Brief report The effect of prolonged exposure to war stress on the comorbidity of PTSD and depression among hospital personnel Yuval Palgi a, ⁎, Menachem Ben-Ezra b , Shai Langer c , Nir Essar c a Department of Psychology, Sharet Building, Tel Aviv University, Ramat Aviv, Tel Aviv 69978 Israel b Department of Social Work, Ariel University Center of Samaria, Ariel, Israel c Department of Psychology, Derby University Branch in Israel, Or-Yehuda, Israel ABSTRACT ARTICLE INFO Article history: Received 6 May 2007 Received in revised form 21 September 2007 Accepted 1 June 2008 Keywords: Trauma War stress Hospital personnel Impact of Event Scale Comorbidity Center of Epidemiologic Studies-Depression The relationship between exposure to war stress and to traumatic and depressive symptoms among hospital personnel is understudied. Hospital personnel who were exposed to frequent missile attacks and casualties of war, both military and civilians (n =106), were assessed for posttraumatic stress disorder (PTSD) symptoms and depression a month after the war between Lebanon and Israel erupted. Increased risk for PTSD symptoms was found to be highly associated with increased risk for depression. Logistic regression analysis showed that hospital personnel with increased risk for PTSD symptoms had a significantly elevated risk for depression in comparison to hospital personnel without increased risk for PTSD symptoms (odds ratio= 18.86, 95%CI = 4.08–87.07). These findings show that hospital personnel exposed to prolonged war stress exhibited higher levels of depression in comparison to previous single exposure researches. No profession differences were found in the levels of depression, but physicians were found to be less vulnerable than other hospital staff to develop PTSD symptoms. PTSD symptoms were significantly associated with depression. The results warrant further longitudinal study. © 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The connection between traumatic exposure and the clinical phenomena of posttraumatic stress disorder (PTSD) is well estab- lished in the literature as presented in DSM-IV (American Psychiatric Association, 1994). Other psychiatric conditions, however, are known to occur in the aftermath of trauma (Breslau et al.,1991; Kozari-Kovai et al., 2001). One of the most prevalent psychiatric conditions that develops after traumatic exposure is depression (Creamer et al., 2001; Grieger et al., 2003). There is a debate in the literature about the connection between PTSD and depression (Roberts and Robbins, 2006). The general consensus is that most cases of post-exposure depression are comorbid with PTSD. In addition, there are some independent cases in which depression and posttraumatic symptoms are presented alone as a result of exposure to the trauma (Shalev et al., 1998; O'Donnell et al., 2004). In recent years there has been a plethora of research on the effects of exposure to traumatic events on emergency and rescue personnel (Guo et al., 2004; Elhai et al., 2006; Witteveen et al., 2006; Long et al., 2007). However, medical personnel are still an understudied group among all other emergency and rescue personnel (Firth-Cozens et al., 1999; Weinberg and Creed, 2000; Luce et al., 2002; Ben-Ezra et al., 2007). One of the most frequently exposed but understudied populations is hospital person- nel (Ben-Ezra et al., 2007). This group is exposed to extreme and prolonged stressful situations that make hospital personnel a risk group for psychiatric morbidity. On the other hand, this group is considered to be resilient due to its high level of activity and perceived control over stressful situations (Firth-Cozens et al., 1999; Weinberg and Creed, 2000). Few studies have systematically examined the effect of exposure to extreme stress on hospital personnel (Luce et al., 2002; Hodgetts et al., 2003). Prior studies examined exposure to victims of bombings, terror attacks and sniper shootings which represented only a single trauma or indirect exposure to multiple traumas (Luce et al., 2002; Hodgetts et al., 2003; Kerasiotis and Motta, 2004; Weiniger et al., 2006). To the best of our knowledge, no studies have assessed the comorbidity between PTSD and depression among hospital personnel exposed to war stress. Earlier studies that measured PTSD symptoms among hospital personnel did it only after a single traumatic event, and neglected to measure depressive symptoms. We extend our previous preliminary report (Ben-Ezra et al., 2007) by adding an administrative staff group, and we examine depressive symptoms as well. We hypothesized that among hospital personnel with increased risk for Psychiatry Research 168 (2009) 262–264 ⁎ Corresponding author. Tel.: +972 4 8210086. E-mail address: yuvalfpa@post.tau.ac.il (Y. Palgi). 0165-1781/$ – see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2008.06.003 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres