Depressive symptoms among women in Raqqa Governorate, Syria: associations with intimate partner violence, food insecurity, and perceived needs

Abstract

Background.Raqqa Governorate, Syria has recently been affected by overlapping conflicts related to the Syrian Civil war and occupation by ISIS, resulting in widespread displacement and disruption of economic livelihoods. However, little information is currently known about mental health needs and risk factors among women. Therefore, this study sought to examine potential risk factors for depressive symptoms among married women living in northern Syria.Methods.Data were collected between March and April 2018 as part of an evaluation of an International Rescue Committee cash transfer program targeted toward vulnerable households. Using cross-sectional data from 214 married women participating in the program, linear regression models were generated to explore the associations between depressive symptoms [nine-item Patient Health Questionnaire (PHQ-9)] and its potential risk factors, including food insecurity, perceived deprivation of basic needs [the Humanitarian Emergency Settings Perceived Needs Scale (HESPER) scale], and past-3-month intimate partner violence (IPV).Results.The average depressive symptom score was 10.5 (s.d.: 4.9; range: 2–27). In the final adjusted model, any form of recent IPV (β = 2.25; 95% CI 0.92–3.57; p = 0.001), severe food insecurity (β = 1.62; 95% CI 0.27–2.96; p = 0.02) and perceived needs (β = 0.38; 95% CI 0.18–0.57; p = 0.0002) were associated with an increase in depressive symptoms.Conclusion.Study findings point to the need to address the mental health needs of women in conflict-affected areas of Syria. Programming to address risk factors for depression, including IPV and other factors associated with daily stressors such as food insecurity and deprivation of basic needs, may be effective in reducing depression in this population.

Cash assistance programming and changes over time in ability to meet basic needs, food insecurity and depressive symptoms in Raqqa Governorate, Syria: Evidence from a mixed methods, pre-posttest

“…Additionally, other analyses from the present study demonstrate that during the period of cash transfer delivery, some forms of past-three month intimate partner violence amongst a married sub-sample increased, although causality cannot be inferred due to the lack of counterfactual. [19] Nonetheless, such experiences of violence have been shown to be associated with a nearly three-fold increase in risk of depressive symptoms in this context [42], suggesting a potential dynamic relationship between cash assistance, intimate partner violence, and depressive symptoms in Raqqa Governorate, Syria.…”

Vulnerabilities of Syrian refugee children in Turkey and actions taken for prevention and management in terms of health and wellbeing

“…Syrian refugee children are exposed to various traumatic events such as loss of a loved one, witnessing combat or life threat during war and flight ( Gormez et al, 2018 ). Other social risk factors during post-migration period such as child labor, family violence, and child marriage also negatively affect the psychosocial wellbeing of Syrian refugee children in Turkey ( El Arab & Sagbakken, 2019 ; Falb et al, 2019 ; Habib et al, 2019 ; Usta et al, 2019 ; Wringe et al, 2019 ). Associated with these risk factors, studies indicate higher estimates of PTSD, depression, and anxiety among Syrian refugee children compared to Turkish children.…”

“…A study conducted by UNHCR in 2015 found that the highest risk for Syrian refugee children was psychological concern (51 %) followed by children dropped out of school (25 %) and child labor (11 %) ( UNHCR, 2015. p. 19 ). It is also important to mention that the risks identified in this study, including child labour ( Habib et al, 2019 ), child marriages ( El Arab & Sagbakken, 2019 ; Wringe et al, 2019 ) and domestic violence ( Falb, Blackwell, Stennes, Hussein, & Annan, 2019 ; Usta, Masterson, & Farver, 2019 ) in addition to the aforementioned higher risks, are factors which are likely to influence psychological wellbeing negatively.…”

“…Finally, at the cultural level, patriarchal beliefs were identified as risk factors for family violence in refugee families ( Timshel et al, 2017 ). In a recent study with Syrian women in northern Syria, emotional, physical, and sexual intimate partner violence were found as predictors of depressive symptoms among women ( Falb et al, 2019 ). Moreover, intimate partner violence in Syrian families found to be increasing the violence towards children by their mothers ( Usta et al, 2019 ).…”

Pre-positioning an evaluation of cash assistance programming in an acute emergency: strategies and lessons learned from a study in Raqqa Governorate, Syria

“…Despite this increased investment in cash assistance in recent years, little is known about how cash influences the household dynamics and experiences of violence amongst women in humanitarian settings, including sexual exploitation or intimate partner violence (IPV). Such investigation is important as Syrian women often experience different forms of violence, including IPV [ 10 ] and baseline data from the present study indicated that a staggering one in three women in the sample had experienced IPV in the past 3 months [ 11 ]. In largely stable low and middle income countries, a recently completed systematic review of cash transfers, typically delivered as part of long standing social protection schemes, revealed that many cash transfer programs are associated with reductions of IPV; however, a small number of other programs had no or negative effect [ 12 ].…”