Trauma-related Stress Symptoms Research Articles

Utilizing Parent-Child Interaction Therapy with Trauma-Directed Interaction in a Young Male in Out of Home Care Who Had Experienced Trauma

Child abuse and neglect in young children can lead to trauma-related stress symptoms that can be challenging to manage. Parent-Child Interaction Therapy (PCIT), a strong evidence-based behavioral parent training program used for young children with behavior issues, has been used in its traditional form with increasing frequency with children and families who have trauma histories, with clinicians tailoring PCIT to use with children who have experienced trauma. Trauma-Directed Interaction (TDI) is a new systematic adaption to the standard PCIT parent training program that has the potential to help treat trauma in younger children. TDI includes several trauma-informed techniques that are added to a course of standard PCIT treatment including psychoeducation regarding trauma, recognition of feelings, and emotional regulation. This case study illustrates the use of a manualized trauma adaptation to PCIT (TDI) with a three-year-old boy who had a history of child maltreatment and his caregiver. This case provides a summary of the progression of this intervention and the results obtained. Results from the case indicated that TDI treatment was effective in not only reducing child trauma and behavioral symptoms but also in reducing mild caregiver mental health concerns. The next steps for TDI treatment and need for further research are discussed.

The impact of post-traumatic stress on the mental state of university hospital physicians \u2013 a cross sectional study

BackgroundHospital physicians have an increased risk for post-traumatic stress caused by work-related trauma. This study examines the frequency of reported traumatic events (TE), post-traumatic stress (PTS) and its possible consequences for the mental state and work ability of physicians at a university hospital.MethodsAs part of the mandatory psychological risk assessment, n = 145 physicians (n = 56 female; 38.6%) were examined at a university hospital in Germany in a cross sectional study. TE, PTS and symptoms of depression and anxiety were assessed using the self-report questionnaires “Freiburger Screening Fragebogen to identify patients at risk for the development of a post-traumatic stress disorder in the group of severely injured patients” (PTBS-13), the “Patient Health Questionnaire” (PHQ-2) and the “Generalized Anxiety Disorder scale” (GAD-2). Work ability was assessed using a modified version of the questionnaire for workplace analysis (KFZA). The response rate was 52%.ResultsTraumatic events were experienced by n = 125 physicians (86.2%) throughout their whole career. Of these, 19 physicians (15.2%) reported PTS. PTS is reported by 12 of 56 female physicians (63.2%), compared to 7 of 89 reports of PTS by male physicians (36.8%). Physicians with PTS symptoms had higher depression scores (p = 0.007) compared to physicians without TE or with TE, but without PTS. Physicians with PTS reported significantly reduced work ability caused by constantly interrupted work (p = 0.03). Female gender was the greatest risk factor for the development of PTS. (p = 0.001).ConclusionsPhysicians – especially females – with PTS may have an increased risk of developing depressive symptoms. Therefore, interventions aimed at reducing trauma-related stress symptoms may be helpful in improving mental health of hospital physicians. Further studies with more physicians from different hospitals are necessary to support the results.

Mediating role of avoidance of trauma disclosure and social disapproval in ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder: cross-sectional study in a Lithuanian clinical sample

Background ICD-11 includes a new diagnosis of complex post-traumatic stress disorder (CPTSD), resulting predominantly from reoccurring or prolonged trauma. Previous studies showed that lack of social support is among the strongest predictors of PTSD, but social factors have been sparsely studied in the context of the ICD-11 definition of PTSD and CPTSD. Aims To analyse the factor structure of the International Trauma Questionnaire (ITQ) in a Lithuanian clinical sample and to evaluate the mediating role of social and interpersonal factors in the relationship between trauma exposure and ICD-11 PTSD and CPTSD. Method The sample comprised 280 adults from out-patient mental health centres (age, years: mean 39.48 (s.d. = 13.35); 77.5% female). Trauma-related stress symptoms were measured with the ITQ. Social disapproval was measured with the Social Acknowledgment Questionnaire (SAQ) and trauma disclosure using the Disclosure of Trauma Questionnaire (DTQ). Results ICD-11 PTSD and CPTSD prevalence among the participants in this study was 13.9% and 10.0% respectively. Results indicated that avoidance of trauma disclosure mediated the relationship between trauma exposure and PTSD as well as CPTSD, whereas social disapproval mediated only the relationship between trauma exposure and CPTSD. Conclusions The findings suggest that disclosure of traumatic experiences and support from closest friends and family members might mitigate the effects of traumatic experiences, potentially reducing the risk of developing CPTSD.

