Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: Prevalence and risk factors

Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: Prevalence and risk factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: Prevalence and risk factors Omar Gammoh, Saleh Bazi, Ruba Al Akash, Bilal Sayaheen, Mervat Alsous, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5149651/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract The present study sought to examine the prevalence and correlates of depression, PTSD, and insomnia in a cohort of Palestinian refugees residing in camps located in Jordan during the outbreak of the War on Gaza on Oct.7th .This is a cross-sectional cohort study that employed the convenient sampling method to recruit Palestinian refugees residing in Irbid and Azmi Almufti camps for Palestinian refugees. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. The self-reported PTSD symptoms were evaluated using the brief PTSD scale, and insomnia severity was assessed using the Insomnia Severity Index -Arabic scale (ISI-A). The data analysis from 258 participants showed that severe depression was reported in 178 participants (69%). Additionally, 127 participants (49.2%) reported severe PTSD symptoms, and 156 participants (60.5%) reported severe insomnia symptoms. Regression analysis revealed that “Residents of Azmi Almufti camp” was a significant risk factor for severe depression (OR = 2.22, 95% 1.28–3.85, p = 0.004) and severe PTSD (OR = 1.81, 95% CI = 1.10–2.99, p = 0.02). The use of over-the-counter antihistamines as a sleep aid was a risk factor for severe insomnia (OR = 3.19, 95%CI = 1.17–8.71, p = 0.02) and PTSD (OR = 3.32, 95% CI = 1.34–8.21, p = 0.01). The conflict in Gaza has been observed to correlate with mental health challenges, particularly among Palestinian refugees residing in Jordan. War Gaza mental health refugees Introduction The existence of Palestinian refugees in Jordan is mainly linked to two major dates: 1948 and 1967. In 1948, a war erupted between Israel and the Arabs, resulting in the occupation of almost 77% of Palestinian land by Israel. This catastrophe is known in the Arab world as the Nakba. In 1967, another war erupted between Israel and the Arabs known as Al Naksa, ending with the occupation of new territories including, the Gaza Strip, Sinai Peninsula, the West Bank, and the Golan Heights. Besides the suffering and oppression of Palestinians that resulted from the two defeats, hundreds of thousands were forced to flee their homeland for neighboring countries such as, Lebanon, Syria and Jordan. The number of Palestinian refugee camps in Jordan is 10 official camps recognized by UNRWA (United Nations Relief and Works Agency), and 3 unofficial camps, namely the Prince Hassan Camp, the Madaba Camp, and the Sahab Camp. Palestinians residing in refugee camps are fragile economically and health wise, specifically those who reside in Azmi AlMofti Refugee Camp in Irbid. Moreover, The 35,000 Palestinian refugees residing in Azmi AlMofti Refugee Camp are confronting challenging conditions related to housing, education, humanitarian assistance, healthcare, and social welfare [ 1 – 3 ]. Mental health distress is known to be triggered or exacerbated by continuous exposure to horrific war scenes such as killing civilians, including women and children and bombarding houses, and hospitals [ 4 ]. The adverse impact on mental health stemming from exposure to certain content on social media and other communication resources primarily manifests as depression, post-traumatic stress disorder (PTSD), and insomnia. [ 5 , 6 ]. Although continuous studies are highlighting the mental health challenges faced by Palestinians living in their homeland under occupation [ 7 , 8 ], less evidence has examined the mental health status of the Palestinians residing in refugee camps in Jordan. According to the estimates, about 370,000 Palestinians live in refugee camps distributed in various Jordanian districts. This population is highly vulnerable to mental health distress due to the ongoing armed conflict in Palestine, their homeland, poverty, unemployment, and the challenging environment in their camps [ 9 ]. Therefore, the present study sought to examine the prevalence and correlates of depression, PTSD, and insomnia in a cohort of Palestinian refugees residing in camps located in Jordan, namely Irbid and Azmi Almufti camp located in Irbid, 80 kilometers north of Amman, the capital, during the outbreak of the War on Gaza on October 7th . Material and methods Study design and settings This is a cross-sectional cohort study that employed the convenient sampling method to recruit Palestinian refugees residing in Irbid and Azmi Almufti camps. The study participants were enlisted through on-site visits. All procedures adhered to the principles outlined in the Declaration of Helsinki, and the research protocol was approved by XXXX University IRB committee. The research team communicated the study's objectives to potential participants through in-person interviews. Those who chose to participate were invited to sign a consent form; they retained the autonomy to discontinue their involvement at any stage. Data collection occurred in January 2024. A statistical G power calculation for logistic regression determined that a minimum of 250 participants were necessary for the study. Study instrument The study instrument consisted of the covariates part and the outcome variable part. The covariate part comprised demographics and social media interaction concerning the war on Gaza. The outcome variables assessed were PTSD, depression, and insomnia symptoms. Covariates This section crafted structured inquiries aimed at gathering demographic information from participants. Specifically, participants were asked to provide details regarding their age, gender, marital status, employment status, highest level of education attained, smoking habits, presence of chronic illnesses, and use of chronic medications. Participants were asked whether they have relatives or friends residing in Gaza and how they overcome their sleeping problem by using over-the-counter (OTC) sedating antihistamines as sleep aids or household homeopathic relaxing remedies. Additionally, participants were asked about the frequency with which they share news related to the Gaza war and their opinions on temporarily abstaining from social media interactions to mitigate potential mental health impacts. Outcome variables Depression symptoms The self-reported depressive symptoms were assessed through the Patient Health Quality-9 scale (PHQ-9) Arabic version. This validated scale provides a comprehensive capture of depression symptoms through nine questions rated against Likert-type answers. A score above 14 indicates severe depression. [ 10 , 11 ] Post-Traumatic Stress Disorder Symptoms The self-reported PTSD symptoms were evaluated using the brief PTSD scale originally developed by Foa et al. 1993, translated to Arabic, and validated by [ 12 ] with a Cronbach alpha of 0.79. The scale consists of 17 questions to capture PTSD symptoms according to the DSM-IV guidelines. A score above 25 on this scale reflects severe PTSD symptoms. Insomnia Symptoms The assessment of the self-reported insomnia burden was conducted through the Insomnia Severity Index Arabic version (ISI-A). This validated and reliable scale (Cronbach alpha = 0.81) comprises 7 questions that explore sleep quality for the past week, with a total score range between 0 and 28. A score exceeding 14 indicates severe insomnia. [ 13 , 14 ] Data analysis Data were analyzed using SPSS software version 21. The demographic information of the participants was expressed as frequencies and percentages. Three outcome variables (dependent variables) were found in the study: depression, PTSD, and