ORIGINAL ARTICLE

Getting a Life: Gender Differences in Postwar Recovery

Shaul Kimhi & Yohanan Eshel & Leehu Zysberg &

Shira Hantman

Published online: 13 June 2009# Springer Science + Business Media, LLC 2009

Abstract This study examined gender differences in stresssymptoms and recovery one year after the end of war,among two Israeli samples (adults n=870 and adolescentsn=810). MANOVA analysis indicated that females reportedhigher levels of stress symptoms and lower levels ofpostwar recovery compared to males. Adolescents reportedlower levels of stress and higher levels of recoverycompared to adults. Path analysis supported the following:Gender associated negatively with family support and senseof danger. Sense of danger associated positively withsymptoms and negatively with recovery, while familysupport associated with these variables in the oppositedirection. Mediation test indicated that family support andsense of danger served as mediators between gender andrecovery and between gender and stress symptoms.

Keywords Gender differences . Stress symptoms .

Posttraumatic recovery . Sense of danger . Family support .

Mediation model

Introduction

Studies of the psychological outcomes of war, conducted invarious settings and cultures, have mainly focused on adverseeffects, the most common of which is PTSD (e.g., Al-Turkaitand Ohaeri 2008; Dyregrov et al. 2002; Galea et al. 2003;Thabet and Vostanis 2000; Yaswi and Haque 2008). Asimilar tendency can be found in studies conducted in Israel(e.g., Palmieri et al. 2008). Recent studies have begunlooking at the aftermath of war, as a crisis containing apotential for growth as well as distress and pathology(Levine et al. 2008; O’Rourke et al. 2008). We seek to addto this relatively new body of research by focusing on genderdifferences regarding positive and negative war outcomesone year after the termination of war.

The main purpose of this study is to test a modelaccounting for gender differences in long-term responses tostressful events, in this case—a war, bringing into consid-eration the issue of age. While gender has received a lot ofattention in the literature on coping and reacting to stressfulevents (see for example: Hoffmann et al. 2004; Shu-Chenget al. 2009), age has been emphasized to a lesser extent andevidence is somewhat equivocal, especially in regard to thedifference between adults and adolescents. Some studiessuggest that adolescents exhibit more stress responses thanadults when faced with war or terror attacks (e.g., Comer etal. 2008), while others point in the opposite direction orfind no differences at all (e.g., Jenings et al. 2006). Bothvariables, gender and age, have received some attention inthe context of coping with stress in diverse settings on the

Sex Roles (2009) 61:554–565DOI 10.1007/s11199-009-9660-2

S. Kimhi (*) : L. ZysbergDepartment of Psychology, Tel Hai Academic College,Upper Galilee 12210, Israele-mail: shaul@shamir.org.ile-mail: shaulkim@adm.telhai.ac.il

L. Zysberge-mail: leehuzysberg@yahoo.com

Y. EshelDepartments of Psychology,Tel Hai Academic College and Haifa University,Haifa, Israele-mail: yeshel@mailng.hevra.haifa.ac.il

S. HantmanDepartment of Social Work, Tel Hai Academic College,Upper Galilee, Israele-mail: shirah@adm.telhai.ac.il

pages of Sex Roles (See for example: Hoffman andLewy-Shiff 1992, 1993; Shu-Cheng et al. 2009), but havenot been examined together and not in the psychologicalcontext of post-war reactions. The model we proposeattempts to clarify the interaction between gender and agegroup in affecting stress and psycho-social recovery in anIsraeli population coping with the aftermath of war.

The proposed model relies on two established theories:Cognitive appraisal theory and social support theory. Basedon these models and previous studies, we have hypothe-sized that male and female responses to the aftermath ofwar are mediated by family (social) support and sense ofdanger and that these models will prevail across twodifferent age groups.

Stress and Gender

Most of the studies investigating links between gender andstress (see literature review: Tamres et al. 2002) haveclaimed that females tend to report higher levels of war-related stress (fear, anxiety, and somatic complaints), aswell as more behavioral problems than do males (e.g.,Agronick et al. 2007; Chen 2007; Shu-Cheng et al. 2009).Similar results have been found in Israeli studies (Kimhiand Shamai 2006; Yahav and Cohen 2007; Zeidner 2006),suggesting that gender differences regarding response totraumatic events in Israel are similar to those foundworldwide. Other reports have been cited for other negativestressful events such as natural disasters (e.g., Karen andGerdenio 1994). Only a small number of studies have notfound gender differences in postwar reactions amongchildren (e.g., Hadi et al. 2006). Overall, the literaturereview suggests that females across various cultures tend toreport higher levels of stress in the aftermath of majornegative events.

