The study set out with two intertwined goals: to determine whether the recurrent conflicts at Ein el Helwe were associated with marked hyperglycemia among diabetic residents, and to establish the prevalence of post-traumatic stress disorder within the same population. Ein el Helwe has periodically erupted into armed confrontations that researchers describe as battlefield-like, with exchanges of heavy gunfire, shelling and prolonged sieges that trap civilians inside crowded urban streets. For people with diabetes, such events are not merely frightening; they can directly destabilize the delicate hormonal balance that governs blood glucose. Chronic activation of the stress axis drives sustained secretion of cortisol and catecholamines, hormones that raise blood glucose by stimulating glucose production in the liver and promoting insulin resistance in muscle and fat tissue. In theory, a population living under persistent threat should show both elevated rates of trauma-related psychiatric illness and worse glycemic control, and this study was designed to test that expectation empirically.

The researchers adopted a cross-sectional design, surveying 220 participants with diabetes who lived in the affected area. The sample was predominantly female, with a mean age of 53.22 years and a standard deviation of 13.98, indicating a middle-aged cohort with wide age representation from young adults to the elderly. To assess psychological trauma, the team used an Arabic version of a validated post-traumatic stress disorder scale, allowing respondents to report symptoms in their native language. Glycemic status was captured through patient self-report: each participant provided the most recent reading of their fasting blood sugar level, and values reaching the threshold defined by the researchers as marked hyperglycemia were recorded as such. While self-reported glucose values are inherently less precise than laboratory-measured hemoglobin A1C, the approach reflects the practical realities of research in active conflict settings, where clinical infrastructure is disrupted and follow-up laboratory testing is often impossible.

The psychological findings were stark. Post-traumatic stress disorder was identified in 71.8 percent of participants, with a mean score on the PTSD scale of 45.84 and a standard deviation of 9.94. In other words, more than seven in ten diabetic patients surveyed carried a symptom burden consistent with post-traumatic stress disorder, a rate that towers over prevalence estimates in general populations, which typically range from a few percent to around ten percent depending on the country and measurement instrument. The elevated mean score suggests that symptoms were not marginal; respondents reported substantial clusters of re-experiencing, avoidance and hyperarousal symptoms of the kind catalogued in the Diagnostic and Statistical Manual of Mental Disorders. Living through gunfire, witnessing injury and death, enduring displacement and facing the constant anticipation of the next clash appear to have etched deep psychological scars into this community.

Marked hyperglycemia was reported by almost 15 percent of participants, a figure the authors interpret as a signal of compromised metabolic control within the population. That proportion may seem modest next to the PTSD rate, but it must be read against a backdrop of limited access to medication, erratic food supplies, interrupted medical care and the physiological toll of chronic stress. When the researchers moved from raw prevalence to multivariate statistical analysis, a clearer picture of who was most vulnerable emerged. Three factors independently shaped glycemic control: educational level, the specific living area within or around the camp, and the severity of avoidance and numbness symptoms, one of the core symptom clusters of post-traumatic stress disorder. The prominence of avoidance and numbness is particularly telling, because these symptoms reflect emotional shutdown and social withdrawal, states that can undermine the daily self-management behaviors diabetes demands, from monitoring glucose to adhering to medication schedules and maintaining dietary discipline.

The socioeconomic dimensions of the findings deserve close attention. Education level and living area are both markers of material circumstance, and their independent association with blood sugar control underscores that metabolic health in conflict zones cannot be disentangled from poverty, housing quality and access to health services. The authors also point to sociodemographic factors, lifestyle patterns and cultural aspects as contributors to their results, acknowledging that the relationship between trauma and hyperglycemia is mediated by a web of behavioral and contextual variables. In a refugee setting such as Ein el Helwe, where residents of Palestinian origin have faced decades of displacement and precarity, the accumulation of adversity across a lifetime may compound the acute stresses of recent clashes, creating a cumulative allostatic load that manifests in both psychiatric and endocrine pathology.

