Global Health Institute, American University of Beirut, Beirut, Lebanon.
NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK.
Global Health. 2020 Mar 30;16(1):28. doi: 10.1186/s12992-020-00556-5.
Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility.
A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees' community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified.
Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available.
Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.
黎巴嫩的心理健康和心理社会问题的可用证据有限。最近的定量数据表明，叙利亚难民及其黎巴嫩收容社区的发病率很高，这两个群体都存在显著的治疗差距。本研究旨在确定黎巴嫩收容社区和叙利亚难民社区如何看待心理健康，并确定在两个脆弱性背景下寻求健康的行为和获得健康的障碍。
采用比较定性研究设计，对黎巴嫩收容社区和叙利亚难民社区的 36 名成员进行了总共 36 次半结构化访谈，随后进行了一系列四次参与式群体模型构建 (GMB) 会议。参与者是从两个不同的脆弱性背景下招募的：贝鲁特和贝卡地区。在这些会议中，引出了因果关系图，描述了促使心理健康和心理社会问题发生的因素的共同理解；还确定了寻求健康的行为、途径以及影响健康改善和维持的因素。
两个环境中的社区成员对促成心理健康的因素有类似的看法。参与者指出，长期暴露于战争、冲突的政治和社会影响以及家庭层面的经济限制是促使心理健康和心理社会压力产生的诱发因素。性别和社区之间的融合相关挑战被确定为影响疾病发作和相关护理寻求的因素。寻求健康的途径被发现是由信任、亲人的建议和支持以及确保受影响个人的保密性来塑造的。讨论中的反复出现的主题强调了获得医疗保健的主要障碍，包括从正规医疗系统中寻求医疗保健的时间显著延迟、普遍的社会耻辱感、昂贵的服务费用、缺乏健康保险、对心理健康服务可用性的认识有限以及对现有服务质量的信任有限。
心理健康和心理社会支持策略需要具有性别和融合意识，主要侧重于疾病预防和提高认识，以加强寻求健康的行为。