The literature review suggests two salient explanationsfor these gender differences, which are relevant for a widerange of societies including the Israeli society. The first isbased on different socialization patterns of males andfemales. It has been argued that females have beensocialized to be expressive and to convey their reactionsto stress in a more open manner than males do (Kimhi andShamai 2006). According to this perspective the differencebetween males and females mainly represents differentways of expressing emotions and not necessarily adifference in the level of emotional response. A secondexplanation submits that these gender differences representthe effect of additional mediating variables (e.g., Ansheland Sutarso 2007; Marcotte et al. 2002): The associationbetween gender and response to stressful war events isindirect and mediated by other variables. In this study wehypothesized that females of both age groups would reporthigher levels of stress symptoms, one year after the end of a

war. Furthermore, we hypothesized that cognitive appraisalas well as perceptions of family support (a private case ofsocial support) may serve as such mediating variablesaccounting for this association.

Psychological Growth and Gender

A lot of attention has been paid to the adverse, potentiallypathological outcomes of stressful events in general andwar in particular (Palmieri et al. 2008). PTSD, copingstrategies and subsequent pathologies have often beenresearched. More recently, new emphasis has emerged,focusing on salutogenic factors, viewing crisis as achallenge with double potential: continuous pathologyversus growth and readjustment. These favorable outcomeshave been termed ‘posttraumatic growth’ (Hobfoll et al.2007; Hobfoll et al. 2006; Ickovics et al. 2006). A moremodest and perhaps more realistic aim of posttraumaticgrowth is the ability of people to find “some good emergingfrom their struggle” (Tedeschi and Calhoun 1995, p. 445).It has been claimed that people can reestablish a positiveimage of postwar reality as well as a positive image ofthemselves while accepting the fact that their situation hasnot been improved compared to the pre-trauma condition(Janoff-Bulman 1992).

We submit therefore, that recuperation from war traumasshould be assessed by allowing respondents to rate theirpresent condition as compared with their prewar condition(See Weinrib et al. 2006), and will term this recuperation“posttraumatic recovery” (PTR). The idea that growth anddevelopment may emerge from disastrous experiences isnothing new and harkens back to theories of ego resources,resilience and hardiness in the field of personality (Park andHelgeson 2006; Sagy and Antonovsky 2000; Van Wijk andWaters 2008).

However, studies on positive war outcomes and genderdifferences are rare and results are inconclusive. Somestudies have reported gender differences (e.g., Büchi et al.2007; Prati and Pietrantoni 2006) while others have failedto support these differences (e.g., Polatinsky and Esprey2000). Based on these few studies we hypothesize thatfemales will report lower level of PTR compared to malesin both age groups.

Age, Stress and Growth

Prominent theories pertaining to adolescence emphasizedthe importance of maturation and the establishment ofidentity as the challenging goal of this age (Erikson 1959,1968; Marcia 1966). According to these theories adoles-cence should be considered as a stressful stage. However,these theories did not predict effects of traumatic eventssuch as war on adolescents in comparison to adults. Recent

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studies have indicated equivocal results: While a fewstudies show adolescents and children expressing higherlevels of stress resulting from exposure to acts of terrorismand war (Comer et al. 2008), others point to the opposite(Kimhi and Shamai 2006). Additional research looking intoage, gender and their relationships with stress and copingalso yields inconclusive evidence (Hoffman and Lewy-Shiff1992, 1993; Hoffmann et al. 2004.

In addition, it has been argued that psychologicalresources of older people may dwindle with time (e.g.,Carballo et al. 2004), and they are likely to responddifferently than adolescents to the hardships of war interms of post-war symptoms and recovery, and be affecteddifferently by variables such as sense of danger or socialsupport. Such possible differences may have importantpractical and theoretical implications for forming assistancepolicies in the aftermath of traumatic events.

Based on the above and previous evidence gathered insimilar war-related settings in Israel (e.g., Kimhi andShamai 2006), we hypothesized that age would have aneffect on stress and recovery so that adolescent participantswould exhibit lower levels of stress and higher signs ofrecovery than adults, while maintaining the above-mentioned gender effect.

Cognitive Appraisal

According to the cognitive appraisal theory (Lazarus andFolkman 1984; Folkman and Lazarus 1985), the impact ofwar depends not only on the level of exposure to traumaticexperiences, but also on their perceived impact onindividuals (Folkman et al. 1986). Thus, it was found thatthe effects of war experience on stress symptoms aremediated by cognitive appraisal of the stressor as well as byindividual coping styles (Dandoy and Goldstein 1990).Previous studies have indicated that females tend toappraise negative or traumatic events as more severecompared to males (Tamres et al. 2002).

