Multivariable analysis of health-related quality of life determinants among medical students at a Single Syrian University in a conflict-affected setting: a cross-sectional study using the Arabic SF-36

BACKGROUND: Health-related quality of life (HRQoL) among medical students is particularly vulnerable to academic stressors, especially in populations exposed to armed conflict. This study evaluated the internal consistency and construct validity of the Arabic version of the 36-Item Short Form Health Survey (SF-36) in a cohort of medical students at a single university in Syria and examined determinants of HRQoL during the Syrian civil war. METHODS: A cross-sectional survey was conducted among 181 of 300 medical students (60.3%) from the Faculty of Medicine at Aleppo University who attended continuing medical education sessions between September and November 2024. Self-administered questionnaires captured sociodemographic and clinical characteristics, Arabic SF-36 scores across eight domains, and the Physical Component Summary (PCS) and the Mental Component Summary (MCS). Reliability was assessed using Cronbach's α and composite reliability. Statistical associations were evaluated using t-tests, analysis of variance (ANOVA), and backward-elimination multivariable linear regression. RESULTS: Participants had a median age of 21 years (IQR: 20-22), with 63.5% male. Mean PCS scores (66.6 ± 18.5) were higher than mean MCS scores (55.9 ± 21.3), indicating relatively better physical than mental HRQoL. Among the eight SF‑36 domains, Bodily Pain (74.4 ± 24.3) and Role Physical (73.5 ± 36.9) showed the highest mean scores. Lower body mass index, higher religiosity, and absence of chronic conditions were associated with better HRQoL. In contrast, smoking and daily transport exceeding two hours were independently associated with lower mental domain scores (all p < 0.05). Cronbach's alpha coefficients ranged from 0.467 to 0.91. Four of the eight domains met the conventional reliability threshold of at least 0.70, while the PCS and MCS demonstrated strong internal consistency. CONCLUSIONS: The findings demonstrate that Syrian medical students at Aleppo University experience suboptimal mental HRQoL despite relatively preserved physical functioning. The Arabic SF‑36 showed acceptable overall reliability and appropriate structural correlations for the main summary components and core physical domains. However, several mental and general health domains exhibited lower item consistency. These psychometric characteristics should be considered when interpreting domain-level scores and when adapting the instrument for similar populations affected by conflict.