Journal of Traumatic Stress, Vol. 18, No. 5, October 2005, pp. 491–495 ( C© 2005)

Religiosity and Secondary Traumatic Stress in Israeli-JewishBody Handlers

Ofra Hyman1

This study investigated the relationship between religiosity and levels of secondary traumatic stressin Israeli-Jewish body handlers. The Impact of Event Scale (IES), the General Health Questionnaire,12 Items (GHQ-12), and a prior exposure severity tool were used to assess secondary traumaticstress symptoms in 63 ultraorthodox male body handlers as they compared to 86 secular forensicidentification technicians from the Israeli police. Excluding possible confounders of age and numberof years at the job, there was no significant difference between the religious and nonreligious groupson the intrusion and avoidance scores, whereas the GHQ-12 scores were significantly higher amongthe religious group. Religiosity did not seem to have a salutary effect on secondary traumatic stressin this cohort.

Empirical investigations have consistently demon-strated that religion has a salutary impact on mental healthand well-being (Kark et al., 1996; Townsend, Kladder,Ayele, & Mulligan, 2002), including posttraumatic stressand grief (McIntosh, Silver, & Wortman, 1993; Meisen-helder, 2002). The risk that emergency work can result insecondary traumatic stress has been empirically demon-strated (Figley, 1995). Among the different tasks of emer-gency work, handling of human remains is reported tobe highly stressful due to gruesome scenes of mutila-tion or multiple deaths, without the reward of saving lives(Brandt, Fullerton, Salzgaber, Ursano & Holloway, 1995).Prior investigations of factors that might impact on sec-ondary stress levels in body handlers have included per-ceived social support, work experience, preexposure fearsof mutilation, and preexisting psychological vulnerability(Jones, 1985; McCarroll, Fullerton, Ursano, & Hermsen,1996; McFarlane, 1988a). The impact of religiosity on

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secondary traumatic stress in emergency workers has notbeen studied yet.

The current study investigated whether religiositymitigated the psychological responses to body handlingin a community living under extreme and prolonged warand terrorism related stress. The study examined whetherthere were differences between the secondary traumaticstress symptoms of ultraorthodox versus secular Jewish–Israeli body handlers.

The study’s hypothesis was that the ultraorthodoxbody handlers would report lower levels of secondarytraumatic stress symptoms than nonreligious workers, fortwo reasons. First, the religious acceptance that there isan underlying divine scheme beyond human understand-ing (“The differences between Judaism and Christianity,”n.d.) accommodates even for incomprehensible atrocities.Second, providing the dead with proper burial is amongstthe most sacred of Jewish religious obligations (Judaism101, 1999). Therefore, it was assumed that religious bodyhandlers would derive from this type of work some reli-gious gratification, which would hence mitigate the harsheffects of such exposure.

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C© 2005 International Society for Traumatic Stress Studies • Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jts.20057

492 Hyman

Method

Sample

This study was conducted with personnel from twogroups of Israeli body handlers who had been workingside by side at the same sites, attending to the aftermathof the same events. The first group was drawn from ZAKA(Zihui Korbanot Asson), a volunteer organization drawnalmost exclusively from the ultraorthodox Jewish commu-nity and motivated by the religious imperative to preservelife and provide burial to the dead (Zihui Korbanot Asson,1996). This ultraorthodox community constitutes a totallyseparate Israeli subculture that is governed by strict ob-servance and study of religious law (Goshen-Gottstein,1987). The second group was of mostly secular men,who worked as technicians in the Israeli Police Foren-sic Identification Unit MAZAP (Mohlaha Lezihu Plili).Participation in this unit was voluntary. Tasks includedthe collection of body parts for forensic evidence follow-ing terrorist attacks, car accidents, and criminal events,and for ZAKA, also burial. The two subsamples werenot completely homogeneous in their respective levels ofreligiosity, but were left intact for this study’s analysesbecause the very affiliation with ZAKA indicated partic-ipating in the religious imperative of providing burial forevery human remain, but working with the police did not.

Data were collected from both groups between thethird week of March and the second week of May, 1999.Results from a study of the forensic police have beenreported elsewhere (Hyman, 2004). The total number ofZAKA volunteers who participated in this study was 63,59% of the 106 all male volunteers who belonged to theorganization at the time. The total number of participantsfrom the police’s forensic unit was 86 males, 52% ofthe total Forensic Identification Unit’s population of 165personnel at the time of the study. To match the groupsas much as possible, four female police technicians whoresponded to the questionnaire were not included in thisstudy. No information about those who did not participatein this study was available.