insomnia. Therefore, three distinct binary regression analyses were carried out. Initially, to identify the potential confounders, a univariate analysis was performed to identify the potential confounders showing p < 0.1, which were used to feed the multivariable binary regression model using the backward stepwise approach to identify which factors are independently associated with each of the outcome variables. A p-value of less than 0.05 was considered to be statistically significant. Results Participants characteristics The data analysis from 258 participants showed that 166 (64.3%) were males, 173 (67%) were aged above 26 years, 137(53%) were married, 133 (51.5%) were residents of Irbid camp, 160 (62.01%) were employed, 83 (31.9%) reported having relatives or friends in Gaza, 45 (17.44%) reported losing a family member or a friend in Gaza, 29 (11.2%) reported using self-medication with OTC sedating antihistamine to improve sleep, and 16 (6.2%) reported using self-medication with herbal homeopathy to improve sleep. Table 1 . Table 1 The demographical information of the study sample (n = 258) Factor Category (n; %) Gender Male (166; 64.3%) Female (92; 35.7%) Age Below 26 years (85; 33%) 26 years & above (173; 67%) Marital Status Single (121; 47%) Married (137; 53%) Palestinians Camp location Irbid Camp (133; 51.5%) Maryr Azmi Al-Mufti Camp (125; 48.5%) Employment Status Unemployed (98; 37.9%) Employed (160; 62.01%) Smoking Non-smoking (124; 48.1%) Smoking (134; 51.9%) Relative and Friends in Gaza Yes, I have (83; 31.9%) No, I don’t have (175; 68.1%) Was one of your relatives or acquaintances martyred in Gaza in the current aggression? Yes (45; 17.44%) No (188; 72.87%) I lost communication (25; 9.69%) How are you trying to overcome your current sleep problem? I don't have a problem sleeping. Self-medication with OTC sedating antihistamine to improve my sleep (29; 11.2%) Self- medication with herbal homeopathy to improve my sleep (16; 6.2%) Diagnosed with chronic diseases No (217;84.1%) Yes (40; 15.5%) Receiving long-term medications No (208; 80.6%) Yes (45; 17.4%) How often do you post content (e.g., status updates, photos, videos) to your social media accounts? Several times a day daily (75; 29.07%) 2–3 times a week (47; 18.2%) Once a week (27; 10.5%) Rarely (108; 42.24%) Have you ever taken a break or deactivated your social media accounts due to concerns about your health or safety? Yes (89; 34.5%) No (169; 65.5%) Depression: prevalence and correlates The severity of depression was assessed through the PHQ-9 scale Arabic version, participants scoring 15 and above were considered severely depressed. Therefore, our analysis revealed that 178 participants (69%) reported severe depression. To identify the factors that could be potentially associated with severe depression, a univariate analysis was conducted. The potential confounders: “age”, “marital status”, resident of Azmi Almufti camp”, “employment”, “using OTC antihistamines as a sleep aid”; and long-term medications were identified and used to feed the subsequent multivariable model, which was performed using the backward stepwise model. The multivariable model finally included “resident of Azmi Almufti camp” as a significant risk factor for severe depression (OR = 2.22, 95% 1.28–3.85, p = 0.004). Table 2 Table 2 The association between the participants’ covariates and severe depression (according to the PHQ-9 scale) using univariate and multivariable analysis. Factor Univariate analysis Multivariable analysis OR 95% CI p OR 95% CI p Gender 0.89 0.52–1.54 0.68 Age 1.57 0.91–2.72 0.10 Marital Status 1.72 1.01–2.94 0.04* Azmi Almufti Camp residents 2.22 1.28–3.84 0.004* 2.22 1.28–3.84 0.004 Employment Status 1.78 1.04–3.04 0.04* Smoking 1.49 0.88–2.54 0.13 Relative and Friends in Gaza 0.86 0.49–1.53 0.61 How often do you post content (e.g., status updates, photos, videos) to your social media accounts? 0.86 0.69–1.05 0.14 Have you ever taken a break or deactivated your social media accounts due to concerns about your health or safety? 1.04 0.74–1.49 0.80 Self-medication with OTC sedating antihistamine to improve my sleep 2.82 0.94–8.44 0.06 Self- medication with herbal homeopathy to improve my sleep 3.07 0.67–13.95 0.14 Diagnosed with chronic diseases 1.68 0.75–3.71 0.20 Receiving long-term medications 2.17 0.98–4.82 0.05 PTSD: prevalence and correlates We used the Arabic-validated Scale [ 12 ] for assessing the self-reported PTSD symptoms with a cut-off score above 25 for severe PTSD symptoms. We report that 127 participants (49.2%) reported severe PTSD symptoms. The univariate analysis was carried out to identify the potential confounders of severe PTSD. We report that “smoking”, “Resident of Azmi Almufti camp”, “posting the war news on social media”, and “using OTC antihistamines as a sleep aid” were regarded as potential confounders and were further used to build the multivariable binary logistic regression model as above. The multivariable model finally included “Resident of Azmi Almufti camp”, and “using OTC antihistamines as a sleep aid” as significant risk factors for severe PTSD (OR = 1.81, 95% CI = 1.10–2.99, p = 0.02) and (OR = 3.32, 95% CI = 1.34–8.21, p = 0.01) respectively. Table 3 . Table 3 The association between the participants’ covariates and severe PTSD (according to the Foa scale) using univariate and multivariable analysis. Factor Univariate analysis Multivariable analysis OR 95% CI p aOR 95% CI p Gender 0.98 0.59–1.63 0.94 Age 1.41 0.83–2.37 0.20 Marital Status 1.33 0.81–2.17 0.26 Azmi Almufti Camp residents 1.81 1.1–2.96 0.01* 1.81 1.10–2.99 0.02* Employment Status 1.16 0.70–1.92 0.57 Smoking 1.76 1.07–2.88 0.02* Relative and Friends in Gaza 0.80 0.47–1.35 0.40 How often do you post content (e.g., status updates, photos, videos) to your social media accounts? 0.83 0.68-1.00 0.05 Have you ever taken a break or deactivated your social media accounts due to concerns about your health or safety? 0.82 0.59–1.14 0.25 Self-medication with OTC sedating antihistamines to improve my sleep 3.31 1.35–8.13 0.009* 3.32 1.34–8.21 0.01* Self- medication with herbal homeopathy to improve my sleep 2.15 0.71–6.48 0.17 Diagnosed with chronic diseases 0.81 0.41–1.59 0.54 Receiving long-term medications 1.03 0.54–1.96 0.91 Insomnia: prevalence and correlates Insomnia was assessed using the ISI-A scale, with a threshold score above 14 used to screen for severe insomnia symptoms. A total of 156 participants (60.5%) reported severe insomnia symptoms. The univariate analysis identified “receiving long-term medications for chronic diseases” and “using OTC antihistamines as a sleep aid” as potential confounders. The multivariable binary logistic regression showed that only using OTC antihistamines as a sleep aid” was a risk factor for severe insomnia (OR = 3.19, 95%CI = 1.17–8.71, p = 0.02). Table 4 . Table 4 The association between the participants’ covariates and severe insomnia (according to the ISI-A scale) using univariate and multivariable analysis. Factor Univariate analysis Multivariable analysis OR 95% CI p aOR 95% CI p Gender 1.18 0.70-2.00 0.52 Age 1.28 0.75–2.17 0.36 Marital Status 1.23 0.74–2.02 0.42 Azmi Almufti Camp residents 1.03 0.62–1.69 0.92 Employment Status 1.33 0.80–2.23 0.26 Smoking 1.13 0.69–1.87 0.61 Relative and Friends in Gaza 1.09 0.64–1.86 0.74 How often do you post content (e.g., status updates, photos, videos) to your social media accounts? 1.10 0.89–1.36 0.35 Have you ever taken a break or deactivated your social media accounts due to concerns about your health or safety? 