By Dr. Karny Jabotinsky-Rubin, MD, MSc, BSc
Psychiatrist, IsraClinic | October 12, 2026
New findings from Israel’s National Mental Health Barometer highlight an important challenge in psychiatric care: psychological symptoms may improve long before people regain their ability to work, maintain relationships, and participate fully in everyday life.
Three years after the events of October 7, 2023, Israel continues to face significant mental health challenges.
While many people have experienced gradual psychological improvement, a substantial proportion of the population continues to report difficulties with everyday functioning.
According to findings from Israel’s ongoing National Mental Health Barometer, approximately one in five adults reports severe impairment in daily functioning associated with their mental health.
The research, conducted by the Clalit Research Institute and the Myers-JDC-Brookdale Institute, provides an important perspective on the long-term psychological consequences of prolonged exposure to trauma, uncertainty, and chronic stress.
Perhaps its most significant finding is not simply the prevalence of psychological distress.
It is the apparent gap between improvements in psychiatric symptoms and the recovery of everyday functioning.
For clinicians, patients, and families, that distinction matters.
The National Mental Health Barometer has followed changes in psychological well-being among Israeli adults since the outbreak of the war in October 2023.
A national survey report published in 2026 documented severe mental health-related functional impairment among 19% of respondents in October 2024 and 21% in July 2025.
The fourth survey round included 2,713 participants, including 1,282 individuals who had participated in earlier rounds.
The researchers used validated assessment instruments, including the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, the PTSD Checklist for DSM-5 (PCL-5) for post-traumatic stress symptoms, and the Work and Social Adjustment Scale (WSAS) for functional impairment.
These instruments helped distinguish psychological symptoms from their effects on everyday life.
The findings indicate that substantial functional impairment has remained common, even as some measures of psychological distress have improved.
Women and individuals with greater exposure to traumatic events were among the groups showing increased vulnerability.
Importantly, these figures describe self-reported symptoms and functional difficulties. They should not be interpreted as the prevalence of formally diagnosed psychiatric disorders.
Psychological distress, psychiatric symptoms, and clinically established diagnoses are related but different concepts.
Mental health difficulties can affect several areas of everyday life, including employment, education, family responsibilities, social participation, and personal relationships.
These difficulties may persist even when a person continues working, managing household responsibilities, or appearing outwardly stable.
Someone may no longer experience frequent panic attacks but still avoid social situations.
Another person may report fewer depressive symptoms while remaining emotionally disconnected from family members.
A person recovering from trauma may sleep better and experience fewer intrusive memories yet continue to struggle with trust, intimacy, or ordinary daily activities.
Such experiences illustrate why recovery cannot always be measured through symptom reduction alone.
In psychiatry, treatment effectiveness is frequently evaluated through changes in clinical symptoms.
For depression, clinicians may assess mood, motivation, sleep, concentration, and other symptoms.
For post-traumatic stress disorder (PTSD), assessment may focus on intrusive memories, avoidance, changes in mood and cognition, and heightened arousal.
For anxiety disorders, improvement may involve fewer panic attacks, reduced excessive worry, or greater tolerance of previously distressing situations.
These are important indicators of treatment response.
However, they do not necessarily describe how well a person is functioning in everyday life.
A patient may experience meaningful symptom relief without returning to their previous level of social, occupational, or interpersonal functioning.
This is why contemporary psychiatric care distinguishes between two related outcomes.
Symptomatic remission refers to a substantial reduction in psychiatric symptoms, sometimes to a level below an established clinical threshold.
It is an important treatment objective, particularly in conditions such as major depressive disorder, bipolar disorder, and schizophrenia.
However, remission does not automatically mean that every aspect of the patient’s life has recovered.
Functional recovery concerns the person’s ability to participate in everyday life.
It may involve returning to work or education, maintaining relationships, managing daily responsibilities, participating in social activities, and regaining independence.
The goals are not identical for every patient.
For one person, recovery may mean returning to professional responsibilities.
For another, it may mean rebuilding relationships, living independently, or gradually becoming comfortable outside the home.
