The cost of ongoing war: escalation of continuous traumatic stress response over time and later functional, adjustment, and affective difficulties.

BACKGROUND: Continuous Traumatic Stress Response (CTSR) refers to psychological, emotional, and behavioral reactions that emerge under conditions of ongoing, realistic, and future-oriented threat. Recently, CTSR received empirical attention in areas affected by political armed conflict; studies have been cross-sectional. Therefore, there is limited understanding of CTSR dynamics over time. METHODS: The current longitudinal study examined changes in CTSR during the Israel-Hamas war and its associations with functioning problems, maladjustment, and psychological burden (anxiety and depression). The study included 519 Israeli adults assessed during weeks 4-6 of the war (T1), and 264 participants during weeks 23-36 (T2). CTSR was evaluated at both waves, and war exposure, functioning problems, maladjustment, and psychological burden at follow-up. Latent change score models estimate within-person change in CTSR and the prospectively associaitons with follow-up outcomes. RESULTS: Higher baseline CTSR and greater increases in CTSR were prospectively associated with greater functioning problems, maladjustment, and psychological burden at follow-up. CONCLUSIONS: CTSR may be a dynamic indicator of accumulating psychological risk. Monitoring changes in CTSR during prolonged conflict may help identify individuals at increased risk for later functional impairment, maladjustment, and emotional difficulties. CTSR-informed assessment may improve early identification, triage, and prevention efforts in populations exposed to continuing danger.