War experience is very likely to increase fears andanxieties that will aggravate negative responses such asstress symptoms (e.g., Ehntholt and Yule 2006). Cognitiveappraisal in the present study was operationalized as senseof danger: How much a person perceives himself or hisfamily as being under continuous threat. According tocognitive appraisal theory, gender differences seem toreflect contrasting gender roles, expecting females but notmales to turn to help in case of trouble (Tamres et al. 2002),and rewarding females more readily for seeking such help(Collins and Miller 1994; Kimhi and Shamai 2006; Norberget al. 2006). Accordingly, we expected the following: (a)Females, beyond age groups, would report higher levels ofsense of danger compared to males. (b) Adults, beyondgender, would report higher levels of sense of danger

compared to adolescents. (c) Sense of danger wouldmediate the relationship between gender and the two waroutcomes: positively associate with stress symptoms andnegatively with postwar recovery.

Family Support

Social support theory emphasizes the important role ofsocial support in general and family support in particular inextreme stress situations (Bronfenbrenner 2005). Bothfamily beliefs and family cohesiveness have been foundto be crucial resources for the adaptation of its members instressful situations (Patterson and Garwick 1994; Walsh1998). For example, Shamai and Kimhi (2007) foundsupportive family atmosphere to be a mediator betweengender, level of exposure to threat, and impact of stressamong Israeli adolescents living along the Lebanese border.Accordingly, we expected the following: (a) Females,beyond age groups, would report higher levels of familysupport compared to males. (b) Adolescents, beyondgender, would report higher levels of family supportcompared to adults. (c) Family support would mediate therelationship between gender and the two war outcomes, i.e.negatively associate with stress symptoms and positivelywith postwar recovery.

The Second Lebanon War

The current study focuses on the long-term impact of waron individuals living in a war afflicted Israeli community,about a year after the Second Lebanon War taking place inthe summer of 2006. The conflict began when Hezbollahmilitants purposely fired rockets at Israeli border towns as adiversion for an anti-tank missile attack on two armoredHumvees patrolling the Israeli side of the border fence. Ofthe seven Israeli soldiers in the two jeeps, two werewounded, three were killed, and two were captured andtaken to Lebanon. Israel responded with massive airstrikesand artillery fire on targets in Lebanon including Beirut'sRafic Hariri International Airport, an air and naval blockadeand a ground invasion of southern Lebanon. Hezbollah thenlaunched more rockets into northern Israel and engaged theIsrael Defense Forces (IDF) in guerrilla warfare fromhardened positions. The conflict killed over a thousandpeople, widely reported to be mostly Lebanese civilians,severely damaged Lebanese civil infrastructure, and dis-placed approximately one million Lebanese and 300,000–500,000 Israelis, although most were able to return to theirhomes. On 11 August 2006, the United Nations SecurityCouncil unanimously approved UN Resolution 1701 in aneffort to end the hostilities.

The town of Kiryat Shemona, situated near the Lebaneseborder, was badly hit during the war by the approximately

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200 rockets targeting it. The vast majority of the inhabitantswho were affected by the bombardment had to flee theirhomes during the war, and to cope with the extensivedestruction caused to their town (Israeli Ministry of ForeignAffairs 2006). Moreover, they had to go on living withcontinuous uncertainty, fearing the resumption of hostili-ties. The current study focuses on gender differences inresponding to the aftermath of war one year after itstermination, in order to broaden our knowledge of long-term effects of war on males and females.

The Study Predictions and Model

To sum up, we predicted the following: First, femaleswould report higher levels of stress symptoms, higher levelsof family support, higher levels of sense of danger andlower levels of PTR compared with males in both agegroups. These predictions would be tested by MultivariateAnalysis of Variance (MANOVA)F. Second, we predictedthe following associations model (see Fig. 1): Genderwould associate significantly with family support, sense ofdangers, stress symptoms and PTR. Family support andsense of danger would associate significantly with symp-toms and PTR. These predictions would be tested by PathAnalysis (AMOS 16, Arbuckle 2007). Third, we predictedthat family support and sense of danger would serve asmediators between gender and symptoms as well as PTR:Higher family support and a lower sense of danger wouldbe associated with higher PTR and a lower symptomsreport. These predictions would be tested by the Sobel(1982) test for mediation effect.

Based on the above, the following research hypotheseswere examined:

1. Gender effect—Females in both samples will reportlower level of PTR, and higher levels of stresssymptoms, sense of danger and family support,compared to males.

