Stevan E Hobfoll

Rush University Medical Center | Rush · Department of Behavioral Sciences

Background There is currently a deficit of knowledge about how to define, quantify, and measure different aspects of daily routine disruptions amid large-scale disasters like COVID-19, and which psychiatric symptoms were more related to the disruptions. This study aims to conduct a systematic review and meta-analysis on the probable positive associ...

The COVID-19 pandemic has shown that all emergencies, major incidents and disease outbreaks can have substantial mental health consequences, and it has demonstrated the proven need for additional care for populations in the wake of disasters. This book brings together practice and recent developments in pre-hospital emergency care, emergency medici...

The ongoing wars in many regions—such as the conflict between Israel and Hamas—as well as the effects of war on communities, social services, and mental health are covered in this special editorial. This article emphasizes the need for international efforts to promote peace, offer humanitarian aid, and address the mental health challenges faced by...

Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms. Objective: We aimed to examine the associations between regularity of daily routines...

Background There are concerns that the measurement of depression by the Patient Health Questionnaire-9 (PHQ-9), a self-report screening questionnaire, is biased by comorbid stroke sequelae. We, therefore, aimed to investigate these concerns in stroke, benchmarked against a non-stroke comparison sample, using factor analysis. Methods The secondary...

Currently little is known about the interrelations between changes in psychiatric symptoms and changes in resources (personal, social, financial) amid large-scale disasters. This study investigated trajectories of psychiatric symptoms and their relationships with different patterns of changes in personal, social, and financial resources between 202...

IntroductionWar in Ukraine started in March 2014 when Russia annexed Crimea and continues today in the Donbass region of Eastern Ukraine. Over 1.5 million people in these regions have been displaced from their homes. We conducted this study 36 months after the conflict began and interviewed civilians residing in Ukraine.PurposeThis study examines t...

Objectives: The Conservation of Resources (COR) theory suggests that stress results from threatened or actual loss of resources following significant life events. This study used COR theory as the framework to explore the reflection of loss of resources during the COVID-19 pandemic on psychological distress and resilience, in an adult Jewish Israel...

This study examined the mediating effects of coping resources in the prospective associations between daily routine disruptions in the acute phase of COVID-19 and persistent probable anxiety and depression. A prospective, population-representative cohort of 1318 Hong Kong Chinese respondents completed a baseline survey between February and July 202...

Die Theorie der Ressourcenerhaltung ist zu einer der führenden Theorien geworden bei der Vorhersage menschlichen Verhaltens angesichts von Stress. Sie betont neben subjektiv wahrgenommenen Ressourcengewinnen und -verlusten die objektiven Verluste, die zu Stress führen. Dezidiert fordert die Theorie die Betrachtung der sozialen und kulturellen Leben...

Both COVID-19 and unrest are posing a significant threat to population mental health across the globe. This study examined trends of probable depression and anxiety during a time of civil unrest and concurrent COVID-19 in Hong Kong. Four random digit dialing telephone surveys were conducted in July 2019 (n = 1112), February–March 2020 (n = 2003), A...

Objective There is a socioeconomic gradient to depression risks, with more pronounced inequality amid macroenvironmental potential traumatic events. Between mid-2019 and mid-2020, the Hong Kong population experienced drastic societal changes, including the escalating civil unrest and the COVID-19 pandemic. We examined the change of the socioeconomi...

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is un...

Objective: Racial and ethnic minority women from low-resource urban communities experience disproportionately high rates of trauma exposure. Higher rates of lifetime trauma exposure are strongly associated with subsequent psychological sequela, specifically depression and posttraumatic stress disorder (PTSD). Communal mastery is the ability to cope...

Objective The current paper uses the Conservation of Resources Theory to frame an examination of the impact of exposure to political violence on posttraumatic stress symptomology among three groups within Israeli society: (1) Native Born Jews; (2) Foreign Born Jews; and (3) Palestinian Citizens of Israel. Methods The study population was a large n...

Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we teste...

The Strategic Approach to Coping Scale (SACS) is a tool designed to measure coping strategies in terms of the Multiaxial Model of Coping. The aim of this article is to present our work towards adapting the SACS to the Polish cultural context. The Polish translation of this measure and the Rotter Incomplete Sentence Blank were applied to 1,074 Poles...

