Mental healthPTSD

Post-Traumatic Stress Disorder in the Middle East

Affiliations : Department of Psychiatry, USJ, Beirut, Lebanon

Journal reference: doi: 10.1016/j.comppsych.2016.09.007.

Summary: Wars and terror attacks often cause trauma. In his article, Dr Kazour evaluates the impact of trauma on Syrian refugee mental health in Lebanon, and relates this to Post-Traumatic Stress Disorder.

Introduction: Post-traumatic Stress Disorder (PTSD) is a psychiatric illness that can occur in people who have witnessed or experienced traumatic events. People who suffer from this disorder experience repeated involuntary memories, nightmares or flashbacks related to their trauma. They may also avoid people, places or situations that can remind them of the trauma. People who suffer from PTSD also experience negative thoughts and feelings, and may have anger outbursts and have problems concentrating or sleeping. Refugees are at risk of having PTSD as a consequence of migration, traumatic experiences, and resettlement in new cultural settings. Previous studies show that the severity of symptoms of PTSD increase with the intensity of stress. Among war refugees, the risk of PTSD increases if people have suffered from torture, cumulative traumas or political terror. Since 2011, war in Syria has obliged millions of citizens to seek refuge in neighboring countries. Lebanon is one of the main hosting countries during the Syrian crisis. The objective of this study is to evaluate the proportion of Syrian refugees in Lebanon who suffer from PTSD.

Methods: In order to achieve our objective, trained psychologists evaluated adult refugees from Syria living in six camps in the Bekaa region in Lebanon. They used a questionnaire asking about the traumatic events they experienced, symptoms of PTSD, and drug or alcohol consumption, since patients with PTSD may use drugs or alcohol to relieve their symptoms.

Results: In total, 452 persons were evaluated. They were aged between 18 and 65 years (mean age was 35 years) and were in majority women (56%). Most of them were married (82%), one in 4 refugees was unemployed and they had low educational level (one third had no education at all and half the participants only reached elementary school). Only 2% of all participants had a problem related to using drugs or alcohol. Almost 60% of participants were previously exposed to traumas, and 11% had their traumatic experience after being displaced. 35% of persons had experienced symptoms of PTSD and 27% were still having these symptoms at the time of evaluation. However, only 3 Syrian refugees with PTSD had a psychiatric consultation and were prescribed medication for their symptoms. After analysis, the results showed that refugees from Aleppo had more PTSD than those coming from other regions in Syria.

Discussion: This study shows that, in Lebanon, more that 1 in 3 refugees has a lifetime history of PTSD and more than 1 in 4 has current PTSD. These numbers are higher than those seen in other conflicts, possibly due to the ongoing nature of the conflict and the horrifying events experienced by citizens. The region of Aleppo witnessed the most significant escalations of the war, thus explaining the higher levels of PTSD from this region. Also, refugees residing in camps in Lebanon suffer from very difficult living conditions as well as economic, legal and security problems. This represents a prolongation of the traumatic experience till after displacement, also considered as a risk factor for PTSD. This study found low levels of drugs or alcohol use disorders compared to other studies. This may be due to the presence of protective factors consisting of conservative cultural and social norms as well as religious proscription of some addictive substances.
Conclusion: PTSD in adult Syrian refugees in Lebanon is an important mental health issue that needs to be addressed. Very few are those who benefit from psychological and medical support. This may be due to lack of medical care coverage in Syrian refugees’ camps especially in the mental health field, but also to a lack of education about mental health issues and ways to seek support. Finally, other anxiety and depressive disorders are common following a disaster or a trauma. They are less specific to traumas than PTSD, they need however to be assessed and treated since they contribute to the daily suffering of vulnerable populations.

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