Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Matter of will: The association between posttraumatic stress symptoms and the will-to-live Yuval Palgi Department of Gerontology, The Center for Research and Study of Aging, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel ARTICLE INFO Keywords: Posttraumatic stress symptoms Will-to-live Subjective nearness-to-death Older adults ABSTRACT The present study examined how posttraumatic-stress-symptoms presented after prolonged traumatic exposure to rocket attacks are related to the perception of the worthiness of life among individuals in the second half of their lives. Additionally, it was questioned whether the subjective evaluation of the time one has left to live affects this relationship. Using an in-region random digit dialing methodology, phone calls made to residents in the south of Israel, we sampled 339 community-dwelling older adults (age range 50–90; M=65.44, SD=9.77) in Wave 1, 170 of whom were interviewed again in Wave 2 about a year later. Participants completed a phone- questionnaire on posttraumatic-stress-symptoms, subjective nearness-to-death, and will-to-live. The cross- sectional and longitudinal analyses results showed that higher levels of posttraumatic-stress-symptoms were positively related to higher will-to-live in both waves, among individuals who felt further away from death, while higher levels of posttraumatic-stress-symptoms were negatively related or unrelated to lower will-to-live among those who felt close to death in Waves 1and 2, respectively. The findings emphasize that perceptions regarding one's future perspective may affect the quality of the relationship between posttraumatic-stress-symptoms and will-to-live. Theoretical and practical implications are discussed. 1. Introduction Individuals who have been under the threat of death may feel an enhanced sense of worthiness in regard to the value of life, in general. Nevertheless, it was found that a higher frequency of exposure to traumatic events and higher levels of posttraumatic-stress-symptoms are often related to lower will-to-live levels (Kira et al., 2014; Ohry et al., 1994). This apparent paradox can be explained by the deleterious consequences associated with exposure to traumatic experience. Yet, it is interesting to examine whether all of the individuals who demon- strate high posttraumatic-stress-symptoms levels are also prone to have a lower will-to-live, or whether for some individuals under certain conditions, the traumatic experience is associated with higher will-to- live levels. Similar ideas were previously mentioned among individuals who developed posttraumatic-stress-symptoms but perceived their death to be farther away. This perception enabled a renewed apprecia- tion of life, resulting in what is known as posttraumatic growth (Palgi, 2016). Moreover, trauma in old age may exacerbate the aging process, due to aging-related processes such as poorer physical, social, and financial resources, which often deteriorate in warfare-related situa- tions (Palgi et al., 2015). However, this vicious cycle can be mitigated when individuals hold adaptable perceptions regarding issues related to their own aging and death (Palgi et al., 2014; Shrira et al., 2015), and may even turn into resilience (Palgi, 2016; Shrira et al., 2016). The present study examines this question regarding the nature of the association between posttraumatic-stress-symptoms and the will- to-live using a cross-sectional and longitudinal design. The will-to-live is a psychological inner expression of one's commit- ment and desire to continue living (Carmel et al., 2013), and includes both instinctual and cognitive levels. The instinctual level is addressed through spontaneous physiological reactions directed at enabling the individual's continuing existence when coping with death threats. The cognitive level refers to the thinking process in which one considers the worthiness of life and living in the face of current and anticipated conditions involving conflict and hardship (Carmel, 2001a, 2001b). Higher will-to-live levels were related to favorable aspects of life such as less physical illness (Chochinov et al., 1999, 2005), and long-term survival (Carmel et al., 2007; Karppinen et al., 2012). Due to the deleterious results related to posttraumatic-stress- symptoms, one can inquire whether there is a specific factor or factors that may account for higher will-to-live among individuals who suffer from high posttraumatic-stress-symptoms, especially in the second half of life. Previous studies have shown that older age was associated with lower will-to-live (Carmel, 2001a, 2001b; Carmel et al., 2013), probably as a result of age-related physical decline and pain (Chochinov et al., 1999) or negative cognitive perceptions regarding http://dx.doi.org/10.1016/j.psychres.2017.01.021 Received 16 August 2016; Received in revised form 10 December 2016; Accepted 8 January 2017 E-mail address: ypalgi@research.haifa.ac.il. Psychiatry Research 249 (2017) 180–186 Available online 10 January 2017 0165-1781/ © 2017 Elsevier B.V. All rights reserved. MARK