Sage Journals: Discover world-class research

Abstract

Background:

The psychological mechanisms linking war-related nightmares to psychotic experiences remain insufficiently elucidated, especially among the vulnerable displaced population. The present study investigated the mediating effect of anxiety–depression symptoms in the association between war-related nightmares and psychotic experiences within a sample of internally displaced Lebanese citizens during the 2025 southern Lebanon attack.

Methods:

A cross-sectional study was performed on displaced Lebanese citizens between October 2024 and March 2025 and included 249 displaced Lebanese citizens. Three scales were used: The Community Assessment of Psychic Experiences scale-9, the Patient Health Questionnaire-4 and the Nightmares to War scale.

Results:

The indirect effect analysis taking psychotic experiences as the dependent variable was accommodated for the subsequent covariates: education, age and nightmares to war. Psychological distress (indirect effect: Beta = .07; Boot SE = 0.03; Boot CI [0.01, 0.13]) partially mediated the association between nightmares to war and psychotic experiences. Greater levels of nightmares to war were notably linked to higher psychological distress and higher psychological distress was significantly associated with higher psychotic experiences. Moreover, higher nightmares to war were directly associated with more psychotic experiences. The effect size was 0.08 [0.01; 0.15]. The sensitivity analyses showed that anxiety (indirect effect: Beta = .07; Boot SE = 0.03; Boot CI [0.02, 0.13]; effect size = 0.08; 95% CI [0.02, 0.15], but not depression (indirect effect: Beta = .03; Boot SE = 0.02; Boot CI [−0.01, 0.08]; effect size = 0.04; 95% CI [−0.01, 0.10], played an indirect role in the association between nightmares to war and psychotic experiences.

Conclusion:

This study established a significant connection between war-related nightmares and psychotic experiences, with psychological distress partially mediating this relationship and anxiety playing an indirect role in the association. Therefore, our findings highlighted the importance of routine assessment for trauma-related nightmares and affective symptomatology to detect individuals at heightened risk of developing psychotic experiences and thus facilitate timely, evidence-based interventions.

Keywords

nightmares to war psychotic experiences displaced citizens depression anxiety Lebanese

Get full access to this article

View all access options for this article.

References

Abudayya

Bruaset

G. T. F.

Nyhus

H. B.

Aburukba

Tofthagen

(2023). Consequences of war-related traumatic stress among Palestinian young people in the Gaza strip: A scoping review. Mental Health & Prevention, 32, 200305. https://doi.org/10.1016/j.mhp.2023.200305

Akram

Gardani

Irvine

Allen

Ypsilanti

Lazuras

Drabble

Stevenson

J. C.

Akram

(2020). Emotion dysregulation mediates the relationship between nightmares and psychotic experiences: Results from a student population. NPJ Schizophrenia, 6(1), 15. https://doi.org/10.1038/s41537-020-0103-y

Al-Krenawi

(2005). Mental health practice in Arab countries. Current Opinion in Psychiatry, 18(5), 560–564. https://doi.org/10.1097/01.yco.0000179498.46182.8b

Al-Krenawi

Graham

J. R.

(2000). Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work, 25(1), 9–22. https://doi.org/10.1093/hsw/25.1.9

Amone-P’Olak

Otim

B. N.

Opio

Ovuga

Meiser-Stedman

(2014). War experiences and psychotic symptoms among former child soldiers in northern Uganda: The mediating role of post-war hardships – the WAYS study. Social Psychiatry and Psychiatric Epidemiology, 49(11), 1783–1792. https://doi.org/10.1007/s00127-014-0873-5

Ayazi

Lien

Eide

Swartz

Hauff

(2014). Association between exposure to traumatic events and anxiety disorders in a post-conflict setting: A cross-sectional community study in south Sudan. BMC Psychiatry, 14, 6. https://doi.org/10.1186/1471-244X-14-6

Bagautdinova

Mayeli

Wilson

J. D.

Donati

F. L.

Colacot

R. M.

Meyer

Fusar-Poli

Ferrarelli

(2023). Sleep abnormalities in different clinical stages of psychosis: A systematic review and meta-analysis. JAMA Psychiatry, 80(3), 202–210. https://doi.org/10.1001/jamapsychiatry.2022.4599

Baskaran

Marogi

Bitar

Attarian

Saadi

(2023). Improving sleep health among refugees: A systematic review. Neurology Clinical Practice, 13(2), e200139. https://doi.org/10.1212/CPJ.0000000000200139

Borsboom

(2017). A network theory of mental disorders. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 16(1), 5–13. https://doi.org/10.1002/wps.20375

10.

