Maconick Lucy, Ansbro Éimhín, Ellithy Sara, Jobanputra Kiran, Tarawneh Mohammad, Roberts Bayard
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH UK.
Médecins sans Frontières, Amman, Jordan.
Confl Health. 2020 Sep 1;14:63. doi: 10.1186/s13031-020-00309-6. eCollection 2020.
The conflict in Syria has required humanitarian agencies to implement primary-level services for non-communicable diseases (NCDs) in Jordan, given the high NCD burden amongst Syrian refugees; and to integrate mental health and psychosocial support into NCD services given their comorbidity and treatment interactions. However, no studies have explored the mental health needs of Syrian NCD patients. This paper aims to examine the interaction between physical and mental health of patients with NCDs at a Médecins Sans Frontières (MSF) clinic in Irbid, Jordan, in the context of social suffering.
This qualitative study involved sixteen semi-structured interviews with Syrian refugee and Jordanian patients and two focus groups with Syrian refugees attending MSF's NCD services in Irbid, and eighteen semi-structured interviews with MSF clinical, managerial and administrative staff. These were conducted by research staff in August 2017 in Irbid, Amman and via Skype. Thematic analysis was used.
Respondents describe immense suffering and clearly perceived the interconnectedness of their physical wellbeing, mental health and social circumstances, in keeping with Kleinman's theory of social suffering. There was a 'disconnect' between staff and patients' perceptions of the potential role of the NCD and mental health service in alleviating this suffering. Possible explanations identified included respondent's low expectations of the ability of the service to impact on the root causes of their suffering, normalisation of distress, the prevailing biomedical view of mental ill-health among national clinicians and patients, and humanitarian actors' own cultural standpoints.
Syrian and Jordanian NCD patients recognise the psychological dimensions of their illness but may not utilize clinic-based humanitarian mental health and psychosocial support services. Humanitarian agencies must engage with NCD patients to elicit their needs and design culturally relevant services.
鉴于叙利亚难民中存在较高的非传染性疾病负担，叙利亚冲突促使各人道主义机构在约旦为非传染性疾病实施初级服务；鉴于精神健康与心理社会支持与非传染性疾病的合并症及治疗相互作用，还需将其纳入非传染性疾病服务之中。然而，尚无研究探讨叙利亚非传染性疾病患者的精神健康需求。本文旨在约旦伊尔比德的无国界医生组织诊所的背景下，考察社会苦难情境中非传染性疾病患者身心健康之间的相互作用。
这项定性研究包括对叙利亚难民和约旦患者进行16次半结构式访谈，以及对在伊尔比德参加无国界医生组织非传染性疾病服务的叙利亚难民进行2次焦点小组访谈，还包括对无国界医生组织临床、管理和行政人员进行18次半结构式访谈。这些访谈于2017年8月由研究人员在伊尔比德、安曼进行，并通过Skype进行。采用了主题分析法。
与克莱曼的社会苦难理论一致，受访者描述了巨大的苦难，并清楚地认识到他们的身体健康、精神健康和社会环境之间的相互联系。工作人员和患者对非传染性疾病和精神健康服务在减轻这种苦难方面的潜在作用的看法存在“脱节”。确定的可能解释包括受访者对该服务影响其苦难根源的能力期望较低、痛苦常态化、国家临床医生和患者中普遍存在的生物医学对精神疾病的看法，以及人道主义行为体自身的文化立场。
叙利亚和约旦的非传染性疾病患者认识到其疾病的心理层面，但可能不会利用基于诊所的人道主义精神健康和心理社会支持服务。人道主义机构必须与非传染性疾病患者接触，以了解他们的需求并设计与文化相关的服务。