The Strategic Approach to Coping Scale (SACS) is a measure based on the Multiaxial Model of Coping. The original version of the scale consists of nine subscales, which form three second-order factors. An up-to-date review of SACS cultural adaptations was provided in order to examine the evidence for the cultural stability of SACS first- and second-...

Introduction: Assessing and addressing patient histories of trauma constitute a critical component of care for vulnerable populations such as pregnant patients, yet they often go unrecognized in obstetric care. Obstetric providers may feel poorly equipped to address this issue comfortably and effectively. Methods: We designed this didactic modul...

What drives citizens’ support for violence against domestic political actors? Despite its potentially devastating consequences, there is surprisingly little research on the antecedents of this unique form of political violence. Building upon recent insights on the psychological implications of exposure to conflict on support for political violence,...

PTSD symptoms and other negative psychosocial factors have been implicated in the transition from acute to persistent pain. Women (N = 375) who presented to an inner-city Emergency Department (ED) with complaints of acute pain were followed for 3 months. They completed a comprehensive battery of questionnaires at an initial visit, and provided rati...

Background: There are a growing number of forced migrants worldwide. Early detection of poor adjustment and interventions to facilitate positive adaptation within these communities is a critical global public health priority. A growing literature points to challenges within the post-migration context as key determents of poor mental health. Aims: T...

In this chapter we draw on multiple theories— including conservation of resources (COR) theory (Hobfoll, 1989, 2012), traumatic stress theory, and developmental psychopathology (Layne, Beck, et al., 2009; Pynoos, Steinberg, & Wraith, 1995)— to formulate an integrative conceptual framework. Our aims are to propose a diverse “family” of adjustment tr...

Researchers increasingly use meta-analysis to synthesize the results of several studies in order to estimate a common effect. When the outcome variable is continuous, standard meta-analytic approaches assume that the primary studies report the sample mean and standard deviation of the outcome. However, when the outcome is skewed, authors sometimes...

Written for school professionals, this chapter proposes a typology of four different trajectories of positive post-traumatic adjustment (e.g., stress resistance, resilient recovery, protracted recovery) and six different trajectories of negative post-traumatic adjustment (e.g. decline, delayed decline). It also proposes a typology of different attr...

Background: Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have publish...

Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis – ERRATUM - Yin Wu, Brooke Levis, Kira E. Riehm, Nazanin Saadat, Alexander W. Levis, Marleine Azar, Danielle B. Rice, Jill Boruff, Pim Cuijpers, Simon Gilbody, John P.A. Ioannidis, Lorie A. Kloda, Dean McMillan, Scott B....

A multi-national sample was used to investigate mechanisms that were hypothesized to moderate the relationship between exposure to political violence and symptoms of posttraumatic stress (PTS). We hypothesized that a) the phase of the conflict and b) the status asymmetry of the conflicting parties would moderate the relationship between exposure an...

External collective political efficacy (PE) is an individual's perception of the extent to which the government is responsive to the needs of his or her group or community or to its collective actions. Does PE play a role in the association between exposure to political violence and posttraumatic stress? The current study aimed to examine whether s...

Background and Objectives Medical patients often have trauma histories that are not routinely assessed, which can adversely affect health outcomes. Despite growing awareness of this issue, there is limited understanding of factors that influence provider competency in trauma-informed care (TIC). The study examined healthcare providers’ personality...

Background Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total...

How does exposure to terrorism affect political attitudes? This paper presents a new individual-level psychobiological model of political attitudes. Using a unique individual-level data of personal exposure to terrorism, a physiological marker of inflammation (CRP) and a psychological measure of perception of threat to an ongoing conflict—the Israe...

Sustainment of daily routines requires greater psychological resilience and may lead to greater resilience in the face of stressors. Existing scales tend only to focus on emotions and engagement, rather than how well individuals sustain routine behaviors. To address this gap in the literature, we developed the Sustainability of Living Inventory (SO...

Objective: Assess the effectiveness of an interdisciplinary geriatric team intervention in decreasing symptoms of depression among urban minority older adults in primary care. Secondary outcomes included cardiometabolic syndrome and trauma. Method: 250 African American and Hispanic older adults with PHQ-9 scores ≥ 8 and BMI ≥ 25 were recruited f...

