Climate Change, Displacement, and Mental Health: Insights from Conflict-Affected Communities in Somalia

Climate Change, Displacement, and Mental Health: Insights from Conflict-Affected Communities in Somalia | 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 Systematic Review Climate Change, Displacement, and Mental Health: Insights from Conflict-Affected Communities in Somalia Abdolahi Mohamed Adawe, Mohamed Abdirahim Omar, Gallad Dahir Hassan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7991815/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Climate change, exacerbated by prolonged insecurity, profoundly impacts the mental health of vulnerable populations, particularly internally displaced persons (IDPs). This study aimed to investigate the prevalence and associated factors of post-traumatic stress symptoms (PTSS) among IDPs in Somalia. Methodology: A cross-sectional design was employed with 852 IDPs residing in the Banadir region of Somalia. The modified Harvard Trauma Questionnaire (HTQ) was used to assess PTSS. Multivariable ordered logistic regression was then utilized to identify factors associated with PTSS severity. Results: A substantial burden of PTSS was identified, with 55.1% of IDPs reporting moderate and 14.1% reporting high symptom severity. Factors significantly increasing the odds of PTSS included displacement from Hirshabelle (AOR = 2.11, 95% CI: 1.35–3.32) and Somaliland (AOR = 5.02, 95% CI: 2.17–11.57), a belief in climate change (AOR = 1.75, 95% CI: 1.20–2.56), perceiving climate change as the cause of displacement (AOR = 1.72, 95% CI: 1.22–2.43), frustration due to loss of places (AOR = 1.81, 95% CI: 1.16–2.84), and specific livelihood losses such as livestock (AOR = 1.79, 95% CI: 1.18–2.70) and business (AOR = 3.85, 95% CI: 1.32–11.21). Conversely, protective factors included being female (AOR = 0.71, 95% CI: 0.53–0.96), engagement in day labor (AOR = 0.62, 95% CI: 0.38–0.99), relatively better living conditions (poor vs. very poor; AOR = 0.36, 95% CI: 0.22–0.59), and critically, both community (AOR = 0.35, 95% CI: 0.19–0.62) and government support (AOR = 0.12, 95% CI: 0.07–0.21). Unexpectedly, self-reported harmful behaviors were associated with lower odds of PTSS (AOR = 0.69, 95% CI: 0.48–0.99). Conclusion: This study provides evidence of a strong relationship between climate-related displacement and PTSS among Somali IDPs, consistent with findings from other climate–conflict hotspots worldwide. Addressing this challenge requires integrated, context-specific approaches that combine mental health and psychosocial support with climate resilience and humanitarian programming. Strengthening Somalia’s mental health response should be viewed not as an adjunct but as an essential pillar of climate adaptation, disaster risk reduction, and peacebuilding. Climate change conflicts mental health displaced population Somalia Figures Figure 1 1. Introduction The accelerating global climate change (CC) crisis represents pressing health emergencies and acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. This has deleterious effects on people’s mental health, particularly for the vulnerable population, such as those displaced or living in fragile economies ( 1 ). The World Health Organization (WHO) defines mental health as “a state of well-being in which individuals realize their own abilities, can cope with the normal stresses of life, work productively, and contribute to their communities.” That "the climate crisis is a health crisis" is recognized by global health leaders, including the World Health Organization reports have outlined that increased global heating will have catastrophic consequences, such as floods, hurricanes, droughts, and earthquakes have severe consequences on mental health ( 2 , 3 ). However, in fragile and conflict-affected contexts like Somalia, mental health is not merely the absence of mental disorders; it is deeply intertwined with environmental, social, and political instability that heightens exposure to trauma and psychosocial distress. Click or tap here to enter text.Furthermore, the cumulative stressors of conflict, economic instability, and environmental degradation contribute to a heightened burden of mental health disorders, which affect approximately 75% of individuals in low-and middle-income countries ( 4 ). Recent data show that Somalia faces a rising mental health crisis, with major depressive and anxiety disorders increasing by 17.8% and 16.2% in 2020, straining an already fragile health system where one in three people live with mental illness ( 5 ). Among internally displaced persons (IDPs) in Somalia, 59% report depression symptoms and 32% meet post-traumatic stress disorder criteria, reflecting the compounding effects of displacement, conflict, and climate shocks on mental health ( 6 ). The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) listed East Africa among the global hotspots showing high vulnerability to climate hazards ( 7 ). Click or tap here to enter text.This movement and displacement leads to loss of livelihood and property and can thus evoke feelings of hopelessness, helplessness, and homesickness, often correlated with mental illness ( 8 ) Click or tap here to enter text.. Somalia is one of the countries which has been most affected by Climate change with the nation experiencing an increase in severe climatic shocks since 1990, with extreme weather conditions such as the severe droughts of 2011, 2017, and the worst drought in 40 years occurring in 2022 ( 9 ). These climatic shocks has led to a devastating humanitarian crisis, resulting in large-scale internal displacement ( 10 ) Click or tap here to enter text.. In addition to extreme droughts, floods, and climate-induced factors, displacement is often compounded by human-driven crises, including clan-based conflicts and terrorist-related violence, leading to climate-induced displacement and climate refugees ( 11 ). The combined effects of recurrent climatic shocks and social conflict exacerbate the vulnerabilities of internally displaced populations (IDPs), leaving them at greater risk of experiencing mental health challenges( 12 ). These climatic and displacement dynamics intersect with a fragile mental health landscape. Studies show IDPs in Mogadishu experience elevated levels of anxiety and depression, exacerbated by limited access to mental health services ( 6 ).Broader regional analyses indicate that exposure to both climate-induced emergencies and conflict correlates with increased psychological distress, particularly among women and children in humanitarian settings ( 13 , 14 ). The compounded pressures of displacement, livelihood loss, and insecurity have been linked to worsening psychosocial outcomes and weakened resilience in Somali communities (Oberg et al., 2021. Similarly, these climate change events are a threat to Somalia’s capacity to achieve the 2030 Agenda for Sustainable Development Goals and its vow to “leave no one behind” ( 15 ). Moreover, climate change in post-conflict Somalia threatens progress toward sustainable development goals and social stability, placing mental health at the intersection of environmental justice and humanitarian response ( 6 ). The interplay of conflict and climate variability significantly amplifies displacement risks, with research indicating that a one-standard-deviation increase in conflict events can multiply displacement by up to fifty times ( 16 ). Together, these findings illuminate an urgent need for integrated approaches that address mental health not as a peripheral concern but as a core dimension of climate adaptation and IDPs and peacebuilding in Somalia’s conflict-affected regions. This study employed the Harvard Trauma Questionnaire to assess trauma exposure, PTSD prevalence, and related mental health difficulties. It explores the links between climate-induced displacement, social conflict, and PTSD among internally displaced persons in Somalia, providing baseline data on the mental health impacts of climate change on vulnerable populations. 2. Methodology 2.1. Study Design and Participants This study employed a cross-sectional study designed to investigate the mental health impacts of climate change among IDPs in the Banadir region, specifically in three camps namely Raamakuulow, Kabtanlaas, and Goolwayn, situated in the most densely IDP-populated areas around Mogadishu city. The target population consisted of IDPs aged 18 years and older. Data was collected between September 2024 and January 2025. Variables of interest collected include trauma exposure and post-traumatic stress disorder (PTSD) symptoms based on DSM-III criteria, and access to mental health services within this vulnerable group. 