Predictors of depression among Syrian refugee women: A socio-culturally relevant analysis

OBJECTIVES

Syrian refugee women have faced myriad adversities as they have navigated the realities of war, increasing the risk for mental health concerns such as depressive symptomatology. This study explores the nuances of relevant sociocultural factors that can contribute to depressive symptomatology among widowed Syrian refugee women who live in an institutionalized care setting. We explored the impact of past trauma exposure, perceived independence, and a desire to leave the current place of displacement and the interplay between them.

METHODS

The PCRF Traumatic Events Questionnaire and Patient Health Questionnaire (PHQ-9) were administered to 57 Syrian refugee women in Lebanon (Mage = 37; M number of children = 3) to measure levels of trauma exposure and depressive symptoms, respectively. Perceived independence and a desire to leave their current place of residence were measured using 1-item measures.

RESULTS

Using hierarchical regression models, past trauma exposure (B = 1.51, p = .002) and perceived independence (B = 0.33, p = .04) significantly predicted depressive symptoms. A desire to travel (B = 0.84, p = .07) marginally predicted depressive symptoms. Past trauma exposure attenuated the impact of perceived independence on depressive symptoms such that at lower levels of past trauma exposure, higher perceptions of independence predicted higher depression (simple slope = 0.29, t = 2.13, p = .05), while at higher levels of past trauma higher perceptions of independence predicted lower depressive symptoms (simple slope = -0.16, t = -2.21, p = .04). Trauma exposure did not moderate the impact of a desire to leave on depression, but age did.

CONCLUSION

These findings suggest that sociocultural factors may influence women's experiences with depressive symptoms differently, and this heterogeneity must be accounted for when treatment programs are proposed. Further, Syrian refugee women who have lost primary family members may pose different profiles of depressive symptoms than other groups of women.

Listening to the Voices of Syrian Refugee Women in Canada: an Ethnographic Insight into the Journey from Trauma to Adaptation

Syrian refugee women face many obstacles when accessing health services in host countries that are influenced by various cultural, structural, and practical factors. This paper is based on critical ethnographic research undertaken in Canada, to explore Syrian refugee women migration experiences. Also, we aim at critically examining how the intersection of gender, trauma, and violence, and the political and economic conditions of Syrian refugee women shapes their everyday lives and health. The study also investigates the strategies and practices by which Syrian refugee women are currently addressing their healthcare needs and the models of care that are suggested for meeting their physical and mental health needs. Findings show that these women experienced constant worries, hardship, vulnerability, and intrusion of dignity. These experiences and challenges were aggravated by the structure of the Canadian social and healthcare system. This study offers a better understanding of the impact of migration and trauma on Syrian refugee women's roles, responsibilities, gender dynamics, and interaction with Ontario's healthcare system to improve interaction and outcomes. Healthcare models should address these challenges among Syrian refugee families in Canada.

Examination of Breast Cancer Screening Knowledge, Attitudes, and Beliefs among Syrian Refugee Women in a Western Canadian Province

Background

Women living in the Arab world present low breast cancer screening rates, delayed diagnosis, and higher mortality rates.

Purpose

To further explore the Muslim Syrian refugee women’s breast self-examination (BSE), utilization of clinical breast examination (CBE) and mammography.

Methods

A cross-sectional descriptive exploratory study design was used. The sample consisted of 75 refugee women. Data were collected using Champion’s Health Belief Model Scale, the Cancer Stigma Scale, and the Arab Culture-Specific Barriers to Breast Cancer Questionnaire. Descriptive, Pearson correlation and logistic regression analyses were used to analyze the data.

Results

A minority of women had BSE (32%), CBE (12%) and mammograms (6.7%) anytime during their lifetime. Women’s breast cancer screening (BCS) knowledge ranked at a medium level (M = 10.57, SD = 0.40). Low knowledge score, BSE information, policy opposition, responsibility, barriers to BSE, and seriousness were found to be statistically significant in women’s BSE practice. BSE benefits and religious beliefs significantly predict CBE Age, education, knowledge, responsibility, susceptibility, social barriers, and religious beliefs were statistically significant in women’s mammography use (p < .01).

