Prevalence of Post-Traumatic Stress Disorder and Assessment of Happiness Levels Among Syrian University Students

Prevalence of Post-Traumatic Stress Disorder and Assessment of Happiness Levels Among Syrian University Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Post-Traumatic Stress Disorder and Assessment of Happiness Levels Among Syrian University Students Hadeel Ezz-Aldeen Alshaikh Khalil, Walaa Yousef Bakr, Hiba Samer Barakat, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7768518/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Years of ongoing conflict, widespread displacement, and instability in Syria have placed a heavy psychological burden on the country’s population, particularly on its youth. University students, in particular, represent a vulnerable group due to the dual pressures of academic responsibilities and socio-political instability. This study aimed to determine the prevalence of PTSD symptoms among a sample of university students across several Syrian governorates and to examine their association with demographic and trauma-related factors. The study also explores overall happiness levels, aiming to provide a more comprehensive view of the psychological impact of conflict and displacement on this population. Methods A cross-sectional analytical observational survey was conducted among 1,034 students from various Syrian universities using an online questionnaire. The instrument included demographic information, exposure to traumatic events, the PTSD Checklist for DSM-5 (PCL-5), and the Arabic Scale of Happiness (ASH). Descriptive and inferential statistics were used for data analysis. Data analysis incorporated both descriptive and inferential statistics. Associations between categorical variables were examined using chi-square tests. Analyses were conducted with Excel, GraphPad Prism, and Jamovi, with statistical significance set at p < 0.05. Results Of the 1,034 participants, 40.62% met the diagnostic cutoff for probable PTSD based on PCL-5 scores. PTSD prevalence did not significantly differ between males and females (p = 0.201). However, significant variations were found across different academic years and university regions. Regarding trauma exposure, 85.4% of participants reported experiencing at least one traumatic event, and 44.51% of those individuals met the criteria for probable PTSD. A significant association was found between the number of years spent in conflict-affected areas and PTSD prevalence (p = 0.0038). Students with probable PTSD symptoms reported lower happiness scores. Conclusion PTSD is prevalent among Syrian university students, particularly among those with prolonged exposure to conflict. Academic stress and regional instability may compound psychological risk. Despite this, happiness levels ranged from moderate to high, which may reflect some degree of resilience. These findings underscore the need for psychological support programs tailored to university students in post-conflict settings. Post-Traumatic Stress Disorder (PTSD) Syrian university students PCL-5 Arabic Scale of Happiness (ASH) Trauma exposure Happiness Cross-sectional survey Conflict-affected population Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background Since the outbreak of armed conflict in Syria in 2011, the country has undergone profound transformations that have profoundly influenced all dimensions of existence. Among the various humanitarian and socio-cultural consequences of the Syrian conflict, mental health has emerged as one of the most significantly impacted domains, particularly among the youth demographic [ 1 ]. Post-traumatic stress disorder (PTSD) has been recognized as one of the most prevalent psychological afflictions among individuals subjected to extreme conditions, including warfare and armed conflicts [ 2 ]. Recurrent intrusive memories, nightmares, avoidance behaviors, irritability, and sleep disturbances typically characterize PTSD. It is also frequently associated with increased risk of suicidal ideation and other comorbid psychiatric conditions, such as depression and anxiety [ 2 , 3 ]. Civilians and military personnel residing in conflict-affected areas are particularly vulnerable to PTSD and related disorders, with long-lasting emotional and functional consequences [ 4 ]. The manifestation of PTSD can vary in timing and duration. It can occur in two distinct temporal patterns: either immediately or after a period of latency. Estimates of PTSD prevalence often vary due to differences in assessment methodologies, populations studied, and diagnostic criteria [ 5 ]. Individuals with pre-existing mental health conditions may exhibit a heightened propensity to develop PTSD following a traumatic event. However, further research is necessary to ascertain the extent of this association [6]. According to a World Health Organization (WHO) review, the estimated point prevalence of common mental disorders, including mild forms of depression, anxiety, and PTSD, is approximately 13% among populations affected by conflict, with 4% experiencing moderate or severe forms [ 7 , 8 ]. Globally, while about 70% of individuals are exposed to at least one traumatic event in their lifetime, only a small percentage of them, 5.6%, develop PTSD. However, this risk increases more than threefold among those exposed to violent conflicts or Wars [ 9 ]. Regional studies further emphasize the psychological toll of war: a 2020 study in Gaza reported that 53.5% of children exhibited PTSD symptoms [ 10 ]; another study in Palestine found a prevalence of 23.2% among adults [ 11 ]. More recently, following the 2023 conflict in Sudan, PTSD prevalence among displaced persons from Khartoum was reported at 46.7% [ 12 ]. According to the global model, individuals with PTSD experience a lasting alteration in their capacity to feel positive emotion [ 13 ]. This alteration involves a notable decline in the frequency and intensity of positive emotional states, including feelings such as happiness, joy, love, interest, and the capacity for interpersonal connection [ 14 ] Young adults, particularly university students, have been uniquely affected by the protracted Syrian crisis. Many have experienced or witnessed bombings, displacement, and the loss of loved ones, all of which are potent risk factors for PTSD. Despite the growing international body of research on the mental health consequences of war, there is a marked scarcity of research specifically addressing university students in the Syrian context. Little is known about how these traumatic experiences affect their academic performance, psychological well-being, and social functioning [ 15 ]. To address this critical gap in the literature, the present study aimed to: (1) estimate the prevalence of PTSD symptoms among university students in Syria; (2) explore the relationship between direct and indirect exposure to war-related trauma and the likelihood of developing PTSD; (3) assess overall happiness levels in this population; and (4) examine the association between PTSD symptoms and subjective well-being. The study also aims to inform the development of mental health support strategies targeting students in post-conflict settings. By shedding light on these issues, we hope to contribute to a better understanding of the psychological needs of Syrian youth and provide empirical evidence to guide mental health interventions and policy in educational settings throughout the region. 2. Methods 2.1. Study Design and Participants: This study adopted an analytical observational cross-sectional design to assess the prevalence of posttraumatic stress disorder (PTSD) symptoms among university students in Syria. Universities were clustered according to their regions of presence into universities in the South (e.g., Damascus University, Syrian Private University, etc.), North, Center, Coastal, and East. Students from various Syrian universities participated in the study. Participants were recruited using a convenience sampling method through an online questionnaire distributed via social media platforms and university-related online groups on Telegram. The survey was open for responses from the 3 rd of April to the 27 th of May 2025. Participants aged 40 years or older were excluded to maintain a homogeneous age range representative of typical university students. 2.2. Study Instrument The online questionnaire consisted of five main sections: 1. Demographic Information : Including gender, age, place of residence, university, and academic year. 2. Exposure to Traumatic Events : A set of items assessing whether the participant had experienced one or more traumatic events. Note: In this section of the questionnaire, participants were allowed to select more than one traumatic event that happened to them 3. PTSD Checklist for DSM-5 (PCL-5) and Arabic Scale of Happiness (ASH): This study employed the Arabic version of the PCL-5 instrument. This version had been previously validated for the assessment of post-traumatic stress disorder [16]. It contains 20 items rated on a 5-point Likert scale, based on DSM-5 diagnostic criteria. The questions assessed PTSD symptoms using a five-point severity scale: 0 (not at all); 1 (a little bit); 2 (moderately); 3 (quite a bit); and 4 (extremely) [17]. PTSD symptom clusters were divided into the following categories: 1. Re-experiencing memories 2. Persistent avoidance 3. Negative alterations in mood and cognitions 4. Alterations in arousal and reactivity A score between 31 and 33 was considered significant for meeting the probable diagnostic criteria for PTSD based on instrument standards [18]. Accordingly, we selected a cutoff of > 32 in this study, as it falls within that validated range and yields a balanced sensitivity and specificity for our Syrian university student sample. Arabic Scale of Happiness (ASH): A validated scale used to measure participants’ general level of happiness. The scale consisted of fifteen concise statements along with five additional filler items. Each item was rated on a five-point intensity scale. The aggregate score ranged from 15 to 75, with elevated scores reflecting greater levels of happiness [19]. 4. Use of Psychiatric Medications : Questions related to whether the participant had previously or currently used psychiatric medications. 5. Mental Health Services Availability: Questions about whether there were any mental health services available in the participants' areas, and their views on how to improve mental health in Syria. 2.3. Procedure The questionnaire was created using an online survey platform (Google Forms) and distributed electronically (through student groups) and in person. Participation was voluntary, and an informed consent form was included at the beginning of the survey. Additionally, no personal information was collected to ensure anonymity and confidentiality. 2.4. Statistical Analysis Data were analyzed using GraphPad Prism (version 10.4.2), Microsoft Excel (2016), and Jamovi (version 2.6.44). The analysis included calculating percentages for demographic variables, exposure to traumatic events, medication usage, as well as prevalence rates of post-traumatic stress disorder (PTSD), and levels of happiness. Descriptive statistics were conducted for the Arabic Scale of Happiness and the PTSD Checklist for DSM-5 (PCL-5), including median values, standard deviations, and assessment of data normality. The internal consistency value of the PCL-5 scale in this sample was Cronbach's α = 0.938, indicating excellent internal reliability. A cutoff of ≥32 was used to identify participants with potential PTSD symptoms. The internal consistency value of ASH in this sample was good (Cronbach’s α = 0.817). This indicates good internal reliability of the scale in this sample. Chi-square tests were performed to examine the association between PTSD prevalence and categorical variables, including gender, academic year, university region, the number of years participants had lived in conflict-affected areas, and happiness levels, categorized by gender, university region, and academic year. For further analysis, the Arabic Scale of Happiness scores were categorized into four groups—low happiness, moderate happiness, happy, and extremely happy—based on median and standard deviation calculations. Since the data did not follow a normal distribution, Spearman's rank correlation coefficient was used to assess the relationship between continuous variables, such as between PTSD (PCL-5) scores and happiness scores. A binomial logistic regression was conducted to identify significant predictors of PTSD diagnosis among participants. PTSD was coded as 0=not meeting the cutoff for probable PTSD and 1= meeting the cutoff. Data visualization included bar charts and pie charts. Statistical significance was set at p < 0.05. 