Sense of coherence and socio-demographic characteristics predicting

posttraumatic stress symptoms and recovery in the aftermath

of the Second Lebanon War

Shaul Kimhia*, Yohanan Eshela,b, Leehu Zysberga,

Shira Hantmanc and Guy Enoshd

aDepartment of Psychology, Tel Hai Academic College, Tel Hai 12210, Israel; bDepartment ofPsychology, Haifa University, Haifa, Israel; cDepartment of Social Work, Tel Hai AcademicCollege, Tel Hai 12210, Israel; dDepartment of Social Work, Haifa University, Haifa, Israel

(Received 24 June 2008; final version received 15 April 2009)

This study investigated the role of sense of coherence (SOC) as a mediator betweendemographic attributes of individuals (gender, age, economic situation, andexposure to traumatic events during the war) and two war outcomes (postwarstress symptoms and perceived posttraumatic recovery). The participants were 870adults (ages ranged between 20 and 85), who were affected by the Second LebanonWar and were evacuated from their home town. They were administered theresearch questionnaire approximately one year after this war. Path analysisindicated the following: gender, age, economic situation, and exposure weresignificantly associated with level of symptoms as well as perceived recovery.However, three of these connections (age, economic, and exposure) were partiallymediated by SOC which was linked with lower levels of stress symptoms andhigher levels of perceived posttraumatic recovery. Unlike our hypothesis, exposureby age interaction was not significantly associated with SOC and the two waroutcomes. Results supported the hypotheses that SOC mediates between demo-graphic characteristics and negative (symptoms) as well as positive (perceivedrecovery) war outcomes.

Keywords: sense of coherence; stress symptoms; perceived posttraumatic recovery;mediation model; Second Lebanon War

The sense of coherence (SOC) concept comprises three interrelated components:

sense of meaningfulness, comprehensibility, and manageability. Hence, SOC affects

how individuals perceive the world and the events that happen to them as well as the

extent to which they perceive these events as controllable. According to Antonovsky,

SOC is a stable global construct, which is universally meaningful and cuts across

lines of gender, social class, and culture (Antonovsky, 1979, 1987; Sagy &

Antonovsky, 2000). Furthermore, according to Antonovsky SOC is a health-

engendering orientation that functions as a psychologically based stress-resistance

resource. Accordingly, it is a major factor determining one’s ability to cope with

harsh events such as war, as well as the rate of recovery from traumatic events and

return to normal life after experiencing distress. Other researchers have defined such

orientation as a dispositional trait: ‘‘Broad individual differences in behavior,

*Corresponding author. Email: shaul@shamir.org.il

ISSN 1061-5806 print/1477-2205 online

# 2010 Taylor & Francis

DOI: 10.1080/10615800902971513

http://www.informaworld.com

Anxiety, Stress, & Coping

Vol. 23, No. 2, March 2010, 139�152

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thought, and feeling that account for general consistencies across situations and over

time’’ (McAdams & Pals, 2006, p. 212). According to Feldt, Metsapelto, Kinnunen,

and Pulkkinen (2007), SOC and ‘‘big five factors’’ are highly interrelated. Their

study indicated significant relationships between SOC scores and both neuroticism

and conscientiousness in male adolescents (and in addition between SOC and

agreeableness in adolescent girls).

The core hypothesis of the concept is that the stronger the person’s SOC is themore

adequate will his/her capacity to be cope with distress. A recent review of the literature

(Almedom, 2005) posits further that SOC is a preferable concept for analyzing coping

with stress since it is inclusive of the related concepts of resilience and hardiness.

Sense of coherence and severe stress

Negative psychological effects of traumatic events such as wars and acts of terrorism

have been discussed widely in recent research (e.g., Ehntholt & Yule, 2006). These

effects may linger on as posttraumatic distress symptoms (PTSD; Hadi, Llabre, &

Spitzer, 2006), as well as emotional and behavioral problems.

