Introduction

Globally, people face a range of threats emanating from various adverse events, including natural catastrophes, disease outbreaks, and man-made crises. Such events have the potential to erode the resilience and overall well-being of individuals, as well as the communal and societal structures that support them1. Different populations may exhibit varying responses to these events, with each type of adversity eliciting a unique pattern of distress, resilience, and well-being. There are instances when several adverse events unfold simultaneously, such as natural disasters and armed conflicts occurring in tandem with the COVID-19 pandemic2,3,4. Moreover, the way societies react to similar crises can differ significantly, shaped by their distinct social and cultural fabric and historical experiences5.

Scholarly research has shed light on a spectrum of factors that shape the level of distress individuals may endure. Elements that serve as buffers, such as robust social support networks6,7, effective coping mechanisms7, and a strong sense of self-efficacy8, have been shown to alleviate the adverse effects of stressors. On the other hand, certain risk factors, heightened levels of perceived danger9, as well as existing mental health issues10 and a scarcity of communal resources11, have been linked to an escalation of distress symptoms. The literature points to demographic patterns of distress, noting that those with lower socioeconomic status, women, individuals with less education, those who are unmarried and are secular are more likely to report elevated distress levels during various adversities12. Additionally, evidence suggests that human-induced disasters, like conflicts and terrorism, typically result in poorer mental health outcomes than natural disasters13,14. The intricate social consequences inherent in man-made crises add complexity to the healing process and can deepen the experience of distress. In contrast, natural disasters, despite significant potential for considerable damage to livelihoods and property, frequently invoke a collective response from the community. They are often seen as beyond human control, thereby influencing perceptions of distress differently. Yet, the impact of any disaster is heavily influenced by the event’s particular context, the resources available for recovery, and the cultural milieu of the impacted community. The duration of the adversity is also a critical factor—with extended adversities leading to fatigue over time, and new, unprecedented challenges causing increased distress as individuals and communities struggle to adapt to unfamiliar contexts15,16.

Since its creation in 1948, the state of Israel has faced a persistent state of conflict. It is acknowledged that Israeli society is persistently exposed to a multitude of risks and challenges, including geopolitical tensions, controversies over borders and settlements, and regional security threats17. The public in Israel is typically acquainted with transient armed conflicts. Over the last two and a half years, the nation has contended with significant socio-political challenges that extend beyond military action and warfare. Like all nations, Israel has also been impacted by nature-driven adverse events, including the global health crisis of COVID-19, which has introduced additional complexities into the already challenging societal fabric of Israel18.

On October 7, 2023, Hamas, an entity recognized as a terrorist organization by various nations and located in the Gaza Strip, launched a significant and coordinated attack against southern and central Israel. This assault commenced with extensive rocket fire targeting civilian populations, in conjunction with incursion efforts near the Gaza border. This aggressive action led to fierce engagements involving Israeli civilians, law enforcement, and the Israel Defense Forces. The repercussions of this assault have been considerable and continue to evolve. Recent reports suggest that over 1400 Israelis have lost their lives and approximately 5600 have been wounded, marking this as one of the deadliest terrorist attacks in recent history19. In addition, a reported 240 people, including 30 children, were captured by the faction and taken to Gaza. This event has profoundly impacted the nation, resulting in widespread mourning and uncertainty regarding the response.

During the ongoing conflict, civilians in various areas were instructed to remain within or close to fortified structures. The intensification of hostilities near Gaza and Lebanon’s borders led to the internal displacement of around 200,000 individuals by the third week of the conflict, as noted by recent documentation by Peleg and Gendelman19 and Times of Israel20. This turmoil has diminished the sense of personal safety among evacuees, reducing their confidence in the State’s protective measures and security forces. Thus, homes that were once sanctuaries have been stripped of their sense of security. Nevertheless, the prevailing attitude among the populace, shaped by previous conflict experiences, has been a significant trust in the defensive capabilities of the Iron Dome missile defense system as noted by Lahav et al.21.

