School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
BMC Womens Health. 2022 Jan 8;22(1):4. doi: 10.1186/s12905-021-01584-y.
The mental health of refugee women is often affected by multiple risk factors in their social ecology. Assessing these risk factors is foundational in determining potential areas for intervention. We used the social ecological model to examine risk factors associated with self-reported mental health symptoms among clinic-attending Syrian refugee women in Jordan. We hypothesize that individual (older age, unmarried, have more children under 18, difficulty reading/writing with ease), interpersonal (intimate partner violence [IPV]), community and societal level risk factors (greater number of postmigration stressors), will be associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms.
We surveyed 507 women using a cross-sectional clinic-based systematic sampling approach between April and November 2018. We used multivariable regressions to examine associations between different risk factors in the social ecology on depression, anxiety, and PTSD. Additional multivariable regressions explored associations between specific postmigration stressors and mental health conditions.
We found rates of depression among our sample to be 62.92%; anxiety 57.46%; and PTSD 66.21%. Our hypothesis was partially supported. At the individual level, age was directly associated with anxiety (aOR 1.04, 95% CI [1.02, 1.06]) and PTSD (aOR 1.03, 95% CI [1.01, 1.06]), while marriage decreased odds for depression (aOR 0.41, 95% CI [0.19, 0.92]) and PTSD (aOR 0.36, 95% CI [0.15, 0.87]). IPV was associated with depression (aOR 2.78, 95% CI [1.72, 4.47]); anxiety (aOR 3.30, 95% CI [2.06, 5.27]); and PTSD (aOR 5.49, 95% CI [3.09, 9.76]). Each additional community and societal risk factor (postmigration stressor) increased the odds for depression (aOR 1.32, 95% CI [1.22, 1.42]), anxiety (aOR 1.28, 95% CI [1.19, 1.39]), and PTSD (aOR 1.46, 95% CI [1.33, 1.60]).
Understanding social ecological risk factors associated with mental health conditions of Syrian refugee women is vital to addressing their mental health needs. IPV and postmigration stressors are consistently impactful with all mental health conditions. IPV resulted in the largest odds increase for all mental health conditions. Multilevel interventions are needed to address mental health risk factors at multiple levels of the social ecology.
难民女性的心理健康经常受到社会生态中多种风险因素的影响。评估这些风险因素是确定潜在干预领域的基础。我们使用社会生态模型来研究与在约旦就诊的叙利亚难民女性自报心理健康症状相关的风险因素。我们假设个体（年龄较大、未婚、有 18 岁以下的子女较多、读写困难）、人际关系（亲密伴侣暴力[IPV]）、社区和社会层面的风险因素（更多的移民后压力源）与抑郁、焦虑和创伤后应激障碍（PTSD）症状有关。
我们于 2018 年 4 月至 11 月期间采用基于诊所的横断面系统抽样方法对 507 名女性进行了调查。我们使用多变量回归来检查社会生态中不同风险因素与抑郁、焦虑和 PTSD 之间的关系。额外的多变量回归探讨了特定移民后压力源与心理健康状况之间的关系。
我们发现，我们样本中的抑郁发生率为 62.92%；焦虑为 57.46%；PTSD 为 66.21%。我们的假设得到了部分证实。在个体层面上，年龄与焦虑（aOR 1.04，95%CI [1.02，1.06]）和 PTSD（aOR 1.03，95%CI [1.01，1.06]）直接相关，而婚姻降低了抑郁（aOR 0.41，95%CI [0.19，0.92]）和 PTSD（aOR 0.36，95%CI [0.15，0.87]）的几率。IPV 与抑郁（aOR 2.78，95%CI [1.72，4.47]）、焦虑（aOR 3.30，95%CI [2.06，5.27]）和 PTSD（aOR 5.49，95%CI [3.09，9.76]）有关。每增加一个社区和社会层面的风险因素（移民后压力源），抑郁（aOR 1.32，95%CI [1.22，1.42]）、焦虑（aOR 1.28，95%CI [1.19，1.39]）和 PTSD（aOR 1.46，95%CI [1.33，1.60]）的几率都会增加。
了解与叙利亚难民女性心理健康状况相关的社会生态风险因素对于满足她们的心理健康需求至关重要。IPV 和移民后压力源与所有心理健康状况均有显著关联。IPV 导致所有心理健康状况的几率增加最大。需要多层次的干预措施来解决社会生态各个层面的心理健康风险因素。