Studies of severe stress events have also indicated the important role of SOC. For

example, Dudek and Koniarek (2000) have found that a higher level of PTSD was

associated with a lower level of SOC among firefighters. High SOC and spirituality

were positively correlated with lower stress and higher quality of life in chronic

patients (Delgado, 2007). Similarly, it was found that people with a low SOC

reported significantly slower adaptation to the adverse effects of their life experiences

than those with a higher SOC (Surtees, Wainwright, & Khaw, 2006). This study

demonstrated further that SOC was also predictive of mortality. An additional study

of displaced adult Kosovars revealed significant negative correlation between their

SOC and symptoms of depression (Roth & Ekblad, 2006), and Almedom,

Tesfamichael, Mohammed, Mascie-Taylor, and Alemu (2007) demonstrated that

SOC differentiated between displaced and non-displaced Eritreans.

Sense of coherence and positive stress-related outcomes

It has been argued further that traumatic events may also result in positive stress-

related outcomes beyond the pre-traumatic condition (Hobfoll et al., 2007). A more

modest and perhaps more realistic aim of posttraumatic growth is the ability of

people to find ‘‘some good emerging from their struggle’’ (Tedeschi & Calhoun,

1995, p. 445). Posttraumatic growth may be achieved by being able to find something

to hold onto in times of acute stress, even if people who have suffered from hardship

fail to restore previous psychological adjustment levels. Thus, it was found that

people can reestablish a positive image of postwar reality as well as a positive view of

themselves while accepting the fact that their situation has not been improved in

relation to the pre-traumatic condition (Janoff-Bulman, 1992). However, the concept

of posttraumatic growth is still equivocal and many relevant issues require further

research. These include its relation to well-being, whether growth is best conceptua-

lized as a process or an outcome, whether report of growth reflects actual behavioral

change or represents illusion or cognitive distortion supporting coping with distress

(Park & Helgeson, 2006).

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We submit therefore, that recuperation from war traumas should be assessed by

allowing respondents to rate their present condition as compared with their pre-war

condition (see, Weinrib, Rothrock, Johnsen, & Lutgendorf, 2006), and will term this

recuperation ‘‘perceived posttraumatic recovery’’ (PTR). We hypothesize that level

of PTR measured this way, will be associated with improved indicators of adjustment

even when it does not exceed pre-trauma level.

The extensive research linking SOC with reactions to stress has neglected to

investigate its association with a positive outcome such as PTR (e.g., Delgado, 2007),

although Almedom and Glandon (2007) have argued forcefully that poststress

resilience is a psychological attribute in itself and not just the absence of PTSD. The

present study will address this issue.

Additionally, several studies have examined the role of SOC as a mediator

between background variables and distress. For example, demographic character-

istics and explanation of health (Eriksson & Lindstrom, 2007) and; exposure to

violence and psychological, psychosomatic, and cognitive stress reactions (Hogh &

Mikkelsen, 2005). We are not aware of a study which examined SOC as a mediator

between demographic characteristics and outcomes of war. However, based on the

literature, we hypothesized that SOC would serve as a mediator between demo-

graphic characteristics and positive as well as negative war outcomes.

Demographic characteristics predicting distress

Four demographic variables were found to be correlated in coping with traumatic

stress: level of exposure to traumatic events, age, gender, and economic situation.

Exposure to traumatic events

It has been observed that postwar psychosocial damage is substantially affected by

exposure to distressing war experiences: the greater this exposure the higher the level

of stress symptoms (Kimhi & Shamai, 2004). Furthermore, it was also found that

exposure to traumatic events was negatively associated with SOC. Hogh and

Mikkelsen (2005) have studied the relationships between exposure to violence at

work and SOC. They indicated that employees subjected to violence have a weaker

SOC than comparable peers who were not subjected to violence.

