Associations of sleep quality with war-related anxiety, childhood stressors, and war-related stressors in a sample of adult Israeli civilians during the Hamas-Israel war

Abstract

The current study examined the sleep quality of Israeli adults following the onset of the Hamas-Israel war, and the associations of reduced sleep quality with the magnitude of war-related anxiety and exposure to adverse war-related events. We also examined whether exposure to stressors during childhood predicts a greater war-related reduction in sleep quality. 536 Israeli adults (mean age 31.4, 209 women) completed an online survey in January 2024, three months into the war. The survey included questionnaires assessing retrospectively childhood harshness (exposure to morbidity and mortality and low socioeconomic status), adverse childhood experiences, and childhood unpredictability. War anxiety was assessed via the war anxiety scale. The participants also completed the Pittsburgh Sleep Quality Index and the Insomnia Severity Index concerning two time points: (a) retrospectively, before the war, and (b) currently, during the war. Participants reported reduced sleep quality and increased symptoms of insomnia during the war. The magnitude of these changes was predicted by exposure to adverse war experiences both directly and indirectly through war-related anxiety. Poorer sleep quality and increased symptoms of insomnia were also indirectly predicted by childhood exposure to morbidity-mortality of close others and childhood unpredictability through greater war-related anxiety. Thus, exposure to the adverse experiences of war, as well as harsh and unpredictable childhoods, could hinder sleep quality during wartime, with these effects mediated by war-related anxiety.