Continuous Exposure to Terrorism during the COVID-19 Pandemic: A Moderated Mediation Model in the Israeli Context

Round 1

Reviewer 1 Report

Review - Continuous Exposure to Terrorism during the COVID-19 Pandemic

Overall, this is a good study and contribution. The authors recognize both the practicality and limitations of the research. It has high value. I encourage the authors to expand their efforts as well as find ways to communicate their results and recommendations in meaningful ways to broader audiences as well as targeted audiences (government, NGO, alternative) who are able to take needed action and provide needed resources such as funding, access, equipment, personnel, etc. Below are some comments, suggestions, and recommendations. The authors are free to address them or ignore them at their discretion – they are merely suggestions and I certainly may have ‘missed the point” vis-a-vis any particular comment.

Lines 14-15: “... results indicated...” “... results demonstrated...”

Lines 19-20: “... factor. These results point to a need...”

Line 197: “...response, because the respondents were asked...”

Some “word choice” examples which may increase professionalism. There are not many overall. The paper is well-written in English.

Need to clarify/define what exactly “social support” includes: commiserating empathetic partners, family, friends... community social support groups; useful information; protection, prevention, treatment, etc. facilities; accessibility... and so on.

Lines 166-168: Consistency and reduction of confusion: “... 14% were studying for a diploma, 46% were studying for a BA degree, 17% were seeking (?) a permit for more advanced degrees, and 24% were studying (or were they seeking a permit as well?) other topics/degrees.”

Lines 175-176: “The responses were recorded on a three-point scale of 1 = little (a few); 2 = medium; 3 = Much (a lot).

There are a few concerns here. Why is there not a category for 0 exposure (unlikely in their context, but it assumes everyone has been exposed or perceives they have been exposed; unless, all accepted participants already indicated they were exposed during the sampling and COVID-19 period)?

There needs to be a time period for consistency – these are frequencies after all. “1 = little (a few)”. A few times per week, per month, per year, per time COVID started and the study started, in their total time in the area, per lifetime...??? “Medium” and “much” need number ranges. The number ranges also need explanation. These can be compared to reported incidents such as warnings/sirens, missile attacks, explosions, and incendiary kites and balloons (all of which are recorded and reported).

For example, in my personal combat experiences, I’ve been on rural outposts where two rocket or mortar attacks daily were normative – thus, could speculatively be considered “medium”. 25-50 km away, the outposts experiences rocket/mortar attacks 1-2 times per month. On urban outposts, the distances were only 1-2km apart with extreme differences in warning or attack frequencies.

I bring this up to the authors because they are obviously concerned about “perception and what is perceived” and thus should design more appropriate survey instruments in the future.

In lines 181-191 the scales of 1 = not at all to 5 = very much are more acceptable due to the qualitative nature and typical Likert Scale instrument design. However, individuals previously experiencing experiencing a high incident background where it becomes normative to them may respond quite differently from individuals with no previous exposure or experience. Were respondent demographics and previous experiences/exposure recorded? Were all from the same area originally (prior to joining the college? What were their individual experiences to these kind of conditions and incidents in their past? Additionally, although the authors do indicate 90% women responded in an area when (or where – check line 162 for possible typo) 80% of k12 teachers are women (need to explain/define k12 as well)), the authors need to consider what kinds of people would answer the survey (personalities, etc.) and how this may skew results.

Line 207: Why does the depression category measures use a 0-3 scale while the others are 1-5? Is this a PHQ-9 standard and could the authors have designed a similar questionnaire with a 5 point scale for the depression category? However, there is logic to adhering to the PHQ-9 standard for consistency in cumulative or combined depression data for other studies.

Section 2.4 Analytic Plan lines 224-241: Good/adequate, including the bootstrapping technique, etc.

Line 257: Why switch to “corona period”? Should simply be consistent with COVID-19 period.

