[PREGNANCY DUE TO RAPE DURING CAPTIVITY].

INTRODUCTION: Pregnancy due to rape during captivity in female hostages is a complex, devastating and extremely challenging issue for victims, families and medical staff and may raise difficult ethical and clinical issues. Literature on the subject is scarce. Females who became pregnant as a result of rape in captivity in recent history, especially Yazidi women in ISIS captivity, suffered from a wide range of mental disorders including; post-traumatic stress disorder in high prevalence, anxiety, depression, severe dissociative disorder, somatoform disorder and sexual functioning disorders. Higher levels of education and the absence of prior mental disorders predicted better post-traumatic growth. It is crucial to prepare the medical staff to all possible scenarios including a potential refusal of the victim to opt for abortion due to emotional or religious reasons. It is extremely important to respect the victim's wishes and autonomy while avoiding paternalism or prejudice but at the same time offering consultation when confusion arises.

Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes.

The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017-2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators.

BACKGROUND: While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not. METHOD: This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help. RESULTS: Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO. CONCLUSION: Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.

[WHAT DO WE KNOW ABOUT THE TREATMENT OF PRISONERS OF WAR?]

INTRODUCTION: The question of what we know about the treatment of soldiers who are prisoners of war and kidnapped civilians is more relevant today than ever. On October 7, 2023, for 239 Israelis, the transition from an independent and autonomous person to a captive was a sharp, brutal transition that interrupted the continuity of life. Taking prisoners of war (POWs) at this time included, in addition to soldiers, kidnapped civilians, older men, women, teenagers, children and toddlers. The existing knowledge about the treatment of such diverse populations, and in such large numbers, is scarce. Hence, it is a great challenge for all care providers when the POWs return home.

Predicting mental burnout among Israeli Home Front Command soldiers during the COVID-19 pandemic.

BACKGROUND: The present study examined personality, situational and organizational predictors of burnout during COVID-19 in a military setting, based on the salutogenic theory of health (Antonovsky, 1987). METHOD: Questionnaires were completed by 116 reserve Israeli Home Front Command medical staff (71% males). Background variables (e.g., gender), personality variables (self-efficacy and sense of coherence - SOC), situational variables (state-anxiety, self-rated health and sense of threat) and organizational variables (satisfaction with military's and government's handling of the COVID-19 crisis) were measured as predictors of burnout. RESULTS: Females had higher levels of state anxiety and burnout compared to males. Females also reported a lower level of satisfaction with the military's handling of the COVID-19 crisis than males. SOC and state anxiety were the only statistically significant predictors of burnout after controlling for sociodemographic variables. The entire model explained 59.4% of the burnout variance. CONCLUSION: In accordance with salutogenic theory, SOC is associated with active adaptation through use of generalized and specific resistance resources to avoid burnout in a stressful milieu. Psychological support, psychoeducation and simulation training are offered to increase manageability in crisis situations. LIMITATIONS: Following a large dropout rate due to being quarantined, the final sample size was much smaller than planned. Also, although previous longitudinal studies have found SOC to be a causal factor in burnout, the present cross-sectional design limits such conclusions.

Understanding processes that advance suicidal behavior among Israeli active duty soldiers: A mediation model.

OBJECTIVES: The current study was aimed to identify the factors and mechanisms that promote nonsuicidal self-injury and suicidal ideation (SI) as precursors of suicidal behaviors in a sample of 553 Israeli active-duty soldiers. METHODS: A mediation model was used to examine the contribution of posttraumatic stress disorder (PTSD) symptoms, emotion-regulation difficulties, habituation, and risk-taking behaviors to soldiers' self-injury and SI. RESULTS: Results indicated direct effects between PTSD symptoms and self-injury and SI, as well as between emotion regulation difficulties and self-injury. Indirect effects were found between PTSD symptoms and nonsuicidal self-injury (NSSI) through the mechanisms of habituation and risk-taking behavior and between difficulties in emotion regulation and NSSI through the mechanism of risk-taking behaviors. CONCLUSION: To tackle soldiers' suicidal behaviors, clinicians might assess soldiers' PTSD symptoms and difficulties in emotion regulation and intervene by lessening their access to thrill-seeking situations and situations that increase habituation to pain and death.

