Abstract
Syrian refugees may have increased mental health needs due to the frequent exposure to potentially traumatic events and violence experienced during the flight from their home country, breakdown of supportive social networks and daily life stressors related to refugee life. The aim of this study is to report evidence on mental health needs and access to mental health and psychosocial support (MHPSS) among Syrians refugees living in Sultanbeyli-Istanbul, Turkey. A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Sultanbeyli between February and May 2018. We used random sampling to select respondents by using the registration system of the municipality. Data among 1678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilisation, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. The estimated prevalence of symptoms of PTSD, depression and anxiety was 19.6, 34.7 and 36.1%, respectively. In total, 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. The treatment gap (the proportion of these 249 people who did not seek care) was 89% for PTSD, 90% for anxiety and 88% for depression. Several structural and attitudinal barriers for not seeking care were reported, including the cost of mental health care, the belief that time would improve symptoms, fear of being stigmatised and lack of knowledge on where and how to get help. Some negative attitudes towards people with mental health problems were reported by respondents. Syrian refugees hardly access MHPSS services despite high mental health needs, and despite formally having access to the public mental health system in Turkey. To overcome the treatment gap, MHPSS programmes need to be implemented in the community and need to overcome the barriers to seeking care which were identified in this study. Mental health awareness raising activities should be provided in the community alongside the delivery of psychological interventions. This is to increase help-seeking and to tackle negative attitudes towards mental health and people with mental health problems.
Highlights
Conflict-affected populations are at an increased risk of mental disorders due to frequent exposure to potentially traumatic events, multiple losses, breakdown of supportive social networks and accumulation of daily life stressors related to refugee life (Miller and Rasmussen, 2010; Steel et al, 2009; Silove et al, 2017)
The aim of this study is to report evidence on mental health needs and access to mental health and psychosocial support (MHPSS) care among Syrian refugees living in Istanbul, Turkey
Our study reports the first epidemiological study on the estimated prevalence of symptoms of priority mental disorders and access to MHPSS care among Syrian refugees in Istanbul
Summary
Conflict-affected populations are at an increased risk of mental disorders due to frequent exposure to potentially traumatic events, multiple losses, breakdown of supportive social networks and accumulation of daily life stressors related to refugee life (Miller and Rasmussen, 2010; Steel et al, 2009; Silove et al, 2017). Recent data of the World Health Organization estimate the age-standardised point prevalence for depression to be 10.8%, for anxiety disorder (including post-traumatic stress disorder (PTSD)) to be 21.7%, and for PTSD alone to be 15.3% at any point in time among all conflict-affected populations (Charlson et al, 2019). Elevated prevalence of symptoms for common mental disorders has been reported among Syrian refugees who make up the largest single group of displaced people in the world (UNHCR, 2019). Mental disorder symptoms for Syrian refugees living in camps in Turkey and in European host countries have been reported to range from 14 to 44% for Downloaded from https://www.cambridge.org/core. Turkey hosts an estimated 3.6 million Syrian refugees, which makes it the largest refugee hosting country in the world (UNHCR, 2019). The largest refugee hosting city is Istanbul which accommodates over 500 000 Syrian refugees (UNHCR, 2018a, 2018b)
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