As Israel’s conflict with Hamas marks the end of its fourth week, a long-term study shows that drawn out Israel-Arab conflicts contribute to mental health problems among Israeli teens.

Short bursts of violence have negative effects, but longer conflicts weigh more heavily on the young psyche, according to the study.

Published in the Journal of Traumatic Stress in June, the study evaluated the psychiatric and psychological state of nearly 9,000 Israeli Jewish teens over 14 years, from 1998 to 2011. The result is a kind of historical map of the mental health of a generation of young people.

Overall, the teens in the study were much more psychologically distressed than their American peers, who have been known to suffer angst themselves. The discrepancy was larger during escalations in the Arab-Israeli conflict – especially stretches of heightened rocket fire or suicide bombings – and smaller during periods of relative quiet. Psychiatric symptoms followed the same trend.

“Our study shows that adolescents are not unscarred by the conflict here – they hear sirens, they see buses exploding, they lose loved ones,” said Prof. Michelle Slone of Tel Aviv University’s School of Psychological Sciences, who coauthored the large, long-term cross-sectional study with Dr. Anat Shoshani from the Interdisciplinary Center in Herzliya. “It’s the chronic conflict climate, more than acute violent events, that seems to erode mental health.”

The findings have policy implications, the researchers say.

Hitting home

Israel has been in near-constant violent conflict with its neighbors since even before it declared statehood in 1948. The decade and a half of the study was no exception, encompassing periods of terrorism against Israelis, expansion and contraction of Israel’s military control of Palestinian areas, two wars, and heavy rocket fire on Israel’s northern and southern borders. Nearby, the Arab Spring was erupting and the Iranian nuclear threat was growing.

‘We heard examples of just about every way this conflict has touched young people’s lives, from reliving bus bombs to suffering from nightmares and fears’

The researchers gauged the mental health of Israeli Jewish teens in relation to all this violence by annually evaluating different groups at the same schools in northern, central, and southern Israel. The teens were asked about personal experiences of the Arab-Israeli conflict – such as explosions, personal or family member injuries, and damage to property – and screened for psychiatric and psychological disorders.

“We heard examples of just about every way this conflict has touched young people’s lives, from reliving bus bombs to suffering from nightmares and fears,” said Slone.

Data analysis revealed a correlation between exposure to the conflict and mental health symptoms, especially anxiety, depression, obsessive-compulsive disorder, interpersonal sensitivity, phobias, and paranoia.

To look deeper, the researchers divided their results into eight time periods based on events in the Arab-Israeli conflict. The teens showed the most symptoms during escalations in the conflict: the 2006 Lebanon War with its Hezbollah rocket fire on Israel, Israel’s Operation Cast Lead in Gaza and the Palestinian rocket fire that went with it in 2008, and global terrorism, including against Israelis abroad, between 2010 and 2011.

The worst of the worst periods for the teens’ mental health were the peak of the Palestinian uprising between 2001 and 2003 and the Hezbollah rocket fire between 2006 and 2007 – drawn-out periods of terrorism rather than short-term wars or military operations. Slone said wars may be slightly easier for teens to handle because there is often a sense of solidarity, meaning, and control. Also, mental health professionals are mobilized to help.

The teens had the fewest symptoms during quieter periods in the conflict.

A generation at risk

As they expected, the researchers found that the teens had more personal experiences of the conflict during escalations than during lulls. These experiences accounted for the association between the conflict and mental health, they found.

In line with previous research, girls seemed more emotionally affected than boys, particularly during escalations in the conflict.

The results emphasize that Israel’s violent environment puts its teens at risk for mental health problems, the researchers say. The fallout from the accumulated trauma goes well beyond post-traumatic stress disorder and may include a wide range of disorders, psychological symptoms, and developmental impairment, they say.

Because the Arab-Israeli conflict predates the state of Israel, the researchers were not able to assess the mental health of an unaffected group of Israelis. The study also did not measure whether the high levels of psychological symptoms found among the teen were associated with diagnosable disorders or dysfunction.

So would the end of Operation Protective Edge be good news for the mental health of Israel’s teens? That might depend on what comes next. The study indicates that the fundamental problem is the ever-present conflict that forms the backdrop to Israeli teens’ lives and sometimes takes center stage, to traumatic effect. Children are resilient, so resolution of the conflict could bring about spontaneous recovery, they say.

In the meantime, the researchers suggest that Israeli public health services should continue to offer psychological and psychiatric support to teens not just during and after escalations in the conflict, but also to prepare them during quieter periods.