A new study finds that mental health after trauma follows different paths—and tracking changes over time can help identify who may need lasting support. Following 1,035 Israeli adults for six months after October 7, researchers found that most maintained relatively low distress or recovered over time, while others experienced persistent or worsening symptoms. These patterns helped predict later post-traumatic stress symptoms beyond distress levels at a single assessment. Early positive emotions and viewing the world as safe were associated with better outcomes, while empathy, reflecting emotional resonance with others' suffering, was linked to greater distress. The findings highlight that severe early distress does not necessarily signal lasting difficulties—and that repeated assessments can help distinguish recovery from an ongoing need for care.

For many Israelis, the October 7 terrorist attack marked the beginning of months of uncertainty, fear, and repeated exposure to trauma. Yet while emotional strain was very common, people did not all respond in the same way.

A new longitudinal study led by Dr. Dana Katsoty and Prof. Ariel Knafo-Noam of the Hebrew University of Jerusalem and Columbia University, together with Prof. Anthony D. Mancini of Pace University, reveals that psychological adaptation after large-scale trauma follows several distinct patterns. The findings suggest that how distress changes over time, not simply how severe it appears at one moment, can provide valuable insight into who is most likely to develop long-term post-traumatic stress symptoms.

Their analysis identified four distinct trajectories of psychological distress:

• Resilience (54%) – participants experienced relatively low levels of distress throughout the study.
• Recovery (27%) – participants initially reported severe distress but improved substantially over time.
• Chronic distress (18%) – distress remained consistently high across all assessments.
• Delayed onset (2.5%) – distress was initially mild but worsened over the following months.

The researchers also identified several factors associated with these different recovery paths. Participants who were older, male, experienced more positive emotions in the weeks following the attack, perceived the world as generally safe, and regularly volunteered before the war were more likely to demonstrate resilience. In contrast, greater exposure to traumatic events and higher levels of emotional empathy—emotional resonance with others' suffering—were associated with persistent psychological distress.

The findings offer both reassurance and caution. More than half of participants demonstrated resilience, while another quarter recovered despite experiencing severe distress immediately after the attack. At the same time, nearly one in five participants continued to experience persistent psychological distress six months into the war, highlighting the lasting mental health consequences of prolonged conflict.

Perhaps the study's most important finding was that these psychological trajectories predicted PTSD symptoms above and beyond distress measured at a single point in time. Even after accounting for participants' distress levels six months after the attack, the pattern their symptoms followed over those months remained a significant predictor of post-traumatic stress symptoms. In other words, adaptation is not defined simply by where people end up—but by how they get there.

Another notable finding involved empathy. While empathy is typically considered a protective social trait, the study found that empathic distress was associated with higher levels of psychological distress and less adaptive trajectories. Empathic concern, a more regulated form of empathy, painted a more nuanced picture: although it was associated with greater distress, it was also linked to volunteering and supporting others, suggesting that empathy can be both emotionally taxing and socially beneficial during national crises.

Some of the findings challenged conventional assumptions. Contrary to previous research, receiving social support or volunteering during the war did not predict better mental health outcomes or more resilient trajectories. In contrast, individuals who regularly volunteered before the war were more likely to demonstrate resilience, suggesting that long-standing habits and psychological resources may provide greater protection than behaviors adopted during a crisis.

“One of the most important messages from our findings is that early distress does not necessarily mean someone is on a path toward long-term psychological difficulties,” said Dana Katsoty. “Many people who initially experienced severe distress recovered over time. At the same time, a single assessment cannot identify everyone who will need support. Following how symptoms change over time allows us to distinguish natural recovery from patterns that may require clinical intervention.”

The findings underscore the importance of adopting a longitudinal perspective when assessing mental health after mass trauma. Rather than relying solely on early screening, repeated assessments over time may better identify individuals whose symptoms persist, or emerge only months later, allowing mental health services to target support where it is needed most.

As wars, natural disasters, and other prolonged crises become increasingly common around the world, the researchers believe their findings have implications far beyond Israel. Understanding that psychological adaptation is a dynamic process, not a single snapshot, could help clinicians and policymakers develop more effective strategies for identifying risk, allocating mental health resources, and supporting recovery in populations exposed to sustained adversity.

Methodology: The study followed a nationally representative sample of 1,035 Jewish Israeli adults across three time points: approximately two weeks after the October 7, 2023 terrorist attack, seven weeks later, and six months after the attack. Participants completed validated measures of psychological distress, post-traumatic stress symptoms, trauma exposure, emotional experiences, empathy, social support, volunteering, and beliefs about the world. Using longitudinal trajectory analysis, the researchers identified distinct patterns of psychological adaptation over time and examined how these trajectories predicted later PTSD symptoms and how different psychological and behavioral factors predicted trajectory membership.