Background/objectives: Inner-city Black women may be more susceptible to posttraumatic stress disorder (PTSD) than White women, although mechanisms underlying this association are unclear. Living in urban neighborhoods distinguished by higher chronic stress may contribute to racial differences in women's cognitive, affective, and social vulnerabil...

The principal accepted models of post‐traumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well‐being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experie...

ᅟ The Morningness-Eveningness Questionnaire (MEQ) and Munich ChronoType Questionnaire (MCTQ) are sometimes used to estimate circadian timing. However, it remains unclear if they can reflect a change in circadian timing after a light treatment. In this study, 31 participants (25–68 years) completed both questionnaires before and after a 13–28 day mo...

Objective: To examine the feasibility, acceptability, and effects of a home-based morning bright light treatment on pain, mood, sleep, and circadian timing in US veterans with chronic low back pain. Design: An open treatment trial with a seven-day baseline, followed by 13 days of a one-hour morning bright light treatment self-administered at hom...

Dans sa théorie de la conservation des ressources, Hobfoll (1988, 1989) démontre comment les fluctuations de ressources, en pertes, menaces et gains, affectent la santé mentale des individus. En 1992, Hobfoll, Lilly et Jackson ont proposé une étude de ces fluctuations à travers l’évaluation de la conservation des ressources (COR-E), dont nous propo...

Women may be disproportionately vulnerable to acute pain, potentially due to their social landscape. We examined whether positive and negative social processes (social support and social undermining) are associated with acute pain and if the processes are linked to pain via negative cognitive appraisal and emotion (pain catastrophizing, hyperarousa...

We examined the incidence and predictors of threat perceptions toward people who oppose government action (i.e., protestors) following the Umbrella Movement in Hong Kong (September 28th to December 15th, 2014). A population-representative sample of 1,208 citizens (mean age = 46.89 years; 52.4% female) was recruited two months after the conclusion o...

Objective To determine whether sleep disturbance and symptoms of depression mediate the relationship between pain and cognitive dysfunction (CD) in a sample of 115 patients with systemic lupus erythematosus (SLE). Methods A total of 115 patients with SLE completed questionnaires regarding pain, perceived stress, depression, sleep, and CD. Relation...

Background: Given high levels of traumatic stress for low-income, inner-city women, investigating the link between PTSD and pain is especially important. Purpose: Using the Conservation of Resources (COR) Theory, we investigated direct and indirect relationships of PTSD symptoms, vulnerability factors (i.e., resource loss, depressive symptoms and...

Over the past 30 years, conservation of resources (COR) theory has become one of the most widely cited theories in organizational psychology and organizational behavior. COR theory has been adopted across the many areas of the stress spectrum, from burnout to traumatic stress. Further attesting to the theory’s centrality, COR theory is largely the...

Background: Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also someti...

Purpose/objectives: Social support and its relationship to psychological distress are of interest in hematopoietic stem cell transplant (HSCT) as patients are dependent on caregivers pre-, during, and posttransplant. Although social support is critical for managing stress and trauma, posttraumatic stress symptoms (PTSS) may erode social support an...

Aims: To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.

Prior work has considered demand and distress, temporal dynamics, and differential outcomes in defining human stress resilience but not the processes and mechanisms of resilience across different life challenges. The purpose of this chapter is to outline the Drive to Thrive (DTT) theory in an attempt to advance existing understanding of stress adap...

Over the past 30 years, conservation of resources (COR) theory has become one of the most widely cited theories in organizational psychology and organizational behavior. COR theory has been adopted across the many areas of the stress spectrum, from burnout to traumatic stress. Further attesting to the theory's centrality, COR theory is largely the...

This research tested whether chronic or contextually activated Holocaust exposure is associated with more extreme political attitudes among Israeli Jews. Study 1 (N = 57), and Study 2 (N = 61) found that Holocaust primes increased support for aggressive policies against a current adversary and decreased support for political compromise via an ampli...

Conservation of resources (COR) theory informs our understanding of how individuals cope with major stress and trauma. COR theory asserts that traumatic stress occurs when events threaten and erode the basic resources human beings need for survival or self-integrity. This process occurs within an ecological framework, meaning that patterns of risk...

Introduction: Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women's actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetr...

Background: Traumatic events involve loss of resources, which has consistently been found to be associated with developing stress-related illness such as posttraumatic stress disorder (PTSD). Objective: The purpose of this systematic literature review was to determine if there is evidence for the salutatory effect of resource gain on PTSD, and i...