Prior to the outbreak of hostilities on October 7, 2023, Israeli society was already experiencing considerable social, political, and legal unrest. The new coalition government, which took office on December 29, 2022, placed judicial reforms at the forefront, initiating a contentious legal revision. Their proposed changes aimed to limit the Supreme Court’s powers and modify the process for judicial appointments, eliciting strong objections from the opposition. This era witnessed a rise in public protest, with large demonstrations in major cities opposing what they viewed as an infringement on liberal democracy22. The internal strife concerning these legal reforms, set the backdrop for a society navigating deep divisions concerning governance and justice issues as the conflict intensified in October 202323.

In the lead-up to the most recent Israeli elections and the associated socio-political upheaval, the COVID-19 pandemic underscored the extensive impact that an emerging infectious disease can impose on all aspects of society worldwide, including Israel24. The pandemic significantly affected global communities by impacting health, economic, social, and political systems, leading to widespread morbidity and mortality25. In 2021, concurrent with the pandemic, there was a notable rise in violence. During this time, the Israel Defense Forces launched Operation ‘Guardian of the Walls’ in retaliation to rocket attacks from Hamas in Gaza. The fierce conflict resulted in significant destruction and loss of life on both sides, culminating in an 11-day battle that ended with an Egypt-brokered ceasefire.

All these adversities have impacted the population on both individual and societal levels. The primary objective of the current research was to perform a comprehensive evaluation over 2.5 years to examine the impact of various determinants, including demographic factors, levels of resilience and coping strategies, on the distress experienced by societies and individuals in the face of diverse threats. The study aimed to identify key protective and risk factors that are consistently associated with the general public’s levels of distress in adverse conditions. This investigation was designed to dissect the levels of distress across a spectrum of adversities, such as pandemics, military conflicts, and socio-political unrest. By examining these associations, the research targets to illuminate the foundational frameworks of distress and offer evidence-based recommendations for policymaking and the creation of interventions aimed at strengthening these critical societal and individual capacities.

Methods

Data collection

The research utilized a quasi-longitudinal framework, with data gathered at thirteen separate intervals to track changes over time. While data points were collected separately from an ongoing longitudinal cohort during specific adversities, new samples were introduced at additional intervals when a new adversity arose (Covid-19, socio-political unrest, Israel-Gaza war). Each sample mirrored the demographic makeup of the Israeli Jewish adult population, as reflected in the National Statistics Bureau’s figures. A minimum sample size for the Israeli general public was calculated using openEPI software. Proportional sampling was employed based on the population size, using a 95% confidence level. The required minimum sample size in Israel was determined to be 385 respondents per measurement. Each time point measurement exceeded this minimum sample size. A web-based panel provider was in charge of disseminating the survey, ensuring that the demographic makeup in terms of gender, age, and regional spread was maintained. This method of sampling was applied uniformly at all thirteen data collection points.

In response to a series of crises, including a global pandemic, a brief military confrontation, notable socio-political shifts, and an extensive war, this study aimed to gauge the dynamic distress levels across Israel’s populace. Each data collection point provided insight into societal distress levels and their determinants. The research periods are outlined below, with corresponding dates and contextual events: Data for the following timepoints has been retrieved from: COVID-19- Bhatia et al.26; Military operation-Israel Defense Forces27; Israeli Socio-political strife-Israel UJS Portal28; Israel-Gaza War- Reuters29.

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    May 2020: Corona Measurement 1. In May 2020, Israel was actively addressing the early stages of the COVID-19 pandemic. Measures such as an initial lockdown in April, stringent travel limitations, and adherence to physical distancing protocols were enforced. Citizens were required to stay within 100 m of their residences, and from April 12, wearing masks became mandatory in public spaces. The escalating case numbers raised alarms about the healthcare system’s ability to manage the crisis. Nevertheless, the lockdown was lifted on May 4, leading to a cautious relaxation of curbs on educational institutions, transport, commerce, and hospitality sectors. As May progressed, the infection rate declined, prompting the shutdown of COVID-19 wards in hospitals and prompting a sense of optimism among the population. A total of 804 individuals were included in this assessment phase.

