Civilians under missile attack: post-traumatic stress disorder among the Jewish and Bedouin population of Southern Israel.
Over the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations.
The study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD.
Compared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8-10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2-16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1-5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD.
The findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.
Shvartsur R
，Savitsky B
《Israel Journal of Health Policy Research》
Psychological impacts of the Gaza war on Palestinian young adults: a cross-sectional study of depression, anxiety, stress, and PTSD symptoms.
The Gaza Strip has been embroiled in a violent military assault since October 2023, with an immense toll on the civilian population. Armed conflicts threaten the mental health of affected communities and survivors, and psychiatric morbidity increases with forced displacement and with severe and recurrent trauma. This study investigates the prevalence and predisposing factors of depression, anxiety, stress, and PTSD symptoms in a group of young adult students from the Gaza Strip during the war.
A cross-sectional, internet-based survey recruited medical students from the Gaza Strip and used the DASS21, SWLS, and PCL-5 instruments. PTSD diagnosis required having a PCL-5 score ≥ 23 and fulfilling the DSM-5 criteria. Rates of depression, anxiety, stress, and life satisfaction were compared with a previous dataset collected in 2022. Finally, logistic regression models were fitted using R software to identify factors significantly associated with depression, anxiety, stress, and PTSD.
Three hundred thirty-nine medical students participated. Most had been displaced several times, and the great majority had lost a relative, colleague, or friend. Also, a majority had lost their homes and income. 97.05% of participants suffered mild depressive symptoms or higher, while 84.37% and 90.56% reported mild anxiety and mild stress symptoms or higher, respectively. High levels of life dissatisfaction were also found, and 63.40% suffered from PTSD. Symptoms were significantly more prevalent than baseline rates. All participants with PTSD had at least one psychiatric comorbidity. Living in a shelter and having moderate stress symptoms or higher were significantly associated with depression. Being a female, losing a friend, having moderate stress symptoms or higher, and having PTSD predicted having moderate anxiety or higher. Having moderate or higher depression symptoms, moderate or higher anxiety symptoms, and PTSD predicted having moderate stress symptoms or higher. Finally, moderate or higher anxiety and stress symptoms predicted having PTSD.
The study detected very high rates of psychiatric disorders among its population of young adult medical students and outlined a myriad of risk factors associated with higher comorbidity. Interventions are needed to prevent a brewing mental health crisis in the Gaza Strip.
Aldabbour B
，Abuabada A
，Lahlouh A
，Halimy M
，Elamassie S
，Sammour AA
，Skaik A
，Nadarajah S
... -
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Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence.
Mental health problems contribute significantly to the overall disease burden worldwide and are major causes of disability, suicide, and ischaemic heart disease. People with bipolar disorder report lower levels of physical activity than the general population, and are at greater risk of chronic health conditions including cardiovascular disease and obesity. These contribute to poor health outcomes. Physical activity has the potential to improve quality of life and physical and mental well-being.
To identify the factors that influence participation in physical activity for people diagnosed with bipolar disorder from the perspectives of service users, carers, service providers, and practitioners to help inform the design and implementation of interventions that promote physical activity.
We searched MEDLINE, PsycINFO, and eight other databases to March 2021. We also contacted experts in the field, searched the grey literature, and carried out reference checking and citation searching to identify additional studies. There were no language restrictions.
We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that focused on the experiences and attitudes of service users, carers, service providers, and healthcare professionals towards physical activity for bipolar disorder.
We extracted data using a data extraction form designed for this review. We assessed methodological limitations using a list of predefined questions. We used the "best fit" framework synthesis based on a revised version of the Health Belief Model to analyse and present the evidence. We assessed methodological limitations using the CASP Qualitative Checklist. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) guidance to assess our confidence in each finding. We examined each finding to identify factors to inform the practice of health and care professionals and the design and development of physical activity interventions for people with bipolar disorder.
We included 12 studies involving a total of 592 participants (422 participants who contributed qualitative data to an online survey, 170 participants in qualitative research studies). Most studies explored the views and experiences of physical activity of people with experience of bipolar disorder. A number of studies also reported on personal experiences of physical activity components of lifestyle interventions. One study included views from family carers and clinicians. The majority of studies were from high-income countries, with only one study conducted in a middle-income country. Most participants were described as stable and had been living with a diagnosis of bipolar disorder for a number of years. We downgraded our confidence in several of the findings from high confidence to moderate or low confidence, as some findings were based on only small amounts of data, and the findings were based on studies from only a few countries, questioning the relevance of these findings to other settings. We also had very few perspectives of family members, other carers, or health professionals supporting people with bipolar disorder. The studies did not include any findings from service providers about their perspectives on supporting this aspect of care. There were a number of factors that limited people's ability to undertake physical activity. Shame and stigma about one's physical appearance and mental health diagnosis were discussed. Some people felt their sporting skills/competencies had been lost when they left school. Those who had been able to maintain exercise through the transition into adulthood appeared to be more likely to include physical activity in their regular routine. Physical health limits and comorbid health conditions limited activity. This included bipolar medication, being overweight, smoking, alcohol use, poor diet and sleep, and these barriers were linked to negative coping skills. Practical problems included affordability, accessibility, transport links, and the weather. Workplace or health schemes that offered discounts were viewed positively. The lack of opportunity for exercise within inpatient mental health settings was a problem. Facilitating factors included being psychologically stable and ready to adopt new lifestyle behaviours. There were positive benefits of being active outdoors and connecting with nature. Achieving balance, rhythm, and routine helped to support mood management. Fitting physical activity into a regular routine despite fluctuating mood or motivation appeared to be beneficial if practised at the right intensity and pace. Over- or under-exercising could be counterproductive and accelerate depressive or manic moods. Physical activity also helped to provide a structure to people's daily routines and could lead to other positive lifestyle benefits. Monitoring physical or other activities could be an effective way to identify potential triggers or early warning signs. Technology was helpful for some. People who had researched bipolar disorder and had developed a better understanding of the condition showed greater confidence in managing their care or providing care to others. Social support from friends/family or health professionals was an enabling factor, as was finding the right type of exercise, which for many people was walking. Other benefits included making social connections, weight loss, improved quality of life, and better mood regulation. Few people had been told of the benefits of physical activity. Better education and training of health professionals could support a more holistic approach to physical and mental well-being. Involving mental health professionals in the multidisciplinary delivery of physical activity interventions could be beneficial and improve care. Clear guidelines could help people to initiate and incorporate lifestyle changes.
There is very little research focusing on factors that influence participation in physical activity in bipolar disorder. The studies we identified suggest that men and women with bipolar disorder face a range of obstacles and challenges to being active. The evidence also suggests that there are effective ways to promote managed physical activity. The research highlighted the important role that health and care settings, and professionals, can play in assessing individuals' physical health needs and how healthy lifestyles may be promoted. Based on these findings, we have provided a summary of key elements to consider for developing physical activity interventions for bipolar disorder.
McCartan CJ
，Yap J
，Best P
，Breedvelt J
，Breslin G
，Firth J
，Tully MA
，Webb P
，White C
，Gilbody S
，Churchill R
，Davidson G
... -
《Cochrane Database of Systematic Reviews》
ResearchGate
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