Background: In recent decades entire populations have been living under chronic strain, apprehension and violence. This is the case for Palestinians. Despite the increased volume of mass media attention on this situation, little is known about the psychological effects of this condition on this population.

Aims: The study was designed to investigate the lifetime and one-month prevalence of major depression episode (MDE) in a multi-stage sample of 916 adult Palestinians drawn from the Al-Aqsa Intifada.

Methods: The survey was based on personal interviews and was carried out from February to September 2007. The clinical examination used DSM-IV criteria for the detection of MDE, extracted from SCID-I. Data, suicidal behaviour, previous help seeking, medication use and exposure to trauma were also collected.

Results: Lifetime and one-month prevalence of MDE was found to be 24.3% and 10.6%, respectively. Male Palestinians suffered from slightly higher rates of MDE than their female counterparts, but this difference was not statistically significant. Being widowed and living in towns in West Bank also increased the likelihood to develop MDE. A comparison of prevalence rates in refugee and non-refugee populations showed no significant differences. This could be explained by the fact that though refugees were forcibly displaced, they were living among compatriots (non-refugees), thus both groups were experiencing the same sociopolitical adversities. Being also exposed to traumatic events increased the risk of suffering from MDE.

Conclusions: This study provides evidence that a population under continuous strain and apprehension, living in unremitting socioeconomic deprivation, is more likely to suffer from major depression.