Premenstrual syndrome and its association with exposure to political violence, human insecurity, and well-being: a cross-sectional study among Palestinian adolescent refugees.

BACKGROUND: Premenstrual syndrome (PMS) is a common menstruation-related condition among adolescent girls. Vulnerability to environmental and social factors such as living under war, exposure to political violence (EPV), and human insecurity significantly influence the health and well-being of adolescents more generally. However, research on the association between PMS and social determinants in conflict settings remains limited. This study aimed to identify the severity of PMS and its association with EPV, human insecurity, and well-being among adolescent girls in Palestine refugee camps in the West Bank. METHODS: This cross-sectional study included 1,399 girls aged 15-18 years residing in 19 Palestinian refugee camps in the West Bank, occupied Palestinian territory. PMS severity was measured using a scale developed based on the literature, expert input, and the girls' experiences, comprising two categories: "none to mild" and "moderate to severe." EPV was assessed based on past experiences at individual, familial, collective, and cumulative levels. Multivariate analyses were conducted using five regression models with a primary focus on the relationship between PMS severity and EPV. RESULTS: The prevalence of PMS with at least one symptom was 92.1%. PMS severity was positively associated with collective EPV (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1-2.1), whereas individual and familial EPV were only significant when included separately in the model. Girls who experienced two or three types of cumulative EPV (AOR, 2.5; 95% CI, 1.6-3.7) were more likely to experience severe PMS. High levels of human insecurity (AOR, 1.3; 95% CI, 1.0-1.6) and depression-like symptoms (AOR, 1.9; 95% CI, 1.3-2.7) were significantly associated with PMS severity. CONCLUSIONS: The results demonstrate a significant association between PMS severity and EPV, human insecurity, and low levels of well-being. These findings suggest that prolonged occupation and unresolved conflict may adversely impact adolescent health and exacerbate PMS symptoms, highlighting the need to recognize PMS as a public health concern. In protracted conflict settings, integrating psychosocial support and menstrual health education into schools and community-based programs such as primary healthcare facilities may help adolescent girls manage PMS, menstruation-related symptoms, and associated stressors more effectively.