Psychological distress and trauma response among war-exposed young adults in Gaza

Abstract

Abstract The Gaza Strip has suffered massive civilian harm, widespread displacement, and near-total disruption of health services since 7 October 2023, creating an acute humanitarian and mental-health emergency. In this study, we measured anxiety, depression, and post-traumatic stress symptoms and examined their associations with different types of war-related traumatic events among young adults from Gaza. A cross-sectional online survey conducted between October and December 2024 included 604 participants (mean age 21.4 ± 1.6 years) who were exposed to the war, using validated measures of anxiety, depression, post-traumatic stress, and war-related traumatic events. Symptom burden was high: 74.0% of participants scored in the severe/probable range for anxiety, 85.1% for depression, and 79.6% met the threshold for probable PTSD. Most participants reported multiple war-related trauma types (mean 10.4 of 19; 62.9% reported ≥ 10 types). Notably, 44.0% of participants had high trauma exposure (≥ 10 trauma types), severe/probable anxiety, severe/probable depression, and probable PTSD simultaneously. The number of trauma types demonstrated a positive dose–response relationship with symptom severity, correlating with anxiety ( r  = 0.25), depression ( r  = 0.25), and post-traumatic stress symptoms ( r  = 0.35; all p  < 0.001), with no evidence that this association differed by gender. Nevertheless, women reported higher symptom levels across all three domains. Participants who remained in Gaza, and those living in tents or shelters, reported more trauma types than those who had left or lived in houses, and shelter residents showed higher post-traumatic stress symptom severity. At the item level, witnessing family members injured, witnessing shootings, siege, and witnessing an ambulance being prevented from reaching the injured showed the strongest associations with symptom severity. Because the war was ongoing at assessment, these responses are best understood as traumatic-stress reactions to continuing danger; the findings document a severe mental-health emergency among young adults in Gaza and underscore the need for scalable, culturally grounded mental-health support.