Background The October 7, 2023, terrorist attack in Israel and the ensuing prolonged war represent an unprecedented context of ongoing collective trauma. While early studies documented substantial acute psychiatric burden, the long-term trajectories of distress and posttraumatic growth (PTG) across the general population remain less understood. This study traced these trajectories over 27 months, utilizing a rare pre-war baseline to distinguish war-related outcomes from preexisting distress. Methods In this prospective six-wave national cohort study, the analytical sample consisted of 680 Israeli adults (mean age 41.13 years SD = 13.75; 343 50.4% women; 544 80.0% Jewish and 136 20.0% Arab) analyzed via a Generalized Estimating Equations (GEE) framework. Participants were assessed approximately one month before the attack (T1) and followed up at 1 (T2), 6 (T3), 12 (T4), 18 (T5), and 27 (T6) months post-attack. The analytical sample included 29 (4.3%) participants who reported direct exposure to the attack, 129 (18.9%) who reported the loss of loved one, and 102 (15.0%) reported reserve military service during the war. Findings Distress followed a parabolic trajectory characterized by a sharp acute rise followed by gradual attenuation toward baseline levels. Probable PTSD rose from 16.1% (T1) to 29.8% at T2 and declined to 19.7% (T6). Probable depression rose from 30.5% at T1 to 43.1% at T2 and significantly declined to 23.3% (T6). Anxiety rose from 22.1% (T1) to 40.1% at T2 and reached 21.0% (T6). Conversely, PTG increased progressively from T1 (M = 2.48, SD=1.57) to T6 (M = 6.10, SD=1.91; p < 0.001). Probable PTSD trajectory was significantly predicted by Arab ethnicity (OR = 4.07), and direct exposure (OR = 6.31). Probable depression trajectory was predicted by female sex (OR = 1.82), Arab ethnicity (OR = 3.62), and reserve service (OR = 4.38). Probable anxiety trajectory was predicted by Arab ethnicity (OR = 2.20) and reserve service (OR = 2.93), while higher PTG was uniquely predicted by female sex and the loss of a loved one ( p = 0.007). Interpretation Long-term adaptation to ongoing national trauma is characterized by the co-occurrence of symptom stabilization and progressive posttraumatic growth. However, the differential vulnerability identified among Arab citizens, women, and highly exposed groups underscores the necessity for sustained, stratified mental health monitoring while reinforcing the relational and meaning-making resources essential for resilience during prolonged conflict. Funding Not applicable.
Levi‐Belz et al. (Mon,) studied this question.