Anxiety and lifestyle behaviors among Lebanese university students during armed conflict: a cross-sectional study

Political instability and armed conflict impose substantial psychological and behavioral challenges on young adults. University students may experience heightened anxiety alongside disruptions in eating behaviors (EB) and physical activity (PA) during periods of active conflict. This study aimed to examine the associations between anxiety, EB, PA and conflict-related strain among Lebanese university students exposed to war-induced stressors, and to identify the main factors associated with anxiety. A cross-sectional study was conducted among 401 students (mean age = 21 ± 2.2 years) during the most recent armed conflict in Lebanon (September- December 2024). Participants were recruited via snowball sampling from multiple Lebanese universities through an online survey diffused on social media platforms. Validated instruments were used, including the Generalized Anxiety Disorder-7 (GAD-7) scale, the short version of the International Physical Activity Questionnaire (IPAQ-SF), and an adapted EB questionnaire. Additional questions assessed sociodemographic, anthropometric measurements, conflict-related stressors, lifestyle changes and other relevant factors. Clinically significant anxiety (GAD-7 ≥ 10) was observed in 43.6% of students and was more prevalent among females (p = 0.006). Anxiety was significantly associated with employment status (p = 0.014) and smoking status (p = 0.016), whereas EB, PA, and body mass index (BMI) showed no significant associations. In multivariable binary logistic regression, anxiety was associated with full-time employment (OR = 2.62; 95% CI: 1.20–5.73), direct exposure to bombings (OR = 2.77, 95% CI: 1.29–5.92), perceived academic functioning impairment (concentration or motivation) related to online classes (OR = 2.24, 95% CI: 1.00-4.99), stress-related changes in appetite (decreased appetite: OR = 3.63, 95% CI: 1.91–6.90; increased appetite: OR = 3.37, 95% CI: 1.88–6.04). Anxiety was highly prevalent among Lebanese university students during active conflict and was primarily associated with war-related stressors, contextual academic and occupational pressures rather than with EB, PA, or BMI. These findings highlight the importance of context-sensitive mental health support within university communities during periods of socio-political instability and educational disruption.