2. Age group effect—Adolescents will report higherlevels of both family support and PTR, and lowerlevels of sense of danger and stress symptomscompared to adults.

3. Associations model—Gender in both age groups willassociate negatively with family support and sense ofdanger. Sense of danger will associate positively withsymptoms and negatively with PTR. Family supportwill associate with these variables in the oppositedirection.

4. Mediating effects—Family support and sense of dangerwill serve as full or partial mediators between genderand two war outcomes (PTR and symptoms) in bothage-groups.

Method

Participants and Sampling

Adults

This sample included 870 adults (38% males, 62% females)from Kiryat Shemona. Ages ranged from 18 to 85 (M=55.09,SD=16.19). The total sample was comprised of 57.4%respondents who rated their economic standing as low orvery low and only 7.6% who described their economic levelas high. Six percent of the participants had eight years ofeducation or less, 50% between 9–12 years of education and44% had more than 12 years of education.

Thirty-six streets (covering most of the city) weresampled randomly from the street map of Kiryat Shemona.One student was sent to each street and went from door todoor. If no one was at home or if the resident refused toparticipate, the student was instructed to move on to thenext door. This process continued until each student had 20full questionnaires. This sample included 747 respondents(about 15 questionnaires were rejected as a result of partialreplies). In order to guarantee that a wide enough range ofages would be included in the sample, 50 elderly people(aged 65 and above) who were attending the only elderlyactivity center in Kiryat Shemona were also investigated.Research assistants helped them to respond individually tothe research questionnaire. To make sure that individualswith higher educational levels would be represented, 73teachers, who constituted 90% of the teachers of the onlyhigh school of the town, were administered the researchquestionnaire individually. Before responding to the ques-tionnaire all participants were asked to read and to sign aninformed consent that described the main goal of the studyassured the anonymity of the participant and gave them theFig. 1 The study model.

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right not to take part or to stop participating in the study atany time for any reason. Less than 6% of those who were athome during the research assistants’ visits refused to takepart in the study.

Adolescents

Eight hundred and ten school students (46% males, 54%females) from Kiryat Shemona high schools and junior highschools participated in this study. Ages ranged from 12 to 18(M=15.03, SD =1.54). This sample included all students ofsix grade levels who were present in their classes when thestudy took place. Their distribution was as follows: 139students in 7th grade, 176 in 8th grade, 168 in 9th grade, 15710th graders, 145 11th graders, and 25 students in 12th grade.

The data collection took place about one year after theoutbreak of the recent Lebanon War. Questionnaires wereadministered during regular class time with two adultspresent (teacher and research assistant). Anonymity of theparticipants was assured, as well as the right of each studentnot to take part or to stop participating in the study at anytime and for any reason. Only a small number of studentschose not to participate in the study (less than 3%). Theschool served as a trustee of the parents in consenting to thestudents’ participation in this study. This procedure isendorsed by the Israeli Ministry of Education and has beenapproved by the Tel Hai committee for the protection ofhuman subjects. Only a small number of students chose notto participate in the study (less than 3%).

Gender Similarity

In order to eliminate the possibility of a priory differencesbetween males and females we compared demographicvariables for males and females in each of the two agegroups. The demographic variables included: age, numberof years in Kiryat Shemona, number of years in Israel, levelof education, exposure to traumatic events during the war,socioeconomic status and religiosity. Comparison indicatedonly one significant difference between males and females(in both age groups) regarding socioeconomic status:Females reported lower levels of family income comparedwith males among adults (females: M=2.38, SD=1.29,males: M=2.83, SD=1.27, t(870)=4.78, p<.000) and amongadolescents (females: M=2.88, SD=1.21, males: M=3.14,SD=1.19, t(810)=2.86, p=.004). There were no othersignificant demographic differences between males andfemales.

Instruments

The following instruments were used in both age groups(adults and adolescents).

Stress Symptoms

The short version of the Brief Symptom Inventory (BSI,Derogatis and Savitz 2000; Derogatis and Spencer 1982)was utilized. The original inventory consists of 53 items(measuring nine symptom areas). The present study usesonly three subscales (anxiety, depression and somatization)comprising 19 items, scored on a Likert scale ranging from1 (very low) to 5 (very high). For example, scales includeditems such as: Nervousness, bad mood, nausea or stomachdisorders, fear or panic attacks, feeling of worthlessness.Validity and reliability of this scale were examined inseveral studies, including the Hebrew version of the scale(Derogatis and Savitz 2000; Gilbar and Ben-Zur 2002).These studies indicated that the scale is sensitive to stresssituations such as war. Since the overall Alpha Cronbachreliability of the 19 items in the present study were veryhigh (adolescents α=.94 and adults α=.95), a general meanscore of symptoms was employed for each age group.

