Looking for a safe place: the contribution of personal and environmental resources to PTSD among Israeli youth exposed to terror attacks Dr. Anat Ben-Porat Prof. Haya Itzhaky Dr. Yaacov Boaz Yablon Bar-Ilan University, Israel

The goal of the presented study was to shed more light on the contribution of adolescents' environmental and personal resources to PTSD, with particular emphasis on the contribution of place of residence. 2

Since the beginning of the Palestinian El Aqsa Intifada (uprising) in October 2000, Israeli adolescents in recent years ( ), have been exposed to ongoing terror, due to sporadic rocket attacks on the western Negev area. 3

4

Terror adolescents and PTSD adolescents are particularly vulnerable to terrorism-induced trauma during this challenging developmental stage. studies have shown that these adolescents experience intrusive thoughts, sleep disturbances, and avoidance ( Hamama-Raz et al, 2008; Laufer & Solomon, 2009; Weisenberg et al 1993) 5

6 Environmental resources and PTSD There is little information on the impact of variables in the adolescents' environment on PTSD. exposure of entire communities throughout the world to terror, highlights the need to examine the contribution of environmental as well as personal resources to resilience.

7 Environmental resources Place of residence- may reflect the environmental resources available to adolescents. It has been found that residing in a socially disadvantaged or distressed environment increases the likelihood of PTSD ( Dekel & Nuttman-Shwartz 2009; Papageorgiou et al., 2000; Pearce, 1993; Thabet & Vostanis, 1998 ).

8 Environmental resources participation in the community- In situations of trauma, individuals may benefit from community participation, which promotes a sense of belonging and self-determination. It has been found that community participation has been associated with lower levels of distress and elevates life satisfaction ( Itzhaky & Dekel, 2008; Ben- Porat & Itzhaky, 2008)

9 Personal resources Mastery-Among children and adolescents exposed to terror, one of the key components in enhancing mental health is the development of self-efficacy and a sense of control over the situation (Chibbaro & Jackson, 2006). It has been found that persons with a low sense of mastery are more vulnerable to terror-related stress and symptoms ( Chibbaro & Jackson, 2006; Zeidner 2005).

10 levels of exposure and perceived sense of danger levels of exposure- The objective level of threat. perceived sense of danger- The subjective level of threat. It has been found that the subjective component plays a greater role in predicting posttraumatic symptoms than the objective component ( Dyregrov et al, 2000; Gavrilovic,et al, 2002).

11 background variables Age- extensive research has been conducted on the contribution of age to PTSD, but the findings are inconsistent ( Galea, Nandi, Vlaho, 2005; Green, Korol, Grace, & Vary, 1991; Lahad & Leykin, 2010; Pfefferbaum, 1997) Gender- findings indicate that girls are two to six times more likely to report PTSD than boys ( Pat-Horenczyk, 2004; Laufer & Solomon, 2009). on the other hand, findings indicate that severity of symptoms reported by boys is twice as high ( Laufer & Solomon, 2009).

The Research Population 1004 Israeli high school students aged (M=16.02, SD=1.18). All of them residents of the western Negev area of Israel. The participants were divided into two groups based on their place of residence: 224 (92 males, 132 females) students resided in a town characterized by a low SES, and 780 (372 males, 408 females) students were from high SES localities. 12

Results Examination of levels of PTSD among all of the participants revealed that the mean level was 2.02 (SD=0.71). A significant difference was found between the two groups: t(1091)=11.32, p<.001. levels of PTSD were higher among the students living in low SES localities (M=2.46, SD=0.77) than among those living in high-SES localities (M=1.90, SD=0.64). 13

Hierarchical Regression Coefficients for Explaining the Variance in PTSD _______________________________________ steps Predictors Place.31***.13***.10***.07** Gender.20*** Age.17 ***.09***.09***.09*** Exposure.09***.07**.05 Perceived danger.65***.52***.24*** Mastery -.26*** -.24*** Participation.10***.10*** Place x exposure.03 Place x perceived danger.05* Place x mastery -.05* Place x participation R 2.17***.57***.62***.63*** Δ R 2.17***.40***.05***.01***. 14

Key Findings The most noteworthy finding was the significant contribution of the participants' place of residence to explaining PTSD in all of the steps of the regression. place of residence contributed to perceived danger as well as to mastery, particularly in low-SES localities. 15

Key Findings age, perception of danger, mastery, and community participation – contributed significantly to explaining PTSD. Gender and exposure to terror did not contribute directly to explaining the variance in PTSD. 16

Discussion Place of residence and PTSD the findings highlight the substantial contribution of that variable to PTSD. on the one hand, distress is intensified in low-SES localities – especially when the residents feel a sense of danger. On the other hand, in these areas the internal resource, mastery, plays an important role as a mediator of distress. 17

Community participation and PTSD community participation and the perception of themselves as representing the community enable adolescents to cope better with the development of distress resulting from exposure to terror. 18

Sense of mastery and PTSD In a situation of terror, which causes feelings of helplessness, a sense of mastery will allow adolescents to cope better with PTSD by regulating their feelings of distress. 19

Perceived danger and PTSD The extent to which adolescents perceive terror events as a threat to their personal and environmental resources plays a significant role in determining whether or not they develop PTSD. 20

Age gender and PTSD Age- It is possible that as adolescents mature they become more exposed to reality and feel more distress as a result. Gender-It is possible that the perceived threat of terror is so significant that it crosses gender boundaries, and therefore partials out the contribution of gender to the variance in PTSD in the second step. 21

Summary and recommendations There is a need for macro-intervention among adolescents in their communities, as well as for interventions in schools which focus on enhancing personal as well as community resources. Enhancing the adolescents' sense of mastery and increasing their participation in the school and community are important goals for intervention with those populations. 22

At the level of policy there is a need to focus on the residents of low SES areas. At that level, it is the task of practitioners working with low-SES populations to warn policy-makers about the need to increase the resources available to residents of distressed areas. 23

24 Thank you for your kind attention !