Section 3.2: As I understand this, prior exposure to terrorism, COVID-related concerns, and perceived health status (all three) were positively associated (positive correlation) with with depression (depression symptoms) during the COVID period, while perceived social support were negatively associated (negative correlation) with depression (depression symptoms)? More support = less depression symptoms. Both results were hypothesized/expected? This is noted below in section 3.3, although higher social support seems to only weaken depression symptoms but they remain of significant concern? Is this correct? Also, what are the normative depression symptoms in similar sample populations who have no exposure to terrorist threats, etc.? Does a normative incident level or rate need to be considered and mitigated in the results?

Lines 276-289: Some good insights here. It would be helpful to add to this: explain, speculate (create future hypotheses), and summarize in more lay terms for more general audiences in order to increase readership and impact of the overall study. This benefits both authors and communities in practical ways. Although this is addressed in section 4.1, I encourage the authors to push this message stronger and further if possible; through other publications and paths, with practical roadmaps and designs, etc. Of course this will vary with political, economic, cultural, infrastructural contexts, etc., but something more concrete and specific than simply throwing more funding, professionals, organizational infrastructure and facilities at the problem... Difficult to do, because those are the needed things to start with, but what else could be advised to them and in what ways?

Lines 332-336: I would certainly be interested in related resiliency and adaptation studies.

Lines 342- 356: Interesting. Good.

I should have mentioned earlier and may have “missed it”: Compared to populations with no terrorism threats past or present, how much does the threat of COVID increase depression, anxiety, fear, etc. levels in populations who are under terrorism or other forms of life-threatening CTS? That is, Population A (not exposed to CTS) may have risen from a hypothetical 1 to a 5 during COVID, While population B (CTS) may have gone from a 6 to a 7. Comparative analysis added to this study. I do recognize the mediation and moderation model here contributes to that question in various ways, but again, I would be interested in more comparative studies, including studies that compare different social/ethnic groups and cultures; deal with other CTS issues other than terrorism threat levels such as those facing abject poverty and adverse conditions (rural and urban); those in violent high crime neighborhoods; youth in today’s schools (particularly the US); highly politicized extremist and militant social groups; and so forth. Some of these have ‘sort of’ been conducted in similar ways. I do recognize all this cannot be squeezed into the current study and publication, however, but do encourage the authors to added a paragraph on what the think might be useful directions (including hypotheses and methods) in these regards. These issues are partially addressed and adequately recognized in Section 4.2, however.

Section 4.1: Good. See comments above.

Section 4.2: It would be nice to complement the study with an in-the-field Anthropological approach, for example. Also, everyone wants a bigger and more representative sample set in these kinds of studies. Don’t beat yourselves up, but always good to self-reflect on the limitations. However, this is a very good start.

Conclusion: Obvious and thin, but understandable. Need to also stress a need for applied, practical research that caters to variable cultural, political, environmental (as in tropics versus temperate; urban versus rural; etc.), demographic, economic, etc. contexts.

Please refer to the attached reference and there are some articles like this and others which may help expand their data and reference collection which unfortunately may not pop up with key word searches they are targeting. Marshall Steele, BS; Anne Germain, PhD; Justin S. Campbell, PhD. 2017. "Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel". MILITARY MEDICINE, 182, 5/6:e1632.

 

Comments for author File: Comments.pdf

Author Response

Reviewer #2:

Overall, this is a good study and contribution. The authors recognize both the practicality and limitations of the research. It has high value.

Thank you for your positive review and helpful comments.

 

Comment 1:

I encourage the authors to expand their efforts as well as find ways to communicate their results and recommendations in meaningful ways to broader audiences as well as targeted audiences (government, NGO, alternative) who are able to take needed action and provide needed resources such as funding, access, equipment, personnel, etc.

