Overall and sex-specific associations between secondary trauma exposure and health decline post October 7th, 2023: a population-based study

Background: Secondary trauma exposure is associated with secondary traumatic stress and impaired mental well-being, but effects on physical health and behaviors are less understood. This study addresses this gap by examining associations between secondary trauma exposure and physical, mental and behavioral health outcomes six months after the October 7th terror attack in Israel, and whether these differed by sex. Methods: We administered a population-based survey among n = 1128 Israeli adults (50% women). Secondary trauma exposure was assessed by source: professional activity, firsthand accounts, and media (television, internet/social media, newspaper, radio). Outcomes included self-reported worsening mental and physical health, worsening sleep, and initiation of ≥2 negative health behaviors. Overall and sex-stratified logistic regression models were used to estimate average marginal effects adjusted for sociodemographic factors, social wellbeing and direct/indirect trauma. Results: Unexpectedly, profession-related exposure was inversely associated with worsening health behaviors; in sex-stratified analyses, this trend appeared only in men and extended across outcomes (8.3–19.5% lower predicted probabilities). Exposure to firsthand accounts was associated with worsening health behaviors in men and worsening mental health in women (12.0% and 14.6% increases, respectively). Media exposure via television and internet/social media was associated with worsening sleep; exposure to multiple media sources was associated with both worsening sleep and mental health. A cumulative media-exposure effect was observed only in women. Conclusions: Secondary trauma exposure was associated with decline in mental health, physical health and health behaviors, beyond direct/indirect war-related trauma. Source-specific and sex-specific patterns highlight the importance of tailored strategies to reduce health consequences of secondary trauma during crises.