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ImportanceNo clinically applicable diagnostic test exists for severe mental disorders. Lipids harbor potential as disease markers.ObjectiveTo define a reproducible profile of lipid alterations in the blood plasma of patients with schizophrenia (SCZ) independent of demographic and environmental variables and to investigate its specificity in association with other psychiatric disorders, ie, major depressive disorder (MDD) and bipolar disorder (BPD).Design, Setting, and ParticipantsThis was a multicohort case-control diagnostic analysis involving plasma samples from psychiatric patients and control individuals collected between July 17, 2009, and May 18, 2018. Study participants were recruited as consecutive and volunteer samples at multiple inpatient and outpatient mental health hospitals in Western Europe (Germany and Austria [DE-AT]), China (CN), and Russia (RU). Individuals with DSM-IV or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses of SCZ, MDD, BPD, or a first psychotic episode, as well as age- and sex-matched healthy controls without a mental health–related diagnosis were included in the study. Samples and data were analyzed from January 2018 to September 2020.Main Outcomes and MeasuresPlasma lipidome composition was assessed using liquid chromatography coupled with untargeted mass spectrometry.ResultsBlood lipid levels were assessed in 980 individuals (mean [SD] age, 36 [13] years; 510 male individuals [52%]) diagnosed with SCZ, BPD, MDD, or those with a first psychotic episode and in 572 controls (mean [SD] age, 34 [13] years; 323 male individuals [56%]). A total of 77 lipids were found to be significantly altered between those with SCZ (n = 436) and controls (n = 478) in all 3 sample cohorts. Alterations were consistent between cohorts (CN and RU: [Pearson correlation] r = 0.75; DE-AT and CN: r = 0.78; DE-AT and RU: r = 0.82; P −38). A lipid-based predictive model separated patients with SCZ from controls with high diagnostic ability (area under the receiver operating characteristic curve = 0.86-0.95). Lipidome alterations in BPD and MDD, assessed in 184 and 256 individuals, respectively, were found to be similar to those of SCZ (BPD: r = 0.89; MDD: r = 0.92; P −79). Assessment of detected alterations in individuals with a first psychotic episode, as well as patients with SCZ not receiving medication, demonstrated only limited association with medication restricted to particular lipids.Conclusions and RelevanceIn this study, SCZ was accompanied by a reproducible profile of plasma lipidome alterations, not associated with symptom severity, medication, and demographic and environmental variables, and largely shared with BPD and MDD. This lipid alteration signature may represent a trait marker of severe psychiatric disorders, indicating its potential to be transformed into a clinically applicable testing procedure.

Dear Dr. Harvey This letter to the editor responds to recent papers published by the Journal of Loss and Trauma about COVID-19 impact on university student fear, mental health and substance use (Ka...

INTRODUCTION: Schizophrenia, although a debilitating mental illness, greatly affects individuals physical health as well. One of the leading somatic comorbidities associated with schizophrenia is cardiovascular disease, which has been estimated to be one of the leading causes of excess mortality in patients diagnosed with schizophrenia. Although the shared susceptibility to schizophrenia and cardiovascular disease is well established, the mechanisms linking these two disorders are not well understood. Genetic studies have hinted toward shared lipid metabolism abnormalities co-occurring in the two disorders, while lipid compounds have emerged as prognostic markers for cardiovascular disease. In particular, three ceramide species in the blood plasma, Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1), have been robustly linked to the latter disorder. AIM: We aimed to assess the differences in abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in the blood plasma of schizophrenia patients compared to healthy controls. METHODS: We measured the abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in a cohort of 82 patients with schizophrenia and 138 controls without a psychiatric diagnosis and validated the results using an independent cohort of 26 patients with schizophrenia, 55 control individuals, and 19 patients experiencing a first psychotic episode. RESULTS: We found significant alterations for all three ceramide species Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) and a particularly strong difference in concentrations between psychiatric patients and controls for the ceramide species Cer(d18:1/18:0). CONCLUSIONS: The alteration of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) levels in the blood plasma might be a manifestation of metabolic abnormalities common to both schizophrenia and cardiovascular disease.

Dear EditorThis letter to the editor responds to the recently published paper in the Journal of Loss and Trauma about COVID-19’s impact on Russian university student fear, mental health, and substa...

Dear EditorThis letter to the editor responds to recently published papers in the Journal of Loss and Trauma about the COVID-19 impact on student fear, mental health, and substance use (Isralowitz ...

The aim of this cross-sectional study was to examine the impact of gaming and gaming disorder on the wellbeing of Israeli male university students and other adults. Gaming disorder (i.e., persistent, and recurrent gaming activity associated with a lack of control that may be clinically diagnosed) was determined using the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF). Survey participants were recruited from gaming associations, clubs and the gaming community using Facebook. Data were collected in June 2022. A total of 526 males completed the survey (30.9% university students and 69.1% other young adults). Various statistical methods of analysis including regression were used for this study. Significant study group differences revealed university students with more indications of gaming disorder, more burnout, less loneliness, more stimulant (i.e., Ritalin) use, a greater consumption of salt- and/or sugar-loaded foods and lower economic wellbeing. The levels of resilience (i.e., the ability to recover from stress), substance use (e.g., tobacco and alcohol) and weight gain were similar for the two groups. Regression analysis showed gaming disorder as a key predictor of burnout, economic wellbeing and resilience. This study examined only male gamers because of the small number of female respondents. However, additional research is needed about female internet gamers, including their possible exposure to online harassment and sexual degradation. Additionally, additional research should be considered to verify the present study’s findings about gamers based on demographic factors and gaming disorder levels. Prevention and treatment intervention measures, including those that can be made available on campus, should be thought about by university administration personnel and student association leaders in consultation with professionals who are experienced in reducing gaming disorder and other harmful behaviors among students.

Background: Little is known about the COVID-19 impact on Russian medical, psychology and social work students’ psycho-emotional well-being, substance use and resilience. Methods: More than 2000 helping profession students, 75.4% female, participated in an online survey about COVID-19 impact at a peak time of infection (October/November 2020). The Fear of COVID-19 Scale (FCV-19S) and Brief Resilience Scale (BRS) were used for study purposes. Furthermore, the influence of COVID-19 on student psycho-emotional well-being and substance use (i.e., tobacco and alcohol) was examined. Results: Medical, female and religious students reported higher fear values. Social work students reported more current substance use, including binge drinking (five or more drinks on one particular occasion). Students who reported COVID-19 associated with their psycho-emotional well-being had higher fear values. Regarding resilience, no association was found based on the student study area. However, male and non-religious students reported more resilience. Students who reported substance use and psycho-emotional problems had lower resilience values. Conclusion: COVID-19 fear and substance use differs among Russian students based on background characteristics. including gender, religiosity and study area. The FCV-19S and the BRS were found to be reliable instruments for research of COVID-19-related psycho-emotional problems, substance use and resilience. Study findings have implications for “front line” helping profession students in terms of education, training and intervention, in support of promoting their ability to address difficult conditions resulting from the pandemic and other disaster conditions in the future.

Background: The aim of this cross-sectional study was to examine the impact of COVID-19 fear on the well-being of Israeli and Maltese female “help” profession (e.g., social work and psychology) undergraduate students. This cross-national comparison includes factors of depression, anxiety, anger, loneliness, nervousness, substance use, eating behavior, burnout, and resilience. The study hypothesis is that country status, even with different social–cultural characteristics including religiosity, is not a significant factor associated with COVID-19 fear impact on select behavioral characteristics of female university students. Methods: A total of 453 female “help” profession students completed an online survey from January to July 2021. Various statistical methods of analysis including regression were used for this study. Results: The mean COVID-19 fear scores were the same among Israeli and Maltese students. Resilience was found to be higher among Israeli females; burnout was found to be higher among those from Malta. Substance use (i.e., tobacco, alcohol, cannabis, stimulants, or prescription drugs) in the last month was reported by 77.2% of the respondents. No significant differences were found for previous-month substance use based on country status. Regardless of country, respondents who reported more previous-month substance use had higher COVID-19 fear and burnout scores, as well as lower resilience. Due to COVID-19, most respondents (74.3%) reported deterioration of their psycho-emotional well-being in the last month; however, no significant differences were found based on country and religiosity statuses. Furthermore, no significant differences were found for eating behavior changes and weight increase based on country and religiosity statuses. Conclusion: Study findings showed the impact of COVID-19 fear on the well-being of Israeli and Maltese female “help” profession undergraduate students. This study examined only female students; however, additional research is needed to address male students and their experiences. Prevention and treatment intervention measures aimed to increase resilience and decrease burnout, including those that can be made available on campus, should be thought about by university administration personnel and student association leaders in consultation with mental health professionals.

