J Psychiatr Res. 2025 Oct 31;192:296-301. doi: 10.1016/j.jpsychires.2025.10.073. Online ahead of print.
ABSTRACT
BACKGROUND: The October 7th, 2023, terrorist attack triggered a profound mental health crisis in Israel. While the impact of trauma is well-documented, the specific long-term consequences of moral injury (MI), particularly experiences of betrayal by trusted authorities or institutions (PMIE-Betrayal), remain less understood. This study prospectively investigated the contribution of PMIE-Betrayal reported shortly after the attack and psychological distress one year later.
METHODS: A nationwide cohort of Israeli adults (N = 600 completing all waves) was assessed at three time points: T1 (August 2023, pre-attack), T2 (November 2023, one-month post-attack), and T3 (November 2024, one-year post-attack). Participants were measured on anxiety, depression, PTSD symptoms and emotional burnout at T1 and T3 as well as on PMIE-Betrayal on T2.
RESULTS: A significant multivariate effect of PMIE-Betrayal T2 on the combined T3 outcomes was found (F(4, 587) = 57.13, p < .001, partial η2 = .054), after controlling for baseline (T1) symptom levels, demographics, and trauma-related characteristics (direct exposure and loss of a loved one during the attack). Univariate analyses revealed that participants exposure to PMIE-Betrayal at T2 exhibited significantly higher levels of anxiety, depression, PTSD symptoms and burnout at T3, compared to those without betrayal exposure and after controlling for T1 symptoms and covariates.
CONCLUSIONS: Experiencing betrayal by trusted entities shortly after mass trauma significantly contributed to heightened and broader psychological distress one year later, even beyond baseline symptomatology. These findings underscore the persistent negative impact of this specific form of MI and highlight the critical need for clinical assessments and interventions to address betrayal-related wounds.
PMID:41183429 | DOI:10.1016/j.jpsychires.2025.10.073
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