Age

Several studies have indicated that adverse postwar responses were more prevalent

and more enduring among older people (e.g., Tang, 2007). Somewhat similar results

were obtained in a longitudinal study of posttraumatic growth that studied survivors

of three disasters and retested these survivors three years later (McMillen, Smith, &

Fisher, 1997). Other studies reported that SOC tends to be relatively stable and does

not change much over the years (Hendrikx, Nilsson, &Westman, 2008). For example,

Feldt et al. (2007) reported high test-retest stability (five year follow-up) for SOC

among adults, indicating that SOC tends to be stable after the age of 30. Hakanen,

Feldt, and Leskinen’s (2007) longitudinal study has supported Antonovsky’s

hypothesis according to which SOC was more stable among high-SOC individuals

than among low-SOC individuals. Due to the wide range of respondent ages in the

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present study we assumed that age would be associated with SOC as well as stress

symptoms and PTR.

Additionally, a few studies has indicated that exposure to stress affects various

ages differently (e.g., Kimhi & Shamai, 2006). Based on these studies we also

hypothesized that the exposure by age interaction would affect the two war

outcomes: PTR and stress symptoms.

Gender

Most of the studies investigating gender differences in reaction to stress (see

literature review: Tamres, Janicki, & Helgeson, 2002) have claimed that women tend

to report higher levels of war-related stress (fear, anxiety, and somatic complaints),

as well as more behavioral problems than men do (e.g., Kimhi & Shamai, 2006).

Research has failed to find gender differences in SOC scores. A recent 15-year

longitudinal study of Finnish men and women (Volanen, Souminen, Lahelma,

Koskenvuo, & Silventoinen, 2007) has found no SOC differences between men and

women. In line with these data we assumed that gender would be associated with

both stress symptoms and PTR but not with SOC.

Economic situation

Previous data indicated that poor economic conditions were associated with a larger

number of reported symptoms and a lower level of posttraumatic growth (Hobfoll

et al., 2007). Positive associations were also found between economic condition and

SOC. Thus it was found that unskilled occupations were associated with declines in

SOC (Smith, Breslin, & Beaton, 2003). Tsuno and Yamazaki (2007) reported similarly

that SOC was positively correlated with economic status among Japanese urban

residents, but not among rural residents. Economic condition is expected, therefore,

to be positively associated with PTR and negatively linked to the level of symptoms.

These and similar data on predictors of postwar symptoms assume direct links

between these four predictors and the two war outcomes (symptoms and PTR). We

submit that these associations are mediated by SOC. The fact that people who

experienced similar horrors of war respond to them differently, and most of them do

not develop chronic PTSD (Sutker, Davis, Oddo, & Ditta, 1995) which suggests that

the important predicting factors are not demographic characteristics by themselves,

but rather the connotations attached to them by the individual. Based on the

salutogenic model we hypothesized a mediation model associating four demographic

attributes with SOC, and with war outcomes. According to this model, SOC will

serve as a mediator between gender, age, exposure to adverse war experience as well

as perceived economic condition, and both positive (PTR) and negative (symptoms)

war outcomes. The indirect links of these predictors will be stronger than their direct

effects on these two war outcomes. Thus individuals with higher SOC will recover

more rapidly from traumatic stress, and will exhibit greater immunization to acute

stress symptoms. Accordingly, the main research question to be examined in the

current study is as follows: are the effects of socio-demographic variables (gender,

age, economic level, and exposure level) on postwar outcomes, mediated partially or

fully by SOC?

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This expected mediation model was investigated in the present study using a large

Israeli sample of individuals living in the border town of Kiryat Shemona,

approximately one year after they had been targeted by hundreds of rockets shot

from Lebanon during the Second Lebanon War in 2006, causing a massive

destruction of the town (Israeli Ministry of Foreign Affairs, 2006). There is a reason

to believe that all the present respondents were substantially affected by stressful war

events. They were restricted for an entire month to crowded and unequipped shelters

lacking basic provisions such as food or toilets; they were constantly worrying about

the safety of relatives and friends; they risked their lives by emerging from these

shelters to breathe fresh air, to provide for daily needs, and to inspect their homes

despite the continuous shelling; and they did all this under the constant fear evoked

by the roaring of incoming and outgoing artillery. Furthermore, they had to evacuate

their homes and to become displaced persons, not knowing when they would come

back. Displacement was not employed as an additional variable predicting war

outcomes despite its importance for mental health (Almedom et al., 2007), since

practically all the town’s population was displaced during this war.

