Psychological distress in patients with hematological malignancies during the 2023-2025 war in Israel: a national survey and comparison with the COVID-19 pandemic.

BACKGROUND

Patients with hematological malignancies are vulnerable to psychological distress in times of crisis. We evaluated emotional burden, including demographic and clinical factors associated with war-related fears and depression severity, as well as coping strategies, and care continuity during the 2023-2025 war in Israel and compared findings to a prior COVID-19 survey.

METHODS

A national cross-sectional survey was conducted in September 2025 among Hebrew-speaking patients with hematological malignancies. Data included sociodemographic and clinical items, disease management, fears (Likert scales), the Patient Health Questionnaire-9 (PHQ-9), and three open-ended questions analyzed thematically. Results were compared with a similar 2021 COVID-19 survey.

RESULTS

Of 836 patients approached, 188 responded (22%). War affected many patients: 45% had a relative recruited to the army, and 2% reported evacuation or a family member injured/killed. Treatment disruptions were limited (8% delays, 7% alternative therapy, one deferred CAR-T). Depression was frequent (mean PHQ-9 was 10.4 ± 5.6), with 49% in moderate-to-severe ranges, significantly higher than during COVID-19 (9.2 ± 5.9, p = 0.022). Female sex and the wartime period independently predicted depression severity. Mean fear regarding clinic safety was 1.9 ± 1.4 on a 7-point Likert scale and was higher in women, older and lymphoma patients. Thematic analysis revealed fear/anger about war and government (38%) as the most common difficulty, while family support (23%) was the main coping resource.

CONCLUSIONS

Compared to the COVID-19 pandemic, the 2023-2025 war was associated with greater depression severity despite fewer care disruptions. Hematology services should incorporate systematic screening and psychosocial support to safeguard patient well-being during crises.