Naturalistic Study of Posttraumatic Stress Disorder Among Israeli Civilians Exposed to Wartime Attacks

Eytan Ellenberg, Avi Yakir, Zvia Bar-On, Yehuda Sasson, Mark Taragin, Danielle Luft-Afik, Osnat Cohen, Osnat Lavenda, Michal Mahat-Shamir, Yaira Hamama-Raz, Menahem Ben Ezra, B. Christopher Frueh, Ishay Ostfeld

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: Civilians who survive wartime attacks commonly experience substantial psychological distress, including acute stress reactions (ASRs) and posttraumatic stress disorder (PTSD). The authors sought to determine the level of Israeli civilian exposure to wartime attacks, prevalence of posttraumatic stress disorder (PTSD) and physical injuries, and associated medical costs over a 7-year period. Methods: Data from the National Insurance Institute of Israel on civilian survivors of wartime attacks in the 2009-2015 period were retrospectively examined. Results: Overall, 11,476 civilians were affected by 243 wartime attacks during the study period. Of these individuals, 7,561 (65.9%) received early intervention (EI) psychological treatment for ASRs, 1,332 (11.6%) were subsequently adjudicated as having a disability (all causes), and 519 (4.5%) were adjudicated as disabled by PTSD through the end of 2016. Individuals who received immediate ASR treatment were less likely to be disabled by PTSD (p50.001) Among those without physical injuries, the EI was associate with decreased PTSD disability (2.6% of those receiving th EI developed PTSD, whereas 7.2% of those who did not re ceive the EI developed PTSD); however, for those wit physical injuries, the PTSD rate was higher among thos who received the EI (30.4%) than among those who did no receive the EI (5.2%). Individuals having a disability othe than PTSD incurred higher medical costs ($7,153 in 201 U.S. dollars) than individuals with PTSD ($1,960). Conclusions: An approach of providing case manage ment, medical care, behavioral health screening, and E for ASRs in the wake of wartime attacks on civilians mini mized long-term PTSD-related disability.

Original languageEnglish
Pages (from-to)1026-1030
Number of pages5
JournalPsychiatric Services
Issue number9
StatePublished - 1 Sep 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 American Psychiatric Association. All rights reserved.


Office of Medical Affairs, National Insurance Institute of Israel, Jerusalem (Ellenberg, Yakir, Bar-On, Sasson, Taragin, Cohen, Ostfeld); Medintec, Petach-Tikva, Israel (Luft-Afik); Department of Social Work, Ariel University, Ariel, Israel (Lavenda, Mahat-Shamir, Hamama-Raz, Ben Ezra, Ostfeld); Department of Psychology, University of Hawaii, Hilo, and Trauma and Resilience Center, Department of Psychiatry, University of Texas Health Sciences Center, Houston (Frueh). Send correspondence to Dr. Ellenberg ([email protected]). This work was supported by the Office of Medical Affairs, National Insurance Institute of Israel. The authors report no financial relationships with commercial interests.

FundersFunder number
Office of Medical Affairs
National Insurance Institute of Israel


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