Posttraumatic Recovery

PTR was assessed by an eight-item “effects of war” inventorypertaining to perceived war effects (Kimhi and Shamai 2004;Shamai and Kimhi 2006). This scale, employed in assessingthe aftermath of the Israel Defense Forces' withdrawal fromLebanon on people residing along the Lebanese border, hada reported Alpha Cronbach of .83. In a previous study(Kimhi et al. 2009), the PTR scale emerged as a solidindicator for level of returning to normal life one year afterthe war, for adolescents as well as for adults. Similar toWeinrib et al. (2006) we have tapped both positive andnegative possible war effects. Accordingly, respondents wererequested to compare their present situation with their pre-war situation on eight domains of possible war effects:physical health, morale, social activity, school work/workplace, interest and activity in hobbies or sports, emotionalstate, level of optimism, and hope for a better future. Theresponse scale therefore ranged from 1 “much worse thanbefore the war” to 5 “much better than before the war”, with3 standing for “the same as before the war”. A higher scorethus indicated a higher level of PTR or at least a lower levelof relapse. The reliability of the SOC scale in the two agegroups was high (adolescents α=.81 and adults α=.84). Amean PTR score was employed for each age group.

Sense of Danger

Based on Solomon and Prager’s (1992) sense of safetyscale originally included 11 items, subjects were asked torate their level of personal safety during the last two weeksin a number of different areas on a Likert-like scale rangingfrom 1 (not at all) to 5 (very much). The sense of danger

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sub-scale included six items: a sense of personal danger;feeling that the State of Israel is in danger of annihilation; afear of danger to family or dear ones; changes in social lifefollowing the last war; self-imposed limitations on one'sactivities following the war; limited traveling as a result ofthe last war. The reliability of the six items for the two agegroups were adolescents α=.73 and adults α=.77. A meanscore of sense of danger score was employed. An overallsense of danger score was utilized for each age group.

Family Support

Based on earlier research on adolescents living near theLebanese border (Shamai and Kimhi 2007) the following fouritems regarding family support were formulated: relationshipwith parents; sharing thoughts and feelings about the warand the current insecurity in the family; the family as asource of support during the last war; the family as a sourceof support during the present time of insecurity and worry.The reliability of family support scale in the two age groupswas high (adolescents α=.80 and adults α=.86). An overallfamily support mean score was utilized for each age group.

Socioeconomic Status (SES)

Socioeconomic status was assessed by one item: Familyincome compared to average family income in Israel (7,900NIS). The items range from 1 (“much lower than average”)to 5 (“much higher than average”).

Gender

Females were coded as 0 and males were coded as 1.

Results

Hypothesis 1 predicted that females in both age groupswould report lower levels of PTR and higher levels of

symptoms, sense of danger and family support comparedwith males. Hypothesis 2, predicted that adolescents wouldreport higher levels of family support and PTR and lowerlevels of sense of danger and symptoms compared withadults. The two hypotheses were examined by 2×2 (genderby age group) MANOVA (controlling for SES), conductedfor these four items. Results indicated the following: (a)Highly significant gender effect F(4, 1459)=18.58, p< .000:Females across age groups reported higher levels ofsymptoms, higher sense of danger, higher family supportand lower levels of PTR. These results fully support ourfirst hypothesis. (b) Highly significant age group effectsF(4, 1459)=66.20, p< .000. Adolescents reported higherlevels of PTR and lower levels of stress symptoms, higherlevels of family support and lower levels of sense of dangercompared with adults. These results support our secondhypothesis. (c) There was no significant age group bygender interaction effect.

In order to further examine gender and age effects oneach of the four study variables (family support, sense ofdanger, stress symptoms and PTR) we have used UnivariateAnalyses of Variance (ANOVAs) (controlling for SES)conducted on these variables (see Table 1). Resultsindicated the following: (a) significant gender effects(p<.000) for all four variables. (b) significant age groupeffects (p<.01) for PTR and symptoms, but not for familysupport and sense of danger. (c) Gender by age groupinteraction was not significant for any of the four variables.It is also clear from this table that gender has the largesteffect on symptoms, family support and PTR while agegroup has the largest effect on PTR.

Next, for further examination of the associations be-tween the investigated variables by age groups and gender,we calculated means, standard deviations and inter-correlations (controlling for the effect of SES) in each ofthe two age groups (adults and adolescents) for males,females, and the total sample (Table 2). As can be seen inTable 2 the correlation between the two predicted variables(stress symptom and posttraumatic recovery) was negative

Table 1 ANOVA1 —Family support, sense of danger, stress symptom and PTR by gender and age group, means, standard deviations and Fvalues.

