Психиатрические результаты первого two спустя годы после октября 7 - нападения: систематический обзор последствий посттравматического стресса, беспокойства, депрессии и наркомании.

Introduction

The Hamas-led attacks of 7 October 2023 and the subsequent war between Israel and Hamas (“Iron Swords”) constitute a large-scale collective trauma with substantial implications for population mental health (e.g., 1 ). Compared to prior escalations in the region, the magnitude of civilian casualties, geographic breadth of exposure, mass displacement, and prolonged uncertainty created sustained, multidimensional threat conditions affecting large segments of the Israeli population ( 1 ). These circumstances raise urgent questions regarding the nature, distribution, and clinical significance of emerging psychiatric responses following prolonged collective violence. Beyond the immediate regional context, understanding psychiatric responses under conditions of sustained societal threat has broader relevance for mental-health research and policy in settings of protracted conflict and large-scale crises worldwide. In the months following October 7, empirical research expanded rapidly. Cross-sectional surveys, longitudinal cohorts (including pre-war baselines), and studies of civilian, military, and other high-risk subgroups began documenting psychiatric outcomes under conditions of ongoing threat (e.g., 2 – 7 ). This proliferation provides a rare opportunity to examine early psychiatric responses in near real time. However, the literature is characterized by substantial heterogeneity in exposure definitions, sampling strategies, assessment timing, and measurement instruments, challenges commonly observed in disaster mental health research ( 8 ). As a result, findings remain fragmented across symptom domains and population groups, limiting integrative understanding and complicating evidence-based clinical and policy decision-making.

A differentiated synthesis of distinct symptom domains is necessary to distinguish transient stress reactions from patterns that may signal risk for persistent psychopathology ( 9 ). The present review therefore focuses on four domains consistently assessed in the emerging literature: posttraumatic stress symptoms (PTSS), anxiety, depression, and addiction-related outcomes, including problematic substance use and behavioral addictions. PTSS represent trauma-linked symptoms directly associated with exposure to life-threatening events ( 10 ). Anxiety and depressive symptoms, although not trauma-specific, are robust predictors of functional impairment and long-term morbidity following large-scale crises ( 11 ). Addictive behaviors have been theoretically and empirically associated with trauma exposure (e.g., 12 ) and affective dysregulation ( 13 , 14 ) and may emerge as maladaptive coping responses under sustained threat ( 15 , 16 ). However, addiction-related outcomes remain an emerging and comparatively understudied domain in research on large-scale collective trauma.

In addition to variability in symptom domains, exposure to the October 7 attacks and subsequent war has been highly heterogeneous, encompassing direct life-threatening experiences, diverse forms of indirect exposure (e.g., bereavement, displacement, repeated missile alerts, and prolonged media exposure), cumulative stressors, and role-related exposure (e.g., civilians, reservists, evacuees). Accordingly, this review provides the first systematic synthesis of psychiatric outcomes across multiple symptom domains during the first two years following the October 7 attacks. It remains unclear whether the elevated symptom levels reported across studies reflect a uniform rise affecting all domains to a similar degree, or domain-specific elevations in which particular exposure pathways are associated with particular outcomes.

The present systematic review synthesizes empirical studies published during the first two years after the October 7, 2023, attacks. By integrating evidence on prevalence, exposure characteristics, and subgroup differences across PTSS, anxiety, depression, and addictions, this review aims to characterize early prevalence patterns and to delineate how distinct forms of exposure relate to domain-specific psychiatric responses. In doing so, it seeks to inform targeted clinical screening, resource allocation, and public mental health planning under conditions of prolonged collective crisis.

Methods

Protocol and reporting standard

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement ( 17 ). Reporting was guided by the PRISMA 2020 checklist and flow diagram. The review was not prospectively registered. A written review protocol specifying the objectives, eligibility criteria, search strategy, and synthesis plan was prepared before screening commenced, reducing the risk of post-hoc selective reporting. The review was not, however, prospectively registered in a public registry such as PROSPERO. This was a full systematic review, not a rapid review. Although it was initiated promptly in response to an evolving situation, all steps followed standard systematic-review procedures. The absence of prospective registration is acknowledged as a limitation, although the pre-specified protocol, finalized before screening began, mitigates the associated risk of selective reporting.

Review aim

The aim of this review was to synthesize empirical evidence on posttraumatic stress symptoms (PTSS), anxiety, depression, and addictions, including problematic substance use and behavioral addictions, among Israeli populations during the first two years of the Iron Swords since October 7, 2023. Particular attention was given to exposure characteristics, timing of assessment, and differences across demographic and role-defined subgroups in order to clarify domain-specific patterns of psychiatric responses.