2.2. Measures Sociodemographic and displacement data of internally displaced persons (IDPs) were collected using a researcher-designed questionnaire. PTSD symptoms were assessed with a 16-item adaptation of the Harvard Trauma Questionnaire (HTQ), derived from DSM-III criteria, scored on a 4-point severity scale, and averaged for total scores. The HTQ is a validated tool for assessing trauma exposure and PTSD in conflict- and disaster-affected populations. PTSD severity, the main outcome, was constructed as a 5-item index capturing climate change–related psychological impacts (awareness, concern, mental health changes, socio-emotional effects, overwhelm), each rated on a 0–4 Likert scale. Scores ranged 0–20 and were categorized as Low (0–6), Moderate ( 7 – 13 ), or High ( 14 – 20 ). Factor analysis supported a single factor structure (eigenvalue = 2.603; 52.05% variance explained), and internal consistency was acceptable (Cronbach’s α = 0.735). To ensure inclusivity, the questionnaire was translated into Somali. 2.3. Data collection tools Data were collected through face-to-face interviews using KoboToolbox on encrypted mobile devices. Enumerators received five days of training before fieldwork. Rigorous data cleaning ensured data quality. Eligible participants were adults aged 18–65 years residing in designated IDP camps who provided informed consent. Individuals unable or unwilling to consent, or with conditions impairing comprehension, were excluded. 2.4. Statistical Analysis Data were cleaned and analyzed using STATA. Descriptive statistics summarized the data, while analytical tests examined associations. Categorical variables were analyzed using Pearson’s chi-square and percentages. Multivariate logistic regressions identified predictors of PTSD severity. Variables with p < 0.05 were entered into the final model, and results were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). 3. Results A total of 870 individuals from conflict-affected and displaced communities in Somalia participated in the study. After data cleaning, 18 cases were excluded due to uniform or invalid responses, leaving 852 participants for the final analysis. Results are presented in four parts: sample characteristics, prevalence of PTSD, multivariable model identifying significant predictors of PTSD severity. 3.1. Sociodemographic and Displacement Characteristics Among 852 respondents, the predominant age groups were 26–35 years (34.6%). Slightly more than half were male (54.0%). A majority (58.0%) had no formal education, and the main occupations were day laborer (40.7%), unemployed (25.9%), and farmer (25.5%). Over half (52.7%) were not displaced at the time of the survey, while 39.4% had been previously displaced and 7.9% were currently displaced. Conflict (45.8%) and drought (35.7%) were the leading drivers of displacement, with livestock (39.9%) and farming (32.4%) representing the most affected livelihoods as shown in Table 1 . Table 1 Sociodemographic and Displacement Characteristics of Study Participants Characteristic Category Frequency Percent (%) Age Group (Years) 18–25 102 11.97 26–35 295 34.62 36–45 255 29.93 46–55 144 16.90 56+ 56 6.57 Gender Male 460 53.99 Female 392 46.01 Education Level No formal education 494 57.98 Formal education 256 30.05 University and above 102 11.97 Occupation Farmer 217 25.47 Day labourer 347 40.73 Business/Self-employed 67 7.86 Unemployed 221 25.94 Displacement Status Not displaced 449 52.70 Previously displaced 336 39.44 Currently displaced 67 7.86 Primary Cause of Displacement Conflict 390 45.77 Drought 304 35.68 Others 158 18.54 Primary Livelihood Loss Livestock 340 39.91 Farming 276 32.39 Other 236 27.70 3.2. Prevalence of PTSD and Psychosocial Perceptions The prevalence of PTSD symptoms indicated a substantial mental health burden. Over half of respondents (55.1%) exhibited moderate symptom severity, 14.1% reported high severity, and 30.9% had low symptom levels (Fig. 1 ). Most participants (74.1%) perceived climate change as a real phenomenon, with 68.2% linking it to displacement and 72.2% to community conflict. Psychosocial challenges were common, including strained social relationships (61.7%) and reduced self-worth (54.6%), while 51.3% reported stress-related worsening of anxiety and depression. Reported support was minimal, with 91.2% noting the absence of community programs and 89.1% perceiving inadequate government mental health support as shown in Table 2 . Table 2 Perceptions on Climate Change, Psychosocial Factors, and Support Systems (N = 852) Variable Response Frequency Percent (%) Believe Climate Change is Occurring? Yes 631 74.06 No 221 25.94 Climate Change Contributed to Displacement? Yes 581 68.19 No 271 31.81 Climate Change a Factor in Conflict? Yes 615 72.18 No 237 27.82 Difficulties in Social Relationships? Yes 526 61.74 No 326 38.26 Diminished Sense of Self-Worth? Yes 465 54.58 No 387 45.42 Community Support Available? Yes 75 8.80 No 777 91.20 Government Support is Enough? Yes 93 10.92 No 759 89.08 3.3. Multivariable Predictors of PTSD Severity Multicollinearity of the independent variables was assessed using the Variance Inflation Factor (VIF), but no significant multicollinearity was detected (mean VIF = 1.41). However, in multivariable ordered logistic regression, geographic origin was a strong predictor: displacement from Somaliland (aOR = 5.02; 95% CI: 2.17–11.57; p < 0.001) and Hirshabelle (aOR = 2.11; 95% CI: 1.35–3.32; p = 0.001) was associated with higher odds of severe PTSD. Livelihood loss was significant, with loss of business (aOR = 3.85; 95% CI: 1.32–11.21; p = 0.013) and livestock (aOR = 1.79; 95% CI: 1.18–2.70; p = 0.006) predicting greater severity. Perceptions linking climate change to displacement remained significant (aOR = 1.72; 95% CI: 1.22–2.43; p = 0.002). Protective factors included being a day labourer (aOR = 0.62; 95% CI: 0.38–0.99; p = 0.047) and reporting living conditions as poor (vs. very poor) (aOR = 0.36; 95% CI: 0.22–0.59; p < 0.001). Unexpectedly, reporting inadequate government assistance (aOR = 0.12; 95% CI: 0.07–0.21; p < 0.001) or community support (aOR = 0.35; 95% CI: 0.19–0.62; p < 0.001) was inversely associated with PTSD severity. Age and education were significant in crude analyses, (cOR = 1.80; 95% CI: 1.33–2.42; p < 0.001) were highly significant in the unadjusted analysis but became non-significant after controlling for other variables. Table 4 Multivariable Logistic Regression Analysis for Factors Associated with PTSD Severity Unadjusted Adjusted Variable Category (cOR) 95% CI P-value (aOR) 95% CI P-value Age Group (Ref: 18–25) 26–35 0.38 [0.24–0.60] < 0.001 0.80 [0.45–1.42] 0.437 36–45 0.30 [0.19–0.48] < 0.001 0.91 [0.48–1.73] 0.779 46–55 0.29 [0.17–0.48] < 0.001 0.57 [0.29–1.15] 0.117 56+ 0.37 [0.19–0.72] 0.003 0.63 [0.28–1.43] 0.272 Gender (Ref: Male) Female 0.73 [0.56–0.95] 0.018 0.71 [0.53–0.96] 0.025 Education (Ref: No formal) Formal education 1.80 [1.33–2.42] < 0.001 1.01 [0.69–1.50] 0.945 University & above 2.18 [1.44–3.30] < 0.001 0.93 [0.50–1.72] 0.815 Occupation (Ref: Farmer) Day labour 0.54 [0.38–0.75] < 0.001 0.62 [0.38–0.99] 0.047 Business/self-employed 0.81 [0.47–1.41] 0.456 0.74 [0.38–1.45] 0.374 Unemployed 2.22 [1.52–3.25] < 0.001 1.48 [0.80–2.74] 0.208 Displacement Status (Ref: Currently) Previously displaced 1.33 [0.81–2.19] 0.255 0.85 [0.47–1.55] 0.600 Not displaced 1.11 [0.69–1.80] 0.665 0.64 [0.33–1.21] 0.169 Displacement Duration (Ref: <1 year) 1–2 years 1.56 [1.11–2.19] 0.011 1.34 [0.89–2.01] 0.168 Over 2 years 1.48 [1.09–2.00] 0.011 1.24 [0.73–2.10] 0.419 Origin Region (Ref: Southwest) Hirshabelle 2.07 [1.38–3.11] < 0.001 2.11 [1.35–3.32] 0.001 Galmudug 0.68 [0.43–1.09] 0.110 0.78 [0.45–1.36] 0.380 Puntland 1.25 [0.62–2.50] 0.530 1.28 [0.58–2.82] 0.536 Jubaland 0.87 [0.51–1.48] 0.609 1.30 [0.72–2.36] 0.383 Somaliland 4.30 [2.00–9.27] < 0.001 5.02 [2.17–11.57] < 0.001 Others 2.06 [1.44–2.96] < 0.001 2.86 [1.73–4.73] < 0.001 Living Conditions (Ref: Very poor) Poor 0.25 [0.16–0.40] < 0.001 0.36 [0.22–0.59] < 0.001 Adequate 1.10 [0.66–1.83] 0.710 1.07 [0.59–1.92] 0.827 Good 0.71 [0.45–1.11] 0.130 0.57 [0.32–1.02] 0.058 Very good 1.68 [0.32–8.78] 0.540 2.15 [0.28–16.23] 0.460 Belief in Climate Change (Ref: No) Yes 2.71 [1.99–3.70] < 0.001 1.75 [1.20–2.56] 0.004 Climate Change & Displacement (Ref: No) Yes 2.36 [1.77–3.15] < 0.001 1.72 [1.22–2.43] 0.002 Climate Change & Conflict (Ref: No) Yes 2.24 [1.66–3.02] < 0.001 1.25 [0.86–1.80] 0.242 Harmful Behaviors Inc. (Ref: No) Yes 0.69 [0.53–0.92] 0.010 0.69 [0.48–0.99] 0.047 Social Relations Difficulty (Ref: No) Yes 1.47 [1.12–1.93] 0.005 1.01 [0.74–1.37] 0.950 Frustration (Loss of Places) (Ref: No) Yes 2.22 [1.51–3.26] < 0.001 1.81 [1.16–2.84] 0.009 Feeling Detached (Ref: No) Yes 0.90 [0.64–1.27] 0.547 1.04 [0.68–1.59] 0.851 Diminished Self-Worth (Ref: No) Yes 1.08 [0.83–1.40] 0.570 1.04 [0.76–1.43] 0.794 Strained Social Relations Stress (Ref: No) Yes 1.46 [1.12–1.89] 0.005 1.23 [0.90–1.69] 0.184 Ongoing Conflict & Mental Health (Ref: No) Yes 0.65 [0.49–0.86] 0.003 0.77 [0.52–1.14] 0.195 Community Support Avail. (Ref: Yes) No 0.22 [0.14–0.37] < 0.001 0.35 [0.19–0.62] < 0.001 Govt. Support Enough (Ref: Yes) No 0.07 [0.04–0.11] < 0.001 0.12 [0.07–0.21] < 0.001 Cause of Displacement (Ref: Drought) Conflict 1.19 [0.88–1.60] 0.255 0.78 [0.54–1.13] 0.186 Others 1.56 [1.08–2.24] 0.017 0.72 [0.42–1.26] 0.257 Livelihood Loss (Ref: Farming) Livestock 1.36 [1.00–1.86] 0.053 1.79 [1.18–2.70] 0.006 Herding 1.59 [0.84–3.00] 0.155 1.86 [0.90–3.84] 0.095 Fishing 1.51 [0.77–2.96] 0.231 1.79 [0.77–4.16] 0.177 Business 3.51 [1.48–8.36] 0.004 3.85 [1.32–11.21] 0.013 Other 2.03 [1.38–3.00] < 0.001 1.25 [0.66–2.36] 0.498 cOR: Crude Odds Ratio from individual survey logistic regressions. aOR: Adjusted Odds Ratio from multivariable survey logistic regression including all listed variables. CI: Confidence Interval. Significant associations (P-value < 0.05) are bolded. Region of origin was a major determinant: IDPs from Hirshabelle (AOR = 2.11, 95% CI: 1.35–3.32) and Somaliland (AOR = 5.02, 95% CI: 2.17–11.57) had higher odds of PTSS, reflecting regional differences in conflict and resource access, echoing the evidence that regional variations in conflict dynamics, access to resources, and displacement conditions within a single country can differentially shape mental health outcome ( 17 ). 