3. Results 3.1. Socio-demographic characteristics of participants: Out of 1,034 participants, the mean age was 22.80 years (SD = 3.36), with the majority (77.07%) falling within the 19–24-year age group. Most participants were female (74.37%). Regarding childhood residency, 26.11% grew up in Damascus, 28.14% in Rural Damascus, and 9.86% in Latakia. The remaining participants were distributed across other Syrian governorates. A total of 59.86% of the Participants were from southern Syrian universities, with 83.03% from Damascus University. Additionally, 16.44% of the Participants were from central Syrian universities, and 14.31% were from coastal Syrian universities. The academic year distribution was as follows: first year (10.83%), second year (13.54%), third year (13.83%), fourth year (18.28%), fifth year (27.75%), sixth year (2.61%), and Higher degrees (13.06%). Note that the sixth year is only for medical students. Details on the socio-demographic data of our sample are available in Table 1 . Table 1 Socio-demographic characteristics of participants Variable N % Gender Male 265 25.63% Female 769 74.37% Current academic year Undergraduate Studies First year 112 10.83% Second year 140 13.54% Third year 143 13.83% Fourth year 189 18.28% Fifth year 288 27.75% Sixth year (medical students) 27 2.61% Postgraduate studies 135 13.06% Age ≤ 18 27 2.61% 19–24 797 77.07% ≥ 25 210 20.31% Childhood residency Damascus 270 26.11% Rural Damascus 291 28.14% Daraa 95 9.19% Suwayda 15 1.45% Aleppo 59 5.71% Homs 32 3.09% Latakia 102 9.86% Tartus 47 4.55% Hama 23 2.22% Idlib 27 2.61% Hasakah 24 2.32% Deir ez-Zor 28 2.71% Raqqa 16 1.55% Quneitra 5 0.48% Current residency Damascus 342 33.08% Rural Damascus 290 28.05% Daraa 78 7.54% Suwayda 11 1.06% Aleppo 58 5.61% Homs 36 3.48% Latakia 110 10.64% Tartus 55 5.32% Hama 19 1.84% Idlib 19 1.84% Hasakah 3 0.29% Deir ez-Zor 3 0.29% Raqqa 3 0.29% Quneitra 7 0.68% Universities regions South 619 59.86% North 92 8.90% East 5 0.48% Middle 170 16.44% Coastal 148 14.31% 3.2. Exposure to traumatic events A total of 85.40% (n = 883) of participants reported exposure to at least one traumatic event, including multiple displacements (54.8%), witnessing violent acts (54.3%), loss of family members (42.6%), and school dropout (30.9%). 54.84% (n = 567) of participants had lived for more than 6 years in a conflict-affected area, and 16.25% (n = 168) had lived 4–6 years in such areas. Note The questionnaire allowed more than one answer to be selected for exposure to traumatic events; therefore, each individual could have selected multiple answers, and the percentage may exceed 100% (n = 1034). Information on sample distribution based on trauma exposure is in Figs. 1 , 2 3.3. PTSD prevalence according to demographic variables Based on responses to the PCL-5, 40.62% of the sample met the cutoff score ( ≥ 32) for probable PTSD diagnosis. No statistically significant association was found between gender and PTSD prevalence (chi-square = 1.570, P = 0.201). The findings of this study demonstrated a statistically significant relationship between the current academic year and prevalence of PTSD (Chi-square = 27.35, P = 0.0001), as the survey revealed that the proportion of fifth-year students diagnosed with PTSD was notably higher compared to other groups. On the other hand, Post-graduate students diagnosed with PTSD were notably higher compared to post-graduate students with no PTSD diagnoses. Participants diagnosed with PTSD from southern and coastal universities accounted for the majority of PTSD cases. The prevalence of PTSD was notably higher among students from the coastal universities compared to those not meeting diagnostic criteria (Chi-square = 41.95, p < 0.0001 ) A comparative analysis of the data revealed that students residing in the governorates of Latakia and Tartus exhibited a substantially higher prevalence of PTSD symptoms compared to students with no PTSD Symptoms in the same governorate. A significant association was found between current residency and PTSD prevalence (Chi-square = 88.77, P < 0.0001). Details about PTSD Prevalence according to Demographic variables in Table 2 . Table 2 PTSD Prevalence according to Demographic Variables Probable PTSD NO Probable PTSD Total (100%) Chi-square P value N(%) N(%) Gender Female 321(41.74) 448(58.26) 769 1.570 0.201 Male 99(37.36) 166(62.64) 265 Academic year Undergraduate Studies First year 39(34.82) 73(65.17) 112 27.35 0.0001 Second year 64(45.71) 76(54.28) 140 Third year 50(34.96) 93(65.03) 143 Fourth year 67(35.45) 122(64.55) 189 Fifth year 110(38.19) 178(61.80) 288 Sixth year (Medicine) 10(37.07) 17(62.96) 27 Postgraduate studies 80(59.29) 55(40.74) 135 Universities region Southern 216(34.89) 403(65.10) 619 41.95 < 0.0001 Northern 37(40.22) 55(59.78) 92 Central 70(41.17) 100(58.83) 170 East 4(80) 1(20) 5 Coastal 93(62.84) 55(37.16) 148 Current residency Damascus 134(39.18) 208(60.81) 342 88.77 < 0.0001 Rural Damascus 91(31.37) 199(68.62) 290 Daraa 57(73.07) 21(26.92) 78 Suwayda 3(27.27) 8(72.72) 11 Aleppo 20(34.48) 38(65.51) 58 Homs 21(58.33) 15(41.66) 36 Latakia 70(63.63) 40(36.37) 110 Tartus 37(67.27) 18(32.72) 55 Hama 10(52.63) 9(47.36) 19 Idlib 8(42.10) 11(57.89) 19 Hasakah 1(33.33) 2(66.66) 3 Deir ez-Zor 2(66.66) 1(33.33) 3 Raqqa 0 3(100) 3 Quneitra 2(28.57) 5(71.42) 7 3.4. PTSD prevalence according to traumatic events and number of years spent in a conflict-affected area Among participants who reported exposure to traumatic events, 44.51% (n = 393) exhibited symptoms consistent with probable PTSD. Students who had traumatic events, such as witnessing violent acts, being displaced multiple times, were more likely to develop PTSD symptoms (Chi-square = 30.04, P = 0.0002). 61.67% of students who lived in a conflict-affected area for more than 6 years showed higher levels of PTSD Prevalence among other groups. Note The questionnaire allowed more than one event to be selected, so the sum of the percentages may exceed 100% (n = 1034) The analysis showed a statistically significant association between the number of years spent in a conflict zone and the likelihood of developing PTSD (Chi-square = 13.42, P = 0.0038) Further information on PTSD prevalence related to traumatic exposure is presented in Table 3 and Fig. 3 . Table 3 PTSD Prevalence according to traumatic events PTSD Test Probable PTSD (within the Exposed Group) NO Probable PTSD (within the Exposed Group) Chi-Square P Value N(%) N(%) Traumatic Event Loss of a Family member 207(16.12) 234(15.28) 30.04, 8 0.0002 Exposure to direct bombardment 224(17.44) 297(19.39) Physical injuries 24(1.86) 17(1.11) Food Insecurity 111(8.64) 119(7.77) School dropout 147(11.45) 175(11.43) Multiple displacements 233(18.14) 336(21.94) Arrest or detention 51(3.97) 32(2.09) Witnessing violent acts 276(21.49) 286(18.68) No exposure to any traumatic event 11(0.85) 35(2.28) Years living in a conflict-affected area More than 6 Years 259(61.66) 308(50.16) 13.42, 3 0.0038 4–6 Years 57(13.57) 111(18.07) 1–3 Years 56(13.33) 108(17.59) Less than a Year 48(11.42) 87(14.16) 3.5. Happiness Levels Among Participants The overall mean happiness score among participants was [52.35 ± 10.66]. Based on their scores, students were categorized into four groups: low happiness, moderate happiness, happy, and extremely happy. Most students fell into the moderate happiness category (34.14%, n = 353), while a small proportion reported low happiness levels (17.31%, n = 179). When examining happiness levels by gender, a significant relationship was observed between male and female students (Chi-square = 10.41, p = 0.01522). Additionally, a statistical association in levels of happiness according to academic year using the Chi-square Test was found (chi-square = 29.13, P = 0.046) In terms of university regions, students from southern universities and coastal universities reported higher happiness scores than those from northern or central regions (chi-square = 50.28, P < 0.001) The detailed distribution of happiness categories across demographic groups is shown in Table 4 and Fig. 4 . Table 4 Happiness Levels Among Participants variable Happiness Level Chi-square P value Low N(%) Moderate N(%) Happy N(%) Extremely Happy N(%) Gender Female 129(16.78) 275(35.76) 240(31.21) 125(16.25) 10.41 0.0154 Male 50(19) 78(29) 73(28) 64(24) Academic year Undergraduate First year 20(17.85) 37(33.03) 27(24.10) 28(25) 29.13 0.0469 Second year 23(16.42) 37(26.42) 54(38.57) 26(18.57) Third year 17(11.88) 52(36.26) 43(30.07) 31(21.67) Fourth year 35(18.52) 59(31.21) 65(34.39) 30(15.87) Fifth year 51(17.70) 100(34.77) 83(28.81) 54(18.75) Sixth year 2(7.40) 14(51.85) 6(22.22) 5(18.51) Postgraduate studies 31(22.96) 54(40) 35(25.92) 15(11.12) Universities regions South 80(12.92) 214(34.57) 208(33.60) 117(18.90) 50.28 < 0.0001 North 12(13.04) 35(38.04) 28(30.43) 17(18.47) East 1(20) 1(20) 1(20) 2(40) Central 35(20.58) 51(30) 49(28.82) 35(20.58) Coastal 51(34.45) 52(35.13) 27(18.24) 18(12.16) 3.6. The correlation between Post-Traumatic Stress Disorder (PTSD) and subjective happiness levels. A statistically significant moderate negative correlation was found between PTSD symptom severity (PCL-5 scores) and happiness levels (Spearman’s r = − 0.3721, 95% CI: − 0.4250 to − 0.3168, p < 0.0001), indicating that higher levels of PTSD symptoms were associated with lower reported happiness among participants (n = 1034). 3.7. Logistic Regression The logistic regression analysis revealed that postgraduate students were significantly more likely to develop PTSD compared to fifth-year students (OR = 1.684, p = 0.025). Current residence in Damascus and Rural Damascus was associated with lower odds of PTSD compared to Daraa (p < 0.05). In contrast, residence in Latakia and Tartus showed 3 times the likelihood of being diagnosed with PTSD (ORs = 3.256, p = 0.006) (ORs 3.485, p 0.006). Traumatic stress exposure was a strong predictor (OR = 4.189, p < 0.001), and longer duration of residence in conflict areas was associated with elevated risk of PTSD prevalence. Model fit: Nagelkerke R² = 0.194; McFadden’s R² = 0.115, AIC = 1295. Logistic regression is further explained in Table 5 . Table 5 Binomial regression variable B P-Value Odd Ratio 95% confidence interval Lower Upper Dependent variable: PTSD vs NO PTSD Gender (Female vs Male) -0.1479 0.369 0.863 0.6246 1.191 Academic Year (Fifth year vs First year) 0.1784 0.484 1.195 0.7256 1.969 Academic Year (Fifth year vs Second year) 0.4770 0.038 1.611 1.0278 2.526 Academic Year (Fifth year vs Third year) -0.0754 0.745 0.927 0.5889 1.460 Academic Year (Fifth year vs Fourth year) -0.1302 0.535 0.878 0.5821 1.324 Academic Year (Fifth year vs Sixth year) -0.1213 0.787 0.886 0.3677 2.134 Academic Year (Fifth year vs Postgraduate studies) 0.5211 0.025 1.684 1.0682 2.654 University Region (Southern vs Coastal) -0.0116 0.977 0.988 0.4404 2.219 University Region (Southern vs Northern) 1.0693 0.060 2.913 0.9574 8.866 University Region (Southern vs Central) -0.0594 0.795 0.942 0.6022 1.475 Current Residency (Damascus vs Daraa) -0.7200 0.015 0.487 0.2730 0.868 Current Residency (Damascus vs Rural Damascus) -0.4522 0.012 0.636 0.4477 0.904 Current Residency (Damascus vs Latakia 1.1806 0.006 3.256 1.4121 7.509 Current Residency (Damascus vs Tartus) 1.2484 0.006 3.485 1.4279 8.504 Current Residency (Damascus vs Aleppo) -1.3283 0.035 0.265 0.0768 0.914 Current Residency (Damascus vs Homs) 0.7201 0.086 2.055 0.9019 4.681 Current Residency (Damascus vs Hama) 0.1020 0.844 1.107 0.4005 3.062 Current Residency (Damascus vs Deir ez-Zor) 0.9017 0.475 2.464 0.2078 29.207 Current Residency (Damascus vs Idlib) -1.2227 0.100 0.294 0.0685 1.265 Current Residency (Damascus vs Suwayda) -0.6763 0.412 0.508 0.1011 2.557 Current Residency (Damascus vs Quneitra) -0.5642 0.514 0.569 0.1044 3.098 Exposure to traumatic Events (No vs Yes) 1.4325 < .001 4.189 2.5737 6.818 Number of Years living in a conflict-affected area ( More than 6 years vs 4–6 Years) -0.4625 0.019 0.630 0.4281 0.926 Number of Years living in a conflict-affected area ( More than 6 years vs 1–3 years) -0.5464 0.008 0.579 0.3870 0.866 Number of Years living in a conflict-affected area ( More than 6 years vs Less than a year) -0.4117 0.075 0.663 0.4209 1.043 3.8. Use of Psychiatric Medications A total of 12.09% of participants who exhibited PTSD symptoms had been administered psychiatric medications, with 58.50% of those participants having been prescribed antidepressants (e.g., fluoxetine, sertraline), 31.97% having been prescribed anxiolytics, and 9.52% having been prescribed carbamazepine. 