Response:

We added a plain-words explanation of the findings and their implications in section 5 (conclusions): “Exposure to continuous traumatic stress can lead to psychologic difficulties, with depression as one of the major negative outcomes. Our findings demonstrate that previous exposure to terror-related CTS can increase COVID-related stress and increase COVID-related depression. Perceived social support could decrees COVID-related depression and minimize the negative effect of CTS during COVID. It is safe to assume that other types of CTS have similar effects and are similarly effected by social sup-port, yet further studies are required to support this assumption. However, the findings are important to governments, institutes, NGOs, community aid agents, therapists, caregivers, educators and individuals. Simply said, organizations, groups, com-munities, families and individuals should recognize the positive effects of social sup-port and act upon this knowledge to support others against the negative effects of CTS and COVID and possibly other stressors. We also concluded that additional research is required, testing and comparing practical implications of exposure to diverse sources of CTS and stressors, in different demographical, political, cultural and socioeconomic environments” (see page 1)0.

 

Below are some comments, suggestions, and recommendations. The authors are free to address them or ignore them at their discretion – they are merely suggestions and I certainly may have ‘missed the point” vis-a-vis any particular comment.

 

Comments 3-6:

Lines 14-15: “... results indicated...” “... results demonstrated...”

Lines 19-20: “... factor. These results point to a need...”

Line 197: “...response, because the respondents were asked...”

Some “word choice” examples which may increase professionalism. There are not many overall. The paper is well-written in English.

Responses:

We followed your suggestions, corrected the language per you recommendations in lines 14-15 (page 1), lines 19-20 (page 1) and lines 197 (page 5).

In addition, we had the manuscript language re-checked by a native English-speaking language-editor.

 

Comment 7:

Need to clarify/define what exactly “social support” includes: commiserating empathetic partners, family, friends... community social support groups; useful information; protection, prevention, treatment, etc. facilities; accessibility... and so on.

Response:

Perceived social support in this study includes support from family members, friends and collogues at college. We added this definition near the end of section 1.3: “Perceived social support (PSS) in this study includes support from family members, friends and collogues at college” (see page 3).

 

Comment 8:

Lines 166-168: Consistency and reduction of confusion: “... 14% were studying for a diploma, 46% were studying for a BA degree, 17% were seeking (?) a permit for more advanced degrees, and 24% were studying (or were they seeking a permit as well?) other topics/degrees.”

Response:

We changed the wording to improve consistency and corrected a typo in the percentage: “14% were studying for a diploma, 46% for a BA degree, 16% for advanced degrees and 24% other studies” (see page 4).

 

Comment 9:

Lines 175-176: “The responses were recorded on a three-point scale of 1 = little (a few); 2 = medium; 3 = Much (a lot). There are a few concerns here. Why is there not a category for 0 exposure (unlikely in their context, but it assumes everyone has been exposed or perceives they have been exposed; unless, all accepted participants already indicated they were exposed during the sampling and COVID-19 period)?

Response:

You are correct and thank you for this important comment. Obviously, the questioner included four categories (0-3) and we updated the manuscript to reflect this: “The participants were asked about prior exposure to four types of terrorism during the past 12 months… Participants indicated the extent of exposure on a four-point scale of 0 = no exposure; 1 = little (a few); 2 = medium; 3 = Much (a lot). We used subjective exposure rates (low/medium/high) in order to reflect participants’ subjective perceived experience” (see page 5).

 

Comment 10:

There needs to be a time period for consistency – these are frequencies after all. “1 = little (a few)”. A few times per week, per month, per year, per time COVID started and the study started, in their total time in the area, per lifetime...??? “Medium” and “much” need number ranges. The number ranges also need explanation. These can be compared to reported incidents such as warnings/sirens, missile attacks, explosions, and incendiary kites and balloons (all of which are recorded and reported). For example, in my personal combat experiences, I’ve been on rural outposts where two rocket or mortar attacks daily were normative – thus, could speculatively be considered “medium”. 25-50 km away, the outposts experiences rocket/mortar attacks 1-2 times per month. On urban outposts, the distances were only 1-2km apart with extreme differences in warning or attack frequencies. I bring this up to the authors because they are obviously concerned about “perception and what is perceived” and thus should design more appropriate survey instruments in the future.