Variables Adults Adolescents Gender effect Age-group effect Gender by Group

Male(N=310)

Female(N=519)

Male(N=357)

Female(N=426)

M SD M SD M SD M SD F(1, 1466) F(1, 1466) F(1, 1466)

Sense of danger 2.17 .82 2.33 .84 2.03 .82 2.25 .75 6.56** 1.97 N.S

Stress symptoms 1.87 .84 2.19 .95 1.68 .77 1.98 .84 24.80*** 10.65*** N.S

PTR 2.61 .64 2.39 .61 3.15 .64 2.96 .58 31.28*** 255.09*** N.S

**p<.01, ***p<.001, 1 Controlling for SES

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in both samples (adults r(1, 820) = −.393, p<.000,adolescents r(1, 699) = −.262, p<.000). Overall the patternsof correlations in the two samples were similar with oneexception. The correlation between family support and PTRwere significantly positive among adolescents (higherfamily support, higher PTR reported) and negative amongadults (higher family support, lower PTR reported). Inaddition, among adolescents family support correlatedsignificantly with stress symptoms while among adults thiscorrelation was not significant.

The correlations among adult and adolescent males alsorevealed similar patterns of correlations with one exception.

The correlations between family support and PTR wassignificant among adolescent males but not among adultmales. The correlations among adult and adolescentfemales were similar to the overall samples. Additionalanalysis which did not control for SES resulted insubstantially the same results.

According to our third hypothesis gender in both agegroups would associate negatively with family support andsense of danger; sense of danger would associate positivelywith symptoms and negatively with PTR; family supportwould associate with these variables in the oppositedirection. To test this hypothesis a path analysis (AMOS

Table 2 Pearson correlations1, means and standard deviations of research variables among age groups and gender.

Variables Group 1 2 3 4Overall (adults N=829, Adolescents N=783 )

1. Family support Adults – −.020 −.050 −.123***Adolescents .038 −.178*** .182***

2. Sense of danger Adults – .495*** −.264***Adolescents .531*** −.161***

3. Symptoms Adults – −.393***Adolescents −.262***

4. PTR Adults –

Adolescents

M (SD) Adults 5.48 (1.67) 2.07 (.92) 2.27 (.83) 2.47 (.64)

Adolescents 5.62 (1.35) 1.71 (1.16) 1.87 (.84) 3.05 (.61)

Male (adults N=310, Adolescents N=357)

1. Family support Adults – −.137* −.115* −.075Adolescents −.012 −.071 .270***

2. Sense of danger Adults – .501*** −.278***Adolescents .469*** −.106

3. Symptoms Adults – −.406***Adolescents −.208***

4. PTR Adults –

Adolescents

M (SD) Adults 5.11 (1.80) 1.87 (1.26) 1.87 (.83) 2.61 (.64)

Adolescents 5.49 (1.38) 1.65 (1.16) 1.68 (.77) 3.16 (.63)

Female (adults N=519, Adolescents N=426)

1. Family support Adults – −.047 −.038 −.125**Adolescents −.072 −.280*** .158**

2. Sense of danger Adults – .485*** −.265***Adolescents .555*** −.227***

3. Symptoms Adults – −.307***Adolescents −.357***

4. PTR Adults –

Adolescents

M (SD) Adults 5.69 (1.56) 1.98 (1.30) 2.19 (.95) 2.40 (.61)

Adolescents 5.74 (1.28) 1.71 (1.14) 1.98 (.85) 2.96 (.58)

*p<.05, **p<.01, ***p<.001, 1 controlling for SES

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16, Arbuckle 2007) and the estimation method of full-information maximum-likelihood (FIML) was used foreach of the two age groups:

A. Adults—All paths except one were significant (seeFig. 2): Gender associated negatively with family supportand sense of danger. Sense of danger associated positivelywith symptoms and negatively with PTR. Family supportassociated negatively with PTR. However, contrary to ourhypothesis, the path from family support to symptoms wasnot significant (default model). Next, we constrained thisinsignificant path to zero, and examined the final model.The model was not significantly different from the defaultmodel (∆χ2=.3.482, ∆df=1, p=.062). The fit indices for thefinal model have proved to be good (χ2=4.41, df=2,p=.110; χ2/df=2.207; NFI=.992, RFI=.941, IFI=.996,CFI=.996; RMSEA=.037). These results mainly supportour third hypothesis regarding adults.