4. Discussion Since the end of the years of war in Syria that began in 2011, the mental health of individuals—particularly among the younger population—has become a crucial topic. In light of this, we conducted this study to determine the prevalence of post-traumatic stress disorder (PTSD) among university students, considering the scarcity of such research in Syria and its absence in previous years. This research aims to shed light on the psychological suffering experienced by these students. Many studies show that young people, especially university students, are among the most vulnerable to psychological disorders due to the developmental stage they are undergoing and increasing academic and social pressures [ 20 ]. Our study found that 85.40% of Syrian university students reported experiencing at least one traumatic event during their lifetime, and 44.51% of those students exhibited symptoms consistent with probable PTSD—a figure comparable to Cusack et al. ’s finding that 70% of college students reported trauma exposure, of which 34.4% met PTSD criteria [ 21 ]. The results indicate that a significant proportion of Syrian university students suffer from PTSD symptoms, reflecting the profound impact of recent conflicts and traumatic events on Syrian society. In our sample, the PTSD prevalence was 40.62% , which is broadly consistent with regional studies in localized conflict contexts. For example, a study in conflict-affected communities in Sudan reported 36.6% of PTSD prevalence [ 22 ], a value close to ours and indicative that prolonged war exposure raises psychological symptom rates. A study among medical students in Gaza found an even higher prevalence ( 63.4%) , suggesting that exposure severity, sample characteristics (students vs. general population), and timing of assessment influence observed rates [ 23 ]. Local research in Syria reported 28.2% among university students in Deir-ez-Zor, highlighting regional variability [ 15 ]. These findings are congruent with broader evidence from conflict-affected populations showing long-term effects of war-related trauma [ 24 ]. Geographically, the highest number of PTSD-positive students were from southern universities (e.g., Damascus University) and coastal universities (e.g., University of Lattakia), likely reflecting the higher response rates from these regions. Within specific governorates, students from Hama, Daraa, Latakia, and Tartus had elevated PTSD rates compared to the other areas, and this may be explained by the intense and recent traumatic events that have affected these areas. While prior research in relatively stable educational environments indicates only minor differences in PTSD prevalence between first-year and final-year students [ 16 ], our findings reveal a different pattern: fifth-year and postgraduate students showed a markedly higher rate of PTSD symptoms. This discrepancy may reflect the unique burden of chronic stress, cumulative trauma exposure, and prolonged instability faced by Syrian students throughout their academic journey. The most common traumas reported were witnessing violent acts, multiple displacements, and direct exposure to bombing—consistent with the nature of the Syrian conflict and civilian exposure to direct violence. Most students with probable PTSD had experienced such events, supporting studies indicating that internally displaced persons (IDPs) face greater trauma exposure than non-displaced groups, and that homelessness and forced displacement are strongly associated with PTSD symptoms [ 25 , 26 ]. Participants who lived in conflict-affected areas for more than 6 years exhibited significantly elevated PTSD prevalence, supporting prior research that prolonged trauma exposure increases the likelihood of chronic PTSD [ 27 , 8 ]. Interestingly, although many studies suggest a higher risk of PTSD among females [ 28 ], our study did not find a statistically significant gender difference—even though females comprised the majority of the sample—consistent with findings from Al Furat University in Deir ez-Zor [ 15 ]. Contrary to several international reports ranking Syria low in global happiness indices [ 29 , 30 ], most participating students in our sample reported moderate to high happiness levels. This discrepancy may be due to the sample’s demographic characteristics—university students often have higher hope, future orientation, and social connectedness, all protective factors for psychological well-being. Importantly, our study identified a moderate, statistically significant negative correlation between PTSD symptoms and happiness levels, as measured by Spearman’s rho. This indicates that higher PTSD symptoms are associated with lower happiness and life satisfaction—paralleling community-based research in Quality of Life Research showing that individuals with moderate to severe PTSD report decreased life satisfaction [ 31 ], and a 2024 study in Traumatology, which found that core PTSD symptoms such as emotional numbness and anhedonia strongly predict diminished quality of life [ 32 ]. These findings illustrate that PTSD not only undermines psychological health but also diminishes the individual’s capacity for positive emotions and life satisfaction—highlighting the enduring emotional toll of trauma on Syrian university students. . 5. Limitation The deployment of an online self-administered questionnaire has the potential to introduce selection bias towards participants who are electronically active or interested in the topic of mental health, thereby impacting the validity of the findings, and the use of convenience sampling may limit the generalizability of the findings to the entire population of Syrian university students. Additionally, the disproportionate distribution of participants among different universities may compromise the overall representativeness of the sample. A comparable investigation at the national scale might be necessary to enhance the generalizability of the findings. The study also lacked qualitative measures or individual interviews, which may limit the depth of psychological analysis and the ability to explore participants’ experiences in more detail. 6. Conclusion This study demonstrated a high prevalence of PTSD among university students, particularly among those who had experienced multiple traumatic events and lived for extended periods in conflict-affected areas. Additionally, the findings revealed that happiness levels among the students ranged from moderate to high, which may contribute to their ability to engage productively in society and cope with the challenges of the post-conflict context. Therefore, this study suggests: (1) Establishing psychological support units in universities; (2) Training academic staff to detect students' psychological symptoms; (3) Strengthening qualitative measurement tools in the future, which can change the psychological reality of university students and significantly reduce stress and the likelihood of developing mental disorders. Declarations Ethics approval The Biomedical Research Ethics Committee at Damascus University approved the study protocol. The study was conducted in accordance with ethical principles of the Declaration of Helsinki. ID number: PH-200825-492 Clinical trial number Not applicable. Consent to participate Participation in this study was entirely voluntary. At the beginning of the online questionnaire, participants were informed about the study's purpose and assured that their responses would remain confidential and anonymous. No identifying personal information, including names, was requested. Completion of the questionnaire was considered as implied consent to participate. Conflict of interest The authors declare no competing interests. Funding This research received no external funding from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions Hadeel Ezz-Aldeen Alshaikh Khalil was responsible for the study conception and design, data collection, statistical analysis, and paper writing. Walaa Yousef Bakr, Hiba Samer Barakat, Noura Husain Berkdar, and Huda Mohammed Alkoussani contributed to participant recruitment and distribution of the questionnaire. Youssef Latifeh & Lama A.Youssef supervised the project, reviewed the final manuscript, and provided academic guidance. Corresponding author Correspondence to Lama A. Youssef References Carta MG, Moro MF, Bass J. War traumas in the Mediterranean area. Int J Soc Psychiatry. 2015;61(1):33–8. Yehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;1:15057. Jain N, Prasad S, Czárth ZC, et al. War psychiatry: Identifying and managing the neuropsychiatric consequences of armed conflicts. J Prim Care Community Health. 2022;13:21501319221106625. Lim ICZY, Tam WWS, Chudzicka-Czupała A, et al. Prevalence of depression, anxiety, and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis. Front Psychiatry. 2022;13:978703. Kessler RC, Rose S, Koenen KC, et al. How well can PTSD be predicted from pre-trauma risk factors? World Psychiatry. 2014;13(3):265–74. American Psychological Association. Clinical practice guideline for the treatment of PTSD. 2017. Available from: https://www.apa.org/ptsd-guideline [Accessed 7 Sep 2025]. World Health Organization. Mental health in emergencies [Internet]. Available from: https://www.who.int/mental_health/emergencies/en/ [Accessed 7 Sep 2025]. Charlson F, van Ommeren M, Flaxman A, et al. New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. Lancet. 2019;394(10194):240–8. Koenen KC, Ratanatharathorn A, Ng L, et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med. 2017;47(13):2260–74. Abudayya A, Bruaset GTF, Nyhus HB, et al. Consequences of war-related traumatic stress among Palestinian young people in the Gaza Strip: A scoping review. Ment Health Prev. 2023;32:1–15. Hasanovic M, Sinanovic O, Selimbasic Z, et al. Psychological disturbances of war-traumatized children. Croat Med J. 2006;47(1):85–94. Qutaiba M. The psychological impact of war on youth: A review. Int J Multidiscip Res. 2023;5(5):1–7. Pugach CP, May CL, Wisco BE. Positive emotion in PTSD: Global or context-specific? J Trauma Stress. 2023;36(2):444–56. Fonzo GA. Diminished positive affect and traumatic stress: A review. Neurobiol Stress. 2018;9:214–30. Yousef L, et al. PTSD prevalence among university students in Deir ez-Zor after armed conflict. Syrian J Psychiatry. 2021;8(1):24–31. Pereira JL, Guedes-Carneiro GM, Netto LR, et al. Types of trauma, PTSD, and academic performance. J Nerv Ment Dis. 2018;206(7):507–12. Blevins CA, Weathers FW, Davis MT, et al. The PTSD Checklist for DSM-5 (PCL-5): Development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98. Othieno CJ, Okoth R, Peltzer K, et al. PTSD, depression, and health-risk behavior among Nairobi students. Int J Psychiatry Med. 2015;50(3):299–316. Abdel-Khalek AM. The Arabic Scale of Happiness (ASH): Psychometric characteristics. Compr Psychol. 2013;2. 10.2466/02.09.CP.2.5 . Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. Cusack SE, Jonas DE, Forneris CA, et al. Psychological treatments for PTSD: A systematic review. JAMA. 2017;317(5):541–50. Khalil KA, Mohammed GTF, Ahmed ABM, et al. War-related trauma and posttraumatic stress disorder in refugees, displaced, and nondisplaced people during armed conflict in Sudan: A cross-sectional study. Confl Health. 2024;18:66. Aldabbour B, Abuabada A, Lahlouh A, et al. Psychological impacts of the Gaza war on Palestinian young adults: A cross-sectional study of depression, anxiety, stress, and PTSD symptoms. BMC Psychol. 2024;12(1):696. Hassan G, Ventevogel P, Jefee-Bahloul H, et al. Mental health of Syrians affected by armed conflict. Epidemiol Psychiatr Sci. 2016;25(2):129–41. Silva MA, et al. Internal displacement and psychological impact. Int J Ment Health. 2004;33(2):57–73. Elhadi YAM, et al. PTSD among displaced Darfuri women. J Nerv Ment Dis. 2012;200(10):860–5. Morina N, Stam K, Pollet TV, Priebe S. Prevalence of PTSD in war civilians: A systematic review. Lancet Psychiatry. 2014;1(5). Berenz EC, et al. Gender differences in PTSD: An update. J Anxiety Disord. 2016;40:60–71. World Happiness Report. Global happiness rankings. 2017. Available from: https://worldhappiness.report [Accessed 7 Sep 2025]. CountryEconomy. Syria Happiness Index. 2019. Available from: https://countryeconomy.com [Accessed 7 Sep 2025]. Schnurr PP, Lunney CA, Bovin MJ, Marx BP. PTSD and quality of life in Iraq and Afghanistan veterans. Clin Psychol Rev. 2013;33(8):724–36. Uzer T, Arslan B, Yalcin E. PTSD and quality of life in post-conflict youth. Traumatology. 2024;30(1):15–27. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 30 Nov, 2025 Reviewers agreed at journal 18 Nov, 2025 Reviewers invited by journal 10 Nov, 2025 Editor invited by journal 13 Oct, 2025 Editor assigned by journal 10 Oct, 2025 Submission checks completed at journal 10 Oct, 2025 First submitted to journal 02 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7768518","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":547098986,"identity":"df8cc8a9-b1c3-4c78-9648-7a7c94934c16","order_by":0,"name":"Hadeel Ezz-Aldeen Alshaikh Khalil","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Hadeel","middleName":"Ezz-Aldeen Alshaikh","lastName":"Khalil","suffix":""},{"id":547098987,"identity":"d51950e6-d3f3-423f-8013-51fd75529985","order_by":1,"name":"Walaa Yousef Bakr","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Walaa","middleName":"Yousef","lastName":"Bakr","suffix":""},{"id":547098988,"identity":"dc797752-c8dc-4712-b39b-0d6808d378b4","order_by":2,"name":"Hiba Samer Barakat","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Hiba","middleName":"Samer","lastName":"Barakat","suffix":""},{"id":547098989,"identity":"7401d3cf-5128-4037-b6bb-803248a7024f","order_by":3,"name":"Noura Husain Berkdar","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Noura","middleName":"Husain","lastName":"Berkdar","suffix":""},{"id":547098990,"identity":"88368fda-3ae7-4886-8638-9a229fb573de","order_by":4,"name":"Huda Mohammed Alkoussani","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Huda","middleName":"Mohammed","lastName":"Alkoussani","suffix":""},{"id":547098991,"identity":"5533e52a-b573-43d1-8217-6f1a2dc05735","order_by":5,"name":"Youssef Latifeh","email":"","orcid":"","institution":"Damascus University","correspondingAuthor":false,"prefix":"","firstName":"Youssef","middleName":"","lastName":"Latifeh","suffix":""},{"id":547098992,"identity":"c1e7c641-59a2-4c39-b8b8-313fe45e35e9","order_by":6,"name":"Lama A. 