1.01 0.72–1.41 0.94 Self-medication with OTC sedating antihistamines to improve my sleep 3.19 1.17–8.71 0.02* 3.19 1.17–8.71 0.02* Self- medication with herbal homeopathy to improve my sleep 1.86 0.57–6.01 0.30 Diagnosed with chronic diseases 1.65 0.79–3.24 0.17 Receiving long-term medications 1.72 0.86–3.44 0.10 Discussion The present study aimed to identify the prevalence and correlates of depression, PTSD, and insomnia as self-reported symptoms in a cohort of Palestinian refugees residing in Jordan during the outbreak of the War on Gaza. We report a high rate of all the above-mentioned symptoms. Also, our findings revealed that the residents of Azmi Almufti camp were at higher risk for severe depression and PTSD symptoms. In addition, using sedating antihistamines as a sleep aid was associated with severe PTSD and insomnia symptoms. This huge burden of depression and PTSD in the study sample is attributed to multifactorial, interrelated, and complicated factors, a nexus worth exploring. Our findings demonstrated that the refugees residing in Azmi Almufti camp were more prone to severe depression and PTSD. Exploring mental health status in this population is faced with social and cultural barriers [ 9 ]. Poor living conditions, poverty, and a lack of jobs could explain, at least in part, this finding. According to published data dated back in 2011, Azmi Almufti camp is the second poorest camp with the highest rate of unemployability in general and in women reaching up to 18% in total and 25% for females [ 15 ]. Although no updates are yet available about the socio-economic status of the Azmi Almufti camp, however, the authors expect a more challenging situation due to the Syrian conflict that has led to Syrian refugees migration mainly to Irbid, thus posing additional restrains on Jordan, the hosting country. Poor mental health status encompasses the behavior of individuals to adopt negative behaviors, for example, in a cross-sectional study comprising more than 73000 Palestinians living in Jordan camps, depressive symptoms were associated with days of missing schools, the same study points out the high rates of depressive symptoms namely loneliness, suicidal ideation, and worry among adolescents [ 16 ]. The findings of this study highlighted that participants using OTC sedating antihistamines as a sleep aid were at higher risk for severe insomnia and PTSD symptoms. Self-medication with sedating antihistamines is a common practice in many populations due to its availability, safety, and affordability [ 17 ]. In addition, earlier, our research group demonstrated that OTC sedating antihistamines are the most recommended sleep aid by community pharmacists in Jordan [ 18 ]. Our findings can be explained as follows: participants experiencing severe insomnia and PTSD symptoms tend to use the “available” medications to alleviate their symptoms, conversely, these severe symptoms could be due to antihistamines, as they stimulate the Central Nervous System, which could result in difficulty sleeping or insomnia or users may take overdoses of antihistamines due to tolerance [ 19 ]. According to the literature, the clear benefits of sedating antihistamines have not been proven yet [ 20 , 21 ]. Similarly, antihistamines are ineffective in alleviating PTSD symptoms. Furthermore, they could exacerbate symptoms due to their complex pharmacological actions [ 22 ]. This is the first study, to the best our knowledge, that highlighted the prevalence and risk factors of depression, PTSD, and insomnia experienced by the Palestinian refugees residing in Jordan during the outbreak of the October7th war in their homeland in Palestine- Gaza. Although the current study has several strengths, including the unique sample type, the validated scales, and the sound data analysis performed, some limitations exist. For example, the study did not include a follow-up phase to monitor the changes in the mental health spectrum of the participants, also, the study did not provide a thorough psychiatric assessment by specialists in the camps due to social and cultural barriers to mental health. Conclusion In conclusion, the impact of the ongoing war on Gaza demonstrated to be associated with mental health distress outside the borders of Gaza. Palestinian refugees residing in Jordan for decades are highly affected mentally. Comprehensive and immediate actions are warranted to address the mental health and well-being of this vulnerable community by addressing the modifiable risk factors. Declarations Ethics Declaration: The protocol was approved by Yarmouk University IRB committee in accordance with the Declaration of Helsinki Acknowledgments : The first author would like to thank Sama, Suzi, Yasmina, and Nour. Competing interest: The authors declare no conflicts of interest Data availability statement: The data will be provided by the corresponding author upon request Authors contributions : 1) made substantial contributions to the conception (Omar Gammoh, Saleh Bazi) or design of the work (Omar Gammoh, Mervat Alsous); or the acquisition, analysis (Saleh Bazi, Ruba Al Akash), or interpretation of data (Bilal Sayaheen, and Mervat Alsous); 2) drafted the work or revised it critically for important intellectual content(Omar Gammoh, Bilal Sayaheen, and Mervat Alsous) 3) approved the version to be published Omar Gammoh, Saleh Bazi, Ruba Al Akash, Bilal Sayaheen, and Mervat Alsous 4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (Omar Gammoh). References Bocco R. UNRWA and the Palestinian refugees: a history within history. Refug Surv Q. 2009;28:229–52. Akram S. UNRWA and Palestinian refugees. Oxford Handb Refug forced Migr Stud. 2014; Irfan AE. Educating Palestinian refugees: The origins of UNRWA’s unique schooling system. J Refug Stud. 2021;34:1037–59. Greinacher A, Derezza-Greeven C, Herzog W, Nikendei C. Secondary traumatization in first responders: a systematic review. Eur J Psychotraumatol. 2019;10:1562840. Wiederhold BK. A legacy of trauma: how local conflicts can have global implications for mental health. Cyberpsychology, Behav. Soc. Netw. Mary Ann Liebert, Inc., publishers 140 Huguenot Street, 3rd Floor New~… p. 803–4. Mahamid FA, Berte DZ. Portrayals of violence and at-risk populations: Symptoms of trauma in adolescents with high utilization of social media. Int J Ment Health Addict. 2020;18:980–92. Haj-Yahia MM, Greenbaum CW, Lahoud-Shoufany L. Palestinian Adolescents’ Prolonged Exposure to Political Violence, Self- Esteem, and Post-Traumatic Stress Symptoms. J Interpers Violence. 2021;36:4137–64. Giacaman R, Rabaia Y, Nguyen-Gillham V, Batniji R, Punamäki R-L, Summerfield D. Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Glob Public Health. 2011;6:547–59. McKell C, Hankir A. Barriers to treatment of mental health problems for Palestinian people in refugee camps in Jordan: a cross-sectional study. Lancet [Internet]. 2018;391:S8. Available from: http://dx.doi.org/10.1016/S0140-6736(18)30333-7 AlHadi AN, AlAteeq DA, Al-Sharif E, Bawazeer HM, Alanazi H, AlShomrani AT, et al. An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample. Ann Gen Psychiatry. 2017;16:1–9. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. 46202:606–13. Wadaa NN. Secondary Traumatic Stress Symptoms in Military Parents of Iraqi Army. Mustansiriyah J Arts. 2016;39. Morin C. Insomnia: Psychological assessment and management. [Internet]. 1993 [cited 2019 Nov 2]. Available from: https://psycnet.apa.org/record/1993-98362-000 Suleiman KH, Yates BC. Translating the insomnia severity index into Arabic. J Nurs Scholarsh. 2011;43:49–53. Zhang ÅAT and H. The socio-economic conditions of Jordan ’ s Palestinian camp refugees. 2011. Nathani K, Lee WC, Taha S, Horino M, Seita A, Serag H. The Association Between Mental Well-Being and School Attendance Among Palestinian Adolescent Refugees in UNRWA Schools. J Child Adolesc Trauma [Internet]. 2023;16:339–50. Available from: https://doi.org/10.1007/s40653-022-00460-7 Farzam K, Sabir S, O’Rourke MC. Antihistamines. 