Background
The Israel-Hamas war and the extensive personal and national trauma it entailed greatly increased the need for mental health treatment. To adapt services and the types and scope of interventions to the needs of the population, it was necessary to assess the extent of distress over time, identify populations at risk, and map treatment seeking patterns.
Objectives
- Estimate the proportion of people with symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) and the extent of impairment in daily functioning over time since the outbreak of the war on October 7, 2023.
- Identify factors associated with these symptoms and impairment in functioning.
- Identify patterns of seeking and receiving treatment among different population groups.
Methods
An ongoing online self-administered survey has been conducted in a representative sample of Israel’s adult population. To date, it has been conducted at five time points: December 2023-January 2024 (n = 2,686); April-May 2024 (n = 1,746 returning respondents); September-October 2024 (n = 1,766 returning respondents); July 2025 (n = 2,713, including 1,282 returning respondents); and May 2026 (n = 1,524 returning respondents).
The survey included validated instruments to identify symptoms of PTSD (PCL-5), depression (PHQ-9), and anxiety (GAD-7), and, beginning at the third time point, also impairment in daily functioning (WSAS). Also included were questions about exposure to war-related events, mental health history, and patterns of seeking and receiving treatment. To ensure representativeness, the survey data were weighted according to relevant population characteristics.
Findings
At the first time point (December 2023-January 2024), 41% of respondents met the clinical threshold for depression, anxiety, or PTSD. By the second time point (April-May 2024), this rate decreased significantly and then remained relatively stable across the following three time points. At the fifth time point (May 2026), 32% of respondents still met at least one clinical threshold. About half of those who met a clinical threshold at the first time point remained above it by the fifth time point. Severe impairment in daily functioning was measured from the third time point (September-October 2024), and its prevalence remained fairly stable across the three time points in which it was assessed (19%-22%).
Throughout the study, differences were observed among population groups in rates of distress and impairment in daily functioning, with higher rates found among women, younger adults, and Arabs. At the fifth time point (May 2026), after adjustment for other variables, the likelihood of exceeding a clinical threshold was especially high among people with a previous mental health diagnosis and among those who perceived their ability to cope with the situation as low. Increased likelihood was also found among Arabs, people who had experienced trauma previously, and those who had been directly or indirectly exposed to war-related events. Similar factors were associated with the combination of meeting a clinical threshold and severe functional impairment.
At all time points, about two-thirds of respondents reported that they did not feel a need for mental health treatment. Among those who did feel such a need, only about half sought it. The proportion of respondents who sought treatment but did not receive it was low at all time points (2%-4%).
At the fifth time point (May 2026), the main reasons for not seeking treatment among those who felt a need for it were personal barriers, such as lack of time, other commitments, or embarrassment about seeking treatment (28%); accessibility barriers, including treatment cost, waiting times, and distance from home (27%); a desire to cope on their own (23%); and lack of interest in existing treatment options (17%).
Perceived need for treatment and receipt of treatment were more common among respondents who reported severe functional impairment: 28% of them received treatment (compared with 14% in the full sample), and 41% felt a need for treatment but did not seek it (17% in the full sample). Among those who felt a need for treatment but did not seek it, accessibility barriers were more common among respondents reporting severe functional impairment than among those who did not (34% and 20%, respectively).
Conclusions and Recommendations
The findings to date point to widespread and persistent psychological distress in the Israeli adult population, which, in a substantial proportion of cases, is also reflected in impaired daily functioning. At the same time, a persistent gap was found between perceived need for treatment and seeking treatment. This gap stems from a combination of personal barriers, accessibility barriers, a desire to cope independently, and lack of interest in existing treatment options. The findings indicate that differences in distress and service use are associated with a range of demographic, personal, and contextual factors, and that different combinations of these factors may be associated with different needs and service use patterns.
The findings support the initiative led by Israel’s health plans and the Ministry of Health to expand mental health services and diversify the services offered to patients. When planning services and defining target groups, it is important to consider the combination of characteristics associated with the development of symptoms, perceived need for treatment, and patterns of seeking treatment, so that services can be tailored to different needs and preferences and offer alternatives for people not interested in existing treatments. These efforts should be accompanied by continued action to reduce accessibility barriers.
Related Publications (Hebrew)
- Mental Health During the Israel-Hamas War: An Ongoing National Survey: Findings from five Time Points
- Mental Health During the Israel-Hamas War: An Ongoing National Survey of the Adult Population in Israel: Findings from Four Time Points
- Mental Health During the Israel-Hamas War: An Ongoing National Survey: Findings from Three Time Points
Posters (Hebrew)
- A Generation on the Edge: Effects of the Israel-Hamas War on the Mental Health of Young Adults in Israel
- Mental Health During the War: Patterns of Seeking and Receiving Treatment
- Disparities Between Jews and Arabs in Mental Health
- An Improving Trend? Mental Health Among the General Population in Israel During the Israel-Hamas War: Findings from an Ongoing National Survey
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