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12:04:59","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":137954,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/3f8af90d0e84472df4c630ce.html"},{"id":96364939,"identity":"a510c402-d645-4329-83fe-b2fdfa0af359","added_by":"auto","created_at":"2025-11-20 10:09:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11484,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of years living in conflict-affected areas\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/a00f2d520f981d0755674f4c.png"},{"id":96286487,"identity":"bd38627c-c3b3-4584-b3e6-9f0bae25b16e","added_by":"auto","created_at":"2025-11-19 12:04:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19460,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eExposure to traumatic events\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/b1a0219f498d16ee68da9abc.png"},{"id":96286489,"identity":"70af8e37-5bd4-4084-9abb-d96c8e91c95c","added_by":"auto","created_at":"2025-11-19 12:04:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":6515,"visible":true,"origin":"","legend":"\u003cp\u003eExposure to traumatic stress and PTSD\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/de3bbff4ce63b9557119f220.png"},{"id":96286493,"identity":"cec84eaa-770d-4ef2-9e60-cff71869ef2b","added_by":"auto","created_at":"2025-11-19 12:04:59","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":12571,"visible":true,"origin":"","legend":"\u003cp\u003eHappiness Levels among Participants\u003c/p\u003e","description":"","filename":"Onlinefloatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/a01e21f953f9fae3ef27e36f.png"},{"id":96369354,"identity":"768cff42-1e3b-42a6-a3ce-de65f737b97a","added_by":"auto","created_at":"2025-11-20 10:20:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1489236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7768518/v1/707579bf-0cee-420a-9280-43c8d0983819.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Post-Traumatic Stress Disorder and Assessment of Happiness Levels Among Syrian University Students","fulltext":[{"header":"1. Background","content":"\u003cp\u003eSince the outbreak of armed conflict in Syria in 2011, the country has undergone profound transformations that have profoundly influenced all dimensions of existence. Among the various humanitarian and socio-cultural consequences of the Syrian conflict, mental health has emerged as one of the most significantly impacted domains, particularly among the youth demographic [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Post-traumatic stress disorder (PTSD) has been recognized as one of the most prevalent psychological afflictions among individuals subjected to extreme conditions, including warfare and armed conflicts [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecurrent intrusive memories, nightmares, avoidance behaviors, irritability, and sleep disturbances typically characterize PTSD. It is also frequently associated with increased risk of suicidal ideation and other comorbid psychiatric conditions, such as depression and anxiety [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Civilians and military personnel residing in conflict-affected areas are particularly vulnerable to PTSD and related disorders, with long-lasting emotional and functional consequences [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe manifestation of PTSD can vary in timing and duration. It can occur in two distinct temporal patterns: either immediately or after a period of latency. Estimates of PTSD prevalence often vary due to differences in assessment methodologies, populations studied, and diagnostic criteria [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Individuals with pre-existing mental health conditions may exhibit a heightened propensity to develop PTSD following a traumatic event. However, further research is necessary to ascertain the extent of this association [6].\u003c/p\u003e\u003cp\u003eAccording to a World Health Organization (WHO) review, the estimated point prevalence of common mental disorders, including mild forms of depression, anxiety, and PTSD, is approximately 13% among populations affected by conflict, with 4% experiencing moderate or severe forms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Globally, while about 70% of individuals are exposed to at least one traumatic event in their lifetime, only a small percentage of them, 5.6%, develop PTSD. However, this risk increases more than threefold among those exposed to violent conflicts or Wars [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRegional studies further emphasize the psychological toll of war: a 2020 study in Gaza reported that 53.5% of children exhibited PTSD symptoms [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; another study in Palestine found a prevalence of 23.2% among adults [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. More recently, following the 2023 conflict in Sudan, PTSD prevalence among displaced persons from Khartoum was reported at 46.7% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAccording to the global model, individuals with PTSD experience a lasting alteration in their capacity to feel positive emotion [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This alteration involves a notable decline in the frequency and intensity of positive emotional states, including feelings such as happiness, joy, love, interest, and the capacity for interpersonal connection [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eYoung adults, particularly university students, have been uniquely affected by the protracted Syrian crisis. Many have experienced or witnessed bombings, displacement, and the loss of loved ones, all of which are potent risk factors for PTSD. Despite the growing international body of research on the mental health consequences of war, there is a marked scarcity of research specifically addressing university students in the Syrian context. Little is known about how these traumatic experiences affect their academic performance, psychological well-being, and social functioning [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo address this critical gap in the literature, the present study aimed to: (1) estimate the prevalence of PTSD symptoms among university students in Syria; (2) explore the relationship between direct and indirect exposure to war-related trauma and the likelihood of developing PTSD; (3) assess overall happiness levels in this population; and (4) examine the association between PTSD symptoms and subjective well-being. The study also aims to inform the development of mental health support strategies targeting students in post-conflict settings.\u003c/p\u003e\u003cp\u003eBy shedding light on these issues, we hope to contribute to a better understanding of the psychological needs of Syrian youth and provide empirical evidence to guide mental health interventions and policy in educational settings throughout the region.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch3\u003e\u003cstrong\u003e2.1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eStudy Design and Participants:\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis study adopted\u0026nbsp;an analytical observational cross-sectional design\u0026nbsp;to assess the prevalence of posttraumatic stress disorder (PTSD) symptoms among university students in Syria.\u003c/p\u003e\n\u003cp\u003eUniversities were clustered according to their regions of presence into universities in the South (e.g., Damascus University, Syrian Private University, etc.), North, Center, Coastal, and East.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudents\u003c/strong\u003e from various Syrian universities participated in the study. Participants were recruited using a\u0026nbsp;\u003cstrong\u003econvenience sampling method\u003c/strong\u003e through an online questionnaire distributed via social media platforms and university-related online groups on Telegram.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe survey was open for responses from the 3\u003csup\u003erd\u0026nbsp;\u003c/sup\u003eof April to the 27\u003csup\u003eth\u0026nbsp;\u003c/sup\u003eof May 2025.\u003c/p\u003e\n\u003cp\u003eParticipants aged\u0026nbsp;\u003cstrong\u003e40 years or older were excluded\u003c/strong\u003eto maintain a homogeneous age range representative of typical university students.\u003c/p\u003e\n\u003ch3\u003e2.2.\u0026nbsp;Study Instrument\u003c/h3\u003e\n\u003cp\u003eThe online questionnaire consisted of five main sections:\u003c/p\u003e\n\u003cp\u003e1. \u003cstrong\u003eDemographic Information\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Including gender, age, place of residence, university, and academic year.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eExposure to Traumatic Events\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e A set of items assessing whether the participant had experienced one or more traumatic events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: In this section of the questionnaire, participants were allowed to select more than one traumatic event that happened to them\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp;\u003cstrong\u003ePTSD Checklist for DSM-5 (PCL-5) and Arabic Scale of Happiness (ASH):\u003c/strong\u003e This study employed the Arabic version of the PCL-5 instrument. This version had been previously validated for the assessment of post-traumatic stress disorder\u0026nbsp;[16]. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;It contains 20 items rated on a 5-point Likert scale, based on DSM-5 diagnostic criteria. The questions assessed PTSD symptoms using a five-point severity scale: 0 (not at all); 1 (a little bit); 2 (moderately); 3 (quite a bit); and 4 (extremely) [17].\u003cbr\u003e\u0026nbsp;PTSD symptom clusters were divided into the following categories:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Re-experiencing memories\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Persistent avoidance\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Negative alterations in mood and cognitions\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Alterations in arousal and reactivity\u003cbr\u003eA score between 31 and 33 was considered significant for meeting the probable diagnostic criteria for PTSD based on instrument standards [18]. Accordingly, we selected a cutoff of \u003cu\u003e\u0026gt;\u003c/u\u003e\u003cstrong\u003e32\u003c/strong\u003e in this study, as it falls within that validated range and yields a balanced sensitivity and specificity for our Syrian university student sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArabic Scale of Happiness (ASH):\u003c/strong\u003e A validated scale used to measure participants\u0026rsquo; general level of happiness. The scale consisted of fifteen concise statements along with five additional filler items. Each item was rated on a five-point intensity scale. The aggregate score ranged from 15 to 75, with elevated scores reflecting greater levels of happiness [19].\u003c/p\u003e\n\u003cp\u003e4. \u003cstrong\u003eUse of Psychiatric Medications\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Questions related to whether the participant had previously or currently used psychiatric medications.\u003c/p\u003e\n\u003cp\u003e5. \u003cstrong\u003eMental Health Services Availability:\u003c/strong\u003e Questions about whether there were any mental health services available in the participants\u0026apos; areas, and their views on how to improve mental health in Syria.\u003c/p\u003e\n\u003ch3\u003e2.3. Procedure\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was created using an online survey platform (Google Forms) and distributed electronically (through student groups) and in person. Participation was voluntary, and an informed consent form was included at the beginning of the survey. Additionally, no personal information was collected to ensure anonymity and confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.\u0026nbsp;Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using GraphPad Prism (version 10.4.2), Microsoft Excel (2016), and Jamovi (version 2.6.44). The analysis included calculating percentages for demographic variables, exposure to traumatic events, medication usage, as well as prevalence rates of post-traumatic stress disorder (PTSD), and levels of happiness. Descriptive statistics were conducted for the Arabic Scale of Happiness and the PTSD Checklist for DSM-5 (PCL-5), including median values, standard deviations, and assessment of data normality.\u003c/p\u003e\n\u003cp\u003eThe internal consistency value of the PCL-5 scale in this sample was Cronbach\u0026apos;s \u0026alpha; = 0.938, indicating excellent internal reliability. A cutoff of \u0026ge;32 was used to identify participants with potential PTSD symptoms.\u003c/p\u003e\n\u003cp\u003eThe internal consistency value of ASH in this sample was good (Cronbach\u0026rsquo;s \u0026alpha; = 0.817). This indicates good internal reliability of the scale in this sample.