Emotional distress and other health-related dimensions among elderly survivors of the Shoa living in the community.
BACKGROUND
In prior community studies survivors of the Shoa (Hebrew for Holocaust) scored higher on emotional distress (ED) than Europe-born Jews who were not in Nazi-occupied countries during World War II (WWII).


OBJECTIVE
Are elderly Shoa survivors, who by definition have survived the difficulties of a long life, equally distressed? ED was assessed among a population of elderly survivors living in the community, about 55 years after the end of WWII. ED was also examined by the severity of exposure to adverse life conditions during the war. In addition, other health-related dimensions, e.g., sleep disturbances and social activities, were measured.


METHODS
A national survey of 5,055 respondents, of whom 4,231 were Jewish-Israelis, was conducted among community residents aged 60 years and over. The research population included former residents of Nazi-occupied countries (N=896). This group was compared with Europe- and America-born individuals who resided elsewhere during WWII (N=331). All respondents were administered, among many other items, the 12-GHQ to measure ED and a questionnaire that included socio-demographic and other health-related variables. Bivariate and multivariate methods of analysis were used to compare distributions and to identify relevant factors.


RESULTS
The group of elderly survivors was significantly more distressed than the comparison group. Individuals who had been in ghettos, hiding, or labor or extermination camps had higher mean scores than survivors who were in Nazi-occupied countries, but were spared those experiences. Multivariate analysis showed that the direct effect of the Shoa experience was no longer evident when two other Shoa-dependent variables, years of education and number of chronic health conditions, were entered into the model. Sleep disturbances were more often present in the survivors than among their counterparts, including after controlling for other variables. Social activities that contribute to well-being were more limited among survivors.


CONCLUSIONS
Fifty years after WWII there was partial evidence of increased emotional distress among our group of elderly survivors, and clear evidence for the presence of adverse effects on other health-related dimensions and pleasurable activities.
Shemesh
Annarosa A
AA
Health Economics, Ministry of Health, Jerusalem, Israel. Anat.Shemesh@moh.health.gov.il
Kohn
Robert
R
Radomislensky
Irina
I
Brodsky
Jenny
J
Levav
Itzhak
I
D000223:Adaptation, Psychological; D000342:Affective Symptoms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003209:Concentration Camps; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006306:Health Surveys; D017767:Holocaust / Q000523:psychology*; D006801:Humans; D007557:Israel; D007585:Jews / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D028683:National Socialism; D010555:Personality Inventory; D011788:Quality of Life; D012737:Sex Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology*