{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T16:02:48Z","timestamp":1774627368203,"version":"3.50.1"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:sec id=\"ab-ybr250018-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>This study provides insight into change patterns of posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), and prolonged grief disorder (PGD) under conditions of continuous trauma. Clarification of how these disorders are associated with somatization and pain is essential for the assessment and development of integrated care models for continuous trauma\u2013exposed populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250018-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine longitudinal change patterns of PTSD, CPTSD, and PGD and assess their associations with somatization and pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250018-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>A population-based cohort study was conducted between November 2023 and December 2024 using an online panel survey in a nationally representative sample of Israeli adults (aged 18-71 years) exposed to the October 7, 2023, terror attack and subsequent war. Quota sampling was used to match the national census on age and sex. Eligibility criteria included age 18 years or older, Hebrew fluency, residency in Israel during data collection, and provision of written informed consent. Change patterns were identified across 2 measurements, approximately 1 year apart.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250018-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Probable PTSD and CPTSD were assessed using the International Trauma Questionnaire and PGD via the International Grief Questionnaire, based on standard cutoffs. Somatization was measured using the Somatic Symptom Scale\u20138 and pain using the Short-Form McGill Pain Questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250018-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 2028 participants at baseline (mean [SD] age, 42.7 [14.6] years; 51.4% women), 1598 (78.8%) completed the follow-up assessment 1 year later (mean [SD] age, 42.7 [14.6] years; 51.4% women). PTSD decreased from 17.8% to 8.2% and CPTSD from 13.1% to 9.3%; PGD remained stable (4.4% to 4.3%). The resilient pattern was most common (PTSD and CPTSD, 62.7%; PGD, 93.0%). Chronic, delayed, and shifting patterns (PTSD and CPTSD, 3.0%-4.5%; PGD, 1.7%-2.6%) were significantly associated with greater somatization (PTSD and CPTSD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.205; 95% CI, 0.200-0.215;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001; PGD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.036; 95% CI, 0.029-0.042;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), sensory pain (PTSD and CPTSD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.087; 95% CI, 0.075-0.099;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001; PGD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.029; 95% CI, 0.015-0.043;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), and affective pain (PTSD and CPTSD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.088; 95% CI, 0.071-0.105;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001; PGD, \u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.033; 95% CI, 0.017-0.049;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), with large effect sizes for PTSD and CPTSD somatization and small to medium effect sizes for all other associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250018-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cohort study provides a longitudinal view of stress-related disorders during ongoing trauma, showing dynamic PTSD and CPTSD patterns and stable PGD. The association between psychological distress and somatic burden emphasizes the need for trauma-informed care addressing mental and physical health under long-term exposure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2025.3046","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T16:00:49Z","timestamp":1762358449000},"page":"287","source":"Crossref","is-referenced-by-count":1,"title":["Change Patterns of Posttraumatic and Grief Disorders and Their Somatic Variables in Ongoing Trauma"],"prefix":"10.1001","volume":"83","author":[{"given":"Yafit","family":"Levin","sequence":"first","affiliation":[{"name":"School of Social Work, Ariel University, Ariel, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menachem","family":"Ben-Ezra","sequence":"additional","affiliation":[{"name":"School of Social Work, Ariel University, Ariel, 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