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• In this nationwide prospective study, we aimed to determine differences in psychopathology between Jews and Arabs in the post-October 7th attack. • Citizens belong to the Arab ethnic minority in Israel were found to be at a higher risk for psychopathology in the aftermath of the October 7, 2023. • Arabs presented a higher prevalence of probable PTSD and depression, controlling for prevalence of probable diagnoses at T1. On October 7, 2023, Israeli citizens came under an unprecedented terrorist attack that impacted the entire country. Recent research has begun to document the mental health impact of the attack but has yet to address the question of whether the attack had a differential impact across ethnic communities. In this nationwide prospective cohort study, we aimed to determine possible differences in psychopathology between Jews and Arabs in the post-October 7th attack. Specifically, we aimed to understand the role ethnicity may play in changes in probable PTSD, depression, and anxiety diagnoses from pre- to post-attack. The sample comprised 656 participants (332 female, 50.7%) aged 18–85 (M = 41.01, SD = 13.72). Of this cohort, 557 participants (84.9%) were Jews, and 99 (15.1%) were Arabs, reflecting their national proportionality. Validated self-report questionnaires were completed to assess PTSD, depression, and anxiety at two time points: August 20 to 30th, 2023 (T1; 6–7 weeks before the attack) and November 9–19, 2023 (T2; 5–6 weeks after the attack). At T2, Arab Israeli participants reported significantly higher prevalences of probable PTSD, depression, and anxiety diagnoses than Jewish Israeli participants. A series of hierarchical logistic regressions revealed that, compared with Jews, Arab participants presented with higher prevalence of probable PTSD (OR = 2.53 95% CI = 1.46–4.37, p < 0.0001), depression (OR = 1.68 95% CI = 1.35–3.01, p < 0.0001) and anxiety (OR = 6.42 95% CI = 3.95–10.52, p < 0.0001), controlling for prevalences of probable diagnoses at T1 as well as for trauma-related variables. Citizens belonging to the Arab ethnic minority in Israel were found to be at higher risk for psychopathology in the aftermath of the October 7, 2023, terrorist attack compared with their Jewish majority counterparts. Thus, it becomes critical to employ culturally sensitive assessments and interventions following the attack to prevent the development of chronic symptoms and disorders. [ABSTRACT FROM AUTHOR]

Lesbians, gays, bisexuals, and transgender individuals (LGBT) are at high risk for suicide. This study aimed to examine an integrative psychological model of risk factors among LGBT individuals and explore the psychological pathways connecting social stigma, mental pain, and interpersonal characteristics to suicidal ideation and behavior (SIB) in this population. LGBT adults ( N = 473) responded to an online questionnaire about stigma, mental pain, interpersonal characteristics, as well as suicidal ideation and behaviors. We found group differences between LGBT respondents in the study variables: Transgender people reported the highest levels of SIB and depression, closely followed by bisexuals. The association between stigma-related variables and SIB was mediated by depression, entrapment, and perceived burdensomeness. These results highlight the role of entrapment and burdensomeness in facilitating suicide risk among LGBT adults, as they may increase the damaging effect of negative societal stigma against LGBTs and thus, elevate the suicide risk in this population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Aims: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Method: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Results: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Limitations: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Background: Perpetrating or witnessing acts that violate one's moral code are frequent among military personnel and active combatants. These events, termed potentially morally injurious events (PMIEs), were found to be associated with an increased risk of depression, in cross-sectional studies. However, the longitudinal contribution of PMIEs to depression among combatants remains unclear., Method: Participants were 374 active-duty combatants who participated in a longitudinal study with four measurement points: T1-one year before enlistment, T2-at discharge from army service, and then again 6- and 12-months following discharge (T3 and T4, respectively). At T1, personal characteristics assessed through semi-structured interviews. At T2-T4, PMIEs and depressive symptoms were assessed., Results: At discharge (T2), a total of 48.7% of combatants reported experiencing PMIEs incident, compared with 42.4% at T3 and 30.7% at T4. We found a significant interaction effect in which combatants endorsing PMIEs at discharge reported higher severity of depression symptoms at discharge (T2) than combatants who reported no PMIEs. This effect decreased over time as depression levels were lower at T3 and T4., Conclusions: PMIE experiences, and especially PMIE-Betrayal experiences, were found to be valid predictors of higher severity of depression symptoms after the first year following discharge.

Background: While it is already known that potentially morally injurious events (PMIEs) have a deleterious effect on veterans, little is known about the changes in PMIEs subjective appraisals over time, as well as its contribution to changes in psychiatric symptoms. In the current study, we longitudinally assessed subjective appraisals of PMIEs experienced during combat military service and their associations with posttraumatic stress symptoms (PTSS) among recently discharged combat veterans., Method: Participants were 374 veterans who participated in a one-year longitudinal study with three measurement points: T1-one month before discharge from army service, and then again six months and twelve months following discharge (T2 and T3, respectively)., Results: Latent Growth Mixture Modeling (LGMM) indicated heterogenic patterns of changes in PMIEs across measurements. The 'resilient' (low and stable PMIEs) trajectory best represented PMIE, followed by 'recovery' and 'chronic' fluctuating trajectories. Moreover, the 'resilient' PMIEs trajectory was found to be consistently associated with lower PTSS scores compared to 'chronic' or 'worsening' trajectories., Conclusions: Our findings are the first to identify longitudinal trajectories of PMIEs subjective appraisals and to provide evidence of their association with PTSS, which might serve as potential assessment and intervention targets among recently discharged traumatized veterans., Competing Interests: Declaration of Competing interest All authors declare no conflict of interest of any kind., (Copyright © 2024. Published by Elsevier Ltd.)