Parent–Child Interaction Therapy for a 3-Year-Old Girl With Post-Traumatic Stress Disorder: Restoration to Her Father’s Care Following a Period in Out-of-Home Care

Child abuse and neglect in very young children can lead to trauma-related stress symptoms that can be challenging to treat. Children exposed to multiple traumas occurring in the context of a caregiving relationship are sometimes more severely affected, evidenced by diverse negative behavioral, physical, social, and emotional consequences. Some of these children go on to develop post-traumatic stress disorder (PTSD). Parent–child interaction therapy (PCIT) is a dyadic play-based treatment for children with behavior problems and their parents or caregivers. There is limited research relating to the application of PCIT with very young children with PTSD with some studies actively excluding families where PTSD was present (Herschell et al., 2017). Additionally, there are no articles relating to treatment of a child restored to the care of a parent following out-of-home care (OOHC) and fewer still relating to a child restored to the care of her father. This case study illustrates the use of PCIT with a 3-year-old girl with PTSD, recently restored to her father’s care. It highlights how the use of PCIT in this case not only improved behavioral indicators of traumatic stress, but also afforded this child permanency and stability. The case study provides a summary of the progression of this intervention and the results obtained throughout treatment and 4 years post-intervention. The results indicated that PCIT, with trauma-informed tailoring, was an effective treatment in this case and contributed to safe and permanent care for this child.

Pandemic-Related Stress Symptoms Among Norwegian Parents of Adolescents in Grades 6 to 8.

We investigated pandemic-related stress symptoms during the first COVID-19 lockdown period in spring 2020 among parents of adolescents that were 11 to 13 years old in the study period. We also investigated whether parental stress symptoms were associated with family situation and family activities during lockdown. Altogether 147 couples reported about their own trauma-related stress symptoms following the outbreak of the pandemic. Among the respondents, 9.5% of the mothers and 10.2% of the fathers had scores over cutoff on the screener (IES-6) measuring stress symptoms, a non-significant gender difference. Scores on the screener were not associated with family contamination or lockdown consequences. Family activities during lockdown did not impact the pandemic stress symptom levels. Whereas, the experience of the COVID-19 pandemic pose a stressor to most people, it is unlikely to be a criterion A event for other than directly affected families.

Age-related similarities and differences in networks of acute trauma-related stress symptoms in younger and older preschool children

ABSTRACT Background: Prior research on trauma-exposed preschool children has found various levels of trauma-related stress symptoms depending on age, which might be explained by developmental factors. Objective: This study uses network analysis to extend prior research and compare symptom presentation in younger and older preschoolers in the acute phase (first 4 weeks) following a potentially traumatic event. Method: Parent-reported trauma-related acute stress symptoms were assessed using the Pediatric Emotional Distress Scale – Early Screener via www.kidtrauma.com. First, the overall symptom severity and symptom levels were compared between younger (1–3 years) and older (4–6 years) preschoolers. Further, two Gaussian graphical models of stress symptoms in younger (n = 242; M age = 2.3 years; SD age = 0.6 years) and older preschoolers (n = 299; M age = 4.8 years; SD age = 0.7 years) were modelled and compared. Results: Overall symptom severity did not differ between the groups. Symptom levels for developmental regression and avoidance of talking about the event were higher in older preschoolers. The network structures of the younger and the older preschoolers were largely similar. Highly central symptoms in both networks were trauma-unrelated fear and anger. The connections between fear of reminders and clinginess and trauma-unrelated fear and clinginess were stronger in the older preschoolers’ network. The connections between worry and sadness and withdrawal; fear of reminders and creation of games, stories, and pictures; and whininess and clinginess were all stronger in the younger preschoolers’ network. Conclusions: Trauma-related stress symptomatology of younger and older preschoolers may not differ greatly in the acute phase. Trauma-unrelated fear and anger seem to be central symptoms in both groups. However, examining symptom-level associations across age groups revealed differential connections that might arise from developmental differences. If replicated in longitudinal and within-subject studies, these findings could help tailor interventions for trauma-exposed preschoolers in the acute phase.

