turn, is associated with higher distress levels. Moreover, current loss of resources compounds the impact of earlier resource losses incurred during the Holocaust.

Johnson DM, Palmieri PA, Jackson AP, Hobfoll SE. · Summa-Kent State Center for the Treatment and Study of Traumatic Stress, Summa Health System, Akron, OH, USA. · J Trauma Stress. · Pubmed #17427905 No free full text.

Abstract: Conservation of resources theory (S. E. Hobfoll, 1988, 1999) hypothesizes that loss of resiliency resources can contribute to abused women's posttraumatic stress disorder (PTSD) symptoms, which, in turn, contribute to a further loss of resources, which can make abused women even more vulnerable to future stressors. This study investigates the impact of PTSD symptoms on abused women's future loss of resources-resources that women both value and need to aid their ongoing adjustment. Posttraumatic stress disorder symptoms contributed to future resource loss in abused women, even when controlling for the effects of prior resource loss and depression. Emotional numbing symptoms of PTSD accounted most for women's resource loss. Findings highlight the importance of research and intervention that more directly examines the link between emotions and resource loss.

Vranceanu AM, Hobfoll SE, Johnson RJ. · Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, WAC 812, Boston, MA 02114-3117, USA. · Child Abuse Negl. · Pubmed #17215039 links to  free full text

Abstract: OBJECTIVE: This retrospective, cross-sectional study explored the hypothesis that multiple forms of child abuse and neglect (child multi-type maltreatment; CMM) would be associated with women's lower social support and higher stress in adulthood, and that this, in turn, would amplify their vulnerability to symptoms of depression and posttraumatic stress disorder (PTSD). METHOD: Participants were 100 women recruited from an inner-city gynecological treatment center for low-income women. Data were analyzed via structural equation modeling (SEM) with Lisrel 8.0. RESULTS: CMM was directly predictive of decreased social support and increased stress in adulthood. CMM was also directly predictive of PTSD symptoms, but not depression symptoms in adulthood. Social support partially mediated the relationship between CMM and adult PTSD symptoms, and stress fully mediated the relationship between CMM and adult symptoms of depression. CONCLUSIONS: Findings support both direct and mediational effects of social resources on adult depression and PTSD symptoms in women with histories of CMM, suggesting that resources are key factors in psychological adjustment of CMM victims.

Schumm JA, Briggs-Phillips M, Hobfoll SE. · Harvard Medical School and the VA Boston Healthcare System, Brockton, MA 02301, USA. · J Trauma Stress. · Pubmed #17195981 No free full text.

Abstract: This study represents one of the largest examinations of how child abuse, adult rape, and social support impact inner-city women (N = 777). Using retrospective self-report, the effects of interpersonal trauma were shown to be cumulative such that women who experienced either child abuse or adult rape were 6 times more likely to have probable posttraumatic stress disorder (PTSD), whereas women who experienced both child abuse and rape were 17 times more likely to have probable PTSD. High social support predicted lower PTSD severity for women who experienced both child abuse and adult rape, but not for women who reported one or none of these traumas. Results suggest that social support, when left intact, might buffer the cumulative impact of child and adult interpersonal traumas.

Hobfoll SE, Tracy M, Galea S. · The Applied Psychology Center, Kent State University, Kent, OH 44242-0001, USA. · J Trauma Stress. · Pubmed #17195971 No free full text.

Abstract: The authors interviewed by phone 2,752 randomly selected individuals in New York City within 6 to 9 months after the attacks of September 11, 2001 on the World Trade Center, and 1,939 of these were reinterviewed at a 12- to 16-month follow-up. It was hypothesized that resource loss would significantly predict probable posttraumatic stress disorder (PTSD) and probable depression since September 11, and that resource loss's impact would be independent of previously identified predictors relating to individuals' demographic characteristics, history of stressful event exposure, prior trauma history, peritraumatic experience, and social support. Second, it was predicted that reported traumatic growth would be related to greater, not lesser, psychological distress. The authors' findings supported their hypotheses for resource loss, but traumatic growth was unrelated to psychological outcomes when other predictors were controlled.

Hobfoll SE, Canetti-Nisim D, Johnson RJ. · Department of Psychology, Kent State University, Kent, OH 44242-0001, USA. · J Consult Clin Psychol. · Pubmed #16649865 No free full text.

Abstract: The authors conducted a large-scale study of terrorism in Israel via telephone surveys in September 2003 with 905 adult Jewish and Palestinian citizens of Israel (PCIs). Structural equation path modeling indicated that exposure to terrorism was significantly related to greater loss and gain of psychosocial resources and to greater posttraumatic stress disorder (PTSD) and depressive symptoms. Psychosocial resource loss and gain associated with terrorism were, in turn, significantly related to both greater PTSD and depressive symptoms. PCIs had significantly higher levels of PTSD and depressive symptoms than Jews. Further, PTSD symptoms in particular were related to greater authoritarian beliefs and ethnocentrism, suggesting how PTSD may lead to a self-protective style of defensive coping.

Schumm JA, Stines LR, Hobfoll SE, Jackson AP. · Kent State University, Kent, Ohio, USA. · J Trauma Stress. · Pubmed #16281244 No free full text.

Abstract: Child sexual abuse and child physical abuse were compared to assess how these experiences might both positively predict and sensitize women to the effects of current stress exposure, assessed in terms of psychosocial resource loss (e.g., personal and interpersonal resources). Resource loss was in turn, hypothesized to increase later depressive mood and posttraumatic stress disorder severity. Participants were 176 low-income women (58% African American, 38% European American), interviewed twice over 6 months. Child sexual abuse predicted increases in resource loss, which then predicted posttraumatic stress disorder and depressive mood. Women who reported higher levels of child physical abuse were more negatively impacted by resource loss than those who reported lower child physical abuse. Results suggest that child abuse results in both greater stress exposure later and greater vulnerability to that exposure.

Schumm JA, Hobfoll SE, Keogh NJ. · Department of Psychology, Kent State University, Kent, Ohio 44242-0001, USA. · J Trauma Stress. · Pubmed #15141791 No free full text.

Abstract: Child physical abuse (CPA) and child sexual abuse (CSA) were hypothesized to be associated with revictimization and interpersonal resource loss in adulthood. These adulthood experiences were, in turn, hypothesized to increase risk for current posttraumatic stress disorder (PTSD). High-risk women were recruited from an innercity drug and alcohol treatment center (N = 105). Interpersonal resource losses, partner-produced physical assault, adulthood rape, CPA, and CSA had direct effects on PTSD. CPA and CSA also had indirect effects on PTSD through rape, which, in turn, predicted PTSD. Results suggest that the traumatic origins of current PTSD among substance-using women are multifaceted and support the importance of considering interpersonal coping resources in evaluating and treating female substance users.