The Moderating Role of Demoralization on the Association Between Exposure to War and Posttraumatic Stress Symptoms Among Israeli Civilians in Reaction to the October 7 War: A Longitudinal Study

Background: During wartime, many people experience distress, uncertainty, helplessness and a lack of control. These negative feelings are at the root of demoralization symptoms. Objectives: The present prospective study examined the impact of exposure to war and demoralization symptoms on PTSS 6 months later. Methods: Participants were 338 Israeli citizens with indirect war exposure. Participants answered questionnaires on exposure to war, demoralization and PTSS at two time points (4 weeks and 6 months after the onset of the October 7 war). Results: The study revealed that higher exposure to war (Time 1) was associated with higher levels of demoralization symptoms (Time 1) and PTSS (Time 2). Moreover, the moderation analysis indicated that the impact of exposure to war on PTSS was significant only for medium (b = 4.279, SE = 1.33, p < 0.001) and high (b = 8.304, SE = 1.88, p < 0.001) levels of demoralization. Conclusion: Demoralization symptoms and PTSS are likely to occur during wartime. However, war exposure alone does not explain PTSS; it is contingent on demoralization levels. Demoralization shortly following the outbreak of war appears to be a predictor of PTSS. This finding suggests that screening for demoralization with a brief simple questionnaire might be a useful clinical tool to identify individuals in the short term who may have increased risk of PTSD in the long term.