Conclusions

Participants’ breast cancer screening practices were low. Health beliefs, Arab culture and stigma about cancer affected women’s BCS practices. Faith-based interventions may improve knowledge and practices.

Birth Experience in Syrian Refugee Women in Turkey: A Descriptive Phenomenological Qualitative Study

A negative birth experience affects the woman's subsequent pregnancy, and delivery processes negatively, decreases patient satisfaction, and the high anxiety/stress experienced during pregnancy/delivery is transferred to the next generations by epigenetic transmission. In this study, women's birth experiences of Syrian refugees in Turkey aimed to describe in-depth. It was designed as a descriptive phenomenological qualitative study. Fifteen refugee women included in the sample gave birth in Turkey, living in Turkey's southern city. In-depth interviews were conducted with women. Six themes were formed in the results: "quantitatively enough but unsatisfactory service," "not providing autonomy," "think that she was neglected," "no respect to privacy," "feeling loneliness/fear in the delivery room," and "prejudice." The factors that negatively affect the pregnancy and birth experiences of Syrian refugee women are language/communication barriers, the provision of care services that are incompatible with their religious and cultural values, and their prejudice regarding discrimination.

Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives

Background

Turkey hosts the world’s largest community of Syrians displaced by the conflict. The Minimum Initial Service Package (MISP) is a coordinated set of priority reproductive health services. There is not any scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. The objectives of this review is to identify the situation of sexual and reproductive health (SRH) among Syrian refugee women in Turkey, and document the health services provided for them in terms of the components of MISP. We hoped to show evidence of gaps and help guide future research to focus on priority areas to improve the range, quality, and access to SRH services and to recommend public health interventions.

Method

The literature search was conducted in Turkish and English. Multiple electronic databases (Turkish Medline, Google Scholar, PubMed, Web of Science, Medline, Cochrane Database of Systematic Reviews, EBSCOHost, CINAHL, and Embase) were searched from January 2011 to May 2018. References published in the peer-reviewed literature, the grey-literature, and on websites were eligible for inclusion if they had conducted research on one or more of the following SRH topics specifically for Syrian women in Turkey: maternal and neonatal health/antenatal care, HIV and sexually transmitted infections, use of contraceptives, sexual violence, and services delivery and accessibility. References were excluded if any of the following criteria were relevant: not specific to Syrian women refugees in Turkey. Firstly, the titles and abstracts of the articles that were found were examined to determine if they met the eligibility criteria. Secondly, if the abstracts and titles met one or more of the eligibility criteria, the full text of the articles have been examined. Finally, standard forms were prepared and used to summarize the articles narratively. The results of the screening were recorded in Excel spreadsheets for comparison, and any disagreements among the researchers were resolved by consensus. The studies were grouped according to the MISP objectives.

Results

A total of 24 publications were eligible for inclusion in the review. Consanguineous marriage rate was 56%. The rate of marriage under age 18 were very high. Mean age at first marriage was found to be between 18 and 20. The rate of antenatal care was inadequate. The rate of using a modern contraceptive method was 24% among married and all age groups of Syrian women. The rates of unmet family planning needs were about 35%. Among patients admitted to gynecology outpatient clinics, about half of the applicants were reported to have abnormal vaginal discharge. The reported rates of sexual violence were about 8%. Only 20% of Syrian women had regular gynecological visits.

Conclusion

Overall, we conclude that early marriage, low modern contraceptive use, unmet need for contraception, sexual and gender-based violence are the major SRH issues reported. There is a need for further studies to identify the barriers limiting service uptake as well as to document successful practices. Long term strategies to improve the SRH status of Syrian refugee women should be developed with participation of all stakeholders. This review is significant in terms of that it is the first scoping review assessing the RH situation of Syrian refugees in Turkey within the framework of the MISP objectives. Based on the data of this review, relevant policy makers should consider to improve the SRH status of Syrian women refugees in Turkey.