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Assaf SA, Nuwayhid I, Habib RR. A conceptual framework on pre- and post-displacement stressors: the case of Syrian refugees. Front Public Health 2024; 12:1372334. [PMID: 38737863 PMCID: PMC11082271 DOI: 10.3389/fpubh.2024.1372334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Researchers have documented multiple stressors and mental health problems along the journey of refugees as they are displaced to seek refuge in nearby and remote host countries. This article examines published research on Syrian refugees to propose a framework to conceptualize Syrian refugees' pre- and post-stressors and their collective impact on their mental health. The proposed framework provides a comprehensive understanding of the interconnected pathways between pre-displacement stressors, post-displacement stressors, and mental health outcomes for Syrian refugees. Pre-displacement stressors are best captured by the concept of trauma centrality and emotional suppression. Post-displacement stressors, categorized under financial, political, and social themes, have a direct impact on the mental health of the refugees, but could also play a partial mediating role on the impact of pre-displacement stressors on mental health. The framework suggests a direct pathway between the experience of war-related traumatic events and mental health and introduces the country of residence as a potential moderator of the severity of mental health. The latter is primarily influenced by local policies and the host communities' acceptance of refugees. We believe that the proposed framework can guide the work of researchers, policymakers, and practitioners concerned with the mental health and well-being of Syrian refugees. Additionally, although based on the experience of Syrian refugees, it presents a holistic perspective that could be adapted in other refugee settings.
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Affiliation(s)
- Sara A. Assaf
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rima R. Habib
- Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Somasundaram D, Jayasuriya R, Perera R, Thamotharampillai U, Wickremasinghe R, Tay AK. Effect of daily stressors and collective efficacy on post-traumatic stress symptoms among internally displaced persons in post-war northern Sri Lanka. BJPsych Open 2023; 9:e180. [PMID: 37818719 PMCID: PMC10594160 DOI: 10.1192/bjo.2023.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Daily stressors have been shown to mediate the relationship of war trauma and trauma-related distress among refugees and internally displaced persons exposed to war and conflict. AIMS To examine the extent to which the relationship between war-related trauma and mental distress was mediated by daily stressors and collective efficacy among internally displaced communities a decade after exposure to war. METHOD In a cross-sectional study, we recruited a random sample of residents in villages severely affected by conflict in five districts in the Northern Province of Sri Lanka. Measures of war trauma, daily stressors, collective efficacy and post-traumatic stress symptoms (PTSS) were examined. Statistical analyses of the mediating and moderating effects of daily stressors were conducted using regression based methods. RESULTS Daily stressors mediated the association of war trauma and PTSS, as both paths of the indirect effect, war trauma to daily stressors and daily stressors to PTSS, were significant. The predictive effect of war trauma on PTSS was positive and significant at moderate and high levels of daily stressors but not at low levels. Higher levels of neighbourhood informal social control, a component of collective efficacy, function as a protective factor to reduce effects of war trauma and daily stressors on mental distress in this population. CONCLUSIONS Daily stressors are an important mediator in the well-established relationship between war exposure and traumatic stress among internally displaced persons, even a decade after the conflict. Mental health and psychosocial support programmes that aim to address mental distress among war-affected communities could reduce daily stressors and enhance collective efficacy in this context.
