War exposure, evacuation, and psychological and behavioural outcomes following a large-scale traumatic event

Background: Armed conflict may affect civilian mental health not only through direct exposure to traumatic events but also through displacement-related disruption. Following the 7 October 2023, attacks on Israel and the subsequent war, limited evidence has examined the distinct roles of direct war exposure and evacuation in shaping both psychological and behavioural outcomes.Objective: To examine the associations of direct war exposure and evacuation with anxiety, depressive symptoms, sleep disturbances, changes in eating behaviour, and weight change among Israeli civilians, and to assess whether younger age and lower pre-war household income show indirect associations with poorer outcomes through evacuation and direct war exposure.Method: Data were collected in March 2025 through a cross-sectional online survey of 513 adults in Israel, including 209 evacuees and 304 non-evacuees. Outcomes included anxiety, depressive symptoms, sleep disturbances, eating-behaviour change, and weight change. Multivariable models and mediation analyses were used to examine the roles of war exposure, evacuation, age, and pre-war household income.Results: Evacuated participants reported higher levels of sleep disturbances, anxiety, and depressive symptoms and were markedly more likely to report changes in eating behaviour and body weight. Eating changes were reported by 62.2% of evacuees compared with 31.9% of non-evacuated participants, and weight stability was substantially less common among evacuees. In multivariable models, direct war exposure was more strongly associated with anxiety, sleep disturbances, and eating-behaviour change, whereas evacuation was more consistently associated with depressive symptoms and weight instability. Younger age and lower pre-war household income showed indirect associations with poorer outcomes through evacuation and/or direct war exposure.Conclusions: Direct war exposure and evacuation were associated with different patterns across the psychological and behavioural outcomes examined. Post-conflict mental health responses should address not only trauma exposure itself but also displacement and socioeconomic vulnerability as important determinants of civilian wellbeing.