The research team set out to fill a well-recognized gap in the literature. While individual studies have examined single psychiatric outcomes in conflict-affected populations, population-level data simultaneously assessing PTSD, depression, anxiety, and subjective well-being among general adults in the West Bank had remained limited. The investigators designed an analytical cross-sectional study using multi-stage convenience sampling, recruiting 1,615 participants aged 18 or older across all three regions of the West Bank. Data were collected face-to-face at community sites and through an online survey, a hybrid approach intended to reach respondents across varied geographic and socioeconomic circumstances.

Methodologically, the study leaned on four widely validated screening instruments administered in their Arabic versions. The PCL-5, or PTSD Checklist for DSM-5, captured symptoms of post-traumatic stress aligned with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The PHQ-9, or Patient Health Questionnaire-9, measured depressive symptom severity, while the GAD-7, or Generalized Anxiety Disorder-7, quantified anxiety. Subjective well-being was assessed with the WHO-5 Well-Being Index, a short measure developed under the World Health Organization framework. Using these instruments together allowed the researchers to estimate prevalence for each condition and, crucially, to model how specific conflict-related exposures and sociodemographic factors independently shaped each outcome.

The headline figures demand attention. Probable PTSD was found in 38.3 percent of participants, with a 95 percent confidence interval of 35.9 to 40.6 percent. Moderate depression or worse affected 53.4 percent, moderate anxiety 46.3 percent, and poor well-being a striking 78.9 percent. These are not clinical diagnoses confirmed by structured interviews; they are screening thresholds, which the authors acknowledge. Yet the consistency of elevation across four distinct psychological domains, measured with validated tools in a large sample, signals a population carrying an extraordinary and multidimensional burden of distress.

The analytical core of the paper lies in its multivariable regression models, which disentangled the independent contributions of five conflict-related exposures: displacement, settler violence, military raids, death or injury of a family member, and house demolition. All five were independently associated with higher PTSD symptom scores. Displacement emerged as the strongest predictor, with an unstandardized coefficient of 6.24 on the PCL-5 scale, followed by settler violence at 5.53, both statistically significant at p less than .001. In practical terms, respondents who had been forced from their homes scored, on average, more than six points higher on a 80-point symptom inventory than otherwise similar respondents who had not, a substantial effect for a single exposure variable.

That displacement outranks even direct bereavement in the statistical models is a finding with theoretical weight. Trauma research has long distinguished between discrete traumatic events and prolonged, destabilizing disruptions to the social and material foundations of life. Losing one’s home combines acute loss with ongoing uncertainty about safety, shelter, livelihood, and identity, and the present data suggest that this compound disruption leaves a deeper psychometric footprint than any single violent event. Settler violence, the second strongest predictor, similarly points to the psychological impact of threats that are recurrent, localized, and unpredictable, conditions that behavioral science associates with sustained hypervigilance and learned fear generalization.

Sociodemographic factors told their own story. Income insufficiency consistently predicted worse outcomes across all four measures, linking economic deprivation to higher PTSD and depression scores, greater anxiety, and lower well-being. This pattern underscores that financial insecurity is not merely a background variable in conflict settings but an active amplifier of psychological harm, likely by constraining coping options, prolonging exposure to unsafe conditions, and eroding the sense of control that protects mental health. The finding carries direct implications for humanitarian programming, suggesting that economic support interventions may yield measurable psychological dividends alongside their material ones.

Perhaps the most consequential result concerns mental health services. Only 25.1 percent of participants reported having access to mental health care, a figure that itself quantifies a massive service gap. Among those with access, the association was encouraging but incomplete: service contact was linked to lower depression and anxiety scores and higher well-being, but not to reduced PTSD symptom severity. The authors interpret this dissociation as evidence of a missing trauma-specific layer in available care. Generic counseling and pharmacological support may alleviate mood and anxiety symptoms, but PTSD typically responds best to trauma-focused therapies, such as prolonged exposure or cognitive processing approaches, which require trained providers and are rarely available in low-resource conflict settings.

The study’s design carries limitations that readers should weigh. As a cross-sectional survey, it captures associations at a single point in time and cannot establish that conflict exposures caused the observed symptoms, however biologically and psychologically plausible such causation appears. Convenience sampling, even when staged across regions and modalities, risks underrepresenting the most severely affected or least reachable populations, and screening instruments approximate rather than confirm clinical diagnoses. The authors themselves call for future longitudinal research to track symptom trajectories and to test whether the exposure-outcome gradients they observed persist, deepen, or attenuate as circumstances evolve.

Even with those caveats, the implications are difficult to ignore. A population in which nearly four in ten adults screen positive for PTSD and four in five report poor well-being is a population whose psychological infrastructure is being eroded in real time. The researchers argue for trauma-focused, exposure-informed, and scalable mental health interventions in protracted conflict settings, with attention to the specific exposures, displacement above all, that drive the heaviest symptom burden. They also frame the findings as relevant to mental health system strengthening more broadly, noting that the gap between the conditions people screen positive for and the services they can reach is itself a modifiable determinant of population health. As conflicts elsewhere in the world grow protracted, the West Bank data offer a rigorous, sobering template for measuring what sustained violence does to the minds of those who live under it, and a reminder that rebuilding psychological well-being may be as urgent as rebuilding anything else.

Subject of Research: Mental health burden and conflict-related trauma among Palestinian adults in the West Bank

Article Title: Prolonged conflict and its psychological toll: post-traumatic stress disorder, anxiety, depression, and poor well-being among Palestinians in the West Bank

Article References: Zrineh, A., Qadous, S., Jarrad, L., Khalil, A., Daraghmeh, A., AbuShamma, F., Zahdeh, M., Aqel, B., Ghneimat, M., Khudair, M. Y., Natsheh, S., Saifi, W., Awwad, S., & Alwawi, A. (2026). Prolonged conflict and its psychological toll: post-traumatic stress disorder, anxiety, depression, and poor well-being among Palestinians in the West Bank. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08705-7

Image Credits: AI Generated

DOI: 10.1186/s12888-026-08705-7

Keywords: PTSD, depression, anxiety, well-being, armed conflict, West Bank, Palestine, displacement, settler violence, mental health services, PCL-5, cross-sectional study