With about 1200 individuals murdered, the massacre of October 7th was one of the deadliest terrorist attacks in modern history. The mental health consequences of terrorist attacks have been documented. However, little is known of the impact of the potentially morally injurious experience (PMIE) of betrayal--in which individuals feel betrayed by leaders they once trusted--on levels of psychological burden in the aftermath of such an attack. In this national prospective cohort study, we examined to what extent the PMIE of betrayal exacerbates the risk for posttraumatic stress disorder (PTSD) and depression in the wake of the October 7th terrorist attack. A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 (M = 41.01, SD = 13.72) completed validated self-report questionnaires assessing PTSD, depression, and PMIE-betrayal at two timepoints: T1, in August 2023 (6-7 weeks before the attack) and T2, in November 2023 (5-6 weeks after the attack). In two hierarchical logistic regressions, we found that experience of PMIE-betrayal predicted diagnoses of both PTSD (OR 1.92, 95% CI 1.26-2.92) and depression (OR 2.03, 95% CI 1.37-3.01) at T2, beyond probable PTSD/depression at T1 and demographic and trauma-related variables. Moreover, in two repeated-measure analyses predicting PTSD/depression symptoms, we found significant interactions between PTSD/depression trajectories and PMIE-betrayal, meaning that the increase of PTSD/depression symptoms was significantly higher among participants experiencing betrayal in the context of the attack. Our study highlights the impact of PMIE of betrayal on the dramatic increase in psychopathology following the October 7th terror attack on Israel's population. Clinicians treating individuals coping with PTSD and depression should attend to their patients' possible exposure to betrayal following the attack. Moreover, national leaders and policymakers should take significant steps to repair the public's betrayal experience., (© 2024. The Author(s).)

The terrorist attack of October 7, 2023, and its accompanying war have increased the risk for posttraumatic stress symptoms (PTSS) and suicide ideation (SI). In this national prospective cohort study, we examined the extent to which a sense of loneliness moderates the association between PTSS and SI in the wake of the October 7th attack and the Israel-Hamas war. A representative sample of 710 Israeli adults (362 female, 51.1 %) aged 18-85 (M = 41.01, SD = 13.72) participated in a longitudinal study assessing depression, current SI, and loneliness at two time points: T1, one month before the attack (August 2023) and T2 (November 2023), one month after the attack. We found two significant interactions in which a sense of loneliness at T2 moderated the link between both PTSS at T1 and T2 and current SI at T2. Specifically, the level of PTSS contributed to current SI at T2 more strongly among individuals reporting higher loneliness levels than those reporting low loneliness levels. Clinicians treating individuals coping with high PTSS levels should attend to their patients' sense of loneliness, as it comprises a significant risk factor for current SI and may be considered an important target in treatment., Competing Interests: Declaration of competing interest The authors declare no conflict of interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: With >1300 civilians murdered, the terrorist attack of October 7 is one of the deadliest terrorist attacks in modern history. Previous research documented a sharp increase in depression in the aftermath of the attacks and the military conflict that followed. In this national prospective cohort study, we examined to what extent perceived belongingness (PB) moderates the association between depression and suicide ideation (SI) in the wake of the October 7th terrorist attack., Methods: A representative sample of 710 Israeli adults (of them, 362 females, 51.1 %), Jews (557, 79.9 %), and Arabs (153, 20.1 %), aged 18-85 (M = 41.01, SD = 13.72) completed questionnaires assessing depression, current SI, and perceived belongingness at two timepoints: T1 (in August 2023) and T2 (in November 2023)., Results: Perceived belongingness at T1 predicted SI at T2 beyond demographic and trauma-related characteristics. Importantly, we found a significant interaction in which a PB at T1 moderated the link between depression and current SI at T2. Specifically, the level of depression at T2 contributed to current SI-T2 more strongly for individuals with low PB levels than for individuals with high PB levels., Discussion: Our study highlights the impact of PB on SI following the October 7th terrorist attack. Clinicians treating individuals coping with depression should attend to their patients' sense of belongingness, as low PB comprises a significant risk factor for current SI. Moreover, community and national initiatives that could increase levels of PB among the citizens may help to diminish suicide risk in the aftermath of the attack., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study examined the roles of resilience and willingness to seek psychological help in influencing Post-Traumatic Growth (PTG) among 173 emerging adults who experienced parental loss during their school years. A positive relationship was found between resilience, the willingness to seek psychological help, and PTG. Participants who endured loss over five years prior manifested increased PTG (New-Possibilities, Spiritual Change, and Appreciation of Life sub-scales) relative to those with more recent losses. The multiple regression model was notable, accounting for 33% of the variance in PTG. Both resilience and the willingness to seek psychological help assistance significantly predicted PTG, surpassing other predictors in the model. It is worth noting that the type of loss, whether sudden or anticipated, did not alter PTG levels. In essence, this study underscores the enduring positive psychological impact of parental loss on emerging adults, highlighting the critical need for comprehensive psychological resources and support for such individuals., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Being a man has been recognized as a salient risk factor for suicide. Adopting uncompromised masculine perceptions (i.e., conforming to the masculine gender role norms) may restrict emotional expressiveness in men, which, in turn, may contribute to depression and somatization symptoms. We examined the moderating role of psychological flexibility and alexithymia in the relationship of masculinity with depression and somatization symptoms. A sample of 119 men completed measures of masculinity, alexithymia (difficulty identifying and delivering subjective feelings), psychological flexibility, depression, and somatization symptoms in a cross-sectional design study. Psychological flexibility levels moderated the relationship between masculinity and depression symptoms: Masculinity contributed as positively associated with depression symptoms when psychological