Mental health of adolescents during times of war

War-related prolonged stress is associated with poorer adolescent mental health. This cross-sectional study aimed to characterize the mental health of adolescents in Israel during an ongoing war situation and to examine how emotional, cognitive, and occupational factors were associated with their mental health during this period.

Data from 973 Israeli adolescents (ages 13-18, 65.8% female) were collected remotely eight months after the October 7th, 2023, attack and the subsequent war. Participants completed validated self-report questionnaires assessing their mental health, dispositional resilience, subjective executive functions (EFs), sense of coherence, and war-related changes in their daily-life participation.

Overall, 40.2% of adolescents scored within the abnormal range for mental health symptoms, exceeding the expected normative 10%. Female and older participants reported worse emotional status. Adolescents reported reduced participation across all occupational domains, with notable individual variability. A regression model explained over 50% of the variance in mental health scores, with greater executive dysfunction and lower resilience showing the strongest associations with poorer mental health. Decision tree analysis indicated that adolescents with better inhibitory control and more stable participation were more likely to report better mental health. Among adolescents with EF difficulties, lower arousal symptoms were associated with better mental health.

These findings indicate a substantial and concerning mental health burden among adolescents living under prolonged war-related stress and highlight individual differences linked to internal resources and participation. EFs, patterns of daily-life participation, and arousal symptoms were associated with adolescents' capacity to cope with war-related stress. Addressing them as potential intervention targets may help mitigate the long-term negative consequences of prolonged conflict-related stress.