Comparison of Psychological Distress and Demand Induced by COVID-19 during the Lockdown Period in Patients Undergoing Peritoneal Dialysis and Hemodialysis: A Cross-Section Study in a Tertiary Hospital

Background: Since the outbreak of COVID-19 in December 2019, it has spread rapidly and widely, bringing great psychological pressure to the public. In order to prevent the epidemic, traffic lockdown was required in many areas of China, which led to inconvenience of treatment for dialysis patients. This study was conducted to explore the psychological distress and the psychological demand induced by CO­VID-19 in the patients undergoing dialysis and compare the difference between hemodialysis (HD) and peritoneal dialysis (PD) patients during the traffic lockdown period. Methods: Questionnaires were given to the dialysis patients in the West China Hospital of Sichuan University. The Impact of Event Scale (IES) was used to investigate the patients’ trauma-related distress in response to COVID-19. Results: 232 eligible respondents were enrolled in this cross-section study, consisting of 156 PD patients and 76 HD patients. The median IES score for all the enrolled patients was 8.00 (2.00–19.00), which belonged to the subclinical dimension of post-traumatic stress symptoms (PTSS). HD patients had a significant higher IES score than PD patients (11.50 vs. 8.00) (p < 0.05). HD patients already got more psychological support from the medical staff. According to IES scores, 22.4% HD patients and 13.4% PD patients were classified as having moderate or severe PTSS, which need psychological support (p < 0.05). But more patients of both groups considered psychological support was necessary (HD: 50%, PD: 45.5%) (p > 0.05). In the multivariate regression analysis, we found that dialysis vintage, the impact of COVID-19 on the severity of illness and daily life, and confidence in overcoming the disease contributed to IES score (p < 0.05). Conclusions: HD patients had more severe trauma-related stress symptoms than PD patients. When major public healthy events occurred, careful psychological estimate and sufficient psychological support should be provided to the dialysis patients, especially to the HD patients.

Validation of the Impact of Event Scale With Modifications for COVID-19 (IES-COVID19).

Viral outbreaks can be experienced as disruptive and can be associated with trauma-related stress symptoms. In the current study, we adjusted the Dutch version of the Impact of Event Scale (IES) to assess traumatic stress symptoms related to the impact of the COVID-19 outbreak. The psychometric properties of this Impact of Event Scale with modifications for COVID-19 (IES-COVID19) were investigated by administering the IES-COVID19 to 380 university students who participated during the early stage of the COVID-19 outbreak, upon invitation via e-mail. Using confirmatory factor analysis, the factor structure of the IES-COVID19 was found to be similar to the original IES, indicating two latent factors: intrusion and avoidance, χ2(85) = 147.51, CFI = .92, TLI = .90, RMSEA = .044, SRMR = .049. Cronbach’s alpha showed acceptable internal consistency of the total IES-COVID19, α = .75. Pearson’s correlations of the IES-COVID19 over time were also sufficient, demonstrating adequate test–retest reliability, r = .62. Significant correlations (ranging between .15 and .50) between the IES-COVID19 and symptoms of depression, anxiety, stress, stress-related rumination, as well as negative social interactions, demonstrate adequate convergent validity. Overall, the IES-COVID19 shows to be a valid and reliable measure that can be utilized to investigate trauma-related stress symptoms of intrusion and avoidance related to the short- and long-term impact of the COVID-19 outbreak.

A-43 Post-Traumatic Stress Symptoms in Sport-Related Concussion and Orthopedic Injury: An Initial Comparison

Abstract Objective Few studies have compared psychological responses to injury following sport-related concussion versus injury in general. The aim of this pilot investigation was to explore whether trauma-related stress symptoms differ between adolescents with sport-related concussion (SRC) vs. orthopedic injury (OI). Method Participants age 12-18 with SRC (n=48) or OI (n=12) presented to specialty clinics in the North Texas Concussion Registry (ConTex) within 21 days of injury (M= 6.7). Total scores from the PTSD Checklist for DSM-5 (PCL-5) were calculated (range=0-80). Independent t-test compared PCL-5 symptom scores between SRC and OI, and post-hoc analyses examined frequency of symptoms reported within each group. Results There was no significant difference between mean PCL-5 scores in SRC and OI groups, and both obtained scores above the typical cutoff for PTSD, defined as scores &amp;gt;30 (range= 0-46; SRC=10%, OI=16%). Most commonly reported symptoms for both SRC and OI were sleep problems, feeling jumpy, and being “super alert.” SRC subjects were more likely to report difficulty concentrating (SRC=42%; OI=16%), while OI subjects were more likely to report feeling distant from other people (OI=50%; SRC=20%). Conclusions While total post-traumatic stress symptoms may not differ between SRC and OI groups, there may be differences in individual trauma-related symptoms based upon the nature of injury. Both injury groups may be susceptible to sleep difficulties and hypervigilance, yet SRC individuals may experience more cognitive complaints, while OI may report more feelings of isolation. Furture studies will need to use the PCL-5 with larger sample sizes and recovery indices to provide a more detailed comparison of the injury groups.

Efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters: A protocol of systematic review.

Background:This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters.Methods and analysis:The following electronic databases will be searched up to May 2019 without language or publication status restrictions: Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. We will also search Korean, Chinese, and Japanese databases. Any clinical studies with original data related to ear acupuncture for trauma-related disorders after large-scale disaster will be included. Traumatic stress-related symptoms will be assessed as primary outcomes. Depression, anxiety, adverse events, and total effective rate will be evaluated as secondary outcomes. Two researchers will independently perform the study selection, data extraction, and assessment of study quality. Descriptive analyses of the details of participants, interventions, and outcomes for all included studies will be conducted. Data synthesis and analysis will be performed using RevMan version 5.3. The methodological quality of the included studies will be evaluated according to the study design.Ethics and dissemination:Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations.PROSPERO registration number:CRD42019134658.

A PSYCHO-SOCIAL THERAPEUTIC GROUP WORK PROGRAMME PREVENTING THE ONSET OF POST-TRAUMATIC STRESS DISORDER AMONG POLICE OFFICIALS ATTACHED TO THE SPECIALISED UNITS IN THE SOUTH AFRICAN POLICE SERVICE

This article focuses on the development of a psycho-social therapeutic programme (PTP) for police officials attached to the specialised units in the North West province. The objective is to prevent the onset of post-traumatic stress disorder and the development of trauma-related stress symptoms soon after exposure to a traumatic event. The main focus of this article is on the themes and contents of the designed PTP. The themes of the programme are schematically presented, after which it is discussed in detail according to the subject, aim and content

A PSYCHO-SOCIAL THERAPEUTIC GROUP WORK PROGRAMME PREVENTING THE ONSET OF POST-TRAUMATIC STRESS DISORDER AMONG POLICE OFFICIALS ATTACHED TO THE SPECIALISED UNITS IN THE SOUTH AFRICAN POLICE SERVICE

This article focuses on the development of a psycho-social therapeutic programme (PTP) for police officials attached to the specialised units in the North West province. The objective is to prevent the onset of post-traumatic stress disorder and the development of trauma-related stress symptoms soon after exposure to a traumatic event. The main focus of this article is on the themes and contents of the designed PTP. The themes of the programme are schematically presented, after which it is discussed in detail according to the subject, aim and content

Posttraumatic stress symptoms predict impaired neutrophil recovery in stem cell transplant recipients.

Despite the potentially life-saving effects of stem cell transplant (SCT), many transplant patients experience traumatic stress reactions due to mortality threat, interpersonal isolation, financial and occupational loss, and invasive medical procedures. Emerging evidence suggests that trauma-related stress symptoms (TSS) predict significant health complications following SCT. The aim of the current prospective study was to examine TSS in the acute aftermath of SCT as a predictor of neutrophil recovery following SCT, a crucial component of immune defense against infection. Fifty-one autologous SCT recipients were assessed for TSS 7 days after SCT. Patients' absolute neutrophil counts were collected from medical charts for the first 30 days following SCT. Hierarchical linear growth modeling was used to test the hypothesis that TSS at day 7 would be associated with delayed recovery of neutrophil counts from days 9 to 30 post SCT, that is, when neutrophil counts began to recover. As hypothesized, TSS measured 7 days after SCT was significantly associated with slower neutrophil recovery even after pre-existing TSS, depression, distress related to physical symptoms, and potential medical confounds were statistically controlled. Exploratory analyses showed that of the TSS symptom clusters, re-experiencing symptoms and hyperarousal symptoms predicted neutrophil recovery, whereas avoidance symptoms did not. Though traumatic stress symptoms may be a normative response to SCT, our findings suggest that TSS following SCT may interfere with neutrophil recovery and overall health. These results provide further insight as to potential mechanisms by which traumatic stress translates to poor medical outcomes for SCT patients.

