That terrorism causes psychological trauma is nothing new.

Most would agree that causing trauma is one of terrorism’s primary goals. But now a study in Israel has found that exposure to even the threat of terrorism, not an actual terror attack, can have negative physical effects, including raising the resting heart rate and increasing the risk of a heart attack.

“Because this is Israel, we are unfortunately aware of the threat of terror attacks much more profoundly than other countries,” Hermona Soreq said. Dr. Soreq is a professor of molecular neuroscience at Hebrew University and one of the researchers who conducted the study. “These are tough times; this has been going on for a long time and it’s a chronic situation.”

Soreq conducted the study alongside Shani Shenhar-Tsarfaty, a postdoctoral fellow in the department of neurological sciences. The study was conducted on more than 17,000 healthy Israelis who visit the Tel Aviv Sourasky Medical Center annually for routine checkups and agreed to volunteer their medical data to the research. The subjects underwent general medical exams including blood tests, heart rate and stress tests, and were asked questions that surveyed more than 300 psychological and physiological parameters meant to document both their physical and mental states.

“We asked them to fill out a very detailed questionnaire and asked questions about their medical history as well as their beliefs and how optimistic their approach to life was and what their perceived control over their work was,” Senhar-Tsarfaty said. “We asked them how stressed they were regarding terror and how anxious they were,” all questions intended to judge what Soreq called a “chronic stress situation.”

Sharon Toker, head of the organizational behavior program at Tel Aviv University, said that there are more than ten years of research in the study, starting in 2002, in the midst of the second Intifada, the Palestinian uprising in Israel that included suicide bombings and shooting attacks. Throughout this time, the subjects’ medical results were catalogued, as well as their questionnaire responses, to see if psychosocial factors could predict heart problems over and above medical factors.

“One of the standard tests that was included is a measurement of pulse,” Soreq said. “In normal, healthy individuals the pulse rate goes down with age, but in part of the population the pulse rate goes up.

“That has been recognized for a while now as a predictor of risk for cardiac attack or stroke, but nobody asked, ‘How does chronic stress because of the threat of terror affect our health?'”

When the exam data and the questionnaires’ responses were combined, the researchers found that the resting heart rate was affected by physiological characteristics such as the level of physical fitness and inflammation index reflecting the activity of the immune system. An ongoing increase in heart rate was associated with psychological factors, like fear of terrorism.

Fear of terror was found to be a major factor in annual increases in resting heart rate. Some 4.1 percent of study participants demonstrated an elevated fear of terror that predicted an increase in their resting heart rates, which in turn could increase their risk of heart disease. None of the subjects in the study had ever actually been harmed in a terror attack; the effects were just a byproduct of the fear that an attack could happen.

The average heartbeat in the group, comprised of subjects between the ages of 20 and 65, was around 60 beats per minute, but an increase to 70 to 80 beats per minute was observed in those that showed a higher fear of terrorism. In other words, for people with an elevated fear of terror the heart beats faster, and the associated risk of heart disease is higher.

Toker said that these effects were observed mainly in white collar workers with an average of 15 years of education – the demographic into which most of the study’s participants fit. The researchers conclude that if these effects are seen in this population, noneducated people in lower socioeconomic classes are more likely to exhibit stronger effects than those surveyed.

These results “should be taken very seriously by governments when they try to assess the level to which they affect their citizens,” Toker said. “These people were just civilians who read about terror attacks and were exposed just by living in an area where [terror attacks] occurred. You cannot overrule reports that they fear this situation because we see how it affects their health.”

Toker added that when a government calculates the cost of terror, it should include the impact on the entire population, not just those most directly affected by terrorist attacks.

“Usually people look at the direct effect, like PTSD, among people directly exposed, but here we talk about a more prevalent cost, which was unknown until now,” Toker said. “Between 2002 and 2004 there were 550 attempted terror attacks on civilians, which led to the death of 880 civilians, and that’s why people are afraid.

“You can just step out of your house and find yourself in the midst of a terror attack.”

The Media Line