\u003c/p\u003e\n\u003cp\u003eChi-square tests were performed to examine the association between PTSD prevalence and categorical variables, including gender, academic year, university region, the number of years participants had lived in conflict-affected areas, and happiness levels, categorized by gender, university region, and academic year.\u003c/p\u003e\n\u003cp\u003eFor further analysis, the Arabic Scale of Happiness scores were categorized into four groups\u0026mdash;low happiness, moderate happiness, happy, and extremely happy\u0026mdash;based on median and standard deviation calculations.\u003c/p\u003e\n\u003cp\u003eSince the data did not follow a normal distribution, Spearman\u0026apos;s rank correlation coefficient was used to assess the relationship between continuous variables, such as between PTSD (PCL-5) scores and happiness scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA binomial logistic regression was conducted to identify significant predictors of PTSD diagnosis among participants.\u003c/strong\u003e\u003cstrong\u003ePTSD was coded as 0=not meeting the cutoff for probable PTSD and 1= meeting the cutoff.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData visualization included bar charts and pie charts. Statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Socio-demographic characteristics of participants:\u003c/h2\u003e\u003cp\u003eOut of 1,034 participants, the mean age was 22.80 years (SD\u0026thinsp;=\u0026thinsp;3.36), with the majority (77.07%) falling within the 19\u0026ndash;24-year age group. Most participants were female (74.37%).\u003c/p\u003e\u003cp\u003eRegarding childhood residency, 26.11% grew up in Damascus, 28.14% in Rural Damascus, and 9.86% in Latakia. The remaining participants were distributed across other Syrian governorates.\u003c/p\u003e\u003cp\u003eA total of 59.86% of the Participants were from southern Syrian universities, with 83.03% from Damascus University. Additionally, 16.44% of the Participants were from central Syrian universities, and 14.31% were from coastal Syrian universities.\u003c/p\u003e\u003cp\u003eThe academic year distribution was as follows: first year (10.83%), second year (13.54%), third year (13.83%), fourth year (18.28%), fifth year (27.75%), sixth year (2.61%), and Higher degrees (13.06%). Note that the sixth year is only for medical students.\u003c/p\u003e\u003cp\u003eDetails on the socio-demographic data of our sample are available in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics of participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25.63%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e74.37%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eCurrent academic year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eUndergraduate Studies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.83%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.54%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.83%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFourth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18.28%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFifth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e27.75%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSixth year (medical students)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.61%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePostgraduate studies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.06%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.61%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e19\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e77.07%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.31%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003eChildhood residency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDamascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e270\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.11%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRural Damascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.14%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDaraa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.19%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSuwayda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.45%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAleppo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.71%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.09%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLatakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.86%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTartus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.55%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHama\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eIdlib\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.61%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHasakah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeir ez-Zor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.71%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRaqqa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.55%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eQuneitra\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003eCurrent residency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDamascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33.08%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRural Damascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.05%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDaraa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.54%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSuwayda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.06%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAleppo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.61%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLatakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.64%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTartus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.32%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHama\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eIdlib\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHasakah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeir ez-Zor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRaqqa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.29%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eQuneitra\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.68%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eUniversities regions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSouth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59.86%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNorth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.48%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.44%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCoastal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.31%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Exposure to traumatic events\u003c/h2\u003e\u003cp\u003eA total of 85.40% (n\u0026thinsp;=\u0026thinsp;883) of participants reported exposure to at least one traumatic event, including multiple displacements (54.8%), witnessing violent acts (54.3%), loss of family members (42.6%), and school dropout (30.9%).\u003c/p\u003e\u003cp\u003e54.84% (n\u0026thinsp;=\u0026thinsp;567) of participants had lived for more than 6 years in a conflict-affected area, and 16.25% (n\u0026thinsp;=\u0026thinsp;168) had lived 4\u0026ndash;6 years in such areas.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003cp\u003eThe questionnaire allowed more than one answer to be selected for exposure to traumatic events; therefore, each individual could have selected multiple answers, and the percentage may exceed 100% (n\u0026thinsp;=\u0026thinsp;1034).\u003c/p\u003e\u003c/p\u003e\u003cp\u003eInformation on sample distribution based on trauma exposure is in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3. PTSD prevalence according to demographic variables\u003c/h2\u003e\u003cp\u003eBased on responses to the PCL-5, 40.62% of the sample met the cutoff score (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;32) for probable PTSD diagnosis.\u003c/p\u003e\u003cp\u003eNo statistically significant association was found between gender and PTSD prevalence (chi-square\u0026thinsp;=\u0026thinsp;1.570, P\u0026thinsp;=\u0026thinsp;0.201).\u003c/p\u003e\u003cp\u003eThe findings of this study demonstrated a statistically significant relationship between the current academic year and prevalence of PTSD (Chi-square\u0026thinsp;=\u0026thinsp;27.35, P\u0026thinsp;=\u0026thinsp;0.0001), as the survey revealed that the proportion of fifth-year students diagnosed with PTSD was notably higher compared to other groups. On the other hand, Post-graduate students diagnosed with PTSD were notably higher compared to post-graduate students with no PTSD diagnoses.\u003c/p\u003e\u003cp\u003eParticipants diagnosed with PTSD from southern and coastal universities accounted for the majority of PTSD cases. The prevalence of PTSD was notably higher among students from the coastal universities compared to those not meeting diagnostic criteria (Chi-square\u0026thinsp;\u003cem\u003e=\u003c/em\u003e\u0026thinsp;41.95, p\u0026thinsp;\u003cem\u003e\u0026lt;\u003c/em\u003e\u0026thinsp;0.0001\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA comparative analysis of the data revealed that students residing in the governorates of Latakia and Tartus exhibited a substantially higher prevalence of PTSD symptoms compared to students with no PTSD Symptoms in the same governorate. A significant association was found between current residency and PTSD prevalence (Chi-square\u0026thinsp;=\u0026thinsp;88.77, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003eDetails about PTSD Prevalence according to Demographic variables in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e PTSD Prevalence according to Demographic Variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eProbable PTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNO Probable PTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTotal (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e321(41.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e448(58.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e769\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1.570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.201\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99(37.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e166(62.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eAcademic year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eUndergraduate Studies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39(34.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e73(65.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e27.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64(45.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76(54.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50(34.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e93(65.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e143\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFourth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67(35.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e122(64.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFifth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e110(38.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e178(61.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSixth year (Medicine)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(37.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17(62.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePostgraduate studies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80(59.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55(40.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eUniversities region\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSouthern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e216(34.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e403(65.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e619\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e41.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNorthern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(40.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55(59.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCentral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(41.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100(58.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e170\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCoastal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93(62.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55(37.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003eCurrent residency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDamascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e134(39.