Israel Center on Addiction, Netanya, Israel.
Department of Communication Studies, Ben Gurion University of the Negev, Beer-Sheva, Israel.
JAMA Netw Open. 2024 Jul 1;7(7):e2423993. doi: 10.1001/jamanetworkopen.2024.23993.
Research has shown evidence of increased substance use (ISU) in populations affected by mass terrorism; however, less is known regarding how psychosocial factors interact to estimate ISU following such events.
To examine which factors are associated with reporting ISU, test whether psychological distress (PD) mediated the association between exposure to trauma and reporting ISU, and whether the mediation effect differed among those with prior mental health (MH) difficulties and those without.
DESIGN, SETTING, AND PARTICIPANTS: A partially representative cross-sectional survey of the adult Jewish population in Israel (aged 18-70 years) was conducted 4 weeks after October 7, 2023 (October 31 to November 5, 2023). A national Web panel using quotas based on national distributions was used. Randomly chosen adult Jewish members were invited to participate until a predetermined sample size was reached.
The study measures included reporting ISU (outcome), PD (mediator), exposure to terror events and sociodemographic characteristics (variables), and prior MH difficulties (moderator). Hypotheses regarding outcome and variables were formulated before data collection.
A total of 7000 invitations were distributed, 2679 individuals consented, 1432 were excluded owing to quota limits, 74 failed attention tests, and 205 opted out, resulting in 968 participants (490 women [50.6%]; mean [SD] age, 41.5 [14.6] years). Hierarchical regression analysis revealed that participants were significantly more likely to report ISU if they had experienced direct exposure (odds ratio [OR], 5.75; 95% CI, 2.53 to 13.05), indirect exposure (OR, 1.84; 95% CI, 1.27 to 2.67), media exposure (OR, 1.22; 95% CI, 1.09 to 1.36), PD (OR, 1.80; 95% CI, 1.44 to 2.25), or previous MH difficulties (OR, 2.76; 95% CI, 1.86 to 4.09). PD partially mediated the association between indirect exposure (b = 0.20; 95% CI, 0.11 to 0.31) and media exposure (b = 0.14; 95% CI, 0.10 to 0.19) and reporting ISU. No evidence was found to support previous MH difficulties as a moderator of these indirect effects (indirect exposure, b = -0.003; 95% CI, -0.28 to 0.28; media exposure, b = 0.01; 95% CI, -0.06 to 0.08).
This study contributes to the research on the association of mass terrorism with ISU while shedding important light on the role it may play in the self-medication of PD following exposure, even in those who might have no previous MH difficulties. These insights are crucial for planning essential health services and preventive measures.
研究表明，受大规模恐怖主义影响的人群中存在物质使用增加（ISU）的证据；然而，对于心理社会因素如何相互作用来估计此类事件后的 ISU 知之甚少。
检验哪些因素与报告 ISU 相关，检验创伤暴露与报告 ISU 之间的关联是否由心理困扰（PD）介导，以及这种中介效应是否在有或没有先前心理健康（MH）困难的人群中存在差异。
设计、地点和参与者：对以色列成年犹太人口（18-70 岁）进行了部分代表性的横断面调查，调查时间是在 2023 年 10 月 7 日（10 月 31 日至 11 月 5 日）后四周。使用基于全国分布的配额的全国网络小组进行调查。随机选择成年犹太成员邀请他们参加，直到达到预定的样本量。
研究措施包括报告 ISU（结局）、PD（中介）、恐怖事件暴露和社会人口学特征（变量）以及先前的 MH 困难（调节变量）。在数据收集之前，就结局和变量提出了假设。
共发放了 7000 份邀请，2679 人同意，由于配额限制，1432 人被排除在外，74 人未通过注意力测试，205 人选择退出，最终有 968 人（490 名女性[50.6%]；平均[SD]年龄，41.5[14.6]岁）参加。分层回归分析显示，如果参与者经历了直接暴露（优势比[OR]，5.75；95%置信区间，2.53 至 13.05）、间接暴露（OR，1.84；95%置信区间，1.27 至 2.67）、媒体暴露（OR，1.22；95%置信区间，1.09 至 1.36）、PD（OR，1.80；95%置信区间，1.44 至 2.25）或先前的 MH 困难（OR，2.76；95%置信区间，1.86 至 4.09），他们更有可能报告 ISU。间接暴露（b=0.20；95%置信区间，0.11 至 0.31）和媒体暴露（b=0.14；95%置信区间，0.10 至 0.19）与报告 ISU 之间的关联部分由 PD 介导。没有证据表明先前的 MH 困难是这些间接效应的调节变量（间接暴露，b=-0.003；95%置信区间，-0.28 至 0.28；媒体暴露，b=0.01；95%置信区间，-0.06 至 0.08）。
本研究对大规模恐怖主义与 ISU 之间的关联研究做出了贡献，同时还阐明了它在创伤暴露后 PD 自我治疗中的可能作用，即使在那些可能没有先前 MH 困难的人群中也是如此。这些见解对于规划基本保健服务和预防措施至关重要。