Aim Schizophrenia manifests differently in women and men. This disease starts at a young age, leads to disability at working age. The aim of our work was to study sex differences, association between social factors and different parameters of the clinical picture and the course of the disease. Methods This study was performed using population of Russian patients (men: 345, women: 310). Patients were examined using DSM-V, Bush-Francis catatonia rating scale (BFCRS), Positive and Negative Syndrome Scale (PANSS), 4-Items Negative Symptoms Assessment (NSA-4) and Frontal Assessment Battery (FAB). Results Sex differences were mainly shown through negative symptoms, which were more severe in male patients. Men were shown to experience a decrease in social functioning and earlier age of onset. A positive family history further influenced negative symptoms and age of onset. When comparing scores before and after inpatient treatment (4 weeks), sex differences were not so pronounced. Female patients and patients with high levels of education, no conflictual relationship with family and active labour activity showed a later age of onset of the prodromal events and manifestation age. The decrease in the number of social contacts correlated with lower age of disability. The association between social factors and the severity of psychotic symptoms was shown across DSM-V, PANSS, NSA-4 and FAB, but not for BFCRS. Social factors were associated with negative symptoms of schizophrenia, but not with positive. Conclusion For successful treatment of patients with schizophrenia, the discussed factors must be considered and schizophrenia treatment methods should be primarily aimed at improving social functioning.

This article examines interconnections between politics and culture in the early Soviet era, using Leon Trotsky’s activities in the campaign for a new everyday life (novyi byt) in 1923 as a case-study. Traditionally, scholars pay attention primarily to Trotsky’s writings on literature and art. In contrast, this article shows the important role of Trotsky’s brochure ‘Problems of Everyday Life’ in the development of a new field of political communication that became the space for criticism of different political and cultural aspects of Soviet power and Bolshevik rule. Using archival and press sources, it shows how the campaign was spread both from below and above, and what were the reasons for its failure to become an alternative cultural revolution.

COVID-19 is a major source of fear, stress, and anxiety as well as a major factor impacting the health and wellbeing of people worldwide. The present study builds on the recently developed "Fear of COVID-19 Scale" (Ahorsu et al., In International Journal of Mental Health and Addiction, 10.1007/s11469-020-00270-8, 2020). The sample comprised of 850 participants, male and female young adults from Russia and Belarus. The majority of survey participants are university students and graduates. Females, students, and others from Russia report higher levels of COVID-19-related fear than those from Belarus. Respondents from Russia and Belarus report less fear than people from Iran who were surveyed earlier. The scale used for the present survey evidenced a good Cronbach's Alpha measure of internal consistency or reliability (0.809). Clearly, further research is needed across locations and over time about the nature and extent of fear caused by COVID 19. Overall, the FCV-19S appears to be a valuable and brief instrument that may provide useful information for intervention and policy purposes to migrate fear and problem behavior linked to infectious disease outbreaks.

Medical and allied health sciences professionals are increasingly dealing with clients who use cannabis for medical and recreational purposes. Yet, university curricula in many countries do not provide education for students and professionals in medicine and allied health fields including psychology about medical cannabis (MC) use. This study compares the attitudes and beliefs toward medical cannabis among psychology students at universities in Malta and Russia. Data were collected through an online survey for Maltese students and a pen-and-paper survey for Russian students. The present study did not evidence any difference based on gender. However, students who reported personal cannabis use, regardless of country status, were more likely to recommend MC for patient treatment and believe cannabis use does not pose serious physical or mental health risks. Significant differences among the students from Malta and Russia may be attributed to the legal standing of MC in the countries involved. However, a key finding from all students is the dearth of education about cannabis for health-related conditions and the need for curricula based on evidence-based research for informed decision-making.

