Prevalence of and risk factors for depression among female Syrian refugees and Jordanians with chronic disease: a pilot study

Background: Chronic disease and depression are primary contributors to morbidity among displaced and local populations. Aims: This study aims to address the prevalence for and risk factors of comorbid depression among Jordanian and Syrian women with known chronic disease. Methods: To provide evidence for mental health intervention planning, we conducted a cross-sectional survey to investigate determinants of depression among female Syrian refugees and Jordanians with chronic disease living in Amman. A total of 272 female Syrian refugees and Jordanians with chronic disease were recruited from 4 clinics across Amman from June to August 2017. We compared demographic and health characteristics and depression level and identified predictors of depression via multivariable ordinal regression. Results: Moderate to high levels of depression were reported in 55.9% of the participants, with a prevalence of 41.1% among Jordanians and 70.6% among Syrians. Syrians with chronic disease had 2.73 times greater odds of higher levels of depression than their Jordanian peers. After adjusting for age, income, spouse employment status, gastrointestinal or genitourinary disorder status, and perceived self-efficacy, Syrians were not at significantly greater odds of reporting higher levels of depression. Risk factors for higher depression levels included having an unemployed spouse, diagnosis of gastrointestinal or genitourinary disorder and low perceived self-efficacy. Conclusion: Depression is frequently comorbid with chronic physical conditions and has a deleterious impact on health status. Mental health interventions and chronic disease management tailored to differences among local and displaced communities may reduce disease burden and disability.

Exploring the bidirectional relationship between chronic disease and depression among female Syrian refugees and Jordanians: a qualitative analysis

Background: Nearly 700 000 Syrian refugees currently reside in Jordan. Chronic disease and neuropsychiatric conditions are leading contributors of morbidity among refugee and host communities. The bidirectional relationship between depression and chronic disease is not well studied among displaced Syrian or Jordanian women. Aims: This qualitative study explores the bidirectional relationship between chronic illness and comorbid depression, as well as related themes, among Jordanian and Syrian women with known chronic disease—populations that receive medical care through distinct and evolving health care structures—to assist providers and policy makers in creating culturally sensitive interventions. Methods: Forty Jordanian women and Syrian refugees with chronic disease were interviewed at four clinical settings in Amman, Jordan. Data collection occurred from June–August 2017. Content analysis was completed with Dedoose, a qualitative coding software. Results: The majority of Syrian women endorsed a relationship between their chronic disease and depression. Some women felt too depressed to take medication for chronic conditions, while others felt depression contributed to chronic illnesses. Syrian women reported less perceived social support than Jordanian women. Although some Syrians were unable to afford medications, they reported fewer negative health care experiences than Jordanians. Both populations endorsed female-specific hardships impacting their mental health, including the demands of motherhood, household duties, and marital strife. Conclusion: This study explores the intersection of depression and chronic disease among Syrian and Jordanian women. By documenting stressors and experiences accessing health care, mental health and chronic disease interventions can be integrated and tailored to these populations.

Knowledge of, attitudes to and participation in clinical trials in Jordan: a population-based survey

Background: Clinical trials are important to improve public health care. However, recruiting participants for trials can be difficult. Aims: This study assessed public knowledge of and willingness to participate in clinical trials in Jordan and examine the sociodemographic characteristics associated with knowledge and willingness and the reasons behind unwillingness to participate.Methods: The questions were part of a representative, population-based survey in 2011 that included 3196 Jordanian in-dividuals. In a home-based interview, participants were asked about: sociodemographic characteristics, and knowledge of and participation in clinical trialsResults: Only 21.8% of respondents knew what a clinical trial was and (1.2%) had participated in a trial. About 25% of re-spondents indicated their willingness to enrol in a trial. Significantly more men (24.1%) than women (19.3%) knew what clinical trials were (P < 0.001), whereas more women (4.3%) than men (2.9%) said they would be very likely to agree to participate in trials. People aged 40–49 years had better knowledge of and greater willingness to participate in trials than other age groups. Income was positively associated with knowledge of trials but negatively associated with willingness to participate. Higher education was positively correlated with knowledge of and willingness to take part in trials. The main reasons for not participating in trials were concern about the risk to own health (61.1%) and not being convinced about the outcome and benefits of clinical trials (29.7%). Conclusion: The low level of knowledge of and willingness to participate in clinical trials indicates that strategies are needed to educate the public about the nature and importance of clinical trials.

Contexte : Les essais cliniques sont importants pour améliorer les soins de santé publique. Cependant, le recrutement des participants pour ces essais peut s’avérer difficile. Objectifs : La présente étude visait à évaluer la connaissance publique des essais cliniques et la volonté d’y participer en Jordanie, et à examiner les caractéristiques sociodémographiques associées, ainsi que les raisons expliquant leur réponse négative.Méthodes : Les questions ont été posées dans le cadre d’une enquête en population représentative menée en 2011 auprès de 3 196 Jordaniens. Lors d’un entretien conduit à domicile, des questions ont été posées aux participants sur leurs caractéristiques sociodémographiques, leur connaissance des essais cliniques et leur participation à ces derniers. Résultats : Seuls 21,8 % des personnes interrogées savaient ce qu’est un essai clinique, et 1,2 % d’entre elles avait déjà participé à ce type d’essai. Près de 25 % des personnes interrogées ont signifié leur volonté de participer à un essai clinique. Les hommes étaient significativement plus nombreux (24,1 %) que les femmes (19,3 %) à savoir ce qu’est un essai clinique (p < 0,001). À l’inverse, davantage de femmes (4,3 %) que d’hommes (2,9 %) ont indiqué être très susceptibles d’accepter de participer à des essais cliniques. Les personnes âgées de 40 à 49 ans avaient une meilleure connaissance des essais cliniques et une plus grande volonté d’y participer que les autres groupes d’âge. Les revenus étaient associés de façon positive à la connaissance des essais cliniques, mais de façon négative à la volonté d’y participer. Un niveau d’éducation élevé avait une corrélation positive avec la connaissance des essais cliniques et la volonté d’y participer. Les principaux motifs de non-participation aux essais étaient l’inquiétude concernant le risque pour la santé personnelle (61,6 %) et le fait de ne pas être convaincu des résultats et du bénéfice des essais cliniques (29,7 %). Conclusion : Le faible degré de connaissance et de volonté de participer à des essais cliniques indique que des stratégies de sensibilisation du grand public à la nature et à l’importance des essais cliniques sont nécessaires.