Coping efficacy as a mediator between combat exposure events and probable PTSD

Combat exposure significantly increases the risk of PTSD and psychological distress among military personnel. PTSD is often associated with poorer coping with personal and interpersonal demands. This cross-sectional study examined whether functional coping efficacy mediates the relationship between combat exposure and psychological outcomes among 1076 Israeli reserve soldiers (96.5% male, mean age 30.7 years) referred to a military Combat Stress Reaction Unit for evaluation and treatment during the war following the October 7th attack. Participants completed assessments measuring combat exposure; a brief Coping Efficacy Scale evaluated task performance, emotional control, interpersonal relationships and self-worth. The PTSD Checklist for DSM-5 (PCL-5) quantified PTSD severity and inferred probable PTSD status (PCL score ≥33), and the Brief Symptoms Inventory (BSI) evaluated psychological distress (BSI score ≥40). Mediation analyses examined direct and indirect statistical pathways between combat exposure and clinical outcomes. Combat exposure showed weak correlations with symptoms severity (r = 0.11, p < .001), whereas coping efficacy domains demonstrated strong negative associations with PTSD and general psychological distress (r = -0.33 to-0.60, all p < .001). Indirect association models indicated task performance and self-worth were significantly linked to the relationship between combat exposure and PTSD symptoms (indirect effects: β = 0.03, p < .001 for both). For general psychological distress, only task performance showed significant indirect association (β = 0.04, p < .001). These findings highlight functional coping domains, particularly task performance and self-worth, as strongly associated with psychological outcomes following combat exposure and underscore their potential clinical relevance in early assessment and intervention planning.