Eligibility criteria

Studies were eligible for inclusion if they:

Employed an empirical quantitative, qualitative, or mixed-methods design.

Examined at least one of the following outcomes: PTSS, anxiety, depression, problematic substance use, or behavioral addictions.

Were conducted among Israeli populations, including the general population as well as relevant subgroups such as reservists, evacuees, bereaved individuals, adolescents, or children exposed to the war context.

Were published between October 7, 2023 and October 7, 2025.

Eligible designs included cross-sectional, longitudinal, cohort, and case-control studies. Qualitative and mixed-methods studies were included when they reported empirical data relevant to the review objectives. Commentaries, editorials, theoretical papers, case reports, dissertations, and other non-empirical publications were excluded. Only studies published in English or Hebrew were included. Studies were excluded if they did not assess at least one of the predefined symptom-domains (PTSS, depression, anxiety, or addiction-related outcomes).

Information sources and search strategy

A systematic search was conducted in PubMed, PsycINFO, Scopus , and Web of Science . The initial search was performed on July 27, 2025 and updated through December 30, 2025, which served as the final search date. Reference lists of included studies were screened to identify additional eligible publications.

Search strategies combined controlled vocabulary (e.g., MeSH terms) and free-text keywords relating to:

Exposure to the October 7 attacks, the ongoing war, terror, or related conflict terms;

Psychiatric outcomes, including PTSS/PTSD, anxiety, depression, substance use, and behavioral addictions; and

Psychiatric responses at the individual or population level. The complete search strategy for each database, including all search terms and Boolean operators, is provided in Appendix S1. Searches were limited to publications from October 2023 onward and to articles published in English or Hebrew.

Selection process

All records were exported and managed using a structured screening tool (Google Sheets). Duplicate records were manually removed prior to screening.

Titles and abstracts were independently screened by two reviewers. Full texts of potentially eligible studies were retrieved and independently assessed for inclusion by the same reviewers. Disagreements were resolved through discussion and, when necessary, consultation with a third reviewer. Reasons for exclusion at the full-text stage were documented. The selection process is summarized in the PRISMA flow diagram.

Data collection process

Data were independently extracted by two reviewers using a standardized extraction form. Extracted data were cross-checked, and discrepancies were resolved through discussion and consensus. In two instances where full-text articles were not accessible through institutional databases, corresponding authors were contacted directly. The authors provided the full manuscripts, which were subsequently assessed for eligibility. Exposure was not a focal outcome of this review and was not coded or rated by the review team. Where the primary studies characterized exposure (e.g., as direct, indirect, cumulative, or role-related), these characterizations were recorded as reported by the original authors. Accordingly, the exposure categories referred to in the synthesis reflect the descriptions used in the primary studies rather than an a priori or independently coded exposure framework, and they are presented descriptively alongside the symptom-domain findings.

Data items

For each included study, the following information was extracted:

Authors and year of publication.

Study design.

Population characteristics (including age and gender distribution) when available.

Population subgroup (e.g., general population, reservists, evacuees, bereaved individuals, youth).

Timing of assessment relative to October 7, 2023.

Exposure characteristics, including direct, indirect, cumulative and role-related exposure when available.

Psychiatric outcomes assessed.

Measurement instruments used.

Key quantitative indicators (e.g., prevalence rates, mean scores, effect sizes) or qualitative findings.

Functional outcomes (e.g., quality of life, occupational functioning), when reported.

Risk of bias assessment

Risk of bias was assessed independently by two reviewers using design-specific appraisal tools. Cohort studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Cohort Studies, cross-sectional studies were assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies, and qualitative studies were evaluated using the JBI Critical Appraisal Checklist for Qualitative Research ( 18 ). Risk of bias ratings were summarized descriptively and informed the interpretation of findings (Appendix S2).

Each study was appraised across relevant methodological domains, including sampling strategy, measurement validity, confounding control (where applicable), and appropriateness of analytic methods. Disagreements were resolved through discussion and consensus.

No studies were excluded based on quality assessment alone. Instead, methodological limitations were considered qualitatively in the interpretation of findings.