2019; Gammoh OS, Al-Smadi A, Turjman C, Mukattash T, Kdour M. Valerian: An underestimated anxiolytic in the community pharmacy? J Herb Med [Internet]. 2016;6:193–7. Available from: http://dx.doi.org/10.1016/j.hermed.2016.09.001 Richardson GS, Roehrs TA, Rosenthal L, Koshorek G, Roth T. Tolerance to daytime sedative effects of H1 antihistamines. J Clin Psychopharmacol. 2002;22:511–5. Culpepper L, Wingertzahn MA. Over-the-counter agents for the treatment of occasional disturbed sleep or transient insomnia: a systematic review of efficacy and safety. Prim care companion CNS Disord. 2015;17:26162. Vande Griend JP, Anderson SL. Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc [Internet]. 2012;52:e210–9. Available from: http://dx.doi.org/10.1331/JAPhA.2012.12051 Shiromani PJ, Keane TM, Ledoux J. Post-traumatic stress disorder: Basic science and clinical practice. Post-Traumatic Stress Disord Basic Sci Clin Pract. 2009;1–409. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 19 Nov, 2024 Reviews received at journal 12 Nov, 2024 Reviewers agreed at journal 08 Nov, 2024 Reviews received at journal 04 Nov, 2024 Reviewers agreed at journal 31 Oct, 2024 Reviewers agreed at journal 30 Oct, 2024 Reviewers invited by journal 21 Oct, 2024 Editor assigned by journal 16 Oct, 2024 Submission checks completed at journal 07 Oct, 2024 First submitted to journal 25 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5149651","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379812855,"identity":"cb25202d-16b4-42d1-b1cd-8e6ede08026a","order_by":0,"name":"Omar Gammoh","email":"","orcid":"","institution":"Yarmouk University Shafiq Irshidat Str","correspondingAuthor":false,"prefix":"","firstName":"Omar","middleName":"","lastName":"Gammoh","suffix":""},{"id":379812856,"identity":"ce201254-c8bf-4d1f-9e4c-d6122479d432","order_by":1,"name":"Saleh Bazi","email":"","orcid":"","institution":"Yarmouk University Shafiq Irshidat Str","correspondingAuthor":false,"prefix":"","firstName":"Saleh","middleName":"","lastName":"Bazi","suffix":""},{"id":379812857,"identity":"15268238-11cc-48c8-af2e-a054f4ed6f94","order_by":2,"name":"Ruba Al Akash","email":"","orcid":"","institution":"Yarmouk University Shafiq Irshidat Str","correspondingAuthor":false,"prefix":"","firstName":"Ruba","middleName":"Al","lastName":"Akash","suffix":""},{"id":379812858,"identity":"1bcc0b60-0ec3-44c0-90c4-a2bc19c352ab","order_by":3,"name":"Bilal Sayaheen","email":"","orcid":"","institution":"Yarmouk University Shafiq Irshidat Str","correspondingAuthor":false,"prefix":"","firstName":"Bilal","middleName":"","lastName":"Sayaheen","suffix":""},{"id":379812863,"identity":"6c739389-e5bf-413d-a0a5-99f3e88621ba","order_by":4,"name":"Mervat Alsous","email":"","orcid":"","institution":"Yarmouk University Shafiq Irshidat Str","correspondingAuthor":false,"prefix":"","firstName":"Mervat","middleName":"","lastName":"Alsous","suffix":""},{"id":379812865,"identity":"cc8140fa-72f6-4b5b-a4e7-3f6f10954db9","order_by":5,"name":"Albara Alomari","email":"data:image/png;base64,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","orcid":"","institution":"University of Doha for Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"Albara","middleName":"","lastName":"Alomari","suffix":""}],"badges":[],"createdAt":"2024-09-25 07:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5149651/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5149651/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":69771286,"identity":"c0d5b4b7-2a5f-45f3-a23b-cef45d31f848","added_by":"auto","created_at":"2024-11-25 06:39:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":703121,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5149651/v1/8d00a79c-2009-4a7b-809e-413c3fc8d720.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: Prevalence and risk factors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe existence of Palestinian refugees in Jordan is mainly linked to two major dates: 1948 and 1967. In 1948, a war erupted between Israel and the Arabs, resulting in the occupation of almost 77% of Palestinian land by Israel. This catastrophe is known in the Arab world as the Nakba. In 1967, another war erupted between Israel and the Arabs known as Al Naksa, ending with the occupation of new territories including, the Gaza Strip, Sinai Peninsula, the West Bank, and the Golan Heights. Besides the suffering and oppression of Palestinians that resulted from the two defeats, hundreds of thousands were forced to flee their homeland for neighboring countries such as, Lebanon, Syria and Jordan. The number of Palestinian refugee camps in Jordan is 10 official camps recognized by UNRWA (United Nations Relief and Works Agency), and 3 unofficial camps, namely the Prince Hassan Camp, the Madaba Camp, and the Sahab Camp. Palestinians residing in refugee camps are fragile economically and health wise, specifically those who reside in Azmi AlMofti Refugee Camp in Irbid. Moreover, The 35,000 Palestinian refugees residing in Azmi AlMofti Refugee Camp are confronting challenging conditions related to housing, education, humanitarian assistance, healthcare, and social welfare [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMental health distress is known to be triggered or exacerbated by continuous exposure to horrific war scenes such as killing civilians, including women and children and bombarding houses, and hospitals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The adverse impact on mental health stemming from exposure to certain content on social media and other communication resources primarily manifests as depression, post-traumatic stress disorder (PTSD), and insomnia. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough continuous studies are highlighting the mental health challenges faced by Palestinians living in their homeland under occupation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], less evidence has examined the mental health status of the Palestinians residing in refugee camps in Jordan. According to the estimates, about 370,000 Palestinians live in refugee camps distributed in various Jordanian districts. This population is highly vulnerable to mental health distress due to the ongoing armed conflict in Palestine, their homeland, poverty, unemployment, and the challenging environment in their camps [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, the present study sought to examine the prevalence and correlates of depression, PTSD, and insomnia in a cohort of Palestinian refugees residing in camps located in Jordan, namely Irbid and Azmi Almufti camp located in Irbid, 80 kilometers north of Amman, the capital, during the outbreak of the War on Gaza on October 7th .\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and settings\u003c/h2\u003e \u003cp\u003eThis is a cross-sectional cohort study that employed the convenient sampling method to recruit Palestinian refugees residing in Irbid and Azmi Almufti camps.\u003c/p\u003e \u003cp\u003eThe study participants were enlisted through on-site visits. All procedures adhered to the principles outlined in the Declaration of Helsinki, and the research protocol was approved by XXXX University IRB committee. The research team communicated the study's objectives to potential participants through in-person interviews. Those who chose to participate were invited to sign a consent form; they retained the autonomy to discontinue their involvement at any stage. Data collection occurred in January 2024. A statistical G power calculation for logistic regression determined that a minimum of 250 participants were necessary for the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy instrument\u003c/h3\u003e\n\u003cp\u003eThe study instrument consisted of the covariates part and the outcome variable part. The covariate part comprised demographics and social media interaction concerning the war on Gaza. The outcome variables assessed were PTSD, depression, and insomnia symptoms.