War's psychological legacy: a study of mental health challenges among children and adolescents in Azerbaijan after the second Karabakh War.

As a result of the Second Karabakh War in 2020, a significant number of children and adolescents in Azerbaijan experienced severe psycho-emotional difficulties, including post-traumatic stress disorder (PTSD), anxiety, and depression. This mixed-method longitudinal study aimed to comprehensively assess levels of anxiety, depression, and PTSD among children and adolescents in the affected regions of Azerbaijan, and to evaluate the effectiveness of psychological support interventions across three sequential phases from 2020 to 2023. Psycho-emotional status was assessed through clinical interviews, behavioral observations, and standardized questionnaires (State-Trait Anxiety Inventory, Beck Depression Inventory-II, PTSD Checklist for DSM-5-PCL-5, and CATS, parent version). All instruments were used in validated Azerbaijani versions. The study covered 2,400 participants aged 5-16 years. Findings revealed high levels of anxiety (65%), depression (40%), and PTSD (70%), with adolescents aged 12-14 being the most affected (depression prevalence reaching 50%). Girls reported higher anxiety levels than boys (70% vs. 60%). Intervention programs-including art therapy, group sessions, and parental training-were associated with a significant reduction in anxiety (65%) and depressive symptoms (40%) (p < 0.05). This is the first large-scale empirical study in Azerbaijan to address post-war mental health in children and adolescents, emphasizing the importance of long-term psychological support and integrated rehabilitation in post-conflict settings.