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    July 2020: Corona Measurement 2. In July 2020, Israel witnessed a resurgence of COVID-19 infections, necessitating the reinstatement of certain preventative measures previously relaxed. The government enforced targeted lockdowns to quell outbreaks in specific locales, sparking debates over the efficacy of these interventions. The mood among Israelis had shifted; they were now grappling with frustration, growing skepticism, and diminishing trust in their leadership and health authorities. The data collection for this period included 804 participants.

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    October 2020: Corona Measurement 3. By the time October 2020 arrived, Israel found itself grappling with a second surge in COVID-19 cases. To curb the spread, the government reinstated a country-wide lockdown in September, marking the second such measure in a span of seven months. Economic concerns mounted as the restrictions continued, and the health system faced significant pressure with hospitals nearing full capacity. In response, the Health Ministry developed a comprehensive nine-phase plan for a gradual exit from the lockdown, which commenced on October 18. A total of 804 individuals were surveyed during this assessment period.

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    January 2021: Corona Measurement 4. As of January 2021, Israel was contending with its third wave of COVID-19 infections. Amid this, the government initiated an extensive vaccination drive, fostering a guarded hope that vaccination efforts would mitigate the pandemic’s impact. Nonetheless, the threat posed by emerging virus variants led to the implementation of an additional, more stringent lockdown on January 8, following an earlier, less restrictive closure that commenced on December 27, which had kept educational institutions open. This survey phase collected data from 701 participants.

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    May 2021: Operation “Guardian of Walls”/Corona measurement 5. In May 2021, Israel conducted a military initiative in Gaza named “Operation Guardian of the Walls” as a countermeasure to the escalation in rocket fire from Gaza into Israeli territory. This conflict resulted in numerous casualties and extensive damage within Gaza. International calls for de-escalation led to diplomatic efforts to secure a ceasefire, which was achieved following 11 days of hostilities. During this period, the number of participants surveyed was 595.

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    October 2021: Corona measurement 6. During October 2021, Israel faced a fourth wave of the COVID-19 pandemic. In response, the government rolled out a ‘Green Pass’ policy, mandating proof of vaccination or a recent negative test for entry into certain public spaces. This period was marked by active discussions regarding the efficacy of these health measures and their economic implications. Data for this period was collected from a sample of 2002 individuals.

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    February 2022: Corona measurement 7. In February 2022, Israel found itself facing a fifth wave of COVID-19 cases. The authorities reintroduced a suite of containment strategies, some of which reinstated earlier relaxed restrictions. Public discourse was rife with analysis on the adequacy of these interventions and their repercussions on the economic landscape. This survey period involved a cohort of 600 individuals.

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    October 2022: Prior to the November 2022 Elections, Israel contended with an intricate political scenario. A string of inconclusive electoral outcomes had led to extended political flux, raising questions about the government’s capacity to tackle critical issues such as economic stability, security, and the ongoing COVID-19 health crisis. The upcoming elections were anticipated as a pivotal moment to resolve the stalemate and establish a robust administration capable of effective governance. A total of 785 individuals were sampled for this analysis.

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    February 2023: Following the November 2022 elections, by February 2023, Israel witnessed considerable public outcry against judicial changes proposed by the incumbent right-wing government. Massive crowds converged in Jerusalem, especially around the parliament, decrying the initial legislative proposal that aimed to alter the judicial appointment process. Accusations of governmental overreach and fears that such reforms could undermine democratic principles and centralize power with the prime minister were rampant among the demonstrators. These rallies were a continuation of protests that began in early January, consistently attracting large numbers. The data for this event was gathered from 785 participants.

