Editorial review--Israeli civilians under heavy bombardment: prediction of post-traumatic symptom severity.

We congratulate Somer et al for this interesting and important research. 1 During the 34 days of fighting of the Second Lebanon War II (12 July to 14 August 2006), civilians in Israel's northern region suffered a bombardment of approximately 4,000 rockets. On average, daily attacks were around 120 rockets struck daily. The rockets attacks resulted in 2,774 anxiety and acute stress reaction casualties that were evacuated from the scene. Subsequently, the bombardments led to a high prevalence of post-traumatic stress disorders (PTSD). 2 Previous research investigated factors that increase the risk of developing PTSD symptoms. The risk factors include: degree of exposure, history of prior trauma, peri-traumatic dissociation, and perceived direct-life threat. 3 Bleich et al studied the psychiatric implications of SCUD missile attacks on the civilian population during the Persian Gulf War in 1991, and found, in a survey of 12 hospitals admitting casualties in Israel, that approximately 43% of the 773 casualties evacuated to hospitals were diagnosed as psychological casualties. 4 Israel had absorbed 18 missile attacks. 4 Another study of the Israeli population before, during, and after the SCUD missile attacks associated with the Gulf War found a 250% increase in the risk for clinical depression during the period of the SCUD missile attacks. 5 In their study, Somer et al examined the degree of exposure to trauma during the Second Lebanon War, history of trauma exposure, severity of PTSD symptoms, peri-traumatic dissociation, and perceived direct-life threat, in a sample of citizens near the northern border, compared to a sample of citizens in the of center of Israel that were not exposed to direct rocket attacks. 1 The impact of past trauma exposure on the relationship between subsequent exposure to heavy bombardment and PTSD symptom severity among Israeli civilians was examined. Somer et al were surprised to find that the relationship between the degree of exposure to rockets bombardment and severity of PTSD symptoms was not moderated by exposure to previous trauma. 1 In fact, they found that overall , prior trauma exposure served as a partial buffer to distress. They suggested that the explanation of these results might be that prior trauma exposure enhanced the development of resilience to repeated bombardments and terror. There is agreement in the literature that repeated exposure to trauma has an impact on an individual's reaction to later traumatic experiences, 9 but the direction of the impact is not clear.Two …