Mental health profiles and resilience among medical students in an active conflict zone: a cluster analysis.

BACKGROUND

Medical students globally face elevated mental health risks, yet those in conflict-affected regions experience compounded stressors. Lebanon's overlapping crises offer a unique context for examining resilience under conditions of extreme stress. This study aims to 1) evaluate depression, anxiety, resilience, and stress levels among medical students, 2) identify anxiety‒depression clusters, and 3) assess predictors such as demographics or resilience associated with each cluster.

METHODS

We conducted a cross-sectional survey of medical students at a Lebanese medical school between December 2024 and March 2025. Validated instruments assessed anxiety (GAD-7), depression (PHQ-9), perceived stress (PSS-10), and resilience (BRS). Clusters of anxiety and depression were identified, then bivariate and multivariable analyses were performed with the clusters being the dependent variable. An alpha of 0.05 was considered statistically significant.

RESULTS

A total of 187 students participated in this survey. At least mild to moderate symptoms of anxiety and depression were found at 77% and 80% of the participants, with 33% reporting high perceived stress and 26% low resilience. Three distinct clusters were identified, the 'high-risk group', the 'medium-risk group', and the 'low-risk group'. Common factors significantly associated with the 'high-risk group' or 'medium-risk group' included smoking, experiencing social isolation and high perceived stress. Being engaged in regular extracurricular activities (adjusted OR (95% CI) = 0.04 (0.004; 0.41), p = 0.006) was associated with lower odds of belonging to the 'high-risk group'; while having a high resilience level (0.06 (0.006; 0.61); p = 0.02) was associated with lower odds, and exercising irregularly (3.96 (1.24; 12.7); p = 0.02) with higher odds of belonging to the 'medium-risk group'.

CONCLUSION

Medical students in this conflict-affected region experience alarming levels of anxiety, depression, and stress, yet resilience provides a degree of protection. Tailored, risk-based interventions combined with stress-management, resilience training, and healthy lifestyle habits are essential. Further longitudinal research is needed to assess long-term impacts.