Background: The COVID-19 pandemic caused global chaos, stress, and uncertainty among citizens. In addition, social distancing regulations led to health, social, and financial stressors and major changes in everyday life. All this is having an impact on the mental and physical condition of the population. Previous studies showed that prolonged stressful situations may result in posttraumatic stress symptoms (PTSS).
Purpose: This study examined the factors associated with PTSS to identify populations at risk of major posttraumatic stress reactions during the COVID-19 pandemic.
Research progress: The first phase of the study (04/2020) included the development of the research questionnaires, consisting of the following measures: PTSS, world assumptions, loneliness, posttraumatic growth (PTG), loss of resources, and uncertainty stress. We conducted three repeated cross-sectional online surveys in a sample of the Israeli population. The questionnaires were administered about a month after the first lockdown on 6/2020 (T1), then again at 2 months (7/2020; T2) and 3 months (8/2020; T3) after the first lockdown. The sample featured 653 participants at T1, 261 participants at T2, and 256 participants at T3.

Results: The results showed that at T1, participants rated their PTSS as low: recurrent experience of trauma (M = 2.15, SD = 1.09); avoidance (M = 2.13, SD = 1.14); emotional detachment (M = 2.22, SD = 1.15); and irritability (M = 1.77, SD = 1.04). However, a significant increase was reported at T2 (p < .001), followed by a decrease at T3 (p < .05). At T1, 31% reported having all four PTSS (recurrent trauma, avoidance, emotional detachment, and irritability) to some degree. At T2, 38% reported having all four PTSS, and at T3, 39% reported all four symptoms. The world assumptions subscales (including participants’ assumptions of the world to be a just, controlled, and predictable place) were rated in the middle range of the scale, indicating a medium level of assumption of the world as a just place and a medium-high level of assumption of the world as a controlled and predictable place. No changes in world assumptions were observed throughout the three measurements. Participants rated their level of loneliness as medium and PTG as medium-low (PTG subscales: relating to others: M = 2.26, SD = 1.23; new possibilities: M = 2.19, SD = 1.30; personal strength: M = 2.54, SD = 1.23; spiritual change: M = 2.07, SD = 1.57; life appreciation: M = 2.78, SD = 1.26). There was a slight increase in sense of loneliness and a slight decrease in PTG from T1 to T3. However, these changes were not statistically significant. Loss of resources and uncertainty-related stress were mid-scale (M = 3.62, SD = 1.60; M = 3.58, SD = 1.44, respectively), indicating medium levels of loss of resources and uncertainty-related stress. At T2, loss of resources increased significantly and remained high at T3 (p = .001). No significant change was found in uncertainty-related stress among the three measurement points.
The multiple regression analyses for PTSS showed that at T1, PTSS was significantly associated with higher loss of resources, uncertainty-related stress, sense of loneliness, and assumption of the world to be just. Among the background variables, only employment status was significantly associated with PTSS: Participants who reported other employment situations (maternity leave, student, retired) had higher levels of PTSS. At T2, loss of resources, higher uncertainty-related stress, loneliness, and higher sense of control predicted higher PTSS. PTSS at T1 predicted higher PTSS at T2. Muslims and participants who reported “other religion” had lower levels of PTSS compared to employed participants. Uncertainty-related stress and loneliness predicted higher PTSS at T3. However, T1 PTSS predicted lower levels of PTSS in T3. The multiple regression analyses for PTG in T2 showed that more PTSS and less T1 loneliness predicted higher PTG. In addition, those who reported other religions and those who were born in Israel reported higher PTG. In T3, less loneliness and T2 PTSS predicted more PTG. In addition, Muslims, older participants, and employed participants had lower levels of PTG.
Conclusions: This study showed that a third of participants experienced PTSS to some degree at all three points. Risk factors for PTSS were uncertainty-related stress, loss of resources, and increased sense of loneliness. The low levels of PTG indicate that members of the public find it difficult to experience positive changes as a result of adversity. The different aspects of PTG such as relationships with others, internal strength, and new possibilities are being challenged by the ongoing social distancing and isolation. It could be that when the threat of the coronavirus gradually subsides, then positive transformations will accrue. There is a need to identify these at-risk individuals and offer coping and problem-solving strategies. Intervention programs designed to improve the public’s resilience should enhance personal and collective strategies for preventing PTSS and increasing PTG, focusing on vulnerable subgroups.