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Affiliation(s)
| | - Rohan Jayasuriya
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Ruwanthi Perera
- Department of Rogavijnana, Faculty of Indigenous Medicine, Gampaha Wickramarachchi University of Indigenous Medicine, Yakkala, Sri Lanka
| | | | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Alvin Kuowei Tay
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
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Habib RR, Katrib RS, Katrib FS, Abi Younes E, Ziadee M, Al Barathie J. Mistreatment at work and musculoskeletal pain in male and female working Syrian refugee children. ERGONOMICS 2022; 65:1469-1476. [PMID: 35348432 DOI: 10.1080/00140139.2022.2051610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/25/2022] [Indexed: 06/14/2023]
Abstract
Since the Syrian war in 2011, Syrian refugees in Lebanon have continued to experience socioeconomic deprivation, resorting many families to child labour as a form of survival. Adopting a gender-sensitive analysis, this study explores the relationship between psychosocial adversities and musculoskeletal pain among male and female Syrian refugee children in Lebanon, using data from a cross-sectional survey of working Syrian refugee children between 8 and 18 years in informal tented settlements in the Bekaa Valley of Lebanon. The majority of working children (4090) worked in agriculture (75.8%). Of the children who experienced musculoskeletal pain, 27.4% worked despite severe pain, three-quarters of the children worked under time pressure, over a third (37.4%) were physically abused at work, and the majority (95.8%) had a good relationship with their co-workers. Logistic regression models revealed a significant association between exposure to psychosocial stressors at work and musculoskeletal pain among male and female children.Practitioner summary: This study is the first to obtain direct testimony on musculoskeletal pain and psychosocial risk factors, among Syrian refugee children in Lebanon. Using a gender-sensitive analysis, the survey results demonstrated associations between exposure to psychosocial stressors and musculoskeletal pain among male/female Syrian refugee children enduring strenuous working conditions.
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Affiliation(s)
- Rima R Habib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Reem S Katrib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah S Katrib
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elio Abi Younes
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Micheline Ziadee
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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van Sint Fiet A, de la Rie S, van der Aa N, Bloemen E, Wind T. The relevance of social capital and sense of coherence for mental health of refugees. SSM Popul Health 2022; 20:101267. [PMID: 36281249 PMCID: PMC9587331 DOI: 10.1016/j.ssmph.2022.101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Migration puts refugees in a completely new social context when simultaneously some have to deal with previously experienced traumatic events and post-migration stressors. Social capital and sense of coherence could be key resources to improve mental health of refugees. This study aims to examine the interplay between social capital (structural and cognitive), sense of coherence and mental health of refugees in the Netherlands. Objective The present study was conducted to i) examine if social capital (structural and cognitive) and mental health are related in a population of Dutch refugees, and ii) test if sense of coherence has a moderating and/or a mediating effect on this relation. Method Data were collected through questionnaires (n = 154) in a cross-sectional survey at different locations throughout the Netherlands. The data were analysed with multiple regression analyses and nonparametric bootstrapping using SPSS. Results Social capital (structural and cognitive) was positively related to mental health. In addition a positive relation between sense of coherence and mental health of refugees was found. The relationship between cognitive social capital and mental health was completely mediated by sense of coherence. No moderation effect of sense of coherence on the relation between social capital and mental health was found. Conclusions The current study contributed to understanding the social mechanism that determines refugee mental health: participating in social groups (structural social capital) and having supportive and trusting relationships (cognitive social capital), whilst experiencing life as comprehensible, manageable, and meaningful (sense of coherence) are positively related to better mental health of refugees. Findings indicate that preventive interventions aiming to enhance refugees' mental health may be more effective when targeting and promoting both social capital and sense of coherence, from a relatively early stage after arrival in the Netherlands. Structural and cognitive social capital are positively related to mental health of refugees. A positive relation is found between sense of coherence and mental health of refugees. Sense of coherence mediates this relation between cognitive social capital and mental health. Including resiliency factors and strengthening social mechanisms may create more effective mental health interventions.
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Affiliation(s)
- Antoine van Sint Fiet
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
- Corresponding author. Arq Centrum ’45, Nienoord 5, 1112 XE Diemen, the Netherlands.