[THE PSYCHOLOGICAL IMPACT OF COVID-19 ON MENTAL HEALTH - LITERATURE REVIEW].

INTRODUCTION: The spread of epidemics resulting in many deaths has been known since the dawn of civilization, for example, the typhus and smallpox epidemics and the plague. Early in the previous century there was an outbreak of the Spanish Flue and towards the end of the 60's, the AIDS epidemic (HIV). Since the start of the current century, several epidemics broke out and spread to various places around the world, for instance, SARS (Severe Acute Respiratory Syndrome), the Avian Influenza and the Swine Influenza. In 2014 there was an outbreak of Ebola (Ebola virus disease) and in 2015 the Zika virus emerged and there were more. Epidemics cause havoc and impact all areas of life. Each epidemic takes an unfathomable price in lives. It is estimated, for example, that the AIDS epidemic took the lives of some 30 million people. The Corona virus (Covid-19) broke out in China, towards the end of 2019 and spread to most parts of the world. The implications of the outbreak are similar in many countries, among others, due to the uncertainty regarding the way the virus spreads, the appropriate treatment, the lack of vaccination and the high rate of deaths. Naturally, at such times physical protection is a top priority. However, coping with the implications to people's mental health is no less important and these may result in long-term negative impacts.

[THE PSYCHOLOGICAL IMPACT OF A PANDEMIC OUTBREAK ON MEDICAL STAFF - LITERATURE REVIEW].

INTRODUCTION: In January 2020, the World Health Organization (WHO) declared an international emergency due to the outbreak of COVID-19. In March 2020 the WHO announced that the epidemic could be characterized as a pandemic. Subsequently, the WHO acknowledged the importance of providing support to the medical teams, realizing the enormous burden and stress facing this group. The aim of the present study is to review the up-to-date professional literature dealing with the psychological impact of a pandemic outbreak on medical staff. The literature existing so-far is scarce. It does, however, provide evidence of the short- and long-term impact of such epidemics on the mental health of the medical teams. Direct exposure to affected patients, the risk of contagion, a subjectively negative perception of one's medical condition and being in isolation or quarantine, all constitute risk factors for mental symptoms such as depression, anxiety and post-trauma. A sense of control, especially regarding the means of protection and controlling infection, altruistic acceptance of the work-related risks, social support, good team-spirit in the medical unit and support from superiors are all protective factors.

A neural correlate for common trait dissociation: Decreased EEG connectivity is related to dissociative absorption.

OBJECTIVE: Dissociation refers to a disintegration between psychological elements; common manifestations are embodied in "absorption and imaginative involvement," a propensity for being immersed in a stimulus while oblivious to the environment, and acting without awareness. Trait dissociation was hypothesized to relate to lower EEG signal connectivity, but studies on healthy populations are scarce. The present study set out to examine whether dissociative absorption in a nonclinical sample would be associated with decreased intrahemispheric coherence. METHOD: In 84 healthy Israeli soldiers (49% females; Mage = 22.24, SD = 2.64), resting-state electroencephalography (rsEEG) was recorded for a period of 3 min with eyes closed and 3 min with eyes open. RESULTS: Decreased coherence was related to high dissociative absorption in the long (frontal-occipital) range, and in one of the pairs of the short range (central-parietal). The effects emerged mostly in the left hemisphere, in both eyes-open and eyes-closed conditions, and for a range of spectral bands, although long-range effects were more pronounced in slow-wave bands (theta and delta). CONCLUSIONS: Dissociative absorption is manifested in segregated cortical activity, supporting the notion that it may represent less integrated mental functioning. The findings contribute to our understanding of the neural correlates of consciousness and personality.

Absorbed in sleep: Dissociative absorption as a predictor of sleepiness following sleep deprivation in two high-functioning samples.

In recent years, a labile sleep-wake cycle has been implicated as a cause for dissociative experiences, and studies show that dissociation is elevated following sleep deprivation. Dissociative individuals may find it harder to regulate sleepiness in the face of sleep disruption. Although there is significant variability in reactions to sleep deprivation, research on trait predictors is scarce. The present study examined the ability of trait dissociation to prospectively predict sleepiness following sleep loss and recovery sleep. Two high-functioning samples, namely, Remotely Piloted Aircraft officers (N=29) and Air Force jet pilots (N=57) completed state and trait questionnaires assessing sleep and dissociation before and after full or partial sleep loss. Dissociative absorption was a consistent predictor of an increase in sleepiness following sleep loss and following recovery sleep, controlling for baseline sleepiness levels. We discuss the findings in light of a difficulty to regulate and monitor consciousness states.

