A cross-sectional study of screened depression prevalence among Gaza war survivors who fled versus those who remained

The escalating conflict in Gaza since October 2023 has caused an unprecedented humanitarian crisis, widespread destruction, and mass displacement, profoundly impacting mental health. While depression is prevalent in war-affected regions, Gaza shows exceptionally high rates, with some studies reporting up to 99.5% prevalence. Crucially, comparative studies directly examining depression prevalence between Gaza war survivors who remained and those who fled have been notably absent. This cross-sectional study aimed to compare screened depression prevalence among Gaza war survivors, specifically differentiating between those who remained within Gaza and those who fled to outside Palestine, and to assess associated sociodemographic and war-related factors. Data were collected from 788 adult Palestinian participants, including 383 individuals who fled Palestine and 405 who remained in Gaza. Depression symptoms were assessed using the online self-administered Patient Health Questionnaire-9 (PHQ-9). Depression severity levels were classified according to standard cut-off scores, and logistic regression analyses were conducted to identify factors associated with depression. An alarmingly high overall prevalence of moderate-to-severe depression (82%) was found, with 37% experiencing severe depression. The fled group exhibited a significantly higher prevalence of moderate-to-severe depression (90.86%) compared to the non-fled group (72.59%), with nearly half (49.87%) of the fled group suffering from severe depression. Logistic regression analysis revealed that being in the fledgling group, younger age, and losing a family member significantly increased the odds of moderate-to-severe depression. Over 20% of respondents reported suicidal ideation nearly every day. Risk factors for depression appeared to operate similarly across both populations. This study highlights an exceptionally high prevalence of depression among Gaza war survivors, with those who fled experiencing significantly greater severity. The findings underscore the profound psychological burden of forced displacement and emphasize the urgent need for comprehensive, long-term mental health support for all war survivors.