On October 7, 2023, at least 3,000 people attended the Supernova music festival near Kibbutz Re’im in southern Israel. At least 364 of the festival goers were murdered and more than 40 taken hostage after Hamas terrorists descended on the event during the early hours of the day. 

A year later, many of the survivors are still struggling to move on with their lives, battling anxiety, stress, depression and post-traumatic stress disorder (PTSD). 

In October, festival survivor Shirel Cohen took her own life on her 22nd birthday, having battled severe PTSD for months. 

Veteran psychiatrist and researcher Prof. Hagit Cohen, says there are several significant risk factors for PTSD. Knowing these risk factors better could potentially improve the way victims of traumatic events are treated in the immediate aftermath. 

“These risk factors could have been there before the event, such as age and sex, or after it, like drugs and alcohol,” Cohen, the head of the Anxiety and Stress Research Unit at Faculty of Health Sciences in Ben-Gurion University of the Negev (BGU), tells ISRAEL21c. 

Her latest, one-of-a-kind research focuses precisely on that, examining whether the use of substances by the festival partygoers at the time of the attack contributed to the development of the negative mental-health symptoms, which could be precursors of PTSD. 

Blame it on the alcohol

The research, conducted by scientists from BGU and Sheba Medical Center, and recently published in the World Psychiatry scientific journal, found that alcohol had the strongest and most damaging effect on the stress response to the event. 

“The initial findings showed that those who used drugs and alcohol exhibited levels of anxiety and depression that were higher compared to those who remained sober,” Cohen explains. 

Cohen led the study together with Sheba’s Dr. Nitza Nakash, in collaboration with BGU’s Gal Levy and Yarden Dajarno from the Department of Psychology and the Faculty of Health Sciences, and Sheba’s Prof. Yossi Zohar and his student Tal Malka, Prof. Mark Weiser, and Prof. Raz Gross.

According to their findings, 60 percent of the festival attendees consumed illegal drugs, including those who mixed drugs with alcohol. Another 40% did not use drugs, and this percentage includes people who stayed completely sober as well as those who only consumed alcohol.

“Later we found that among those who consumed alcohol, whether mixed with drugs or on its own, the levels of negative symptoms were the highest compared to those who only took drugs, and of course compared to those who were sober.” explains Cohen.  

“There is also the effect of a hangover at play, because some of them were drinking alcohol the entire night leading up to the attack.” 

Cohen says it’s important to note that the study examined those who voluntarily reached out to Sheba seeking help to cope with their emotional distress. 

PTSD risk factors 

The questionnaires filled out by 123 survivors for this research were submitted less than a month after the attack, and were meant to measure the immediate levels of anxiety and stress, a phenomenon called “acute stress reaction.”

The median age of the survivors in the study was 28; 71 of the participants were male and 52 female. It did not include participants with additional traumas such as serious physical injuries or first-degree family members killed in the attack, nor those with a history of mental disorders.

The study did not intend to examine PTSD, since its onset begins around the third month following a traumatic event. 

“PTSD patients are those for whom the symptoms of the acute stress reaction don’t go away months after [the traumatic event].” 

Cohen says that studies on PTSD should be done around a year after the incident in order to produce accurate results. This is why she and her team are now gearing up for new research on Supernova survivors, focusing primarily on PTSD.

She says the current study serves more as a useful tool to identify those risk factors that can potentially predict the development of PTSD.

“For instance, those who consumed alcohol reported symptoms of dissociation during the attack, which lasted much longer compared to those who didn’t consume alcohol,” she notes, adding that dissociation is a known risk factor for PTSD.

“The longer the dissociation lasts [during the traumatic event], the more chance there is of developing PTSD later on.” 

Wider implication of the study

Cohen says these findings could potentially help answer much broader questions regarding our relationship with alcohol and its connection to negative emotional responses in our lives. 

“For example, if I had a stressful day and I decide to drink some alcohol and smoke a cigarette, am I making the situation better or worse in the long run when it comes to stress in my life?”

Cohen explains that previous studies proved that alcohol negatively impacts motor memory, “and now we know it impacts traumatic memory as well.” 

She notes that understanding alcohol as a potential risk factor for PTSD can overhaul the way medical professionals treat people in the immediate aftermath of the event. 

“For instance, if a person at an emergency room following a car accident admits to drinking alcohol, we can give him a specific treatment knowing there’s already a chance of developing PTSD there.”

She adds the findings are both “of social and clinical interest,” enabling understanding “of the biological process of response to traumatic experiences” including anything from traffic accidents to sexual or physical assault.

Post-traumatic growth

Finally, I ask Cohen if the entire country of Israel is suffering right now from PTSD following the October 7 attacks and the subsequent war. 

“There is an overuse of the term PTSD happening nowadays; I don’t like it,” she replies.

“We know from clinical studies that most people recover from traumatic events, and even grow from them. It’s called post-traumatic growth.”

Cohen says that only a minority of people develop actual, clinically verified PTSD, and even they can recover with the right treatment. 

“Our nation has known events worse than these; the majority of those who survived the Holocaust recovered and went on to start families.

“We’ll grow and become stronger from it.”