Long‐term health and wellbeing of people affected by the 2002 Bali bombing

To examine the physical and mental health status of individuals directly affected by the 2002 Bali bombing, 8 years after the incident. Cross-sectional study of people directly exposed to and/or bereaved by the 2002 Bali bombing who had participated in a New South Wales Health therapeutic support program. Telephone interviews were conducted during July - November 2010. The sample was weighted to reflect the population of interest, registered participants in the program (n = 115). Self-rated physical health, personal resilience (Connor-Davidson Resilience Scale), past-03 psychological distress and daily functioning (Kessler Psychological Distress Scale), and traumatic stress-related symptoms (Primary Care PTSD Screen). Of 81 individuals contacted, 55 responded (68%). Mean age of respondents was 50 years (range, 20-73 years), 32 were female, and seven were physically injured in the bombing. Most (45/55) reported good physical health, but 12 were experiencing high or very high levels of psychological distress. Being injured in the attack was associated with current functional impairment (P = 0.04) and very high levels of distress (P = 0.005). Lower distress was associated with perceived family support (P> = 0.03) and being in a marital or de facto relationship (P = 0.02). Complicated grief factors were consistently associated with high psychological distress, traumatic stress-related symptoms and lower personal resilience. Eight years after the bombing, directly affected individuals had good physical health but relatively high rates of psychological distress. Marital or de facto relationships and perceived family support appear to be protective factors against long-term distress. Bereavement factors were the strongest correlates of trauma symptoms and distress. Outreach and screening programs incorporating complicated grief items may be useful in the longer-term support of such individuals.

Relationships Among Childhood Trauma, Posttraumatic Stress Disorder, and Dissociation in Men Living with HIV/AIDS

This study examined the relationships among dissociation, childhood trauma and sexual abuse, and posttraumatic stress disorder (PTSD) symptoms in HIV-positive men. Data were collected from 167 men enrolled in a randomized clinical trial that examined a group therapy intervention to decrease HIV-related risk behavior and trauma-related stress symptoms. Participants completed the Trauma History Questionnaire, the Impact of Events Scale–Revised, and the Stanford Acute Stress Reaction Questionnaire. Overall, 35.3% of the participants reported having experienced childhood sexual abuse. A total of 55.7% of the sample met diagnostic criteria for PTSD. The intensity of dissociative symptoms that participants endorsed was positively associated with experience of childhood sexual abuse (r = .20, p < .01). Dissociative symptoms were also positively associated with specific PTSD symptoms, notably hyperarousal (r = .69, p < .001). Hierarchical regression indicated that hyperarousal symptoms accounted for more of the variance in dissociation than childhood sexual abuse. These results suggest that childhood sexual abuse may be involved in the development of dissociative symptoms in the context of adulthood stress reactions. Furthermore, the pattern of the association between dissociation and PTSD is consistent with the possibility of a dissociative PTSD subtype among HIV-positive men.

Symptomatology in adolescents following initial disclosure of sexual abuse: The roles of crisis support, appraisals and coping

Objective The present study examined possible explanations for symptom development and variability in sexually abused adolescents. A theoretical model of sexual abuse, in which appraisal, coping and crisis support play prominent roles, was tested in a clinical group of 100 sexually abused adolescents. Method Participants, aged 12–18 years, completed questionnaires regarding severity of abuse, negative appraisals, crisis support, coping strategies, and trauma-related stress symptoms. Results Since severity of abuse had no influence on the association between appraisals and symptoms it was eliminated from our model. Structural equation modeling analyses showed a significant interrelationship between the examined concepts. Adolescents who appraised the abuse as more threatening showed more internalizing and externalizing trauma symptoms. Moreover, more negative appraisals were associated with more avoidance as well as with more active coping strategies. Direct crisis support was associated with less negative appraisals and with the use of more active coping strategies. Conclusions The study showed that especially the buffering role of crisis support and the role of negative appraisals explained symptom development and variety in sexually abused adolescents. Practice implications Adaptation to sexual abuse includes the ways in which adolescents perceive the event as threatening and harmful, how they cope with the abusive experience, and how they receive direct support from their family. Clinicians, therefore, need to expand the focus of their assessments beyond age- and trauma-specific symptoms, to age- and trauma-specific appraisals, coping, and social support. The assessment of these factors should take place as soon as possible after the disclosure of the abuse. Individualized treatment plans and clinical interventions need to be based on these personal and environmental variables, rather than reliance on the influence of abuse-related characteristics, such as the severity or type of abuse.

