The importance of studying activity engagement and other sources of resilience among Holocaust survivors during stressful life events

The COVID-19 pandemic has threatened the health and well-being of older adults around the world, but certain subgroups, such as trauma survivors, could be more affected than others as they may face once again a threat to their health and their lives. Holocaust survivors (HSs) constitute a particularly vulnerable group of trauma survivors since they often report increased posttraumatic symptoms (PTSs) and psychological distress compared to non-HS comparisons. At the same time, however, they display general resilience, which helps them live productive and meaningful lives (Barel et al., 2010; Ohana et al., 2014). The COVID-19 pandemic may pose a specific threat to HS, as it could remind them of past traumas from theHolocaust. Recent research has suggested this is the case and highlighted that some HS are more vulnerable in the face of the pandemic, especially those with high PTS (Maytles et al., 2021) and those who contracted an infectious disease during the Holocaust (Shrira et al., 2020). Given the vulnerabilities of HS in the pandemic, we should ask which factors promote resilience and improve their coping. Within this context, Bergman et al. (2021) have written an important paper on the potential sources of resilience among HS. Specifically, they address the question of whether engaging in activities during the pandemic is related to less psychological distress among HS. Previous research has demonstrated that among trauma-exposed adults, engaging in planful problem-solving activities is associated with reduced distress (Hansen and Ghafoori, 2017). Furthermore, planful problem solving is a prominent feature in the narratives of survivors both during and after the Holocaust (Suedfeld et al., 1997). The study by Bergman et al. underlines the importance of activity engagement as a means of coping with external negative events and yields important results in view of future research and practice with vulnerable older populations. Data for this study were collected from 131 older Jewish Israelis aged 76+ years, between April and June 2020. During this period, COVID-19 restrictions were gradually lifted and were not reintroduced until July 2020. The sample was divided into HS with either high or low PTS and comparisons (not directly exposed to the Holocaust). All participants in the comparison group had low PTS. Psychological distress was measured using the Patient Health Questionnaire-4 (PHQ-4) scale of depressive symptoms and anxiety. Activity engagement was assessed by a four-item scale constructed for the study, which measured the extent to which participants engaged in four activities during the preceding weeks: physical activity, leisure activities, daily planning, and execution of the daily plans. Drawing on this dataset, Bergman et al., analyzed the distress of HS and the role of activity engagement. They found those survivors not suffering from high-PTS reported psychological distress similar to that of the comparison group. However, high-PTS survivors reported increased psychological distress. An interaction analysis of PTS and activity engagement within the HS group revealed that high-PTS survivors displayed extremely high levels of psychological distress when activity engagement was low but significantly lower levels of distress when activity was high. This study offers several compelling strengths. First, it uses a timely dataset of those who did and did not experience the Holocaust, collected during a global pandemic in which the lives of older adults were threatened, and they faced restrictions to their freedom, in a manner that could bear some resemblance to Holocaust experiences. Second, this study joins other investigations during COVID-19 which point to the general resilience of older adults in the face of the pandemic (Vahia et al., 2020). That is, most participants in the study (80%), both HS and comparisons, did not display high levels of distress in the face of the pandemic. They showed resilience, and this could have helped them deal with the new threat. The study is also noteworthy for its focus on the vulnerabilities and coping mechanisms of HS. It found that in parallel to their resilience, some HS showed a specific vulnerability related to the psychological effects of the pandemic. The finding suggests that HS with high PTS may be particularly vulnerable to the effects of COVID-19,more so than International Psychogeriatrics (2021), 33:12, 1241–1243 © International Psychogeriatric Association 2021