4. Discussion This study reveals a substantial burden of post-traumatic stress symptoms (PTSS) among internally displaced persons (IDPs) in Somalia, a country simultaneously facing protracted conflict and escalating climate shocks. More than half of respondents reported moderate PTSS (55.1%), while 14.1% reported high-severity symptoms. Key predictors included geographic origin, livelihood loss (business and livestock), and perceptions linking climate change to displacement. Conversely, protective factors included female gender, engagement in day labor, better socioeconomic status, and perceived community and government support. These findings emphasize the intertwined nature of climate change, displacement, and mental health in fragile and conflict-affected settings. Our findings align with global evidence showing that climate-related hazards exacerbate psychological morbidity, particularly among vulnerable populations such as IDPs and refugees. In climate-conflict hotspots like Darfur, South Sudan, and Afghanistan, PTSD prevalence among displaced populations ranges between 40–60%, reflecting exposure to cumulative trauma, forced migration, and livelihood insecurity ( 18 , 19 ) Similarly, displacement linked to environmental degradation and extreme weather in Bangladesh and the Philippines has been shown to elevate mental health risks, underscoring the global scale of climate-related psychological impacts ( 20 , 21 ). In our study, belief in climate change and its attribution to displacement were independently associated with PTSS. This aligns with research from Australia, Pakistan, and the United States showing that perceived climate threats, even in the absence of direct disaster exposure, are linked to heightened psychological distress, eco-anxiety, and trauma-related symptoms ( 22 ). This phenomenon reflects the growing recognition of climate change indeed amplifies existing social and psychological vulnerabilities. Geographic origin was among the strongest predictors of PTSS. Respondents displaced from Somaliland and Hirshabelle exhibited markedly higher odds of severe symptoms compared to those from Southwest State. This reflects the complex layering of climate shocks and insecurity, where differential access to resources, displacement dynamics, and security conditions shape mental health outcomes ( 23 ). Loss of livelihoods, particularly business and livestock, was also strongly associated with PTSS. Similar findings have been documented in drought-affected rural communities in Kenya and Ethiopia,which is the concept of ecological grief, referring to mourning of lost environments, livelihoods, or cultural identity due to climate change with intimate linkage to economic insecurity, and psychological distress ( 24 ). An unexpected finding was the protective association between female gender and PTSS. While women are often more vulnerable to gender-based violence and mental distress in conflict zones ( 25 ). Our findings mirror other Somali studies suggesting that women may demonstrate stronger coping networks and adaptive resilience within displacement settings ( 17 ). Cultural norms around collective caregiving and social cohesion may explain this trend, though further qualitative work is needed. Day laborers showed lower PTSS severity compared to farmers, suggesting that flexible, cash-based livelihoods may buffer psychological stress by offering agency and reducing reliance on climate-sensitive farming. Better socioeconomic status was also protective, aligning with evidence that economic stability mitigates climate-related psychological distress in LMICs. Perceptions of inadequate government and community support were also inversely associated with PTSS. This counterintuitive finding may reflect low institutional trust, where expectations are already minimal, leading individuals to rely more on informal coping networks, as has been observed in other fragile contexts. This study highlights the urgent need to position mental health as a core component of climate adaptation and humanitarian response in fragile states. Evidence from Uganda and Ethiopia shows that integrating psychosocial support into displacement response frameworks can improve mental health outcomes and resilience( 26 ). For Somalia, this entails scaling up community-based mental health services integrated within climate resilience and embedding psychosocial components into disaster preparedness, climate adaptation planning, and strengthening informal and community-led support systems, particularly where institutional trust is low. The strength of our study is that it contributes empirical evidence from one of the world’s most climate-vulnerable and conflict-affected settings, drawing on a large sample of IDPs and validated tools such as the Harvard Trauma Questionnaire.To our knowledge, it is among the first studies to examine the intersection of climate-related displacement, livelihood loss, and mental health in Somalia. However, limitations include its cross-sectional design, which precludes causal inference, potential self-reporting bias, particularly on sensitive behavioral indicators, and the absence of objective environmental exposure data. Longitudinal studies incorporating geospatial climate exposure and mental health trajectories could strengthen causal pathways. 5. Conclusion Climate change acts as a force multiplier in fragile states, intensifying displacement, disrupting livelihoods, and exacerbating psychosocial distress. This study provides evidence of a strong relationship between climate-related displacement and PTSS among Somali IDPs, consistent with findings from other climate–conflict hotspots worldwide. Addressing this challenge requires integrated, context-specific approaches that combine mental health and psychosocial support with climate resilience and humanitarian programming. Strengthening Somalia’s mental health response should be viewed not as an adjunct but as an essential pillar of climate adaptation, disaster risk reduction, and peacebuilding. Abbreviations PTSD Post-Traumatic Stress Disorder IDPs Internally Displaced Persons WHO World Health Organization UNICEF United Nations International Children's Emergency Fund HTQ Harvard Trauma Questionnaire VIF Variance Inflation Factor DSM Diagnostic and Statistical Manual of Mental Disorders IPCC Intergovernmental Panel on Climate Change Declarations Funding Funding is not available for this submission Ethics approval This study received ethical approval from ethics review board (EBR), Somali National University (JUS/KCC&CT/215/2025). All participants were provided informed consent prior to data collection, and participation was entirely voluntary, and confidentiality upheld. It followed the 1964 Helsinki Declaration, prioritizing human dignity, safeguarding displaced and conflict-affected individuals, and promoting wellbeing while minimizing risks throughout the research process. Competing interests The authors declare no competing interests. Author Contribution All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. Abdolahi Mohamed Adawe conceptualized the study and led the overall research design. Mohamed Abdirahim Omar and Gallad D. Hassan contributed to the statistical analysis and managed the software tools used in data processing. Omar Abdihamid thoroughly revised the manuscript and provided critical feedback throughout the writing process. All authors read and approved the final manuscript. Acknowledgements Not applicable. Data Availability The data used in this study can be obtained from the corresponding author upon a reasonable request. 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Rahman MM, Shobuj IA, Alam S, Sadia AM, Khanam S, Hossain MT, et al. The unforeseen tide: exploring mental health impacts of the 2024 flash flood in Bangladesh. BMC Public Health. 2025;25(1):2728. Cianconi P, Betrò S, Janiri L. The Impact of Climate Change on Mental Health: A Systematic Descriptive Review. Front Psychiatry. 2020;11:74. White BP, Breakey S, Brown MJ, Smith JR, Tarbet A, Nicholas PK, et al. Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review. Ann Glob Health. 2023;89(1):66. Kagunda J, Hasham A, Logie CH, Evelia H, Gachoki C, Omondi B, et al. Climate change and resource insecurity-related mental health stressors among young adolescents in Kenya: Qualitative multi-method insights. Glob Ment Health (Camb). 2025;12:e105. Wahid SS, Musyimi C, Oestericher B, Khakali L, Carruth L, Mendenhall E, et al. Ecological grief among farmers and pastoralists in Ethiopia and Kenya. SSM - Mental Health. 