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    August 2023: Subsequent to the November 2022 elections, by August 2023, Israel saw the continuation of substantial protests sparked by the government’s proposed extensive judicial reforms. These demonstrations, which began in January, were primarily against attempts to curtail the authority of the Supreme Court. Week after week, tens of thousands of citizens consistently protested nationwide, culminating in the 39th week with a massive procession to Jerusalem. This peak coincided with the legislative progression of a major reform bill in the parliament, which was passed. The survey conducted in this context involved 785 individuals.

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    October 2023: In the immediate aftermath of the October 7 attacks attributed to Hamas, Israel found itself in a severe security emergency. The nation witnessed an intensified outbreak of hostilities, including numerous rocket firings from the Gaza Strip into Israeli territory. In retaliation, the Israeli government proclaimed a state of war against Hamas and embarked on a military offensive aimed at halting the aggression, a conflict that resulted in numerous fatalities on both sides. Amidst concerns for civilian safety, there were concerted diplomatic efforts to establish a ceasefire. The data collected during this period reflected responses from 2002 individuals.

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    November 2023: Six weeks into the Israel-Gaza war, Israel was deeply engaged in an intense military confrontation. A significant military campaign had been initiated in the Gaza region as a counteraction to the surge in rocket launches into Israeli areas. The hostilities had resulted in extensive damage and numerous casualties among both the Israeli and Gazan populations. Amidst these conditions, there were significant worries about the ramifications for civilian life, alongside active attempts to negotiate a ceasefire. Furthermore, the northern border of Israel with Lebanon is a site of hostilities where the Israeli Defense Forces and Hezbollah engage in reciprocal exchange of fire.The number of participants surveyed during this interval was 1613.

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    January 2024: As of January 14, the Israel-Gaza war had surpassed 100 days. The six weeks leading up to this date were characterized by sustained Israeli military operations in Gaza with rise in Israeli troop casualties. In the course of these operations, there was also a tragic incident where Israeli forces inadvertently killed three hostages. On the first day of 2024, Israel indicated intentions to commence a partial troop withdrawal from Gaza, transitioning to a more strategic phase of its military efforts, expected to continue for an extended period. Additionally, on January 11, 2024, the International Court of Justice began preliminary hearings in a case where South Africa has leveled charges against Israel, alleging the perpetration of state-sponsored genocide against Palestinians, a claim Israel has rejected. The number of participants was 1360.

The Tel Aviv University Ethics Committee granted ethical approvals (approval numbers: 0001150-1 from April 7, 2020, 0,001150-2 from May 13, 2021, 0,001150-3 from June 8, 2022, 0005985-1 from January 16, 2023, 0005985-2 from December 3, 2023). Informed consent was secured from all participants before their participation. All methods were performed in accordance with the relevant guidelines and regulations.

Measurements

All scales utilized in the study are based on validated tools throughout varied contexts and adversities (See: Kimhi et al.30; Ballada et al.5; Kaim et al.31; Kimhi et al.32). For the purpose of the current study, only measures that were collected across all thirteen time points were included in this study. The items of each index were computed into a composite index score by averaging the respective items.

Distress symptoms

To assess symptoms of psychological distress, a scale comprising eight questions was employed, deliberately omitting the query regarding suicidal ideation for ethical considerations. This tool, modified from the work by Derogatis & Kathryn33, provided participants with a spectrum to evaluate various emotional states—with each item assessing nervousness, loneliness, mood disturbances, interest levels, hopelessness, tension, restlessness, and feelings of worthlessness from 1 (not at all) to 5 (extremely). Cronbach Alpha throughout the 13 measurements ranged from 0.889 to 0.918.

Societal resilience

The measure of societal resilience was based on a sixteen-item scale by Kimhi et al.16. Participants expressed their level of agreement ranging from 1 (strongly disagree) to 6 (strongly agree), evaluating their confidence in key societal structures. This included their trust in government decision-making processes, support from leaders in times of crisis, reliance on security forces, sense of national pride, hopefulness for the country’s future, and faith in national institutions like the police, parliament, media, and military. Cronbach Alpha throughout the 13 measurements ranged from 0.849 to 0.913.