Mental health and resiliency following 44 months of terrorism: a survey of an Israeli national representative sample

BackgroundIsraeli citizens have been exposed to intense and ongoing terrorism since September 2000. We previously studied the mental health impact of terrorism on the Israeli population (Bleich et al., 2002), however the long-term impact of ongoing terrorism has not yet been examined. The present study evaluated the psychological sequelae of 44 months of terrorism in Israel, and sought to identify factors that may contribute to vulnerability and resilience.MethodsThis was a telephone survey using strata sampling of 828 households, which reached a representative sample of 702 adult Israeli residents (84.8% contact rate). In total, 501 people (60.5%) agreed to participate. The methodology was similar to that of our previous study. Exposure to terrorism and other traumatic events, number of traumatic stress-related symptoms (TSRS), percentage of respondents with symptom criteria for post-traumatic stress disorder (PTSD), traumatic stress (TS) resiliency and feelings of depression, anxiety, optimism, sense of safety, and help-seeking were the main outcome measures.ResultsIn total, 56 participants (11.2%) were directly exposed to a terrorist incident, and 101 (20.2%) had family members or friends exposed. Respondents reported a mean ± SD of 5.0 ± 4.5 TSRS; 45 (9%) met symptom criteria for PTSD; and 72 (14.4%) were TS-resilient. There were 147 participants (29.5%) who felt depressed, 50 (10.4%) felt anxious, and almost half (235; 47%) felt life-threatening danger; 48 (9.7%) felt the need for professional help. Women and people of Arab ethnicity had more TSRS, more PTSD, and less TS resiliency. Injury following a life-threatening experience, a major stressful life event, and a major loss of income were associated with PTSD. Immigrant status, lower education, low sense of safety, low sense of social support, high societal distress, and injury following life-threatening experiences were associated with TSRS. TSRS did not increase with exposure severity. This study revealed less depression and functional impairment, similar rates of PTSD, increased help-seeking and poorer TSRS and TS resiliency than our initial study, 2 years previously.DiscussionThe response of people in Israel to 4 years of terrorism is heterogeneous. Vulnerability factors change over time; Arab ethnicity, immigrant status and less education, not found to be risk factors in our previous study, were found in the present study to contribute to trauma-related distress. Prior experience of highly stressful events increases vulnerability to adverse psychological effects of terror.

Recurrence of post traumatic stress disorder

Traumatic events can have an enduring effect on an individual's wellbeing, even causing a recurrence of trauma-related stress symptoms 50 years later. This lasting impact means that those working with older people need an awareness of those symptoms and education in their management.

Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel.

The terrorist attacks on Israeli society have been ongoing since September 2000. However, few studies have examined the impact of terrorism on nationally representative population samples, and no study has examined the psychological impact of ongoing terrorism in Israel. To determine the level of exposure to terrorist attacks and the prevalence of traumatic stress-related (TSR) symptoms, symptoms of posttraumatic stress disorder (PTSD), and sense of safety after 19 months of terrorism in Israel, and to identify correlates of the psychological sequelae and the modes of coping with the terrorism. Telephone survey conducted April-May 2002, using a strata sampling method, of 902 eligible households and a representative sample of 742 Israeli residents older than 18 years (82% contact rate) and a final participation of 512 (57%). Number of TSR symptoms, rates of those with symptom criteria for PTSD and acute stress disorder assessed by the Stanford Acute Stress Reaction Questionnaire, self-reported feelings of depression, optimism, sense of safety, help-seeking, and modes of coping. Of 512 survey participants, 84 (16.4%) had been directly exposed to a terrorist attack and 191 (37.3%) had a family member or friend who had been exposed. Of 510 participants who responded to questions about TSR symptoms, 391 (76.7%) had at least 1 TSR symptom (mean, 4.0 [SD, 4.5]; range, 0-23; mean intensity, 0.8; range, 0-4). Symptom criteria for PTSD were met by 48 participants (9.4%) and criteria for acute stress disorder, by 1 participant; 299 (58.6%) reported feeling depressed. The majority of respondents expressed optimism about their personal future (421/512 [82.2%]) and the future of Israel (307/509 [66.8%]), and expressed self-efficacy with regard to their ability to function in a terrorist attack (322/431 [74.6%]). Most expressed a low sense of safety with respect to themselves (307/509 [60.4%]) and their relatives (345/507 [67.9%]). Few reported a need for professional help (27/506 [5.3%]). Female sex, sense of safety, and use of tranquilizers, alcohol, and cigarettes to cope were associated with TSR symptoms and symptom criteria for PTSD; level of exposure and objective risk were not. The most prevalent coping mechanisms were active information search about loved ones and social support. Considering the nature and length of the Israeli traumatic experience, the psychological impact may be considered moderate. Although the survey participants showed distress and lowered sense of safety, they did not develop high levels of psychiatric distress, which may be related to a habituation process and to coping mechanisms.