Sleep quality and the burden of PTSD and depression in a conflict-affected cohort: a cross-sectional study from Syria

Psychiatric morbidity is disproportionately high in conflict-affected populations. Sleep disturbance—manifesting as insomnia, nightmares, and fragmented sleep—appears to be a central, modifiable correlate of trauma-related psychopathology. We examined the association between sleep quality and the burden of post-traumatic stress disorder (PTSD) and depressive symptoms in adults living in conflict-affected regions. We analyzed data from N = 1,700 adults (18–79 years) collected at Tishreen Military Hospital and affiliated centers (April–October 2024). Sleep quality was captured as ordinal categories (Poor, Average, Good) derived at source from the Pittsburgh Sleep Quality Index (PSQI). PTSD and depression were stored in the analytic dataset as normalized 0–10 indices anchored to PCL-5 and PHQ-9 frameworks, respectively (not raw totals). Primary analyses included one-way ANOVA for PTSD across sleep categories and Pearson correlation between PTSD and depression. Mean age was 49.11 ± 18.05 years; sleep quality distribution: Poor (n = 666; 39.2%), Average (n = 681; 40.1%), Good (n = 353; 20.8%). The PTSD index differed markedly across sleep categories (F(2,1697) = 195.6, p < 0.001), with progressively lower PTSD burden from Poor → Average → Good sleep. The PTSD–depression association was small but significant (r≈0.15, p < 0.001). Descriptively, the PTSD index averaged 4.68 ± 1.73, and the depression index averaged 4.86 ± 1.87. In this large, conflict-context cohort, poorer sleep quality aligned with substantially higher PTSD symptom burden, while the PTSD–depression link was modest. Sleep health should be prioritized as a feasible, scalable target within multidisciplinary mental-health programming in conflict settings. Methodologically, inferences were aligned to data granularity (composite indices; ordinal PSQI), and no latent-variable SEM was attempted.