Functional recovery should therefore be evaluated in relation to the patient’s circumstances, abilities, priorities, and personal goals.
A clinically successful treatment should consider both the reduction of symptoms and the patient’s ability to live a meaningful, sustainable life.
Prolonged exposure to traumatic events can affect mental health in several ways.
Some individuals develop PTSD. Others experience depression, anxiety disorders, sleep disturbances, or adjustment difficulties.
Many experience significant distress without meeting the diagnostic criteria for a specific psychiatric disorder.
Repeated exposure to threatening events, displacement, bereavement, uncertainty, and disruption of ordinary routines may also interfere with social and occupational functioning.
Importantly, the relationship between trauma and mental health is not uniform.
Two people exposed to similar circumstances may experience very different psychological consequences.
Their responses can be influenced by previous experiences, social support, physical health, individual vulnerabilities, and the availability of appropriate care.
The Israeli findings highlight the importance of understanding these differences rather than assuming that psychological recovery follows a predictable timetable.
They also reinforce a central clinical principle: persistent difficulties in everyday functioning deserve attention, even when the most obvious psychiatric symptoms have become less severe.
The findings have practical implications for psychiatric assessment and long-term treatment planning.
A comprehensive evaluation should examine more than the presence or absence of symptoms.
It should also consider how those symptoms affect the patient’s relationships, work, independence, and quality of life.
In major depressive disorder, improvements in mood do not always resolve difficulties with motivation, concentration, emotional engagement, or social participation.
Residual symptoms and functional limitations may remain after an otherwise successful course of treatment.
These difficulties require careful assessment.
Depending on the clinical picture, treatment may involve reviewing medication, addressing persistent symptoms, introducing or adjusting psychotherapy, and supporting a gradual return to meaningful activities.
A person with an anxiety disorder may experience fewer acute episodes while continuing to organise daily life around avoidance.
For example, someone whose panic attacks have become less frequent may still avoid public transport, unfamiliar places, or social situations.
Treatment should therefore consider both symptom control and the gradual restoration of activities that anxiety has restricted.
Evidence-based psychotherapy, including cognitive behavioural therapy (CBT), can play an important role when clinically appropriate.
PTSD treatment may successfully reduce intrusive memories, nightmares, or heightened arousal.
Nevertheless, difficulties with emotional regulation, trust, relationships, and participation in ordinary life may persist.
Trauma-focused psychotherapy, including appropriate forms of CBT and eye movement desensitisation and reprocessing (EMDR), can help address PTSD symptoms.
Additional therapeutic work may be necessary when functional difficulties remain.
Treatment should be guided by a comprehensive assessment rather than by the assumption that every persistent difficulty is necessarily caused by PTSD.
Psychiatric recovery is not always a linear process.
Symptoms may improve, remain stable, or fluctuate over time.
Changes in family circumstances, physical health, employment, social relationships, and exposure to additional stress can influence the course of recovery.
For some patients, a short course of treatment may be sufficient.
Others benefit from longer-term follow-up, particularly when their condition is recurrent, complex, or associated with substantial functional impairment.
Long-term care may involve periodic psychiatric reassessment, medication monitoring when indicated, psychotherapy, relapse prevention, and support for social or occupational recovery.
The frequency and duration of follow-up should reflect the patient’s clinical needs.
Importantly, ongoing care does not necessarily mean continuing the same treatment indefinitely.
A treatment plan should be reviewed and adjusted as the patient’s condition changes.
The findings from Israel’s National Mental Health Barometer are consistent with a broader principle of clinical psychiatry: treatment outcomes should be evaluated in the context of the individual patient’s life.
At IsraClinic, a private psychiatric clinic in Tel Aviv, this principle is reflected in the clinic’s individualised approach to psychiatric assessment and treatment in Israel.
The clinic’s Psychoergonomic Method is an internally developed clinical framework that emphasises collaboration with the patient, coordinated care, ongoing assessment, and adjustment of treatment according to individual needs.
