Ruhnke Simon A, Hertner Laura, Köhler Judith, Kluge Ulrike
Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
Berlin Institute for Empirical Integration and Migration Research, Humboldt Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany; Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Soc Sci Med. 2024 Apr;346:116700. doi: 10.1016/j.socscimed.2024.116700. Epub 2024 Feb 20.
Refugees are frequently shown to have worse mental health outcomes than non-displaced populations. This fact is commonly attributed to traumatic pre-displacement experiences. While important, the focus on trauma risks overlooking the role socioeconomic living-conditions in different arrival and transit contexts can play in determining refugees' mental distress. Building on the ecological model of refugee distress, we investigate how social ecological conditions relate to the mental distress of Syrians in Lebanon and Turkey. Both countries present important spaces of arrival and transit for millions of displaced Syrians, each with a specific historical, political, social and economic context.
The empirical analysis is based on data gathered in early 2021 in face-to-face surveys among displaced Syrians in Lebanon (N = 1127) and Turkey (N = 1364). Individual mental distress is evaluated using the Patient Health Questionnaire (PHQ-8) score as the dependent variable in a multivariate regression analysis.
Social ecological factors do not only differ in their extent of deprivation between Lebanon and Turkey. They also differ in their relationship with individual mental health outcomes. In Lebanon, limited access to the health care system and having family in the same city are major risk factors for elevated mental distress, whereas in Turkey, these are low education, poverty, unemployment as well as employment as day laborer. Discrimination and social isolation emerge as relevant predictors in both countries.
Based on this analysis, we argue that a context-specific understanding of mental distress amidst the social ecology refugees face in countries of refuge and transit is necessary. This approach needs to be pursued to provide adequate support and alleviate refugees' mental distress both, in the country of first refuge and after possible onward migration. In addition to clinical implications, the study particularly highlights the important role anti-discrimination and social inclusion policies could play in promoting refugee mental health.
研究表明，难民的心理健康状况往往比非流离失所人群更差。这一现象通常归因于流离失所前的创伤经历。虽然这很重要，但对创伤的关注忽略了社会经济生活条件在不同抵达和中转背景下对难民心理困扰的影响。基于难民困境的生态模型，我们研究社会生态条件与黎巴嫩和土耳其叙利亚人的心理困扰之间的关系。这两个国家都是数百万流离失所叙利亚人的重要抵达和中转地，各自有着特定的历史、政治、社会和经济背景。
实证分析基于2021年初对黎巴嫩（N = 1127）和土耳其（N = 1364）流离失所叙利亚人进行的面对面调查所收集的数据。在多元回归分析中，使用患者健康问卷（PHQ - 8）得分作为因变量来评估个体的心理困扰。
社会生态因素不仅在黎巴嫩和土耳其的匮乏程度上存在差异。它们与个体心理健康结果的关系也有所不同。在黎巴嫩，获得医疗保健系统的机会有限以及家人在同一城市是心理困扰加剧的主要风险因素，而在土耳其，这些因素是低教育水平、贫困、失业以及日工就业情况。歧视和社会孤立在两国都是相关的预测因素。
基于此分析，我们认为有必要在难民在避难和中转国家所面临的社会生态背景下，对心理困扰有针对性地进行理解。需要采取这种方法，以便在首个避难国以及可能的后续迁移后，提供充分的支持并减轻难民的心理困扰。除了临床意义外，该研究特别强调了反歧视和社会包容政策在促进难民心理健康方面可能发挥的重要作用。