No Way Out: Entrapment as a Moderator of Suicide Ideation Among Military Personnel.

OBJECTIVE: Suicide is a leading and growing cause of death in the military during peacetime. This study sought to examine the psychological mechanisms relating to entrapment, stress, and psychological protective factors facilitating suicide ideation among military personnel. METHOD: The study population comprised 168 soldiers (aged 18-21) divided into 3 groups: suicide attempters (n = 58), those receiving treatment by a mental health professional, reporting no suicidal behavior (n = 58), and controls (n = 50). RESULTS: In general, the suicidal group scored higher than the 2 other groups in stress levels and entrapment but lower than the other 2 groups in perceived problem-solving abilities and perceived social support. Moreover, the interaction of stress and entrapment predict suicide ideation beyond stress, protective factors, and entrapment alone. CONCLUSION: Entrapment is an important predictor of suicide ideation and can serve as a moderator, in that its presence may exacerbate the harsh situation of subjective stress within the military context and intensify it into a suicide risk.

Risk of suicide among female adolescents with eating disorders: a longitudinal population-based study.

PURPOSE: Suicide is a major cause of death among individuals with eating disorders. This study examined risk of suicide among females with eating disorders based on population-based military data. METHODS: Data on diagnoses of eating disorders from the pre-induction screening for psychopathology and diagnoses assigned during military service were merged with data on later suicide from the nationwide Israeli Death Registry. We identified 1,356 females with eating disorders and compared their risk of suicide to a population-based control group of females without eating disorders over a mean follow-up period of 8.5 ± 5.34 years. RESULTS: Females with eating disorders had a higher rate of suicide (0.22 %, n = 3) compared to females without eating disorders (0.03 %, n = 166). Having a moderate-severe eating disorder was associated with increased risk of suicide (RR = 12.50, 95 % CI = 3.86-38.09), whereas none of the females diagnosed as having a mild eating disorder died by suicide. CONCLUSIONS: Females with moderate-severe eating disorders are at risk of suicide and should be monitored for suicidal intent.

The Psychological Impact of Exposure to Battle on Medics: A Cross-Sectional Study of Ex-Soldiers Who Sought Help From the IDF Combat Reaction Unit.

INTRODUCTION: The present study's central aim was to examine two questions: (1) Will there be differences in mental health outcomes between medics and non-medics who sought help at the Israeli Combat Reaction Unit (CRU)? (2) Will there be differences in mental health outcomes between combatants and non-combatants? MATERIALS AND METHODS: This cross-sectional study included files of 1,474 Israeli Defense Forces ex-service members (89% combatants, of whom 13% were medics; 11% non-combatants, of whom 6% were medics), who filled out questionnaires on admission for evaluation at the CRU.Dependent variables were mental health measures and included two PTSD measures (Clinician-Administered PTSD Scale and PTSD Checklist for DSM-5), Beck Depression Inventory, Dissociative Experience Scale, and Brief Symptom Inventory. Military profession (medics vs. non-medics) and status (combatant vs. non-combatant) were the independent variables. Background variables were also examined. RESULTS: We found no substantial differences between medics and non-medics in the mental health measures. When looking at combat and non-combat separately, the non-combat medics (CMs), in general, were in better mental health conditions than the other three groups- CMs, non-medic combatants, and non-medic non-combatants-all of whom had similar scores in the mental health measures. However, compared to the rest, non-CMs took considerably longer years before approaching the CRU. CONCLUSIONS: The elapsed time to seek help for non-MCs was explained by their reluctance to seek help, not being combatants, and being medics who are portrayed as resilient. Recommendations for encouraging this subgroup to seek help were given.

Relationships of DSM-5 PTSD symptom clusters to suicidal ideation and death ideation in outpatient military veterans.