Objective: PTSD and depression are related to perceived physical health impairment in veterans, but little is known about the effects of psychological treatment on impairment. We examined the impact of an interactive online treatment for veterans with trauma-related distress, including (a) whether treatment effects include reduced perceived physic...

Background and objective: This study tested three alternative explanations for research indicating a positive, but heterogeneous relationship between self-reported posttraumatic growth (PTG) and posttraumatic stress symptoms (PSS): a) the third-variable hypothesis that the relationship between PTG and PSS is a spurious one driven by positive relat...

Social media use has proliferated in the past ten years and studies are beginning to investigate the association between social media use and its effect on mental health. This study extends this literature by testing a novel hypothesis that social resource loss on social media (e.g., “unfriending”) may be associated with increased symptoms of depre...

This pilot study evaluated the feasibility, acceptability, and preliminary effectiveness of tailored cognitive-behavioral resilience training (TCBRT) for trauma-exposed individuals with a variety of subsyndromal psychological symptoms. TCBRT is a brief, flexible intervention that allows individuals to select the areas they wish to target using comm...

Background: Traumatic events and posttraumatic stress disorder (PTSD) are associated with increased risk for cardiopulmonary disease (CPD) in veterans, men, and primarily White populations. Less is known about trauma, PTSD, and CPD burden among low-income, racial minority residents who are at elevated risk for trauma and PTSD. It was hypothesized...

Post-traumatic stress disorder (PTSD) occurs in 5–10% of the population and is twice as common in women as in men. Although trauma exposure is the precipitating event for PTSD to develop, biological and psychosocial risk factors are increasingly viewed as predictors of symptom onset, severity and chronicity. PTSD affects multiple biological systems...

Despite heightened rates of depression and posttraumatic stress disorder (PTSD) among in Iraq/Afghanistan veterans, the majority of distressed veterans will not receive mental health care. Overcoming barriers to mental health services requires innovative approaches to broaden the reach of evidence-based treatment. The current study examined the eff...

Trauma in the form of natural disasters, war, and other catastrophic events is ubiquitous. Exposure to traumatic events has been recognized as part of the human experience and has the potential to impact subsequent development across the life span, although individual responses to trauma vary widely. In this chapter, we discuss common sources of tr...

In considering resilience to stress there are several key organizing principles that will aid both research and understanding. Understanding resilience is critical to illumination of the stress process, be it for purposes of research, policy, or intervention. Bonanno, Romero, and Klein (this issue) provide an excellent review of thinking on resilie...

Objectives Meta-analytic evidence based on cross-sectional investigations between posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) demonstrates that the two concepts are positively related and that ethnic minorities report greater PTG. Few longitudinal studies have quantified this relationship so the evidence is limited regarding...

Background Exposure to ongoing political violence and stressful conditions increases the risk of post traumatic stress disorder (PTSD) in low-resource contexts. However, much of our understanding of the determinants of PTSD in these contexts comes from cross-sectional data. Longitudinal studies that examine factors associated with incident PTSD may...

Conservation of resources (COR) theory was originally introduced as a framework for understanding and predicting the consequences of major and traumatic stress, but following the work of Hobfoll and Shirom (1993), COR theory has been adopted to understanding and predicting work-related stress and both the stress and resilience that occur within wor...

Despite the potentially life-saving effects of stem cell transplant (SCT), many transplant patients experience traumatic stress reactions due to mortality threat, interpersonal isolation, financial and occupational loss, and invasive medical procedures. Emerging evidence suggests that trauma-related stress symptoms (TSS) predict significant health...

Background and objectives: Posttraumatic stress disorder (PTSD) and Major Depressive Disorder (MDD) are associated with high disease burden. Pathways by which PTSD and MDD contribute to disease burden are not understood. Design: Path analysis was used to examine pathways between PTSD symptoms, MDD symptoms, and disease burden among 251 low-incom...

Does exposure to political violence prompt civilians to support peace? We investigate the determinants of civilian attitudes toward peace during ongoing conflict using two original panel datasets representing Israelis (n=996) and Palestinians in East Jerusalem, the West Bank and Gaza (n=631) (149 communities in total). A multi-group estimation anal...

