The Association of Conflict-Related Trauma with Markers of Mental Health Among Syrian Refugee Women: The Role of Social Support and Post-Traumatic Growth

Abstract

Background: Syrian refugee women not only suffered the refuging journey but also faced the burden of being the heads of their households in a new community. We aimed to investigate the mental health status, traumatic history, social support, and post-traumatic growth (PTG) of Syrian refugee women. Methods: A cross-sectional study was conducted using a structured interviewer-administered survey between August and November 2019. Syrian refugee women who head their households and live outside camps were eligible. The survey included items investigating socio-demographic characteristics and conflict-related physical trauma history. The Refugee Health Screener-15 (RHS-15) scale was used to screen for emotional distress symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD), with a score range of 0−4 and higher scores indicating emotional distress. The Multidimensional Scale of Perceived Social Support (MSPSS) was utilized to assess the perceived support from family, friends, and significant others (score range 1−7), with scores of 3−5 and 5.1−7.0 representing moderate and high support, respectively. The PTG Inventory (PTGI) scale investigated the positive transformation following trauma; the score range was 0−5, and the cutoff point of ≥3 defined moderate-to-high growth levels. Results: Out of 140 invited refugee women, 95 were included, with a response rate of 67.9%. Their mean (SD) age was 41.30 (11.75) years, 50.5% were widowed, and 17.9% reported their husbands as missing persons. High levels of conflict-related traumatic exposure were found, including threats of personal death (94.7%), physical injury (92.6%), or both (92.6%); and a history of family member death (92.6%), missing (71.6%), or injury (53.7%). The mean (SD) RHS-15 score was above average (2.08 (0.46)), and most women (90.5%) were at high risk for depression, anxiety, and PTSD symptoms. The mean (SD) MSPSS score was 5.08 (0.71), representing moderate social support, with friends' support being the highest (5.23 (0.85)). The mean (SD) PTGI score was 2.44 (0.48), indicating low growth, with only 12.6% of women experiencing moderate-to-high growth levels. Spiritual change and personal strength had the highest sub-scores, with moderate-to-high growth levels experienced by 97.9% and 84.2%, respectively. Most women were more optimistic and religious, had feelings of self-reliance and better difficulties adapting, and were stronger than they thought. Statistically significant correlations of MSPSS and its subscales with RHS-15 and PTGI were detected. Conclusion: Significant but unspoken mental health problems were highly prevalent among Syrian refugee women and an imminent need for psychological support to overcome traumatic exposure. The role of social support seems to be prominent and needs further investigation.

War trauma and strategies for coping with stress among Ukrainian refugees staying in Poland

“…The conducted analyses indicate that gender and command of Polish have impact on mental health disorders measured with the use of RHS-15. Women scored higher on the scale of mental health disorders, which had also been observed in numerous similar studies (Schlaudt, 2020;Kheirallah et al, 2022). To a certain extent, high scores obtained by women may result from the fact that upon leaving Ukraine they had to cope with a change in gender roles and thus became exposed to the loss of social status (Yuzva, 2023).…”

“…What is also surprising is that praying has no protective effect in the case of the researched group. The positive impact of prayer was observed in the study carried out among Syrian (Kheirallah et al, 2022) and Ukrainian refugees (Oviedo et al, 2022). Spirituality has a crucial role in coping with war trauma.…”

“…(from 39% to 51%) was observed by Schlaudt et al (2020). On the basis of these comparisons, it may be claimed that high levels of mental health disorders are observed among the refugees who flee the countries amid war, such as Syria, Iraq, or Afghanistan (Borho et al, 2022;Kheirallah et al, 2022). On the other hand, lower levels of mental health disorders were recorded among refugees from the countries where military operations were not taking place, such as Cuba, Somalia, or Burma (Polcher, Calloway, 2016, Bosson et al,2015Schlaudt, 2020).…”

Mental health consequences among Sudanese due to the armed conflicts and civil unrest of 2023: a cross-sectional study

“…The findings from Kheirallah et al (2022) focused on female refugees from Syria living in Jordan, showing that a significant proportion of respondents displayed symptoms of distress and scored positively on measures of mental health issues. This highlights the specific vulnerabilities faced by women in war-affected populations.…”

‘Now I Have Dreams in Place of the Nightmares’: An Updated Systematic Review of Post-Traumatic Growth Among Refugee Populations

“…The finding that refugee women experience higher levels of PTG is supported by the broader literature, with Vishnevsky et al (2010) proposing that women are more likely than men to engage in behaviors that facilitate PTG, such as ruminative thinking and emotion-focused coping. However, findings from the broader literature also suggest that refugee women experience unique gender-related trauma and adjustment challenges that worsen their physical and mental anguish (Kheirallah et al, 2022), with Vallejo-Martín et al (2021) highlighting the unmet need for psychosocial health care in this population. Future research is needed to investigate the distinct traumatic experiences of refugee men and women, and the complex ways in which these experiences may facilitate, or hinder, PTG.…”