The biological plausibility of a direct trauma-hyperglycemia pathway is well established in the broader literature. Post-traumatic stress disorder has been repeatedly linked to dysregulation of the hypothalamic-pituitary-adrenal axis, altered sympathetic nervous system activity, systemic inflammation and insulin resistance, mechanisms that collectively increase the risk of type 2 diabetes and worsen control in those who already have it. Conversely, the burden of managing a chronic disease like diabetes can itself be traumatic, raising the possibility of bidirectional reinforcement in which poor glycemic control heightens psychological distress, and distress in turn destabilizes glucose metabolism. Sedentary behavior imposed by curfews and gunfire, stress-related overeating or reliance on cheap, high-calorie foods during shortages, sleep disruption caused by nighttime violence, and smoking or other coping behaviors may all serve as intermediate links between the sound of artillery and the number on a glucose meter.

The study’s limitations are candidly acknowledged by its authors, and they matter for interpretation. The cross-sectional design captures a single snapshot in time and cannot establish whether trauma preceded hyperglycemia or vice versa. Glycemia was assessed by patient report of the most recent fasting blood sugar reading rather than by standardized laboratory measurement of fasting glucose or hemoglobin A1C, introducing potential recall and measurement error. The reliance on a single camp population, while offering unusual homogeneity of exposure, limits generalizability to other conflict settings. The authors explicitly call for future studies to monitor glycemia levels directly and longitudinally to produce more reliable findings, and they suggest that objective biochemical measures would strengthen the evidentiary base considerably.

Even with these caveats, the work carries weighty implications for clinical practice and humanitarian policy. Health programs serving populations in conflict zones routinely treat physical and mental illness in parallel silos, with diabetes clinics operating separately from mental health services, if mental health services exist at all. The finding that avoidance and numbness symptoms independently predict poorer glycemic control argues for integrated care models in which screening for post-traumatic stress disorder becomes a routine part of diabetes management, and in which psychological interventions are recognized as tools of metabolic medicine. Trauma-informed approaches to chronic disease care, including attention to safety, trust and emotional regulation, may be essential for achieving glycemic targets among patients whose daily lives are shaped by violence. Conversely, stabilizing blood sugar may buffer some of the physiological consequences of trauma, suggesting that metabolic care is also a form of mental health protection.

The researchers, based in the Nursing Department of the Faculty of Health Sciences at Beirut Arab University, secured ethical approval from their institution’s Institutional Review Board and obtained informed consent from all participants in simple Arabic, including residents of Palestinian origin categorized as refugees, who were assured that participation carried no privileges and non-participation no penalties. The study received no external funding, and the authors declare no competing interests. Published as an open-access article with a citable DOI, the research arrives at a moment when armed conflict continues to flare across the region, and when the global health community is increasingly recognizing that wars injure people in ways that outlast the bullets. For the diabetic patients of Ein el Helwe, the findings confirm what their daily experience suggests: the violence outside their doors does not stay outside their bodies. It registers in their minds as post-traumatic stress, and in their bloodstreams as sugar their bodies can no longer regulate. Addressing that dual burden will require health systems that treat the psyche and the pancreas as parts of a single, war-scarred whole.

A recent epidemiological survey spearheaded by Kovess-Masfety and Makhashvili provides a detailed comparative analysis of the mental health profiles of Georgian IDPs versus their non-displaced counterparts. Deploying a methodologically robust cross-sectional design, the study encompassed data from 1,765 non-displaced individuals and 203 IDPs, offering a comprehensive snapshot of the psychological toll exacted by forced displacement within the region. This work utilizes internationally validated diagnostics, including the International Trauma Questionnaire (ITQ) for post-traumatic stress disorder (PTSD) evaluation and the Composite International Diagnostic Interview (CIDI) for assessing anxiety and depressive disorders, ensuring the reliability and clinical relevance of the findings.

The significance of this study lies in its illumination of the disproportionate burden of trauma borne by internally displaced populations. The IDP group exhibited markedly higher exposure to multiple traumatic events; notably, over twenty-two percent reported experiencing four or more distinct traumatic incidents, a stark contrast to the mere one percent in non-IDP populations. This heightened trauma exposure directly correlates with an increased prevalence of PTSD symptoms, with IDPs demonstrating a PTSD symptom impairment rate exceeding 8.5%, compared to just over 1.3% among non-displaced individuals. These disparities underscore the profound psychological vulnerability fostered by prolonged displacement and insecure living conditions.

