For several years, both before and during the Israel-Hamas War, a research team from Tel Aviv University monitored the prevalence of post-traumatic symptoms among combat soldiers during active service and after discharge. The researchers found that the war has intensified psychological distress, and the number of respondents reporting significant post-traumatic stress symptoms rose to 12%.
Recent reports indicate burnout among IDF reservists, some of whom have served in multiple combat rounds for extended periods of time. While reserve duty turnout exceeded 100% at the beginning of the war, current reports show a decline to 75% to 85%.
Several reasons have been suggested for this drop, such as harm to reservists’ employment and livelihood; negative impact on their families and social lives; anger over inequality in the burden of service, with a very small part of the population called up repeatedly; and a general decline in motivation as the unusually long war goes on.
Another significant factor is the deterioration in mental resilience of soldiers exposed to traumatic combat experiences, especially those who have developed considerable post-traumatic symptoms following reserve duty during the Israel-Hamas War.
The TAU study, which has examined the prevalence of post-traumatic symptoms among combat soldiers for several years, was presented at TAU’s recent Future of Israel Conference sponsored by the Kadar Foundation. The researchers used a Hebrew version of a questionnaire that is considered the gold standard for self-reporting such symptoms, with respondents self-rating the severity of their symptoms.
The results of this questionnaire provide only an estimation of the respondent’s condition and cannot replace a formal diagnosis of post-traumatic stress disorder (PTSD) that is made through a structured clinical interview.
But at the same time, numerous studies – both in Israel and abroad – indicate a strong correlation of 0.70 to 0.85 between the results of self-report screening tools and clinical interview outcomes.
This means that individuals reporting severe symptoms in the questionnaire tend to receive high scores in structured clinical interviews as well.
The study was led by neuroscience and psychology Prof. Yair Bar-Haim, head of TAU’s National Center for Traumatic Stress and Resilience. It will be published in a peer-reviewed medical journal.
The researchers followed 579 soldiers drafted into one of the IDF’s infantry brigades in March 2019, four and a half years before October 7, 2023, when Hamas terrorists attacked southern Israel, murdered, and hijacked many.
Bar-Haim told The Jerusalem Post that post-traumatic symptoms were measured among IDF soldiers during the Yom Kippur War almost 52 years ago and American soldiers in Vietnam, Afghanistan, and other locations; even though some wars were short and others long, the rates were similar in all of them.
However, the field was younger decades ago, so many soldiers may have suffered from it but not been diagnosed.
FOR THE new study, participants filled out the symptom questionnaire at five points in time – enlistment, after 15 months of service, after 27 months of service, six months after honorary discharge, and 18 months post-discharge (several months into the Israel-Hamas War).
Findings indicate that as service progressed, the percentage of soldiers reporting multiple symptoms at clinically significant levels increased (according to the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, the standard classification of mental disorders used by mental health professionals in the US and most of the world.)
At the first data collection point, when the subjects enlisted, less than 0.5% of recruits suffered from pre-existing PTSD. After about 18 months in the army – six months of combat training plus nine months of active deployment – the figure rose to 2.6%.
Toward the end of the regular military service, after several additional combat deployments, it reached 4.4%. Six months post-discharge, despite the hope that the severity of symptoms would be reduced after leaving the army, the rate rose again, with nearly eight percent reporting clinical levels of PTSD symptoms.
In fact, these data reflect a relatively quiet period, with no war or substantial military operation in Israel.
The fifth data collection point occurred several months into the Israel-Hamas War. About 85% of the study’s participants had been called up for reserve duty and took part in the war.
As expected, the war worsened psychological problems, and the number of respondents reporting significant post-traumatic stress symptoms rose to about 12%.
“These data reflect one draft round of one IDF infantry brigade – such as the paratroopers, Golani, or Givati – recruited in 2019 and discharged in 2022. During these soldiers’ regular service, Israel was not involved in a war or special military operation, so these figures reflect PTSD symptom severity among IDF combat soldiers during routine activity, mainly in the West Bank,” wrote the researchers.
“While the increase in symptoms during regular service could be seen as moderate, the study points to a sharp rise in self-reported clinical PTSD symptoms after discharge. The cause of this rise is unknown, but it stands to reason that the social support and sense of belonging provided by the military environment diminishes considerably once the soldiers are discharged and return to their individual lives.
“The Israel-Hamas War generated an additional rise, with about 12% of the original sample reporting clinically significant PTSD symptoms. Far from surprising, these figures are consistent with what is known about post-traumatic symptoms following high-intensity warfare in both the IDF and other armies.
Israel's mental health system is 'in a state of emergency'
“The data also contribute to the understanding that Israel’s mental health system is in a state of emergency. Decision-makers must act urgently to devise long-term solutions for treating a large number of veterans with PTSD.”
The researchers stressed that “ these solutions must look beyond the horizon, at least two or three decades ahead. They should include accelerated and high-quality training of therapists, along with the establishment of strong regional clinics specializing in trauma therapy for veterans.”
The team didn’t examine women who served in Gaza, as it focused on male-only units, but Bar-Haim said he would be glad to study them, as well as relatives of hostages and of those murdered on October 7, who surely suffer from a high rate of PTSD.
The Central Bureau of Statistics launched a survey this month examining the impact of reserve duty on family members.
As for the Defense Ministry’s rehabilitation department, Bar-Haim said, “it has serious problems. There are good people who want to help, but if there is one case manager for 1,000 veterans. They can’t help as much as needed, so there is outsourcing, which is less effective.”
He concluded that “the study’s findings are compatible with the large numbers of discharged combat soldiers seeking assistance and recognition from the Defense Ministry’s rehabilitation department. The data may also partially explain the current decline in reservist turnout rates.
“Reservists suffering from multiple symptoms are often unable to report for additional service. Even though the IDF is taking many steps to prevent and treat PTSD, the portrayed situation places an immense burden on the military, the Defense Ministry, the rehabilitation department, and Israeli society as a whole. The greatest pressure of all falls on the veterans and their families.”