| | - Simone de la Rie
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Niels van der Aa
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
| | - Evert Bloemen
- Pharos, Dutch Centre of Expertise on Health Disparities, Arthur van Schendelstraat 600, 3511 MJ, Utrecht, the Netherlands
| | - Tim Wind
- ARQ National Psychotrauma Center, Nienoord 5, 1112 XE, Diemen, the Netherlands
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Jones N, Baird S, Abu Hamad B, Bhutta ZA, Oakley E, Shah M, Sajdi J, Yount KM. Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic. PLoS One 2022; 17:e0261773. [PMID: 35108293 PMCID: PMC8809558 DOI: 10.1371/journal.pone.0261773] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/10/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience. METHODS Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable Jordanians, living in camps, host communities and informal tented settlements. We utilize mixed-methods analysis combining multivariate regression with deductive qualitative tools to evaluate pandemic impacts and associated policy responses on adolescent wellbeing and mental health, at three and nine months after the pandemic onset. We also explore the role of support systems at individual, household, community, and policy levels. FINDINGS We find the pandemic has resulted in severe economic and service disruptions with far-reaching and heterogenous effects on adolescent wellbeing. Nine months into the pandemic, 19.3% of adolescents in the sample presented with symptoms of moderate-to severe depression, with small signs of improvement (3.2 percentage points [pp], p<0.001). Two thirds of adolescents reported household stress had increased during the pandemic, especially for Syrian adolescents in host communities (10.7pp higher than any other group, p<0.001). Social connectedness was particularly low for girls, who were 13.4 percentage points (p<0.001) more likely than boys to have had no interaction with friends in the past 7 days. Adolescent programming shows signs of being protective, particularly for girls, who were 8.8 percentage points (p<0.01) more likely to have a trusted friend than their peers who were not participating in programming. CONCLUSIONS Pre-existing social inequalities among refugee adolescents affected by forced displacement have been compounded during the COVID-19 pandemic, with related disruptions to services and social networks. To achieve Sustainable Development Goal targets to support healthy and empowered development in adolescence and early adulthood requires interventions that target the urgent needs of the most vulnerable adolescents while addressing population-level root causes and determinants of psychosocial wellbeing and resilience for all adolescent girls and boys.
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Affiliation(s)
- Nicola Jones
- Gender and Adolescence: Global Evidence (GAGE), ODI, London, United Kingdom
| | - Sarah Baird
- Department of Global Health, George Washington University, Washington, DC., United States of America
| | - Bassam Abu Hamad
- Department of Public Health, Al Quds University, Gaza, State of Palestine
| | - Zulfiqar A. Bhutta
- Department of Nutritional Sciences, Hospital for Sick Children, Toronto, Canada
- Aga Khan University, Karachi, Pakistan
| | - Erin Oakley
- Department of Global Health, George Washington University, Washington, DC., United States of America
| | - Manisha Shah
- Luskin School of Public Affairs, University of California, Los Angeles, CA, United States of America
| | - Jude Sajdi
- Information and Research Center, King Hussein Foundation, Amman, Jordan
| | - Kathryn M. Yount
- Department of Global Health, Emory University, Atlanta, GA, United States of America
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Villalonga-Olives E, Wind T, Armand A, Yirefu M, Smith R, Aldrich D. Social capital based mental health interventions for refugees: A systematic review. Soc Sci Med 2022; 301:114787. [DOI: 10.1016/j.socscimed.2022.114787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/15/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
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Slone M, Peer A. Children's Reactions to War, Armed Conflict and Displacement: Resilience in a Social Climate of Support. Curr Psychiatry Rep 2021; 23:76. [PMID: 34613521 DOI: 10.1007/s11920-021-01283-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this review was to unravel recent evidence for children's reactions to war and armed conflict focusing on resilience factors mitigating adverse psychological and psychiatric consequences. RECENT FINDINGS Three categories of mitigating resilience factors emerged from the literature - personal, family, and community factors. In addition, a unifying model of moderating resilience factors emerged, proposing a higher-tier environmental dimension conceptualized here as social climate of support. Wars and armed conflict affect children both by direct exposure to threats, and by disruption of the social fabric supporting development. The notion of producing a climate of social support can direct policy toward service provision and resilience-based programs that both build individual capacities and encompass development of the resources of families, schools, community, and societal structures supportive of children's adjustment and wellbeing. Future research should shift toward systems thinking within a socio-ecological nesting of individual, familial, community, and societal systems.