flexibility was low, but no such association was found at moderate or high levels of psychological flexibility. As a cognitive factor promoting adaptive emotional regulation, psychological flexibility might reduce depression symptoms among inflexible masculine men. Clinical implications relate to diagnosing at-risk subgroups and their treatment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Exposure to potentially morally injurious events (PMIEs) during military service is associated with heightened suicidal ideation (SI). However, no longitudinal study has established temporal associations between these variables and examined the possible mediating roles of depression and loneliness in this effect., Methods: Participants were 374 active-duty Israeli combatants who participated in a five-year longitudinal study with four measurement points: T1- one year before enlistment, T2- one month before discharge from army service, and then again six months and twelve months following their discharge (T3 and T4, respectively). Data were assessed through semi-structured interviews and validated self-report questionnaires., Results: Above and beyond pre-enlistment personal characteristics (T1) and combat exposure (T2), PMIEs-'betrayal' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of depression. Moreover, both PMIEs-'betrayal' and 'self' (T2) predicted more frequent SI over the past twelve months (T4) through the mediation of loneliness., Limitations: We used self-report measures to assess PMIEs and SI, which may suffer from various biases., Conclusions: Our findings are the first to provide evidence of longitudinal, temporal associations between exposure to PMIEs and SI. Notably, potential interventions might consider addressing the loneliness experienced following exposure to PMIEs during military service, among recently discharged traumatized veterans., Competing Interests: Declaration of competing interest We declare no financial/personal interest conflict of interest of all sorts that could affect our objectivity., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Suicide prevention is a priority globally. Community nurses are on the frontline of healthcare, and thus well placed to identify those at risk of suicide and act to prevent it. However, they are often ill-equipped to do so. This study examines whether depression management training for nurses may also help them manage suicide-risk patients., Method: This quasi-experimental study used a questionnaire that included a randomly assigned textual case vignette, measures related to patient descriptions portrayed in the vignette, and demographic and clinical/training information. The participants were 139 Israeli nurses who were mostly Jewish, Israeli-born, and married women working as community nurses. Almost half had completed depression management training (DMT) in their routine work., Results: Nurses who completed depression management training were more likely than non-trainees to query the patient regarding mental status and suicide plans and were more likely to refer them to appropriate further treatment. The graduate nurses also reported higher self-competence and more positive attitudes regarding their ability to assess depression and suicide risk than nurses who had not received depression management training., Discussion: The results highlight the importance of depression management training, as suicide assessment and referral are among the major steps to suicide prevention.

Background: Exposure to potentially morally injurious events (PMIEs) during military service has been associated with heightened trauma-related guilt levels, which in turn, could increase suicide risk among combat veterans. However, no longitudinal study has established temporal associations between these variables while examining a Moderated mediation model with self-forgiveness as a possible moderator of the PMIEs-suicide risk links during the first year following discharge., Method: Participants were 374 active-duty Israeli combatants who participated in a 5-year longitudinal study with three measurement points: 1 month before discharge from army service (T1), then 6 months (T2), and 12 months (T3) following their discharge. Data were assessed through semistructured interviews and validated self-report questionnaires., Results: All PMIE dimensions at T1 were negatively associated with self-forgiveness at T1 and positively associated with levels of trauma-related guilt at T2 and suicide risk at T3. Our longitudinal moderated mediation model findings indicate that, among those reporting low levels of self-forgiveness, higher levels of PMIE-Self and PMIE-Others at T1 contribute to trauma-related guilt levels at T2, which, in turn, are linked to a higher suicide risk at T3 among those reporting low levels of self-forgiveness., Conclusions: Experiencing PMIEs, especially PMIE-Self and PMIE-Other, proved to be validated predictors of trauma-related guilt and, in turn, of suicide risk during the first year after the veterans' discharge. Combatants at their discharge from the military should have access to targeted self-forgiveness interventions, as these interventions can have a buffering effect on the development of suicidal ideation and behaviors following PMIEs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: The magnitude of the Oct 7, 2023 attack in southern Israel was without precedent. More than 1300 civilians were murdered, and 240 civilians were kidnapped and taken hostage. In this national cohort study, for which baseline outcome data were established before the attacks, a prospective assessment of posttraumatic stress disorder (PTSD), depression, and generalized anxiety disorder (GAD) was conducted one month after the attack., Methods: A representative sample of 710 Israeli adults (362 female, 51.1%), Jews (557, 79.9%) and Arabs (153, 20.1%), aged 18-85 years (mean = 41.01, SD = 13.72) completed the study at two timepoints: T1, on Aug 20-30, 2023 (6-7 weeks before the attack) and T2, on Nov 9-19, 2023 (5-6 weeks after the attack). 30 (4.2%) of the 710 participants had direct exposure to the attack, and 131 (18.5%) had loved ones who were murdered, kidnapped, or injured during the attack., Findings: Probable PTSD prevalence almost doubled from 16.2% at T1 to 29.8% at T2 (p < 0.0001), with the prevalence of probable GAD and depression also increasing from 24.9% at T1 to 42.7% at T2, and from 31.3% at T1 to 44.8% at T2, respectively. Direct exposure to the attack was found to contribute to probable PTSD (OR = 3.15, 95% CI = 1.48-6.65) and probable depression (OR = 2.18, 95% CI = 1.02-4.87) at T2., Interpretation: Our study suggests a broad and significant impact of the Oct 7, 2023 attack on the mental health of the Israeli population. The findings underscore the need to provide rapid, nationwide assessments and triage for interventions to address the mental health needs of Jewish and Arab citizens., Funding: Not applicable., Competing Interests: Not applicable., (© 2023 The Authors.)

