Key Takeaways
- A longitudinal study of 680 Israeli adults documented sharp increases in probable posttraumatic stress disorder (PTSD), depression, and anxiety following the October 7, 2023 attacks, followed by substantial declines over 27 months.
- Probable PTSD increased from 16.1% before the attacks to 29.8% shortly afterward, then declined to 19.7% by January 2026.
- Depression and anxiety followed similar patterns. By the final assessment, probable depression was below its pre-attack level, while anxiety was approximately back to baseline.
- Psychological distress remained unevenly distributed across population groups, and improvements in overall screening rates did not mean every individual recovered.
- International attitudes toward Israel and Israeli people have become more negative. Whether perceived international rejection has independently affected Israelis’ mental health remains unknown.
Introduction
A woman overlooking Jerusalem. A longitudinal study documented sharp increases in PTSD, depression, and anxiety symptoms after October 7, followed by declines over 27 months.
The October 7, 2023 attacks in Israel were followed by a sharp increase in psychological distress, with early research documenting substantial rises in symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety.
But the longer-term consequences were less clear. Would psychological distress remain elevated throughout the subsequent war, or would symptoms gradually decline?
A longitudinal study published in June 2026 in eClinicalMedicine provides an unusually detailed perspective. Researchers followed Israeli adults whose mental health had been assessed before October 7 and examined changes across the following 27 months (Levi-Belz et al., 2026).
The study found that probable PTSD, depression, and anxiety increased markedly after the attacks before declining over time. By January 2026, probable depression had fallen below its pre-attack level, while anxiety had returned to approximately baseline. Probable PTSD remained numerically higher than before October 7, although the difference was not statistically significant.
These overall improvements did not occur uniformly. Some participants continued to experience substantial psychological distress, and certain population groups had higher odds of screening positive for psychiatric conditions.
The findings emerge against a broader backdrop of prolonged conflict and increasingly negative international attitudes toward Israel and Israeli people. Whether those attitudes have contributed to psychological distress among Israelis remains an important but unanswered question.
What the 27-Month Study Examined
Levi-Belz et al. (2026) analyzed data from 680 Israeli adults, including 544 Jewish and 136 Arab participants.
The original cohort included 908 adults surveyed in August 2023, approximately six to seven weeks before the October 7 attacks.
Researchers conducted subsequent assessments in November 2023, March 2024, November 2024, April 2025, and January 2026.
Of the original participants, 560 completed the final assessment. The analytical sample included individuals who participated in at least three of the six survey waves.
The researchers used generalized estimating equations, a statistical method that allowed participants with incomplete follow-up data to contribute to the analysis.
Among the 680 participants, 29 reported direct exposure to the October 7 attacks, 129 reported that a loved one had died during the attacks or subsequent war, and 102 reported military reserve service.
Participants completed established questionnaires measuring PTSD symptoms, depression, anxiety, and posttraumatic growth.
The researchers examined changes in these outcomes and investigated whether demographic characteristics, previous mental health symptoms, and wartime experiences were associated with different psychological responses.
An important strength was the availability of mental health measurements collected before October 7. Many studies of traumatic events begin only afterward, making it difficult to distinguish new symptoms from pre-existing psychological difficulties.
However, the study was observational. It could document changes and associations but could not determine precisely how much distress resulted from the attacks, the subsequent war, or other overlapping circumstances.
PTSD, Depression, and Anxiety Rose Sharply Before Declining
Levi-Belz et al. (2026) documented substantial increases in probable psychiatric conditions shortly after October 7, followed by declines over the subsequent 27 months.
| Mental health measure | Before October 7 | Approximately one month after | 27 months after |
|---|---|---|---|
| Probable PTSD | 16.1% | 29.8% | 19.7% |
| Probable depression | 30.5% | 43.1% | 23.3% |
| Probable anxiety | 22.1% | 40.1% | 21.0% |
Source: Levi-Belz et al. (2026). Percentages represent participants meeting questionnaire thresholds for probable psychiatric conditions, not confirmed clinical diagnoses.
Probable PTSD nearly doubled shortly after the attacks. Depression and anxiety also increased substantially.
By January 2026, however, the proportion screening positive for probable depression had fallen significantly below its pre-attack level, from 30.5% to 23.3% (p = 0.008).
Probable anxiety declined from 22.1% before October 7 to 21.0% at the final assessment, returning to approximately its baseline level.
Probable PTSD remained numerically higher than before the attacks, at 19.7% compared with 16.1%. However, the baseline-to-final difference was not statistically significant (p = 0.149).
