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Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
https://doi.org/10.1186/s13584-024-00665-1 Israel Journal of Health Policy
Research
*Correspondence:
Orly Sarid
orlysa@bgu.ac.il
1The Spitzer Department of Social Work, Ben-Gurion University of the
Negev, Beer Sheva 84105, Israel
2The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
3School of Social Work, Yaira Hamama-Raz, Ariel University, Ariel, Israel
Abstract
Background Conducted in May 2024, this study examines the well-being of Israeli evacuees and non-evacuees from
conict zones. We assess health-related quality of life (HRQoL), meaning in life (MIL), coping strategies, psychological
symptoms, and self-mastery. Aims include exploring eects of trauma and socio-demographics on HRQoL and MIL,
analyzing mediating roles of psychological symptoms and coping, and evaluating if evacuation status moderates
these relationships during ongoing conict.
Methods In May 2024, seven months post–October 7th attacks, we conducted a cross-sectional study with 366
participants (221 evacuated, 145 non-evacuated) via a survey company. We assessed HRQoL (SF-12), MIL (MLQ),
psychological symptoms (PHQ-4), self-related and other-related coping strategies (Brief COPE), and self-mastery
(Self-Mastery Scale) through self-reported measures. Path and moderated mediation analyses evaluated relationships
among socio-demographics, psychological symptoms, coping variables, HRQoL, and MIL.
Results Except for self-mastery, northern and southern evacuees showed no signicant dierences and were
combined into one group. Path analysis revealed signicant associations between traumatic life events, HRQoL,
and MIL. Traumatic events were negatively associated with the physical component summary (PCS) of HRQoL and
positively with anxiety, depression, and coping (self and others- problem-solving). Depression negatively related
to PCS, mental component summary (MCS), and MIL, while coping (self and others) was positively associated with
MIL. Moderated mediation analysis showed evacuated participants had higher dysfunctional coping, whereas non-
evacuated participants demonstrated a stronger positive relationship between anxiety and the search for meaning.
Conclusion Despite regional dierences, evacuees exhibited similar psychological responses, likely due to the
shared experience of displacement. Traumatic events negatively impacted their HRQoL and MIL. Adaptive coping
strategies—self-related and problem-focused coping through helping others—played signicant roles in mitigating
these eects. The theoretical frameworks of Conservation of Resources (COR) theory, Taylor’s “tend and befriend”
model, and Frankl’s existential framework provided a basis for explaining these ndings.
Keywords Traumatic events, Health-related quality of life, Meaning in life, Coping strategies, Self-mastery, Evacuation
Coping, meaning in life, and quality of life
during ongoing conict: insights from Israeli
populations
OrlySarid1* , LiatHamama2 and YairaHamama-Raz3
Page 2 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
On October 7, 2023, an attack by Hamas precipitated a
massacre, numerous abductions, the outbreak of war,
and the evacuation of approximately 126,000 people [1].
is study, focused on individuals from the southern and
northern regions of Israel who were evacuated due to the
conict, as well as those who remained in their homes fur-
ther inland with less direct exposure. Both evacuees and
non-evacuees were surveyed to assess various aspects of
their well-being, including quality of life, meaning in life,
coping strategies, and psychological symptoms.
Background
Health policymakers face signicant challenges in ensur-
ing the well-being of people in conict zones, where
increased health risks and disrupted protective factors
are prevalent [2].
Traumatic life events signicantly inuence individuals’
physical and mental health, aecting their health-related
quality of life (HRQOL) and sense of meaning in life
(MIL). Guided by Taylor’s bio-psycho-social framework
[3] which conceptualizes health outcomes as processes
linking environmental factors, stress responses, and
coping resources—we explored both direct and indirect
paths from traumatic life events and socio-demographic
variables to HRQOL and MIL outcomes.
HRQOL is dened as an individual’s functioning and
perceived well-being in physical and mental health
domains [4]. MIL, on the other hand, is characterized by
beliefs, values, and goals that provide purpose and coher-
ence [5, 6]. Frankl [7] emphasized that life can hold sig-
nicant meaning even in dire circumstances, highlighting
the role of inherent human signicance in adapting to
and overcoming traumatic experiences [8–10].
Building on Taylor’s model, we examined the direct
eects of traumatic life events and socio-demographic
factors on HRQOL and MIL. Additionally, we investi-
gated indirect eects mediated by symptoms, coping
strategies, and self-mastery, drawing on Hobfoll’s con-
servation of resources theory (COR) [11]. According to
Hobfoll, individuals strive to obtain, retain, and protect
their resources, and the loss or threat of loss of these
resources can lead to stress and adverse health outcomes.
In this study, we assessed the health outcomes of
evacuees from both the northern and southern regions
of Israel, as well as individuals who were not evacuated.
Despite the dierent contexts of evacuation, each stem-
ming from distinct traumatic events—we hypothesize
that coping strategies, psychological symptoms, and
health outcomes may be consistent across the two groups
of evacuees. In other words, the experience of evacuation
may overshadow other dierences, inuencing all aspects
of their experiences.
Based on Taylor’s model we explored literature look-
ing for direct paths from traumatic life events and
socio-demographic variables to HRQoL and MIL out-
comes. We then explored indirect paths through symp-
toms, coping strategies, and self-mastery using Hobfoll’s
conceptualization.
Relationships between traumatic life events, socio-
demographic variables with HRQoL and MIL
e theoretical model of COR [11], provides valuable
insight into the impact of displacement, separation from
social networks, and the traumatic events associated
with wartime on mental health. According to the COR
model, individuals strive to obtain, retain, and protect
their resources, with stress occurring when resources are
threatened or lost [11]. is model has been applied to
examine responses to traumatic and high-stress situa-
tions, especially in conict and disaster contexts [12–14].
e COR framework emphasizes that the loss of per-
sonal, social, or material resources signicantly aects
mental health and well-being [15]. Previous research
indicated that traumatic life events including violence,
abuse, and life-threatening diseases have been linked to
lower HRQoL, particularly among women [16].
Socioeconomic status (SES) signicantly impacts phys-
ical health, though its eect on psychological health was
less evident [17]. However, a recent study demonstrated
that when individuals have a more positive subjective
appraisal of their SES, their physical and mental HRQoL
also tends to increase [18]. Additionally, low educational
attainment has been associated with lower HRQoL [19].
Regarding gender, women in nurturing roles often experi-
ence a decrease in HRQoL, as they bear a disproportion-
ate burden of caregiving responsibilities in the domestic
sphere compared to their male counterparts [20].