Background: Combatants who are exposed to events that transgress deeply held moral beliefs might face lasting psychopathological outcomes, referred to as Moral Injury (MI). However, knowledge about pre-deployment factors that might moderate the negative consequences of MI is sparse. In this prospective study, we examined pre-enlistment characteristics and pre-deployment personality factors as possible moderators in the link between exposure to potentially morally injurious events (PMIEs) and psychiatric symptomatology among Israeli active-duty combatants. Methods: A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements (T1: 12 months before enlistment, T2: Six months following enlistment - pre-deployment, and T3: 18 months following enlistment - post-deployment). Participants' characteristics were assessed via semi-structured interviews (T1) and validated self-report measures of personality factors: emotional regulation, impulsivity, and aggression (T2) and combat exposure, PMIEs, psychiatric symptomology and posttraumatic symptoms (T3) between 2019 and 2021. Results: Pre-enlistment psychiatric difficulties and negative life events contributed to higher exposure to PMIEs post-deployment. Higher levels of pre-deployment aggression and lower levels of emotional regulation and impulsivity moderated the association between betrayal, PMIEs and psychiatric symptomology post-deployment, above and beyond pre-enlistment psychiatric difficulties and life events. Conclusions: Our results highlight that pre-deployment emotional regulation, impulsivity and aggressiveness levels should be assessed, screened, and identified among combatants, as they all facilitate psychiatric symptomology (and PTSS) after combatants are exposed to PMIEs of betrayal. Such pre-assessment will enable the identification of at-risk combatants and might provide them with tailor-made preparation regarding moral and ethical situations that should be investigated in future research.

Understanding mental health professionals' (MHPs) willingness to treat suicidal older adults is critical in preventative psychotherapy. We examined the effect of a hypothetical patient's age and suicide severity on MHPs' willingness to treat or refer them to another therapist. Vignettes of hypothetical patients were presented to 368 MHPs aged 24-72 years. The vignettes had two age conditions (young/old) and three suicidality severity conditions. MHPs completed measures of their levels of willingness to treat/likeliness to refer and their levels of ageism. As suicide severity intensified, MHPs were less willing to treat and more likely to refer. Willingness to treat was the lowest for the old/suicide attempt condition. Ageism moderated the relationships between patient age and willingness to treat: MHPs with higher ageism were less willing to treat older than younger patients, regardless of suicidality severity. Findings indicate that MHPs with higher ageism levels are more reluctant to treat older suicidal patients and highlight the need for training MHPs to reduce ageism and enhance competence in suicide interventions.