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Affiliation(s)
- Michelle Slone
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel.
| | - Ayelet Peer
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
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Habib RR, Mikati D, Al-Barathie J, Abi Younes E, Jawad M, El Asmar K, Ziadee M. Work-related injuries among Syrian refugee child workers in the Bekaa Valley of Lebanon: A gender-sensitive analysis. PLoS One 2021; 16:e0257330. [PMID: 34543313 PMCID: PMC8452013 DOI: 10.1371/journal.pone.0257330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Syrian refugees in Lebanon have endured increasing hardships since the onset of the Syrian war in 2011, with many resorting to child labor. Working refugee children endure socioeconomic deprivation and harsh working conditions. This study explores the relationship between working conditions and the reporting of injuries among male and female Syrian refugee children in Lebanon and the related gender differences. Methods and findings A cross-sectional survey of Syrian refugee children working in the Bekaa Valley of Lebanon was conducted in 2017. Face-to-face interviews with children (8 to 18 years) collected sociodemographic information and testimonies of their work experiences. Logistic regression tested the association between reporting of injuries and risk factors including school enrolment, field of work, means of transportation to work, age started working, number of working hours, multiple jobs, work pressure and hazards, and abuse. Analyses were stratified by gender. Of the 4090 surveyed working children, the majority reported working in agriculture (75.8%). Around a third (31.4%) reported being injured at work with a higher proportion in males. The most common reported injuries were cuts and wounds (44.9%), with males showing a higher proportion for all types of injuries compared to females. Nearly one fifth of reported injuries (19.8%) required medical attention in a hospital, with males reporting higher proportions than females for most types of injuries. The study findings revealed the association of multiple risk factors with an increased odds of reporting an injury, which included working in more than one job (AOR, 1.71; CI, 1.20–2.43; p = 0.003), working under pressure (AOR, 1.64; CI, 1.36–1.97; p<0.001), the use of sharp or heavy objects (AOR, 1.88; CI, 1.58–2.24; p<0.001), and experiencing physical abuse at work (AOR, 2.46; CI, 1.97–3.08; p<0.001). The odds of reporting an injury increased with every additional hour of work per day (AOR 1.08; CI, 1.02–1.14; p = 0.006). Most of these findings persisted in the male and female stratified models, with few exceptions. Males who went to work in a pickup truck had significantly lower odds of being injured than those who walked (AOR, 0.65; CI, 0.51–0.83; p = 0.001); this finding did not reach significance for females. Having longer work hours per day was significantly linked to higher odds of injury for females (AOR, 1.07; CI, 1.02–1.12; p = 0.008); but not for males. The main limitations of this study were its cross-sectional design and the use of self-reported variables. Conclusions This study is the first to obtain direct testimony on work-related injuries and working conditions, exploring gender differences, among Syrian refugee children in Lebanon. Results demonstrated the association between the occurrence of injury and multiple risk factors highlighting their strenuous working conditions, with some differences detected between males and females. Many injuries can be prevented through direct safety interventions and proper implementation of child labor policies. Multidimensional interventions are essential to address the complex evolving challenges facing refugees.
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Affiliation(s)
- Rima R. Habib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- * E-mail:
| | - Diana Mikati
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Elio Abi Younes
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohammed Jawad
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom
| | - Khalil El Asmar
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Micheline Ziadee
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Abouzeid M, Halwani DA, Mokdad AH, Habib RR. A Generation at Risk: The Impacts of Lebanon's Escalating Humanitarian Crisis on Children. Front Public Health 2021; 9:704678. [PMID: 34485230 PMCID: PMC8415263 DOI: 10.3389/fpubh.2021.704678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Lebanon is in the midst of a rapidly escalating, unprecedented humanitarian crisis that is plunging the country deep into poverty and threatens population well-being, economic development, social welfare and national and regional stability. The dire situation is due to the compounding effects of the August 2020 Beirut blast, massive economic collapse and the COVID-19 pandemic, in a setting of longstanding entrenched political corruption and a dysfunctional, mismanaged crisis response by the state. This current emergency occurs on the background of a turbulent history and complex regional geopolitical context – including the Syrian refugee crisis, the ongoing influence of foreign actors and their local proxies, the United-States-imposed sanctions, endemic corruption, a culture of nepotism and entitlement among the political dynasties, dysfunctional power-sharing and deep-seated sectarian divides. With over half the population now living in poverty, a generation of children are among those at risk. This Perspective provides a brief overview of Lebanon's current complex humanitarian crisis, discusses the impacts of the evolving situation on youth and proposes a suite of recommendations to mitigate the effects.
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Affiliation(s)
- Marian Abouzeid
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC, Australia.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dana A Halwani
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Rima R Habib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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