The theoretical model is presented in Figure 1.

Based on the above discussions, we formulated the following hypotheses:

1. Lower level of exposure to traumatic events during the war, young age, being a

male and a better economic situation will associate with lower level of stress

symptoms and higher level of PTR.

2. SOC will serve as a partial mediator between gender, age, economic situation,

and level of exposure to traumatic events and both stress symptoms and PTR:

higher exposure to traumatic events and lower economic situation will be

positively associated with symptoms and negatively linked to PTR. However,

higher SOC will have a negative effect on level of symptoms and a positive

effect on PTR.

Figure 1. Theoretical model � SOC as a mediator between demographic characteristics and

two war outcomes.aSOC � sense of coherence.bPTR � posttraumatic recovery.

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3. Exposure by age interaction will affect SOC, stress symptoms, and PTR.

Accordingly, SOC will serve as a partial mediator between exposure by age

interaction and stress symptoms and PTR.

Method

Participants

The sample constituted 870 adults (40% men, 60% women), residents of the border

town of Kiryat Shemona. Ages ranged from 20 to 85 (M�44.12, SD�16.19). In

addition, 44% had more than 12 years of education, 50% had 9�12 years of

schooling, and 6% had studied eight years or less.

Sampling and procedure

Three sub-samples were included: (a) 36 streets (covering most of the city streets)

were sampled randomly from the map of Kiryat Shemona, about 10 months after the

2006 fighting. One research assistant covered each street, going from door to door.

In the event of absenteeism or refusal to participate, students were instructed to

move on to the next door. Less than 6% of those who were at their home during the

research assistants’ visits refused to take part in the study.

This process continued until each research assistant had completed 20

questionnaires. The sample included 747 respondents (about 15 questionnaires

were rejected as a result of incomplete responses). (b) In order to guarantee inclusion

of a wide enough range of ages in the sample, 50 elderly people (aged 65 and above)

of the daycare center for older adults in Kiryat Shemona were added. Research

assistants helped them respond individually to the research questionnaire. (c) To

ensure representation of individuals with a higher level of education, 73 teachers,

which constituted 90% of the local high-school teachers, were administered the

research questionnaire individually. The three samples were administered with the

research questionnaire concurrently. Administering the questionnaires ranged from

45 to 90 minutes each. The individual administration of the survey seems to account

for the fact that only 12 questionnaires were discarded due to missing data (more

than 20 items missing served as a cut-off point). Overall, missing data rate were less

than 3%, handled by using pair-wise exclusion method. The front page of the

questionnaire included a short explanation about the study, a consent form to

participate, and assurance of anonymity of respondents. The questionnaire was

administered after the respondent has signed the consent form.

The vast majority of the sample responded in Hebrew. A small number of older

people were administered a Russian version of the questionnaire. No differences were

found between the responses of these two versions.

Instruments

Sense of coherence

The short form of SOC scale was employed (Antonovsky, 1987). This scale,

consisting of 13 items, measures three components of SOC: meaningfulness,

manageability, and comprehensibility. Responses were indicated using a seven-point

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bi-polar scale. Five of the items were reverse-scored such that higher numerical

ratings indicated higher levels of SOC for all items. A general SOC mean score was

employed. The internal reliability (Cronbach alpha coefficient) of this score in the

present study was .79. Validity and reliability data for the 13-item SOC scale are

presented in Antonovsky (1992), Gana and Garnier (2001), and Hittner (2007). In

addition, the SOC scale has been translated and adopted for use in many languages

and the scale has been found as grounded in robust primary research of cross-

cultural relevance (e.g., Almedom et al., 2007). No such translation was required in

this study since the scale was originally written in Hebrew.