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e208(60.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e342\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003e88.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"13\" rowspan=\"14\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRural Damascus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e91(31.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e199(68.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e290\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDaraa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57(73.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21(26.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSuwayda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(27.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(72.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAleppo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(34.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38(65.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(58.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15(41.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eLatakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70(63.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40(36.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e110\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTartus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(67.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18(32.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHama\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(52.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9(47.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eIdlib\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8(42.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11(57.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eHasakah\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(33.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2(66.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDeir ez-Zor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(66.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(33.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRaqqa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eQuneitra\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(28.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5(71.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.4. PTSD prevalence according to traumatic events and number of years spent in a conflict-affected area\u003c/h2\u003e\u003cp\u003eAmong participants who reported exposure to traumatic events, 44.51% (n\u0026thinsp;=\u0026thinsp;393) exhibited symptoms consistent with probable PTSD.\u003c/p\u003e\u003cp\u003eStudents who had traumatic events, such as witnessing violent acts, being displaced multiple times, were more likely to develop PTSD symptoms (Chi-square\u0026thinsp;=\u0026thinsp;30.04, P\u0026thinsp;=\u0026thinsp;0.0002).\u003c/p\u003e\u003cp\u003e61.67% of students who lived in a conflict-affected area for more than 6 years showed higher levels of PTSD Prevalence among other groups.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e\u003cp\u003eThe questionnaire allowed more than one event to be selected, so the sum of the percentages may exceed 100% (n\u0026thinsp;=\u0026thinsp;1034)\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe analysis showed a statistically significant association between the number of years spent in a conflict zone and the likelihood of developing PTSD (Chi-square\u0026thinsp;=\u0026thinsp;13.42, P\u0026thinsp;=\u0026thinsp;0.0038)\u003c/p\u003e\u003cp\u003eFurther information on PTSD prevalence related to traumatic exposure is presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePTSD Prevalence according to traumatic events\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003ePTSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eTest\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProbable PTSD\u003c/p\u003e\u003cp\u003e(within the Exposed Group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNO Probable PTSD\u003c/p\u003e\u003cp\u003e(within the Exposed Group)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-Square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP Value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003eTraumatic Event\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLoss\u0026nbsp;of\u0026nbsp;a Family\u0026nbsp;member\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e207(16.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e234(15.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e30.04,\u0026nbsp;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.0002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExposure\u0026nbsp;to\u0026nbsp;direct\u0026nbsp;bombardment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e224(17.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e297(19.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"7\" rowspan=\"8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhysical\u0026nbsp;injuries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(1.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(1.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFood\u0026nbsp;Insecurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111(8.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119(7.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool\u0026nbsp;dropout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147(11.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e175(11.43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMultiple\u0026nbsp;displacements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e233(18.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e336(21.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArrest\u0026nbsp;or\u0026nbsp;detention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51(3.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32(2.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWitnessing\u0026nbsp;violent\u0026nbsp;acts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e276(21.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e286(18.68)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u0026nbsp;exposure\u0026nbsp;to\u0026nbsp;any\u0026nbsp;traumatic\u0026nbsp;event\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(0.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(2.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eYears living in a conflict-affected area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore\u0026nbsp;than\u0026nbsp;6\u0026nbsp;Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e259(61.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e308(50.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e13.42,\u0026nbsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.0038\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u0026ndash;6\u0026nbsp;Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57(13.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111(18.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;3\u0026nbsp;Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56(13.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108(17.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess\u0026nbsp;than\u0026nbsp;a\u0026nbsp;Year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48(11.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87(14.16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Happiness Levels Among Participants\u003c/h2\u003e\u003cp\u003eThe overall mean happiness score among participants was [52.35\u0026thinsp;\u0026plusmn;\u0026thinsp;10.66].\u003c/p\u003e\u003cp\u003eBased on their scores, students were categorized into four groups: low happiness, moderate happiness, happy, and extremely happy. Most students fell into the moderate happiness category (34.14%, n\u0026thinsp;=\u0026thinsp;353), while a small proportion reported low happiness levels (17.31%, n\u0026thinsp;=\u0026thinsp;179).\u003c/p\u003e\u003cp\u003eWhen examining happiness levels by gender, a significant relationship was observed between male and female students (Chi-square\u0026thinsp;=\u0026thinsp;10.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01522). Additionally, a statistical association in levels of happiness according to academic year using the Chi-square Test was found (chi-square\u0026thinsp;=\u0026thinsp;29.13, P\u0026thinsp;=\u0026thinsp;0.046)\u003c/p\u003e\u003cp\u003eIn terms of university regions, students from southern universities and coastal universities reported higher happiness scores than those from northern or central regions (chi-square\u0026thinsp;=\u0026thinsp;50.28, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e\u003cp\u003eThe detailed distribution of happiness categories across demographic groups is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHappiness Levels Among Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e\u003cp\u003eHappiness Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi-square\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eHappy\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eExtremely Happy\u003c/p\u003e\u003cp\u003eN(%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129(16.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e275(35.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e240(31.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e125(16.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e10.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.0154\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50(19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e78(29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e73(28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e64(24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eAcademic year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(17.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37(33.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27(24.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28(25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e29.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e0.0469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(16.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37(26.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e54(38.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e26(18.57)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(11.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(36.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43(30.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31(21.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFourth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(18.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e59(31.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e65(34.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30(15.87)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFifth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51(17.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e100(34.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e83(28.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e54(18.75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSixth year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(7.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14(51.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6(22.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5(18.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePostgraduate studies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(22.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e54(40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e35(25.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15(11.12)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eUniversities regions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eSouth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80(12.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e214(34.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e208(33.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e117(18.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e50.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNorth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(13.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35(38.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28(30.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17(18.47)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1(20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2(40)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCentral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(20.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e51(30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e49(28.