A prospective study of resilience, stress, and mental and physical health following a large-scale terrorist attack

On October 7, 2023, the southern and central regions of Israel experienced a deadly terror attack that resulted in the deaths of approximately 1,400 civilians and the abduction of 251 people. Previous studies document adverse psychological and physical consequences of exposure to large-scale violence or terror attacks and identify resilience as an important protective factor. The mechanisms that link resilience with health outcomes in the context of a prolonged collective trauma, however, remain insufficiently understood. This prospective study examines the mediating role of stress in the association between resilience and both mental and self-rated physical health among civilians after a large-scale incident. The study tracks 250 participants across two time points, with assessments conducted shortly before and several months after the attack. Findings reveal that mental and self-rated physical health decline significantly after the attack; resilience is positively associated with mental and self-rated physical health; and synchronous-mediation analyses indicate that these associations are statistically mediated by perceived stress, whereas no significant time-lagged mediation effects are observed. These findings support the relevance of an established resilience–stress–health framework in the context of prolonged collective trauma and suggest that perceived stress may represent one pathway from resilience to health outcomes. Further investigation of the personal, social, and biological determinants of resilience may inform interventions aimed at promoting adaptation during prolonged adversity.