Brandt

Henssler

Müller

Wall

Gabel

Heinz

(2019). Risk of psychosis among refugees: A systematic review and meta-analysis. JAMA Psychiatry, 76(11), 1133–1140. https://doi.org/10.1001/jamapsychiatry.2019.1937

11.

Burns

Wickramage

Musah

Siriwardhana

Checchi

(2018). Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: A cross-sectional survey. Conflict and Health, 12(1), 41. https://doi.org/10.1186/s13031-018-0176-7

12.

Bursac

Gauss

C. H.

Williams

D. K.

Hosmer

D. W.

(2008). Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine, 3, 17. https://doi.org/10.1186/1751-0473-3-17

13.

Charlson

van Ommeren

Flaxman

Cornett

Whiteford

Saxena

(2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1

14.

Chu

R. S. T.

Chu

I. W. L.

Yip

E. W.

Chan

J. K. N.

Wong

C. S. M.

Hui

C. L.

Chen

E. Y. H.

Chan

S. K. W.

Lee

E. H. M.

Lui

S. S. Y.

Chang

W. C.

(2025). Cognitive functioning in people with psychotic experiences: A systematic review and meta-analysis study. Molecular Psychiatry, 30(3), 1184–1194. https://doi.org/10.1038/s41380-024-02823-y

15.

Clark

L. A.

Watson

(1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316–336. https://doi.org/10.1037//0021-843x.100.3.316

16.

Compean

Hamner

(2019). Posttraumatic stress disorder with secondary psychotic features (PTSD-SP): Diagnostic and treatment challenges. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 88, 265–275. https://doi.org/10.1016/j.pnpbp.2018.08.001

17.

Comtesse

Powell

Soldo

Hagl

Rosner

(2019). Long-term psychological distress of Bosnian war survivors: An 11-year follow-up of former displaced persons, returnees, and stayers. BMC Psychiatry, 19(1), 1. https://doi.org/10.1186/s12888-018-1996-0

18.

Cuijpers

van Straten

Warmerdam

Andersson

(2008). Psychological treatment of depression: A meta-analytic database of randomized studies. BMC Psychiatry, 8(1), 36. https://doi.org/10.1186/1471-244X-8-36

19.

DeVylder

J. E.

Lehmann

Chen

F. P.

(2015). Social and clinical correlates of the persistence of psychotic experiences in the general population. Schizophrenia Research, 169(1-3), 286–291. https://doi.org/10.1016/j.schres.2015.08.039

20.

Esposito

Benitez

Barza

Mellman

(1999). Evaluation of dream content in combat-related PTSD. Journal of Traumatic Stress, 12(4), 681–687. https://doi.org/10.1023/A:1024725319777

21.

Faccini

Del-Monte

(2024). Bad dream, nightmares and psychopathology: A systematic review. Frontiers in Psychiatry, 15, 1461495. https://doi.org/10.3389/fpsyt.2024.1461495

22.

Farah

Obeid

Malaeb

Haddad

Fekih-Romdhane

Hallit

(2023). Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults. BMC Psychiatry, 23(1), 272. https://doi.org/10.1186/s12888-023-04778-w

23.

Fares

Gebeily

Saad

Harati

Nabha

Said

Kanso

Abdel Rassoul

Fares

(2017). Post-traumatic stress disorder in adult victims of cluster munitions in Lebanon: A 10-year longitudinal study. BMJ Open, 7(8), e017214. https://doi.org/10.1136/bmjopen-2017-017214

24.

Farhood

Zurayk

Chaya

Saadeh

Meshefedjian

Sidani

(1993). The impact of war on the physical and mental health of the family: The Lebanese experience. Social Science & Medicine, 36(12), 1555–1567. https://doi.org/10.1016/0277-9536(93)90344-41982.

