The unfolding of psychological distress following the October 7 attack on Israel: The impact of exposure, gender, and event centrality

Background: Mass disasters, whether natural or human-made, pose significant public health challenges, with some individuals demonstrating resilience, whereas others experience persistent emotional distress that may meet diagnostic criteria for mental health disorders. We explored key risk factors for distress following the October 7, 2023, Hamas attacks on Israel, focusing on trauma exposure, gender, and event centrality. Method: A longitudinal study design was used, assessing posttraumatic distress (PTSD), depression, generalized anxiety, event centrality, and functioning at approximately three (T1; n=858) and seven (T2, n=509) months post-attack. Results: Replicating findings from war trauma literature, we documented a high comorbidity among PTSD, depression, and anxiety; greater distress in women; and a dose-response relationship between exposure and distress. Event centrality was consistently linked to distress at both time points. Extending the literature, we found that gender, exposure, and event centrality contributed to distress at each time point. Moreover, important gender-specific patterns of risk and distress were revealed. In addition, distress at T1, event centrality at T1, gender, and continuous exposure contributed to distress at T2. Whereas distress and event centrality remained stable, functioning improved significantly from T1 to T2, highlighting the different trajectories of distress and recovery. Conclusions: Personalized approaches and continuous monitoring of individuals exposed to cumulative trauma are highlighted. The importance of assessing multiple indices of trauma – distress, functioning, and meaning –to address mental health needs in the wake of mass disasters is emphasized.