{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:05:45Z","timestamp":1789200345280,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Beyond direct trauma, armed conflicts generate cumulative structural losses, including repeated displacement, housing destruction and economic collapse. Although prior research has linked trauma exposure to impaired quality of life (QoL), the pathways through which cumulative war\u2010related losses affect domain\u2010specific QoL remain underexamined. We conducted a cross\u2010sectional survey in August 2025 among 894 adults across the Gaza Strip. Participants completed the Arabic WHOQOL\u2010BREF and the PHQ\u20104, and QoL domain scores were transformed to a 0\u2013100 scale. Multivariable linear regression identified independent predictors of overall and domain\u2010specific QoL, and mediation analyses assessed whether psychological distress mediated the associations between cumulative resource loss (housing damage, forced relocations and loss of income source) and QoL outcomes. QoL scores were markedly low across domains, particularly in the environmental (mean: 25.91) and psychological (mean: 35.60) domains, with an overall QoL mean of 37.46. Psychological distress was highly prevalent (mean PHQ\u20104\u2009=\u20096.9), with 94.3% scoring above the normal range, 64.9% screening positive for probable anxiety and 65.5% for probable depression. In multivariable models, psychological distress was the strongest and most consistent predictor of reduced QoL across all domains (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    range: \u22121.67 to \u22122.28 per 1\u2010point increase in PHQ\u20104; all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Forced relocations were independently associated with lower QoL across all four domains, whereas housing destruction and income loss showed domain\u2010specific effects, particularly on psychological and environmental QoL. Mediation analyses showed that psychological distress partially mediated the association between cumulative resource loss and QoL, accounting for 26% of the association with overall QoL and 29%\u201341% of the association with domain\u2010specific outcomes, indicating both direct structural and indirect mental health pathways. QoL impairment during the current war in Gaza appears more severe than previously documented in the area and lower than that reported in other recent conflict settings. Cumulative resource loss has both direct and indirect effects on QoL, with psychological distress serving as a key explanatory pathway. Integrated humanitarian responses that address both structural restoration and scalable mental health interventions are urgently needed.\n                  <\/jats:p>","DOI":"10.1002\/cpp.70338","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:11:02Z","timestamp":1789197062000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cumulative War\u2010Related Resource Loss and Multidimensional Quality of Life in Gaza: The Mediating Role of Psychological Distress"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-4039","authenticated-orcid":false,"given":"Belal","family":"Aldabbour","sequence":"first","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7247-9524","authenticated-orcid":false,"given":"Alaa E.","family":"Elshafee","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed E.","family":"Hammad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Abdaljaber","family":"Alkhaldi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahia Maher","family":"Mezied","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Z.","family":"Alshaikhali","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tareq A.","family":"Mkadmh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan Ahmed","family":"Abudan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Tammem","family":"Alaqad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awad Mohammed","family":"Alnjjar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud Fares","family":"Attaallah","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Islamic University of Gaza  Gaza State of Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latefa Ali","family":"Dardas","sequence":"additional","affiliation":[{"name":"Deanship of Scientific Research The University of Jordan  Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1007\/s00787-026-02964-1","article-title":"Mechanisms of Risk and Resilience Among War\u2010Affected Adolescents in Gaza: The Mediating Role of Posttraumatic Stress and the Moderating Role of Prosocial Behavior","volume":"35","author":"Aldabbour B.","year":"2026","journal-title":"European Child & Adolescent Psychiatry"},{"issue":"1","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1186\/s40359-024-02188-5","article-title":"Psychological Impacts of the Gaza War on Palestinian Young Adults: A Cross\u2010Sectional Study of Depression, Anxiety, Stress, and PTSD Symptoms","volume":"12","author":"Aldabbour B.","year":"2024","journal-title":"BMC Psychology"},{"key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s13034-026-01024-5","article-title":"Trauma and Mental Health Burden of Gaza's Displaced Children During War: A Cross\u2010Sectional Study","volume":"20","author":"Aldabbour B.","year":"2026","journal-title":"Child and Adolescent Psychiatry and Mental Health"},{"issue":"1","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-025-13423-z","article-title":"Quality of Life Among Healthcare Workers in Gaza During the October 7 War: A Cross\u2010Sectional Analysis","volume":"25","author":"Aldabbour B.","year":"2025","journal-title":"BMC Health Services Research"},{"key":"e_1_2_14_6_1","doi-asserted-by":"crossref","DOI":"10.1177\/24705470251334943","article-title":"The Psychological Toll of War and Forced Displacement in Gaza: A Study on Anxiety, PTSD, and Depression","volume":"9","author":"Aldabbour B.","year":"2025","journal-title":"Chronic Stress"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s41983-026-01067-7","article-title":"Trauma, Environmental Insecurity, and Coping Strategies as Determinants of Sleep Disturbances Among Adults in Gaza During Wartime","volume":"62","author":"Aldabbour B.","year":"2026","journal-title":"Egyptian Journal of Neurology, Psychiatry and Neurosurgery"},{"key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12914-015-0064-9","article-title":"Long\u2010Term Mental Health of War\u2010Refugees: A Systematic Literature Review","volume":"15","author":"Bogic M.","year":"2015","journal-title":"BMC International Health and Human Rights"},{"issue":"3","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/JNR.0000000000000146","article-title":"The Reliability and Validity of the Arabic World Health Organization Quality of Life\u2010BREF Instrument Among Family Caregivers of Relatives With Psychiatric Illnesses in Jordan","volume":"25","author":"Dalky H. F.","year":"2017","journal-title":"Journal of Nursing Research"},{"issue":"1","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/smi.2513","article-title":"Coping Strategies as Mediators and Moderators Between Stress and Quality of Life Among Parents of Children With Autistic Disorder","volume":"31","author":"Dardas L. A.","year":"2015","journal-title":"Stress and Health"},{"issue":"1","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-025-00655-3","article-title":"Healthcare Accessibility, Utilization, and Quality of Life Among Internally Displaced People During the Sudan War: A Cross\u2010Sectional Study","volume":"19","author":"Elmukashfi ShamsEldin Elobied H.","year":"2025","journal-title":"Conflict and Health"},{"issue":"9","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"2371","DOI":"10.1007\/s11136-013-0386-9","article-title":"Quality of Life, Human Insecurity, and Distress Among Palestinians in the Gaza Strip Before and After the Winter 2008\u20102009 Israeli War","volume":"22","author":"Hammoudeh W.","year":"2013","journal-title":"Quality of Life Research"},{"key":"e_1_2_14_13_1","article-title":"The Gaza Conflict and Its Implications for the Sustainable Development Goals: A Comprehensive Analysis","author":"Hassoun A.","year":"2025","journal-title":"Environment, Development and Sustainability"},{"key":"e_1_2_14_14_1","unstructured":"Human Rights Watch.2024. \u201c\u201cHopeless Starving and Besieged\u201d Israel's Forced Displacement of Palestinians in Gaza.\u201d 14\/11\/2024."},{"issue":"2","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1521\/soco.1989.7.2.113","article-title":"Assumptive Worlds and the Stress of Traumatic Events: Applications of the Schema Construct","volume":"7","author":"Janoff\u2010Bulman R.","year":"1989","journal-title":"Social Cognition"},{"issue":"6","key":"e_1_2_14_16_1","first-page":"613","article-title":"An Ultra\u2010Brief Screening Scale for Anxiety and Depression: The PHQ\u20104","volume":"50","author":"Kroenke K.","year":"2009","journal-title":"Psychosomatics"},{"issue":"1","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.47470\/0016-9900-2023-102-1-88-92","article-title":"Analysis of the Quality of Life in the Population Living Under Post\u2010War Conditions","volume":"102","author":"Mardiyan M. A.","year":"2023","journal-title":"Hygiene and Sanitation"},{"key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1186\/1471-2458-13-624","article-title":"Subjective