25.

Farran

(2021). Mental health in Lebanon: Tomorrow’s silent epidemic. Mental Health & Prevention, 24, 200218. https://doi.org/10.1016/j.mhp.2021.200218

26.

Fekih-Romdhane

Helmy

Alhuwailah

Shuwiekh

H. A. M.

Naser

A. Y.

Maalej

Obeid

Cheour

Hallit

(2024). Mediating effect of depression and acute stress between exposure to Israel-Gaza war media coverage and insomnia: A multinational study from five Arab countries. BMC Public Health, 24(1), 1498. https://doi.org/10.1186/s12889-024-18996-8

27.

Fekih-Romdhane

Houissa

Loch

A. A.

Cheour

Hallit

(2024). Psychotic experiences and psychological distress in adolescents: An examination of longitudinal bidirectional effects across sex. Child and Adolescent Psychiatry and Mental Health, 18(1), 124. https://doi.org/10.1186/s13034-024-00825-w

28.

Fekih-Romdhane

Malaeb

Sakr

Dabbous

Obeid

Hallit

(2024). Validation of the Arabic language version of the shortest form of the community assessment of psychic experiences (CAPE-9) in a young adult population-based sample. Retrieved from https://www.researchgate.net/publication/381753358_Validation_of_the_Arabic_language_version_of_the_shortest_form_of_the_Community_Assessment_of_Psychic_Experiences_CAPE-9_in_a_young_adult_population-based_sample

29.

Figueiredo

Petravičiūtė

(2025). Examining the relationship between coping strategies and post-traumatic stress disorder in forcibly displaced populations: A systematic review. European Journal of Trauma & Dissociation, 9(2), 100535. https://doi.org/10.1016/j.ejtd.2025.100535

30.

Fisher

H. L.

Lereya

S. T.

Thompson

Lewis

Zammit

Wolke

(2014). Childhood parasomnias and psychotic experiences at age 12 years in a United Kingdom birth cohort. Sleep, 37(3), 475–482. https://doi.org/10.5665/sleep.3478

31.

Fisher

H. L.

Schreier

Zammit

Maughan

Munafò

M. R.

Lewis

Wolke

(2013). Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin, 39(5), 1045–1055. https://doi.org/10.1093/schbul/sbs088

32.

Fletcher

P. C.

Frith

C. D.

(2009). Perceiving is believing: A Bayesian approach to explaining the positive symptoms of schizophrenia. Nature Reviews Neuroscience, 10(1), 48–58. https://doi.org/10.1038/nrn2536

33.

Freeman

Garety

(2014). Advances in understanding and treating persecutory delusions: A review. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1179–1189. https://doi.org/10.1007/s00127-014-0928-7

34.

Freeman

Sheaves

Waite

Harvey

A. G.

Harrison

P. J.

(2020). Sleep disturbance and psychiatric disorders. Lancet Psychiatry, 7(7), 628–637. https://doi.org/10.1016/S2215-0366(20)30136-X

35.

Fried

E. I.

van Borkulo

C. D.

Cramer

A. O.

Boschloo

Schoevers

R. A.

Borsboom

(2017). Mental disorders as networks of problems: A review of recent insights. Social Psychiatry and Psychiatric Epidemiology, 52(1), 1–10. https://doi.org/10.1007/s00127-016-1319-z

36.

Fritz

M. S.

MacKinnon

D. P.

(2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.x

37.

Frostholm

Petrie

K. J.

Ornbøl

Fink

(2014). Are illness perceptions related to future healthcare expenditure in patients with somatoform disorders? Psychological Medicine, 44(13), 2903–2911. https://doi.org/10.1017/S003329171400035X

38.

Garrett

(2025). Psychoanalytic notes on psychosis, disturbances in perception, delusional narratives, and the Bayesian predictive processing model of the brain. Psychoanalytic Inquiry, 0(0), 1–18. https://doi.org/10.1080/07351690.2025.2501504

39.

Hamamra

Mahamid

Bdier

(2025). Trauma and sleep disruption in Gaza: A qualitative content analysis of war-related effects. BMC Psychology, 13(1), 284. https://doi.org/10.1186/s40359-025-02599-y

40.