Depression is a serious mental disorder that affects more than 300 million people worldwide. Due to the lack of effective treatment methods, the pathogenesis of depression is necessary to study in order to understand its development and find new therapies. The review describes the main mechanisms of depression, including the monoamine hypothesis, impairment of the hipotalamic-pituitary-adrenal axis, decreased production of neurotropic factors, and neuroinflammation. Genetic correlations, gene polymorphisms, and epigenetic mechanisms are also considered. Common and different features of the etiology are analyzed for depression and depressive conditions associated with other pathologies (schizophrenia, Parkinson disease, and Alzheimer's disease). Modern experimental methods used to investigate the molecular mechanisms of depressive conditions are described with a focus on gene knockouts in laboratory animals and the CRISPR/Cas technology. Consideration is given to optogenetic and chemogenetic methods and analyses of genetic polymorphisms and their combinations. The data may provide for a better integral understanding of the modern ideas about the pathogenesis of depression as an isolated or comorbid disorder and the prospects in studying the mechanisms of depressive conditions.

Dear Dr. Harvey, In July 2020 a Journal of Loss and Trauma letter to the editor was published titled “Fear, Depression, Substance Misuse and Related Conditions among Multi-National Medical Students...

Dear Dr. Harvey,The Ben Gurion University of the Negev—Regional Alcohol and Drug Abuse Research Center (Israel) cooperates with Russian Federation colleagues to research mental health and substance...

Objectives: To examine attitudes and beliefs about medical cannabis (MC), and specifically about its application for pain management, across medical students in Israel and Thailand. Design: Cross-sectional survey which measured attitudes and beliefs about MC. Participants were additionally asked to rate the perceived efficacy of MC for different medical conditions that are related to pain (arthritis, chronic pain, fibromyalgia and multiple sclerosis). Pearson's Chi-squared test was used to compare between students from the participating universities. Results: 430 medical students participated, 37.9 % (n = 163) from Israel and 62.1 % (n = 267) from Thailand. Personal cannabis use was reported by 55.6 % of the Israeli and only by 6.9 % of the Thai students (p < .001). Israeli secular students, compared to those from Thailand, were more likely to recommend MC for patient treatment, less concerned about serious physical and mental health risks, and more inclined to support legalization of recreational cannabis. Israeli students reported more permissive attitudes toward MC, but reported feeling less prepared to answer patient/client questions about MC than their Thai counterparts. Conclusions: The findings of this study accentuate the need for curriculum designed around MC use to promote students' preparedness to serve patients in pain or with other medical conditions that may benefit from MC use.

Objectives Worldwide, considerable attention is being given to cannabis use for medical conditions. In the current study, we sought to assess attitudes and beliefs about MC among social work students from the US and Israel. Methods We sought to assess attitudes and beliefs about MC among a sample of 417 social work students (230 from the US and 187 from Israel) who voluntarily participated in an anonymous online survey. Chi-square tests were used to analyze differences between groups. Results Most of the US and Israeli participants (84.3 % and 96.7 %, respectively) reported no formal education about MC; and, they would recommend MC for their clients. Participants who reported any cannabis use, compared to non-users, were more likely to believe MC could benefit physical or mental health and less inclined to believe use of the substance poses serious physical or mental health risks. Secular, compared to religious students, believed it has more benefits for physical and/or mental health. Conclusions Our findings evidence a considerable dearth of formal evidence-based education about cannabis for medical conditions in two university-based cohorts, despite beliefs in MC as useful for physical and mental health conditions. Efforts to develop curricula and training programs for social work students are needed since they will be among key professionals addressing client needs from health care and counseling perspectives.

Objectives To assess knowledge, attitudes and beliefs regarding medical cannabis among Israeli medical, nursing, social work and other health related students as well as to outline the formation of an instrument for standardized data collection on these topics. Methods An invitation to participate with a link for the online survey was sent to all students pursuing a degree in medicine, nursing, social work, and other health disciplines in the Ben Gurion University of the Negev, Israel. The instrument included 32 items that measured knowledge, attitudes and beliefs regarding medical cannabis. In addition, demographic data were collected and participants were asked about the frequency of medical or recreational cannabis use. Results Among the 763 participants, 596 were females (78 %), and the mean age was 25.8 years. While the reported personal use of medical cannabis was minimal (1.9 %), cannabis use for recreational purposes was relatively common (54.0 %). The vast majority believed that medical cannabis holds significant health benefits but expressed concerns regarding potential risks of cannabis use. Additionally, the vast majority of students felt unprepared to answer patients' questions about medical cannabis and expressed a desire to receive more training. Several significant differences between the different academic disciplines were observed. Conclusions In light of current regulatory and scientific developments, it is apparent that students of health professions will need a greater level of understanding of medical cannabis than previous generations of students. This study emphasizes the ample need for more knowledge and formal education to students of health and related professions.

