Psychological distress, PTSD, and complex PTSD in a war-torn population: a two-wave longitudinal study among medical...

Since October 2023, civilians in Gaza have endured prolonged military assaults, repeated displacement, and the collapse of essential services-conditions that impose severe, cumulative psychological trauma. Medical students constitute a particularly vulnerable civilian subgroup, balancing personal insecurity with clinical and academic duties amid war. This study examined how prolonged war exposure affects psychological distress and post-traumatic stress disorder (PTSD) and explored the prevalence and predictors of Complex PTSD (CPTSD) among medical students in Gaza.

We conducted a longitudinal study involving 74 medical students in Gaza across two time points (June 2024 and May 2025). Participants, enrolled in one of two local medical schools, completed validated Arabic versions of the Depression, Anxiety, and Stress Scale (DASS-21), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ). Changes in psychological symptoms over time were assessed using paired sample t-tests. Repeated-measures ANOVA was used to assess whether changes differed by gender, and multiple linear regression was used to identify predictors of CPTSD at the second screening in 2025.

Significant changes were observed over time in displacement patterns and trauma exposure, with both forced migration and the number of traumatic events increasing markedly (p < 0.001). Although some reductions in symptom scores were observed, psychological distress and trauma-related symptoms remained high. Sixty-two (83.8%) and 56 (75.7%) of participants met the cutoff criteria for PTSD (PCL-5 instrument) in 2024 and 2025, respectively. In 2025, 39% of participants met ICD-11 criteria for PTSD (ITQ instrument), 19% met criteria for complex PTSD (CPTSD), and 28.4% reported disturbances in self-organization. Additionally, 64%, 43%, and 43% of participants reported severe to extremely severe levels of depression, anxiety, and stress, respectively, in 2025. Females consistently reported higher levels of distress across all domains, although changes over time did not significantly differ by gender. PTSD symptom severity in 2025 was the only significant predictor of CPTSD (β = 0.485, p < 0.001) in a model explaining 79% of the variance in CPTSD scores (R² = 0.806), while trauma exposure and general psychological distress were not significant predictors.

Although general psychological symptoms showed modest improvement, the persistently high rates of PTSD and the emergence of complex PTSD underscore the long-term mental health effects of prolonged conflict in Gaza. These findings underscore the need to prioritize trauma-informed mental health interventions for Gaza's medical students-a group essential to the region's future healthcare system-addressing not only acute distress but also the cumulative effects of chronic trauma on identity, self-regulation, and functioning.