Response:

We used a 1-year timeframe as described in the manuscript: “The participants were asked about prior exposure to four types of terrorism during the past 12 months” (see page 5).

As for the suggestion to use specific numerical values to measure exposure prevalence: it might have improved comparing results to other empirical studies; however, we were trying to measure perceived, subjective experience (“…in order to reflect participants’ subjective perceived experience”), rather than measurable frequencies of exposure, in order to analyze the effects of perceptions and emotions (perceived social support, perceived exposure, perceived COVID stressors) on PHQ-9-measured depression symptoms.

 

Comment 11:

In lines 181-191 the scales of 1 = not at all to 5 = very much are more acceptable due to the qualitative nature and typical Likert Scale instrument design. However, individuals previously experiencing a high incident background where it becomes normative to them may respond quite differently from individuals with no previous exposure or experience.

Were respondent demographics and previous experiences/exposure recorded? Were all from the same area originally (prior to joining the college? What were their individual experiences to these kind of conditions and incidents in their past? Additionally, although the authors do indicate 90% women responded in an area when (or where – check line 162 for possible typo) 80% of k12 teachers are women (need to explain/define k12 as well)), the authors need to consider what kinds of people would answer the survey (personalities, etc.) and how this may skew results.

Response:

We added to the demographic data (“The majority of the participants (93%) reported living in southern Israel in regions that were exposed to continuous terror attacks”), and K12 definition (“primary to high school”) to section 2.2 in page 4.

We added the possible results-skew to the limitations section (4.2): “…effectively sampling a specific population with possible specific characteristics, that night have skewed the results” (see page 10).

 

Comment 12:

Line 207: Why does the depression category measures use a 0-3 scale while the others are 1-5? Is this a PHQ-9 standard and could the authors have designed a similar questionnaire with a 5 point scale for the depression category? However, there is logic to adhering to the PHQ-9 standard for consistency in cumulative or combined depression data for other studies.

Response:

PHQ-9 is widely accepted measure, validated in multiple studies in diverse populations. This was the reason we chose to use it. The fact that it uses a 4-point construct has no statistical influence on the analysis, using standardized scale scores. We saw no reason to design a new 5-point based scale when we could use the validated PHQ-9, and as you mentioned, using the PHQ-9 improves the ability to compare results with other studies.

 

Comment 13:

Section 2.4 Analytic Plan lines 224-241: Good/adequate, including the bootstrapping technique, etc.

Thank you.

 

Comment 14:

Line 257: Why switch to “corona period”? Should simply be consistent with COVID-19 period.

Response:

We corrected the wording and changed corona to COVID-19 in line 257 and in section 3.4.

 

Comment 15:

Section 3.2: As I understand this, prior exposure to terrorism, COVID-related concerns, and perceived health status (all three) were positively associated (positive correlation) with depression (depression symptoms) during the COVID period, while perceived social support were negatively associated (negative correlation) with depression (depression symptoms)? More support = less depression symptoms. Both results were hypothesized/expected? This is noted below in section 3.3, although higher social support seems to only weaken depression symptoms but they remain of significant concern? Is this correct?

Response:

Your understanding is generally correct; however, the research construct prevents us from using terms of causality so we cannot presume that perceived social support (PSS) weakens depression symptoms (this would need a longitudinal construct that we consider for future studies). Under this limitation, we can only say that we did not find a significant direct effect of PSS on depression symptoms but we did find a significant mitigating effect of PSS on the relationship between COVID concerns and depression symptoms. We did verify the suggested model but the results do not imply causality.   

 

Comment 16:

Also, what are the normative depression symptoms in similar sample populations who have no exposure to terrorist threats, etc.? Does a normative incident level or rate need to be considered and mitigated in the results?