This distinction matters. The study did not establish a statistically significant remaining elevation in probable PTSD at the final assessment, but that does not mean every participant had returned to their previous mental health status.
The results demonstrate that substantial psychological distress can follow a major traumatic event without remaining at its initial peak indefinitely.
They also illustrate why group-level changes require careful interpretation. A declining proportion of participants screening positive does not necessarily mean the same individuals recovered. Some may have improved, others may have developed new symptoms, and some may have experienced persistent difficulties.
Psychological Distress Was Uneven Across Israeli Society
The subgroup analyses in Levi-Belz et al. (2026) identified important differences in mental health outcomes.
Arab Israeli participants had higher adjusted odds of probable PTSD, depression, and anxiety than Jewish participants.
Direct exposure to the October 7 attacks was associated with greater odds of probable PTSD at the final assessment.
Military reserve service was associated with higher odds of probable depression and anxiety, while women had higher odds of probable depression.
In the final-assessment analysis, Arab participants had approximately four times the adjusted odds of probable PTSD compared with Jewish participants.
This was an odds ratio, not evidence that Arab Israelis were four times as likely to have a clinically confirmed PTSD diagnosis.
The association also does not establish why the difference occurred.
Arab Israelis have diverse identities, political perspectives, and experiences of the conflict. The study could not fully determine which social, economic, or psychological factors accounted for the observed disparities.
Likewise, military reservists may differ considerably in their exposure to danger, bereavement, disruption, and prolonged stress.
These findings show why national averages can obscure important differences in psychological burden.
International Isolation: A Possible Additional Source of Stress?
Alongside the psychological consequences of October 7 and the subsequent war, Israelis have faced a changing international environment.
Public attitudes toward Israel have become more negative across numerous countries.
In a March 2026 survey, Pew Research Center found that 60% of American adults held an unfavorable view of Israel, compared with 42% in 2022 (Silver, 2026).
A separate Pew survey of 44,657 people across 36 countries, conducted between February and May 2026, documented predominantly negative attitudes toward Israel in many surveyed countries.
Unfavorable opinions were reported by 78% of respondents in Spain and Sweden, 73% in Germany, and 69% in the United Kingdom (Silver & Clancy, 2026).
These findings demonstrate widespread negative attitudes toward Israel, although opinions about a country and its government should not automatically be interpreted as attitudes toward its citizens.
Americans Have Also Become More Negative Toward Israeli People
A Pew Research Center survey conducted in May 2026 examined Americans’ attitudes toward Israeli people separately from their opinions of the Israeli government.
In 2022, 25% of American adults reported an unfavorable view of Israeli people. By 2026, that proportion had increased to 42%.
Over the same period, favorable views of Israeli people declined from 67% to 52%.
Attitudes toward the Israeli government were more negative, with 62% of respondents expressing an unfavorable opinion in 2026.
The survey included 12,574 American adults and had an overall margin of error of 1.3 percentage points (Alper & Silver, 2026).
These findings show that declining favorability has extended beyond Israel’s government to Israeli people as a group.
Nevertheless, a narrow majority of Americans continued to view Israelis favorably.
The survey cannot establish whether individual Israelis experienced discrimination, rejection, or hostility in their personal relationships.
Could Perceived International Rejection Affect Mental Health?
Changing international attitudes may create additional social pressures for some Israelis, particularly those who study, work, travel, or maintain personal relationships abroad.
Experiences of rejection, discrimination, or weakened social belonging could plausibly contribute to psychological distress.
However, the mental health studies discussed here do not establish such a connection among Israelis.
Levi-Belz et al. (2026) did not directly measure participants’ perceptions of foreign public opinion, experiences of discrimination abroad, or feelings of international social isolation.
Furthermore, unfavorable opinions about Israel should not automatically be equated with prejudice against Israeli individuals.
Criticism of government policies, interpersonal discrimination, and antisemitism are distinct phenomena that require separate examination.
The psychological implications may also differ among Jewish and Arab Israeli citizens, whose identities, political perspectives, and experiences of the conflict are diverse.
Future research could examine whether perceived rejection or discrimination predicts mental health outcomes after accounting for previous psychiatric symptoms, exposure to violence, bereavement, military service, and other relevant factors.
For now, the evidence establishes that international attitudes have changed, but not that these changes independently contributed to the psychiatric symptoms measured in the Israeli cohort.
