Mental health and psychosocial wellbeing of Syrians affected by armed conflict

Abstract

Aims. This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.Methods. We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.Results. Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.Conclusions. Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.

Resilience and Mental Health Risks among Syrian Refugees in Europe: A Cultural Perspective

“…Although these symptoms are found to be prevalent, some studies remarked high levels of resilience among this particular refugee group and suggested that such manifestations do not necessarily indicate psychopathology (e.g. posttraumatic stress disorder, depression), unless they cause intense distress and functional impairment [15]. Congruently, a growing number of research emphasize the importance of the establishment of the interventions that promote such resiliency in coping with distress among Syrian refugees [16].…”

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

“…Refugees are at considerable risk of developing symptoms of common mental disorders including depression, anxiety, posttraumatic stress disorder (PTSD) and related somatic health symptoms (de Jong, Komproe, & Van Ommeren, 2003; Fazel, Wheeler, & Danesh, 2005; Hassan, Ventevogel, Jefee-Bahloul, Barkil-Oteo, & Kirmayer, 2016; Steel et al, 2009). Epidemiological studies indicate that the age-standardized point prevalence of PTSD and major depression in conflict-affected populations is estimated to be 12.9% and 7.6%, respectively (Charlson et al, 2016).…”

“…As a comparison, it has been estimated that approximately 4.4% of the world population suffers from major depression (WHO, 2017) and 3.3% from PTSD (Stein et al, 2014). Although good epidemiological data on psychosis is lacking, it is also likely that psychotic symptoms in Syrians have increased (Hassan et al, 2016; Hijazi & Weissbecker, 2015). Child refugees may be especially at risk of developing emotional and behavioural problems, with one study of Syrian refugee children in Turkey reporting that nearly half show clinically significant levels of anxiety and withdrawal (Cartwright, El-Khani, Subryan, & Calam, 2015).…”

“…Further, refugees themselves often lack knowledge about existing treatment possibilities (Maier & Straub, 2011), which may be the result of a lack of culturally appropriate information about the available services (Fassaert et al, 2009). Refugees, in common with many in the general population, may distrust mental health care, or avoid visiting mental health care practitioners because of shame, embarrassment or fear of rejection by family or friends and being labelled ‘mad’ or ‘crazy’ (Hassan et al, 2016). …”

The assessment of psychopathology among traumatized refugees: measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups

“…The consequent influx of refugees in Europe (UNHCR, 2015) is currently dominating the news and the political debate. War experiences, persecution, hunger, loss of loved ones, a long and unsafe journey, and settlement in refugee camps all take their mental and physical toll (de Jong, Komproe, & Van Ommeren, 2003; Hassan, Ventevogel, Jefee-Bahloul, Barkil-Oteo, & Kirmayer, 2016). The resulting long- and short-term mental health and psychosocial consequences are many and varied, and a proportion of refugees seek health care for these mental health problems in their host country (de Jong, 2002; de Jong, Komproe, & Van Ommeren, 2003; Hassan et al, 2016).…”