Response :

These are very important questions indeed, however our results cannot answer these questions and further studies are required for that.

 

Comment 17:

Lines 276-289: Some good insights here. It would be helpful to add to this: explain, speculate (create future hypotheses), and summarize in more lay terms for more general audiences in order to increase readership and impact of the overall study. This benefits both authors and communities in practical ways. Although this is addressed in section 4.1, I encourage the authors to push this message stronger and further if possible; through other publications and paths, with practical roadmaps and designs, etc. Of course this will vary with political, economic, cultural, infrastructural contexts, etc., but something more concrete and specific than simply throwing more funding, professionals, organizational infrastructure and facilities at the problem... Difficult to do, because those are the needed things to start with, but what else could be advised to them and in what ways?

Response:

We added a “general audience” summary of the findings and  implications in section 5 (conclusions), in basic and general terms avoiding “professional” terms: “Exposure to continuous traumatic stress can lead to psychologic difficulties, with depression as one of the major negative outcomes. Our findings demonstrate that previous exposure to terror-related CTS can increase COVID-related stress and increase COVID-related depression. Perceived social support could decrees COVID-related depression and minimize the negative effect of CTS during COVID. It is safe to assume that other types of CTS have similar effects and are similarly effected by social sup-port, yet further studies are required to support this assumption. However, the findings are important to governments, institutes, NGOs, community aid agents, therapists, caregivers, educators and individuals. Simply said, organizations, groups, com-munities, families and individuals should recognize the positive effects of social sup-port and act upon this knowledge to support others against the negative effects of CTS and COVID and possibly other stressors” (see page 10).

 

Comment 18:

Lines 332-336: I would certainly be interested in related resiliency and adaptation studies.

Response:  We are very interested in this topic and look forward to future studies.

Comment 19:

Lines 342- 356: Interesting. Good.

I should have mentioned earlier and may have “missed it”: Compared to populations with no terrorism threats past or present, how much does the threat of COVID increase depression, anxiety, fear, etc. levels in populations who are under terrorism or other forms of life-threatening CTS? That is, Population A (not exposed to CTS) may have risen from a hypothetical 1 to a 5 during COVID, While population B (CTS) may have gone from a 6 to a 7. Comparative analysis added to this study. I do recognize the mediation and moderation model here contributes to that question in various ways, but again, I would be interested in more comparative studies, including studies that compare different social/ethnic groups and cultures; deal with other CTS issues other than terrorism threat levels such as those facing abject poverty and adverse conditions (rural and urban); those in violent high crime neighborhoods; youth in today’s schools (particularly the US); highly politicized extremist and militant social groups; and so forth. Some of these have ‘sort of’ been conducted in similar ways. I do recognize all this cannot be squeezed into the current study and publication, however, but do encourage the authors to added a paragraph on what they think might be useful directions (including hypotheses and methods) in these regards. These issues are partially addressed and adequately recognized in Section 4.2, however.

Response:

You are certainly correct about additional knowledge that is needed. The questions you raise and the diverse characteristics of CTS and of the populations that suffer from CTS should be further studied. However, the scope of this study is limited to the specific research questions (it is already almost too long for publishingJ). Nevertheless, we added in section 4.2: “To extend our understanding, future research should also include cross-sectional studies that compare different social/ethnic groups and cultures and diverse CTS types, using the same measuring tools. Finally, longitudinal research is required to test causality of the effects and relationships between research variables” (see page 10).

 

Comment 20:

Section 4.1: Good. See comments above.

Response:

We used some of your suggestions as described above.

 

Comment 21:

Section 4.2: It would be nice to complement the study with an in-the-field Anthropological approach, for example. Also, everyone wants a bigger and more representative sample set in these kinds of studies. Don’t beat yourselves up, but always good to self-reflect on the limitations. However, this is a very good start.

Response:

We improved the last part of the section, as described in our response to comment 19 above.