We have long outgrown the capacity of the accepted clinical models of trauma, and a paradigm shift in our thinking is long overdue. The data on traumatic stress were posited from a certain cognitive-behavioural viewpoint, with particular emotional components based almost in their entirety on western, mostly white individuals seeking treatment for p...

The influence of caregiver post-traumatic stress disorder (PTSD) on asthma symptoms in high-risk children with asthma is unknown. This study is part of the Rush Center for Urban Health Equity. Community outreach was used to recruit 64 families with children 5-12 years of age who were overweight/obese with asthma. Asthma symptoms were self-report;...

Objective: Patient anger can be challenging for providers, and may hinder the patient-provider relationship. Research on the relationships among patient anger, relationships with health care providers and medical outcomes, however, has been limited to anecdotal accounts and cross-sectional studies. This study examined relationships among patient a...

The prolonged and complex Israeli—Palestinian conflict profoundly affects the health and wellbeing of both Palestinians and Israelis.1 The present escalation between Hamas and Israel follows a well-worn pattern of confrontation. Superior Israeli military force means that Palestinians have more physical casualties. On both sides, however, many civil...

Can endorsement of the ethos of conflict alter psychological effects of exposure to political violence? Israelis and Palestinians have been in a state of political and military turmoil for decades. We interviewed 781 Israelis and 1,196 Palestinians living in the West Bank, Gaza Strip, and East Jerusalem. Using structural equation modeling, we found...

The physiological impact of citizens’ prolonged exposure to violence and conflict is a crucial, yet underexplored issue within the political science and biology literature. We examined the impact of high levels of exposure to rocket and terrorist attacks on biological markers of immunity and inflammation in a sample of Israelis. A stratified random...

Die Theorie der Ressourcenerhaltung (engl. conservation of resources-theory, abgek. COR-theory) ist neben der herausragenden Pionierarbeit von Lazarus und Folkman (1984; transactional model of stress) im Laufe der letzten 20 Jahre zu einer der führenden Stresstheorien geworden. Obwohl die Theorie der Ressourcenerhaltung grundsätzlich anerkennt, das...

Objective: Sleep disturbances, including trouble falling and remaining asleep and recurrent nightmares, are symptoms of posttraumatic stress. A growing body of literature indicates that sleep disturbance may also convey vulnerability for the continuation of other symptoms of posttraumatic stress, including fear, anxiety, and heightened arousal. Ho...

We examined how difficulties with emotion regulation, social support, and interpersonal violence in adult relationships mediated the relationship between childhood abuse and post traumatic symptoms (PTS) in adults. We fit a multiple mediation model to data from 139 socio-economically disadvantaged women (85% African American) of whom 44% endorsed m...

Acknowledgements: This study was made possible, in part, by grants from the National Institute of Mental Health (R01 MH073687) and the Ohio Board of Regents. The authors have no conflict of interest to report.

In this article we examine the rationale and utility of integrated behavioral-medical interventions for two patient populations during acute periods of increased vulnerability to posttraumatic stress disorder (PTSD): pregnant women with prior trauma history and patients undergoing bone marrow transplant (BMT).

Hobfoll’s conservation of resources (COR) theory was developed independently of Foa’s SRT and is a motivational theory of stress focusing on the prediction of stress and resilience. In this chapter, Lisa Stines Doane, Jeremiah Schumm, and Stevan Hobfoll discuss ways in which the psychological economy of resources sustains and protects people and ho...

In this article, I build on Lawrence Palinkas's empirical and theoretical approach and bring in more fully the focus of conservation of resources (COR) theory that Palinkas discusses. Palinkas analyzes technological disaster from psychological, sociological, and broader cultural perspectives. By more fully weaving in the principles and corollaries...

We examined the effect of family life, work, and war-related stressors on posttraumatic stress disorder (PTSD) symptoms, depression symptoms, perceived physical health, and perceived functioning in a large sample of 796 randomly selected Air Force men and women who were deployed during the period of October 7, 2001 to September 2004. As predicted b...

Intrafamilial violence is starkly understudied in the context of mass casualty and political violence. We conducted a three-wave prospective study of 383 female and 363 male Palestinian adults living in the West Bank, Gaza Strip, and East Jerusalem, interviewed beginning in September 2007, and again at 12- and 18-month intervals, regarding how poli...