War Exposure, Psychosocial Stress, and Immune Dysregulation: A Retrospective Population-Based Study in Conflict-Affected Southern Yemen

Project Overview This research investigates the biological embedding of war trauma by examining associations between conflict exposure, psychosocial distress, and immune-inflammatory dysregulation among adults in active conflict zones of Southern Yemen. Using a retrospective population-based design with 1,500 participants, we demonstrate that war exposure creates measurable physiological alterations through stress-mediated pathways, contributing to both mental health burden and somatic disease. Key Findings · Strong dose-response relationships between war exposure severity and PTSD/depression/anxiety symptoms · Significant immune dysregulation with elevated NLR, PLR, ESR, and CRP levels in high-exposure groups · PTSD mediates 46.7% of the effect of war exposure on systemic inflammation · High-risk subgroup (25%) identified with co-occurring severe PTSD, marked inflammation, and anemia (87.7% prevalence) · Sequential pathway established: War Exposure → PTSD → Inflammation → Anemia Methodological Strengths · Sample: 1,500 adults from 11 conflict-affected districts in Southern Yemen (2022-2025) · Design: Retrospective population-based study using routinely collected clinical/laboratory data · Exposure assessment: Multidimensional war exposure index (displacement, injury, loss, livelihood damage) · Psychometric measures: PCL-5 (PTSD), PHQ-9 (depression), GAD-7 (anxiety) with Arabic validation · Biological markers: NLR, PLR, CRP (standard assay), ESR, hemoglobin, anemia status · Statistical rigor: Multivariable regression, path analysis (SEM), cluster analysis, survival analysis, comprehensive sensitivity testing · Transparency: Complete analysis code, validation procedures, and reproducibility measures Scientific and Humanitarian Significance This study provides: 1. First large-scale evidence from an active conflict zone linking war trauma to objective immune dysregulation 2. Mechanistic understanding of how psychological trauma becomes biologically embedded 3. Practical biomarkers (NLR, PLR, CRP) feasible for low-resource humanitarian settings 4. Clinical implications for integrated mental-physical health interventions in conflict zones 5. Policy relevance for humanitarian health responses in Yemen and similar contexts