Understanding the Mental Health Crisis Among Syrian Refugee Children and Adolescents in Lebanon

Background

Syrian refugee children and adolescents living in informal settlements in Lebanon face overwhelming mental health challenges

The mental health of refugee children and adolescents is a critical yet under-researched area. Much of existing research focuses on refugee populations in high-income countries, leaving significant gaps in understanding the mental health challenges faced by children in less stable environments.  

The majority of the world’s refugees live in lower and middle-income countries such as Lebanon – a lower middle-income country that hosts close to a million Syrian refugees. Many of these refugees live in informal settlements, where children and adolescents face numerous challenges that impact their mental health. Understanding the links between them and their environment is key to developing effective interventions. 

 

What were the aims of this study?

Understanding mental health issues among Syrian refugee children and adolescents in Lebanon

The primary aim of the study was to determine the prevalence and predictors of mental health disorders among Syrian refugee children and adolescents living in informal settlements in Lebanon. The researchers sought to identify how common mental disorders are and the specific factors that contribute to mental health problems in this population. The study also aimed to provide data that is more representative of refugees globally, many of whom live in similar conditions of ongoing adversity and violence.

 

How was this study carried out?

A comprehensive study involving Syrian refugee children  and their caregivers

Researchers collected data from a cohort of 1,591 child-caregiver pairs living in informal tented settlements in Lebanon and completed follow-ups on 1,000 pairs after one year. They were recruited from several settlements in the Beqaa region to ensure representation of the refugee population. The study focused on children aged 8-16 years whose families had fled Syria in the past four years.

Children and their caregivers were interviewed within their homes. Questionnaires were used to measure symptoms of PTSD, depression, anxiety, and conduct disorders, as well as a range of factors thought to cause mental health problems.

A smaller group of 134 children from the initial cohort were chosen for in-depth clinical interviews to obtain more objective diagnoses of mental health disorders. The subsample for clinical interviews were generally representative of the initial group.

 

What were the key findings?

High rates of PTSD, depression, anxiety and conduct problems among refugee children

The study revealed:

• 39.6% of children had PTSD
• 26.9% had conduct or oppositional defiant disorder
• 20.1% suffered from depression
• 47.8% had anxiety disorders.

In total, more than half (57.5%) met the criteria for at least one common mental disorder. 

In addition to this, among children with a mental disorder, 79.2% had more than one disorder. For instance, depressive and anxiety disorders were strongly associated, and PTSD commonly co-occurred with anxiety, depression, and/or conduct or oppositional defiant disorders.  

The study also aimed to identify the predictors of mental health problems. Exposure to daily stressors emerged as the strongest predictor of these issues. Stressors included violence, lack of access to basic resources, poor living conditions, and limited educational opportunities. The chronic stress associated with these daily challenges significantly contributed to children’s mental health problems. Several other key predictors such as war-related trauma, mother’s mental health, and child maltreatment were also identified.

 

What are the implications of this research?

Need for comprehensive, culturally sensitive interventions alongside improvements in living conditions to support refugee children

The results from this study have significant implications for policymakers, mental health professionals, and humanitarian organisations. The high rates of mental disorders and the high level of comorbidity underscores the complexity of mental health issues in refugee children and the need for comprehensive treatment approaches. There is a clear need for a mental health care model that addresses broader issues such as housing, health and education. Addressing these structural challenges is important in alleviating stress that will otherwise have a substantial impact on caregivers’ and children’s mental health. Broader interventions aimed at fostering livelihoods and creating social support networks, especially for caregivers, are also necessary alongside high-quality mental health treatments. 

Additionally, this study addresses the bias for studies in high-income countries by providing data from a large cohort of Syrian refugees living in informal settlements in Lebanon. This is more representative of the majority of refugees globally, particularly those living in camps, who often face ongoing adversity and the threat of violence even when they’re settled in ‘safe’ countries. By implementing culturally sensitive and comprehensive interventions, alongside addressing the challenging conditions that refugees face on a daily basis, we can help these children recover from their traumatic experiences and build a healthier future. 

 

About the Study Group

The study was conducted by a team of experts in psychology and mental health, including Dr Fiona S. McEwen (Kings College London, UK), Claudinei E. Biazoli Jr (Queen Mary University of London, UK, Universidade Federal do ABC), Dr Cassandra M. Popham (Queen Mary University of London, UK), Patricia Moghames (Médecins du Monde, France), Dahlia Saab (Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Saint George Hospital University Medical Center), Dr John Fayyad (IDRAAC, Saint George Hospital University Medical Center, Balamand University), Prof Elie Karam (IDRAAC, Saint George Hospital University Medical Center, Balamand University), Dr Tania Bosqui (University of Beirut, Trinity College Dublin) and Prof Michael Pluess (University of Surrey, UK).