Synthesis of results

Given substantial heterogeneity in study designs, populations, exposure definitions, outcome measures, and timing of assessments, a meta-analysis was not conducted. This heterogeneity precluded meaningful quantitative pooling. Specifically, studies varied in the operationalization of exposure, in outcome instruments and screening cutoffs (e.g., brief two-item screeners versus full symptom inventories), and in the timing of assessment relative to October 7, and in their sampling frames. In addition, substantial sample overlap across reports drawn from shared national panels would violate the assumption of independent samples required for meta-analytic pooling. Findings were synthesized narratively and summarized in structured tables.

Studies were grouped by outcome domain (PTSS, anxiety, depression, addiction) and examined in relation to exposure characteristics and population subgroup where available. Patterns, consistencies, and discrepancies across studies were identified, with attention to methodological limitations and contextual factors.

Given the conceptual and empirical overlap between anxiety and depressive symptoms, and variability in their operationalization, findings were synthesized jointly, with distinctions noted where relevant.

Results

The database searches identified 4,588 records. A total of 3,945 duplicate or clearly irrelevant records were removed prior to title and abstract screening. The remaining 643 records were screened, of which 448 were excluded, leaving 195 full-text articles were assessed for eligibility. Of these, 127 were excluded for documented reasons, and 68 studies met the inclusion criteria and were included in the final synthesis. Reasons for exclusion at the full-text stage are detailed in the PRISMA flow diagram ( Figure 1 ).

The 68 included studies were published between October 7, 2023, and October 7, 2025, and encompassed cross-sectional, longitudinal, or repeated-measures designs. Study populations included general adult samples as well as high-risk or role-exposed groups, such as reservists, evacuees, bereaved individuals, and war-exposed children. A detailed overview of study characteristics, populations, outcomes assessed, and measurement instruments is presented in Table 1 .

Risk of bias was assessed using design-specific JBI appraisal tools. Common methodological limitations included non-probability sampling, reliance on self-report measures, and the predominance of cross-sectional designs, limiting causal inference. A summary of the risk of bias assessment is provided in Appendix S2.

Posttraumatic Stress Symptoms

Posttraumatic stress symptoms (PTSS) were examined in 45 studies of the 68 included studies, including 36 population-based studies and 9 conducted with high-risk or duty-related groups. Of these, 18 studies employed longitudinal or repeated-measures designs. Elevated PTSS levels and above-cutoff rates for probable PTSD were consistently reported following October 7. Above established clinical screening thresholds were documented in the general adult population during the initial months of the war ( 35 , 54 , 56 ). Rates were particularly high among treatment-seeking and role-exposed groups, including IDF reservists seeking care ( 73 ), individuals who lost a close family member or friend during the October 7 attack or the subsequent war ( 43 ), and young adults ( 71 , 77 ). Longitudinal finding indicated heterogeneous symptom trajectories over time. While PTSS declined over time in some populations, symptoms remained elevated among subgroups characterized by sustained exposure or role-related strain ( 43 – 45 , 49 ).

PTSS severity varied systematically according to types of trauma exposure. In reservist samples, specific combat-related events, such as hand-to-hand combat, exposure to human remains, and physical injury, were associated with higher PTSS and distinct symptom clusters ( 73 ). Elevated PTSS was also linked to sustained threat contexts and cumulative or indirect stressors, including prolonged missile attacks, broader war-related exposure, and role-linked burdens such as body-handling tasks ( 42 , 70 , 78 ).

Beyond exposure characteristics, PTSS severity was also associated with psychosocial vulnerabilities and protective resources. Higher symptom levels were observed among individuals reporting maladaptive emotion-regulation strategies, reduced psychological resources, and elevated demoralization early in the war ( 39 , 75 , 78 ). In contrast, greater perceived social support, particularly from friends or significant others, was associated with lower PTSS severity ( 68 ).

PTSS vulnerability also varied according to prior trauma history and developmental context. Among older adults with previous war exposure, intrusive cognitive linkage of past and current traumatic events was associated with elevated PTSS and affective symptoms ( 77 ). Higher PTSS rates were also observed among descendants of Holocaust survivors, particularly when parental or grandparental PTSD was reported ( 7 , 76 ). Among war-exposed children, maternal posttraumatic symptoms were strongly associated with child PTSS, especially in preschool-aged samples ( 58 ).

