title: Holocaust survivors coping with open heart surgery decades later: posttraumatic symptoms and quality of life.
abstract: OBJECTIVE
  History of prolonged traumatization has been associated with reduced quality of life (QoL) and difficulties in coping with major life-threatening conditions. We assessed the association between the impact of Holocaust experience (posttraumatic symptoms) and QoL of patients before and after an open heart surgery.
  
  
  METHODS
  Sixty-three Holocaust survivors were interviewed before open heart surgery (at admission), 52 at follow-up at 1 week, and 58 at follow-up at 6 months. The interview included background data, Impact of Event Scale (IES), Mastery scale, and QoL measured by the Nottingham Health Profile. Medical data were retrieved from the patients' charts.
  
  
  RESULTS
  The total IES score indicate a high level of posttraumatic symptoms at all the time points (close to a mean of 18), but there was a clear trend of changes in the avoidance subscale: At admission, the patients manifested lower avoidance compared with the levels after the surgery and at the follow-up. No significant differences in IES were found by Holocaust experiences. Significant improvements in most components of QoL were found at the follow-up. In multivariate analyses at each time point, the findings show that those with higher levels of posttraumatic symptoms are more at risk for problems in pain and mobility domains of QoL at admission, for emotional reaction after the surgery, and at the follow-up, these associations are only at trend level, while lower sense of mastery became significant.
  
  
  CONCLUSIONS
  The improvement in QoL despite persistence of the impact of the Holocaust may indicate that past severe prolonged traumatization does not necessarily reduce the survivors' ability to cope with and regain physical and psychosocial functioning after a severe life-threatening medical condition. This may be further generalized to other significant crisis situations in life, such as prolonged periods of stress, suffered by many populations throughout the world.
authors.affiliation: Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel. shaulsch@tasmc.health.gov.il
authors.forename: Shaul
authors.initials: S
authors.lastname: Schreiber
authors.forename: Varda
authors.initials: V
authors.lastname: Soskolne
authors.forename: Haim
authors.initials: H
authors.lastname: Kozohovitch
authors.forename: Ehud
authors.initials: E
authors.lastname: Deviri
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001026:Coronary Artery Bypass / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000523:psychology*; D017767:Holocaust / Q000523:psychology*; D006801:Humans; D007389:Internal-External Control; D007557:Israel; D007585:Jews / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D011183:Postoperative Complications / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D012017:Referral and Consultation; D012069:Religion and Psychology; D012803:Sick Role; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology; D017741:Survivors / Q000523:psychology*