 

Comment 22:

Conclusion: Obvious and thin, but understandable. Need to also stress a need for applied, practical research that caters to variable cultural, political, environmental (as in tropics versus temperate; urban versus rural; etc.), demographic, economic, etc. contexts.

Response:

Section 5 (Conclusions) was re-written. The conclusions are now more focused and understandable by diverse readers. We also referenced your suggestion regarding the need for additional research: “Exposure to continuous traumatic stress can lead to psychologic difficulties, with depression as one of the major negative outcomes. Our findings demonstrate that previous exposure to terror-related CTS can increase COVID-related stress and increase COVID-related depression. Perceived social support could decrees COVID-related depression and minimize the negative effect of CTS during COVID. It is safe to assume that other types of CTS have similar effects and are similarly effected by social sup-port, yet further studies are required to support this assumption. However, the findings are important to governments, institutes, NGOs, community aid agents, therapists, caregivers, educators and individuals. Simply said, organizations, groups, com-munities, families and individuals should recognize the positive effects of social sup-port and act upon this knowledge to support others against the negative effects of CTS and COVID and possibly other stressors. We also concluded that additional research is required, testing and comparing practical implications of exposure to diverse sources of CTS and stressors, in different demographical, political, cultural and socioeconomic environments” (see page 10).

 

Comment 23:

Please refer to the attached reference and there are some articles like this and others that may help expand their data and reference collection, which unfortunately may not pop up with key word searches they are targeting. Marshall Steele, BS; Anne Germain, PhD; Justin S. Campbell, PhD. 2017. "Mediation and Moderation of the Relationship Between Combat Experiences and Post-Traumatic Stress Symptoms in Active Duty Military Personnel". MILITARY MEDICINE, 182, 5/6:e1632.

Response:

Thank you for this reference to a very interesting study. We referenced it in section 1.1: “Steele et al. (2017) tested 972 US Navy sailors for PTSD symptoms and found that the most significant difference in PTSD screening group scores between participants below and above PCL30 cut-off were depression scores, suggesting that depression is a major contributor to PTSD symptomatology” (see page 2).

 

Reviewer 2 Report

Thanks for inviting me to review this manuscript. This is a very interesting and well-organised paper. I have only two major comments:

This paper is a bit similar to Amram-Vaknin et al. (2022). So it would be crucial to emphasis the contributions of this study in a clearer way. Preferably before section 1.1 (but maybe section 1.4 is more suited to this paper), something like “therefore this paper contributes to the literature in the following ways: theoretically… empirically…, and practically…”. And of course, by indicating your contributions, you will be able to show how this paper is distinct from previous studies such as the aforementioned one.

I would like to see something more in the discussion section, about comparisons between people under continuous exposure to terrorism and those who have been experiencing other forms of continuous traumatic stress. According to Eagle & Kaminer’s (2013) conceptualisation of CTS, many other groups of people also suffer from it. For example, in the Chinese context, migrant workers can be seen as a population group under continuous traumatic stress, they have experienced various physical and psychological issues during the pandemic (Liu et al., 2022). Likewise, in the US context, black people who are more likely to live in communities with high rates of community and police violence may face more severe mental health challenges (Mendenhall et al., 2021). What would your findings tell researchers and practitioners in other contexts?

Reference

Amram-Vaknin, S., Lipshits-Braziler, Y., & Tatar, M. (2022). Psychological functioning during the COVID-19 lockdown: The role of exposure to continuous traumatic stress in conflict-ridden regions. Peace and Conflict: Journal of Peace Psychology, 28(2), 151.

Eagle, G., & Kaminer, D. (2013). Continuous traumatic stress: Expanding the lexicon of traumatic stress. Peace and Conflict: Journal of Peace Psychology, 19(2), 85.

Liu, Q., Liu, Z., Kang, T., Zhu, L., & Zhao, P. (2022). Transport inequities through the lens of environmental racism: rural-urban migrants under Covid-19. Transport policy, 122, 26-38.

