OBJECTIVE: The authors investigated the impact of continuous and
repeated stress on Israeli civilians exposed to missile attacks during the
Gulf War. METHOD: Study 1 included 26 healthy volunteers aged 28-59 years.
Their scores on the Hamilton Anxiety Rating Scale and levels of plasma
cortisol and growth hormone (GH) were evaluated before, during, and after
the war. Study 2 included 13 healthy volunteers aged 25-59 years. Their
scores on the state portion of the State-Trait Anxiety Inventory and levels
of cortisol and GH were measured three times daily (8:00 a.m., noon, and
6:00 p.m.) at two time points (during and after the war). RESULTS: Anxiety
levels of civilians exposed to the threat of war and later to actual
missile attacks were significantly higher before and during the war than
afterward. Anxiety during the war reached a peak in the evening. The
increase in anxiety was not accompanied by any change from basal morning
cortisol and GH levels or by diurnal variations in these hormones.
CONCLUSIONS: Anxiety levels during the war were similar to those 1 day
before its onset, which can be explained by the nature of coping processes.
During the war, anxiety levels were highest in the evening, reflecting the
war routine (missile attacks occurred mostly at night). The unaltered
hormone levels and their normal diurnal variations despite the subjects'
persistent anxiety were probably due to adaptation of the
hypothalamic-pituitary- adrenal and hypothalamic-somatotropin axes to