Hamner

M. B.

Frueh

B. C.

Ulmer

H. G.

Arana

G. W.

(1999). Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biological Psychiatry, 45(7), 846–852. https://doi.org/10.1016/s0006-3223(98)00301-1

41.

Harb

G. C.

Cook

J. M.

Phelps

A. J.

Gehrman

P. R.

Forbes

Localio

Harpaz-Rotem

Gur

R. C.

Ross

R. J.

(2019). Randomized controlled trial of imagery rehearsal for posttraumatic nightmares in combat veterans. Journal of Clinical Sleep Medicine, 15(5), 757–767. https://doi.org/10.5664/jcsm.7770

42.

Hartley

Haddock

Vasconcelos

Emsley

Barrowclough

(2014). An experience sampling study of worry and rumination in psychosis. Psychological Medicine, 44(8), 1605–1614. https://doi.org/10.1017/S0033291713002080

43.

Hassan

Ventevogel

Jefee-Bahloul

Barkil-Oteo

Kirmayer

L. J.

(2016). Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiology and Psychiatric Sciences, 25(2), 129–141. https://doi.org/10.1017/S2045796016000044

44.

Hofmann

S. G.

Asnaani

Vonk

I. J.

Sawyer

A. T.

Fang

(2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1

45.

Jasim

(2021). Patterns of psychiatric morbidity before and after a war in Lebanon at twelve months following cessation of hostilities. AACE Clinical Case Reports, 7(1), 1. Retrieved from https://benthamopenarchives.com/abstract.php?ArticleCode=TOPJ-8-1

46.

Jou

Y. C.

Pace-Schott

E. F.

(2022). Call to action: Addressing sleep disturbances, a hallmark symptom of PTSD, for refugees, asylum seekers, and internally displaced persons. Sleep Health, 8(6), 593–600. https://doi.org/10.1016/j.sleh.2022.09.003

47.

Kammerer

M. K.

Bub

Lincoln

T. M.

(2021). The relationship between nightmares and psychotic experiences in young adults. Sleep Medicine, 77, 315–322. https://doi.org/10.1016/j.sleep.2020.08.014

48.

Karam

E. G.

Mneimneh

Z. N.

Dimassi

Fayyad

J. A.

Karam

A. N.

Nasser

S. C.

Chatterji

Kessler

R. C.

(2008). Lifetime prevalence of mental disorders in Lebanon: First onset, treatment, and exposure to war. PLoS Medicine, 5(4), e61. https://doi.org/10.1371/journal.pmed.0050061

49.

Kirmayer

L. J.

Gomez-Carrillo

Veissière

(2017). Culture and depression in global mental health: An ecosocial approach to the phenomenology of psychiatric disorders. Social Science & Medicine, 183, 163–168. https://doi.org/10.1016/j.socscimed.2017.04.0341982.

50.

Krakow

Hollifield

Johnston

Koss

Schrader

Warner

T. D.

Tandberg

Lauriello

McBride

Cutchen

Cheng

Emmons

Germain

Melendrez

Sandoval

Prince

(2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 286(5), 537–545. https://doi.org/10.1001/jama.286.5.537

51.

Kroenke

Spitzer

R. L.

Williams

J. B.

Löwe

(2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50(6), 613–621. https://doi.org/10.1176/appi.psy.50.6.613

52.

KrzysztofRutkowski. (2001). Anxiety, depression and nightmares in PTSD. Archives of Psychiatry and Psychotherapy. Retrieved from https://ruj.uj.edu.pl/server/api/core/bitstreams/eb9198ba-203f-4ec1-8c68-7255049a6f2e/content

53.

Linscott

R. J.

van Os

(2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine, 43(6), 1133–1149. https://doi.org/10.1017/S0033291712001626

54.

Mark

Toulopoulou

(2016). Psychometric properties of “community assessment of psychic experiences”: Review and meta-analyses. Schizophrenia Bulletin, 42(1), 34–44. https://doi.org/10.1093/schbul/sbv088

55.