Anxiety and depression

Anxiety and depressive symptoms were widely assessed in the reviewed studies and emerged as central affective responses in the months following October 7. Multiple population-based studies documented marked elevations relative to available pre-attack baselines, with substantial proportions exceeding established screening clinical cutoffs during the early phase of the war ( 5 , 54 , 56 ). Longitudinal and repeated-measures findings indicated that although symptom levels declined over time for some groups, anxiety and depressive symptoms remained elevated among individuals exposed to sustained threat or ongoing stressors, including reserve-duty participants, evacuees, and bereaved individuals ( 43 – 45 ). These patterns suggest that anxiety and depressive symptoms were particularly sensitive to prolonged stress exposure rather than discrete traumatic events alone.

Anxiety and depressive symptoms were systematically associated with both direct trauma exposure and broader contextual stressors. Direct exposure to traumatic events, loss of close others, forced displacement, income loss, and prolonged missile-attack contexts were each linked to elevated symptom severity ( 22 , 38 , 70 ). Indirect and cumulative stressors, including food insecurity and extensive media exposure, were also associated with increased anxiety and depressive symptoms, even after adjustment for sociodemographic characteristics and prior mental health status ( 28 , 31 , 32 ). In some studies, perceived stress mediated the association between war exposure and anxiety and depression ( 53 , 70 ), underscoring the role of stress appraisal in persistence of anxiety and depressive symptoms.

Pronounced group differences were repeatedly observed. Women consistently reported higher anxiety and depressive symptom levels than men across samples ( 22 , 36 , 47 ). Elevated symptom levels were also documented among ethnic minority groups, including Arab Israelis and Mizrahi participants, (Jews of Middle Eastern and North African descent) particularly under conditions of high stress ( 2 , 22 , 34 ). Additional vulnerability was observed among individuals facing socioeconomic or role-related strain, such as unemployed evacuees, postpartum women delivering during the war, spouses of reserve soldiers, and caregivers of war-exposed children ( 40 , 41 , 61 , 80 ).

Beyond structural factors, lower levels of personal resources (e.g., psychological capital, self-mastery, resilience) and maladaptive coping patterns (e.g., emotional suppression, self-coldness) were associated with greater symptom severity ( 21 , 24 , 27 , 32 , 40 ). Anxiety and depressive symptoms were also linked to reduced health-related quality of life and daily functioning, even when symptoms severity declined over time ( 6 , 36 , 38 ).

Addiction-related outcomes

Addiction-related outcomes were examined in only three studies published during the two years following October 7, two of which focused on substance use. Both studies reported post-attack increases in substance use ( 30 , 35 ). Increased use was associated with greater exposure severity, psychological distress, and prior mental health difficulties. Direct exposure emerged as the strongest correlate of increased substance use, while psychological distress partially mediated associations between indirect exposure and substance use. Differential risk patterns were observed by gender and exposure level, including higher cannabis use among men and greater tranquilizer use among individuals with higher exposure.

The single study examining behavioral addictions focused on gambling ( 50 ). Increased gambling was observed primarily among men without prior gambling problems who reported greater difficulties in emotion regulation. No comparable increase was observed among women, and lower emotion regulation difficulties appeared protective among individuals with higher baseline gambling risk. Overall, the limited evidence suggests selective, exposure- and distress-related increases in addiction-related outcomes rather than generalized population-wide escalation.

Discussion

The synthesis of evidence indicates that the psychiatric impact of the October 7 attacks and the ensuing war did not manifest as a unitary deterioration across symptom domains, but as a differentiated pattern in which persistence, severity, and risk varied systematically across subgroups. Across PTSS, anxiety, depression, and more preliminarily, addiction-related outcomes, psychiatric burden was consistently associated with the types of trauma exposure, the continuity of threat, and pre-existing structural and personal vulnerabilities, rather than with exposure occurrence alone. At the same time, these domains did not operate in isolation. PTSS, anxiety, and depressive symptoms frequently co-occurred, consistent with the well-documented comorbidity among these conditions following mass trauma ( 81 , 82 ). The domain-specific patterns described below therefore reflect differences in emphasis and trajectory across partly overlapping conditions, rather than mutually exclusive responses.

