Mental Health Self-Stigma of Syrian Refugees With Posttraumatic Stress Symptoms: Investigating Sociodemographic and Psychopathological Correlates

Abstract

Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self , Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t = 2.65, p = 0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma (β = 0.18, p = 0.044), controlling for sociodemographic covariates.Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.

Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people

“…Moreover, the majority of participants came from Syria (53.7%) and were male (72.4%). This distribution is similar to the general population of forcibly displaced people in Germany and common for current samples in this research area (Bär et al, 2021 ; Lindheimer et al, 2020 ). Even though, in the present sample and previous research (Livingston & Boyd, 2010 ), no gender differences in self-stigma were found, gender differences in help seeking are a common finding (Maguen et al, 2012 ; Marshall et al, 2006 ).…”

Stigmatizing attitudes towards depression among university students in Syria

“…In each result, we attempted to investigated enough similar papers with close questionnaires, and discussed the similarities and the differences. However, we did not discuss studies that involved Syrians in asylum countries [ 32 , 33 ].…”

“…In the perceived stigma subscales, respondents were asked their beliefs about most of the other people’s attitudes toward people with depression symptoms described in the vignette (e.g., “Most people believe that people with depression could snap out of it if they wanted”). The response of each item was measured on a five-point scale ranging from “strongly agree” to “strongly disagree” [ 32 ]. The Chinese version of the scale has been widely used with good reliability and validity [ 38 ].…”

“…By checking the literature, we found no similar studies in Syria that assess the stigma among the population toward mental health patients. However, some studies have followed post-traumatic self-stigmitizing Syrians in asylum countries [ 32 , 33 ]. Similar studies have taken part in Arab countries like Saudi, Lebanon, and Oman [ 34 – 36 ].…”

Attitude of Syrian students toward GAD patients: An online cross-sectional study

“…Toward the end of the study, it was concluded that since these students were highly-aware of the dynamics of both these illnesses, they had significantly lower personal stigmas for either of these conditions. Overall, this study helped promote that increased planned campaigning toward reducing stigmas plays a more significant role in eliminating the presence of social stigmas regarding these mental health disorders ( 37 ). Stigmas have always posed significant challenges and risks to the population that is considered the target audience here: people suffering from GAD.…”