BackgroundrnBy the year 2020, depression is projected to be the second leading cause of disability and thernfourth leading contributor to the global burden of disease. Depression and post traumaticrnstress disorder (PTSD) are among the commonest mental health problems in refugeerncommunities. Studies have shown that exposure to traumatic events refugees encountered inrnthe pre-migration, during exile and post-migration periods are associated with symptoms ofrnPTSD and depression in refugee populations. There were inconclusive findings from previousrnstudies that have looked into the differential predictive significance of trauma related factors,rnparticularly that of exposure to in pre-migration and post-migration traumatic experiencesrnwith symptoms of PTSD and depression among refugees. More importantly, there is no arnrebust study that investigated the significance of association between trauma related andrnsocio-demographic factors as predictors of psychological symptoms in Eritrean refugeesrnliving in Ethiopia. Despite the fact that there are several studies on detection of depression inrnthe community using different measures, valid depression measure adapted in Eritreanrnculture for Eritrean community in humanitarian settings does not exist. In this regard, thernlatent factor structure (symptom presentation) for most measures of depression in many lowrnincome countries, particularly in almost all African countries, is not well understood rnAlthough there is abundant literature and theoretical basis on the co-morbidity of PTSD andrndepression in people affected by trauma, the extent of symptom co-variance and overlaprnbetween the two frequently reported forms of psychological symptoms by refugees (PTSDrnand depression) is not well known particularly in our study population. rnMental health research is also increasingly focusing on the importance of investigatingrnresilience in dealing with risk factors for mental health problems, such as personal copingrnstyles and sense of coherence in people who are vulnerable for mental health problems inrnhumanitarian crisis. Although extensive studies on the topic of resilience and sense ofrncoherence were carried out among Eritreans in humanitarian settings, empirical adaptation rnstudies on resilience measures and their validity were not given due attention. There is nornquantitative evidence to confirm the psychometric properties of resilience measures inrnEritrean refugees living in Ethiopia to date. rnThere is also increasing concern on the co-morbidity of alcohol misuse with other mentalrnhealth problems in refugee population in the context of humanitarian settings (refugee rnxivrn camps). Indeed, the current study tried to investigate the relationship between theory drivenrnrisk and protective factors with mental health concerns of refugees (depression, PTSD andrnalcohol misuse) in Eritrean refugees living in Mai Aini refugee camp. rnObjectives: The objectives of this study are to: (a) identify which socio- demographic and rntrauma related factors are associated with PTSD and depression; (b) explore the direct,rnmediating and moderating effects of traumatic events on PTSD and depression; (c)rndetermine the psychometric properties of measures employed in the study; (d) determine thernstructural relationship between exposure to cumulative trauma and poor mental healthrn(indicated by co morbid symptoms of depression, PTSD and alcohol misuse). rnMethods: Cross-sectional study was conducted. In the survey, 562 adults were randomlyrnselected from Eritrean refugees living in Mai Aini camp, Ethiopia. Center for EpidemilogicrnStudies Depression (CES-D) scale, Post-Migration Living Difficulties checklist, PrimaryrnCare PTSD screener (PC-PTSD), Oslo Social Support Scale (OSS-3), Sense of CoherencernScale (SoC-13), Coping Style scale and Fast Alcohol Screening Test (FAST) werernadministered concurrently. rnData were analyzed using multiple linear regression modeling, path analysis andrnmultivariable logistic regression model. In order to estimate the structural relationshiprnbetween exposure to trauma, risk and protective factors (as mediating factors), and co morbid rnmental health outcomes (indicated by PTSD, depression and alcohol misuse), StructuralrnEquation Modeling (SEM) was employed. SEM was also employed to identify thernpercentage of variance explaining common latent factors by the three outcomes of mentalrnhealth concerns in refugees (PTSD, depression and alcohol misuse). It was also used tornestimate symptom co-variance between symptoms of PTSD and depression. In order to testrnthe factor structure of measures used in the present study, Confirmatory Factor Analysisrn(CFA) was carried out. rnResults rnPTSD and depression symptoms did not vary across major demographic variables withrnrespect to gender, age and marital status. Exposure to pre-migration trauma was associatedrnsignificantly both with increased symptoms of PTSD (Î² =0.11, p