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e35(20.58)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eCoastal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e51(34.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e52(35.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27(18.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e18(12.16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.6. The correlation between Post-Traumatic Stress Disorder (PTSD) and subjective happiness levels.\u003c/h2\u003e\u003cp\u003eA statistically significant moderate negative correlation was found between PTSD symptom severity (PCL-5 scores) and happiness levels (Spearman\u0026rsquo;s r = \u0026minus;\u0026thinsp;0.3721, 95% CI: \u0026minus;\u0026thinsp;0.4250 to \u0026minus;\u0026thinsp;0.3168, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), indicating that higher levels of PTSD symptoms were associated with lower reported happiness among participants (n\u0026thinsp;=\u0026thinsp;1034).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.7. Logistic Regression\u003c/h2\u003e\u003cp\u003eThe logistic regression analysis revealed that postgraduate students were significantly more likely to develop PTSD compared to fifth-year students (OR\u0026thinsp;=\u0026thinsp;1.684, p\u0026thinsp;=\u0026thinsp;0.025). Current residence in Damascus and Rural Damascus was associated with lower odds of PTSD compared to Daraa (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In contrast, residence in Latakia and Tartus showed 3 times the likelihood of being diagnosed with PTSD (ORs\u0026thinsp;=\u0026thinsp;3.256, p\u0026thinsp;=\u0026thinsp;0.006) (ORs 3.485, p 0.006). Traumatic stress exposure was a strong predictor (OR\u0026thinsp;=\u0026thinsp;4.189, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and longer duration of residence in conflict areas was associated with elevated risk of PTSD prevalence.\u003c/p\u003e\u003cp\u003eModel fit: Nagelkerke R\u0026sup2; = 0.194; McFadden\u0026rsquo;s R\u0026sup2; = 0.115, AIC\u0026thinsp;=\u0026thinsp;1295.\u003c/p\u003e\u003cp\u003eLogistic regression is further explained in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinomial regression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003evariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c5\" namest=\"c4\" rowspan=\"2\"\u003e\u003cp\u003eOdd Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003e95% confidence interval\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003eDependent variable: PTSD vs NO PTSD\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (Female vs Male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1479\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.6246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.191\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs First year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.1784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.7256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.969\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs Second year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.4770\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.611\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.0278\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.526\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs Third year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.0754\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.745\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.927\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.5889\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.460\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs Fourth year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1302\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.5821\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.324\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs Sixth year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.1213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.787\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.3677\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.134\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic Year (Fifth year vs Postgraduate studies)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.5211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.684\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.0682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.654\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity Region (Southern vs Coastal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.0116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.977\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.988\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.4404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.219\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity Region (Southern vs Northern)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.913\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.9574\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8.866\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity Region (Southern vs Central)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.0594\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.942\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.6022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.475\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Daraa)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.7200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.487\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.2730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.868\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Rural Damascus)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.4522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.4477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.904\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Latakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.1806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e3.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.4121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7.509\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Tartus)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.2484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e3.485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.4279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e8.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Aleppo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.3283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.0768\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.914\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Homs)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.7201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.055\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.9019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.681\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Hama)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.1020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.844\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e1.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.4005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Deir ez-Zor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.9017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.2078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e29.207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Idlib)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.2227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.0685\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.265\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Suwayda)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.6763\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.1011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent Residency (Damascus vs Quneitra)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.5642\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.514\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.569\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.1044\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExposure to traumatic Events (No vs Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.4325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e4.189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e2.5737\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e6.818\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Years living in a conflict-affected area ( More than 6 years vs 4\u0026ndash;6 Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.4625\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.630\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.4281\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.926\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Years living in a conflict-affected area ( More than 6 years vs 1\u0026ndash;3 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.5464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.3870\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.866\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Years living in a conflict-affected area ( More than 6 years vs Less than a year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.4117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.4209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.8. Use of Psychiatric Medications\u003c/h2\u003e\u003cp\u003eA total of 12.09% of participants who exhibited PTSD symptoms had been administered psychiatric medications, with 58.50% of those participants having been prescribed antidepressants (e.g., fluoxetine, sertraline), 31.97% having been prescribed anxiolytics, and 9.52% having been prescribed carbamazepine.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eSince the end of the years of war in Syria that began in 2011, the mental health of individuals\u0026mdash;particularly among the younger population\u0026mdash;has become a crucial topic. In light of this, we conducted this study to determine the prevalence of post-traumatic stress disorder (PTSD) among university students, considering the scarcity of such research in Syria and its absence in previous years. This research aims to shed light on the psychological suffering experienced by these students.\u003c/p\u003e\u003cp\u003eMany studies show that young people, especially university students, are among the most vulnerable to psychological disorders due to the developmental stage they are undergoing and increasing academic and social pressures [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study found that \u003cb\u003e85.40%\u003c/b\u003e of Syrian university students reported experiencing at least one traumatic event during their lifetime, and \u003cb\u003e44.51%\u003c/b\u003e of those students exhibited symptoms consistent with probable PTSD\u0026mdash;a figure comparable to Cusack \u003cem\u003eet al.\u003c/em\u003e\u0026rsquo;s finding that 70% of college students reported trauma exposure, of which 34.4% met PTSD criteria [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results indicate that a significant proportion of Syrian university students suffer from PTSD symptoms, reflecting the profound impact of recent conflicts and traumatic events on Syrian society. In our sample, the PTSD prevalence was \u003cb\u003e40.62%\u003c/b\u003e, which is broadly consistent with regional studies in localized conflict contexts. For example, a study in conflict-affected communities in Sudan reported \u003cb\u003e36.6%\u003c/b\u003e of PTSD prevalence [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e], a value close to ours and indicative that prolonged war exposure raises psychological symptom rates. A study among medical students in Gaza found an even higher prevalence (\u003cb\u003e63.4%)\u003c/b\u003e, suggesting that exposure severity, sample characteristics (students vs. general population), and timing of assessment influence observed rates [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Local research in Syria reported \u003cb\u003e28.2%\u003c/b\u003e among university students in Deir-ez-Zor, highlighting regional variability [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These findings are congruent with broader evidence from conflict-affected populations showing long-term effects of war-related trauma [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGeographically, the highest number of PTSD-positive students were from southern universities (e.g., Damascus University) and coastal universities (e.g., University of Lattakia), likely reflecting the higher response rates from these regions. Within specific governorates, students from Hama, Daraa, Latakia, and Tartus had elevated PTSD rates compared to the other areas, and this may be explained by the intense and recent traumatic events that have affected these areas.