A new Yale-led study found that more than one-third of Israeli adults surveyed during the third month of the Israel-Hamas war suffered from probable post-traumatic stress disorder (PTSD), revealing widespread psychological distress among people in Israel.
Another 16.3% of the 1,511 adults whose experiences were considered by the researchers reported clinically significant dissociation.
Notably, 17.8% of individuals who were not directly exposed to traumatic events still met the clinical threshold for PTSD, underscoring the profound impact of indirect or “by-proxy” exposure during ongoing threat. Three-quarters of the population reported mild to moderate dissociative symptoms, and nearly half (46.9%) exhibited mild to moderate PTSD symptoms, even without direct exposure.
The results were published in Journal of Trauma & Dissociation. The study was led by first author Dori Rubinstein, PhD, postdoctoral associate in the Yale Department of Psychiatry, and senior author Ilan Harpaz-Rotem, PhD, Glenn H. Greenberg Professor of Psychiatry and of Psychology at Yale School of Medicine and an affiliate of the U.S. Department of Veterans Affairs National Center for PTSD.
The study also demonstrated strong cumulative trauma effects: Individuals exposed to three or more potentially traumatic events (PTEs) showed significantly higher PTSD and dissociative symptoms than those with fewer exposures. These findings emphasize the additive burden of repeated trauma in conflict settings.
Together, the researchers say these results challenge the adequacy of the DSM-5 Criterion A definition of trauma in contexts of ongoing conflict, where indirect exposure and sustained threat can lead to clinically significant distress. As the war now approaches its end, the paper is especially relevant to understanding the enduring mental health impact of mass trauma and guiding interventions that address both direct and indirect exposure.
The study was a collaboration among four research teams across Israel, the United States, and Germany, including the Community Stress Prevention Center (Kiryat Shmona, Israel), Tel Hai Academic College, Ben-Gurion University of the Negev, and Martin Luther University Halle-Wittenberg.
The research was supported by internal institutional resources from the participating centers. No external funding was used.