Concerning MIL, SES (including subjective SES), was
found to be positively correlated with meaning in life
[21–23]. Economic resources may enhance purpose, sig-
nicance, and coherence, which are vital components of
meaning [19]. Women were found to have higher levels
of the presence of MIL and a higher tendency to search
for MIL than men [6].
Relationships between socio-demographic variables and
the mediators’ variables (psychological indicators, coping
strategies, and self-mastery)
Socio-demographic factors, such as age, place of resi-
dence, marital status, and nancial status, are linked to
psychological symptoms such as anxiety and depression
during disasters [25, 26]. For example, Ukrainian adults
during the Russian invasion showed higher depression
levels if they were older, lived in rural areas, were unmar-
ried, or had lower nancial status [25]. Women college
students in disaster-prone areas in Indonesia exhibited
higher anxiety than men [26].
Page 3 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
In the context of coping strategies, scholars dene cop-
ing as conscious cognitive and behavioral processes used
to manage stressful physical and psychological events
[27–29]. In this study, we focused on the Carver COPE
[27] scale as a method to monitor individuals’ conscious
coping strategies following trauma, rather than utiliz-
ing support scales that measure perceived social sup-
port. is approach emphasizes the importance of active
engagement in coping processes, as opposed to passive
reliance on perceived support. Common coping strat-
egies include emotion-focused coping, which aims to
reduce emotional burdens through activities such as
actively reaching out to others for social and instru-
mental support, humor, acceptance, and religious ritu-
als. Another strategy is problem-focused coping, which
addresses stress through actions like active coping, seek-
ing informational support, planning, and positive refram-
ing. Lastly, dysfunctional coping involves maladaptive
behaviors such as avoidance, self-blame, denial, and sub-
stance use, including smoking, drugs, and alcohol [30].
A study among internally displaced individuals and host
communities in war-aected regions of Nigeria found
that being single, living in camps, and aged 18–29 pre-
dicted the use of emotion-focused and dysfunctional
coping strategies [31]. Interestingly, individuals aged
18–29 and over 50 also employed problem-focused cop-
ing strategies, suggesting that younger adults may utilize
a broader range of coping mechanisms.
In the current study, we also examine coping strategies
that involve helping others. We extended Taylor’s [32]
original “tend and befriend” concept to explore the role
of providing social support through coping processes.
Coping strategies that involve aiding others not only
mitigate stress eects but also enable individuals to bet-
ter understand and articulate the support they provide,
touching upon underexplored intrapersonal aspects of
coping [33, 34]. Coping for others involves behaviors,
emotions, and cognitive expressions aimed at helping
others, such as problem-solving, giving advice, or oer-
ing humor and emotional support. e literature lacks
comprehensive measures for these strategies; therefore,
we adapted Carver’s [35] questionnaire to include coping
related to helping others. According to Frankl [7], indi-
viduals who helped others in concentration camps were
better able to cope with their helplessness, maintained
resilience, and found meaning. Prioritizing others’ needs
can cultivate a sense of purpose, even in adversity, sug-
gesting an altruistic pathway that benets the helper by
fostering social connections and enhancing well-being
[36, 37]. It is important to note that coping related to
helping others is a strategy for managing ongoing stress,
with outcomes that can be adaptive or maladaptive
for the provider depending on the context [38]. Conse-
quently, its impact on the provider’s mental health is not
predetermined. Finally, regarding the link between socio-
demographic variables and self-mastery—dened as an
individual’s perceived control over life events [39] and
known to enhance coping with stress [40]—a previous
study found higher self-mastery levels among men, as
well as individuals with higher education, higher income,
and better health status [41].
Relationships between mediators’ variables with HRQoL
and MIL
Previous research has demonstrated a negative asso-
ciation between psychological symptoms of anxiety and
depression with mental and physical quality of life (QoL)
[42]. Additionally, these psychological symptoms were
linked to a diminished sense of purpose in life [43].
As for self-coping strategies, dysfunctional coping was
linked to decreased QoL, while problem- and emotion-
focused strategies improved QoL over time during the
COVID-19 pandemic [44]. Similarly, MIL was strongly
correlated with problem- solving and emotion-focused
adaptive coping strategies in the face of daily stress-
ors and severe trauma [45]. Specically, MIL has been
linked to problem-focused coping mechanisms, such as
positive reinterpretation, proactive planning, and self-
ecacy, and to a lesser extent, emotion-focused behav-
iors [45]. e concept of self-mastery is discussed in the
context of displacement and evacuation. is is particu-
larly relevant where stressors from both material and
interpersonal sources disrupt daily routines and contrib-
ute to poorer mental health [46, 47]. Hou and colleagues
[48] identied two types of daily routines: primary and
secondary. Primary routines involve behaviours neces-
sary for maintaining a livelihood, such as hygiene, sleep,
eating, and home maintenance. In contrast, secondary
routines are optional and depend on motivation and
preferences, including activities like exercising, leisure,
social activities, and employment. Both routines are
crucial for maintaining a sense of normalcy and control
over one’s life. In the context of war, displacement exac-
erbates the irregularity of daily routines and reduces the
sense of predictability and coping exibility, which, in
turn, leads to deteriorating mental health over time [46].
High self-mastery can potentially mediate the negative
eects of disrupted routines by promoting adaptive cop-
ing mechanisms. It enables individuals to maintain feel-
ings of autonomy and self-ecacy, fostering innovative
problem-solving strategies [49]. e current study aims
to highlight the role of self-mastery—the ability to cope
with the challenges of displacement, and its eects on
health and the nding of MIL.
Given the context, the objectives of the present study
are as follows:
Page 4 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
1. To compare evacuees from the northern and
southern regions of Israel in terms of HRQoL, MIL,
psychological indicators, self-coping strategies,
self-mastery, and coping strategies related to helping
others.
2. To investigate the direct relationships between the
independent variables (traumatic life events and
socio-demographic background) and the dependent
variables (HRQoL and MIL).
3. To analyze the direct relationships between the
independent variables and the mediating variables,
including psychological indicators, self-coping
strategies, self-mastery, and coping strategies related
to helping others.
4. To evaluate the relationships between the mediating
variables and the dependent variables (HRQoL and
MIL). We hypothesize that psychological indicators
(anxiety and depression) will negatively correlate
with both HRQoL and MIL. We further hypothesize
that individuals who utilize adaptive coping strategies
(self/others problem- and emotion-focused coping)
will report higher HRQoL and greater MIL.