Individual resilience

Individual resilience was assessed using the Connor-Davidson Resilience Scale, as modified by Campbell-Sills in 200734. The scope of the scale employed varied at different times, alternating between a succinct two-item version and a more extensive ten-item version. Respondents gauged their level of accord with statements such as “I am able to adjust to changes,” using a scale ranging from 1 (completely disagree) to 5 (strongly agree). Cronbach Alpha throughout the 13 measurements ranged from 0.792 to 0.911.

Hope

The hope scale, originally developed by Jarymowicz & Bar-Tal35 to assess hope for peace in the Middle East, was adapted to measure hope for personal and collective post-crisis recovery. It includes five items rated from 1 (very little hope) to 5 (high hope). An example of an item includes, “I have hope that I will emerge strengthened from the crisis”. Cronbach Alpha throughout the 13 measurements ranged from 0.911 to 0.939.

Morale

Morale is evaluated through a single-question measure asking participants to rate their current state of spirits, with the scale options extending from 1, signifying ‘very poor,’ to 5, indicating ‘very good.’

Sense of danger

The scale, an adaptation of Solomon and Prager’s 1992 model, consists of five items that assess emotional states, ranging from 1 (not at all) to 5 (very much), reflecting on the past two weeks 36. A sample item from the scale asks respondents, “To what extent do you feel that your life is in danger due to the current situation (War, conflict, pandemic, etc.)?” Cronbach Alpha throughout the 13 measurements ranged from 0.718 to 0.858.

Demographics

The demographic data collected consistently across all time points included age, gender (1 = Male, 2 = Female), religiosity (1 = Secular, 2 = Traditional, 3 = Religious, 4 = Ultra-orthodox), income (1 = Much lower than the average, 2 = Lower than the average, 3 = Average, 4 = Higher than the average, 5 = Much higher than the average), education (1 = Elementary school, 2 = High school, 3 = Beyond high school (not a college diploma), 4 = Bachelor’s degree, 5 = Master’s degree and above), and marital status (1 = Single, 2 = Married, 3 = Divorced, 4 = Widower, 5 = In a relationship).

Statistical analysis

The analysis employed descriptive statistical methods like frequency, mean, and standard deviation to characterize the variations in distress levels at the thirteen different points of data collection. To detect significant shifts in average distress levels across these points, a one-way between- subjects ANOVA followed by Bonferroni post-hoc tests was applied. Additionally, Spearman rho correlation was calculated to explore the relationships between distress and other measured variables across all thirteen data points.

Associative factors for distress levels were also examined. Stepwise regression analyses were carried out to understand the impact of different variables assessed at each of the thirteen time points. Variables included in the regression models were demographic factors (such as gender, age, religiosity, income, education, and marital status), individual resilience, societal resilience, hope, morale and danger. These statistical tests were conducted using the SPSS software, version 29, and the threshold for statistical significance was established at p < 0.05.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation.

Results

The research delineates the dynamic trajectory of distress levels over two and a half years, shaped by multiple adversities, as depicted in Fig. 1. It reveals that distress levels fluctuate markedly in response to significant events. Notably, distress peaked during the latter stages of the study, particularly after the October 7th incident and throughout the Israel-Gaza conflict’s three assessments, where changes were highly significant (p < 0.001). A subsequent notable trend was the significant reduction in distress levels recorded across the conflict’s three subsequent assessments. A one-way ANOVA was performed to compare the effect of time on distress levels which revealed statistically significant differences (F(12, 12,677) = [41.955], p < 0.001). To further delineate temporal changes, we analyzed differences between consecutive assessments, marking significant changes with an asterisk. Notable significant changes were detected with Bonferroni post-hoc test between the following pairs of assessments: 7 and 8 (p < 0.05); 10 and 11 (p < 0.001); 11 and 12 (p < 0.001); and 12 and 13 (p < 0.01). Please see Appendix 1 for further information on the mean and standard deviation of all the additional measured indexes.

