Risk and protective factors for posttraumatic stress disorder among Israeli civilians in the aftermath of 7 October: the TERUMAH (Trauma, Civic Engagement, Resilience and Health) study

Background: Few studies of posttraumatic stress disorder (PTSD) risk in civilian populations during armed conflict consider a wide range of risk and protective factors. Objective: This study aimed to estimate the population prevalence of PTSD and related risk and protective factors in an Israeli civilian population in the aftermath of 7 October and the subsequent war. Methods: Participants (ages ≥18) completed population-based surveys 6 months after the onset of the 7 October war and again 9 months later (n=813). PTSD was assessed using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (PCL-5, score>31) among those reporting their most bothersome traumatic event (n=435). Baseline measures included sociodemographics, social wellbeing (social support, social integration, resilience) and coping behaviours (sleep, physical activity, weight gain, smoking/alcohol use, intensity of volunteering). Traumatic exposure and stress included trauma type (direct, indirect and secondary), a count of traumatic experiences, a family member in combat and previous trauma. Multivariable models assessed risk and protective factors for PTSD, adjusting for all covariates. Results: Overall population prevalence of PTSD was 15.6%, and 29.2% among those reporting a traumatic event. Statistically significant risk factors included low vs. high income (13.7% higher predicted probability), high count of traumatic experiences (19.4% higher), worse sleep (11.9% higher) and high perceived threat (12.6% higher). Protective factors included high resilience (14.5% lower predicted probability) and moderate-intensity volunteering (18.5% lower). Sensitivity analyses indicated additional risk/protective factors associated with alternative definitions of PTSD. Conclusion: Findings suggest that among those who experience war-related traumatic events, low income, multiple traumatic events, worsening sleep patterns and high levels of perceived threat may increase risk of PTSD, while moderate levels of volunteering and high levels of resilience may lower that risk. Results suggest volunteering as a novel community-level preventive intervention strategy to reduce the risk of posttraumatic symptoms and PTSD. This study estimates PTSD in a civilian population during wartime.Low income, exposure to multiple traumatic events, high perceived threat and worsening sleep are associated with higher PTSD risk.Moderate levels of volunteering and resilience are linked to lower PTSD risk.Findings suggest volunteering as a novel community-level preventive intervention strategy to reduce risk of posttraumatic symptoms and PTSD. This study estimates PTSD in a civilian population during wartime. Low income, exposure to multiple traumatic events, high perceived threat and worsening sleep are associated with higher PTSD risk. Moderate levels of volunteering and resilience are linked to lower PTSD risk. Findings suggest volunteering as a novel community-level preventive intervention strategy to reduce risk of posttraumatic symptoms and PTSD.