Tracy, Melissa, Hoboll, E. Stevan, Canetti-Nisim, Daphna, Galea, Sandro (2007). Depressive Symptoms in a Population Exposed to Ongoing Terrorism. American Journal of Epidemiology 165 (11), 447- 457.
PURPOSE: We sought to assess the predictors of depressive symptoms in a population–based cohort exposed to ongoing and widespread terrorism. METHODS: Interviews of a representative sample of adults living in Israel, including both Jews and Arabs, were conducted between August and September 2004, with follow-up interviews taking place between February and April 2005. Censoring weights were estimated to account for differential loss to follow-up. Zero-inflated negative binomial models with bootstrapped confidence intervals were fit to assess predictors of severity of depressive symptoms, assessed using items from the Patient Health Questionnaire. RESULTS: A total of 1613 Israeli residents participated in the baseline interview (80.8% Jewish, 49.4% male, mean age 43 years); 840 residents also participated in the follow-up interview. In multivariable models, Israeli Arab ethnicity, lower household income, lower social support, experiencing economic loss from terrorism, experiencing higher levels of psychosocial resource loss, and meeting criteria for post-traumatic stress disorder were significantly associated with increased severity of depressive symptoms. CONCLUSIONS: Material deprivation is the primary modifiable risk factor for depressive symptoms in the context of ongoing terrorism. Efforts to minimize ongoing material and economic stressors may mitigate the mental health consequences of ongoing terrorism.