The invisible wounds of war: a study of insomnia and psychological distress among healthcare students in conflict-affected Syria

Abstract Background Medical students globally face high rates of depression, anxiety, and burnout, exacerbated by stressful academic environments and recent crises like the COVID-19 pandemic. This is particularly critical in conflict-affected regions like Syria, where psychological support is limited. This study aims to investigate the prevalence and impact of these mental health issues among healthcare students in such challenging contexts. Methods This cross-sectional study surveyed 507 healthcare students (medicine, dentistry, pharmacy) at the University of Kalamoon between June 26 and July 24, 2025. Data were collected using the Insomnia Severity Index (ISI) and the Depression, Anxiety, and Stress Scale (DASS‑21). Statistical analysis was performed using SPSS with Mann‑Whitney U and Kruskal‑Wallis H tests. Results Subthreshold insomnia (44.8%), moderate depression (26.2%), and extremely severe anxiety (24.9%) were common in the sample. Female students reported significantly higher anxiety (p = 0.033). Pharmacy students demonstrated the highest levels of depression, anxiety, stress, and insomnia (p-values = 0.001 to 0.042). Low income was significantly associated with elevated depression and insomnia (p = 0.026, p = 0.022). Overall, the direction of associations showed that female gender, pharmacy faculty, low income, and prior psychiatric history were linked to worse psychological outcomes. Conclusion Our findings underscore the urgent need for more comprehensive, broader, and multicenter studies, both at the level of Syrian universities and the Middle East as a whole, to gain a deeper understanding of students’ mental health and the factors influencing it. In addition, there is an urgent need for preventive and therapeutic psychological interventions, including counseling, psychological support, and health education.