McGrath

J. J.

Saha

Al-Hamzawi

A. O.

Alonso

Andrade

Borges

Bromet

E. J.

Oakley Browne

Bruffaerts

Caldas de Almeida

J. M.

Fayyad

Florescu

de Girolamo

Gureje

de Jonge

Kovess-Masfety

Lepine

J. P.

Lim

C. C.

, . . . Kessler

R. C.

(2016). Age of onset and lifetime projected risk of psychotic experiences: Cross-national data from the world mental health survey. Schizophrenia Bulletin, 42(4), 933–941. https://doi.org/10.1093/schbul/sbw011

56.

McGrath

J. J.

Saha

Lim

C. C. W.

Aguilar-Gaxiola

Alonso

Andrade

L. H.

Bromet

E. J.

Bruffaerts

Caldas

Almeida

J. M.

Cardoso

de Girolamo

Fayyad

Florescu

Gureje

Haro

J. M.

Kawakami

Koenen

K. C.

Kovess-Masfety

Lee

S., . . .

Kessler

R. C.

(2017). Trauma and psychotic experiences: Transnational data from the world mental health survey. British Journal of Psychiatry, 211(6), 373–380. https://doi.org/10.1192/bjp.bp.117.205955

57.

Monsonet

Rockwood

N. J.

Kwapil

T. R.

Barrantes-Vidal

(2022). Psychological pathways to paranoia and psychotic-like experiences in daily-life: The mediating role of distinct affective disturbances. Schizophrenia Bulletin, 48(5), 1053–1065. https://doi.org/10.1093/schbul/sbac071

58.

Morgan

Fisher

(2007). Environment and schizophrenia: Environmental factors in schizophrenia: Childhood trauma - A critical review. Schizophrenia Bulletin, 33(1), 3–10. https://doi.org/10.1093/schbul/sbl053

59.

Najem

Malaeb

Sakr

Dabbous

Fekih-Romdhane

Hallit

Obeid

(2025). Mediating effect of intolerance of uncertainty between fear of war and mental health in adults during the Israel-Palestine war of 2023. Discover mental health, 5(1), 19. https://doi.org/10.1007/s44192-025-00144-2

60.

Navarro-Mateu

Alonso

Lim

C. C. W.

Saha

Aguilar-Gaxiola

Al-Hamzawi

Andrade

L. H.

Bromet

E. J.

Bruffaerts

Chatterji

Degenhardt

de Girolamo

de Jonge

Fayyad

Florescu

Gureje

Haro

J. M.

Karam

E. G.

, . . . McGrath

J. J.

(2017). The association between psychotic experiences and disability: Results from the WHO world mental health surveys. Acta Psychiatrica Scandinavica, 136(1), 74–84. https://doi.org/10.1111/acps.12749

61.

Neuner

Pfeiffer

Schauer-Kaiser

Odenwald

Elbert

Ertl

(2012). Haunted by ghosts: Prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in northern Uganda. Social Science & Medicine, 75, 548–554. https://doi.org/10.1016/j.socscimed.2012.03.028

62.

Nygaard

Sonne

Carlsson

(2017). Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: A retrospective cohort study. BMC Psychiatry, 17(1), 5. https://doi.org/10.1186/s12888-016-1166-1

63.

Obeid

Hemade

Malaeb

Sakr

Dabbous

Ying

Jiang

Meng

Fekih-Romdhane

Hallit

(2024). Psychometric properties of the ultra-brief self-report patient health questionnaire-4 (PHQ-4) to assess anxiety and depression in Arabic-speaking adults. BMC Psychiatry, 24(1), 537. https://doi.org/10.1186/s12888-024-05978-8

64.

B. H.

Smith

Koyanagi

(2024). Psychotic experiences are associated with greater impairment among students in higher education with depression and anxiety in the United States. Journal of Affective Disorders, 344, 325–328. https://doi.org/10.1016/j.jad.2023.10.083

65.

Waldman

Stickley

DeVylder

J. E.

Koyanagi

(2019). Psychotic experiences and physical health conditions in the United States. Comprehensive Psychiatry, 90, 1–6. https://doi.org/10.1016/j.comppsych.2018.12.007

66.

Pavlova

Rogowska

A. M.

(2023). Exposure to war, war nightmares, insomnia, and war-related posttraumatic stress disorder: A network analysis among university students during the war in Ukraine. Journal of Affective Disorders, 342, 148–156. https://doi.org/10.1016/j.jad.2023.09.003

67.