Dear Dr. Harvey,The global spread of coronavirus disease (COVID-19) and the uncertainties linked to infection, quarantine, social interaction, and prevention generate anxiety, depression, and subst...

Despite significant research, the benefits and risks of cannabis for medical purposes remain elusive. However, there is one factor about the substance that is clear - there is a dearth of knowledge about attitudes and beliefs toward its use in Russia where the substance in any form is strictly prohibited. The aim of this study was to examine the impact of affiliation with religion on university student attitudes and beliefs toward cannabis for medical conditions. Survey data were collected from 828 medical and allied health students at two Russian universities. Findings indicate that students with a religious affiliation were significantly more likely to express negative attitudes towards medical cannabis.

Objectives To assess the relationship between religiosity and medical cannabis (MC) knowledge, attitudes and beliefs among university medical and allied health (i.e., nursing and social work) students. Methods This study uses data collected from 540 Israeli male and female, Jewish and Bedouin-Arab, religious and secular students. Pearson’s chi-squared and Fisher exact tests for categorical variables were used to determine the relationship. Results Religious, compared to secular, students reported less personal cannabis use and contact with others who use the substance. Regarding attitudes and beliefs, religious students were more likely to believe cannabis use poses serious physical and mental health risks and were less likely to recommend it for patient treatment. The majority of all students, religious and secular, believed cannabis can be addictive; are not prepared to answer patient/client MC questions; and, have not received formal education about MC. Religiosity was not found related to student knowledge about cannabis and its use for medical conditions. Conclusions This study is the first in Israel to examine the relationship between religiosity and student MC knowledge, attitudes and beliefs. Results evidence the relationship that should be used for curriculum development, education and field practice purposes linked to patient care.

Negative implications of exposure to violence on health and wellbeing of youth have been observed and studied worldwide, especially in Israel. Youth in the western Negev of the country have been exposed to missile and terror attacks for more than a decade. However, implications of such prolonged exposure have not been fully studied. This study is aimed at the implications of exposure to such conditions on youth in the town of Ofakim in the Negev. A focus group was conducted with youth following the Israeli Defense Forces’ “Protective Edge” response to continued attacks from Gaza (July–Aug. 2014). Focus group participants reported high stress levels during the operation that resulted in an increase of substance use including alcohol, tobacco, cannabis, synthetic cannabis-like substances (e.g., “Nice Guy,” “Spice” and “Black Mamba”) and changes in eating and sleeping behavior. The Ofakim resilience center served as a shelter for participants providing for them with physical and emotional comfort. Staying in the “shelter” used for protection against missile attack promoted youth resilience. Exposure to violence has a significant impact on the health and wellbeing of young people and others. A secure receptive facility that provides trust and support can serve as an important moderator of the negative impact of emergency conditions. From the results reported in this article, further research is needed to fully assess the long-term effects of stress conditions including the use of cannabis and synthetic cannabis-like substances among youth and other residents in the Western Negev.

This paper aims to review patterns of cannabis (i.e., marijuana and hashish) use among high-risk Israeli youth and young adults based on research conducted by the Ben-Gurion University, Regional Alcohol and Drug Abuse Research Center. A total of 1074 Israeli youth (67.0% male, 33.0% female) were studied from 2004 to 2016. The youth and young adults included those placed in residential programs for learning and/or behavior problems (youth villages) and were school dropouts referred to a 90-day treatment facility for drug abuse. Country of origin, determined by mother’s birthplace, revealed 42.4% of the youth was of Israeli origin and 57.6% from other countries—mostly the former Soviet Union and Ethiopia. About “village” youth, no gender or religious status (secular/non-secular) differences were found for lifetime and last month cannabis use. Immigrant origin youth, than those with Israeli status, reported more lifetime and last month use as well as cannabis availability. Youth from families with low socio-economics status reported a higher rate of last month cannabis use than those with better economic conditions. Among school dropouts, no gender or religious status differences were found for lifetime and last month cannabis use and availability. For all study youth, binary logistic regression results indicated six factors significantly predicted last month cannabis use: male gender, age, last month binge drinking, illicit drug selling, reduced relations with friends, and cannabis availability. In terms of policy and service provision, high-risk youth (e.g., those in residential programs, whether for learning and/or behavior problems) should be priority for drug prevention efforts.

