Israeli women reported a far sharper slide in sleep and mental health than men after October 7, especially when they were heavily exposed to war content across multiple media platforms, according to a population-based study accepted for publication in Comprehensive Psychiatry.
The study, titled “Sex differences in secondary trauma exposure and health decline during crisis,” was authored by Liat Orenstein (Gertner Institute for Epidemiology and Health Policy Research at Sheba Medical Center), Arielle Kaim and Bruria Adini (Tel Aviv University), and Sharon Stein Merkin (Gertner Institute and UCLA).
The researchers looked at what happens when people absorb trauma indirectly, through constant exposure to disturbing images, videos, and stories. They call it “secondary trauma,” meaning stress that builds up from repeated contact with traumatic details, even when a person was not directly harmed.
To measure that effect, the team surveyed 1,128 Israeli adults (half women) about six months after the October 7 attacks, asking whether their mental health, physical health, sleep, and daily health habits had worsened since the war began.
They tracked three main routes of exposure: through work, through firsthand accounts (hearing from people directly affected), and through media (television and internet or social media, plus other formats).
The strongest signal in the study was sleep.
High exposure to war-related content on television and on the internet/social media was linked to worsening sleep.
Then came the gap that matters for readers: when exposure piled up across more than one platform, women’s outcomes got worse faster.
The researchers found a clear dose-response pattern for sleep overall, meaning people exposed heavily through more types of media were more likely to report worse sleep.
When they split the results by sex, that “more sources, worse outcomes” pattern appeared only among women, while men showed increased risk linked to a single high-exposure source but did not show the same step-by-step worsening as sources stacked up.
One number captured the difference: among people heavily exposed through multiple media sources, the model’s predicted probability of worsening sleep reached 73% for women, compared with 49% for men.
Mental health also showed gender split
The study found that heavy exposure from two or more media sources was linked to worsening mental health overall.
Men showed an association between a single media source and worsening mental health, and the researchers reported that the sex interaction for mental health was statistically significant.
The broader pattern still leaned in one direction: women had higher predicted probabilities of deteriorating health associated with cumulative media exposure, especially sleep, and the study’s discussion highlights “higher overall health deterioration among women compared to men.”
Personal stories hit women and men differently
Media was not the only trigger.
When secondary exposure came through firsthand accounts, the sex divide showed up again. In the sex-stratified results, the study linked this type of exposure to worsening mental health in women, while men showed a different pattern, with a link to worsening health behaviors (changes like eating, exercise, smoking, or alcohol use).
Supplementary figures cited in the paper describe large gaps in predicted probabilities for those exposed through firsthand accounts, including 57% vs. 22% for worsening mental health and 66% vs. 41% for worsening sleep, in women compared to men.
Why might women have been hit harder?
The paper does not claim a single cause, but it offers several plausible explanations rooted in wartime life.
One suggested factor is the spike in household and economic responsibilities many women carried during the war, including childcare and covering responsibilities when partners were called up. The authors point to reserve duty recruitment and note that a large portion of those recruited were fathers.
They also flag possible differences in help-seeking behavior and health reporting patterns, and mention socioeconomic differences in some exposed professions as additional factors that could influence what people report and how they cope.
On the media side, the researchers note that television and social media can share the same high-intensity ingredients: vivid images, video clips, and constant updates, which can amplify fear responses and keep stress cycling instead of fading.
Caveat about men’s 'no pile-up' finding
The study also offers a technical caution that matters for interpretation.
The authors write that one possible reason men did not show the same cumulative effect with multiple media sources is that the subgroup of men with high exposure to more than one media type was relatively small. They also note that this group had a higher share of past volunteering, which could reflect different coping tools or support systems.