Pigeon

W. R.

Campbell

C. E.

Possemato

Ouimette

(2013). Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. Journal of Psychosomatic Research, 75(6), 546–550. https://doi.org/10.1016/j.jpsychores.2013.09.004

68.

Porter

Haslam

(2005). Predisplacement and post displacement factors associated with mental health of refugees and internally displaced persons: A meta-analysis. Journal of the American Medical Association, 294(5), 602–612. https://doi.org/10.1001/jama.294.5.602

69.

Powell

Rosner

Butollo

Tedeschi

R. G.

Calhoun

L. G.

(2003). Posttraumatic growth after war: A study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology, 59(1), 71–83. https://doi.org/10.1002/jclp.10117

70.

Preacher

K. J.

Kelley

(2011). Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. APA PsycNet, 16, 93–115. https://doi.org/10.1037/a0022658

71.

Rayan

Fawaz

(2018). Cultural misconceptions and public stigma against mental illness among Lebanese university students. Perspectives in Psychiatric Care, 54(2), 258–265. https://doi.org/10.1111/ppc.12232

72.

Reeve

Nickless

Sheaves

Freeman

(2018). Insomnia, negative affect, and psychotic experiences: Modelling pathways over time in a clinical observational study. Psychiatry Research, 269, 673–680. https://doi.org/10.1016/j.psychres.2018.08.090

73.

Reeve

Sheaves

Freeman

(2019). Sleep disorders in early psychosis: Incidence, severity, and association with clinical symptoms. Schizophrenia Bulletin, 45(2), 287–295. https://doi.org/10.1093/schbul/sby129

74.

Rogowska

A. M.

Pavlova

(2023). A path model of associations between war-related exposure to trauma, nightmares, fear, insomnia, and posttraumatic stress among Ukrainian students during the Russian invasion. Psychiatry Research, 328, 115431. https://doi.org/10.1016/j.psychres.2023.115431

75.

Sateia

M. J.

(2014). International classification of sleep disorders: Highlights and modifications. Chest, 146(5), 1387–1394. https://doi.org/10.1378/chest.14-0970

76.

Schultz

J. H.

Forsberg

J. T.

Harb

Alisic

(2021). Prevalence and characteristics of posttraumatic nightmares in war- and conflict-affected students. Nature and Science of Sleep, 13, 423–433. https://doi.org/10.2147/NSS.S282967

77.

Sheaves

Onwumere

Keen

Stahl

Kuipers

(2015). Nightmares in patients with psychosis: The relation with sleep, psychotic, affective, and cognitive symptoms. Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie, 60(8), 354–361. https://doi.org/10.1177/070674371506000804

78.

Sheaves

Porcheret

Tsanas

Espie

C. A.

Foster

R. G.

Freeman

Harrison

P. J.

Wulff

Goodwin

G. M.

(2016). Insomnia, nightmares, and chronotype as markers of risk for severe mental illness: Results from a student population. Sleep, 39(1), 173–181. https://doi.org/10.5665/sleep.5342

79.

Sheaves

Rek

Freeman

(2023). Nightmares and psychiatric symptoms: A systematic review of longitudinal, experimental, and clinical trial studies. Clinical Psychology Review, 100, 102241. https://doi.org/10.1016/j.cpr.2022.102241

80.

Shehata

(2014). Evaluating the effect of an educational program on level of professional burnout among family physicians in faculty of medicine - Suez Canal university. Retrieved from https://www.researchgate.net/profile/Mohamed-Shehata-36/publication/337824456_Evaluating_the_Effect_of_an_Educational_Program_on_Level_of_professional_Burnout_among_Family_Physicians_in_Faculty_of_Medicine_-_Suez_Canal_University/links/5dec96b1299bf10bc3495abb/Evaluating-the-Effect-of-an-Educational-Program-on-Level-of-professional-Burnout-among-Family-Physicians-in-Faculty-of-Medicine-Suez-Canal-University.pdf#page=6

81.