B. Adolescents—All paths were significant (see Fig. 3):Gender associated negatively with family support and senseof danger. Sense of danger associated positively withsymptoms and negatively with PTR. Family supportassociated positively with PTR and negatively withsymptoms. The fit indices for the default model haveproved to be good (χ2=3.101, df=1, p=.078; χ2/df=3.103;NF I = . 993 , RF I = . 900 , I F I = . 995 , CF I = . 996 ;RMSEA=.050). These results support our third hypothesisregarding adolescents.

In order to examine our fourth hypothesis that familysupport and sense of danger would serve as a mediatorsbetween gender and each of the two war outcomes (PTRand symptoms) in both age-groups, a Sobel test formediation was used (Sobel 1982).

A. Adults. Family support served as a partial mediatorbetween gender and PTR (z=2.94, p<.001) and between

gender and symptoms (z=4.52, p<.000). Sense of dangerserved as a partial mediator between gender and PTR(z=2.46, p<.001) but not between gender and symptoms.These results mainly support our fourth hypothesis regard-ing adults.

B. Adolescents. Family support served as a partialmediator between gender and PTR (z=2.25, p<.05) andbetween gender and symptoms (z=2.31, p<.01). Sense ofdanger served as a partial mediator between gender andPTR (z=2.97, p<.001) but not between gender andsymptoms. These results mainly support our fourth hypoth-esis regarding adolescents. Overall, the pattern of mediationin the two age groups was similar.

Discussion

The study examined gender differences in postwar stresssymptoms and recovery (termed here PTR). Similarpatterns of associations were found among adults andadolescents samples. Our results indicated that femalesreported higher levels of stress symptoms, lower levels ofposttraumatic recovery, higher levels of sense of danger aswell as higher family support. In addition, the present studyexamined a theoretical model according to which sense ofdanger and family support served as mediators betweengender and positive as well as negative war outcomes.

These results corroborated those of previous researchindicating that females experience higher levels of stresscompared with males following traumatic event (Agronicket al. 2007; Chen 2007; Gavranidou and Rosner 2003;Kimhi and Shamai 2006; Ronen et al. 2003; Schraedley etal. 1999; Smith et al. 2002; Weekes et al. 2005; Yahav andCohen 2007). Moreover, the fact that these differences wereretained over an age range of 70 years, and persisted a yearafter the event, suggests that they reflect some basicdifferences between males and females.

Fig. 3 Path analysis model with standardized estimates amongteenagers (N=820): Gender, age, family support sense of danger andtwo war outcomes.

Fig. 2 Path analysis model with standardized estimates among adults(N=870): Gender, age, family support, sense of danger and two waroutcomes.

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Studies associating gender and negative stress relatedoutcomes are common. The contribution of the current studyis the finding that sense of danger mediates the associationbetween gender and stress symptoms among adults andadolescents. Similar previous results (Tamres et al. 2002;Zeidner 2006) suggested that females feel much moreinsecure and anxious. In our study females reported worryingthat another war might erupt significantly to a greater extentthan males did in both age-groups. In other words, femalesappraised potential threats as more severe compared to male.These cognitive appraisals explained large portions of thehigher level of symptoms reported by females one year afterthe war. These results further corroborate Lazarus' (1966)model. According to this model it is the cognitive processthat intervenes between the stimulus and the emotionalreaction and elicits the threat experience.

Furthermore, since there was no reason to assumedifferences in income between families of male and femaleparticipants, we concluded that a possible explanation forthe fact that females in our two samples reported lowerlevels of family average income compared to males, pointsat differences in cognitive appraisals: females tend toperceive the economic hardship as more severe comparedto males in both age groups.

Overall, our model suggested that under extreme stressconditions such as war or acts of terror females of all ages aremore likely to respond by perceiving the situation as moredangerous and developing higher anxiety levels, which maybe expressed by a larger number of retained psychological andphysical symptoms compared with males. Concurrently, theytend to judge war as affecting them more negatively thanmales do (Agronick et al. 2007; Chen 2007; Gavranidou andRosner 2003; Kimhi and Shamai 2006; Schuster et al. 2001;Yahav and Cohen 2007). These results are in accordancewith Tamres et al. (2002) meta-analytic review of genderdifferences in coping behavior, which has indicated that, inthe majority of studies, females appraise stressors as moresevere than males do. The present results have clearlysupported this view: Sense of danger was found to be thebest predictor of stress symptoms in the two samples.