5. To examine a mediation model assessing the role
of mediators (psychological symptoms, self-coping
strategies, self-mastery, and coping strategies related
to helping others) on the relationship between
the independent variables (socio-demographic
background and traumatic life events) and the
dependent variables (HRQoL and MIL). We
hypothesize that group status (evacuee versus non-
evacuee) will serve as a moderator in the mediation
model.
Methods
is cross-sectional study was conducted in Israel in May
2024, seven months after the October 7th attack and the
beginning of the Swords of Iron War. e research pro-
tocol was approved by the three principal researchers’
ethics committees. Participants were recruited via iPanel,
Israel’s leading online research platform, which follows
ESOMAR’s international guidelines and manages a panel
of about 100,000 members.
e inclusion criteria for the sample were as follows:
Participants had to provide informed consent, be at least
21 years old, uent in Hebrew and have been evacuated
from their homes within the rst month after October
7, 2023. Exclusion criteria included pregnant women,
those not procient in Hebrew, returned hostages, and
individuals who declined participation. All participants
were fully informed about the study’s aims and consented
before participating.
Participants
e sample size for the moderated-mediation hypoth-
esis was calculated via two separate power analyses.
e mediation aspect was assessed using a Monte Carlo
power simulation through the mc_power_med app [50],
indicating that a minimum of 300 participants would be
required to achieve 80% power (1-β), based on medium
eect sizes for each model path (r = .3), and an alpha
level of 0.05. For the moderation component, G*Power
3.1.951 was employed, which estimated that 120 partici-
pants would be sucient to detect a medium eect size
(f2 = 0.15) with at least 80% power (1-β) and an alpha of
0.05. e study’s actual sample size of 360 participants
surpassed both estimates, thereby ensuring ample statis-
tical power for both components.
e study involved 366 participants: 221 individu-
als evacuated from war zones in southern and northern
Israel, and 145 individuals who were not evacuated due
to their greater distance from the conict borders in the
northern and southern regions (a control group). Par-
ticipants’ ages ranged from 19 to 82 years (M = 40.93,
SD = 13.50). Most participants were female (62.8%,
n = 230), married or in a committed relationship (60.7%,
n = 222), and reported an average or below-average
income (66.9%, n = 245). About half had tertiary educa-
tion (51.1%, n = 187). No signicant sociodemographic
dierences were found between evacuees and non-evac-
uees, except for the fact that there were more women in
the evacuee group (69.7% vs. 52.4%).
Measures
Participants completed a series of standardized self-
report questionnaires, previously validated for Israeli
populations and showing strong psychometric proper-
ties. e measures are grouped according to their role in
the study:
Independent variables
Sociodemographic data included information on par-
ticipants’ gender, age, marital status, education, income,
region of residence (north or south), and whether they
were evacuated from their homes.
Traumatic life events were assessed using the List of
reatening Experiences Questionnaire (LTE-Q [52]),
which evaluates 12 major adverse events from the past
two months, such as job loss or serious illness, using a
yes/no format. Among our participants, 35.5% (n = 130)
reported no traumatic events, 38.3% (n = 140) reported
one to two events, and 26.2% (n = 96) rep orted three
and more events. e most frequently reported events
were the death of a close family friend or relative (27%),
a serious illness or injury of a close relative (24.3%),
unemployment or prolonged job-seeking lasting over a
month (21.9%). e original questionnaire demonstrated
Page 5 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
Cronbach’s alpha of .8452, while the current study yielded
an acceptable alpha of 0.70.
Mediating variables
Depression and anxiety were assessed using the Patient
Health Questionnaire 4-item (PHQ-4) [53], which
includes a 2-item depression scale (e.g., “Feeling down,
depressed, or hopeless”) and a 2-item anxiety scale (e.g.,
“Feeling nervous, anxious, or on edge”). Participants
rated how often they were bothered by certain problems
over the past two weeks on a 4-point scale from 0 (“not
at all”) to 3 (“nearly every day”). e original PHQ-4
had Cronbach’s alphas of 0.85 for depression and 0.81
for anxiety [53]. In this study, the alphas were 0.86 for
depression and 0.84 for anxiety.
Coping strategies (self) were measured using the Brief
COPE questionnaire [35], which assesses coping using 14
subscales (each subscale has 2 items) divided into three
overarching coping styles: emotion-focused (12 items;
e.g., “I’ve been getting emotional support from others”),
problem-focused (8 items; e.g., “I’ve been thinking hard
about what steps to take”), and dysfunctional strategies
(8 items; e.g., “I’ve been giving up trying to deal with
it”) [27]. Each item was rated on a 4-point scale from 1
(“I haven’t been doing this at all”) to 4 (“I’ve been doing
this a lot”), with higher scores indicating greater degree
to which the respondent has been engaging in that cop-
ing style. In this study, Cronbach’s alphas were 0.71 for
emotion-focused, 0.84 for problem-focused, and 0.70 for
dysfunctional strategies.
Coping strategies (other) were measured by adapting
Brief COPE [35] to assess coping through aiding oth-
ers. Items from the original subscales were reworded to
reect helping behaviors, capturing how individuals cope
with stress by supporting others rather than focusing
solely on intra-personal strategies (e.g., “I taught some-
one how to take action to improve the situation”, “I sup-
ported someone who told me they refused to believe it
happened”, “I encouraged someone to use alcohol or
other substances to improve their mood”).
A conrmatory factor analysis (CFA) was conducted
with the study participants. e analysis revealed poor
t indices [χ2(347) = 2266.57, χ2/df = 6.53, CFI = 0.69,
RMSEA = 0.12, SRMR = 0.11], with 7 items (ve from dys-
functional coping and two from emotion-focused cop-
ing) showing low loadings. As a result, the decision was
made to focus solely on the problem-focused coping fac-
tor. e CFA for the problem-focused coping items indi-
cated a poor to excellent t [χ2(20) = 143.60, χ2/df = 7.18,
CFI = 0.93, RMSEA = 0.13, SR MR = 0.06]. An examination
of modication indices suggested adding a correlation
between the error terms of items 12 (“I taught someone
to view the situation in a dierent light, making it appear
more positive to them) and 17 (“I’ve been looking for
something good in what is happening”) to improve the
t. is adjustment signicantly improved the t indi-
ces (Δχ² = 127.57, Δdf = 9, p < .001), supporting a three-
factor structure with acceptable to excellent t indices
[χ2(19) = 56.09, χ2/df = 2.95, CFI = 0.98, RMSEA = .07,
SRMR = .03]. e internal consistency of the problem-
focused coping (other) factor was excellent α = .92.