Background: Exposure to potentially morally injurious events (PMIEs) during military service is known to be associated with psychiatric symptoms. However, antecedents and outcomes of exposure to PMIEs have only been studied in cross-sectional or retrospective-designed studies. In this prospective study, we examined associations between preenlistment characteristics, predeployment psychological factors, exposure to PMIEs, posttraumatic stress disorder (PTSD), and psychiatric symptoms, and the moderating roles of ethical leadership and ethical preparation, among combatants., Method: A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements. Participants' characteristics were assessed via semistructured interviews and validated self-report measures between 2019 and 2021., Results: Above and beyond preenlistment personal characteristics and psychiatric symptoms, predeployment psychological flexibility predicted higher levels of exposure to PMIEs-Other and Betrayal, and combat exposure predicted higher levels of exposure to PMIEs-Self, Other, and betrayal. Moreover, PMIEs-Betrayal predicted higher levels of PTSD and psychiatric symptoms, and ethical preparation predicted lower PTSD and psychiatric symptoms. Importantly, among combatants who reported high levels of ethical preparation and leadership, the association between exposure to PMIEs and PTSD and psychiatric symptoms following deployment dissolved., Conclusions: This is the first prospective study of antecedents and outcomes of exposure to PMIEs among active-duty combatants. Clinicians treating combatants should be aware of the putative role of psychological flexibility for exposure to PMIEs, as well as the promising mitigating role of ethical leadership and preparation for moral injury and psychopathological outcomes among combatants. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Suicide-loss survivors (SLSs)-individuals who lost family member to suicide, have been recognized as at risk for several mental health complications, including depression and suicide. Recent studies have emphasized the contribution of prolonged grief (PG) symptoms and suicide-related shame as facilitators of depression and suicide risk in the aftermath of suicide loss. In this six-year longitudinal design study, we examined self-criticism as a moderator of the link between PG and depression and suicide risk, with suicide-related shame mediating these links., Method: Participants were 152 SLSs (130 females) aged 18-70 who completed questionnaires assessing prolonged grief, depression, and suicide risk as well as trauma-related shame and self-criticism., Results: A moderated mediation model shows that high self-criticism intensified the relations between PG and shame and between shame and depression and suicide risk, above and beyond the contribution of the longitudinal PG trajectory. Importantly, the indirect effects of PG on both depression and suicide risk via shame levels were found only among SLSs with high levels of self-criticism., Conclusion: The findings highlight the critical longitudinal role of self-criticism in facilitating depression and suicide risk among SLSs with higher levels of PG. Theoretical implications relating to healing processes and focused clinical recommendations are discussed, including interventions for addressing self-criticism and suicide-related shame in the aftermath of suicide loss., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The nature of newspaper coverage of suicide events can impact suicide risk. Thus, the World Health Organization published recommendations for reporting suicide in the media. To date, Israel has no data regarding adherence to these media guidelines and no indication of the influence of the Israeli National Suicide Prevention Program (NSPP) on adherence. Aiming to fill these gaps, the current study examined (1) Israeli newspapers' adherence to the guidelines for suicide coverage and (2) the impact of the NSPP on the adherence level of media reporting., Method: Adherence to newspapers coverage guidelines was examined in two leading Israeli newspapers at three time points: T1 (2012, two years before the NSPP's establishment), T2 (2016-2017, 2-3 years after its establishment), and T3 (2018-2019, 4-5 years after NSPP's establishment). All articles reporting on suicide or suicidal behavior were analyzed at each time point regarding their adherence to the media guidelines., Results: Two hundred articles were assessed and analyzed. The adherence level was 49.35% across all time points. We found improved adherence at T2 (after the initiation of the NSPP) in most of the guidelines but a slight decline at T3. Adherence to guidelines regarding prevention ( Do guidelines) showed no significant improvement over time., Conclusions: General adherence to guidelines was relatively low. However, steps can be taken to improve media coverage of suicide stories. The NSPP should make greater efforts to promote changes in media coverage of suicide events in Israel, such as providing information about risk factors, prevention, and intervention. HIGHLIGHTSA longitudinal study examined Israeli newspapers over three time points in the last decade.General adherence level to the suicide coverage guidelines was 49.35% across all time points.The National Suicide Prevention Program was linked to improvement in adherence to most guidelines.

Objective: Moral injury (MI) is a stressor-related phenomenon that may entail long-term ramifications. However, no study to date has examined mental health professionals' (MHPs') knowledge and treatment perspectives regarding patients with MI. This study aims to shed light on MHPs' perspectives in an experimental design using a manipulation concerning a hypothetical patient., Method: The sample included 846 MHPs who were presented with one of four vignettes of a virtual patient with differential clinical conditions. Participants were then posed several questions regarding the patient's clinical condition, their willingness to treat, and their knowledge regarding MI., Results: Most participants reported no knowledge regarding MI. MHPs receiving MI-related scenarios were less willing to treat and more willing to refer the patient out than MHPs receiving non-MI scenarios. Professional seniority and training concerning MI contributed to greater familiarity with MI., Conclusion: The findings highlight that MHPs have minimal knowledge of MI, which may relate to their reluctance to treat patients with the psychological manifestations of MI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Many people lost a relative during the COVID-19 pandemic. Such a loss may have deleterious implications due to the circumstances of bereavement during lockdowns and social distancing. This study