Veterans with PTSD are at higher risk for suicide. This study examined the specific associations of PTSD symptom clusters with suicidal ideation (SI) and death ideation (DI), independently from depressive symptom clusters. Participants included 695 Israeli male outpatient military veterans (M = 25.35 years, SD = 5.65), divided into subsamples of probable PTSD (PTSD Checklist for DSM-5 [PCL-5] ≥ 33) and subthreshold PTSD scores (PCL-5 < 33). Data were extracted from medical chartsand self-report questionnaires. The main analyses included logistic regression to evaluate the associations between SI and DI (Brief Symptom Inventory, items 9 and 39) and PTSD symptom clusters (PCL-5), controlling for depressive symptom clusters (Beck Depression Inventory; cognitive-affective and somatization) in each subsample. The results showed that, for veterans with probable PTSD, the negative alterations in cognition and mood symptom cluster was positively correlated with SI and DI, while avoidance was negatively correlated with SI, independently from depressive symptoms clusters. In those with sub-syndromal PTSD, the re-experiencing cluster was positively correlated with DI, independently from the depressive symptom clusters. These findings highlight the importance of targeting PTSD components, such as negative alterations in cognition and mood symptoms experienced by veterans with PTSD, as part of suicide prevention efforts.

The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit.

INTRODUCTION: This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU). MATERIALS AND METHODS: This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined. RESULTS: Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression. CONCLUSIONS: While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.

Are intelligent people more likely to get vaccinated? The association between COVID-19 vaccine adherence and cognitive profiles.

INTRODUCTION: Since vaccination adherence is crucial in reducing morbidity and mortality during a pandemic, we characterized the association between demographic, intelligence, and personal attributes and COVID-19 vaccination adherence among young adults. METHODS: Cohort study including vaccination data of 185,061 personnel, collected during 13 months of COVID-19 vaccination campaign, while a wide array of vaccination incentives were offered. The effect of demographic data (age, gender and socioeconomic status), military medical fitness - fit for combat service, administrative service, or unfit (volunteering), general intelligence score (GIS) and military social score (MSS) assessing social abilities, on vaccine adherence (allocating by IMOH guidelines) was examined. RESULTS: Adherent (vs. nonadherent) personnel presented higher GIS (mean 5.68 ± 1.84 vs. 4.72 ± 1.91) and MSS (median 26 (IQR 23-29) vs. 24 (IQR 19-26)), p < 0.001 for both. Higher intelligence was the strongest predictor for vaccine adherence (OR = 5.38, 95 %CI 5.11-5.67, p < 0.001). The probability for vaccine adherence increased in association with escalating GIS scores, with highest GIS females more likely to adhere to vaccination than same-level males (OR = 5.66, 95 %CI 5.09-6.28 vs. OR = 3.69, 95 %CI 3.45-3.94, respectively, p < 0.001 for both). Medically fit service-members were approximately three times as likely to be adherent than volunteering personnel (OR = 2.90 (95 %CI 2.65-3.17) for administrative and OR = 2.94 (95 %CI 2.70-3.21) for combative fitness, p < 0.001 for both). CONCLUSIONS: During a COVID-19 vaccination campaign, addressing vaccine hesitancy contributing factors and providing wide vaccine availability, GIS and physical fitness had the strongest association with vaccination adherence among young adults. When planning future vaccination campaigns, implementing these insights should be considered to improve adherence.

Predictors of Emotional Distress in Combat Military Flight Engineers.

OBJECTIVE: Exposure to distressing sights (DSs) during combat missions may cause emotional distress. The present study aimed to investigate the association between exposure to DSs involving severe injuries and fatalities during rescue missions and emotional distress, in Israeli Air Force (IAF) helicopter flight engineers (FEs). METHODS: Cross-sectional design using self-report questionnaires. The independent variables included demographics, personal, and military variables-exposure to DSs throughout a whole career service. The dependent variables included Depression (Beck Depression Inventory); State-Trait Anxiety Inventory; Post-traumatic stress disorder (PTSD Checklist-PCL-5); Somatization (Patient Health Questionnaire); Maslach Burnout Inventory; and Coping Strategies (The Brief COPE). The variables PTSD, depression, and anxiety were examined twice: once as dichotomous variables according to the pathology cutoff point and again as a continuous variable to reveal the intensity of symptoms. RESULTS: Participants were 106 IAF helicopter FEs (mean age = 39.32, SD = 8.75). Linear regression revealed that initial exposure to distressing battlefield sights (i.e., exposure to severe injuries and fatalities) was a predictor of depression symptoms. Career service FEs aged 31-40 were found to be at the highest risk of emotional distress, with a predictive factor for anxiety symptoms. Use of nonadaptive coping strategies was found to predict depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms. CONCLUSION: A significant association was found between exposure to DSs involving severe injuries and fatalities during rescue missions and anxiety, depression, somatization, and burnout. This population is generally perceived as tough and resilient, and this study has a unique contribution in identifying its vulnerabilities. Psychological intervention is crucial after participating in such missions.

