Chronic War-Related Psychological Distress and Immune-Mediated Anaemia in Conflict-Affected Children: A Dose-Response Mediation Analysis from Southern Yemen

This project repository contains all data, materials, and analysis code for the study titled "Chronic War-Related Psychological Distress and Immune-Mediated Anaemia in Conflict-Affected Children: A Dose-Response Mediation Analysis from Southern Yemen." Study Overview: This community-based analytical cross-sectional study investigated the biopsychosocial pathway linking war-related psychological distress to anaemia among 600 children (aged 6-59 months) in conflict-affected districts of southern Yemen. The primary objectives were to: 1) examine the dose-response relationship between psychological distress severity and haemoglobin levels, 2) assess the mediating role of systemic inflammation (C-reactive protein), and 3) evaluate effect modification by displacement status and household food insecurity. Key Findings: The study demonstrates a robust, graded association between psychological distress and anaemia, with systemic inflammation mediating approximately one-third of this relationship. Internally displaced and severely food-insecure children showed disproportionately steeper declines in haemoglobin per unit increase in distress. Repository Contents: · Data: · File_S1_Deidentified_Dataset.csv: The complete, de-identified dataset for all 600 participants. · Code: · File_S2_Complete_Statistical_Analysis_Code.R: The full R script used for all statistical analyses, including data cleaning, regression models, mediation analysis (PROCESS macro), latent class analysis, and generation of all figures and tables. · Materials: · File_S3_Ethical_Approvals_Consent_Forms.docx: Full ethical approval certificates, informed consent documents, child assent scripts, and data security protocols from Radfan College University, Lahej, Yemen (IRB Ref: YEM-IRB-2025-097). · File_S4_Assessment_Tools_Questionnaires.docx: All study instruments, including the validated Arabic versions of the Child PTSD Symptom Scale (CPSS-5), Preschool Feelings Checklist (PFC), Household Food Insecurity Access Scale (HFIAS), and full demographic questionnaire. · File_S5_Supplementary_Tables.docx: Complete set of supplementary tables (S1-S12). · File_S6_S7_S8_Protocol_Manuals_Plan.docx: Integrated document containing the study protocol (S6), field training manual (S7), and pre-analysis plan (S8). · File_S10_Observational_Studies_Checklists.docx: Completed reporting checklists (STROBE, RECORD, CONSORT Extension, etc.). Usage Notes: All data are fully de-identified. The analysis code is commented and reproducible. We encourage use of these materials for replication, educational purposes, or secondary analysis in accordance with the provided CC-BY 4.0 license.