Post-traumatic Stress Symptoms and Suicide Risk among Syrian Refugees: The Mediating Role of Anxiety Sensitivity

Forced migration, as exemplified by the ongoing Syrian refugee crisis, has been consistently associated with elevated rates of psychiatric conditions, including post-traumatic stress disorder (PTSD), depression, anxiety, and increased suicide risk. However, the psychological mechanisms linking trauma-related symptoms to suicide risk in refugee populations remain insufficiently understood. The present study examines the mediating role of anxiety sensitivity in the relationship between PTSD symptoms and suicide risk among Syrian refugees residing in Turkey. Data were collected from 627 Syrian refugees aged 18-65 years living in Bursa province. Participants completed validated self-report measures assessing PTSD symptoms (Impact of Event Scale-Revised; IES-R), depression (Beck Depression Inventory; BDI), anxiety sensitivity (Anxiety Sensitivity Index-3; ASI-3), and suicide risk (Suicide Probability Scale; SPS). Elevated PTSD symptom levels were observed in 81.2% of the sample. Logistic regression and mediation analyses were conducted to examine associations between PTSD symptom clusters, anxiety sensitivity dimensions, and suicide risk. Results indicated that intrusion and hyperarousal symptoms were positively associated with suicide risk, whereas avoidance symptoms and physical concern (ASI-3 subscale) were negatively associated. Mediation analysis revealed that cognitive concern-defined as fear of losing mental control-partially mediated the association between PTSD symptoms and suicidal ideation (SPS suicidal ideation subscale). Taken together, these findings suggest that maladaptive interpretations of cognitive distress may represent a clinically relevant target for reducing suicide risk in trauma-exposed refugee populations. In contrast, avoidance and heightened awareness of bodily sensations may function as temporary protective strategies in the context of overwhelming stress. Overall, the findings underscore the importance of trauma-informed interventions that prioritize suicide stabilization in forcibly displaced individuals prior to the initiation of PTSD-focused treatment.