Israeli military veterans who saw violence of any kind -- from fighting in a war to being a bystander in a terror attack - were three times more likely to develop aggressive behavior in civilian life than those who did not, regardless of whether or not they served in a combat unit, according to a new study of post-army men. The survey, which polled 1,000 men aged 21 to 48, was conducted by Metiv, the Israel Psychotrauma Center at Jerusalem’s Herzog Medical Center.
Every year, thousands of released Israeli combat soldiers face the difficult transition back to civilian life. Many spend months overseas as a means to discharge and mitigate the psychological impact of intense combat experiences faced during their military service.
Despite the well-known image of the resilient Israeli soldier, long-term effects of veterans’ exposure to stress from combat are well documented.
Few studies on IDF PTSD
Veterans can suffer from a myriad of psychological difficulties ranging from difficulties in relationships, aggressiveness, sleep disturbances, substance abuse and depression.
The prevalence of PTSD among veterans has been studied mostly among US veterans who were deployed to battlefronts such as Iraq and Afghanistan and upon return from a specific front or among soldiers who sought treatment for their problems. But until now, the prevalence of PTSD and associated psychological symptom profiles comparing combat and non-combat veterans in Israel has not been studied.
In Israel, PTSD in the general population exposed to rockets and missiles from terrorists fluctuates, though at times of increased conflict it can be as high as 10%.
Despite the high participation rate in the army due to mandatory service there have been few studies comparing military-related outcomes among combatants and non-combatants following their compulsory military service.
“What is important when looking at soldiers is not their formal status of being in a combat unit or serving elsewhere, but more the exposure to combat situations."
Metiv
Metiv's study on IDF combat veterans
The study, conducted via questionnaires in September 2021 and analyzed by clinical psychologist and Metiv research head Dr. Anna Harwood-Gross and Metiv director-general and PTSD expert Prof. Danny Brom, was titled “Exposure to combat experiences: PTSD, somatization and violence amongst combat and non-combat veterans.”
Half the veterans served in combat units and in firefights, while the other half were not engaged in combat. Exposure to combat was determined by asking whether participants had been under fire, taken part in a combat situation, been next to a combat situation, witnessed from afar a combat situation or were never exposed to a combat situation during their military service. The study has been submitted to a journal for publication.
“What is important when looking at soldiers is not their formal status of being in a combat unit or serving elsewhere, but more the exposure to combat situations. The exposure does happen also to a certain degree to people serving in non-combat roles. While combat veterans demonstrated more psychological symptoms than non-combat veterans, the greatest difference was observed for those exposed to combat experiences regardless of service type,” they wrote.
The Metiv team stated that the study “directly impacts the design of post-military care structures and indicates that greater attention should be paid to the characteristics of an individual’s service rather than to their role classification.
There are many post-military program protocols, but the majority are designed for combat units. It is recommended to consider whether these programs are suitable for non-combatants and if not, how to adjust them for both combatant and non-combatant populations.”
Helping IDF soldiers with PTSD
For the last 13 years, Metiv – which promotes healthy coping and post-traumatic growth within Israeli society through innovative evidence-based interventions, training and research – has run its Peace of Mind program for veterans to become more aware of how tense and short-fused they are. They have held about 120 such trips in which more than 2.000 veterans participated.
Combat units that fought together are sent abroad for a week as guests of local Jewish communities to escape the pressure and are helped to process their battle experiences in learning strategies to deal with trauma and loss.
This process, according to Brom, helps to better adapt the soldier to civilian life, develop resilience and coping resources and identify those who need individual treatment.
After their return, there are follow-up workshops six weeks and six months later, led and facilitated by experienced clinical social workers and psychologists from Metiv.
The new survey assessed PTSD, depression, anxiety and bodily symptoms in addition to the prevalence of physical violence.
Veterans and violence in civilian life
Veterans exposed to combat who were not violent before their military service tended to exhibit higher PTSD and somatic symptoms and greater anxiety.
The researchers noted that non-combatants are not immune from combat exposure; indeed, it appears the act of deployment provides exposure to combat events for all branches of the military.
However, there was a significant difference between combatants and non-combatants. Fully 77.7% (415) of combatants had been under fire, in combat or near it; 6.4% (34) witnessed combat and 15.9% (85) were not exposed. Among the non-combatants, only18.2% (95) were actively exposed; 11.3% (59) witnessed combat; and 70.5% (368) were not exposed.
The Metiv team noted that PTSD treatment for veterans in Israel “has been blighted by fierce criticism over inclusion criteria, insurmountable levels of bureaucracy and a recent reform driven by a veteran immolating himself following difficulties getting recognized as suffering from combat related PTSD.
”While there is no research assessing non-combatants’ access to veteran PTSD services in Israel, the current media coverage of the mental health reform highlighted how difficult it was to be recognized as a combatant with PTSD, let alone as a non-combatant.”