\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eThis section crafted structured inquiries aimed at gathering demographic information from participants. Specifically, participants were asked to provide details regarding their age, gender, marital status, employment status, highest level of education attained, smoking habits, presence of chronic illnesses, and use of chronic medications. Participants were asked whether they have relatives or friends residing in Gaza and how they overcome their sleeping problem by using over-the-counter (OTC) sedating antihistamines as sleep aids or household homeopathic relaxing remedies. Additionally, participants were asked about the frequency with which they share news related to the Gaza war and their opinions on temporarily abstaining from social media interactions to mitigate potential mental health impacts.\u003c/p\u003e\n\u003ch3\u003eOutcome variables\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDepression symptoms\u003c/h2\u003e \u003cp\u003eThe self-reported depressive symptoms were assessed through the Patient Health Quality-9 scale (PHQ-9) Arabic version. This validated scale provides a comprehensive capture of depression symptoms through nine questions rated against Likert-type answers. A score above 14 indicates severe depression. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePost-Traumatic Stress Disorder Symptoms\u003c/h2\u003e \u003cp\u003eThe self-reported PTSD symptoms were evaluated using the brief PTSD scale originally developed by Foa et al. 1993, translated to Arabic, and validated by [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] with a Cronbach alpha of 0.79. The scale consists of 17 questions to capture PTSD symptoms according to the DSM-IV guidelines. A score above 25 on this scale reflects severe PTSD symptoms.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInsomnia Symptoms\u003c/h3\u003e\n\u003cp\u003eThe assessment of the self-reported insomnia burden was conducted through the Insomnia Severity Index Arabic version (ISI-A). This validated and reliable scale (Cronbach alpha\u0026thinsp;=\u0026thinsp;0.81) comprises 7 questions that explore sleep quality for the past week, with a total score range between 0 and 28. A score exceeding 14 indicates severe insomnia. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS software version 21. The demographic information of the participants was expressed as frequencies and percentages. Three outcome variables (dependent variables) were found in the study: depression, PTSD, and insomnia. Therefore, three distinct binary regression analyses were carried out. Initially, to identify the potential confounders, a univariate analysis was performed to identify the potential confounders showing p\u0026thinsp;\u0026lt;\u0026thinsp;0.1, which were used to feed the multivariable binary regression model using the backward stepwise approach to identify which factors are independently associated with each of the outcome variables. A p-value of less than 0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipants characteristics\u003c/h2\u003e \u003cp\u003eThe data analysis from 258 participants showed that 166 (64.3%) were males, 173 (67%) were aged above 26 years, 137(53%) were married, 133 (51.5%) were residents of Irbid camp, 160 (62.01%) were employed, 83 (31.9%) reported having relatives or friends in Gaza, 45 (17.44%) reported losing a family member or a friend in Gaza, 29 (11.2%) reported using self-medication with OTC sedating antihistamine to improve sleep, and 16 (6.2%) reported using self-medication with herbal homeopathy to improve sleep. 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\u003eThe demographical information of the study sample (n\u0026thinsp;=\u0026thinsp;258)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\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(n; %)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(166; 64.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(92; 35.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelow 26 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(85; 33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 years \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(173; 67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(121; 47%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(137; 53%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePalestinians Camp location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIrbid Camp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(133; 51.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaryr Azmi Al-Mufti Camp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(125; 48.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(98; 37.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(160; 62.01%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(124; 48.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(134; 51.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelative and Friends in Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes, I have\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(83; 31.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo, I don\u0026rsquo;t have\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(175; 68.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWas one of your relatives or acquaintances martyred in Gaza in the current aggression?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(45; 17.44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(188; 72.87%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI lost communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(25; 9.69%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHow are you trying to overcome your current sleep problem?\u003c/p\u003e \u003cp\u003eI don't have a problem sleeping.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-medication with OTC sedating antihistamine to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(29; 11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf- medication with herbal homeopathy to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(16; 6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiagnosed with chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(217;84.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(40; 15.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eReceiving long-term medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(208; 80.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(45; 17.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHow often do you post content (e.g., status updates, photos, videos) to your social media accounts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeveral times a day daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(75; 29.07%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(47; 18.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(27; 10.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(108; 42.24%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHave you ever taken a break or deactivated your social media accounts due to concerns about your health or safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(89; 34.