Figure 1
figure 1

Levels of distress across 13 time points. Significance according to Bonferroni post-hoc test (*). Note: * Indicates significant difference between the two measurements according to Bonferroni post-hoc test (p<0.05).Time point measurement 1 refers to- May, 2020 (Corona measurement 1); Time point measurement 2 refers to July, 2020 (Corona measurement 2); Time point measurement 3 refers to July, 2020 (Corona measurement 3); Time point measurement 4 refers to January, 2021 (Corona measurement 4); Time point measurement 5 refers to May, 2021 (Operation "Guardian of Walls"/Corona measurement 5); Time point measurement 6 refers to October, 2021 (Corona measurement 6); Time point measurement 7 refers to February, 2022 (Corona measurement 7); Time point measurement 8 refers to October, 2022 (Before Prime Minister/ Cabinet Elections); Time point measurement 9 refers to February, 2023 (Immediately following Prime Minister/ Cabinet Elections); Time point measurement 10 refers to August, 2023 (After Prime Minister/ Cabinet Elections); Time point measurement 11 refers to October, 2023 (Immediately following October 7th Attacks by Hamas); Time point measurement 12 refers to November, 2023 ( Six weeks following beginning of Israel- Gaza War); Time point measurement 13 refers to January 2024, (14 weeks following beginning of Israel- Gaza War).

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Table 1 presents Spearman rho correlation coefficients between distress, and the additional variables assessed throughout the thirteen measurements. Across all thirteen time points a consistent significant positive correlation was found between danger and distress (range between r of 0.396 to 0.636). Furthermore, across all thirteen time points a significant negative correlation was found between morale (range between r of − 0.364 to − 0.707), individual resilience (range between r of -0.280 to -0.489), hope (range between r of − 0.246 to − 0.437), and societal resilience (range between r of − 0.162 to − 0.373). Across several, but not all, observed time points, a notable inverse relationship was found where increased distress levels were linked to younger age groups, lower incomes and the less religious.

Table 1 Spearman rho (alongside p-value measurement) of distress measurement with twelve variables examined across 13 time points.
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Table 2 outlines the findings from stepwise linear regression analyses on distress levels over thirteen time points. Morale, inversely related, and perceived danger, directly related, consistently emerged as the top associations with distress. Additionally, individual resilience was significantly and inversely associated with distress at all time points. Age and religiosity also emerged as negative associations with distress in most of the models. In the majority of the models, morale was the primary association with distress, except in the initial two models post-October 7th attack, which marked the onset of the Israel- Gaza war; in these instances, the perception of danger was the dominant association with distress. The models explained between 50.1 and 62.1% of the variance in distress levels, as indicated by R2 values ranging from 0.501 to 0.621.

Table 2 Results of thirteen step-wise linear regressions of associations with distress over 13-time points. Note: All standardized ß values are significant in the step-wise linear regressions (*- p-value less than 0.05, **- p-value less than 0.001) .Time point measurement 1 refers to- May, 2020 (Corona measurement 1); Time point measurement 2 refers to July, 2020 (Corona measurement 2); Time point measurement 3 refers to July, 2020 (Corona measurement 3); Time point measurement 4 refers to January, 2021 (Corona measurement 4); Time point measurement 5 refers to May, 2021 (Operation "Guardian of Walls"/Corona measurement 5); Time point measurement 6 refers to October, 2021 (Corona measurement 6); Time point measurement 7 refers to February, 2022 (Corona measurement 7); Time point measurement 8 refers to October, 2022 (Before Prime Minister/ Cabinet Elections); Time point measurement 9 refers to February, 2023 (Immediately following Prime Minister/ Cabinet Elections); Time point measurement 10 refers to August, 2023 (After Prime Minister/ Cabinet Elections); Time point measurement 11 refers to October, 2023 (Immediately following October 7th Attacks by Hamas); Time point measurement 12 refers to November, 2023 ( Six weeks following beginning of Israel- Gaza War); Time point measurement 13 refers to January 2024, (14 weeks following beginning of Israel- Gaza War).
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Discussion