Mendenhall, R., Ethier, K., Lee, M. J., Overton, K., & Houser, S. (2021). Trauma over the Life Course for Black Mothers in Chicago: Understanding Conditions, Meaning Making and Resiliency. J Family Med Prim Care Open Acc, 5, 159.

 

 

Author Response

Reviewer #1:

Thanks for inviting me to review this manuscript. This is a very interesting and well-organised paper. I have only two major comments:

Thank you for your positive review.

 

Comment 1:

This paper is a bit similar to Amram-Vaknin et al. (2022). So it would be crucial to emphasis the contributions of this study in a clearer way. Preferably before section 1.1 (but maybe section 1.4 is more suited to this paper), something like “therefore this paper contributes to the literature in the following ways: theoretically… empirically…, and practically…”. And of course, by indicating your contributions, you will be able to show how this paper is distinct from previous studies such as the aforementioned one.

Response:

We improved the reference to Amram-Vaknin et al. study in section 1.3 (CTS and COVID-19) “This research found lower resilience and higher rates of anxiety and stress among participants exposed to missile attacks in comparison to participants that hadn’t been ex-posed to terror attacks [43]” and  emphasized the study contribution in section 1.4 per your suggestion: “This study focused on depression among the Israeli population, that have been exposed to the CTS of terror threats for many years, and who have had to cope with COVID-19 concerns under missile and rocket attacks. Amram-Vaknin et al. [46] suggested that that CTS may be a potential as a risk factor for psychological difficulties during COVID-19. This study tests CTS as a risk factor for depression and tests perceived social support as a protective factor against depression during the COVID-19 pandemic. The paper contributes to the theoretical knowledge by suggesting and verifying a path model and by testing the empirical relationships between the factors, with theoretical and practical implications” (see page 3).

 

Comment 2:

I would like to see something more in the discussion section, about comparisons between people under continuous exposure to terrorism and those who have been experiencing other forms of continuous traumatic stress. According to Eagle & Kaminer’s (2013) conceptualization of CTS, many other groups of people also suffer from it. For example, in the Chinese context, migrant workers can be seen as a population group under continuous traumatic stress, they have experienced various physical and psychological issues during the pandemic (Liu et al., 2022). Likewise, in the US context, black people who are more likely to live in communities with high rates of community and police violence may face more severe mental health challenges (Mendenhall et al., 2021). What would your findings tell researchers and practitioners in other contexts?

Response:

It is quite difficult to compare most of our findings to other studies. The study focused on verifying the mediation-mitigation model. We did measure the levels of terror related CTS among the participants but the measure was subjective (perceived CTS) and probably not comparable to other studies. COVID-related stressors levels were not measured by other studies (at least not using the same scale) and perceived social support measure included support from family, friends and college colleagues. The suggested path model was not suggested by other papers (yet) and we can’t compare it to other studies. We believe that the only “comparable” results are supporting Amram-Vaknin et al. (2022) conclusion, that CTS can be a risk factor to psychological difficulties during COVID-19.  We did not suggest that terrorism-related-CTS is different from other types of CTS - suggesting that requires a very different study contract, one that neither of the referenced studies had.

We added our thoughts regarding what would our findings tell researchers and practitioners in other contexts to the discussion (just before section 4.1): “We tested the effects of terrorism-related CTS and perceived social support on depression during COVID-19. We assume that similar effects exist with previous exposure to other types of CTS (war, national disasters and even persistent life difficulties arising from racism or poverty etc.) and interacting with stressors other than COVID. This assumption has to be tested and verified in future studies; However, the reported negative mental health outcomes of diverse CTS situations are comparable, suggesting that diagnosis and treatment might also be comparable, reflecting on professional training of therapists but also on public education programs promoting social support” (see page 10).

    

Round 2

Reviewer 2 Report

I am satisfied with the revised manuscript. Thanks for sharing.