{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:19:36Z","timestamp":1792545576948,"version":"4.5.0"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Exposure to severe combat situations significantly raises the risk of depression and post-traumatic stress disorder (PTSD). Trauma survivors may use dissociation as a defense mechanism, increasing the likelihood of PTSD. This study aims to explore the roles of dissociation and depression in PTSD among soldiers exposed to combat who sought help from the Israel Combat Stress Reaction Unit. Method: This cross-sectional study involved 927 individuals who participated in a particular military operation in 2014 [98.5% male (n = 906); mean age = 27.08 (SD = 5.93)]. Participants completed three questionnaires: the Dissociative Experiences Scale (DES), the Beck Depression Inventory (BDI), and the Post-Traumatic Stress Symptom Checklist (PCL-5) for PTSD. Results: Our results showed that severe PTSD (PCL score \u2265 33) was found in 30.4% of participants, and 76.6% showed dissociative symptoms (DES score \u2265 30). Additionally, 23.5% experienced moderate depression, while 19.1% reported severe depressive symptoms. A Generalized Linear Model revealed that both depression and dissociation significantly contribute to PTSD. Individuals with depression were three times more likely to experience post-traumatic symptoms compared to 1.23 times for those with dissociative symptoms. Conclusions: Life-threatening situations significantly predicted higher PTSD symptoms, serving as a risk factor for depression and dissociation, which play important roles in PTSD, with depression having notably greater impact.<\/jats:p>","DOI":"10.3390\/ijerph22060814","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T04:32:37Z","timestamp":1747888357000},"page":"814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Roles of Dissociation and Depression in PTSD Among Soldiers Exposed to Combat"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0611-137X","authenticated-orcid":false,"given":"Leah","family":"Shelef","sequence":"first","affiliation":[{"name":"School of Social Work, Sapir College, D.N. Hof Ashkelon 7916500, Israel"},{"name":"Center for Mental Health Services and Mental Resilience, Israel Defense Forces-Medical Corps, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9849-2106","authenticated-orcid":false,"given":"Nir","family":"Spira","sequence":"additional","affiliation":[{"name":"School of Social Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv Yaffo 6818211, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1608-1751","authenticated-orcid":false,"given":"Uzi","family":"Bechor","sequence":"additional","affiliation":[{"name":"Center for Mental Health Services and Mental Resilience, Israel Defense Forces-Medical Corps, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2118-0724","authenticated-orcid":false,"given":"Jacob","family":"Rotschield","sequence":"additional","affiliation":[{"name":"Center for Mental Health Services and Mental Resilience, Israel Defense Forces-Medical Corps, Ramat Gan 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1312-2643","authenticated-orcid":false,"given":"Eran","family":"Shadach","sequence":"additional","affiliation":[{"name":"School of Social Sciences, The Academic College of Tel Aviv-Yaffo, Tel Aviv Yaffo 6818211, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa040603","article-title":"Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care","volume":"351","author":"Hoge","year":"2004","journal-title":"N. 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