Trajectories over time in the prevalence of substance and behavioral addictions and common mental health issues in Israel, 2022-2025

Abstract Background Traumatic events, such as terror attacks and war, are expected to impact mental health. These potential effects can be explored by assessing the mental health of the general population of Israel, from before the events of October 7, 2023 and over the course of the Swords of Iron war. Methods General population data were collected from Jewish adults in Israel before October 7 (April 2022), after October 7 (December 2023), and over the course of the ongoing war (March 2024, June 2024, February 2025), in a series of repeated cross-sectional samples with longitudinal data on a subset of the respondents. Among a subset of the sample including individuals who were surveyed in April 2022 and at least one follow-up time point (N=1,368), we used regression analysis to model trajectories over time in prevalence of problematic non-medical use of alcohol, tobacco, cannabis, sedatives, prescription stimulants, and prescription opioid painkillers; problematic use of internet, social media, electronic gaming, gambling, pornography, and compulsive sexual behavior; and post-traumatic stress disorder (PTSD), depression, and anxiety. Trajectories were modeled overall and moderation analysis was used to determine if trajectories differed by gender or age. Results Different patterns were observed by outcome. Different trajectories were observed before and after December 2023, suggesting that the events of October 7 th and the early war may have been a key transition point, for problematic use of alcohol, tobacco, sedatives, opioid painkillers, gambling, sexual behaviors, internet and PTSD. Smooth changes over time were observed for problematic use of gaming and social media, and anxiety and depression. No changes over time were observed for problematic use of cannabis, stimulants, and pornography. Many outcomes showed different trajectories by gender and age. Conclusions Findings suggest possible effects of ongoing trauma and war and suggest that outcome-specific and group-specific strategies may be warranted. Monitoring the prevalence of addictions and other common mental health issues in the general population during and after nationally traumatic events is important to understand the evolving mental health of the population and provide information and resources for potential interventions. Awareness of the potentially harmful effects of such life events, as well as the consequences of maladaptive coping styles on health and well-being, should be increased.