Stress symptoms

The short version of the Brief Symptom Inventory (BSI; Derogatis & Savitz, 2000;

Derogatis & Spencer, 1982) was utilized. The original inventory consists of 53 items

(measuring nine symptom areas). The present study uses only three sub-scales

(anxiety, depression, and somatization) and is comprised 19 items, scored on a Likert

scale ranging from one (very low) to five (very high). Validity and reliability of this

scale have been examined in several studies, including the Hebrew version of the scale

(Derogatis & Savitz, 2000; Gilbar & Ben-Zur, 2002). These studies have indicated

that the scale is sensitive to stress situations like war. Since the overall Alpha

Cronbach reliability of the 19 items in the present study was very high (.94), a general

mean score of symptoms was employed.

Perceived posttraumatic recovery

PTRwas assessed by an eight-item ‘‘effects of war’’ inventory pertaining to perceived

war effects (Kimhi & Shamai, 2004). This scale, employed in assessing the aftermath

of the Israeli Defense Forces (IDF’s) withdrawal from Lebanon on people residing

along the Lebanese border, had reported an Alpha Cronbach of .83. In a previous

study (Kimhi, Eshel, Zysberg, & Hantman, in press), the PTR scale identified a long-

term impact of war on adolescents and adults and emerged as a solid indicator for

level of return to normal life one year after the war. Similar to Weinrib et al. (2006),

we have tapped both positive and negative possible war effects. Accordingly,

respondents were requested to compare their present situation with their pre-war

situation in eight domains of possible war effects: ‘‘In comparison with my situation

before the war, at present’’: physical-health situation, morale, social activity,

situation in my principal area of activity (studies, work), level of interest and

activity in my hobbies and/or in sports, emotional state, and level of optimism. Scale

ranged therefore from one ‘‘much worse than before the war’’ to five ‘‘much better

than before the war,’’ with three standing for ‘‘the same as before the war.’’ Inter item

correlations were all significant at level pB.001. Correlations ranged from .14 to .65,

median correlation was .39. A factor analysis (Principle component, Varimax

rotation) revealed a two factor model including a general recovery factor and an

additional rather weak specific factor pertaining to two items (optimism and hope).

Due to the relatively high reliability of the general PTR scale, a�.85 in the present

study, we decided to use an overall mean of all the items. A higher score thus

indicated a higher level of PTR or at least some degree of relapse.

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Exposure to traumatic war events

This instrument, based on Palmieri, Canetti-Nisim, Galea, Johnson, and Hobfoll

(2008) scale, measures level of exposure to traumatic events. It contains four items

(witnessing death, witnessing casualties, being injured, and fear of death). A four-

point response scale determined whether each of these outcomes of war happened to

the individual personally (four), to a close family member (three), to a member of the

extended family (two), and to friends (one). An additional three items constructed

specifically for this study (Scale 1�4), pertained to the following issues: difficult/

traumatic events experienced during the last war; damage caused to one’s house

during the war; and rockets falling in the vicinity of home during the war. The sum of

all these items indicates level of exposure to traumatic war events. No internal

consistency coefficient was computed for this scale since its items refer to independent

war distresses whose accumulation indicates higher exposure to stress.

Economic condition

The economic situation was measured by three items: economic situation before the

war, economic situation today, and family income compared to average family

income in Israel (7900 NIS). The items ranged from one (‘‘very bad’’) to five (‘‘very

good’’). Alpha Cronbach reliability of the scale was .73. General economic

condition’s mean score was employed.

Gender

Women were coded as zero and men coded as one.

Results

A preliminary correlation matrix across the investigated variables (see Table 1)

indicated that in line with previous research, SOC was positively correlated with PTR

Table 1. Pearson correlations between investigated variables.