2025;7:100456. Suza M, Warner J, Pacillo G, Laderach P, Dijk H. Women's Vulnerabilities to Climate Insecurity and Violence: Household-Level Evidence From Bangladesh. Rural Sociol. 2025;90. Nguyen AJ, Lasater ME, Lee C, Mallawaarachchi IV, Joshua K, Bassett L, et al. Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. J Migration Health. 2023;7:100168. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 03 Nov, 2025 Editor assigned by journal 03 Nov, 2025 Submission checks completed at journal 03 Nov, 2025 First submitted to journal 30 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. 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11:41:32","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":110744,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7991815/v1/add2144f3e4268bae6364c1f.html"},{"id":95018104,"identity":"9b06c46f-51d8-46a8-ae14-71874144657a","added_by":"auto","created_at":"2025-11-03 11:41:32","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19896,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of PTSD Severity\u003c/p\u003e","description":"","filename":"groupimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7991815/v1/1411c9d649b867e6ac2e5180.jpeg"},{"id":95229719,"identity":"d4f69690-2451-4365-9f12-610306400c85","added_by":"auto","created_at":"2025-11-05 16:36:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":940704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7991815/v1/b624004f-984f-46c5-9a29-98cad0b30a40.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Climate Change, Displacement, and Mental Health: Insights from Conflict-Affected Communities in Somalia","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe accelerating global climate change (CC) crisis represents pressing health emergencies and acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. This has deleterious effects on people\u0026rsquo;s mental health, particularly for the vulnerable population, such as those displaced or living in fragile economies (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe World Health Organization (WHO) defines mental health as \u0026ldquo;a state of well-being in which individuals realize their own abilities, can cope with the normal stresses of life, work productively, and contribute to their communities.\u0026rdquo; That \"the climate crisis is a health crisis\" is recognized by global health leaders, including the World Health Organization reports have outlined that increased global heating will have catastrophic consequences, such as floods, hurricanes, droughts, and earthquakes have severe consequences on mental health (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, in fragile and conflict-affected contexts like Somalia, mental health is not merely the absence of mental disorders; it is deeply intertwined with environmental, social, and political instability that heightens exposure to trauma and psychosocial distress. Click or tap here to enter text.Furthermore, the cumulative stressors of conflict, economic instability, and environmental degradation contribute to a heightened burden of mental health disorders, which affect approximately 75% of individuals in low-and middle-income countries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecent data show that Somalia faces a rising mental health crisis, with major depressive and anxiety disorders increasing by 17.8% and 16.2% in 2020, straining an already fragile health system where one in three people live with mental illness (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Among internally displaced persons (IDPs) in Somalia, 59% report depression symptoms and 32% meet post-traumatic stress disorder criteria, reflecting the compounding effects of displacement, conflict, and climate shocks on mental health (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe 2022 report of the Intergovernmental Panel on Climate Change (IPCC) listed East Africa among the global hotspots showing high vulnerability to climate hazards (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Click or tap here to enter text.This movement and displacement leads to loss of livelihood and property and can thus evoke feelings of hopelessness, helplessness, and homesickness, often correlated with mental illness (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Click or tap here to enter text.. Somalia is one of the countries which has been most affected by Climate change with the nation experiencing an increase in severe climatic shocks since 1990, with extreme weather conditions such as the severe droughts of 2011, 2017, and the worst drought in 40 years occurring in 2022 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These climatic shocks has led to a devastating humanitarian crisis, resulting in large-scale internal displacement (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Click or tap here to enter text.. In addition to extreme droughts, floods, and climate-induced factors, displacement is often compounded by human-driven crises, including clan-based conflicts and terrorist-related violence, leading to climate-induced displacement and climate refugees (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe combined effects of recurrent climatic shocks and social conflict exacerbate the vulnerabilities of internally displaced populations (IDPs), leaving them at greater risk of experiencing mental health challenges(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These climatic and displacement dynamics intersect with a fragile mental health landscape. Studies show IDPs in Mogadishu experience elevated levels of anxiety and depression, exacerbated by limited access to mental health services (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).Broader regional analyses indicate that exposure to both climate-induced emergencies and conflict correlates with increased psychological distress, particularly among women and children in humanitarian settings (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe compounded pressures of displacement, livelihood loss, and insecurity have been linked to worsening psychosocial outcomes and weakened resilience in Somali communities (Oberg et al., 2021. Similarly, these climate change events are a threat to Somalia\u0026rsquo;s capacity to achieve the 2030 Agenda for Sustainable Development Goals and its vow to \u0026ldquo;leave no one behind\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Moreover, climate change in post-conflict Somalia threatens progress toward sustainable development goals and social stability, placing mental health at the intersection of environmental justice and humanitarian response (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The interplay of conflict and climate variability significantly amplifies displacement risks, with research indicating that a one-standard-deviation increase in conflict events can multiply displacement by up to fifty times (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTogether, these findings illuminate an urgent need for integrated approaches that address mental health not as a peripheral concern but as a core dimension of climate adaptation and IDPs and peacebuilding in Somalia\u0026rsquo;s conflict-affected regions. This study employed the Harvard Trauma Questionnaire to assess trauma exposure, PTSD prevalence, and related mental health difficulties. It explores the links between climate-induced displacement, social conflict, and PTSD among internally displaced persons in Somalia, providing baseline data on the mental health impacts of climate change on vulnerable populations.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Design and Participants\u003c/h2\u003e\u003cp\u003eThis study employed a cross-sectional study designed to investigate the mental health impacts of climate change among IDPs in the Banadir region, specifically in three camps namely Raamakuulow, Kabtanlaas, and Goolwayn, situated in the most densely IDP-populated areas around Mogadishu city. The target population consisted of IDPs aged 18 years and older. Data was collected between September 2024 and January 2025. Variables of interest collected include trauma exposure and post-traumatic stress disorder (PTSD) symptoms based on DSM-III criteria, and access to mental health services within this vulnerable group.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Measures\u003c/h2\u003e\u003cp\u003eSociodemographic and displacement data of internally displaced persons (IDPs) were collected using a researcher-designed questionnaire. PTSD symptoms were assessed with a 16-item adaptation of the Harvard Trauma Questionnaire (HTQ), derived from DSM-III criteria, scored on a 4-point severity scale, and averaged for total scores. The HTQ is a validated tool for assessing trauma exposure and PTSD in conflict- and disaster-affected populations.