Procedure

Procedures and instruments used in this study havebeen described in detail elsewhere (Hyman, 2004). Inbrief, the Israeli Police’s Headquarters coordinated thestudy with both groups. Participation in the study wason a voluntary basis and informed consent was obtained.Questionnaires were completed anonymously and handedin collectively. No officer from police headquarters waspresent at the interviews.

Measures

Religiosity and Demographics

Participants were requested to rank their level of re-ligiosity as part of the demographic questionnaire. Rank-ing was according to four levels of religiosity (secular,traditional, religious, and ultraorthodox) commonly dis-tinguished within the Jewish-Israeli society (Witztum,Malkinson, & Rubin, 2001).

Three additional separate items, designed to iden-tify the occurrence and measure the perceived severity ofthree types of prior trauma (combat, body handling, andpersonal trauma), were also included in the demographicquestionnaire. Reliability and validity of this tool werenot tested.

Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez,1979)

The IES is a 15-item self-report questionnaire, mea-suring levels of intrusion (7 items) and avoidance (8 items)symptoms. This instrument has shown high internal con-sistency (α = .86 to .92; Zilberg, Weiss, & Horowitz,1982) and has been widely used in trauma research, in-cluding in Israel (Schwarzwald, Solomon, Weisenberg, &Mikulincer, 1987). Because of the sample’s frequent ex-posure, and to measure cumulative levels of symptoms, in-structions were adjusted and respondents were requestedto consider intrusion and avoidance symptoms they hadexperienced within the last week, as they related to theirtotal work experience in body handling, instead of a singleevent.

General Health Questionnaire, 12 Items (GHQ-12;Goldberg, 1972)

This instrument identifies general psychological dis-tress symptoms in community populations. It has beenwidely used in trauma research in many different cul-tural settings. Reliability was established through split-half and yielded an r = .83 and validity was establishedthrough a median correlation coefficient of .70 (Goldberg& Williams, 1988). Of the four versions of this instrument(60, 30, 28, and 12 items), the short version was used forfeasibility purposes.

The Social Support Questionnaire (SSQ; Sarason,Levine, Basham, & Sarason, 1983)

The SSQ is a 27-item self-report tool, measuring sat-isfaction as well as perceived availability of social support.

Religiosity and Secondary Trauma 493

This instrument has been previously utilized through-out the world, including Israel (Florian, Mikulincer, &Bucholtz, 1995), with samples that varied in numerousways including age, occupation, and ethnocultural back-ground (Wallston, Alagna, McEvoy-DeVellis, & DeVellis,1983). Internal reliability was high (α = .97 for the avail-ability and α = .94 for the satisfaction subscales).

Translation of Instruments

The questionnaire and letter of explanation were ad-ministered in Hebrew. A previously used Hebrew trans-lation of the IES (Solomon, 1995) was obtained from theauthor (Zehava Solomon, Tel Aviv University, School ofSocial Work), whereas reverse translation was used withthe GHQ-12, SSQ, and the demographic questionnaire.Reliability and validity of the final translations were nottested.

Statistical Analyses

Chi-square tests (categorical variables) and t tests(continuous variables) were utilized to compare the twosubsamples. Analyses of covariance (ANCOVA) wereused to compare the two groups on each of the threeoutcome measures of intrusion, avoidance, and GHQ-12scores, controlling for age and work years.

Table 1. Comparison of Descriptive Findings Between the Religious and Nonreligious Subgroups

Religious (n= 63) Nonreligious (n= 86)

Variable M (SD) n M (SD) n t df p

Agea 43.55 (11.27) 58 38.75 (5.57) 76 −2.97 78.2 <0.1Work years 5.61 (7.37) 54 12.63 6.02 82 6.08 134 <.01Number of 3.86 (3.45) 63 3.35 (2.87) 86 −0.98 147 <ns∗

exposuresMonths since 0.30 (0.87) 40 0.38 (0.83) 48 1.95 86 ns

last exposureb

Social support 2.50 (1.34) 50 2.62 (1.59) 77 0.41 125 nsavailability

Social support 0.48 (0.43) 42 0.34 (0.39) 69 −1.79 109 nssatisfactionb

Exposure 2.19 (0.71) 42 2.80 (0.83) 69 3.93 109 <.01severity

Intrusiona 5.84 (4.69) 56 9.73 (7.56) 86 3.73 139.8 <.01Avoidance 8.29 (6.95) 57 12.20 (8.28) 86 2.94 141 <.01GHQ-12 1.22 (0.29) 62 1.09 (0.22) 85 −2.98 145 <.01

Note. GHQ-12 = General Health Questionnaire, 12 Items.aIn those cases where the homogeneity of variance assumption was violated, the t , df , and p valueswere based on a correction for the violation of this assumption. bA two-sample median test wasalso conducted and the results were identical.∗ns = >.05.