Self-mastery was assessed using the Self-Mastery Scale
[39], which comprises seven statements that measure the
extent to which individuals perceive their life outcomes
as being under their control rather than determined by
fate (e.g., “I have little control over the things that hap-
pen to me”). Participants responded using a 4-point Lik-
ert scale ranging from 1 (strongly disagree) to 4 (strongly
agree), with higher scores indicating a weaker sense of
personal mastery. In this study, Cronbach’s alpha was
0.77.
Dependent variables
Health-related quality of life
(HRQoL) was assessed using the Short Form-12 Health
Survey (SF-12) [54], a tool designed to evaluate the physi-
cal and mental components of quality of life. It consists of
12 questions across eight health domains: physical func-
tioning, role limitations due to physical health, bodily
pain, general health perceptions, vitality, social func-
tioning, role limitations due to emotional problems, and
mental health. Responses are combined into two sub-
scales: the Physical Component Summary (PCS) and the
Mental Component Summary (MCS), each ranging from
0 (worst) to 100 (best). Cronbach’s alphas were 0.80 for
the PCS and 0.81 for the MCS.
Meaning in life
(MIL) was assessed using the Meaning in Life Question-
naire (MLQ) [5], which includes two subscales: the pres-
ence of meaning (MIL-P) and the search for meaning
(MIL-S). e MIL-P measures how meaningful a person
perceives their life to be (5 items: e.g., “I understand my
life’s meaning”), while the MIL-S assesses their motiva-
tion to nd or deepen life’s meaning (5 items; e.g., “I am
searching for meaning in my life”). Each item is rated on a
7-point scale from 1 (Absolutely untrue) to 7 (Absolutely
true), with higher scores indicating greater meaning in
life. In the original scale, Cronbach’s alphas were 0.87 for
MIL-S and 0.86 for MIL-P. In this study, they were 0.87
for MIL-S and 0.91 for MIL-P.
Statistical analysis
Before conducting the analyses, the dataset was exam-
ined for outliers and assessed for normality. No outliers
were identied [55], and all variables exhibited normal
skewness and kurtosis values [56]. For the study’s rst
aim, we analyzed whether evacuees from the northern
Page 6 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
and southern regions of Israel diered in their experi-
ences and responses. Independent samples t-tests were
used for continuous variables, and chi-square (χ²) tests of
independence were performed for categorical variables.
Based on Taylor’s model bivariate analyses were sub-
sequently performed to investigate the relationships
between background variables, mediators, and depen-
dent variables. Pearson’s correlations were utilized for
continuous variables, while point-biserial correlations
were employed for associations involving dichotomous
and continuous variables.
To address study aims 2 through 5, path analysis was
conducted with paths specied according to the results
of the bivariate analyses. Independent variables included
gender, income, and traumatic life events; media-
tors comprised anxiety, depression, coping measures
(self and other), and self-mastery; dependent variables
encompassed HRQoL and MIL measures; and covariates
included age, family status, education, and evacuation.
Model estimation was performed using the maximum
likelihood method, and model t was evaluated using
several goodness-of-t-indices [57]: the χ2/df index,
which is deemed acceptable if less than 5 and excellent
if between 1 and 3; the Comparative Fit Index (CFI),
with values above 0.90 considered adequate and above
0.95 considered excellent; the Root Mean Square Error
of Approximation (RMSEA), with values below 0.08
indicating an adequate t and below 0.06 indicating an
excellent t; Standardized Root Mean Squared Residual
(SRMR), with values below 0.10 considered adequate and
below 0.08 considered excellent. Non-signicant paths
were excluded to achieve the most parsimonious model
[58], followed by a comparison between the initial and
parsimonious models. A modication indices test was
subsequently conducted to determine whether additional
paths could be incorporated to improve the t of the par-
simonious model, followed by a comparison between the
parsimonious and modied models. Model comparisons
were conducted using the Expected Cross-Validation
Index (ECVI), Akaike’s Information Criterion (AIC), and
Bayes Information Criterion (BIC), with lower values
indicative of better t [59]. To evaluate the signicance
of the indirect eects, condence intervals (CI) were esti-
mated for each indirect eect based on 5,000 bootstrap
samples [60]. An indirect eect was considered signi-
cant if the CI did not include zero [61]. A multiple group
path analysis was also conducted based on evacuation,
comparing a fully unconstrained model with no equality
constraints, to a constrained model with all coecients
held constant across groups. A signicant χ [2] square
dierence test suggests evidence of non-invariant param-
eters [62], and each path was tested for invariance. Addi-
tionally, moderated mediation analyses were conducted
exclusively for relevant indirect eects, specically, those
comprising at least one path moderated by evacuation
during war.
e statistical tests were performed using IBM SPSS
Statistics version 29. Path analysis was conducted using
IBM SPSS Amos version 24, employing the “Specic indi-
rect eects” [63] to analyze the specic indirect eects;
“Multigroup Analysis” plugin [64] to examine multiple
group path analysis, including path comparisons by evac-
uation during war; and “MyModMed” estimand [56] for
moderated-mediation analyses. An alpha level of 0.05
(two-tailed) was set for all statistical tests.
Results
Regarding the rst aim of the study, Table1 presents the
background characteristics, mediators, and dependent
variables of evacuees, stratied by their residential area
prior to evacuation. Notably, except for self-mastery, all
comparisons between these groups across these variables
yielded non-signicant results. erefore, we combined
them into a single evacuee group.
Tables2 and 3 display the associations between back-
ground variables, mediators, and dependent variables.
However, since path analysis accounts for all associations
among these variables, the results are presented with a
focus on model t and path estimates.
Following the proposed theoretical model, we con-
ducted a path analysis to examine the hypothesized rela-
tionships among variables. e estimated model showed
an excellent t with the data. However, an examination
of the path model revealed several non-signicant paths,
including all the paths of education and emotion-focused
coping (self). Consequently, a more parsimonious model
was evaluated. A comparison between the initial and
parsimonious models favored the latter. Additionally,
incorporating intercorrelations between the error terms
of mediators and between the error terms of dependent
variables further improved the model t, making the par-
simonious-modied model the most favorable. e nal
model, depicted in Fig.1, exhibited an excellent t with
the data (see Table4).
e analysis of path coecients revealed several sig-
nicant relationships. Income showed a negative rela-
tionship with problem-focused coping (other) and MCS.