A first cross-cutting theme concerns the role of sustained and cumulative exposure. Across domains, persistent or elevated symptoms were more frequently observed among individuals exposed to continuous threat, cumulative stressors, or role-related strain, including reservists, bereaved individuals, evacuees, and those in high-demand roles (e.g., 2 , 22 , 23 , 32 , 37 – 40 , 42 , 56 ). This pattern is consistent with broader trauma research showing that PTSD risk varies not only by the occurrence of trauma exposure but also by exposure proximity, intensity, and cumulative direct and indirect trauma burden ( 83 , 84 ). For PTSS, specific combat-related experiences, such as close-quarter combat, physical injury, and perceived responsibility for civilian harm, were associated with higher symptom levels and distinct symptom profiles ( 37 , 42 ), aligning with theoretical models of the psychiatric impact of ethically charged or role-embedded experiences ( 85 , 86 ). For anxiety and depression, symptom persistence appeared to reflect cumulative stress load, chronic uncertainty, and the erosion of coping resources rather than discrete traumatic events alone (e.g., 87 , 88 ). Across domains, then, the continuity and accumulation of exposure, more than its initial occurrence, were associated with the course of psychiatric symptoms under prolonged collective threat.

A second theme concerns individual, developmental, and social moderators of vulnerability. Maladaptive emotion-regulation strategies (e.g., 31 , 75 ) and early demoralization (e.g., 78 ) were associated with higher symptom severity, consistent with broader evidence linking dysregulated affective processing to symptom maintenance ( 89 , 90 ), whereas perceived social support, particularly from close relationship partners, was consistently associated with lower symptom severity (e.g., 24 , 68 , 91 ). Developmental and intergenerational factors further structured risk: intrusive linkages between past and current war exposure were associated with more severe symptoms among older adults ( 27 , 55 , 77 ), and elevated symptoms among descendants of Holocaust survivors ( 52 , 76 ) and among war-exposed children whose mothers reported elevated posttraumatic symptoms ( 58 ) point to the reactivation of trauma-related vulnerabilities across generations. Socioeconomic and role-related strain compounded these risks, with higher symptom levels among evacuees, unemployed individuals, ethnic-minority populations, and spouses of reserve soldiers ( 38 , 40 , 56 ). Beyond symptom levels, elevated anxiety and depression were also associated with impaired daily and occupational functioning ( 6 ), underscoring that psychiatric burden in this context extended beyond symptom counts to everyday role performance. Observed gender differences, with women reporting higher internalizing symptoms ( 22 ), align with broader epidemiological findings ( 92 ) but warrant caution, as self-report instruments may under-capture stress responses more common among men, including physiological reactivity and externalizing behaviors ( 93 – 95 ).

Against this cross-domain convergence, addiction-related outcomes followed a more selective, context-dependent pattern. Examined in only three studies, the available evidence suggests targeted rather than population-wide increases: post-attack increases in substance use were associated with greater exposure severity and higher psychological distress ( 30 , 35 ), with direct exposure the strongest correlate and psychological distress partially mediating increased use among indirectly exposed individuals. The single study of gambling identified a gender-specific pattern, with increased gambling primarily among men reporting greater emotion-regulation difficulties ( 50 ). Although the current evidence does not permit conclusions regarding the prevalence of substance use or gambling disorders during a prolonged collective crisis, these associations echo the same cross-cutting moderators, exposure intensity, regulatory capacity, and gender, identified across the other domains.

Practice and policy implications

These findings indicate that broad, population-level psychiatric responses are unlikely to be sufficient on their own; targeted, context-sensitive approaches are needed to identify and support groups at heightened risk. The convergence of elevated risk among reservists, bereaved individuals, evacuees, intergenerational trauma-affected families, and socioeconomically strained groups suggests that screening and service delivery should prioritize these populations rather than assume uniform need across the population. Because PTSS, anxiety, and depression frequently co-occurred, integrated services addressing comorbid presentations, rather than single-disorder pathways, may be particularly appropriate in this context. The association between distress and impaired functioning further suggests that services should target not only symptom reduction but also the restoration of daily and occupational functioning. These priorities are consistent with trauma-informed models of care developed in other contexts of mass and community trauma ( 96 , 97 ), which emphasize accessible, stepped, and population-tailored responses under conditions of ongoing threat.

Research implications

Several priorities follow for future research. First, sustained longitudinal follow-up extending beyond the acute crisis period will be essential to determine whether observed symptom elevations represent transient stress reactions or consolidation into chronic psychiatric conditions requiring ongoing clinical intervention. Second, future studies should incorporate standardized diagnostic instruments rather than brief screeners alone, and should routinely assess functional outcomes alongside symptom prevalence, given evidence that impairment and symptoms do not fully overlap. Third, exposure should be operationalized systematically and integrated into analytic models, so that the differential contributions of exposure type, intensity, and cumulative burden can be distinguished from pre-existing vulnerability. Addressing these gaps would strengthen causal inference and support the development of predictive models capable of identifying individuals at greatest risk under conditions of protracted conflict.