Studies associating gender and positive stress-relatedoutcomes are very scarce and inconclusive. An additionalunique contribution of this study is the finding that femalesreported lower levels of posttraumatic recovery than males,one year after the termination of war. Our study indicatesthat cognitive appraisal, or sense of danger, also mediatedbetween gender and post war recovery. Sense of dangerexplained large portions of the gender differences regardingthis outcome in both samples. Moreover, sense of dangerwas the best predictor of PTR among adults and significantpredictor among adolescents. To the best of our knowledgethe associations between cognitive appraisal and recoveryhave not been studied before.

It is possible, therefore, that females recover moreslowly from stressful war events than males mainly due tonegative cognitive appraisals of threat that continue totrouble them one year after the termination of war. Thisconclusion may have important implications suggesting thatunder certain conditions females may be regarded as an atrisk group, possibly requiring specific interventions aimedat reducing or coping with negative cognitive appraisals.

In our study, family support was found to play differentroles in the two samples. Among adults, family supportserved as a partial mediator between gender and PTR, butunlike what we hypothesized, a higher level of reportedfamily support was associated with less postwar recovery.In addition, there was no significant effect of family supporton stress symptoms. In the adolescent sample, the directionwas reversed: The greater the family support, the more PTRand the fewer stress symptoms were reported. Theimportance of family beliefs and cohesiveness as crucialresources for adapting with stressful events was emphasizedin previous studies (Bronfenbrenner 2005; Patterson andGarwick 1994; Walsh 1998). It seems that female schoolstudents needed much more family support than adultfemales in order to cope with stress. In addition, it is worthnoting that family support in the two samples did serve asmediator between gender and PTR but not stress symptoms.If these results are supported by additional studies, it mighthave significant practical implications regarding the role offamily support in times of crisis.

A possible explanation for the reversed effect of familysupport and PTR among adults and adolescents may be thedifferent, often conflicting perceptions of the notion of familyamong adults and adolescents. While adolescents perceivetheir family as a source of support in times of crisis (e.g.,Shamai and Kimhi 2007), adults who have to provide thissupport are likely to worry about their loved ones in times ofhardship, and their family may become a detrimentaldeterminant in their coping. Additional research is requiredto determine the relative contribution of cognitive appraisalsand family support as determining negative and positive wareffects among males and females of various ages.

Our data regarding age group differences corroborate afew studies indicating that adolescents reveal higher abilityto return to normal life after a traumatic experiencecompared to adults (e.g., Kimhi and Shamai 2006).Possible explanations for these differences could be theclaims that adolescents are not responsible for raising afamily and that they are more occupied with themselves andtheir relations with peers and have “less time” to worryabout external events. Further research is needed to supportthese explanations.

A large number of studies have concentrated on genderdifferences in a wide range of areas. However, it should benoted that these differences may be contingent on cultural

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norms and may be associated with different dependentvariables in different cultures (Tamres et al. 2002).Although our study is based on Israeli samples, there isreason to believe that it has identified a general trend whichis common to other cultures as well. Although furtherresearch is required to substantiate this claim, we believethat responses to extreme stress are likely to have universalfeatures which are common to members of differentsocieties (Goldberger and Breznitz 1993).

Limitations of the Study and Directions for Future Research

Some limitations of this study should be mentioned. First, thedata presented above are based solely on self report. Futureresearch may benefit from adding behavioral measures ofreasserted stress symptoms and posttraumatic recovery, aswell as observations on everyday coping. Unfortunately,traumatic events like war are not predictable and it would bevery difficult to explore such events using prospective design,though it would be a better one. Second, both postwarsymptoms and PTR seem to change with time. Thecorrelational design of the present study limits drawingconclusions concerning causal relations among the investi-gated variables. A longitudinal design is required to furthersubstantiate cause and effect relations between these variables.Third, this study investigated a single community which hadto cope with the aftermath of war. Additional studies of warafflicted communities as well as those which were not affectedto a great extent by war should also be conducted tosubstantiate the present findings.

Last, one should bear in mind that this research investigatesIsraeli males and females who have unfortunately had muchexperience with negative and stressful experiences due to theprevalent conditions in this geographical area. It may be askedhow much of our results are applicable to gender differencesin other cultures and settings. One possible way to respond tothis question is by comparing Israeli data on coping withtraumatic events (e.g., Kimhi and Shamai 2006; Ronen et al.2003; Yahav and Cohen 2007; Zeidner 2006) with researchpertaining to the same issue based on subjects from othercultures (e.g., Schuster et al. 2001; Tamres et al. 2002).While this comparison points at similar patterns of responsessupporting the generality of our results, additional studies arerequired to support such generalization.

Acknowledgement This study was supported by grant from theUJA Federation of New York.

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