Anxiety-Depression Symptoms Mediate the Connections Between Nightmares to War and Psychotic Experiences Among Internally Displaced Lebanese Citizens During the 2025 Southern Lebanon Attacks.
Carla Hokayem, Georges Haddad, Mirna A. Fawaz, Rabih Hallit, Diana N. Malaeb, Sahar Obeid, Souheil Hallit, Feten Fekih Romdhane
International Journal of Social Psychiatry September 2026 DOI: 10.1177/00207640261433235 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional study Peer reviewed |
|---|---|
| Sample size | 249 |
| Population | Internally displaced Lebanese citizens during the 2025 southern Lebanon attack |
| Measures | Community Assessment of Psychic Experiences scale-9, Patient Health Questionnaire-4, Nightmares to War scale |
| Topics | Anxiety Depression Dreaming |
| Keywords | Lebanese Displaced citizens Nightmares to war Psychotic experiences |
| Key findings | War-related nightmares were directly associated with more psychotic experiences, and psychological distress partially mediated this association (indirect effect Beta = .07, Boot CI [0.01, 0.13]). Sensitivity analyses indicated anxiety, but not depression, played an indirect role (anxiety Beta = .07, CI [0.02, 0.13]; depression Beta = .03, CI [-0.01, 0.08]). |
Abstract
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. 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. 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. 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.
Comparable studies
Other cross-sectional and survey studies on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Insomnia Symptoms, Nightmares, and Suicidal Ideation in a College Student Sample Undergraduate students at a large, public university in the southeastern United States | 2011 | Observational cross-sectional survey | n = 583 |
| Prevalence and Correlates of Frequent Nightmares: A Community-Based 2-Phase Study Middle-aged Hong Kong Chinese adults from the community, mean age 40.9 years (SD 5.5,... | 2010 | Cross-sectional survey with subsequent clinical evaluation (two-phase design) | n = 8,558 |
| Factors of home dream recall: a structural equation model Adults (general population sample) | 2003 | Cross-sectional survey with structural equation modeling | n = 444 |
| The Phenomenology of Lucid Dreaming: An Online Survey Respondents to an online survey about lucid dreams | 2014 | Online survey | n = 684 |
| Frequency of Lucid Dreaming in a Representative German Sample Representative sample of German adults | 2011 | Cross-sectional survey | n = 919 |
Citations in the library
Cites 14
- Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda. Social Science & Medicine August 1, 2012
- Nightmares in Patients with Psychosis: The Relation with Sleep, Psychotic, Affective, and Cognitive Symptoms The Canadian Journal of Psychiatry August 1, 2015
- Emotion dysregulation mediates the relationship between nightmares and psychotic experiences: results from a student population Schizophrenia June 1, 2020
- Prevalence and Characteristics of Posttraumatic Nightmares in War- and Conflict-Affected Students Nature and Science of Sleep March 1, 2021
- Bad dream, nightmares and psychopathology: a systematic review Frontiers in Psychiatry October 8, 2024
and 9 more in the library