Traumatic life events were negatively correlated with
PCS, and positively associated with all mediators. Anxi-
ety was positively related to search for meaning, whereas
depression exhibited negative relationships with PCS,
MCS, and presence of meaning. Additionally, problem-
focused coping (self) was positively related to pres-
ence of meaning, while dysfunctional coping (self) had
a negative association. Self-mastery was found to have
negative relationships with both MCS and presence of
meaning. at it, the stronger the sense of personal mas-
tery was, the higher these measures were. Conversely,
Page 7 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
problem-focused coping (other) was positively linked to
both search for meaning and presence of meaning.
A subsequent analysis of the indirect eects revealed
that all modeled indirect eects were signicant, except
for the eect of income on presence of meaning through
problem-focused coping (other) (see Table 5). e
results indicated that being female, as opposed to male,
and having experienced more traumatic life events pre-
dicted higher scores on anxiety, depression, problem-
focused coping (self), dysfunctional coping (self), and
Table 1 Background variables, mediators, and dependent variables of evacuees by residential area before evacuation
North South
Characteristic (n = 102) (n = 119)
Background M SD M SD t d
Age 40.54 12.38 41.40 13.95 -0.48 -0.07
Traumatic life events 1.01 0.88 1.08 0.92 -0.54 -0.07
Income 2.83 1.28 2.84 1.32 -0.06 -0.01
n%n% χ2
Gender 0.32
Male 29 28.4 38 31.9
Female 73 71.6 81 68.1
Family status 0.16
Married or in a relationship 58 56.9 78 66.1
Other 44 43.1 40 33.9
Education 0.02
Non-academic 49 48.0 56 47.1
Academic 53 52.0 63 52.9
Questionnaire M SD M SD t d
Anxiety 2.66 1.81 2.44 1.87 0.89 0.12
Depression 2.63 1.94 2.39 1.87 0.94 0.13
Problem-focused coping - Self 18.98 4.98 20.22 5.80 -1.69 -0.23
Emotion-focused coping - Self 26.00 5.36 26.94 6.49 -1.18 -0.16
Dysfunctional coping - Self 15.77 4.39 15.70 4.24 0.13 0.02
Self-mastery 2.22 0.59 2.07 0.49 2.09*0.28
Problem-focused coping - Other 17.47 5.84 18.89 6.88 -1.64 -0.22
PCS 50.13 9.51 48.62 9.76 1.16 0.16
MCS 35.42 12.59 37.81 11.07 -1.50 -0.20
Search for meaning 23.15 6.97 23.05 6.88 0.10 0.01
Presence of meaning 23.33 7.47 25.12 6.57 -1.89 -0.25
Note. Data wer e missing for 26 cases for i ncome and one case fo r family status. Hi gher self-maste ry scores indica te a weaker sense of per sonal mastery. PCS = Physical
Component S cale; MCS = Mental Component S cale.
*p < .05
Table 2 Associations between background variables and both mediators and dependent variables
Variable Age Gender aFamily status bEducation cIncome Traumatic life events Evacuation during war d
Anxiety − 0.03 0.25*** − 0.18*** 0.07 0.01 0.27*** 0.18***
Depression − 0.05 0.19*** − 0.22*** 0.05 − 0.004 0.25*** 0.17**
Problem-focused coping - Self − 0.02 0.23*** − 0.02 0.02 − 0.02 0.22*** 0.16**
Emotion-focused coping - Self − 0.14** 0.15** − 0.09 0.06 − 0.05 0.15** 0.11*
Dysfunctional coping - Self − 0.01 0.16** − 0.16** 0.04 − 0.04 0.26*** 0.08
Self-mastery 0.02 − 0.04 − 0.02 0.03 − 0.04 0.11*0.08
Problem-focused coping - Other − 0.05 0.20*** − 0.06 0.07 − 0.13*0.16** 0.13*
PCS − 0.21*** − 0.04 0.07 0.06 0.11*− 0.32*** − 0.17***
MCS 0.13*− 0.21*** 0.13*− 0.11*− 0.05 − 0.22*** − 0.24***
Search for meaning − 0.03 0.12*− 0.08 0.09 − 0.03 0.02 0.10*
Presence of meaning 0.11*0.05 0.19*** − 0.03 0.05 − 0.11*0.32***
Note. N = 366. Highe r self-mastery scor es indicate a weaker sense of p ersonal mastery. PCS = Physical Component S cale; MCS = Mental Component S cale
a 0 = Ma le, 1 = Fe male; b 0 = Other, 1 = Married or in a relat ionship; c 0 = Non -academic , 1 = Aca demic; d 0 = N o, 1 = Yes
*p < .05. **p < .01. ***p < . 001
Page 8 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
problem-focused coping (other). In turn, higher anxiety
scores predicted higher search for meaning scores, while
higher depression scores predicted lower scores on PCS,
MCS, and presence of meaning. Additionally, higher
scores on problem-focused coping (self) and dysfunc-
tional coping (self) predicted lower search for meaning
scores, whereas higher scores on problem-focused cop-
ing (other) predicted higher scores on both search for
meaning and presence of meaning. Furthermore, a higher
number of traumatic life events was linked to higher
self-mastery scores (meaning lower sense of personal
mastery), which subsequently predicted lower scores
on MCS and presence of meaning. In terms of income,
the indirect eect on search for meaning through prob-
lem-focused coping (other) was signicant, with higher
income predicting lower scores on problem-focused cop-
ing (other), which subsequently predicted lower search
for meaning scores (see Fig.1).
Finally, the multiple group path analysis on the par-
simonious modied model indicated that the uncon-
strained model had a better t than the constrained
model (Δχ2 = 57.33, Δdf = 32, p = .004). Furthermore,
comparing the paths of evacuees showed several signi-
cant moderations: the association between traumatic life
events and dysfunctional coping (self) was positive, while
it was non-signicant for those who were not evacuated.
In contrast, the positive relationship between anxiety and
search for meaning, as well as the negative relationship
between self-mastery and MCS, were signicant for par-
ticipants who were not evacuated, but non-signicant
for those who were evacuated (see Table6). However, all
relevant moderate-mediation analyses resulted in non-
signicant results (all p’s > 0.277).
