Anxiety, depression, and post-traumatic stress disorder among Palestinian refugees in Egypt: Gender-stratified item-level Bayesian network analysis

Abstract

BACKGROUND: Mental disorders pose a substantial global burden, particularly among conflict-affected populations. This study aimed to examine gender-stratified, item-level networks of anxiety, depression, and posttraumatic stress disorder (PTSD) among Palestinian refugees in Egypt following the 2023 war on Gaza. METHODS: A cross-sectional study was conducted among 558 Palestinians aged > 18 years displaced to Egypt. Anxiety, depression, and PTSD were assessed using the Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Impact of Event Scale-6, respectively. Bayesian network analyses were applied to identify central symptoms and the strongest within- and cross-diagnostic associations. RESULTS: In the male network, suicidal ideation and loss of energy emerged as the most central symptoms. The strongest cross-diagnostic association was observed between anticipatory fear and depressed mood. Within diagnostic domains, the strongest associations were found between uncontrollable worry and excessive worrying (anxiety), loss of energy and appetite change (depression), and war-related intrusive thoughts and hypervigilance (PTSD). In the female network, psychomotor agitation or retardation and suicidal ideation were the most central symptoms. The strongest cross-diagnostic association was between trouble relaxing and anhedonia. The strongest within-domain associations were observed between feeling anxious and being easily annoyed (anxiety), loss of energy and depressed mood (depression), and war-related intrusive thoughts and reminders of war (PTSD). CONCLUSIONS: Identifying gender-specific core symptoms and both within- and cross-diagnostic associations in this vulnerable population is crucial to inform targeted interventions and reduce comorbidity.