This quasi-longitudinal study provides valuable insights into the key associations with distress across 13-time points during significant events, including the COVID-19 pandemic and various political and security-related events in the state of Israel. Our analyses revealed several key findings that contribute to the broader understanding of levels of distress in the face of adversity. The longitudinal research conducted beyond more than a two-and-a-half-year period elucidates the evolving landscape of psychological distress, highlighting its sensitivity to a range of the onset of adverse circumstances. The trajectory of distress showcased significant oscillations, directly mirroring the impact of novel stressors (for example, transition between COVID-19 to the period of socio-political unrest, to then the October 7th attack and the ongoing war). The data compellingly demonstrate this dynamic relationship, with distress levels peaking significantly during the latter stages, notably following the October 7th attack on Israel and throughout the Israel-Gaza conflict, compared to other periods in the study. This accentuates the profound psychological repercussions of terrorism, war and man-made emergencies as compared to distress levels observed among the other adversities, which is in line with previous work of Makwana13 and Hackbarth et al.14. Throughout the ongoing war, adaptation by the civilian population to the prolonged state of war gave rise to a ‘new normal’ where initial increases in distress over time give way to habituation (although these distress levels are still significantly higher than the pre-war levels)37. Moreover, a notable rise in distress was documented during the third COVID-19 measurement in October 2020. Although this increase was not statistically significant when compared to the adjacent data points, it coincided with Israel confronting a second wave of COVID-19 infections. This resurgence prompted the government to impose a second national lockdown in September, the second of its kind within half a year38. The increase in distress noted in October 2020 could be linked to the considerable psychological burden triggered by the resurgence of COVID-19 cases and the ensuing national lockdown. This period was marked by heightened health concerns and significant economic repercussions that reverberated throughout the society, exacerbating stress and uncertainty across the population. Conversely, the eighth measurement period recorded the lowest distress levels, occurring at a time when COVID-19 was no longer the dominant concern26; but rather the period just before upcoming national elections28. The reduced levels of distress observed in the eighth measurement period may indicate a habituation to a new ‘emergency routine’ adopted during prolonged adversity, such as the COVID-19 pandemic, leading to a normalization of stress responses as individuals acclimate to the ongoing situation, or it could reflect a collective sense of relief as the imminent threat posed by COVID-19 diminished15. Additionally, this period of relative calm before the national elections might indicate a shift in public focus, from immediate health concerns to socio-political considerations.

Furthermore, the findings of stepwise linear regressions across all thirteen time points, indicated that morale consistently emerged as a significant association, often overshadowing other variables in its impact on psychological well-being. This finding underscores the pivotal role of morale, suggesting that high spirits within a group or individual are inversely related to the experience of distress, reinforcing the notion that morale is a critical factor in mitigating psychological distress. While the literature has consistently regarded hope as a buffer against distress, the notion of morale—characterized by an individual’s appraisal of the present circumstances rather than future expectations—has not been similarly identified as a protective element, to the best of the authors’ knowledge39. Interestingly, during the initial phase of the Israel-Gaza conflict, the usual predominance of morale was supplanted by perceived danger as the primary associative factor with distress. This shift accentuates the profound impact that immediate threats have on mental states. In situations where danger is imminent, the perception of life-threatening danger appears to exert a more direct and powerful influence on psychological distress than morale40. This nuanced understanding is crucial for interventions aimed at reducing distress during such acute crises. Danger has previously emerged as a primary significant association with distress, such as in findings by Kimhi et al.9 throughout the covid-19 pandemic. By recognizing the variable impact of these associations in different contexts, psychological support may be tailored to address the most pressing needs of those affected. Moreover, individual resilience presented as a persistent negative association with distress, corroborating past research, including that of findings throughout COVID-19 in an international study comparing Brazil, the Philippines, and Israel41.

