Mental health of palestinian undergraduates during the War on Gaza: a cross-sectional study on PTSD, CPTSD, and psychological distress

Armed conflicts severely impact civilian mental health, with prolonged exposure linked to complex trauma presentations. This cross-sectional study investigated the prevalence of post-traumatic stress disorder (PTSD), complex PTSD (CPTSD), and psychological distress among 819 Palestinian undergraduate students across West Bank universities during the Gaza war. Data were collected between February and April 2024 using an online survey that included the International Trauma Questionnaire (ITQ; ICD-11 criteria) and the General Health Questionnaire-12 (GHQ-12). Associations between conflict exposure variables and mental health outcomes were analyzed using non-parametric statistics and multinomial logistic regression. Mental health conditions were highly prevalent: 87.2% (95% CI: 84.7–89.4%) reported psychological distress, and 51.9% met criteria for a PTSD diagnosis, with 25.5% classified as PTSD-only and 26.4% as complex PTSD. Disturbances in self-organization were present in 38.6% of participants. Female students exhibited greater PTSD symptom severity compared to males (median = 12 vs. 10, p < 0.001). Multinomial logistic regression revealed that crossing four or more military checkpoints was associated with over three-fold higher odds of both PTSD-only (AOR = 3.66) and CPTSD (AOR = 3.42), while prior mental health diagnoses specifically predicted CPTSD (AOR = 2.07) but not PTSD-only. Religious coping was predominant (90.4%), yet only 2.6% had accessed professional mental health services. These findings reveal a substantial mental health crisis among Palestinian university students, underscoring the need for expanded, culturally sensitive, and context-based mental health interventions within universities.