Psychiatric outcomes in the first two years after the October 7 attacks: a systematic review of posttraumatic stress, anxiety, depression, and addiction-related outcomes.

OBJECTIVES: The October 7 attacks and ensuing war created conditions of sustained, multidimensional trauma. This systematic review synthesizes studies from the first two years of the war to clarify early prevalence of post-traumatic stress symptoms (PTSS), anxiety, depression, and addiction-related outcomes in the Israeli population. METHODS: Following PRISMA 2020 guidelines, PubMed, PsycINFO, Scopus, and Web of Science were searched identifying studies published between October 7, 2023 and October 7, 2025 (final search date December 30, 2025). Guided by the PICOS framework, eligible studies assessed psychiatric outcomes among Israeli populations exposed to the October 7 attacks or subsequent war. Outcomes of interest included posttraumatic stress, anxiety, depression, and addiction-related outcomes, and observational quantitative and qualitative studies were included. Risk of bias was assessed using Joanna Briggs Institute tools. Findings were synthesized narratively, with attention to exposure characteristics, subgroup differences, and time of assessment. RESULTS: Sixty-eight studies met inclusion criteria. Symptom trajectories were heterogeneous and varied with exposure intensity and contextual vulnerability. Elevated PTSS was associated with direct, cumulative, and role-related exposure. Anxiety and depression were widely documented and persisted among individuals facing sustained threat, socioeconomic strain, or displacement. Addiction-related outcomes, an emerging and comparatively understudied domain, were examined in only three studies, with preliminary evidence suggesting exposure and distress-associated increases in substance use and gambling. CONCLUSIONS: Psychiatric responses following October 7 were domain-specific and associated with exposure, ongoing stress, and structural and individual vulnerabilities, underscoring the need for targeted, longitudinal monitoring in prolonged crisis contexts.