Intergenerational Associations of Childhood War Exposure, Adverse Childhood Experiences, and Mental Health 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. This study examined intergenerational associations 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) and characterized G1 clinical symptoms and service use. Using community-partnered recruitment, 92 G1 (mean age 28.1 years, SD 4.5) participants reported on their own adverse childhood experiences (ACEs), psychiatric symptoms, past mental health service use, and duration of CWE in their 184 immigrant parents (G0; mean maternal and paternal ages 54.6 and 58.7 years, respectively). G1s showed high levels of clinical range psychopathology: 48.9% for depression, 44.6% for anxiety, and 22.5% 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 = 0.04) and PTSD symptoms (mean PCL-5 = 26.3 vs. 15.5; p < 0.01), while males reported greater nicotine use symptoms (mean 1.2 vs. 0.5; p = 0.01). Maternal CWE duration was associated with G1 depression (ρ = 0.24; p = 0.023) and PTSD (ρ = 0.22; p = 0.037); Paternal CWE was associated with G1 nicotine use (ρ = 0.21; p = 0.047). These results remained largely consistent after controlling for G1 ACEs. Only 25.9% of G1s with clinical threshold symptoms accessed care in the past year. Findings highlight distinct maternal and paternal intergenerational patterns and major gaps in service use.