A Community–Based System Dynamics Approach for Understanding Factors Affecting Mental Health and Health Seeking Behaviors in Beirut and Beqaa Regions of Lebanon

Abstract

Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereas a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion included significant delays in health seeking from the formal health system and widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and trust in the quality of service as major barriers to access. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.

Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon

“…In response to the Syrian crisis, the MoPH in collaboration with the Ministry of Social Affairs and with local and international non-governmental organizations (NGOs) have been providing free-of-charge primary healthcare services, including mental health services, for UNHCR-registered Syrian refugees. Yet, due to limited financial capacities, these efforts have been reportedly unable to meet the increasing needs of these vulnerable populations [ 46 , 47 ]. The situation is even worse for unregistered refugees who have restricted capacities to receive the appropriate healthcare support [ 47 ].…”

“…It is also possible that mental health services are not reaching enough refugees. Notwithstanding the value of the provided services, Syrian refugees cite many barriers to seeking mental health services in Lebanon, including lack of trust in and limited knowledge of available services, limited mental health literacy and perceived need for treatment, lack of services especially in rural areas, associated difficulties in commuting, financial barriers and lack of mental health coverage, and social stigma which may impede refugees seeking healthcare fearing of shame and discrimination [ 46 ]. Furthermore, due to pervasive cultural beliefs, Syrian refugees tend to seek religious healers as a first line of treatment for mental illness given their perceived cultural appropriateness and their reduced association with social stigma when compared to mental health professionals [ 48 ].…”

“…Although some of the same justifications that have been previously cited in the literature may still be used to explain these gender-based variations, other explanations that are specific to Syrian refugees in Lebanon should be considered. For example, women in refugee settings tend to be subjected to early and forced marriage and bear family responsibilities at an early age, in addition to being exposed to sexual harassment and violence in the household and community at large [ 46 ], all of which are potential stressors that increase the risk of developing moderate to severe depression symptoms. Also, these women allude to child rearing and associated responsibilities as important sources of stress and anxiety, especially when considering their worries about the discrimination and bullying their children may face in schools in Lebanon [ 46 ].…”

The state of psychiatric research in the Asia Pacific region

“…The latter group has been of particular interest, with many studies assessing the mental health needs of Syrians and other refugees who fled their nations to Lebanon (E. Karam et al, 2016; Kerbage et al, 2020; Yassin, Taha, Ghantous, Atoui, & Forgione, 2018). Lastly, many mental health interventional activities are being studied in these groups (Dirani, Raad, & Akoury‐Dirani, 2018; Harper Shehadeh et al, 2020; Kaplan, El Khoury, Lize, Wehbe, & Mokhbat, 2019; Noubani et al, 2020).…”

Evaluating a capacity building program on women’s health for displaced community health workers in fragile settings in Lebanon

“…Although some difficulties were faced in establishing credibility in their communities, most of the CHW were able to gain the trust of others because of the certification they received, their consistency in their behavior, the credibility of the institution that delivered the training, and the fact that they had used physical copies of the learning material when sharing the information. Finally, the training contributed a step forward towards supporting relationships between Syrian and Lebanese individuals, a relationship previously reported to be tense [32], as a result of their engagement and interactions in educational activities.…”