Terror exposure and psychiatric rehabilitation utilization: A national study of jewish citizens in israel

Background: The association between exposure to terror and psychiatric rehabilitation service utilization (i.e., of housing, employment, and education) is yet to be examined in persons with schizophrenia, yet it is relevant to public health policy during emergencies. Accordingly, the current study aims to examine the association between exposure to terror and psychiatric rehabilitation service utilization among Jewish citizens in Israel. Method: Information from a nationally representative sample from the (I) Case-Management Study of persons with schizophrenia (N=696) was merged with (II) psychiatric hospitalization and service utilization data in the Israeli National Psychiatric Case Registry (1990-2012) and (III) terror attack data in the Global Terrorism Database. The association between exposure to terror and time to service use was quantified using Cox regression modeling unadjusted and adjusted for covariates. Results: Cox regression models showed that exposure to terror attacks was statistically significantly (P<.05) associated with more subsequent service utilization compared to no terror exposure (unadjusted: HR =1.34, 95% CI = 1.13-1.59; adjusted: HR =1.43, 95% CI = 1.19-1.71). In the adjusted sensitivity analysis, these results remained statistically significant (P<.05) among males and females. However, the association was null following-up for 180 days from hospitalization discharge, and for exposure to terror attack with/without fatalities. Conclusions: Exposure to terror attacks was associated with psychiatric rehabilitation services but not up to 180 days. Future service provision appears appropriate to reduce the time to receive psychiatric rehabilitation services following exposure to terror attacks.