Prevalence and correlates of anxiety, depression, and symptoms of trauma among Palestinian adults in Gaza after a year of war: a cross-sectional study

Armed conflicts have a devastating effect on the civilian population, not only by direct violence but also by causing long-lasting psychiatric conditions, such as post-traumatic stress disorder (PTSD), depression, and anxiety, as a result of exposure to traumatic events such as displacement, loss of loved ones, and destruction of homes. The military attack on Gaza, which has been ongoing since October 7, 2023, compounds an environment of continuing fear, uncertainty, and loss, which markedly increases the prevalence of mental health disorders. This study aims to assess the prevalence of anxiety, probable PTSD, and depression in the population of Gaza after one year of continuous war. This study aims to offer a comprehensive perspective on the mental health challenges experienced by the people of Gaza. Data collection was carried out between November 10, 2024, and January 10, 2025. Four hundred five participants completed an online self-reported questionnaire, distributed via emails, social media platforms, and community networks. The survey screened for symptoms of PTSD (PCL-5), anxiety (GAD-7), and depression (PHQ-9), and included items assessing exposure to war-related experiences. The findings indicated alarmingly high rates of mental health symptoms, with 72.7% of participants reporting moderate to severe depression (PHQ-9 >= 10), 65% reporting moderate to severe anxiety (GAD-7 >= 10), and 83.5% meeting the threshold for probable PTSD (PCL-5 >= 33). The mean scores indicated moderate to severe symptom levels for anxiety and depression, with GAD-7 at 13.16 and PHQ-9 at 14.32. The mean PCL-5 score was 48.16, reflecting a substantial burden of PTSD symptoms among participants. A substantial proportion had lost a family member (45.7%), experienced a military siege (82.5%), witnessed someone being killed or injured (80.5%), and reported losing their work due to the conflict (42.7%). Binary logistic regression analysis revealed that losing a family member was significantly associated with moderate or higher levels of depression (OR = 2.395, p = 0.010) and anxiety (OR = 1.929, p = 0.027). Similarly, living in the northern part of the Gaza Strip was significantly associated with moderate or higher levels of depression (OR = 1.755, p = 0.039) and anxiety (OR = 2.395, p = 0.010). The simultaneous presence of any two of the three mental health conditions was statistically significant, with p values for each pairwise association being less than 0.05. The study revealed that the population of Gaza had an extremely high prevalence of diagnosable mental disorders, as determined through validated screening tools for anxiety, depression, and PTSD. These findings have far-reaching implications, emphasizing the urgent need not only for medical and psychosocial support, but more critically, for an end to the ongoing violence that continues to devastate lives and communities.