aimed to explore depressive symptoms, complicated grief, and suicidal ideation in the grieving process among 104 bereaved jewish adults who had lost relatives during the COVID-19 pandemic by completing self-reported questionnaires. The results indicate high suicidal ideation, complicated grief, and depression among them. Bereaved with suicidal ideation have an avoidant attachment and a close relationship with the deceased. These results highlight the adverse implication of COVID-19 on the grief process., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Combatants who are exposed to events which transgress deeply held moral beliefs might face lasting psychopathological outcomes such as Moral Injury (MI) and posttraumatic stress symptoms (PTSS). However, insight about pre-deployment personality factors which might facilitate the MI process and its negative consequences is sparse. In this prospective study, we examined pre-deployment aggressiveness as a possible predictor of exposure to combat and potentially morally injurious events (PMIEs), trauma-related guilt and shame and PTSS among Israeli active-duty combatants. A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements (T1: 12 months before enlistment, T2: 6 months following enlistment-pre deployment, and T3: 18 months following enlistment-post deployment). Participants' characteristics were assessed via semi-structured interviews (T1) and validated self-report measures of aggressiveness (T2), combat exposure, PMIEs and PTSS (T3) between 2019 and 2021. Results show that higher levels of pre-deployment aggressiveness predicted both combat exposure and PMIEs-'betrayal'. Combat exposure mediated the association between aggressiveness and PTSS post deployment. Importantly, pre-deployment aggressiveness was significantly associated with the PMIEs-'betrayal' that are associated with trauma-related guilt and shame, which in turn were associated with high levels of PTSS post deployment. Our results highlight the implications of pre-deployment aggressiveness for different forms of exposure to potentially traumatic events during military service. Identification of at-risk combatants for PTSS following exposure to PMIEs of betrayal might provide these combatants with a tailor-made type of preparation regarding moral and ethical situations, which should be investigated in future studies., Competing Interests: Declaration of competing interest NA., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Recent studies have shown that exposure to potentially morally injurious events (PMIEs) in deployment situations facilitates higher suicide risk among combatants. However, knowledge about pre-deployment factors that may moderate the negative contribution of PMIEs to suicide risk is rare. In this prospective study, we examined pre-enlistment characteristics and pre-deployment personality factors as possible moderators in the link between exposure to self, other, and betrayal dimensions of PMIEs and post-deployment suicide risk among Israeli active-duty combatants., Methods: A sample of 335 active-duty Israeli combatants participated in a 2.5-year prospective study with three waves of measurements: T1-12 months before enlistment, T2-6 months following enlistment (pre-deployment), and T3-18 months following enlistment (post-deployment). Participants were assessed via semi-structured interviews of personal characteristics (e.g., cognitive index) at T1, validated self-report measures of personality factors for emotional regulation, impulsivity, and aggression at T2, and combat exposure, PMIEs, and suicide risk at T3 between 2019 and 2021., Results: All three dimensions of PMIEs were significantly associated with higher suicidal risk among combatants. Importantly, higher levels of pre-deployment aggression and lower levels of emotional regulation moderated the association between PMIEs and suicide risk post-deployment, above and beyond pre-enlistment psychiatric difficulties and life events., Conclusions: Our results highlight the roles of pre-deployment factors of emotional regulation and aggressiveness as possible moderators in the PMIEs-suicide risk link. These results emphasize the need for higher awareness of suicide risk among deployed combatants with low emotional regulation and high aggressiveness. Moreover, tailored interventions aiming to decrease emotional dysregulation and aggressiveness levels should be considered, as such interventions may help reduce suicide risk following combat-related transgressive acts., Competing Interests: Conflict of interests NA., (Copyright © 2022. Published by Elsevier B.V.)

Background: Government actions and participating in protracted-duration protests against it affect protesters' mental health, leading to high distress levels, such as posttraumatic and depressive symptoms. Aside from exposure to violence and other issues, protest participation can pose unique challenges to the protesters as they may be exposed to potentially morally injurious events (PMIEs), such as the betrayal of leaders they once trusted. This study's primary objective was to examine the extent of psychological difficulties among civilians participating in long-duration protests in Israel. More specifically, the study aimed to understand the contribution of exposure to protest-related PMIEs to psychological difficulties such as posttraumatic and depressive symptoms. Method: Participants comprised 4036 Israelis who were actively involved in the unfolding civil protest movement against the government-led judicial overhaul between January 2023 and August 2023. The protesters completed validated self-report questionnaires that included measures of PMIE exposure, PTSD and depressive symptoms. Results: About half (44.3%) of the sample met the criteria for self-report diagnosis of major depression and 10.6% for PTSD. Most of the protesters indicated their exposure to at least one moral injury event, with 63.9% reporting exposure to PMIE-Betrayal. Protesters exposed to PMIEs reported significantly higher levels of both PTSD and depression than non-PMIE-exposed protesters. Hierarchical regression analyses revealed that, beyond demographics and protest-related characteristics such as exposure to violence, PMIE dimensions significantly contributed to both PTSD and depression levels. Conclusions: The findings highlight the mental burden of protesters during the civil protests against the judicial overhaul in Israel. More central to the present research, the findings highlight the critical contribution of PMIEs exposure to this burden. Clinicians treating protesters coping with depression and PTSD following the civil actions should attend to their exposure to PMIEs, which may relate to the deleterious psychological effects among protesters.

