ATLANTA – Personal injury from a rocket attack, sleep difficulties, alcohol use, and nontraumatic major events in the past year significantly predicted functional impairment associated with symptoms of posttraumatic stress disorder in a large study of Israeli civilians exposed to pervasive war and terrorism.
Researchers surveyed 1,001 Israeli residents via telephone during the summer of 2008. A total of 500 respondents who lived close to the town of Sderot near the Gaza Strip and along the northern border of Gaza, an area subjected to frequent rocket attacks over several years, composed a higher-exposure group. Their reports of posttraumatic stress disorder (PTSD) symptoms and impairment were compared with those of 501 respondents who lived in lower-exposure regions of the country.
PTSD severity was similar between groups, but the level of symptom-related impairment was higher in those living in areas struck by rocket attacks.
A large proportion of people interviewed were distressed but did not necessarily meet the full criteria for PTSD, Katie J. Horsey, said in an interview at her poster during the annual meeting of the International Society for Trauma Stress Studies. “Only about 5.5% met full DSM-IV criteria for PTSD, but 29% reported impairment by those symptoms,” she said, adding that this subclinical impairment after exposure to pervasive trauma suggests reliance on a full PTSD diagnosis may be insufficient to identify those most in need of intervention.
The findings in the current study support previous findings that even people with subthreshold symptoms might significantly suffer from PTSD (Behav. Ther. 2009;40:39-49; J. Nerv. Ment. Dis. 2007;195:48-53). Psychosocial resource loss–defined as a loss of hope, of closeness to family, of a sense that one is of value to others, and of feelings of control over one's life–was “very significantly” associated with impairment, according to logistic regression analysis. People who reported a slight degree of loss were more than twice as likely to be impaired (odds ratio, 2.53), for example, and risk increased with a higher degree of loss (OR, 4.59), compared with those with no such loss.
“It may be that people who have more resources are better able to cope with their PTSD,” Ms. Horsey said.
In addition, poor or fair health quality and sleep difficulty each significantly predicted greater risk for functional impairment (OR, 1.71 and 1.73, respectively). “When you are not sleeping well, you cannot cope as well,” said Ms. Horsey, a doctoral student in the Clinical Psychology Program at Kent State University in Akron, Ohio.
Respondents who reported injury to themselves or a close other were at higher risk for impairment (OR, 2.8), compared with those who reported no such injuries (OR, 1.0).
It might be worthwhile to assess PTSD-related impairment–and not just symptoms–even in populations with a low level of symptoms, Ms. Horsey said. Some respondents reporting a high level of symptoms, including some who met all three DSM-IV clusters, did not report impairment. In contrast, some could not function well at a low level of symptoms.
All of the telephone interviews were conducted in Hebrew. The interviewers used the PTSD Symptom Scale–Self-Report Version, a measure previously validated in Hebrew-speaking populations. Impairment was based on a single question about whether posttraumatic symptoms interfered with functioning.
The researchers may explore more specifics, including which symptoms of PTSD are most associated with functional impairment and which areas of life are most impaired by exposure to trauma.
Ms. Horsey had no relevant disclosures. The study was supported by a National Institutes of Health grant.
Only about 5.5% of respondents met full DSM-IV criteria for PTSD, but 29% reported impairment by those symptoms.
Source MS. HORSEY