For all additional analyses and supplementary informa-
tion, please refer to the supplementary appendices (1–3).
Discussion
is study, conducted in May 2024, examined evacuees
from the southern and northern regions of Israel, as well
as individuals who were not evacuated because they lived
farther inland. All evacuees in our study were evacuated
within the rst month following October 7, 2023—the
onset of the war. Evacuees from the northern and south-
ern regions showed no signicant dierences in most
study variables, except for self-mastery. e similarity
in the responses of the evacuees needs to be thoroughly
explained, especially given the regional variations in the
intensity of military actions, with the south experienc-
ing more severe immediate impacts. It is possible that the
concept of a shared reality of displacement may explain
the uniformity in traumatic experiences across regions
[65]. is concept refers to the collective sense of threat,
mutual understanding, and shared experiences of being
displaced that arise during nationwide crises, aecting
Table 3 Correlations between mediators and dependent variables
Variable M SD 1 2 3 4 5 6 7 8 9 10
1. Anxiety 2.28 1.79 ─
2. Depression 2.24 1.85 0.80*** ─
3. Problem-focused coping - Self 18.97 5.34 0.31*** 0.27*** ─
4. Emotion-focused coping - Self 26.00 5.80 0.32*** 0.26*** 0.71*** ─
5. Dysfunctional coping - Self 15.46 4.15 0.45*** 0.50*** 0.38*** 0.38*** ─
6. Self-mastery 2.11 0.53 0.31*** 0.33*** − 0.08 0.02 0.28*** ─
7. Problem-focused coping - Other 17.59 6.42 0.20*** 0.12*0.66*** 0.59*** 0.32*** − 0.05 ─
8. PCS 50.56 8.96 − 0.28*** − 0.28*** − 0.17** − 0.15** − 0.19*** − 0.19*** − 0.07 ─
9. MCS 39.01 11.70 − 0.60*** − 0.68*** − 0.21*** − 0.23*** − 0.41*** − 0.35*** − 0.14** 0.09 ─
10. Search for meaning 22.51 7.00 0.25** 0.21*** 0.31*** 0.26*** 0.16** 0.03 0.32*** − 0.02 − 0.19*** ─
11. Presence of meaning 22.55 6.76 − 0.17** − 0.28*** 0.18*** 0.06 − 0.22*** − 0.33*** 0.19*** 0.09 0.25*** 0.08
Note. N = 366. Highe r self-mastery scor es indicate a weaker sense of p ersonal mastery. PCS = Physical Component S cale; MCS = Mental Component S cale
*p < .05. **p < .01. ***p < . 001
Page 9 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
individuals regardless of their proximity to direct con-
ict zones. Furthermore, the war was ongoing in both
the north and the south, albeit with less intensity in the
north. Media coverage, national alerts, and the mobiliza-
tion of reserves contributed to a pervasive atmosphere of
threat throughout the country. is widespread exposure
and the shared experience of displacement may have led
to similar psychological impacts among evacuees from
dierent regions, as the collective experience of war can
transcend geographical boundaries [66, 67].
We examined a multivariable mediation model based
on Taylor’s [3] framework to identify the mechanisms
aecting HRQoL - specically the physical compo-
nent summary (PCS) and mental component summary
(MCS) - and meaning in life (MIL) - including presence
of meaning and search for meaning Taylor’s conceptual-
ization provides a foundational framework for interpret-
ing our ndings, particularly in relation to aims two- four.
e results concerning the entire sample revealed that
traumatic life events were negatively associated with
Physical Component Summary (PCS) scores and posi-
tively linked to all mediators, including the adapted
subscale measuring problem-focused coping related to
helping others. is indicates that individuals who expe-
rienced more traumatic events tended to struggle more
with anxiety, depression, and maladaptive coping strate-
gies across the entire sample. However, they also dem-
onstrated resilience through adaptive strategies such
as problem-focused and emotion-focused self-coping,
self-mastery, and aiding others through problem-solving
coping.
By expanding the model to include MIL as a depen-
dent variable, we observed that anxiety was positively
related to the search for meaning in life, highlighting that
heightened anxiety can drive individuals to seek pur-
pose. Depression was negatively associated with PCS,
the Mental Component Summary (MCS), and the pres-
ence of meaning, suggesting that it hinders psychological
Table 4 Fit and model comparison indices
Model χ2df χ2/df CFI RMSEA SRMR ECVI AIC BIC
Initial 104.50 60 1.74 0.98 0.05 0.03 1.11 404.50 989.89
Parsimonious 83.72 58 1.44 0.98 0.04 0.04 0.66 239.72 544.13
Parsimonious + MI 64.72 56 1.16 0.99 0.02 0.04 0.62 224.72 536.93
Note. N = 366. CFI = Comparative Fit Index; RMSEA = Root Mean Square Error of Approximation; SRMR = Standardized Root Mean Squared Residual; ECVI = Expected
Cross-Validation Index; AIC = Akaike’s Information Criterion; BIC = Bayes Information Criterion; MI = Modication Indices
Fig. 1 Note. N = 366. Standardized path coecients are presented, controlling for age, family status, and evacuation during war. Measurement errors and
correlations are not displayed for clarity (Appendix 1). Higher self mastery scores indicate a weaker sense of personal mastery. PCS = Physical Component
Scale; MCS = Mental Component Scale. a0 = Male, 1 = Female. *p < .05. **p < .01. ***p < .001
Page 10 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
well-being across the sample. Direct connections were
also established between coping strategies and MIL.
Problem-focused self-coping demonstrated a positive
association with the presence of MIL, while dysfunc-
tional coping exhibited a negative correlation. Addition-
ally, problem-focused coping related to helping others
was positively associated with both the search for mean-
ing and the presence of meaning in life.
ese ndings emphasize the signicance of MIL as
a complementary factor in evaluating quality of life for
the entire sample, highlighting its ability to provide a
sense of purpose even in challenging circumstances.
e pervasive atmosphere of war impacted all partici-
pants, contributing to these results. Engaging in proso-
cial behaviours and focusing on helping others allowed
individuals who had endured traumatic events to nd
renewed purpose and meaning, eectively shifting atten-
tion away from their own condition [6],7. It is interesting
to note that individuals with an established socioeco-
nomic status (SES) tend to engage less in caring behavior
towards others [11]. Self-coping strategies, particularly
among women and those who have experienced mul-
tiple traumatic life events, are linked to increased anxi-
ety and depression. ese negative emotional states can
ultimately lead to lower scores in the search for MIL.