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(169; 65.5%)\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=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDepression: prevalence and correlates\u003c/h2\u003e \u003cp\u003eThe severity of depression was assessed through the PHQ-9 scale Arabic version, participants scoring 15 and above were considered severely depressed. Therefore, our analysis revealed that 178 participants (69%) reported severe depression. To identify the factors that could be potentially associated with severe depression, a univariate analysis was conducted. The potential confounders: \u0026ldquo;age\u0026rdquo;, \u0026ldquo;marital status\u0026rdquo;, resident of Azmi Almufti camp\u0026rdquo;, \u0026ldquo;employment\u0026rdquo;, \u0026ldquo;using OTC antihistamines as a sleep aid\u0026rdquo;; and long-term medications were identified and used to feed the subsequent multivariable model, which was performed using the backward stepwise model. The multivariable model finally included \u0026ldquo;resident of Azmi Almufti camp\u0026rdquo; as a significant risk factor for severe depression (OR\u0026thinsp;=\u0026thinsp;2.22, 95% 1.28\u0026ndash;3.85, p\u0026thinsp;=\u0026thinsp;0.004). 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\u003eThe association between the participants\u0026rsquo; covariates and severe depression (according to the PHQ-9 scale) using univariate and multivariable analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"left\" 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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.52\u0026ndash;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91\u0026ndash;2.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.01\u0026ndash;2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAzmi Almufti Camp residents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.28\u0026ndash;3.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e2.22\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.28\u0026ndash;3.84\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04\u0026ndash;3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.88\u0026ndash;2.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelative and Friends in Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.49\u0026ndash;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you post content (e.g., status updates, photos, videos) to your social media accounts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69\u0026ndash;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever taken a break or deactivated your social media accounts due to concerns about your health or safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-medication with OTC sedating antihistamine to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u0026ndash;8.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- medication with herbal homeopathy to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67\u0026ndash;13.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026ndash;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving long-term medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98\u0026ndash;4.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePTSD: prevalence and correlates\u003c/h2\u003e \u003cp\u003eWe used the Arabic-validated Scale [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] for assessing the self-reported PTSD symptoms with a cut-off score above 25 for severe PTSD symptoms. We report that 127 participants (49.2%) reported severe PTSD symptoms. The univariate analysis was carried out to identify the potential confounders of severe PTSD. We report that \u0026ldquo;smoking\u0026rdquo;, \u0026ldquo;Resident of Azmi Almufti camp\u0026rdquo;, \u0026ldquo;posting the war news on social media\u0026rdquo;, and \u0026ldquo;using OTC antihistamines as a sleep aid\u0026rdquo; were regarded as potential confounders and were further used to build the multivariable binary logistic regression model as above. The multivariable model finally included \u0026ldquo;Resident of Azmi Almufti camp\u0026rdquo;, and \u0026ldquo;using OTC antihistamines as a sleep aid\u0026rdquo; as significant risk factors for severe PTSD (OR\u0026thinsp;=\u0026thinsp;1.81, 95% CI\u0026thinsp;=\u0026thinsp;1.10\u0026ndash;2.99, p\u0026thinsp;=\u0026thinsp;0.02) and (OR\u0026thinsp;=\u0026thinsp;3.32, 95% CI\u0026thinsp;=\u0026thinsp;1.34\u0026ndash;8.21, p\u0026thinsp;=\u0026thinsp;0.01) respectively. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between the participants\u0026rsquo; covariates and severe PTSD (according to the Foa scale) using univariate and multivariable analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"left\" 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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u0026ndash;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.83\u0026ndash;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026ndash;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAzmi Almufti Camp residents\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.1\u0026ndash;2.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.10\u0026ndash;2.99\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u0026ndash;1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.07\u0026ndash;2.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelative and Friends in Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47\u0026ndash;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you post content (e.g., status updates, photos, videos) to your social media accounts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.68-1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever taken a break or deactivated your social media accounts due to concerns about your health or safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u0026ndash;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-medication with OTC sedating antihistamines to improve my sleep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.35\u0026ndash;8.13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.34\u0026ndash;8.21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.01*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- medication with herbal homeopathy to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.71\u0026ndash;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.41\u0026ndash;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving long-term medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54\u0026ndash;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eInsomnia: prevalence and correlates\u003c/h2\u003e \u003cp\u003eInsomnia was assessed using the ISI-A scale, with a threshold score above 14 used to screen for severe insomnia symptoms. A total of 156 participants (60.5%) reported severe insomnia symptoms. The univariate analysis identified \u0026ldquo;receiving long-term medications for chronic diseases\u0026rdquo; and \u0026ldquo;using OTC antihistamines as a sleep aid\u0026rdquo; as potential confounders. The multivariable binary logistic regression showed that only using OTC antihistamines as a sleep aid\u0026rdquo; was a risk factor for severe insomnia (OR\u0026thinsp;=\u0026thinsp;3.19, 95%CI\u0026thinsp;=\u0026thinsp;1.17\u0026ndash;8.71, p\u0026thinsp;=\u0026thinsp;0.02). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between the participants\u0026rsquo; covariates and severe insomnia (according to the ISI-A scale) using univariate and multivariable analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\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=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.70-2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.75\u0026ndash;2.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAzmi Almufti Camp residents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62\u0026ndash;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80\u0026ndash;2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u0026ndash;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRelative and Friends in Gaza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.64\u0026ndash;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you post content (e.g., status updates, photos, videos) to your social media accounts?