Dr. Michal Cohen said that while the “regular population” generally began to bounce back over time, certain groups appeared to take longer to recover
There is no uniform psychological response to the trauma of October 7 and the nearly three years of war that Israelis have endured, according to new research published in Frontiers in Psychiatry.
The first systematic review of psychiatric outcomes since the October 7 attack found that Israelis have followed different psychological trajectories. Some people’s symptoms declined over time, while others continued to experience anxiety, depression, post-traumatic stress symptoms, or addiction-related problems. The research pointed to a combination of factors that can influence these outcomes, including exposure to the war, its intensity and duration, and social and structural vulnerabilities.
Rather than presenting a picture of an entire nation experiencing trauma in the same way, as Israel is often described, the research identified what the authors called “overlapping circles of vulnerability.” Reservists and their families, people who lost loved ones in the war, those uprooted from their homes, and people facing socioeconomic hardship or continued security threats were among the groups that appeared particularly vulnerable.
A national crisis does not necessarily mean that everyone requires the same mental-health response
“A national crisis does not necessarily mean that everyone requires the same mental-health response,” said Dr. Michal Cohen of the Israel Center for Addiction and Mental Health at the Hebrew University of Jerusalem, who led the study with Prof. Mario Mikulincer. “The goal should be to identify people whose distress persists or whose function is impaired over time … The health system should invest in more ways to detect these populations. Not everyone needs the same treatment, but we need to identify what exact support people need to recover.”
The researchers reviewed 68 studies conducted during the two years following the October 7 Hamas attack. Following PRISMA 2020 guidelines for systematic reviews, they searched four major scientific databases: PubMed, PsycINFO, Scopus, and Web of Science. The data were independently extracted and cross-checked.
Instead of focusing on a single population or psychiatric condition, the team examined research on post-traumatic stress symptoms (PTSS), anxiety, depression, and addiction-related outcomes. They looked at how psychological distress manifested across different groups, who appeared most vulnerable, how different levels and types of exposure were associated with mental health, and how people responded when a continuing threat accompanied traumatic events.
PhD student Maor Daniel Levitin also collaborated on the study.
Cohen stressed in an interview with The Media Line that the research focused on PTSS rather than PTSD, as the ongoing war meant the team could examine symptoms but not make definitive PTSD diagnoses.
Cohen said that while the “regular population” generally began to bounce back over time, certain groups appeared to take longer to recover. However, she noted that few studies examine the many populations that still appear to be struggling, including people who were evacuated from their homes. Reservists, for example, emerged as one of the groups experiencing higher levels of distress.
According to figures released by the Defense Ministry in mid-2026, more than 26,000 soldiers had been wounded since the start of the war, and roughly 65% of those wounded were coping with psychological injuries or post-traumatic stress. By 2028, the ministry’s Rehabilitation Department is expected to be treating approximately 100,000 wounded veterans, about half of whom are projected to be living with psychological injuries.
Bereaved families were another group that appeared to continue struggling with anxiety and depression. At the same time, the research suggested that strong social support from friends and family was associated with a lower likelihood of post-traumatic stress symptoms.
Dr. Jordan Lewinski, head of Mental Health Services at Clalit, Israel’s largest health fund, explained that demand for mental health services surged after October 7.
Addiction has received far less attention in the existing research than depression, anxiety, and PTSS. Only three of the 68 studies examined addiction-related outcomes, making it difficult for the researchers to draw a comprehensive picture of how substance use and other addictive behaviors have changed since October 7.
The studies that did examine addiction found that problems tended to increase alongside the severity of a person’s exposure to the war, psychological distress, and previous mental health difficulties. Direct exposure to the events of the war showed the strongest association with increased substance use.
Speaking at the ICAR (Israel’s Collective Action for Resilience) conference in February 2026, Professor Eyal Fruchter, the organization’s co-founder and head of medical and scientific affairs, shared that Israel has already seen a 70% increase in opioid use, while one in four Israelis reports increased substance use. Among young adults aged 18 to 24, nearly 30% reported ongoing substance misuse. Among people with PTSD, Fruchter said, more than half, 54%, also reported substance abuse.
But Cohen said that symptoms and diagnoses such as anxiety and depression may tell only part of the story. Another important measure of recovery is whether people can move forward with their lives: returning to work, caring for their families, maintaining relationships, and managing everyday responsibilities.
I think that we need to look at the functioning of the person
“I think that we need to look at the functioning of the person,” she explained.
Cohen said this means looking beyond whether someone simply goes to work, although employment remains important, and asking how that person is actually functioning. She pointed, for example, to an increase in divorce over the past three years and said more research is needed to understand its relationship to the prolonged crisis. Physical ramifications, including widespread sleep problems, should also be examined as part of the broader picture of Israelis’ well-being, she said.
Taken together, Cohen said, the findings point to the need for a more targeted approach to mental health, one that considers what people have experienced, whether that exposure is continuing, and what resources they have available rather than assuming that psychological needs are the same across the population.
The next step, Cohen told The Media Line, is sustained longitudinal research that follows Israelis over time. Such research could help determine which symptoms are temporary responses to extraordinary circumstances and which are becoming persistent psychiatric conditions that require longer-term intervention.
Cohen said the answers could help the Health Ministry and Israel’s health funds better understand what resources will be needed in the coming years and, perhaps most importantly, which Israelis will need them most.
This report is part of Traumatech, a series developed and created by Maayan Hoffman and debuting on The Media Line. The series explores how Israel is building and exporting breakthrough mental health technologies that can transform life at home and bring hope to communities worldwide.