Previous ndings suggest that employing adaptive cop-
ing strategies helped mitigate symptoms of distress and
enhanced satisfaction with life (68–69).
In our study, we examined coping strategies related
to helping others. While existing research has primar-
ily focused on how individuals perceive social support
from others, coping strategies that involve aiding others
not only mitigate the eects of stress but also enable indi-
viduals to better understand and articulate the support
they have provided, touching upon underexplored inter-
personal aspects of coping [33, 34]. Our ndings revealed
that only the problem-solving subscale demonstrated
reliability. is provides limited insight into how indi-
viduals employ various coping strategies to support oth-
ers. To gain a deeper understanding of these dynamics,
Table 5 Bootstrap results for the indirect eects
95% bootstrap CI
Indirect eect B Lower Upper β
Gender → Anxiety → Search for meaning 0.74 0.32 1.23 0.05
Gender → Depression → PCS -0.76 -1.36 -0.31 − 0.04
Gender → Depression → MCS -2.79 -4.14 -1.56 − 0.12
Gender → Depression → Presence of meaning -0.60 -1.08 -0.22 − 0.04
Gender → Problem-focused coping - Self → Presence of meaning 0.48 0.06 1.01 0.03
Gender → Avoidant coping - Self → Presence of meaning -0.34 -0.78 -0.05 − 0.02
Gender → Problem-focused coping - Other → Search for meaning 0.81 0.36 1.36 0.06
Gender → Problem-focused coping - Other → Presence of meaning 0.38 0.03 0.87 0.03
Income → Problem-focused coping - Other → Search for meaning -0.16 -0.33 -0.01 − 0.03
Traumatic life events → Anxiety → Search for meaning 0.42 0.18 0.71 0.05
Traumatic life events → Depression → PCS -0.50 -0.88 -0.20 − 0.05
Traumatic life events → Depression → MCS -1.83 -2.67 -1.08 − 0.14
Traumatic life events → Depression → Presence of meaning -0.39 -0.72 -0.15 − 0.05
Traumatic life events → Problem-focused coping - Self → Presence of meaning 0.26 0.03 0.54 0.03
Traumatic life events → Dysfunctional coping - Self → Presence of meaning -0.29 -0.60 -0.05 − 0.04
Traumatic life events → Self-mastery → MCS -0.24 -0.53 0.00 − 0.02
Traumatic life events → Self-mastery → Presence of meaning -0.19 -0.43 0.00 − 0.02
Traumatic life events → Problem-focused coping - Other → Search for meaning 0.33 0.11 0.63 0.04
Traumatic life events → Problem-focused coping - Other → Presence of meaning 0.16 0.01 0.37 0.02
Note. N = 366. Only the signicant indirect eects are shown for clarity. Higher self-mastery scores indicate a weaker sense of personal mastery. CI = Condence
Interval; P CS = Physical Comp onent Scale; MCS = Mental Comp onent Scale
a 0 = Ma le, 1 = Fe male
Table 6 Path comparisons by evacuation during war
Path Not evacuated β Evacuated β Δβ pΔ
Traumatic life events → Dysfunctional Coping - Self 0.08 0.33*** − 0.25 0.018
Anxiety → Search for meaning 0.32*** 0.12 0.20 0.024
Self-mastery → MCS − 0.31*** − 0.09 − 0.22 0.007
Note. N = 366. Only the signicant dierences in paths are shown for clarity. Higher self-mastery scores indicate a weaker sense of personal mastery. MCS = Mental
Component Scale
***p < .001
Page 11 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
we recommend that future research incorporate compre-
hensive assessments of the types, frequencies, and quali-
ties of coping strategies aimed at helping others.
By integrating both intrapsychic and interpsychic
coping mechanisms, our study oers a comprehen-
sive understanding of the multifaceted ways individuals
manage stress and adversity. is approach aligns theo-
retically with the concept of community belonging. By
engaging in altruistic behaviors, individuals potentially
strengthen their social support networks and reinforce
their sense of belonging [70]. Such actions not only con-
tribute to personal coping but also enhance communal
resilience, underscoring the interconnected nature of
individual well-being and collective solidarity.
Concerning the fth aim of the study, which com-
pared the pathways between evacuees and non-evacu-
ees, we found a positive association between traumatic
life events and dysfunctional self-coping among evacu-
ees. In contrast, these pathways were non-signicant for
those who were not evacuated. Dysfunctional coping is a
strategy used to avoid provoking threatening feelings by
steering clear of stimuli that trigger such emotions [22],
aiming to reduce emotional stress. It is possible that, due
to the immediate stressors and uncertainties associated
with evacuation, the loss of familiar environments, daily
routines, and support networks, evacuees were more
inclined to employ dysfunctional coping mechanisms. In
line with this notion, traumatic events illustrate “loss spi-
rals”, a key concept of the COR theory [11]. Accordingly,
evacuees, compared to non-evacuated participants, did
not have a stable environment that might have allowed
for a more diverse range of coping strategies, which have
been found to mitigate reliance on maladaptive coping
such as avoidance [71].
Interestingly, among non-evacuated participants, we
observed a signicant positive relationship between
anxiety and the search for meaning. is suggests that
individuals who remain in their homes might channel
their anxiety into a constructive pursuit of personal sig-
nicance or purpose. is nding aligns with Frankl’s
existential perspective, which posits that the search for
meaning is a fundamental human motivation, particularly
in the face of adversity [7]. Furthermore, it corroborates
previous research indicating that individuals confronting
chronic stressors may adopt meaning-making as a coping
strategy, thereby buering against anxiety and promoting
psychological well-beingbeing [75].
Finally, the negative relationship between self-mastery
and MCS scores was signicant among non-evacuated
participants, but not among those evacuated. is sug-
gests that among non-evacuees in a relatively stable envi-
ronment, a stronger sense of self-mastery was associated
with better mental health [62]. According to COR theory
[11], self-mastery may serve as a personal resource that
can empower individuals to develop their abilities and
capacities, thereby reducing stressors and enhancing
well-being [14, 72, 73].
Limitations
is study has several limitations that warrant consid-
eration. First, the cross-sectional design, with data col-
lected at a single point in time, limits the ability to draw
causal inferences during ongoing wartime, especially
when some areas are experiencing intense ghting while
others are relatively calm. e absence of pre-assessment
for mental health indicators, such as anxiety and depres-
sion, further necessitates caution in data interpretation.
