Compounding inequalities: Adolescent psychosocial wellbeing and resilience among refugee and host communities in Jordan during the COVID-19 pandemic

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.

Prevalence of anxiety, depression and post-traumatic stress disorder symptoms and resilience in adolescents during the COVID-19 pandemic in a post-armed conflict area in Colombia

“…Our results from school-attending adolescents in post-con icts areas are in line with emerging evidence that suggests multiple domains of adolescents' psychosocial wellbeing were negatively impacted by the pandemic. Our ndings also agree with other studies of regions affected by armed con ict, where an increase in the prevalence of mental health disorders in young populations has been found (5,7,30,37,38).…”

“…Measures to reduce the spread of the virus-such as lockdowns, physical distancing and school closures-have not only altered family and peer relationships and distanced young people from social spaces like classrooms and games, but also disrupted daily routines and their learning process and education. All of these changes might translate into mental health repercussions which can be particularly profound in vulnerable adolescents who are victims of armed con ict and forced displacement (7).…”

A mixed-method study on adolescents’ well-being during the COVID-19 syndemic emergency

“…Other similar studies have shown how the COVID-19 outbreak and the related risk-reduction strategies have changed the social contexts of adolescents in low- and middle-income countries, with profound implications for their well-being, especially in the case of vulnerable adolescents, including those affected by poverty and armed conflict. In such contexts, pre-existing conditions of disadvantage have had a negative impact on the mental health of adolescents, especially that of girls 65 .…”

Another crisis in the sorrowland: COVID-19 in northeast Syria

“…Evidence suggests that COVID-19 has had severe compounding effects on existing inequalities. Rates of food insecurity and hunger, unemployment, anxiety and social isolation are on the rise and threaten the social fabrics holding refugee communities together as violent conflicts persist [8][9][10]. This may have long-term effects far beyond the pandemic period.…”