Betrayal experiences among individuals living in war zones: A longitudinal study

Objective: Betrayal, a component of moral injury, refers to the harm caused by the deliberate actions or inaction of someone trusted, violating one's values and beliefs. This study examines the impact of betrayal experiences—specifically perceptions of failure by political and military leadership—on mental health outcomes among civilians in Israeli conflict zones, focusing on anxiety, depression, and posttraumatic stress disorder (PTSD). It also explores the relationship between betrayal and war-related factors such as traumatic loss, forced displacement, and income loss, along with the roles of gender and ethnicity. We hypothesized that higher betrayal levels would be associated with more severe mental health symptoms, and war-related experiences, female gender, and ethnic minority status would exacerbate these effects. Methods: A longitudinal study was conducted with 1052 individuals (ages 18–40) living in northern and southern Israel, areas that were exposed to war and mass forced displacement of civilians. Participants were assessed at three time-points: February 2024, March 2024, and May 2024. Measures included the Moral Injury Events Scale focusing on betrayal, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Primary Care PTSD Screen for DSM-5. We measured changes over time using Linear Mixed Models. Results: High levels of betrayal experiences were significantly associated with greater symptoms of anxiety, depression, and PTSD across all timepoints. Traumatic loss, forced displacement, and income loss were strong predictors of increased betrayal experiences, with women and ethnic minorities reporting higher levels of betrayal experiences over time. Conclusions: Our findings underscore the impact of war-related stressors on the sense of betrayal. The study highlights the urgent need for targeted mental health interventions to address the psychological effects of betrayal, particularly among vulnerable groups. Future research should explore these dynamics in more diverse populations to better understand the broader implications of betrayal experiences.