Beyond PTSD, the research meticulously charts a pervasive pattern of anxiety disorders within the internally displaced cohort. Generalized anxiety disorder (GAD) and panic disorders surfaced with significantly elevated odds ratios, even after adjusting for sociodemographic variables including age, employment status, and education level. While depressive disorders presented a surprisingly equivalent prevalence between the two groups, the heightened anxiety spectrum disorders bespeak an urgent need for focused intervention strategies tailored specifically for displaced persons.

Interestingly, the prevalence of suicidal ideation among IDPs was found to be lower than that within the non-displaced population, a finding that invites nuanced interpretation. This counterintuitive result may reflect complex psychosocial protective factors embedded within displaced communities, such as shared social networks or cultural resilience, warranting further qualitative investigation. The nuanced mental health profile of Georgian IDPs challenges simplistic narratives and highlights the importance of multifaceted support mechanisms.

The methodological rigor of the survey bolsters confidence in its conclusions. Utilizing face-to-face interviews administered through validated instruments like the ITQ and CIDI short form allows for precise symptom quantification, while the inclusion of tools such as the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Mental Health Inventory-5 (MH5) enriches the understanding of addictive behaviors and overall psychological distress. This multidimensional approach enables a holistic appreciation of mental health challenges in displaced populations.

One of the critical revelations from the analysis is the enduring nature of psychological distress attributable to displacement, transcending basic sociodemographic factors. Adjusted odds ratios reveal that IDPs are over twelve times more likely to experience PTSD symptoms with functional impairment compared to the general population. Similarly, the risks for generalized anxiety and panic disorders remain significantly elevated, illuminating a chronic mental health crisis masked by the everyday realities of displacement and integration struggles.

The implications of these findings for public health policy and clinical practice are profound. The Georgian case underscores the exigency of embedding mental health support within displacement response frameworks. Psychosocial interventions must prioritize trauma-informed care tailored to the unique experiences of IDPs, reinforcing protective factors and addressing the compounded vulnerabilities induced by forced migration, social marginalization, and economic disenfranchisement.

Moreover, this study invites the global scientific and humanitarian community to re-examine assumptions about mental health outcomes in displaced populations. While PTSD and anxiety emerge as dominant concerns, the equivalence in depressive disorders and substance use disorders indicates heterogeneous mental health patterns that demand adaptive, context-sensitive treatment protocols rather than one-size-fits-all approaches.

Future research trajectories suggested by this survey include longitudinal studies to track the evolution of mental health symptoms among Georgian IDPs over time and experimental interventions designed to ameliorate psychological impairments. Integrating qualitative methodologies could further elucidate the psychosocial dynamics underpinning resilience and coping within displaced communities, providing a balanced perspective amidst the prevailing focus on pathology.

The Georgian example exemplifies the transformative role epidemiological psychiatry can play in unpacking the complex interplay between forced displacement and mental health. As internal displacement remains a pressing global humanitarian challenge, the insights gathered from this national survey resonate far beyond Georgia’s borders, offering critical data to inform international response strategies and to galvanize mental health prioritization in settings of conflict and displacement.

In sum, the study by Kovess-Masfety and Makhashvili stands as a landmark investigation into the psychological consequences of forced migration within Georgia. Its robust design, rigorous data collection, and nuanced analysis provide an indispensable foundation for advancing mental health support for internally displaced persons, highlighting urgent areas for policy action and clinical innovation. The mental well-being of displaced populations hinges on integrating such evidence-based insights into holistic, culturally attuned frameworks of care, a mandate that grows ever more pressing in an era marked by unprecedented human mobility and conflict.

Subject of Research: Mental health consequences of traumatic events on Georgian internally displaced persons (IDPs) compared to non-displaced populations.

Article Title: Traumatic events consequences on the Georgian internally displaced person’s mental health: an epidemiological national survey.

Article References:
Kovess-Masfety, V., Makhashvili, N. Traumatic events consequences on the Georgian internally displaced person’s mental health: an epidemiological national survey. BMC Psychiatry 25, 718 (2025). https://doi.org/10.1186/s12888-025-07137-z

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s12888-025-07137-z