\u003c/p\u003e\u003cp\u003eWhile prior research in relatively stable educational environments indicates only minor differences in PTSD prevalence between first-year and final-year students [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e], our findings reveal a different pattern: fifth-year and postgraduate students showed a markedly higher rate of PTSD symptoms. This discrepancy may reflect the unique burden of chronic stress, cumulative trauma exposure, and prolonged instability faced by Syrian students throughout their academic journey.\u003c/p\u003e\u003cp\u003eThe most common traumas reported were witnessing violent acts, multiple displacements, and direct exposure to bombing\u0026mdash;consistent with the nature of the Syrian conflict and civilian exposure to direct violence. Most students with probable PTSD had experienced such events, supporting studies indicating that internally displaced persons (IDPs) face greater trauma exposure than non-displaced groups, and that homelessness and forced displacement are strongly associated with PTSD symptoms [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eParticipants who lived in conflict-affected areas for more than 6 years exhibited significantly elevated PTSD prevalence, supporting prior research that prolonged trauma exposure increases the likelihood of chronic PTSD [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eInterestingly, although many studies suggest a higher risk of PTSD among females [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e], our study did not find a statistically significant gender difference\u0026mdash;even though females comprised the majority of the sample\u0026mdash;consistent with findings from Al Furat University in Deir ez-Zor [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eContrary to several international reports ranking Syria low in global happiness indices [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e], most participating students in our sample reported moderate to high happiness levels. This discrepancy may be due to the sample\u0026rsquo;s demographic characteristics\u0026mdash;university students often have higher hope, future orientation, and social connectedness, all protective factors for psychological well-being.\u003c/p\u003e\u003cp\u003eImportantly, our study identified a moderate, statistically significant negative correlation between PTSD symptoms and happiness levels, as measured by Spearman\u0026rsquo;s rho. This indicates that higher PTSD symptoms are associated with lower happiness and life satisfaction\u0026mdash;paralleling community-based research in Quality of Life Research showing that individuals with moderate to severe PTSD report decreased life satisfaction [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and a 2024 study in Traumatology, which found that core PTSD symptoms such as emotional numbness and anhedonia strongly predict diminished quality of life [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings illustrate that PTSD not only undermines psychological health but also diminishes the individual\u0026rsquo;s capacity for positive emotions and life satisfaction\u0026mdash;highlighting the enduring emotional toll of trauma on Syrian university students.\u003c/p\u003e\u003cp\u003e.\u003c/p\u003e"},{"header":"5. Limitation","content":"\u003cp\u003eThe deployment of an online self-administered questionnaire has the potential to introduce selection bias towards participants who are electronically active or interested in the topic of mental health, thereby impacting the validity of the findings, and the use of convenience sampling may limit the generalizability of the findings to the entire population of Syrian university students. Additionally, the disproportionate distribution of participants among different universities may compromise the overall representativeness of the sample. A comparable investigation at the national scale might be necessary to enhance the generalizability of the findings. The study also lacked qualitative measures or individual interviews, which may limit the depth of psychological analysis and the ability to explore participants\u0026rsquo; experiences in more detail.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study demonstrated a high prevalence of PTSD among university students, particularly among those who had experienced multiple traumatic events and lived for extended periods in conflict-affected areas. Additionally, the findings revealed that happiness levels among the students ranged from moderate to high, which may contribute to their ability to engage productively in society and cope with the challenges of the post-conflict context.\u003c/p\u003e\u003cp\u003eTherefore, this study suggests: (1) Establishing psychological support units in universities; (2) Training academic staff to detect students' psychological symptoms; (3) Strengthening qualitative measurement tools in the future, which can change the psychological reality of university students and significantly reduce stress and the likelihood of developing mental disorders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Biomedical Research Ethics Committee at Damascus University approved the study protocol. The study was conducted in accordance with ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eID number: PH-200825-492\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in this study was entirely voluntary. At the beginning of the online questionnaire, participants were informed about\u0026nbsp;the study\u0026apos;s purpose and assured that their responses would remain confidential and anonymous. No identifying personal information, including names, was requested. Completion of the questionnaire was considered as implied consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding\u0026nbsp;from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHadeel Ezz-Aldeen Alshaikh Khalil was responsible for the study conception and design, data collection, statistical analysis, and paper writing.\u003c/p\u003e\n\u003cp\u003eWalaa Yousef Bakr, Hiba Samer Barakat, Noura Husain Berkdar, and Huda Mohammed Alkoussani\u0026nbsp;contributed to participant recruitment and distribution of the questionnaire.\u003c/p\u003e\n\u003cp\u003eYoussef Latifeh\u0026nbsp;\u0026amp; Lama A.Youssef supervised the project, reviewed the final manuscript, and provided academic guidance.\u003c/p\u003e\n\u003cp\u003eCorresponding author\u003c/p\u003e\n\u003cp\u003eCorrespondence to Lama A. Youssef\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCarta MG, Moro MF, Bass J. War traumas in the Mediterranean area. Int J Soc Psychiatry. 2015;61(1):33\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYehuda R, Hoge CW, McFarlane AC, et al. Post-traumatic stress disorder. Nat Rev Dis Primers. 2015;1:15057.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJain N, Prasad S, Cz\u0026aacute;rth ZC, et al. War psychiatry: Identifying and managing the neuropsychiatric consequences of armed conflicts. J Prim Care Community Health. 2022;13:21501319221106625.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLim ICZY, Tam WWS, Chudzicka-Czupała A, et al. Prevalence of depression, anxiety, and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis. 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Confl Health. 2024;18:66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAldabbour B, Abuabada A, Lahlouh A, et al. Psychological impacts of the Gaza war on Palestinian young adults: A cross-sectional study of depression, anxiety, stress, and PTSD symptoms. BMC Psychol. 2024;12(1):696.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHassan G, Ventevogel P, Jefee-Bahloul H, et al. Mental health of Syrians affected by armed conflict. Epidemiol Psychiatr Sci. 2016;25(2):129\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilva MA, et al. Internal displacement and psychological impact. Int J Ment Health. 2004;33(2):57\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElhadi YAM, et al. PTSD among displaced Darfuri women. J Nerv Ment Dis. 2012;200(10):860\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorina N, Stam K, Pollet TV, Priebe S. Prevalence of PTSD in war civilians: A systematic review. Lancet Psychiatry. 2014;1(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBerenz EC, et al. Gender differences in PTSD: An update. J Anxiety Disord. 2016;40:60\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Happiness Report. Global happiness rankings. 2017. Available from: https://worldhappiness.report [Accessed 7 Sep 2025].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCountryEconomy. Syria Happiness Index. 2019. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://countryeconomy.com\u003c/span\u003e\u003cspan address=\"https://countryeconomy.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [Accessed 7 Sep 2025].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchnurr PP, Lunney CA, Bovin MJ, Marx BP. PTSD and quality of life in Iraq and Afghanistan veterans. Clin Psychol Rev. 2013;33(8):724\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUzer T, Arslan B, Yalcin E. PTSD and quality of life in post-conflict youth. Traumatology. 2024;30(1):15\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Post-Traumatic Stress Disorder (PTSD), Syrian university students, PCL-5, Arabic Scale of Happiness (ASH), Trauma exposure, Happiness, Cross-sectional survey, Conflict-affected population","lastPublishedDoi":"10.21203/rs.3.rs-7768518/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7768518/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eYears of ongoing conflict, widespread displacement, and instability in Syria have placed a heavy psychological burden on the country\u0026rsquo;s population, particularly on its youth. University students, in particular, represent a vulnerable group due to the dual pressures of academic responsibilities and socio-political instability. This study aimed to determine the prevalence of PTSD symptoms among a sample of university students across several Syrian governorates and to examine their association with demographic and trauma-related factors. The study also explores overall happiness levels, aiming to provide a more comprehensive view of the psychological impact of conflict and displacement on this population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional analytical observational survey was conducted among 1,034 students from various Syrian universities using an online questionnaire. The instrument included demographic information, exposure to traumatic events, the PTSD Checklist for DSM-5 (PCL-5), and the Arabic Scale of Happiness (ASH). Descriptive and inferential statistics were used for data analysis. Data analysis incorporated both descriptive and inferential statistics. Associations between categorical variables were examined using chi-square tests. Analyses were conducted with Excel, GraphPad Prism, and Jamovi, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf the 1,034 participants, 40.62% met the diagnostic cutoff for probable PTSD based on PCL-5 scores. PTSD prevalence did not significantly differ between males and females (p\u0026thinsp;=\u0026thinsp;0.201). However, significant variations were found across different academic years and university regions. Regarding trauma exposure, 85.4% of participants reported experiencing at least one traumatic event, and 44.51% of those individuals met the criteria for probable PTSD. A significant association was found between the number of years spent in conflict-affected areas and PTSD prevalence (p\u0026thinsp;=\u0026thinsp;0.0038). Students with probable PTSD symptoms reported lower happiness scores.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePTSD is prevalent among Syrian university students, particularly among those with prolonged exposure to conflict. Academic stress and regional instability may compound psychological risk. Despite this, happiness levels ranged from moderate to high, which may reflect some degree of resilience. These findings underscore the need for psychological support programs tailored to university students in post-conflict settings.\u003c/p\u003e","manuscriptTitle":"Prevalence of Post-Traumatic Stress Disorder and Assessment of Happiness Levels Among Syrian University Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 12:04:54","doi":"10.21203/rs.3.rs-7768518/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-30T15:48:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"97888409124936662574960969450244849383","date":"2025-11-18T17:37:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T09:33:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T12:21:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T07:28:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T07:26:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-10-02T18:24:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5dd166c-380e-451a-9ef0-1be754412620","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-19T12:04:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 12:04:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7768518","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7768518","identity":"rs-7768518","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}