Prevalence of depression, anxiety and post-traumatic stress disorder among international medical students from conflict zones versus non-conflict areas: a cross-sectional study

BACKGROUND: International medical students face elevated risks of depression, anxiety, post-traumatic stress disorder (PTSD; characterized by re-experiencing, avoidance, and a sense of threat per ICD-11), and complex PTSD (C-PTSD; encompassing core PTSD symptoms alongside disturbances in self-organization, including emotion dysregulation, negative self-concept, and relationship difficulties). This study aims to determine the prevalence of these conditions among students at Ain Shams University (n = 310) and to compare those from conflict-affected regions with those from non-conflict regions. METHODS: This analytical cross-sectional survey (October 2024-January 2025) employed the Depression, Anxiety, and Stress 21 Scale (DASS-21) and the International Trauma Questionnaire (ITQ). Statistical significance was set at p < 0.05. RESULTS: Students experienced a high symptom burden: 36.5% had extremely severe depression, 42.3% had extremely severe anxiety, and 18.4% had extremely severe stress. PTSD was identified in 18.4% of students, while C-PTSD was identified in 21.5%. Students from conflict-affected regions exhibited significantly higher rates across all outcomes compared with non-conflict peers (depression, anxiety, stress, PTSD, and C-PTSD: all p < 0.05). CONCLUSION: International medical students, particularly from conflict-affected areas, exhibit substantial mental health problems. The prevalence of C-PTSD (21.5%) exceeded that of PTSD (18.4%), underscoring chronic trauma impact. Targeted interventions-trauma-informed counseling, peer support, and resilience training-are urgently needed. Findings provide baseline data for the development of culturally sensitive mental health programs at Ain Shams University and similar institutions.