Strengths and limitations

This review has several strengths. To our knowledge, it is the first systematic synthesis of psychiatric outcomes across multiple symptom domains during the first two years following the October 7 attacks, integrating a rapidly emerging and heterogeneous literature within a single framework. Its domain-spanning scope allowed patterns of convergence and divergence across PTSS, anxiety, depression, and addiction-related outcomes to be examined together, and the structured tabulation of instruments, thresholds, timing, and risk of bias supports transparent comparison across studies.

At the same time, the conclusions that can be drawn are constrained by several features of the underlying literature. First, most studies relied on abbreviated screening instruments (e.g., PHQ-2, GAD-2, BSI) rather than comprehensive diagnostic assessments, limiting the ability to differentiate clearly between symptom domains and to estimate the prevalence of specific psychiatric disorders. Second, although exposure was measured in most studies, it was not consistently integrated into analytic models; this limits the ability to disentangle whether observed group differences reflect variation in exposure intensity, differential vulnerability, or both. Moreover, because exposure was characterized differently across the primary studies, reflecting each study’s own operational definitions rather than a uniform framework, direct comparison of exposure-related findings across studies is constrained. A further limitation concerns the substantial non-independence of samples. A number of the included reports recruited participants through the same commercial online survey panels (e.g., Panel4All, iPanel, Midgam), and several appear to derive from shared research programs. Because participant-level identifiers were not available, we could not determine the precise extent to which samples overlapped across reports. Recruitment through a shared panel does not necessarily indicate an identical sample, as independent samples may be drawn from the same panel at different times. Nonetheless, the possibility of partial sample overlap cannot be excluded, and the 68 reports should therefore not be assumed to represent 68 fully independent samples. The data source of each study is recorded in Table 1 to allow readers to assess this possibility. Fourth, several populations likely to carry substantial psychiatric burden, including active-duty military personnel, military families, and children and adolescents, were comparatively underrepresented, potentially resulting in conservative estimates of overall psychiatric impact. Relatedly, the present review focused on the four symptom domains most consistently assessed in the post-October 7 literature. Other outcomes were reported too rarely to support synthesis and represent an important gap for future research. Finally, the temporal scope of the reviewed studies captures acute and early intermediate responses, providing limited insight into longer-term consequences and symptom trajectories. Sustained longitudinal follow-ups extending beyond the acute crisis period will be essential to determine whether observed symptom elevations represent transient stress reactions or consolidation into chronic psychiatric conditions requiring ongoing clinical intervention. Distinguishing between acute stress responses and persistent psychopathology has important implications for service planning, resource allocation, and the design of prevention and treatment strategies. Relatedly, all included studies derive from a single national setting and a specific phase of an ongoing conflict; accordingly, the findings may not generalize fully to other populations, conflict contexts, or health-care systems.

Conclusion

Taken together, the reviewed evidence indicates that psychiatric responses to the October 7 attacks and the ensuing war appeared to be associated not only with exposure occurrence, but also with its continuity, accumulation, and broader social and personal context., with posttraumatic stress, anxiety, and depression frequently co-occurring and addiction-related outcomes following a more selective pattern. Distinguishing transient distress from persistent psychopathology, and symptom burden from functional impairment, will be essential for guiding service planning, resource allocation, and the design of prevention and treatment strategies in this and comparable contexts of prolonged collective crisis.

Funding Statement

The author(s) declared that financial support was not received for this work and/or its publication.

Footnotes

Edited by: Hubertus Himmerich , King’s College London, United Kingdom

Reviewed by: Fangqing Liu , The University of Manchester, United Kingdom

Clare Crole-Rees , University College London, United Kingdom

Kamila KĘDRA , Uniwersytet Rzeszowski Instytut Nauk Medycznych, Poland

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.

Author contributions

MC: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing. ML: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing. OG: Data curation, Investigation, Methodology, Writing – review & editing. EL: Data curation, Investigation, Methodology, Writing – review & editing. TD: Data curation, Investigation, Methodology, Writing – review & editing. MM: Conceptualization, Methodology, Supervision, Writing – review & editing.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1883498/full#supplementary-material

Full search strategy for each database.

Risk of bias assessment: item-level ratings for all included studies.

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Associated Data

Supplementary Materials

Full search strategy for each database.

Risk of bias assessment: item-level ratings for all included studies.

Data Availability Statement

The original contributions presented in the study are included in the article/ Supplementary Material . Further inquiries can be directed to the corresponding author.