In conclusion, the sporadic inverse relationships between distress and variables such as advancing age, greater income, and heightened religiosity may indicate their potential roles as intermittent stress mitigators. However, the variability of their impact throughout the study suggests a complex interplay rather than a steady influence. The recurring non-significance of income as a determinant implies that monetary wealth is not a panacea for psychological stress, in contrast to previous findings42,43. Conversely, the sporadic protective effect of age could reflect a cumulative resilience built from life experiences, facilitating better adaptation to adverse situations9,16. Religiosity’s sporadic negative correlation with distress hints at its potential to foster community bonds and spiritual coping strategies, in line with previous findings of Jokela44. These ephemeral associations, influenced by situational and environmental factors, warrant further inquiry into the mechanisms by which these demographic elements may serve as temporal shields against distress or at times remain unrelated.

Limitations

Despite its thorough scope and analytical depth, this study’s findings must be contextualized within its limitations. Initially, while the participant pool aimed to mirror the demographics of Jewish adults reported by the National Statistics Bureau of Israel, it fell short of encapsulating Israel’s full demographic breadth, especially its ethnic and minority groups. This gap may diminish the generalizability of the findings across the entire Israeli population. Moreover, the study’s quasi-longitudinal design, which sampled different individuals at distinct time points, introduces a degree of variation that might affect data consistency and the ability to draw comparisons over time. Although each measurement collected a representative sample of the Jewish Israeli public, feasibility challenges prevented us from conducting a cohort study over the 2.5 year period, leading us to choose a quasi-longitudinal approach instead. Given the quasi-longitudinal study design, where some participants (but not all) responded to some of the additional measurements, a between-subjects ANOVA is not ideal. Furthermore, the use of self-reports to gauge intricate constructs such as resilience, hope, and distress also carries a risk of subjective bias, possibly overlooking the subtleties of these concepts. Additionally, the insights gleaned are deeply entrenched in the specific sociopolitical and cultural milieu of Israel, which may limit their extrapolation to other settings, potentially affecting their broader applicability. A further constraint is the variable implementation of the Individual Resilience Index, with alternating use of the 2-item Connor-Davidson scale and the 10-item scale, potentially compromising the uniformity and comparability of resilience measurements across the study period. Acknowledging these limitations is crucial for a nuanced interpretation of the study’s outcomes and highlights productive avenues for future research to enhance our comprehension of what impacts on distress levels.

Conclusions

The conclusions drawn from this quasi-longitudinal study underscore the complex interplay between various associations with psychological distress and their fluctuating significance across different adversities and time points. Over the course of more than two and a half years, encompassing 13 distinct periods of measurement during significant events such as the COVID-19 pandemic, socio-political unrest, and the Israel-Gaza conflict, the study has elucidated several key findings. First, morale stands out as a consistent and dominant association with psychological distress, affirming its crucial role in influencing mental health outcomes. Strategies aimed at boosting morale may thus serve as effective interventions to lessen distress, particularly during crises. Furthermore, in the face of immediate threats, such as those experienced during the initial phase of the Israel-Gaza conflict, perceived danger surpasses morale as the most significant associations with distress. This highlights the acute psychological impact of life-threatening situations and the need for targeted mental health support in such contexts. In light of these findings, the implications for mental health interventions are twofold. First, there is a clear imperative to provide preemptive mental health support in anticipation of, during, and following various adversities. Second, the sustained significance of morale, even in the presence of perceived threats, calls for the development of strategies that uphold and enhance morale, as such approaches have the potential to significantly reduce distress in individuals facing crisis conditions. This study contributes to the broader understanding of psychological distress and offers a framework for developing more nuanced and effective mental health support systems.