\u003c/p\u003e\u003cp\u003ePTSD severity, the main outcome, was constructed as a 5-item index capturing climate change\u0026ndash;related psychological impacts (awareness, concern, mental health changes, socio-emotional effects, overwhelm), each rated on a 0\u0026ndash;4 Likert scale. Scores ranged 0\u0026ndash;20 and were categorized as Low (0\u0026ndash;6), Moderate (\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), or High (\u003cspan additionalcitationids=\"CR15 CR16 CR17 CR18 CR19\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Factor analysis supported a single factor structure (eigenvalue\u0026thinsp;=\u0026thinsp;2.603; 52.05% variance explained), and internal consistency was acceptable (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.735). To ensure inclusivity, the questionnaire was translated into Somali.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Data collection tools\u003c/h2\u003e\u003cp\u003eData were collected through face-to-face interviews using KoboToolbox on encrypted mobile devices. Enumerators received five days of training before fieldwork. Rigorous data cleaning ensured data quality. Eligible participants were adults aged 18\u0026ndash;65 years residing in designated IDP camps who provided informed consent. Individuals unable or unwilling to consent, or with conditions impairing comprehension, were excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Statistical Analysis\u003c/h2\u003e\u003cp\u003eData were cleaned and analyzed using STATA. Descriptive statistics summarized the data, while analytical tests examined associations. Categorical variables were analyzed using Pearson\u0026rsquo;s chi-square and percentages. Multivariate logistic regressions identified predictors of PTSD severity. Variables with \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were entered into the final model, and results were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI).\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 870 individuals from conflict-affected and displaced communities in Somalia participated in the study. After data cleaning, 18 cases were excluded due to uniform or invalid responses, leaving 852 participants for the final analysis. Results are presented in four parts: sample characteristics, prevalence of PTSD, multivariable model identifying significant predictors of PTSD severity.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Sociodemographic and Displacement Characteristics\u003c/h2\u003e\u003cp\u003eAmong 852 respondents, the predominant age groups were 26\u0026ndash;35 years (34.6%). Slightly more than half were male (54.0%). A majority (58.0%) had no formal education, and the main occupations were day laborer (40.7%), unemployed (25.9%), and farmer (25.5%). Over half (52.7%) were not displaced at the time of the survey, while 39.4% had been previously displaced and 7.9% were currently displaced. Conflict (45.8%) and drought (35.7%) were the leading drivers of displacement, with livestock (39.9%) and farming (32.4%) representing the most affected livelihoods as shown 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\u003eSociodemographic and Displacement Characteristics of Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group (Years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e392\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e46.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e494\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFormal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e217\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay labourer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e347\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness/Self-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisplacement Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot displaced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e449\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreviously displaced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e336\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrently displaced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Cause of Displacement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConflict\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDrought\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary Livelihood Loss\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLivestock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFarming\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.70\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. Prevalence of PTSD and Psychosocial Perceptions\u003c/h2\u003e\u003cp\u003eThe prevalence of PTSD symptoms indicated a substantial mental health burden. Over half of respondents (55.1%) exhibited moderate symptom severity, 14.1% reported high severity, and 30.9% had low symptom levels (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMost participants (74.1%) perceived climate change as a real phenomenon, with 68.2% linking it to displacement and 72.2% to community conflict. Psychosocial challenges were common, including strained social relationships (61.7%) and reduced self-worth (54.6%), while 51.3% reported stress-related worsening of anxiety and depression. Reported support was minimal, with 91.2% noting the absence of community programs and 89.1% perceiving inadequate government mental health support as shown 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\u003ePerceptions on Climate Change, Psychosocial Factors, and Support Systems (N\u0026thinsp;=\u0026thinsp;852)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\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\" colname=\"c2\"\u003e\u003cp\u003eResponse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelieve Climate Change is Occurring?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e631\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74.06\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClimate Change Contributed to Displacement?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e581\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68.19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClimate Change a Factor in Conflict?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e615\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDifficulties in Social Relationships?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.74\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e326\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiminished Sense of Self-Worth?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e54.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Support Available?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e777\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e91.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovernment Support is Enough?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e759\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e89.08\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=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Multivariable Predictors of PTSD Severity\u003c/h2\u003e\u003cp\u003eMulticollinearity of the independent variables was assessed using the Variance Inflation Factor (VIF), but no significant multicollinearity was detected (mean VIF\u0026thinsp;=\u0026thinsp;1.41). However, in multivariable ordered logistic regression, geographic origin was a strong predictor: displacement from Somaliland (aOR\u0026thinsp;=\u0026thinsp;5.02; 95% CI: 2.17\u0026ndash;11.57; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Hirshabelle (aOR\u0026thinsp;=\u0026thinsp;2.11; 95% CI: 1.35\u0026ndash;3.32; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) was associated with higher odds of severe PTSD. Livelihood loss was significant, with loss of business (aOR\u0026thinsp;=\u0026thinsp;3.85; 95% CI: 1.32\u0026ndash;11.21; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013) and livestock (aOR\u0026thinsp;=\u0026thinsp;1.79; 95% CI: 1.18\u0026ndash;2.70; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006) predicting greater severity. Perceptions linking climate change to displacement remained significant (aOR\u0026thinsp;=\u0026thinsp;1.72; 95% CI: 1.22\u0026ndash;2.43; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003cp\u003eProtective factors included being a day labourer (aOR\u0026thinsp;=\u0026thinsp;0.62; 95% CI: 0.38\u0026ndash;0.99; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047) and reporting living conditions as poor (vs. very poor) (aOR\u0026thinsp;=\u0026thinsp;0.36; 95% CI: 0.22\u0026ndash;0.59; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Unexpectedly, reporting inadequate government assistance (aOR\u0026thinsp;=\u0026thinsp;0.12; 95% CI: 0.07\u0026ndash;0.21; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) or community support (aOR\u0026thinsp;=\u0026thinsp;0.35; 95% CI: 0.19\u0026ndash;0.62; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was inversely associated with PTSD severity. Age and education were significant in crude analyses, (cOR\u0026thinsp;=\u0026thinsp;1.80; 95% CI: 1.33\u0026ndash;2.42; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were highly significant in the unadjusted analysis but became non-significant after controlling for other variables.