International study of the perceived stress and psychological impact of the 7 October attacks on Holocaust survivors

<b>Objective:</b> The terrorist attacks of 7 October 2023 in southern Israel had a significant impact on the mental health of Holocaust Survivors (HS), who are considered to be particularly vulnerable to traumatic events. The aim of the study was to assess the severity of perceived stress and the psychological impact of the 7 October attacks on HS.<b>Methods:</b> The study was conducted from 30 October to 15 December 2023 among HS who were contacted through HS support organisations (OSE, Aloumim). They completed a questionnaire consisting of four sections: socio-demographic data and experiences during the Holocaust, assessment of psychological stress using the Perceived Stress Scale (PSS-10), feelings of isolation, health consequences, and reactions to the 7 October attacks.<b>Results:</b> 171 HS completed the questionnaire with 61 males (35.7%) with a mean age of 86.6+/-4.4 years (min 79-max 97). 59.6%, lived outside Israel, mainly in France. The mean score on the PSS-10 was 17.7 +/-6.0 on a scale of 5 to 40. The average PSS 10 score is not significantly higher in cases of age ≤90 years (18.0 ± 6.0 vs 15.7 ± 6.4, NS), or for those living in Israel (17.2 ± 5.3 vs 18.1 ± 6.6, NS). About a quarter reported feelings of isolation or loneliness following the attacks. The impact of the 7 October attacks was particularly significant among those living outside Israel. Approximately two-thirds felt that the events had rekindled memories of their Holocaust experiences, and nearly one-third observed a decline in their health since the attacks. Among survivors living outside Israel, 86.6% expressed concern about the future safety and identity of their children and grandchildren as Jews.<b>Conclusion:</b> Identifying Holocaust survivors (HS) who are experiencing psychological distress is crucial to providing them with appropriate therapy.