Demographic characteristics SOCa Dependent

Variables 1 2 3 4 5 6 7

1. Gender � �.058 .143*** �.054 .026 �.168*** .165***

2. Age � �.231*** .081* .029 .029*** �.121***

3. Economic � �.208*** .261*** �.396*** .263***

4. Exposure � �.142*** .244*** �.175***

5. SOCa� �.569*** .369***

6. Symptoms � �.429***

7. PTRb�

M .37 44.12 2.90 10.78 4.60 2.07 2.47

(SD) (.49) (16.15) (.90) (5.56) (1.02) (.92) (.63)

aSOC � sense of coherence.bPTR � posttraumatic recovery.*pB.05; ***pB.001.

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and economic condition, and negatively correlated with stress symptoms and

exposure to war traumas. PTR was also positively linked with economic condition

and gender, and negatively correlated with the rest of the investigated variables,

whereas symptoms were negatively related to economic condition and gender

(women reported more symptoms) and positively connected with exposure to

traumatic events and age.

To examine our hypotheses, a path analysis (AMOS 16, Arbuckle, 2007) was

used. We used the maximum-likelihood estimation procedures and missing data were

used with multiple imputations (full information, maximum-likelihood method). As

the hypotheses have assumed a mediating role of SOC between the demographic

variables and the outcome variables, and further, assumed an interaction between

age and exposure, the default model to be examined allowed for all these effects (see

Figure 1). This default model was first compared with a model fixing all the

interaction effects to zero � a no interaction model. The model comparison yielded no

significant differences between the two models (^x2�4.016, ^df�3, p�.260),

indicating the preference for more parsimonious no interaction model. Thus, the third

hypothesis was rejected, and the analysis was continued assuming no age by exposure

interaction effect.

In order to examine the mediation effect of SOC, we compared the no interaction

model with a third model fixing all the paths between the demographic variables and

SOC to zero, to be called model without mediations. The difference between the two

models proved to be significant (^x2�75.746, ^df�4, pB.001), thus indicating

the rejection of the model without mediations in favor of the more inclusive

no interaction model. Further, as one of the mediation paths (the effects of gender

on SOC) was not significant, we constrained this insignificant path to zero, and

examined the final model. The model was not significantly different from the

no interaction model (^x2�.107, ^df�1, p�.744). The fit indices for the final

model have proved to be excellent (x2�4.12, df�4, p�.39; x2/df�1.031; Normal fit

index (NFI)�.999, Relative fit index (RFI)�.988, Incremental fit index (IFI)�

1.00, Comparative fit index (CFI)�1.00; Root mean square error of approximation

(RMSEA)�.006). The model is presented in Figure 2.

Looking further at our final model (Figure 2) indicates the following: (a) gender,

age, economic situation, and exposure to traumatic events significantly predicted

PTR as well as symptoms. Women, older persons, as well as those with a lower

economic situation and higher exposure to traumatic events reported lower level of

PTR and a higher level of stress symptoms one year after the end of the war. These

results generally support Hypothesis 1. (b) SOC served as a partial mediator between

age, economic situation, exposure to traumatic events and the two war outcomes.

However, unlike our hypothesis, SOC did not serve as a mediator for gender.

Moreover, SOC was the best predictor of PTR as well as stress symptoms.

Accordingly, those with higher SOC were less affected by age, exposure, and

economic situation, and they reported higher PTR and a lower level of symptoms.

These results mainly support our second hypothesis. (c) As indicated above, the

exposure by age interaction did not significantly predict SOC, PTR, or symptoms.

These results did not support Hypothesis 3.

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Discussion

Direct associations were examined between a large number of variables and stress

outcomes. The current study examined a mediating model in which SOC served as a

mediator between four demographic characteristics (age, gender, economic situation,

and exposure to traumatic events) and two war outcomes: PTR and stress symptoms.

The results mainly supported our mediating hypotheses. While the four investigated

variables were directly associated with level of symptoms and PTR, the links of three

of them with these war outcomes were mediated by SOC. Our final model indicated

further that SOC did not comprise a mediator for the interactions between exposure

and age. These results further validate the postulation that SOC is a health-

engendering personality trait that functions as a psychologically based stress-

resistance resource (Almedom et al., 2007; Antonovsky, 1979, 1987).

