{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T07:41:53Z","timestamp":1792395713854,"version":"4.4.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Somatization, the physical manifestation of emotional and psychological distress, is a prevalent issue in populations exposed to war and trauma. War\u2010related nightmares are common among displaced individuals and are linked to depression, anxiety, and somatization. Yet, the indirect role of depression\u2010anxiety in the association between war\u2010related nightmares and somatization remains underexplored, particularly in the Lebanese context during the 2024\u20132025 war. This study aimed to examine whether war\u2010related nightmares were associated with somatization both directly and indirectly through anxiety and depression considered simultaneously as parallel mediators among a sample of displaced Lebanese adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross\u2010sectional study enrolled 294 displaced Lebanese adults (mean age 25.4 years; 72.1% female) through a convenience and snowball sampling technique (October 2024\u2013March 2025) that made this study prone to selection bias. A parallel indirect\u2010effect analysis was conducted using SPSS version 27 and PROCESS macro version 5.0, Model 4, with anxiety and depression entered simultaneously as parallel mediators. The model was adjusted for gender, occupation, and number of bombing exposures, and indirect effects were estimated using 5000 percentile\u2010bootstrap samples.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A significant total indirect association between war\u2010related nightmares and somatization through anxiety and depression was observed (indirect effect:\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.14; Bootstrapped Standard Error\u2009=\u20090.04; Bootstrapped 95% Confidence Interval [0.07, 0.21]). The specific indirect association through depression was significant (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.07; BootSE\u2009=\u20090.04; 95% Bootstrapped Confidence Interval [0.01; 0.15]), whereas the specific indirect association through anxiety was not significant (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.06; BootSE\u2009=\u20090.04; 95% Bootstrapped Confidence Interval [\u22120.01; 0.14]). More frequent war\u2010related nightmares were significantly associated with higher anxiety (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.13; SE\u2009=\u20090.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 95% Confidence Interval [0.10, 0.16]) and higher depression (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.12; SE\u2009=\u20090.01,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 95% Confidence Interval [0.09, 0.15]). When both mediators were entered simultaneously, depression was significantly associated with higher somatization (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.58; SE\u2009=\u20090.28,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040; 95% Confidence Interval [0.03, 1.14]), whereas anxiety was not independently associated with somatization (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.50; SE\u2009=\u20090.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.088; 95% Confidence Interval [\u22120.07, 1.06]). War\u2010related nightmares remained directly associated with somatization after accounting for both mediators (\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.42; SE\u2009=\u20090.06,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 95% Confidence Interval [0.30, 0.55]). The total association between war\u2010related nightmares and somatization was\n                      <jats:italic>B<\/jats:italic>\n                      \u2009=\u20090.56 (SE\u2009=\u20090.06\n                      <jats:italic>p\u2009<\/jats:italic>\n                      &lt;\u20090.001; 95% Confidence Interval 0.45, 0.67).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>War\u2010related nightmares were associated with somatization both directly and indirectly through anxiety and depression collectively among a sample of displaced Lebanese adults. The specific indirect association through depression was significant, whereas the specific indirect association through anxiety was not. Although findings should be interpreted within the context of interrelated trauma symptoms and the cross\u2010sectional design, which precludes temporal or causal conclusions, these results suggest a need for integrated mental health interventions addressing war\u2010related nightmares, anxiety, depression, and somatic symptoms in war\u2010affected populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73350","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:29:21Z","timestamp":1791440961000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct and Indirect Associations Between War\u2010Related Nightmares, Anxiety\u2010Depression Symptoms, and Somatization in a Sample of Displaced Lebanese Adults During the 2024\u20132025 Lebanese War: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"given":"Naya","family":"Saadeh","sequence":"first","affiliation":[{"name":"School of Medicine and Medical Sciences Holy Spirit University of Kaslik Jounieh Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1623-6061","authenticated-orcid":false,"given":"Elie","family":"Atallah","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences Holy Spirit University of Kaslik Jounieh Lebanon"},{"name":"Department of Psychiatry Bellevue Medical Center Mansourieh Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2058-8572","authenticated-orcid":false,"given":"Mirna","family":"Fawaz","sequence":"additional","affiliation":[{"name":"College of Health Sciences American University of the Middle East Kuwait Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabih","family":"Hallit","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences Holy Spirit University of Kaslik Jounieh Lebanon"},{"name":"Department of Infectious Disease Bellevue Medical Center Mansourieh Lebanon"},{"name":"Department of Infectious Disease Notre Dame des Secours University Hospital Byblos Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2436-850X","authenticated-orcid":false,"given":"Diana","family":"Malaeb","sequence":"additional","affiliation":[{"name":"College of Pharmacy Gulf Medical University Ajman United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-5689","authenticated-orcid":false,"given":"Souheil","family":"Hallit","sequence":"additional","affiliation":[{"name":"School of Medicine and Medical Sciences Holy Spirit University of Kaslik Jounieh Lebanon"},{"name":"Applied Science Research Center Applied Science Private University Amman Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2569-8017","authenticated-orcid":false,"given":"Feten","family":"Fekih\u2010Romdhane","sequence":"additional","affiliation":[{"name":"The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry \u201cIbn Omrane\u201d Razi hospital Manouba Tunisia"},{"name":"Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0735-4704","authenticated-orcid":false,"given":"Sahar","family":"Obeid","sequence":"additional","affiliation":[{"name":"Department of Psychology and Education, School of Arts and Sciences Lebanese American University Jbeil Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000288013"},{"key":"e_1_2_12_3_1","volume-title":"StatPearls","author":"D'Souza R. 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