Depression, Anxiety and Stress Management

Statement of Problem: Between 40%-60% of the general population are victims of any lifetime trauma. Among persons with schizophrenia, however, this figure is estimated to be as high as 98%. Similarly, in the general population, the rate of exposure to man-made terror with reactive psychopathology of a posttraumatic psychiatric disorder is 7.5%, but among persons with schizophrenia disorder, this figure increases to 13%-29%. Despite these findings, few studies have examined the psychopathological aftermath of exposure to terror or the psychopathological consequences of different types of terrorist attacks among persons with schizophrenia.

Methodology & Theoretical Orientation: A nationally representative random sample with schizophrenia was merged with (I) psychiatric hospitalization data in the Israeli National Psychiatric Case Registry (1990-2012) and (II) terror attack data in the Global Terrorism Database. Time to psychiatric rehospitalization and the Colorado Symptom Index were examined following exposure to terror using Cox regression modeling and ANCOVAs after adjustment for confounders.

Findings: Increased likelihood of psychiatric rehospitalization was statistically (P<.05) associated with prior exposure to terrorist attacks involving bombings or explosions compared to exposure to armed assaults (adjusted HR=1.42, 95% CI=1.09- 1.84); and for attacks involving 1-3 fatalities (adjusted HR=1.47, 95% CI=1.22, 1.77) compared with no fatalities. This trend of statistical significance replicated for terrorist attack types across five sensitivity analyses. The effect of likely exposure to attacks with 1-3 fatalities was significant (P<.05) among males, however, not significant for females, or for 60, 90 and 120 days of follow-up.

Conclusion & Significance: Exposure to attacks with bombings or explosions and 1-3 fatalities among males modestly, but significantly, exacerbated the course of schizophrenia for subjective and objective outcomes. A tentative mechanism is that earlier age of onset among males facilitates less time for premorbid learning and subsequent postmorbid stress adjustment, thereby increasing reactive psychopathology.