Results

The two subsamples of body handlers were first com-pared with regard to a number of background and clini-cal variables. The distinction between the two subsam-ples of body handlers as religious or nonreligious wassupported by the fact that 97% of ZAKA participants de-scribed themselves as ultraorthodox or orthodox, whereasonly 7% of the forensic policemen ranked themselvesas traditional or orthodox, χ2 (3, N = 149) = 115.26,p < .01. No one in the police group described himself asultraorthodox.

As indicated in Table 1, the religious workers weresignificantly older, and had worked as volunteer bodyhandlers for significantly fewer years. On the other hand,there was no statistically significant difference betweenthe two groups with regard to either the number of emer-gency calls they had reported, as best remembered, or thetime interval between the last emergency response and thedate of the interview. Similarly, there were no statisticallysignificant differences between the two groups of work-ers with regard to either the number of sources of socialsupport, or their satisfaction with those sources of socialsupport.

Regarding their perceptions of prior experiences, thegroups differed on the perceived severity of emergencywork. The religious group perceived their exposure assignificantly less severe than did their counterparts. Theyscored significantly lower on the intrusion and avoidance

494 Hyman

scales, but not on the GHQ-12. On the latter scale ZAKApersonnel scored significantly higher. However, when ageand the number of years of body handling were con-trolled, the significant differences between the two groupsfor intrusion and avoidance disappeared. On the otherhand, despite the imposition of these controls, the ultra-orthodox group’s mean score for the GHQ-12 remainedsignificantly higher than that of the police, though sub-clinical (adjusted mean: nonreligious = 1.07, religious =1.27, p < .001; Goldberg & Williams, 1988). Intrusion andavoidance levels ranged between medium and low (Carret al., 1997).

Discussion

In contrast to earlier studies (Kark et al., 1996;McIntosh et al., 1993) and the current study’s hypothe-sis, the data do not demonstrate a salutary effect of reli-gion on mental health as well as posttraumatic stress andgrief. When adjusted for age and time on the job, lev-els of religiosity did not seem to significantly affect thesymptoms of intrusion and avoidance, and did not differ-entiate between the religious and nonreligious subgroups.On the GHQ-12, it was the religious group that had higher,though subclinical, scores. Possible explanations are thatsome unmeasured factors had a salutary effect on thenonreligious police group. Alternatively, religiosity didnot ameliorate the symptoms. Preexisting conditions thatwere beyond the scope of this study might have accountedfor the higher GHQ-12 scores among the religious group.

The study suffered from a number of limitations.Additional factors that might have influenced the results,such as personality and prior psychiatric history, were notinvestigated. All measurements were subsequent to ex-posure, therefore possibly subject to a retroactive effect(McFarlane, 1988b), which interfered with the ability todetermine whether premeasurement perceptions of priorexposures influenced the measured level of symptoms, orvice versa. A natural process of elimination, in which bodyhandlers with higher levels of secondary traumatic stressmight have left the job, could have biased this study’s co-hort. Such a bias might have also influenced the shortertime that religious workers, whose livelihood was totallyindependent of this work, stayed on the job. Further biasesmight have been created in the sample by the self-selectionprocess of volunteering to participate in this investigation,which might have also differed in the two subgroups. Onesuch example could have been the military-like structureof the police, under which some of MAZAP’s personnelmight have chosen to participate in order to conform to theperceived interest of police headquarters in the investiga-

tion. The study could not distinguish between respondentswho had no prior personal trauma or combat experienceand those who did but refrained from reporting it.

Data for the current investigation were collected16 months prior to the commencement of the secondPalestinian uprising, in which frequency and severity ofterrorist attacks increased. A follow-up study could in-form us about the consistency of the current study’s find-ings and the higher levels of general psychological distressamong the ultraorthodox group. Further comparisons ofthe effects of emergency response between religious andnonreligious cohorts of other faiths could add knowledgein regards to the generalizability of the current study’sresults.

Acknowledgments

Special thanks are given to Mr. Haim Hofi, who or-ganized and carried out all aspects of this study in Israel.

Some of the data used in this study were collectedand utilized by the author in her doctoral dissertation,which was accepted by Adelphi University School ofSocial Work, Garden City, New York, in March 2001.

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