Background: During the COVID-19 pandemic, health and social care workers (HSCWs) are facing morally challenging situations and life-threatening decisions. Following exposure to potentially morally injurious events (PMIEs) that undermine deeply held moral beliefs and expectations, HSCWs might experience moral injury (MI) and other deleterious psychiatric consequences. The present study examined associations between exposure to PMIEs, MI symptoms, posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), and self-criticism among HSCWs., Method: A sample of 296 Israeli HSCWs responded to online validated self-report questionnaires in a cross-sectional designed survey in February and March 2021., Results: Participants' self-reported PTSD (8.9%) and CPTSD (4.8%) rates match the rates of Israel's general population. A moderated-mediation model shows that high self-criticism intensified the relations between exposure to PMIEs and MI symptoms, and between MI symptoms and CPTSD symptoms. Importantly, the indirect effect of exposure to PMIEs on both PTSD and CPTSD symptoms via MI symptoms existed only among those with high levels of self-criticism., Conclusions: The study's findings offer a novel overview of the associations between patterns of exposure to PMIEs, MI, PTSD, and CPTSD. Clinicians treating HSCWs coping with COVID-19-related moral injury should be aware of the importance of high self-criticism in the possible posttraumatic sequelae of exposure to PMIEs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: Following exposure to events that transgress moral beliefs and expectations rooted in cultural, organizational, and group-based ethical rules, veterans can experience psychological, social, and spiritual problems referred to as Moral Injury (MI). We examined patterns of exposure to potentially morally injurious events (PMIEs) among Israeli veterans as well as psychological and functional correlates of exposure., Method: A sample of 381 Israeli veterans volunteered to complete a cross-sectional electronic survey between 2017-2018. Latent Class Analysis (LCA) was used to identify classes characterized by unique patterns of exposure to PMIEs and compare differences in psychological and functional problems., Results: Three subgroups were identified: Moral Injury (12.1 %), Betrayal-Only (20.8 %), and Minimal Exposure (67.1 %). Whereas those in the betrayal-only class reported more traditional posttraumatic symptoms and those in the moral injury class reported more moral injury symptoms (i.e., guilt-related cognitions), some psychological problems were shared by veterans assigned to the moral injury and betrayal-only classes (e.g., entrapment). Importantly, while both those in the betrayal-only and moral injury classes had lower forgiveness relative to those in the minimal exposure class, those in the betrayal-only class received more familial support than did those in the moral injury class., Conclusions: The study's findings offer an overview of the complex associations between patterns of exposure to PMIEs and associated outcomes. Clinicians treating veterans coping with combat trauma should be aware of the unique and shared symptoms reported by those with moral injury and betrayal exposures., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Survivors of suicide loss (suicide survivors) are recognized as an at-risk population for several psychiatric complications, including complicated grief (CG) and suicide ideation (SI). Recent studies have emphasized the contribution of interpersonal factors, such as thwarted belongingness and perceived burdensomeness, on distress and suicidality. However, no longitudinal study has examined the predictive values of these interpersonal factors on CG and SI trajectories among suicide survivors to date. In this 42-month prospective design study, we examined interpersonal variables as predictors of CG and SI over time., Method: Participants were 152 suicide survivors, aged 18-70, who completed questionnaires tapping thwarted belongingness, perceived burdensomeness, CG, and SI at index measurement (T1) and again after 18 months (T2) and 40 months (T3)., Results: The integrated model showed that thwarted belongingness and perceived burdensomeness predicted SI and CG levels over time, both directly and indirectly. Thwarted belongingness was found to have a high predictive value on SI levels, whereas perceived burdensomeness was predictive of CG levels., Limitations: The voluntary nature of the participants; self-report measures; lack of pre-suicide-loss assessment., Conclusion: The study's findings highlight the critical role of interpersonal factors in facilitating CG and SI among suicide survivors. Those with higher levels of thwarted belongingness and perceived burdensomeness presented increased prospects of both SI and CG. Theoretical implications relating to healing processes are discussed, as well as focused clinical recommendations, including psychoeducational interventions for addressing PB and TB among suicide survivors., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Research has demonstrated that traumatic experiences have significant links to suicidal ideation (SI), particularly among older adults. The present study examined SI among older adults with a history of war trauma and the role of perceptions relating to one's age (subjective age) in predicting SI., Method: Drawing from a larger longitudinal study, we analyzed data based on interviews with 125 ex-prisoners of war (ex-POWS) from Israel's 1973 Yom Kippur War and a control group of 101 veterans from the same war who did not fall captive (mean age at most recent measurement was 65.05, SD age = 5.29). Participants were interviewed in 2008 (T1) and again in 2015 (T2)., Results: Findings revealed significantly higher levels of SI among ex-POWs than evident among controls and significantly higher levels of SI and subjective age among ex-POWs with PTSD. Furthermore, a sequential mediation analysis indicated that among ex-POWs, the path from T1 PTSD symptoms to subsequent SI was mediated by subjective age at T1, and subjective age at T2, after controlling for age, self-rated health, and SI at T1., Conclusion: A subset of ex-POWs are exposed to continuous suicidal risk throughout their later life, more than 40 years after the war. Furthermore, an older subjective age mediated these associations, independent of the levels of T1 SI, actual age, and self-rated health. These findings suggest debilitating long-term effects of trauma for SI in later life and their connections to advanced psychological aging. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: Posttraumatic growth (PTG) is a significant positive change experienced by an individual following stressful or challenging life events in his or her life. PTG has been explored in various populations; however, only recently, the concept has been applied to suicide bereavement and postvention. This systematic review aims to explore whether PTG can ensue in the aftermath of a suicide loss and what are the sociodemographic and psychological correlates of PTG among suicide-loss survivors., Method: A systematic review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, identified 11 quantitative studies published between 2009 and 2019. The review was followed by an examination of the pooled effect size for the main correlates of PTG., Results: PTG following suicide loss was reported to be positively associated with time since loss, adaptive coping strategies, and help-seeking. Furthermore, perceived social support and self-disclosure mediated the relations between both PTG and attachment style and between PTG and belongingness. A meta-analysis provided evidence that these two factors have strong averaged pool effects for their correlations with PTG., Conclusions: The systematic review and meta-analysis found evidence of PTG following suicide loss and identified several psychosocial correlates of growth. Limitations of the reviewed studies, which included a lack of control groups and cross-sectional design, constrain the generalizability of the findings. Nonetheless, PTG is a relatively new area of research in postvention that carries substantial implications for the delivery of effective support to individuals coping with suicide loss. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The outbreak of COVID-19 has increased potential risks for depression and suicide among older adults. In this paper, we discuss the specific risk factors and current status of older adults in Israel in light of the COVID-19 crisis. Following that, we suggest establishing relevant and effective measures for suicide assessment, intervention, and prevention to avert experiences of loneliness, thwarted belongingness, and perceived burdensomeness and thus prevent suicides during and after the crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: The study of suicide-loss survivors-specifically the study of healing processes in this population-is scant. This study represents an effort to extend this field by developing a comprehensive understanding of the underlying interpersonal facilitators of posttraumatic growth (PTG) among suicide-loss survivors in an 18-month longitudinal design. Our aim was to examine the key interpersonal factors that influence positive growth among survivors over time., Method: Participants included 156 suicide-loss survivors (132 women and 24 men), aged 18 to 70. Participants completed several questionnaires, tapping the interpersonal factors of self-disclosure, social support, thwarted belongingness, and perceived burdensomeness at T1 (baseline). Moreover, participants were assessed on PTG levels twice: at T1 and again at T2 (18 months later)., Results: Belongingness, self-disclosure, and social support were found to be facilitators of increasing PTG levels at T2. Structural equation modeling analysis revealed that self-disclosure and social support mediate the relationship between belongingness and PTG (T2), beyond the contribution of PTG at T1., Conclusions: On the basis of these findings, it can be inferred that the interpersonal factors of belongingness, self-disclosure, and social support play important roles in facilitating PTG among suicide-loss survivors. Thus, basic psychoeducational interventions specifically designed to foster self-disclosure and acquire support can help suicide-loss survivors achieve PTG following their traumatic loss. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Losing a loved one to suicide may have detrimental effects, one of them being suffering from complicated grief (CG). To date, no studies have fully examined the psychological processes that delineate the risk and resilience factors that contribute to CG among suicide-loss survivors (SLSs). We hypothesized that social support and self-disclosure would moderate the relationship between attachment styles and CG for SLS. Questionnaires assessing attachment style, self-disclosure, social support, and CG were completed by 156 SLS participants. A regression model revealed that secure attachment negatively predicted CG, but self-disclosure moderated this association. Secure attachment seems to be a resilient factor for CG. However, SLS with low secure attachment but high in self-disclosure ability use this behavior as a way to impede CG. The capacity to seek out other people, to share experiences with them, and to accept comfort from them may offer a means for SLS to better deal with their tragedy.

Combat veterans have been identified as a major at-risk group for suicide. Moral injury (MI) experiences have recently been acknowledged as significant stressful combat events that may lead to psychopathology, such as suicidal ideation and behaviors (SIB). In this study, we aimed to examine to what extent potential MI events may comprise risk factors for SIB and to explore the mediating role of the entrapment experience in this relationship. A sample of 191 Israeli combat veterans (M ag e   = 25.39, SD = 2.37) completed validated self-report questionnaires in a cross-sectional design study. All potential MI experiences were significantly related to SIB levels among veterans. Moreover, self- and betrayal-based MI experiences were significantly associated with sense of entrapment, which subsequently was associated with high levels of SIB. The integrative model indicated that entrapment and depression served as mediators in the association of MI-SIB. Even years after their release from military service, veterans exposed to potential MI experiences may still feel consumed by their painful memories and still have premonitions of a foreshortened future. Thus, they are more prone to SIB as well as to other mental health problems., (Copyright © 2018. Published by Elsevier B.V.)

Combat stress reaction (CSR) has widespread long-term consequences, including profound psychopathology in the form of posttraumatic stress disorder (PTSD). Studies have established the link between combat, PTSD, and suicidality. However, little is known about the temporal course of suicidal ideation (SI) in general, specifically among war veterans. We aimed to trace the trajectories of SI in the aftermath of war and to explore the role of CSR and PTSD in SI trajectories. Israeli veterans with CSR (n=164) and a matched control group (NCSR, n=111) were assessed, using self-report measures at three points over the course of 20 years. Veterans with CSR reported significantly higher levels of SI, compared to the NCSR group at all measurement points. Among veterans with CSR, SI increased 2 years after the war and then decreased 20 years following the war. This pattern was particularly characteristic of veterans with chronic PTSD. The results indicate that CSR is a strong predictor of subsequent PTSD and suicidality. These findings highlight the importance of prevention and treatment efforts for these traumatized veterans, who are at risk for suicide even 20 years after the end of the war., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Although the study of medically serious suicide behavior is an important strategy for understanding the nature of suicide, little is known about its underlying psychological mechanisms. This gap is addressed here by applying insights from attachment theory to severe suicidal behavior. The results show that both anxious and avoidant attachment patterns predict medical lethality. Path analysis indicated that interpersonal difficulties mediated the paths between insecure attachment patterns and lethality of suicide attempts. These results suggest that the psychological mechanisms of medically serious suicide behavior involve high levels of mental pain amplified by insecure attachment patterns and interpersonal difficulties. Implications for prevention and therapeutic intervention strategies are discussed., (© 2013 The American Association of Suicidology.)