Earlier Research Documented the Immediate Psychological Impact
The 2026 findings build on an earlier prospective study by Levi-Belz et al. (2024), which followed 710 Israeli adults who completed mental health questionnaires before October 7 and again approximately five to six weeks afterward.
The pre-attack measurements were collected between August 20 and 30, 2023.
The proportion screening positive for probable PTSD increased from 16.2% to 29.8%.
Probable generalized anxiety increased from 24.9% to 42.7%, while probable depression rose from 31.3% to 44.8%.
Direct exposure to the attacks was associated with higher odds of probable PTSD and depression.
Importantly, mental health symptoms present before October 7 were among the strongest predictors of subsequent psychological distress (Levi-Belz et al., 2024).
This indicates that psychological vulnerability did not begin uniformly with the attacks.
Previous symptoms and stressful experiences influenced participants’ responses to subsequent events.
The 2024 and 2026 studies involved an overlapping research cohort. Their findings should therefore not be treated as independent confirmations involving entirely separate populations.
Instead, the later study extends the earlier observations by examining changes across a substantially longer period.
Another Study Identified Four PTSD Trajectories
A separate longitudinal study by Levin et al. (2026) examined 1,231 Jewish Israeli adults surveyed in January 2018, April 2022, December 2023, and March 2024.
Researchers used statistical modeling to identify four patterns of PTSD symptoms over time.
The largest group, representing 70.4% of participants, maintained relatively low PTSD symptoms and was classified as following a resilience trajectory.
Another 16.8% belonged to a trauma-vulnerability group, characterized by symptoms that increased after October 7.
A smaller group, 3.5%, showed persistently high symptoms.
The remaining 9.4% followed a trauma-recovery trajectory, characterized by relatively high symptoms before the attacks followed by reductions afterward.
These percentages describe statistical patterns within the study sample, not the prevalence of clinically diagnosed PTSD across Israel.
Levin et al. (2026) also found that previous trauma and exposure to war-related stressors differed across the groups.
The findings reinforce an important point: people exposed to the same national event can experience very different psychological outcomes.
Some maintain relatively stable mental health. Others develop worsening symptoms, while some experience improvement.
However, the study cannot establish that the attacks caused symptom improvement among participants in the recovery group.
Because the sample included Jewish Israeli adults, the results should not automatically be generalized to Arab Israelis or other populations.
Posttraumatic Growth Can Coexist With Distress
Levi-Belz et al. (2026) also examined posttraumatic growth, a term describing perceived positive psychological changes following highly stressful or traumatic experiences.
These changes may involve personal strength, relationships, appreciation of life, or a greater sense of meaning.
Average posttraumatic growth scores increased from 2.48 at the pre-attack assessment to 6.10 at the final follow-up.
The researchers also identified associations between higher reported growth and factors including female sex and the loss of a loved one.
However, these results require careful interpretation.
At baseline, participants reflected on significant stressful experiences that occurred before October 7. Later assessments focused on the attacks and subsequent war.
Because participants were not necessarily evaluating the same experience at each assessment, the scores cannot be treated as a straightforward measure of psychological improvement caused by the war.
Furthermore, self-reported posttraumatic growth does not necessarily indicate objectively measured psychological improvement or the absence of psychiatric symptoms.
A person may report greater appreciation of life or closer relationships while simultaneously experiencing grief, depression, anxiety, or posttraumatic stress.
The findings therefore illustrate that perceived positive changes and ongoing psychological distress can coexist.
They do not demonstrate that traumatic exposure is beneficial or that posttraumatic growth replaces the need for mental health care.
What the Results May Mean for Mental Health Care
Together, the studies by Levi-Belz et al. (2024, 2026) and Levin et al. (2026) show why mental health monitoring during prolonged conflict should extend beyond the immediate aftermath of a traumatic event.
The proportion of participants screening positive for PTSD, depression, or anxiety changed substantially over time, and different population groups showed different patterns of vulnerability.
These findings indicate an overall reduction in psychological distress after the initial increase, but they should not be interpreted as evidence that every affected individual recovered.
Some participants may have improved, others may have developed new symptoms, and some may have continued experiencing substantial difficulties.
Repeated assessment can help identify people whose mental health needs persist or change over time.
Previous psychiatric symptoms, direct exposure, bereavement, and military service may be relevant when identifying groups requiring closer attention.
The international-attitudes findings raise a separate research question: whether perceived rejection, discrimination, or weakening international social ties contribute additional stress for some Israelis.
That question deserves investigation, but it should not be treated as an established explanation for the psychiatric outcomes reported in these studies.