Silove

Ventevogel

Rees

(2017). The contemporary refugee crisis: An overview of mental health challenges. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 16(2), 130–139. https://doi.org/10.1002/wps.20438

82.

Smyth

Steel

Ellett

(2023). The prevalence of non-affective psychosis in refugee populations: A systematic review. Schizophrenia Research, 260, 99–112. https://doi.org/10.1016/j.schres.2023.08.011

83.

Staines

Healy

Coughlan

Clarke

Kelleher

Cotter

Cannon

(2022). Psychotic experiences in the general population, a review: Definition, risk factors, outcomes and interventions. Psychological Medicine, 52(15), 1–12. https://doi.org/10.1017/S0033291722002550

84.

Sun

Zhong

Yang

Zhou

(2024). A longitudinal network of psychotic-like experiences, depressive and anxiety symptoms, and adverse life events: A cohort study of 3,358 college students. Epidemiology and Psychiatric Sciences, 33, e64. https://doi.org/10.1017/S2045796024000726

85.

Thabet

A. A.

Vostanis

(2000). Post traumatic stress disorder reactions in children of war: A longitudinal study. Child Abuse & Neglect, 24, 291–298. https://doi.org/10.1016/S0145-2134(99)00127-1

86.

Turner

W. A

. (1918). Neuroses and psychoses of war. BMJ Military Health, 31(5), 399–413.

87.

UNHCR (2024). Lebanon at a glance. Retrieved September 16, 2025, from https://www.unhcr.org/lb/about-us/unhcr-lebanon-glance

88.

Ursano

R. J.

(1996). Emotional aftermath of the Persian Gulf war: Veterans, families, communities, and nations. American Psychiatric Pub. Retrieved from https://books.google.com.lb/books?hl=en&lr=&id=J-82yrWR0MMC&oi=fnd&pg=PA393&dq=nightmares+and+war+and+psychosis+and+arab&ots=aYJ1kn5F2m&sig=k8QU5zN1yYiojMkfhZBE31hoTjo&redir_esc=y#v=onepage&q=psychosis&f=false

89.

Van der Kolk

B. A.

(2014). The body keeps the score : Brain, mind, and body in the healing of trauma (New York ed.) Viking. Retrieved from https://hendrick.aspendiscovery.org/Record/3942349

90.

van Rossum

Dominguez

M. D. G.

Lieb

Wittchen

H. U.

van Os

(2011). Affective dysregulation and reality distortion: A 10-year prospective study of their association and clinical relevance. Schizophrenia Bulletin, 37(3), 561–571. https://doi.org/10.1093/schbul/sbp101

91.

Verdoux

van Os

(2002). Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophrenia Research, 54(1-2), 59–65. https://doi.org/10.1016/S0920-9964(01)00352-8

92.

Vostanis

(2003). Impact of trauma on Palestinian children’s mental health: Lessons from the Gaza studies. International Psychiatry, 1(2), 5–6. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735244/

93.

Walker

M. P.

van der Helm

(2009). Overnight therapy? The role of sleep in emotional brain processing. Psychological Bulletin, 135(5), 731–748. https://doi.org/10.1037/a0016570

94.

Wang

Scherffius

Liu

Sun

Fan

(2023). Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey. Sleep Medicine, 101, 296–304. https://doi.org/10.1016/j.sleep.2022.11.011

95.

Wigman

J. T.

van Winkel

Raaijmakers

Q. A.

Ormel

Verhulst

F. C.

Reijneveld

S. A.

van Os

Vollebergh

W. A.

(2011). Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: A 6-year longitudinal general population study. Psychological Medicine, 41, 2317–2329. https://doi.org/10.1017/S0033291711000304

96.

Wigman

J. T. W.

Lin

Vollebergh

W. A. M.

van Os

Raaijmakers

Q. A. W.

Nelson

(2011). Subclinical psychosis and depression: Co-occurring phenomena that do not predict each other over time. Schizophrenia Research, 130(1-3), 277–281. https://doi.org/10.1016/j.schres.2011.03.003

Anxiety-Depression Symptoms Mediate the Connections Between Nightmares to War and Psychotic Experiences Among Internally Displaced Lebanese Citizens During the 2025 Southern Lebanon Attacks

Abstract

Background:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References