Intergenerational Relationships of Childhood War Exposure, Mental Health, and Care Utilization in Offspring of Lebanese Immigrants

Lebanese Americans, the largest Arab ethnic group in the United States, remain underrepresented in mental health research despite collective exposure to conflict, displacement, and immigration histories. This study examined the intergenerational association of parental childhood war exposure (CWE) during the Lebanese Civil War (1975–1990) on the mental health of second-generation Lebanese American young adults (G1), as well as the prevalence of clinical threshold symptoms and care utilization in G1s. Using community-partnered recruitment, 92 G1 participants reported on their own adverse childhood experiences (ACEs), psychiatric symptoms, past mental health service use, and their 184 immigrant parents’ (G0) duration of CWE. G1s showed high levels of clinical range psychopathology: 48.9% for depression, 44.6% for anxiety, and 22.8% for PTSD, with 58.7% meeting criteria for at least one internalizing disorder. Females had significantly higher anxiety (mean GAD-7 = 9.7 vs. 7.5; p = .04) and PTSD symptoms (mean PCL-5 = 25.9 vs. 18.1; p < .01), while males reported greater nicotine use symptoms (mean = 1.2 vs. 0.5; p = .01). G0 maternal CWE duration was associated with G1 depression (ρ = .24; p = .023) and PTSD (ρ = .22; p = .037); G0 paternal CWE was associated with nicotine use (ρ = .21; p = .047). Only 25.9% of G1s with clinical threshold symptoms accessed care in the past year. This first empirical investigation of mental health in Lebanese Americans highlights distinct maternal and paternal patterns between parental exposures and child mental symptoms, and striking gaps in care utilization.