Limitations
The mental health studies relied primarily on self-reported questionnaires rather than clinical diagnostic interviews.
Levi-Belz et al. (2026) recruited participants through an online survey panel and included those who completed at least three assessment waves. Although the researchers used statistical methods to incorporate incomplete follow-up data, selection bias and participant attrition remain possible.
The pre-attack baseline was collected during a period of intense domestic political unrest in Israel, rather than under psychologically neutral conditions.
The researchers could not cleanly separate the effects of October 7 from the subsequent war, bereavement, displacement, military service, and other overlapping stressors.
The international polling has different limitations. It measures public attitudes, not the personal experiences or psychiatric symptoms of Israelis.
Negative opinions about Israel do not necessarily translate into interpersonal discrimination, and national polling cannot establish how individual Israelis interpret or experience those attitudes.
Finally, these studies concern specific samples. Their results should not be used to characterize the mental health of every Israeli or to compare the psychological suffering of different populations affected by the conflict.
Final Thoughts
Three years after October 7, longitudinal research reveals a complex pattern of psychological distress and adaptation among Israelis.
Levi-Belz et al. (2026) documented sharp increases in probable PTSD, depression, and anxiety after the attacks, followed by substantial declines over 27 months.
The improvement was not uniform. Direct exposure, previous psychiatric symptoms, and certain demographic and wartime experiences were associated with greater psychological burden.
The distinct PTSD trajectories identified by Levin et al. (2026) further demonstrate that people do not respond to collective trauma in a single predictable way.
Meanwhile, international attitudes toward Israel and Israeli people have become substantially more negative, including in the United States.
Whether those changing attitudes have independently affected Israelis’ mental health remains unanswered.
The evidence documents both a changing psychological landscape within Israel and a changing international environment, but it does not establish a causal relationship between them.
Understanding that relationship will require research measuring perceived international rejection and social belonging alongside mental health outcomes over time.
Funding and Disclosures
Levi-Belz et al. (2026): The authors reported receiving no specific grant from public, commercial, or nonprofit funding agencies and declared no competing interests. They disclosed using Google’s Gemini to help format and organize tables, followed by author review and editing.
Levi-Belz et al. (2024): The paper listed funding as not applicable and its declaration of interests as not applicable.
Levin et al. (2026): The authors reported no specific grant funding and declared no competing interests.
Pew Research Center: The cited surveys provide contextual public-opinion evidence, not clinical mental health findings.
References
Alper, B. A., & Silver, L. (2026, July 9). Americans’ views of Israelis have grown increasingly negative, but views of Palestinians have held fairly steady. Pew Research Center. https://www.pewresearch.org/short-reads/2026/07/09/americans-views-of-israelis-have-grown-increasingly-negative-but-views-of-palestinians-have-held-fairly-steady/
Levi-Belz, Y., Amsalem, D., Groweiss, Y., Blank, C., Kohavi, H., & Neria, Y. (2026). Two years into an ongoing war: A six-wave prospective study of PTSD, depression, anxiety, and posttraumatic growth following the October 7, 2023, attack in Israel. eClinicalMedicine, 96, 104027. https://doi.org/10.1016/j.eclinm.2026.104027
Levi-Belz, Y., Groweiss, Y., Blank, C., & Neria, Y. (2024). PTSD, depression, and anxiety after the October 7, 2023 attack in Israel: A nationwide prospective study. eClinicalMedicine, 68, 102418. https://doi.org/10.1016/j.eclinm.2023.102418
Levin, Y., Shmulewitz, D., Skvirsky, V., Vider, M., Kor, A., Lev-Ran, S., & Mikulincer, M. (2026). Longitudinal PTSD trajectories before and after the October 7, 2023, terror attacks: A nationwide study of Israeli adults. European Psychiatry, 69(1), e13. https://doi.org/10.1192/j.eurpsy.2025.10130
Silver, L. (2026, April 7). Negative views of Israel, Netanyahu continue to rise among Americans, especially young people. Pew Research Center. https://www.pewresearch.org/short-reads/2026/04/07/negative-views-of-israel-netanyahu-continue-to-rise-among-americans-especially-young-people/
Silver, L., & Clancy, L. (2026, June 4). Most people across 36 countries have negative views of Israel and little confidence in Netanyahu. Pew Research Center. https://www.pewresearch.org/short-reads/2026/06/04/most-people-across-36-countries-have-negative-views-of-israel-and-little-confidence-in-netanyahu/