Behavioral Self-Blame in PTSD-Etiology, Risk Factors, and Proposed Interventions.

BACKGROUND: Feeling out of control during a traumatic event may evoke behavioral self-blame (BSB) to avoid feeling helpless following trauma by restoring one's sense of control. BSB is a common, persistent, and treatment-resistant post-traumatic stress symptom. The present study investigates the etiology and risk factors of BSB following a traumatic event and the reasons for its persistence over time. METHOD: Subjects were a group of 546 Israeli ex-combat soldiers (M age = 24.93 ± 5.657) registered in an Israel Defense Forces (IDF) combat reaction clinic. All completed the Peritraumatic Dissociative Experiences Questionnaire (PDEQ), the Brief Symptom Inventory (BSI), and the PTSD Checklist for the DSM-5 (PCL-5). Item 10 of the PCL-5 served to measure BSB. The PDEQ and BSI measured distress and feeling out of control during the event. We used descriptive analyses of the data, t-test, and linear regression analysis to reveal the relationship between the research variables. RESULTS: Feeling out of control during a traumatic event often increases BSB and post-traumatic stress symptoms. A significant correlation emerged between continuing distress characterizing individuals who experience a persistent lack of control and BSB. Female combat soldiers were at a higher risk of BSB than their male counterparts. CONCLUSION: Loss of control experienced during a traumatic event may result in persistent long-term feelings of lack of control over one's behavior.

COVID-19 vs. terrorism: Contribution of the COR theory to the process of coping with invisible threats.

Two years have passed since the outbreak of the COVID-19 pandemic. The entire world is still struggling with the virus and its mutations, and governments have been imposing various restrictions, including social distancing and quarantine. This paper leans on the Conservation of Resources (COR) theoretical model in comparing the impact of COVID-19 with that of an ongoing threat of terror attacks, allowing us to understand the similarities and differences between them. Such exploration could result in an understanding that may guide devising psycho-social interventions to minimize the negative psychological consequences of a continuous life-threatening situation. By applying the extensive available literature on the aftermath of terrorist attacks to the little-known long-run consequences of the COVID-19 pandemic, this paper comes up with several guidelines such as increasing online social support and enhancing adaptive coping with stress, that are applicable on the individual, community, and societal levels.

Contributing Factors to Israeli Soldiers' Adaptation to Military Noncombat Positions.

OBJECTIVE: Adjusting to a military environment is a complex process, with unique demands and various stressors placed on conscripts. In this study, we examined the unique and combined contribution of the independent variables that constitute an individual soldier's personal resources-the meaningfulness of the military role and the match between expectations and the job itself; cognitive flexibility; social support; and seeking help from a mental health officer (MHO)-to the adaptation (dependent variable) of noncombat soldiers to military service. METHOD: The study group comprised 200 Israel Defense Forces noncombat soldiers aged 18-23 years (Meanage = 20.046 years, SD = 0.951). Of them, 107 (53.3%) had consulted a MHO. The remaining soldiers who had not consulted an MHO (n = 93, 46.5%) served as the comparison group. Research tools included the work and meaning questionnaire, the Cognitive Flexibility Scale, the Medical Outcomes Study (social support) questionnaire, and adaptation to the army questionnaire. RESULTS: Adaptation to service was found to relate positively to the meaningfulness of the military role, cognitive flexibility, and social support. Social support partially mediated the relation between cognitive flexibility and adaptation to service. Additionally, soldiers who had consulted an MHO had lower levels of cognitive flexibility and social support, and they adapted less well to service compared to the comparison group. CONCLUSIONS: The study indicates that soldiers who seek help have lower resources. Additional personal and environmental variables that contribute to the adjustment of soldiers in noncombat positions were also identified.