The association between long-distance migration and PTSD prevalence in Syrian refugees.

BACKGROUND: Refugees are forced migrants but there is a large variation in the distance that refugees cover and there is a paucity in the evidence of how this may affect refugees' health and health care needs. OBJECTIVE: We investigated the association between long-distance migration and post-traumatic stress disorder (PTSD), a serious psychiatric disorder associated with deteriorating mental and somatic health. METHODS: Included from 2016-2019 were adult Syrian refugees in Lebanon and Denmark that arrived up to 12 months prior to inclusion. PTSD was assessed using the Harvard Trauma Questionnaire and the estimate of association was obtained by multiply imputing missing data and adjusting for confounding by propensity score-weighting with covariates age, sex, socioeconomic status, trauma experience and general mental well-being, reporting the bootstrap 95-percentile confidence interval (95% CI). Additionally, a number of sensitivity analyses were performed. RESULTS: Included were 599 participants in Lebanon (mean age 35 years old, 73% being female) and 133 participants in Denmark (mean age 30 years old, 47% being female). After multiply imputing missing data and propensity score-weighted adjustment for confounding, migration to Denmark instead of Lebanon was associated with an increase in PTSD prevalence of 9 percentage point (95% CI [-1; 19] percentage point). CONCLUSIONS: Long-distance migration may be associated with an increase in PTSD prevalence in refugees. The migration could be an important factor to consider when assessing refugees' and asylum seekers' health. Practitioners should consider "long-distance migration" in refugee health screenings and in particular when assessing the risk of post-traumatic stress disorder. Future research should be designed to ultimately lead to studies of relevant interventions to lower the risk of post-traumatic stress disorder in refugees.

Asylum seekers' and Refugees' Changing Health (ARCH) study protocol: an observational study in Lebanon and Denmark to assess health implications of long-distance migration on communicable and non-communicable diseases and mental health.

INTRODUCTION: By end of 2018, the European Union countries hosted approximately 2.5 million refugees and Lebanon alone hosted more than 1 million. The majority of refugees worldwide came from Syria. The prevailing study design in published studies on asylum seekers' and refugees' health leaves a number of fundamental research questions unanswerable. In the Asylum seekers' and Refugees' Changing Health (ARCH) study, we examine the health of a homogeneous group of refugees and asylum seekers in two very different host countries with very different migration histories. We aim to study the health impact of the migration process, living conditions, access to healthcare, gene-environment interactions and the health transition. METHODS AND ANALYSIS: ARCH is an international multisite study of the health of adult (>18 years old) Syrian refugees and asylum seekers in Lebanon and Denmark. Using a standardised framework, we collect information on mental and physical health using validated scales and biological samples. We aim to include 220 participants in Danish asylum centres and 1100 participants in Lebanese refugee camps and settlements. We will use propensity score weights to control for confounding and multiple imputation to handle missing data. ETHICS AND DISSEMINATION: Ethical approval has been obtained in Lebanon and Denmark. In the short term, we will present the cross-sectional association between long-distance migration and the results of the throat and wound swab, blood and faeces samples and mental health screenings. In the longer term, we are planning to follow the refugees in Denmark with collection of dried blood spots, mental health screenings and semistructured qualitative interviews on the participant's health and access to healthcare in the time lived in Denmark. Here, we present an overview of the background for the ARCH study as well as a thorough description of the methodology.

Prevalence of depression in Syrian refugees and the influence of religiosity.

BACKGROUND: Many surveys have underlined the high levels of distress Syrian refugees have endured since the conflict aroused in their country, yet few have used reliable diagnostic tools for the clinical assessment of resulting mental disorders. The aim of our study is to assess for the onset of new depressive disorders following the Syrian war, and to investigate the correlation of religiosity with depression. METHODS: Single individual interviews were used, in a sample of 310 Syrian forced migrants, retrospectively assessing for depressive disorders with onset at different timelines of the conflict outbreak. Religiosity was assessed in a cross-sectional design using a reliable, recently developed and tested tool. Bivariate analysis and logistic regression analysis were used with a level of significance at 0.05. RESULTS: The prevalence of current depression was 43.9% (95% Confidence Interval (CI): 38.5-49.4%) with no difference across all socio-demographic factors, including gender. The overall mean for religiosity for the current sample was moderate (mean=9.76; standard deviation SD=2.34). No substantial correlation was found with religiosity. The prevalence rate for pre-war depression was 6.5% (95% CI: 4.2-9.8%) following the global pattern of socio-demographic epidemiological characteristics. Prevalence for past depression was 27.1% (95% CI: 22.5-32.3%); for current dysthymia: 4.5% (95% CI: 2.7-7.4%); for prewar and past dysthymia: 1% (95% CI: 0.3-2.8%), all with no significant differences detected across all demographic variables. CONCLUSION: In this retrospective study on a sample of Syrian refugees who fled their country after the war, we found a substantial emergence of depressive disorders with no meaningful correlation with the level of religiosity.