A year into the war: Longitudinal effects of trauma, displacement, and income loss on mental health in conflict zones

Background: Research has linked war-related stressors like traumatic loss, forced displacement, and income disruption to acute mental health symptoms. Little is known about how symptoms evolve longitudinally during prolonged conflict. Extending our 90-day studies, we tracked clinical symptoms and betrayal-based moral injury over one full year following the October 7, 2023, attack and ensuing war in Israel. We hypothesized stressor-exposed individuals would report persistent psychological distress and heightened betrayal perceptions one year later. Methods: A four-wave longitudinal study followed 1,052 individuals aged 18–40 living in northern and southern Israel, areas heavily affected by October 7 and the ongoing war. Assessments occurred in February, March, and May 2024 and March 2025. Anxiety, depression, and Post-Traumatic Stress Disorder (PTSD) symptoms The Generalized Anxiety Disorder 7-item scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Primary Care PTSD (PC-PTSD) measured. The Moral Injury Events betrayal subscale assessed betrayal-based moral injury. Linear Mixed Models examined symptom trajectories and associations with baseline war-related traumatic loss, forced displacement, and income loss. Results: At baseline, 75 % of participants reported ≥1 probable clinical condition. Symptoms remained high after 12 months (66 %). Baseline exposure to traumatic loss, displacement, or income loss correlated with significantly higher anxiety, depression, PTSD, and betrayal scores across timepoints (F values 14.4-243.9, p<.001). Depression symptoms remained steady over time, whereas betrayal scores significantly increased. Conclusions: This one-year longitudinal study found initial traumatic stressors predicted persistently elevated anxiety, depression, PTSD, and betrayal-based moral injury. Findings highlight the lasting psychological impact of cumulative war-related adversity and call for innovative, sustained treatment strategies that address both acute and evolving effects of prolonged conflict.