The purpose of this paper is to review cannabis use among a cross section of Israeli high school, school dropouts, university students, hospitality workers, and adults in drug treatment. Based on national statistics, 27.0% last year and 19.1% last month cannabis (i.e., marijuana and hashish) use has been reported among 18–65 year olds. This is a higher rate than what is reported in the USA and European countries. Findings across the study groups evidence high rates of cannabis among school dropouts and adults in drug treatment. University students tend to have a higher rate of current use than hospitality workers. Secular status, regardless of the study group, tends to influence cannabis use. Israeli origin university students and hospitality workers report a higher level of current cannabis use than those with other country origin status (i.e., the former Soviet Union). This paper suggests multiple factors be considered, organized, and sustained for policy and prevention purposes.

Tobacco smoking is a major cause of death and disease. In Israel, it has been reported that 22.7% of the population aged 18 and over smoke, mostly using cigarettes. Another smoking method is through a water pipe called hookah or nargila. This paper reviews recent studies of tobacco use among Israeli youth and young adults as well as research conducted by the Ben Gurion University, Regional Alcohol and Drug Abuse Research Center. Study findings evidence high rates of smoking linked to being male, secular, non-Israeli origin, and school dropout. Hookah use may be a “gateway” to cigarette smoking. Youth and young adults reported they believe smoking prevention programs are not effective and do not have a noticeable effect on smoking-related attitudes and behavior. Motivation, peer-supported activities in school and the community, and family factors have been found to be important for possible smoking cessation. This article suggests multiple factors be considered, organized, and sustained to promote smoking cessation.

Alcohol use that causes damage to health and adverse events is a significant public health concern. However, there is a dearth of information about alcohol use among Russian Federation university students. This cross sectional study of 626 students examined their background characteristics, alcohol use, heavy drinking and related problem behavior. Males were more inclined to use alcohol and drink heavily than females; however, no other gender related behavior differences were found. Regression analysis showed heavy drinking more prevalent among students who worked, lived on campus, missed class because of party habits, smoked cigarettes, mixed alcohol and energy drinks, and drank more because of stress. Study findings contribute to usable information for promoting university student health and well-being including academic success through policy and prevention practices as well as for examining the issue elsewhere for comparison and generalization purposes.

Alcohol use is a significant public health concern among university students who tend to have a high level of consumption. There is a dearth of information about female university student alcohol use especially on a cross-national basis. The survey sample consisted of female students from universities located in the cities of Smolensk, Russian Federation (n = 450), and Beer Sheva, Israel (n = 562). The valid and reliable data self-administered collection instrument used, the Substance Use Survey Instrument (SUSI), was translated to Hebrew and Russian and back translated. Binary logistic regression was performed to assess independent predictors of heavy drinking status. Chi-square analysis showed Russian students had significantly lower levels of alcohol use, heavy drinking use, and most related problem behavior than those of their Israeli counterparts. Regression analysis indicated last month smoking, mixing energy drinks and alcohol, being a passenger in a car when the driver had been drinking, academic achievement decline, and missing classes because of party habits significantly predicted heavy drinking among survey participants. Contrary to expected outcomes, Israeli female students reported higher levels of alcohol use and problem behavior than those from the Russian Federation. This survey outcome calls for further investigation of alcohol use beliefs based on ethnic status as well as student background factors that were not addressed.

Shared traumatic reality (STR) is when clinicians function as caregivers and are exposed to the same conditions as their patients. Since 2001, Israeli communities bordering Gaza (i.e., “Otef Gaza”) have experienced repeated missile attacks. Caregivers there have been exposed to trauma on two levels: (1) exposure to vicarious trauma through client interaction and (2) direct exposure resulting from their belonging to the communities affected. Two focus groups of mental health workers (n = 20) from Otef Gaza were conducted. The main theme that emerged was the perception of STR as an ongoing process of adaptation and change rather than a static condition. Participants noted the adaptation process encompass three foci: (1) intrapersonal, (2) clinicians’ spouses and family members, and (3) the broad working environment. Study results contribute to understanding resilience factors and addressing the needs of caregivers in STR conditions.