First Onset in Adulthood of Mental Disorders: Exposure to War vs. Non-war Childhood Adversities: A National Study

Elie Karam1, 2, 3, *, Josleen Al Barathie1, Dahlia Saab1, Aimee Nasser Karam1, 2, 3, #, John Fayyad1, 2, 3, ѱ
1 Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
2 Department of Psychiatry and Clinical Psychology, University of Balamand Faculty of Medicine, Beirut, Lebanon
3 Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 193
Abstract HTML Views: 127
PDF Downloads: 111
ePub Downloads: 77
Total Views/Downloads: 508
Unique Statistics:

Full-Text HTML Views: 109
Abstract HTML Views: 86
PDF Downloads: 90
ePub Downloads: 68
Total Views/Downloads: 353

Creative Commons License
© 2023 Karam et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Head Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Medical Institute for Neuropsychological Disorders (MIND), Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Saint George University of Beirut – SGUB, Chairman of the WPA Epidemiology and Public Health Section, 166227 Ashrafieh, Beirut, Lebanon 1100 2110; Tel: + (961) 1 583583; Fax: + (961) 1 587190; E-mail: author contributed equally to this workѱDeceased



There is evidence that some childhood trauma increases the risk of the first onset of mental disorders and for the first time into adulthood. There are no studies that assessed whether exposure to war has this delayed long-term effect.


To fill this gap by investigating the comparative roles of war and non-war trauma on the first onset of adulthood mood and anxiety disorders.


A nationally representative sample of 2,857 Lebanese was assessed using the World Health Organization Composite International Diagnostic Interview 3.0. with the onset of exposure to trauma and of first onset of mood and anxiety disorders.


Non-war childhood traumata especially those belonging to family malfunctioning continue to exert their effect for the first time well beyond their occurrence as they were the most universal predictors for adult onset of both mood and anxiety disorders. War trauma during childhood predicted mood anxiety and mood (anxiety only in males) only below age 18 y. war childhood trauma predicts the first onset of mood and anxiety disorders before age 18 y in females, but only anxiety in males.


Childhood traumata are not equal in predicting the first onset of mood and anxiety disorders into adulthood. Family malfunctioning looks to carry the longest such risk and war more of shorter immediate effects. This might change though with re-exposure to war in adulthood which might unravel dormant vulnerability.

Keywords: Mood disorders, Anxiety disorders, Adult-onset, War exposure, Childhood adversities, Trauma, Family malfunctioning.