Within this framework, clinical attention extends beyond the immediate reduction of symptoms.
The patient’s everyday functioning, personal priorities, relationships, and ability to maintain a satisfactory quality of life are also considered when evaluating progress.
Depending on the diagnosis and clinical circumstances, treatment may involve psychiatric care, pharmacotherapy, psychotherapy, and coordinated follow-up.
The Psychoergonomic Method is the clinic’s own approach to organising care. It should not be confused with a separately validated treatment or a replacement for established evidence-based clinical guidelines.
The central objective is to develop a treatment plan that addresses the individual patient rather than relying exclusively on the diagnostic label.
Persistent psychological difficulties deserve professional attention when they interfere with everyday life.
This may include a reduced ability to work or study, withdrawal from relationships, loss of interest in previously meaningful activities, persistent anxiety, emotional exhaustion, or ongoing difficulties following traumatic experiences.
A psychiatric assessment can help determine whether these problems are associated with a diagnosable mental health condition, another medical issue, or a combination of contributing factors.
It can also clarify which forms of treatment or support may be appropriate.
Not everyone experiencing distress requires medication, and not every difficulty indicates a psychiatric disorder.
The purpose of assessment is to understand the person’s situation and identify an appropriate response.
The Israeli findings offer an important reminder.
A reduction in psychiatric symptoms is meaningful, but it does not always represent the end of the recovery process.
The ability to maintain relationships, participate in everyday activities, work, study, and pursue personally meaningful goals also matters.
For mental health professionals, this means evaluating treatment outcomes through both clinical symptoms and real-life functioning.
For patients and families, it means recognising that recovery may continue after the most distressing symptoms have improved.
The goal of psychiatric treatment is not simply to reduce symptoms. It is to help people regain the greatest possible degree of stability, independence, and meaningful participation in their own lives.
The findings discussed in this article come from Israel’s ongoing National Mental Health Barometer, conducted by the Clalit Research Institute and the Myers-JDC-Brookdale Institute.
The 2026 research report documents four survey rounds conducted between December 2023 and July 2025.
The fourth round included 2,713 respondents, of whom 1,282 had participated in previous rounds.
The researchers used validated screening instruments to evaluate symptoms of depression, anxiety, post-traumatic stress, and impairment in daily functioning.
The study found severe mental health-related functional impairment among approximately 19% of respondents in October 2024 and 21% in July 2025.
These are observational survey findings. They do not establish individual psychiatric diagnoses or demonstrate that any particular treatment is effective.
Samuel, H., Allon-Sidlik, S., Tzur Bitan, D., Konstantinov, V., Levinsky, Y., Gorelik, Y., Ohana, R., & Balicer, R. (2026).
Mental Health During the Israel-Hamas War: An Ongoing National Survey of the Adult Population in Israel — Findings from Four Survey Rounds.
Myers-JDC-Brookdale Institute. Publication No. S-245-26.
Read the original research report
Dr. Karny Jabotinsky-Rubin, MD, MSc, BSc
Senior Psychiatrist, IsraClinic
Dr. Karny Jabotinsky-Rubin is a senior psychiatrist at IsraClinic with 50 years of clinical experience in Israel and the United States. She has been a member of the IsraClinic medical team since 2014.
Her clinical expertise includes mood and anxiety disorders, post-traumatic stress disorder, schizophrenia-spectrum disorders, complex psychiatric conditions, and forensic psychiatric evaluations.
View Dr. Karny Jabotinsky-Rubin’s professional profile
Author: Dr. Karny Jabotinsky-Rubin, MD, MSc, BSc
Medical Reviewer: Dr. Karny Jabotinsky-Rubin, MD, MSc, BSc
Published: October 12, 2026
Publisher: IsraClinic — Private Expert Psychiatric Clinic, Tel Aviv, Israel
Medical Disclaimer
This article is intended for educational and informational purposes only. It does not replace an individual psychiatric evaluation, medical diagnosis, or professional treatment. Mental health concerns should be discussed with a qualified healthcare professional.