\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 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable Logistic Regression Analysis for Factors Associated with PTSD Severity\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eUnadjusted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eAdjusted\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(cOR) 95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e(aOR) 95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group (Ref: 18\u0026ndash;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.38 [0.24\u0026ndash;0.60]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.80 [0.45\u0026ndash;1.42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.437\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.30 [0.19\u0026ndash;0.48]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.91 [0.48\u0026ndash;1.73]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.779\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.29 [0.17\u0026ndash;0.48]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.57 [0.29\u0026ndash;1.15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.37 [0.19\u0026ndash;0.72]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.63 [0.28\u0026ndash;1.43]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.272\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (Ref: Male)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.73 [0.56\u0026ndash;0.95]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.71 [0.53\u0026ndash;0.96]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation (Ref: No formal)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFormal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.80 [1.33\u0026ndash;2.42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.01 [0.69\u0026ndash;1.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.945\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.18 [1.44\u0026ndash;3.30]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.93 [0.50\u0026ndash;1.72]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation (Ref: Farmer)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay labour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.54 [0.38\u0026ndash;0.75]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.62 [0.38\u0026ndash;0.99]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness/self-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.81 [0.47\u0026ndash;1.41]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.456\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.74 [0.38\u0026ndash;1.45]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.374\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.22 [1.52\u0026ndash;3.25]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.48 [0.80\u0026ndash;2.74]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisplacement Status (Ref: Currently)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreviously displaced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.33 [0.81\u0026ndash;2.19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.85 [0.47\u0026ndash;1.55]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.600\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot displaced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.11 [0.69\u0026ndash;1.80]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.64 [0.33\u0026ndash;1.21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDisplacement Duration (Ref: \u0026lt;1\u0026nbsp;year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.56 [1.11\u0026ndash;2.19]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.34 [0.89\u0026ndash;2.01]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.168\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOver 2 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.48 [1.09\u0026ndash;2.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.24 [0.73\u0026ndash;2.10]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrigin Region (Ref: Southwest)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHirshabelle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.07 [1.38\u0026ndash;3.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.11 [1.35\u0026ndash;3.32]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGalmudug\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.68 [0.43\u0026ndash;1.09]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.110\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.78 [0.45\u0026ndash;1.36]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePuntland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.25 [0.62\u0026ndash;2.50]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.530\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.28 [0.58\u0026ndash;2.82]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.536\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJubaland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.87 [0.51\u0026ndash;1.48]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.30 [0.72\u0026ndash;2.36]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSomaliland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.30 [2.00\u0026ndash;9.27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.02 [2.17\u0026ndash;11.57]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.06 [1.44\u0026ndash;2.96]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.86 [1.73\u0026ndash;4.73]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving Conditions (Ref: Very poor)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.25 [0.16\u0026ndash;0.40]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.36 [0.22\u0026ndash;0.59]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAdequate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.10 [0.66\u0026ndash;1.83]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.07 [0.59\u0026ndash;1.92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.71 [0.45\u0026ndash;1.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.57 [0.32\u0026ndash;1.02]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVery good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.68 [0.32\u0026ndash;8.78]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.15 [0.28\u0026ndash;16.23]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.460\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBelief in Climate Change (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.71 [1.99\u0026ndash;3.70]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.75 [1.20\u0026ndash;2.56]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClimate Change \u0026amp; Displacement (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.36 [1.77\u0026ndash;3.15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.72 [1.22\u0026ndash;2.43]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClimate Change \u0026amp; Conflict (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.24 [1.66\u0026ndash;3.02]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.25 [0.86\u0026ndash;1.80]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHarmful Behaviors Inc. (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.69 [0.53\u0026ndash;0.92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.69 [0.48\u0026ndash;0.99]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Relations Difficulty (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.47 [1.12\u0026ndash;1.93]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.01 [0.74\u0026ndash;1.37]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.950\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrustration (Loss of Places) (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.22 [1.51\u0026ndash;3.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.81 [1.16\u0026ndash;2.84]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeeling Detached (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.90 [0.64\u0026ndash;1.27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.04 [0.68\u0026ndash;1.59]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.851\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiminished Self-Worth (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.08 [0.83\u0026ndash;1.40]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.570\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.04 [0.76\u0026ndash;1.43]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.794\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrained Social Relations Stress (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.46 [1.12\u0026ndash;1.89]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.23 [0.90\u0026ndash;1.69]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOngoing Conflict \u0026amp; Mental Health (Ref: No)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.65 [0.49\u0026ndash;0.86]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.77 [0.52\u0026ndash;1.14]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.195\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Support Avail. (Ref: Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.22 [0.14\u0026ndash;0.37]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.35 [0.19\u0026ndash;0.62]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGovt. Support Enough (Ref: Yes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.07 [0.04\u0026ndash;0.11]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.12 [0.07\u0026ndash;0.21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCause of Displacement (Ref: Drought)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConflict\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.19 [0.88\u0026ndash;1.60]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.78 [0.54\u0026ndash;1.13]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.56 [1.08\u0026ndash;2.24]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.72 [0.42\u0026ndash;1.