Stress-related responses after 3 years of exposure to terror in Israel: Are ideological-religious factors associated with resilience?

Background: The inhabitants of 3 different types of population centers in Israel were assessed as to stress-related symptomatology during 2003 and 2004. These centers have been exposed to 2 distinct forms of violence-sporadic, large-scale terror attacks in the metropolitan areas in the heart of Israel and daily "war-zone" conditions in the settlements beyond the 1967 borders of Israel. Method: A semistructured interview and questionnaire survey of a random sample of 314 inhabitants of a suburb of Tel-Aviv, a settlement in the West Bank (Kiryat-Arba), and the Gush-Katif settlement cluster in the Gaza Strip was performed. Symptoms of acute stress and chronic (posttraumatic) stress as well as symptoms of general psychopathology and distress were assessed. Results: The inhabitants of Gush-Katif, in spite of firsthand daily exposure to violent attacks, reported the fewest and least severe symptoms of stress-related complaints, the least sense of personal threat, and the highest level of functioning of all 3 samples. The most severely symptomatic and functionally compromised were the inhabitants of the Tel-Aviv suburb, who were the least frequently and least directly affected by exposure to violent attacks. Because the Gush-Katif population is exclusively religious, the data were reassessed according to religiousness. The religious inhabitants of Kiryat-Arba had almost the same symptom profile as the Gush-Katif population, whereas secular inhabitants of Kiryat-Arba reported faring worse than did either population in the Tel-Aviv suburb. Conclusion: Deeply held belief systems affecting life-views may impart significant resilience to developing stress-related problems, even under extreme conditions. Religiousness combined with common ideological convictions and social cohesion was associated with substantial resilience as compared to a secular metropolitan urban population.