Prolonged conflict and its psychological toll: post-traumatic stress disorder, anxiety, depression, and poor well-being among Palestinians in the West Bank

Populations living under protracted armed conflict face sustained exposure to multiple stressors. The West Bank has experienced decades of such conditions, with a marked escalation since October 2023. However, population-level data simultaneously assessing PTSD, depression, anxiety, and subjective well-being among general adults in the West Bank remain limited. This study aimed to estimate the prevalence of these four outcomes and to examine the independent contributions of specific conflict-related exposures and sociodemographic factors. An analytical cross-sectional study using multi-stage convenience sampling was conducted between March and June 2026 among 1,615 Palestinian adults (aged 18 years or older) across the three regions of the West Bank. Participants were recruited through face-to-face data collection at community sites and via an online survey. They completed validated Arabic versions of the PCL-5, PHQ-9, GAD-7, and WHO-5. Bivariate analyses and multiple linear regression were used to examine associations with sociodemographic and conflict-exposure variables. The prevalence of probable PTSD was 38.3% (95% CI: 35.9 to 40.6). Over half (53.4%; 95% CI: 51.0 to 55.9) met or exceeded the moderate depression threshold, 46.3% (95% CI: 43.9 to 48.7) the moderate anxiety threshold, and 78.9% (95% CI: 77.0 to 80.9) reported poor well-being. In multivariable regression, all five conflict-related exposures (displacement, settler violence, military raids, family member death or injury, and house demolition) were independently associated with higher PTSD scores. Displacement was the strongest predictor (B = 6.24, p < .001), followed by settler violence (B = 5.53, p < .001). Income insufficiency consistently predicted worse outcomes across all four measures. Access to mental health services, reported by only 25.1% of participants, was associated with lower depression and anxiety scores and higher well-being, but not with PTSD symptom severity. Adult Palestinians in the West Bank exhibit a substantial burden of psychological distress across multiple domains. Conflict-related exposures, particularly displacement and settler violence, are the strongest independent predictors of PTSD symptom severity. The association of mental health service access with lower depression and anxiety, but not PTSD, highlights a gap in trauma-specific care. These findings underscore the urgent need for trauma-focused, exposure-informed, and scalable mental health interventions in protracted conflict settings, with implications for humanitarian programming, mental health system strengthening, and future longitudinal research. Not applicable.