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.257\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLivelihood Loss (Ref: Farming)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLivestock\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.36 [1.00\u0026ndash;1.86]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.79 [1.18\u0026ndash;2.70]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHerding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.59 [0.84\u0026ndash;3.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.86 [0.90\u0026ndash;3.84]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.095\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFishing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.51 [0.77\u0026ndash;2.96]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.79 [0.77\u0026ndash;4.16]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.177\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBusiness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.51 [1.48\u0026ndash;8.36]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.85 [1.32\u0026ndash;11.21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.03 [1.38\u0026ndash;3.00]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.25 [0.66\u0026ndash;2.36]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.498\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\u003ecOR: Crude Odds Ratio from individual survey logistic regressions. aOR: Adjusted Odds Ratio from multivariable survey logistic regression including all listed variables. CI: Confidence Interval. Significant associations (P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) are bolded.\u003c/p\u003e\u003cp\u003eRegion of origin was a major determinant: IDPs from Hirshabelle (AOR\u0026thinsp;=\u0026thinsp;2.11, 95% CI: 1.35\u0026ndash;3.32) and Somaliland (AOR\u0026thinsp;=\u0026thinsp;5.02, 95% CI: 2.17\u0026ndash;11.57) had higher odds of PTSS, reflecting regional differences in conflict and resource access, echoing the evidence that regional variations in conflict dynamics, access to resources, and displacement conditions within a single country can differentially shape mental health outcome (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study reveals a substantial burden of post-traumatic stress symptoms (PTSS) among internally displaced persons (IDPs) in Somalia, a country simultaneously facing protracted conflict and escalating climate shocks. More than half of respondents reported moderate PTSS (55.1%), while 14.1% reported high-severity symptoms. Key predictors included geographic origin, livelihood loss (business and livestock), and perceptions linking climate change to displacement. Conversely, protective factors included female gender, engagement in day labor, better socioeconomic status, and perceived community and government support. These findings emphasize the intertwined nature of climate change, displacement, and mental health in fragile and conflict-affected settings. Our findings align with global evidence showing that climate-related hazards exacerbate psychological morbidity, particularly among vulnerable populations such as IDPs and refugees. In climate-conflict hotspots like Darfur, South Sudan, and Afghanistan, PTSD prevalence among displaced populations ranges between 40\u0026ndash;60%, reflecting exposure to cumulative trauma, forced migration, and livelihood insecurity (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Similarly, displacement linked to environmental degradation and extreme weather in Bangladesh and the Philippines has been shown to elevate mental health risks, underscoring the global scale of climate-related psychological impacts (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our study, belief in climate change and its attribution to displacement were independently associated with PTSS. This aligns with research from Australia, Pakistan, and the United States showing that perceived climate threats, even in the absence of direct disaster exposure, are linked to heightened psychological distress, eco-anxiety, and trauma-related symptoms (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This phenomenon reflects the growing recognition of climate change indeed amplifies existing social and psychological vulnerabilities. Geographic origin was among the strongest predictors of PTSS. Respondents displaced from Somaliland and Hirshabelle exhibited markedly higher odds of severe symptoms compared to those from Southwest State. This reflects the complex layering of climate shocks and insecurity, where differential access to resources, displacement dynamics, and security conditions shape mental health outcomes (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Loss of livelihoods, particularly business and livestock, was also strongly associated with PTSS. Similar findings have been documented in drought-affected rural communities in Kenya and Ethiopia,which is the concept of ecological grief, referring to mourning of lost environments, livelihoods, or cultural identity due to climate change with intimate linkage to economic insecurity, and psychological distress (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAn unexpected finding was the protective association between female gender and PTSS. While women are often more vulnerable to gender-based violence and mental distress in conflict zones (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our findings mirror other Somali studies suggesting that women may demonstrate stronger coping networks and adaptive resilience within displacement settings (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Cultural norms around collective caregiving and social cohesion may explain this trend, though further qualitative work is needed. Day laborers showed lower PTSS severity compared to farmers, suggesting that flexible, cash-based livelihoods may buffer psychological stress by offering agency and reducing reliance on climate-sensitive farming. Better socioeconomic status was also protective, aligning with evidence that economic stability mitigates climate-related psychological distress in LMICs. Perceptions of inadequate government and community support were also inversely associated with PTSS. This counterintuitive finding may reflect low institutional trust, where expectations are already minimal, leading individuals to rely more on informal coping networks, as has been observed in other fragile contexts.\u003c/p\u003e\u003cp\u003eThis study highlights the urgent need to position mental health as a core component of climate adaptation and humanitarian response in fragile states. Evidence from Uganda and Ethiopia shows that integrating psychosocial support into displacement response frameworks can improve mental health outcomes and resilience(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). For Somalia, this entails scaling up community-based mental health services integrated within climate resilience and embedding psychosocial components into disaster preparedness, climate adaptation planning, and strengthening informal and community-led support systems, particularly where institutional trust is low. The strength of our study is that it contributes empirical evidence from one of the world\u0026rsquo;s most climate-vulnerable and conflict-affected settings, drawing on a large sample of IDPs and validated tools such as the Harvard Trauma Questionnaire.To our knowledge, it is among the first studies to examine the intersection of climate-related displacement, livelihood loss, and mental health in Somalia. However, limitations include its cross-sectional design, which precludes causal inference, potential self-reporting bias, particularly on sensitive behavioral indicators, and the absence of objective environmental exposure data. Longitudinal studies incorporating geospatial climate exposure and mental health trajectories could strengthen causal pathways.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eClimate change acts as a force multiplier in fragile states, intensifying displacement, disrupting livelihoods, and exacerbating psychosocial distress. This study provides evidence of a strong relationship between climate-related displacement and PTSS among Somali IDPs, consistent with findings from other climate\u0026ndash;conflict hotspots worldwide. Addressing this challenge requires integrated, context-specific approaches that combine mental health and psychosocial support with climate resilience and humanitarian programming. Strengthening Somalia\u0026rsquo;s mental health response should be viewed not as an adjunct but as an essential pillar of climate adaptation, disaster risk reduction, and peacebuilding.