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The aim of this study is to examine the role of repeated exposure to rocket attacks in the links between personality vulnerability (dependency and self-criticism) and internalizing/externalizing psychopathology. A main-effect vulnerability model (personality leads to psychopathology) was compared with a main-effect scarring model (psychopathology leads to personality vulnerability). Also, a stress-diathesis pattern (personality vulnerability is activated under stress) was compared to a dual-vulnerability pattern (either personality vulnerability or stress, but not both, lead to psychopathology). Israeli adolescents (N = 362) repeatedly exposed to rocket attacks were assessed annually over 3 years. In 2008 and 2010, personality and psychopathology were assessed. Cumulative exposure was measured as the sums of exposure across the three assessment waves. Theoretical models were tested via Autoregressive Cross-Lagged Structural Equation Modeling analyses. Baseline dependency and self-criticism were associated with an increase in anxiety, whereas baseline depression was associated with an increase in dependency. Under low, not high, levels of rocket exposure, self-criticism and depression were longitudinally associated. Violence commission was associated with an increase in dependency under high, not low, cumulative exposure. Results are consistent with both scarring and vulnerability models, and with both stress-diathesis and dual-vulnerability patterns of adolescent risk and resilience.

Objective: The effects of Israeli adolescents' exposure to rocket attacks over time were examined, focusing on anxiety, depression, aggression, and violence commission., Method: A sample of 362 adolescents from southern Israel was followed from 2008 through 2011 with four annual assessments. Measures included exposure to rocket attacks (gauging whether children were affected by rocket attacks, both directly and indirectly, through friends and family), anxiety (items from the State Anxiety Inventory), depression (the Center for Epidemiological Studies Child Depression Scale), aggression (the Orpinas Aggression Scale), and violence commission (from the Social and Health Assessment)., Results: Concurrent and longitudinal findings differed. Wave 1 exposure to rockets attacks was associated with Wave 1 anxiety, depression, and aggression. Longitudinal results evinced only modest effects of exposure on anxiety and depression, no effects on aggression, but robust effects on violence commission. Exposure to terror attacks before the study predicted increased odds of violence commission at the fourth and final wave, controlling for violence commission at the first, second, and third wave. Exposure to rocket attacks in the second wave predicted increased odds of violence commission at the third wave., Conclusion: This is the first longitudinal study attesting to the prospective longitudinal effect of exposure to terrorism on adolescent violence. Findings should serve as a red flag for health care practitioners working in civil areas afflicted by terrorism and political violence., (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Terrorism leads to adolescent depression, but little is known about protective factors. We investigated 90 adolescents (in grades 7-9) residing in Dimona, Israel, before and after their exposure to a suicide bombing., Objective: To examine the prospective effect of social support from friends, parents, and school personnel on the link between bombing-related perceived stress and adolescent depression., Methods: Seven months prior to the suicide bombing, adolescents completed questionnaires as part of an ongoing investigation of youth risk/resilience under stress. The focus of the present study was on the Perceived Social Support Scale. One month subsequent to the suicide bombing, participants were interviewed by telephone about their bombing-related perceived stress (a 1-item measure) and depression (the Center for Epidemiologic Studies Child Depression Scale)., Results: Bombing-related perceived stress was associated with an increase in continuous levels of depression from before to after the bombing (beta = .29; P = .006). Prebombing social support from friends buffered against this effect (beta = -.29; P = .010). Adolescents reporting high bombing-related perceived stress evinced an increase in depression if they reported low levels of friends' support (beta = .61; P < .001) but not high levels of friends' support (beta = .00; P = .98). In addition, social support from friends predicted an increase in adolescent depression over time when bombing-related perceived stress was low (beta = .34; P = .026)., Conclusion: In adolescence, social support from friends might protect against the depressogenic effect of terrorism-related perceived stress.

Objective: This prospective study of 29 Israeli middle school students experiencing terror attacks by Qassam rockets addressed whether higher levels of baseline social support protected adolescents from adverse psychological effects of exposure to rocket attacks., Method: Participants were assessed at two time points 5 months apart, before and after a period of military escalation from May to September 2007. Adolescent self-reported depression was measured at both time points, using the Center for Epidemiological Studies-Child Depression Scale. Social support from family, friends, and school was measured at time 1, via a short form of the Perceived Social Support Scale. Adolescents also reported their exposure to rocket attacks at both time points., Results: There was a significant interaction between social support and exposure to rocket attacks predicting depression over time. As hypothesized, baseline levels of social support buffered against the effect of exposure to rocket attacks on increased depression. Conversely, social support was associated with increased depression for adolescents who were not exposed to rocket attacks., Conclusions: Findings highlight the potential importance of community mental health efforts to bolster schools, families, and peer groups as protective resources in times of traumatic stress.