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026ndash;1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHave you ever taken a break or deactivated your social media accounts due to concerns about your health or safety?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u0026ndash;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-medication with OTC sedating antihistamines to improve my sleep\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.17\u0026ndash;8.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.19\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.17\u0026ndash;8.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.02*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf- medication with herbal homeopathy to improve my sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57\u0026ndash;6.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;3.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReceiving long-term medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u0026ndash;3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to identify the prevalence and correlates of depression, PTSD, and insomnia as self-reported symptoms in a cohort of Palestinian refugees residing in Jordan during the outbreak of the War on Gaza. We report a high rate of all the above-mentioned symptoms. Also, our findings revealed that the residents of Azmi Almufti camp were at higher risk for severe depression and PTSD symptoms. In addition, using sedating antihistamines as a sleep aid was associated with severe PTSD and insomnia symptoms.\u003c/p\u003e \u003cp\u003eThis huge burden of depression and PTSD in the study sample is attributed to multifactorial, interrelated, and complicated factors, a nexus worth exploring. Our findings demonstrated that the refugees residing in Azmi Almufti camp were more prone to severe depression and PTSD. Exploring mental health status in this population is faced with social and cultural barriers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Poor living conditions, poverty, and a lack of jobs could explain, at least in part, this finding. According to published data dated back in 2011, Azmi Almufti camp is the second poorest camp with the highest rate of unemployability in general and in women reaching up to 18% in total and 25% for females [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although no updates are yet available about the socio-economic status of the Azmi Almufti camp, however, the authors expect a more challenging situation due to the Syrian conflict that has led to Syrian refugees migration mainly to Irbid, thus posing additional restrains on Jordan, the hosting country.\u003c/p\u003e \u003cp\u003ePoor mental health status encompasses the behavior of individuals to adopt negative behaviors, for example, in a cross-sectional study comprising more than 73000 Palestinians living in Jordan camps, depressive symptoms were associated with days of missing schools, the same study points out the high rates of depressive symptoms namely loneliness, suicidal ideation, and worry among adolescents [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this study highlighted that participants using OTC sedating antihistamines as a sleep aid were at higher risk for severe insomnia and PTSD symptoms. Self-medication with sedating antihistamines is a common practice in many populations due to its availability, safety, and affordability [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In addition, earlier, our research group demonstrated that OTC sedating antihistamines are the most recommended sleep aid by community pharmacists in Jordan [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Our findings can be explained as follows: participants experiencing severe insomnia and PTSD symptoms tend to use the \u0026ldquo;available\u0026rdquo; medications to alleviate their symptoms, conversely, these severe symptoms could be due to antihistamines, as they stimulate the Central Nervous System, which could result in difficulty sleeping or insomnia or users may take overdoses of antihistamines due to tolerance [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. According to the literature, the clear benefits of sedating antihistamines have not been proven yet [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Similarly, antihistamines are ineffective in alleviating PTSD symptoms. Furthermore, they could exacerbate symptoms due to their complex pharmacological actions [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This is the first study, to the best our knowledge, that highlighted the prevalence and risk factors of depression, PTSD, and insomnia experienced by the Palestinian refugees residing in Jordan during the outbreak of the October7th war in their homeland in Palestine- Gaza. Although the current study has several strengths, including the unique sample type, the validated scales, and the sound data analysis performed, some limitations exist. For example, the study did not include a follow-up phase to monitor the changes in the mental health spectrum of the participants, also, the study did not provide a thorough psychiatric assessment by specialists in the camps due to social and cultural barriers to mental health.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the impact of the ongoing war on Gaza demonstrated to be associated with mental health distress outside the borders of Gaza. Palestinian refugees residing in Jordan for decades are highly affected mentally. Comprehensive and immediate actions are warranted to address the mental health and well-being of this vulnerable community by addressing the modifiable risk factors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Declaration:\u0026nbsp;\u003c/strong\u003eThe protocol was approved by Yarmouk University IRB committee in accordance with the Declaration of Helsinki\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The first author would like to thank Sama, Suzi, Yasmina, and Nour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003eThe data will be provided by the corresponding author upon request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1) made substantial contributions to the conception (Omar Gammoh, Saleh Bazi)\u0026nbsp;or design of the work (Omar Gammoh, Mervat Alsous); or the acquisition, analysis (Saleh Bazi, Ruba Al Akash), or interpretation of data (Bilal Sayaheen, and Mervat Alsous);\u003c/p\u003e\n\u003cp\u003e2) drafted the work \u0026nbsp;or revised it critically for important intellectual content(Omar Gammoh, Bilal Sayaheen, and Mervat Alsous)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3) approved the version to be published\u0026nbsp;Omar Gammoh, Saleh Bazi, Ruba Al Akash, Bilal Sayaheen, and Mervat Alsous\u003c/p\u003e\n\u003cp\u003e4) agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (Omar Gammoh).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBocco R. UNRWA and the Palestinian refugees: a history within history. Refug Surv Q. 2009;28:229\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkram S. UNRWA and Palestinian refugees. Oxford Handb Refug forced Migr Stud. 2014;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrfan AE. Educating Palestinian refugees: The origins of UNRWA\u0026rsquo;s unique schooling system. J Refug Stud. 2021;34:1037\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreinacher A, Derezza-Greeven C, Herzog W, Nikendei C. Secondary traumatization in first responders: a systematic review. Eur J Psychotraumatol. 2019;10:1562840.