Statement of purpose Violence adversely impacts individuals’ mental health and contributes to the development of neuropsychiatric disorders. This study aims to assess the psychological state of the Syrian refugee population exposed to war-related violence and analyze their association with neuropsychiatric morbidity.

Methods/Approach In 2017, a refugee cohort in Lebanon completed the Harvard Trauma Questionnaire (HTQ), Post- Migration Living Difficulties Checklist (PMLDC), Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and the Depression and Anxiety Scale-21 Items (DAS-21). We performed multivariable logistic regressions to examine potential factors associated with long-term neuropsychiatric disorders.

Results Of the 220 refugees, 191 were eligible to participate, of whom 92.15% were exposed to at least one war-related violence. As for the neuropsychiatric morbidity, 64% met the cut-off point for PTSD diagnosis, while 62.8% and 64.4% suffered from moderate to extremely severe depression and anxiety, respectively. We identified war-related violence as the strongest predictor of PTSD (adjusted [OR] 1.16, 95% CI 1.07 – 1.26; p = 0.001) and of severe and extremely severe depression (OR 1.21, 95% CI 1.05 – 1.39; p < 0.01). Only higher anxiety levels were associated with post-migration living difficulties (OR 1.03, 95% CI 1.01 – 1.05; p < 0.0001). While lower educational attainment was a significant risk factor for all three neuropsychiatric disorders, being a male was a significant protective factor for both depression (OR 0.19, 95% CI 0.04 – 0.96; p < 0.05) and anxiety (OR 0.35, 95% CI 0.15 – 0.85; p < 0.05).

Conclusions War-related violence constitutes a major risk factor for multiple neuropsychiatric disorders. Identified prognostic factors include post-migration living difficulties, educational attainment, and gender.

Significance This study highlights the adverse impact of violence on individuals. Generated evidence should be adopted to develop and implement tailored psychological programs targeting refugees and displaced individuals.