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePTSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePost-Traumatic Stress Disorder\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIDPs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInternally Displaced Persons\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUNICEF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Nations International Children's Emergency Fund\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHTQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHarvard Trauma Questionnaire\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVIF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVariance Inflation Factor\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSM\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiagnostic and Statistical Manual of Mental Disorders\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIPCC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntergovernmental Panel on Climate Change\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eFunding is not available for this submission\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003cp\u003eThis study received ethical approval from ethics review board (EBR), Somali National University (JUS/KCC\u0026amp;CT/215/2025). All participants were provided informed consent prior to data collection, and participation was entirely voluntary, and confidentiality upheld. It followed the 1964 Helsinki Declaration, prioritizing human dignity, safeguarding displaced and conflict-affected individuals, and promoting wellbeing while minimizing risks throughout the research process.\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. Abdolahi Mohamed Adawe conceptualized the study and led the overall research design. Mohamed Abdirahim Omar and Gallad D. Hassan contributed to the statistical analysis and managed the software tools used in data processing. Omar Abdihamid thoroughly revised the manuscript and provided critical feedback throughout the writing process. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used in this study can be obtained from the corresponding author upon a reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLawrance EL, Thompson R, Le Vay N, Page J, L., Jennings N. The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications. 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BMC Psychiatry. 2024;24(1):117.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAhmed AA, Ali AA, Yousuf Duale AS, Yousuf AM, Muse AH. Climate change, socioeconomic, environmental, and political drivers of road traffic fatalities in Somalia: a multivariate time series analysis. Front Clim. 2025;Volume 7\u0026ndash;2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMomeni R, Bircan T, King R, Santos EZ. Deciphering climate-induced displacement in Somalia: A remote sensing perspective. PLoS ONE. 2024;19(8):e0304202.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOh W, Muneepeerakul R, Rubenstein D, Levin S. Emergent network patterns of internal displacement in Somalia driven by natural disasters and conflicts. Glob Environ Change. 2024;84:102793.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinko AE. 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Prevalence of Post-Traumatic Stress Disorder and Associated Factors Among Internally Displaced Persons (IDPS) In Mogadishu Cross-Sectional Study. Psychol Res Behav Manag. 2025;18:183\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMusa SA, Hamid A. The impact of Sudan armed conflict and coping strategies on the mental health of the older adult internally displaced persons in Darfur camps. BMC Psychol. 2025;13(1):97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMufti KA, Naeem F, Chaudry HR, Haroon A, Saifi F, Qureshi SM, et al. Post-traumatic stress disorder among Afghan refugees following war. Int Psychiatry. 2007;4(1):7\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahman MM, Shobuj IA, Alam S, Sadia AM, Khanam S, Hossain MT, et al. The unforeseen tide: exploring mental health impacts of the 2024 flash flood in Bangladesh. BMC Public Health. 2025;25(1):2728.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCianconi P, Betr\u0026ograve; S, Janiri L. The Impact of Climate Change on Mental Health: A Systematic Descriptive Review. Front Psychiatry. 2020;11:74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWhite BP, Breakey S, Brown MJ, Smith JR, Tarbet A, Nicholas PK, et al. Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review. Ann Glob Health. 2023;89(1):66.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKagunda J, Hasham A, Logie CH, Evelia H, Gachoki C, Omondi B, et al. Climate change and resource insecurity-related mental health stressors among young adolescents in Kenya: Qualitative multi-method insights. Glob Ment Health (Camb). 2025;12:e105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWahid SS, Musyimi C, Oestericher B, Khakali L, Carruth L, Mendenhall E, et al. Ecological grief among farmers and pastoralists in Ethiopia and Kenya. SSM - Mental Health. 2025;7:100456.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuza M, Warner J, Pacillo G, Laderach P, Dijk H. Women's Vulnerabilities to Climate Insecurity and Violence: Household-Level Evidence From Bangladesh. Rural Sociol. 2025;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNguyen AJ, Lasater ME, Lee C, Mallawaarachchi IV, Joshua K, Bassett L, et al. Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. J Migration Health. 2023;7:100168.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Climate change, conflicts, mental health, displaced population, Somalia","lastPublishedDoi":"10.21203/rs.3.rs-7991815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7991815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Climate change, exacerbated by prolonged insecurity, profoundly impacts the mental health of vulnerable populations, particularly internally displaced persons (IDPs). This study aimed to investigate the prevalence and associated factors of post-traumatic stress symptoms (PTSS) among IDPs in Somalia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u003c/strong\u003e A cross-sectional design was employed with 852 IDPs residing in the Banadir region of Somalia. The modified Harvard Trauma Questionnaire (HTQ) was used to assess PTSS. Multivariable ordered logistic regression was then utilized to identify factors associated with PTSS severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A substantial burden of PTSS was identified, with 55.1% of IDPs reporting moderate and 14.1% reporting high symptom severity. Factors significantly increasing the odds of PTSS included displacement from Hirshabelle (AOR = 2.11, 95% CI: 1.35–3.32) and Somaliland (AOR = 5.02, 95% CI: 2.17–11.57), a belief in climate change (AOR = 1.75, 95% CI: 1.20–2.56), perceiving climate change as the cause of displacement (AOR = 1.72, 95% CI: 1.22–2.43), frustration due to loss of places (AOR = 1.81, 95% CI: 1.16–2.84), and specific livelihood losses such as livestock (AOR = 1.79, 95% CI: 1.18–2.70) and business (AOR = 3.85, 95% CI: 1.32–11.21). Conversely, protective factors included being female (AOR = 0.71, 95% CI: 0.53–0.96), engagement in day labor (AOR = 0.62, 95% CI: 0.38–0.99), relatively better living conditions (poor vs. very poor; AOR = 0.36, 95% CI: 0.22–0.59), and critically, both community (AOR = 0.35, 95% CI: 0.19–0.62) and government support (AOR = 0.12, 95% CI: 0.07–0.21). Unexpectedly, self-reported harmful behaviors were associated with lower odds of PTSS (AOR = 0.69, 95% CI: 0.48–0.99).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study provides evidence of a strong relationship between climate-related displacement and PTSS among Somali IDPs, consistent with findings from other climate–conflict hotspots worldwide. Addressing this challenge requires integrated, context-specific approaches that combine mental health and psychosocial support with climate resilience and humanitarian programming. Strengthening Somalia’s mental health response should be viewed not as an adjunct but as an essential pillar of climate adaptation, disaster risk reduction, and peacebuilding.\u003c/p\u003e","manuscriptTitle":"Climate Change, Displacement, and Mental Health: Insights from Conflict-Affected Communities in Somalia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 11:41:27","doi":"10.21203/rs.3.rs-7991815/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-03T11:01:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-03T07:20:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-03T07:19:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-10-30T17:48:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f67a54d-c5d9-4041-a9d6-1ab91d7bd970","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-12T16:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-03 11:41:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7991815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7991815","identity":"rs-7991815","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}