The moderating role of sustained missile attacks on stress as a mediator between exposure to terror and depression, anxiety, and health.

Objective: This study explored psychological distress in communities impacted by mass trauma, focusing on the effects of sustained missile attacks. Method: The psychological effects of exposure to the October 7, 2023, Hamas attacks were assessed in 173 participants, measuring stress, anxiety, depression, and general health. Results: Analyses of covariance showed that participants directly exposed to Hamas attacks reported higher levels of stress, anxiety, and depression and lower general health compared to nonexposed participants. Moderated mediation analysis indicated that stress mediated the relationship between exposure and psychological distress (anxiety, depression, and general health), with stronger effects among those exposed to intense missile attacks. Gender and marital status significantly were related to psychological distress, with women and married participants reporting higher stress and anxiety. Conclusions: The findings suggest that sustained terror is associated with heightened psychological distress after mass trauma, emphasizing the importance of considering such contexts in psychological assessments.