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:

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.