Correlates of Health-Related Quality of Life Among Forcibly Displaced Adults from Nagorno-Karabakh

Abstract Background In 2023, the entire population of Nagorno-Karabakh (NK) was forcibly displaced to Armenia following a military assault and a preceding blockade. Displacement, trauma, and disrupted daily life may affect health-related quality of life (HRQoL). This study examined socio-demographic and psychosocial correlates of HRQoL among displaced adults from NK. Methods In early 2025, a household survey was conducted among 188 adults (≥18) from 106 households in the Masis community of the Ararat province, Armenia. We used structured interviewer- and self-administered questionnaires capturing socio-demographics, self-reported health status, mental health variables, social support, resilience, and service access. HRQoL was measured using the EQ-5D index. Multivariable linear regression with backward stepwise selection was applied to identify independent correlates of HRQoL. Results Participants had a mean age of 45 years; 71.0% were women, and 73.9% resided in rural areas. The average EQ-5D score was 0.70 (SD = 0.21). In multivariable analysis (adjusted R²=0.37), lower HRQoL was correlated with fair (β= -0.141, p = 0.003) and poor (β= -0.351, p < 0.001) self-reported health (vs. excellent/good), rural residence (vs. urban) (β= -0.083, p = 0.023), and vocational education (vs. no/school ≤12 years) (β= -0.087, p = 0.017). Receiving more emotional support (β = +0.0048, p = 0.005) and greater resilience (β = +0.0056, p = 0.012) were positively associated with HRQoL, while receiving tangible support was negatively associated (β= -0.0047, p = 0.003). Conclusions Self-reported health status, types of social support, resilience, place of residence, and education level were significantly correlated with HRQoL among forcibly displaced adults. Strengthening emotional support and promoting resilience may improve wellbeing. Addressing these factors through targeted interventions and community-centered approaches could help mitigate the adverse effects of displacement and support better HRQoL. Key messages • Displaced people with poorer health, lower education, and rural residence may need more support to improve their quality of life. • Building emotional support and resilience can help improve wellbeing among people affected by forced displacement.