Previous studies show that more extensive exposure to traumatic events is

associated with a higher level of stress symptoms (e.g., Hobfoll et al., 2008). Our

study indicated that exposure to the distress of war; approximately one year after this

war took place, significantly affected PTR and stress symptoms. In addition, our

results indicated that the effect of exposure is mediated by SOC. In other words, levels

of impact of exposure to traumatic events depend on the levels of persons’ SOC.

These results further support the assertion that experiencing either major stress

(e.g., Selye, 1956) or more minor everyday life events (Holmes & Rahe, 1967) burden

Figure 2. Final model � path analysis with standardized estimates, demographic character-

istics, SOC, and two war outcomes.

Note: The paths from gender to SOC, as well as from exposure by age to SOC, PTR, and

symptoms, constrained to zero in this final model and are not presented in the figure. Exposure

by age variable is not presented in the above model as well.aSOC � sense of coherence.bPTR � posttraumatic recovery.

**pB.01; ***pB.001.

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individuals continuously, and their accumulation reduces the ability to cope with

further stressful events. Our study shows further that traumatic events have differential

effects on different individuals. Greater vulnerability seems to be associated with

a higher effect: older age and lower economic situation had a detrimental effect

on people’s ability to cope with stressful events such as war, even a year after its

termination.

The present results are in line with previous studies reporting negative

associations between stress and SOC (Darling, McWey, Howar, & Olmstead, 2007;

Delgado, 2007), and positive correlations between SOC and measures of well-being

(Ekwall & Halberg, 2007), and quality of life (Eriksson & Lindstom, 2007). Results

also support the assertion that a year after experiencing a traumatic event,

symptoms, and PTR constitute two concurrent and different way of responding to

this trauma (Antonovsky, 1987; Jacoby & Keinan, 2003).

In the current study, SOC positively affected PTR and negatively affected

symptoms. It may be concluded, therefore, that people with higher SOC have a better

chance of suffering a lower level of stress symptoms, as well as enjoying higher levels

of PTR after experiencing the hardship of war. Somewhat similar results were

reported by Hart, Wilson, and Hittner (2006) who have found that SOC was

positively correlated with measures tapping psychosocial resilience/protection, and

inversely correlated with measures tapping psychosocial risk/vulnerability.

In addition, the present study seems to suggest that SOC may constitute a

potential predictor for people’s ability to cope with traumatic events, for screening

those who are at the risk of being overwhelmed by stressful conditions, or for

selecting people for special jobs which require high resilience to severe stress (see also

Almedom et al., 2007).

Two conclusions may be drawn from the present data. Firstly, SOC may be

instrumental in decreasing the impact of age, economic situation, and exposure to

traumatic events on the development of stress symptoms. Secondly, by the same

token SOC determines, to some extent, the impact of these variables on PTR. A

possible practical conclusion may suggest that helping people to cope with stress

should aim at adopting general cognitive appraisals such as meaningfulness of life,

accepting life disappointments, or appreciating what life offers, which are determi-

nants of SOC. It appears that developing such cognitive appraisals may constitute

efficient determinants of training people to cope with stress.

Limitations of the study and directions for future research

Three limitations of this study should be mentioned. Firstly, the data presented

above are based solely on self reports. Future research may benefit from adding

behavioral measures of reasserted autonomy, sense of competence, or relations with

others. Secondly, both postwar symptoms and PTR seem to change with time. The

correlational design of the present study does not allow for drawing conclusions

concerning causal relations among the investigated variables. A longitudinal design

is required to point out cause and effect relations between these variables. Thirdly,

this study investigated a single community which had to cope with the aftermath of

war. Additional studies of war afflicted communities as well as those which were not

affected to a greater extent by war should also be conducted to substantiate the

present findings.

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Acknowledgements

This study was supported by grant from the UJA Federation of New York.

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