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiederhold BK. A legacy of trauma: how local conflicts can have global implications for mental health. Cyberpsychology, Behav. Soc. Netw. Mary Ann Liebert, Inc., publishers 140 Huguenot Street, 3rd Floor New~\u0026hellip; p. 803\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMahamid FA, Berte DZ. Portrayals of violence and at-risk populations: Symptoms of trauma in adolescents with high utilization of social media. Int J Ment Health Addict. 2020;18:980\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaj-Yahia MM, Greenbaum CW, Lahoud-Shoufany L. Palestinian Adolescents\u0026rsquo; Prolonged Exposure to Political Violence, Self- Esteem, and Post-Traumatic Stress Symptoms. J Interpers Violence. 2021;36:4137\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiacaman R, Rabaia Y, Nguyen-Gillham V, Batniji R, Punam\u0026auml;ki R-L, Summerfield D. Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Glob Public Health. 2011;6:547\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKell C, Hankir A. Barriers to treatment of mental health problems for Palestinian people in refugee camps in Jordan: a cross-sectional study. Lancet [Internet]. 2018;391:S8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/S0140-6736(18)30333-7\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)30333-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlHadi AN, AlAteeq DA, Al-Sharif E, Bawazeer HM, Alanazi H, AlShomrani AT, et al. An arabic translation, reliability, and validation of Patient Health Questionnaire in a Saudi sample. Ann Gen Psychiatry. 2017;16:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroenke K, Spitzer RL, Williams JBW. The PHQ-9. 46202:606\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWadaa NN. Secondary Traumatic Stress Symptoms in Military Parents of Iraqi Army. Mustansiriyah J Arts. 2016;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorin C. Insomnia: Psychological assessment and management. [Internet]. 1993 [cited 2019 Nov 2]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://psycnet.apa.org/record/1993-98362-000\u003c/span\u003e\u003cspan address=\"https://psycnet.apa.org/record/1993-98362-000\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuleiman KH, Yates BC. Translating the insomnia severity index into Arabic. J Nurs Scholarsh. 2011;43:49\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang \u0026Aring;AT and H. The socio-economic conditions of Jordan \u0026rsquo; s Palestinian camp refugees. 2011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNathani K, Lee WC, Taha S, Horino M, Seita A, Serag H. The Association Between Mental Well-Being and School Attendance Among Palestinian Adolescent Refugees in UNRWA Schools. J Child Adolesc Trauma [Internet]. 2023;16:339\u0026ndash;50. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40653-022-00460-7\u003c/span\u003e\u003cspan address=\"10.1007/s40653-022-00460-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarzam K, Sabir S, O\u0026rsquo;Rourke MC. Antihistamines. 2019;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGammoh OS, Al-Smadi A, Turjman C, Mukattash T, Kdour M. Valerian: An underestimated anxiolytic in the community pharmacy? J Herb Med [Internet]. 2016;6:193\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.hermed.2016.09.001\u003c/span\u003e\u003cspan address=\"10.1016/j.hermed.2016.09.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson GS, Roehrs TA, Rosenthal L, Koshorek G, Roth T. Tolerance to daytime sedative effects of H1 antihistamines. J Clin Psychopharmacol. 2002;22:511\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCulpepper L, Wingertzahn MA. Over-the-counter agents for the treatment of occasional disturbed sleep or transient insomnia: a systematic review of efficacy and safety. Prim care companion CNS Disord. 2015;17:26162.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVande Griend JP, Anderson SL. Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc [Internet]. 2012;52:e210\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1331/JAPhA.2012.12051\u003c/span\u003e\u003cspan address=\"10.1331/JAPhA.2012.12051\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiromani PJ, Keane TM, Ledoux J. Post-traumatic stress disorder: Basic science and clinical practice. Post-Traumatic Stress Disord Basic Sci Clin Pract. 2009;1\u0026ndash;409.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"War, Gaza, mental health, refugees","lastPublishedDoi":"10.21203/rs.3.rs-5149651/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5149651/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe present study sought to examine the prevalence and correlates of depression, PTSD, and insomnia in a cohort of Palestinian refugees residing in camps located in Jordan during the outbreak of the War on Gaza on Oct.7th .This is a cross-sectional cohort study that employed the convenient sampling method to recruit Palestinian refugees residing in Irbid and Azmi Almufti camps for Palestinian refugees. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. The self-reported PTSD symptoms were evaluated using the brief PTSD scale, and insomnia severity was assessed using the Insomnia Severity Index -Arabic scale (ISI-A). The data analysis from 258 participants showed that severe depression was reported in 178 participants (69%). Additionally, 127 participants (49.2%) reported severe PTSD symptoms, and 156 participants (60.5%) reported severe insomnia symptoms. Regression analysis revealed that \u0026ldquo;Residents of Azmi Almufti camp\u0026rdquo; was a significant risk factor for severe depression (OR\u0026thinsp;=\u0026thinsp;2.22, 95% 1.28\u0026ndash;3.85, p\u0026thinsp;=\u0026thinsp;0.004) and severe PTSD (OR\u0026thinsp;=\u0026thinsp;1.81, 95% CI\u0026thinsp;=\u0026thinsp;1.10\u0026ndash;2.99, p\u0026thinsp;=\u0026thinsp;0.02). The use of over-the-counter antihistamines as a sleep aid was a risk factor for severe insomnia (OR\u0026thinsp;=\u0026thinsp;3.19, 95%CI\u0026thinsp;=\u0026thinsp;1.17\u0026ndash;8.71, p\u0026thinsp;=\u0026thinsp;0.02) and PTSD (OR\u0026thinsp;=\u0026thinsp;3.32, 95% CI\u0026thinsp;=\u0026thinsp;1.34\u0026ndash;8.21, p\u0026thinsp;=\u0026thinsp;0.01). The conflict in Gaza has been observed to correlate with mental health challenges, particularly among Palestinian refugees residing in Jordan.\u003c/p\u003e","manuscriptTitle":"Assessment of depression, PTSD, and insomnia symptoms in a cohort of Palestinian migrants residing in Jordanian camps during the outbreak of the War on Gaza: Prevalence and risk factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-25 06:38:21","doi":"10.21203/rs.3.rs-5149651/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-19T06:17:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-12T09:56:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85024088960583509635917643203077302984","date":"2024-11-08T16:20:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-04T15:25:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259569854486904740816207473850094310247","date":"2024-10-31T10:00:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206682708070807580100005381981053900773","date":"2024-10-30T14:44:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-21T13:34:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-16T07:22:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-07T04:05:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2024-09-25T06:52:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cf3d45c-c1a0-4357-a475-2bdefafa8de4","owner":[],"postedDate":"November 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T07:08:53+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-25 06:38:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5149651","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5149651","identity":"rs-5149651","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}