Another limitation of our study is the way we assessed
traumatic events. We used the Traumatic Life Events
Questionnaire [52] and found no signicant dierences
between the two groups of evacuees. However, it is pos-
sible that this tool was not sensitive enough to detect
nuanced variations in trauma exposure. A more detailed
and precise questionnaire may be necessary to accurately
capture the complexity and intensity of these experi-
ences, especially in situations of displacement caused
by war. Additionally, we did not assess traumatic grief,
which is characterized by the simultaneous experience of
trauma and loss and has profound, long-lasting psycho-
logical impacts. erefore, we recommend that future
studies explore this important topic. Furthermore, we did
not measure the impact of trauma on shifts in roles and
responsibilities, nor did we assess community belong-
ing among the study groups. Community belonging is
a vital factor in understanding psychosocial outcomes,
as it encompasses an individual’s sense of connection,
acceptance, and identication with their community [74].
While we believe that assessing coping strategies related
to helping others reects intrinsic mechanisms of com-
munity belonging, our measurements did not explicitly
include all its dimensions, such as participation in com-
munity activities, shared values, and trust within the
community [75]. Engaging in altruistic behaviors can
strengthen social support networks and reinforce one’s
sense of belonging within the community [70]. However,
we acknowledge that these unmeasured factors could
have provided additional insights into psychosocial out-
comes. Future studies should incorporate specic mea-
sures of community belonging and support to expand
upon our ndings.
We also acknowledge the need for comprehensive eval-
uations of the types, frequencies, and qualities of thera-
peutic interventions and other support systems available
to the evacuees. Future investigations could examine
how varying levels of therapy inuence the development
of coping strategies, psychological resilience, and over-
all well-being. Finally, reliance on self-report data may
introduce cognitive biases and social desirability eects.
Page 12 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
To address this, future research should incorporate mul-
tiple data sources and objective measures where possible.
Moreover, the generalizability of our study is limited due
to its focus on an Israeli population with unique cul-
tural characteristics. To enhance external validity, future
research should aim to replicate these ndings across
diverse cultural contexts and populations.
Implication for health policy
Grounded by the theoretical frameworks of the COR
theory [11], Taylor’s “tend and befriend” model [32], and
Frankl’s existential framework [76], our study empha-
sizes the necessity for comprehensive health care policies
that holistically address the needs of individuals aected
by conict-induced evacuation. Specically, health care
systems should prioritize the integration of mental and
physical health services to provide a unied approach
to treatment. Interdisciplinary collaboration is impera-
tive for adapting policies to evolving needs and ensuring
comprehensive care.
Additionally, implementing trauma-informed care
practices is crucial; health care providers must be trained
to recognize and sensitively respond to the eects of
trauma, including evacuation itself, thereby creating sta-
ble and supportive environments [77]. Likewise, incor-
porating meaning-centered therapeutic interventions
inspired by Frankl’s existential perspective can facilitate
the search for purpose, which is particularly healing in
times of profound distress. Targeted interventions should
prioritize enhancing adaptive coping strategies (problem-
focused coping) while addressing the impacts of income
and traumatic experiences on mental health. us, men-
tal health professionals should focus on strengthening
these adaptive coping mechanisms to mitigate the nega-
tive psychological impacts of trauma. Notably, the study
indicates that education and emotion-focused coping
may play a less critical role than initially thought, poten-
tially redirecting future research eorts.
By fostering opportunities for individuals to engage
in altruistic activities—aligned with Taylor’s Tend-and-
Befriend model and Frankl’s ideas—health care policies
can enhance coping mechanisms that involve social sup-
port and community engagement. is approach not
only aids individual recovery but also strengthens social
cohesion within displaced communities. Additionally,
addressing resource loss, as highlighted by COR theory,
should be a critical component of health care strategies.
By integrating social services that assist with housing,
employment, and nancial stability within health care
settings, providers can alleviate external stressors that
exacerbate health issues.
Culturally sensitive and individualized care must also
be emphasized to meet the diverse needs of evacuees,
ensuring that interventions are respectful and eective
across dierent cultural contexts. Enhancing accessibility
to health care through mobile clinics, telemedicine, and
multilingual services will further reduce barriers faced by
evacuees.
Conclusions
e research highlights the need for trauma-informed
care that acknowledges the complex impacts of trau-
matic life events on HRQOL. is study advocates for
a paradigm shift in social policy towards a comprehen-
sive understanding of well-being—one that considers
not only physical and mental health, but also the crucial
role of meaning-making and prosocial coping in achiev-
ing resilience, especially during wartime and traumatic
experiences.
Abbreviations
HRQOL Health-related quality of life
MIL Meaning in life
SES Socioeconomic status
PCS Physical Component Summary
MCS Mental Component Summary
COR Conservation of resources
Supplementary Information
The online version contains supplementary material available at h t t p s : / / d o i . o r
g / 1 0 . 1 1 8 6 / s 1 3 5 8 4 - 0 2 4 - 0 0 6 6 5 - 1 .
Supplementary Material 1
Acknowledgements
We gratefully acknowledge Dr. Eran Druckman for his invaluable and
constructive statistical advice.
Author contributions
All authors (OS, LH, YHR) contributed to the conception of the research idea.
The original draft of the manuscript was written by OS. Conceptualization was
by OS; Methodology, investigation and validation was by OS, LH, and YHR;
Formal analysis and data curation was by OS, LH, and YHR; Writing, editing and
visualization was by OS, LH, and YHR; OS supervised the study.
Funding
This research did not receive any specic grant from funding agencies.
Data availability
The datasets of the current study are available from the corresponding author
upon reasonable request.
Declarations
Ethics approval and consent to participate
Ben Gurion University, Ariel University and Tel Aviv University’s research
ethics committee reviewed and approved the study protocols (Approval
#OT05052024; 0008436-1; AU-SOC-YHR-20240506). All methods were
performed in accordance with the ethical standards as laid down in the
Declaration of Helsinki and its later amendments or comparable ethical
standards. Written informed consent was obtained from all the participants
prior to completing the questionnaire. Questionnaires were coded for
anonymous data analysis. The type of disease and health status were self-
reported by the participants.
Consent for publication
Not applicable.
Page 13 of 14Sarid et al. Israel Journal of Health Policy Research (2025) 14:1
Conicts of interest
The authors declare that they have no competing interests.
Received: 13 October 2024 / Accepted: 25 December 2024
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