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Association of Fear of Terror With Low-Grade Inflammation Among Apparently Healthy Employed Adults

From the National Institute of Occupational & Environmental Health, Raanana, Israel and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (S.M.); Faculty of Management, Tel-Aviv University, Tel-Aviv, Israel (A.S., S.T.); Department of Medicine "D" and Institute for Special Medical Examinations (MALRAM), Tel Aviv Sourasky Medical Center, Tel Aviv, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel (S.B., I.S.).

Address correspondence and reprint requests to Samuel Melamed, PhD, Department of Occupational Health Psychology, National Institute of Occupational & Environmental Health, P.O. Box 3, Raanana 43100, Israel; E-mail: melameds{at}ioh.org.il

OBJECTIVE: Based on evidence that psychological stress may induce a chronic inflammatory process, we hypothesized that the stress caused by chronic fear of terror may be associated with low-grade inflammation. This hypothesis was examined in employed men and women with the presence of low-grade inflammation measured by high sensitivity C-reactive protein (CRP).

METHODS: Apparently healthy employed adults (N = 1153) undergoing periodic health check-ups in a tertiary hospital in Israel completed a questionnaire. Fear of terror (scored 1–5) was assessed by three items measuring the extent to which respondents have deep concern for personal safety, elevated tension in crowded places, and fear of terror strikes causing harm to one’s self or one’s family members. The main outcome measure was the presence or absence of an elevated CRP level (>3.0 mg/L).

RESULTS: Women scored significantly higher on fear of terror compared with men (M = 2.16 vs. M = 1.68, respectively; p < .0001). Most of the study participants who scored high (4 or 5) on fear of terror, reported having experienced this feeling for 1 year or more. In women only, there was a positive association between fear of terror and risk of elevated CRP level (adjusted OR = 1.7, 95% CI 1.2–2.4) in a multivariate model adjusting for generalized anxiety, depressive symptoms, and potentially confounding demographic and biomedical variables.

CONCLUSIONS: Chronic fear of terror in women, but not in men, is associated with elevated CRP levels, which suggests the presence of low-grade inflammation and a potential risk of cardiovascular disease.

Key Words: terror, • stress, • inflammation, • depression, • C-reactive protein.

Abbreviations: CRP = C-reactive protein;; BMI = body mass index;; HDL = high-density lipoprotein;; DSM = Diagnostic and Statistical Manual of Mental Disorders;; PTSD = posttraumatic stress disorder.

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