Abstract
BACKGROUND: Research allowing the recognition of significant associations between post-traumatic stress disorder (PTSD) symptoms and psychotic experiences (PEs), and the identification of potential modifiable factors affecting their trajectories of co-occurrence is paramount for improving mental health of mental health of war victims. However, there remains a dearth of evidence regarding trauma, PTSD and psychosis in regions exposed to prolonged conflict and oppression. Our study aimed to: (1) investigate the direct bidirectional connections between PTSD symptoms and PEs in a sample of adults living in Gaza amidst the ongoing 2023-2024 war, and (2) test the roles of depression and anxiety symptoms as mediators in these connections. METHODS: The study was performed among adult civilians in Gaza during the month of September 2024. At the time of assessment, the study population has been enduring more than 11 months of mass violence, bombing, massacres and starvation. RESULTS: After adjusting for confounding variables, results indicated that depression and anxiety symptoms fully mediated the bidirectional relationship between PTSD symptoms and PEs. Specifically, Gazan participants reporting higher levels of PTSD symptoms also reported higher levels of anxiety/depression, which in turn was related to more severe PEs; and those who had greater PEs also displayed greater anxiety/depression, which in turn was related to higher levels of PTSD symptoms. It is noteworthy that PTSD was not directly associated with PEs in all models. CONCLUSION: The relationship between PTSD and PEs in extremely traumatizing environments seem to be complex. Our results highlight the crucial need for screening and early detection of one condition when the other is present, specifically in war-torn populations. The full mediation effect found may indicate the importance of depression/anxiety symptoms in reducing PEs in war-affected individuals with PTSD, and in alleviating PTSD symptoms in those experiencing PEs as well.