Mental health distress and associated factors among online CBT service users during the Iron Swords War

Background: The October 7, 2023 attacks in Israel and the ensuing Iron Swords War triggered a widespread mental health crisis. In this context, online cognitive behavioral therapy (CBT) has emerged as an accessible and convenient option. Objective: To characterize individuals who sought out online CBT during the war, with regard to their sociodemographic characteristics, wartime exposures, and self-reported psychological distress and to evaluate the associations between sub-populations characteristic and psychological distress severity. Methods: Data were analyzed from electronic medical records of civilians who contacted Sheba BEYOND's virtual CBT clinic between November 2023 and August 2024. Sociodemographic characteristics, psychiatric history, and wartime exposures were available for 520 adults, 199 of whom also completed standardized psychological questionnaires (including PDS-5, GAD-7, PHQ-9) which were used to measure sever psychological symptoms of PTSD, anxiety and depression. Results: Individuals seeking online services during the war represented a diverse population in terms of their socio-demographic background (e.g., age range; level of educational, employment status, and place of residence) and war-related experiences. High rates of psychological symptoms were observed: 62.3% of respondents scored ≥36 on the PDS-5, 43.2% met criteria for severe anxiety (GAD-7 score ≥15), and 20.1% met criteria for severe depression (PHQ-9 score ≥20). The multivariable model indicated that displaced individuals were at a significantly elevated risk for PTSD (OR = 6.33; 95% CI 1.74-23.05), for anxiety symptoms (OR = 4.67; 95% CI 1.76-12.41), and for depressive symptoms (OR = 2.97; 95% CI 1.05-8.36). In addition, history of interpersonal trauma was associated with increase the risk of severe PTSD, anxiety, and depressive symptoms. Discussion: The high level of psychological distress observed in this study highlight the importance of accessible wartime mental health care. By reaching populations across diverse sociodemographic backgrounds and varying levels of trauma exposure, online interventions demonstrate the potential feasibility and accessibility necessary to provide mental health support during time of crisis. The identification of both high symptom severity rates and subpopulation at higher risk provides valuable information for future preparedness for such services during emergencies.