Quality of Life in War\u2010Affected Populations","volume":"13","author":"Matanov A.","year":"2013","journal-title":"BMC Public Health"},{"issue":"1","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.socscimed.2009.09.029","article-title":"War Exposure, Daily Stressors, and Mental Health in Conflict and Post\u2010Conflict Settings: Bridging the Divide Between Trauma\u2010Focused and Psychosocial Frameworks","volume":"70","author":"Miller K. E.","year":"2010","journal-title":"Social Science & Medicine"},{"issue":"2","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/0256-4947.51790","article-title":"The Reliability and Validity of the Short Version of the WHO Quality of Life Instrument in an Arab General Population","volume":"29","author":"Ohaeri J. U.","year":"2009","journal-title":"Annals of Saudi Medicine"},{"issue":"4","key":"e_1_2_14_21_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ahr.2021.100040","article-title":"Assessment of Full and Subsyndromal PTSD and Quality of Life of Internally Displaced Older Adults in Northern Nigeria","volume":"1","author":"Ojeahere M. I.","year":"2021","journal-title":"Aging and Health Research"},{"issue":"12","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0244730","article-title":"The 10\u2010Year Course of Mental Health, Quality of Life, and Exile Life Functioning in Traumatized Refugees From Treatment Start","volume":"15","author":"Opaas M.","year":"2021","journal-title":"PLoS ONE"},{"issue":"2","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1177\/002214650504600206","article-title":"Stress, Health, and the Life Course: Some Conceptual Perspectives*","volume":"46","author":"Pearlin L. I.","year":"2005","journal-title":"Journal of Health and Social Behavior"},{"issue":"5","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jama.294.5.602","article-title":"Predisplacement and Postdisplacement Factors Associated With Mental Health of Refugees and Internally Displaced Persons: A Meta\u2010Analysis","volume":"294","author":"Porter M.","year":"2005","journal-title":"Journal of the American Medical Association"},{"issue":"6","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1176\/appi.ajp.162.6.1171","article-title":"Quality\u2010of\u2010Life Impairment in Depressive and Anxiety Disorders","volume":"162","author":"Rapaport M. H.","year":"2005","journal-title":"American Journal of Psychiatry"},{"issue":"5","key":"e_1_2_14_26_1","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jama.2009.1132","article-title":"Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta\u2010Analysis","volume":"302","author":"Steel Z.","year":"2009","journal-title":"Journal of the American Medical Association"},{"key":"e_1_2_14_27_1","doi-asserted-by":"crossref","first-page":"360","DOI":"10.2307\/2137325","article-title":"Lifetime Traumas and Mental Health: The Significance of Cumulative Adversity","volume":"36","author":"Turner R. J.","year":"1995","journal-title":"Journal of Health and Social Behavior"},{"key":"e_1_2_14_28_1","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs.2025. \u201cHumanitarian Situation Update #317\u2014Gaza Strip.\u201d New York United Nations 2025\/08\/28."},{"key":"e_1_2_14_29_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.psychres.2024.116056","article-title":"Associations Between Mental Health Symptoms, Trauma, Quality of Life and Coping in Adults Living in Ukraine: A Cross\u2010Sectional Study a Year After the 2022 Russian Invasion","volume":"339","author":"Wang S.","year":"2022","journal-title":"Psychiatry Research"},{"issue":"1","key":"e_1_2_14_30_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s40359-025-02386-9","article-title":"Quality of Life Among Healthcare Workers in the Hospitals and Primary Healthcare Centers in Gaza Strip: A Cross\u2010Sectional Study","volume":"13","author":"Younis J.","year":"2025","journal-title":"BMC Psychol"}],"container-title":["Clinical Psychology &amp; Psychotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpp.70338","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cpp.70338","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cpp.70338","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T07:11:06Z","timestamp":1789197066000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cpp.70338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/cpp.70338"],"URL":"https:\/\/doi.org\/10.1002\/cpp.70338","archive":["Portico"],"relation":{},"ISSN":["1063-3995","1099-0879"],"issn-type":[{"value":"1063-3995","type":"print"},{"value":"1099-0879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-05-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70338"}}