Nation under pressure: examining widespread trauma exposure and resilience in Israel

Background: The 7 October 2023, terrorist attacks and the ensuing war led to widespread trauma exposure across Israel. This unprecedented event created a mass collective trauma, impacting millions through direct stressors like rocket fire and indirect exposure via graphic media. This study provides a novel, population-wide analysis of trauma exposure, distress symptoms, and resilience across individual, community, and national levels, during a period of prolonged conflict.Objective: To examine and characterise the circles of trauma exposure among the Israeli civilian population in relation to sociodemographic background, distress levels, and multilevel resilience indices following one year of prolonged war.Method: A national online survey (N = 1,927) was administered one year into the conflict. K-means clustering was used to identify differentiated groups based on mental health and resilience measures, further characterised by sociodemographic factors and trauma exposure.Results: Findings revealed distinct cluster profiles with differing patterns of distress and multi-level resilience. The most vulnerable cluster included more women, young adults, and low-income individuals and showed high distress alongside low resilience, whereas the most resilient profile was characterised by older age, higher income, and higher resilience alongside lower distress. Additional clusters reflected mixed patterns, including moderate distress with relatively elevated resilience. Overall, the results indicate that while trauma exposure is associated with distress levels, multi-level resilience indices can co-occur with varying levels of distress across profiles.Conclusions: Our study mapped multilevel resilience levels during an ongoing conflict and traumatic stress exposure, using k-means clustering approach, highlighting the interplay between personal, communal, and national factors in relation to mental health outcomes. Our findings underscore the importance of addressing resilience holistically, incorporating personal coping resources, social networks, and trust in public institutions, and further offers an updated perspective on the mutual influence between different levels of resilience.