Dataset Information

The Promotive Effects of Social Support for Parental Resilience in a Refugee Context: a Cross-Sectional Study with Syrian Mothers in Lebanon.

ABSTRACT: Exposure to war trauma increases the risk of negative individual and family-level outcomes. However, not all trauma-exposed individuals exhibit mental health or family dysfunction, and some function better than expected given their level of trauma exposure. Research with at-risk populations, including refugees, suggests that social support may promote positive mental health and parenting behavior in the face of adversity. We used cross-sectional data from 291 Syrian refugee mothers to test the role of perceived social support in promoting their psychological and parenting resilience, defined here as better than expected mental health and parenting behavior given level of exposure to war trauma. Psychological and parenting resilience were operationalized using the residual approach, which assesses the difference between mothers' actual score on mental health and harsh discipline measures, and the score predicted by their level of trauma exposure. Linear regression models were used to test for associations between mothers' perceived social support and their psychological and parenting resilience. Results showed that mothers' perceived social support was associated with both psychological and parenting resilience, including after controlling for covariates. Exploratory analyses further suggested that emotional support, but not instrumental support, was associated with mothers' psychological resilience. Social support may have a promotive effect on mothers' mental health and parenting behavior in a context of ongoing conflict and displacement. Identifying intervention strategies to increase social support for refugees, within the framework of a multi-layered intervention approach, could potentially contribute to children's psychosocial resilience via improved maternal mental health and parenting.

SUBMITTER: Sim A

PROVIDER: S-EPMC6541567 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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The Promotive Effects of Social Support for Parental Resilience in a Refugee Context: a Cross-Sectional Study with Syrian Mothers in Lebanon.

Sim Amanda A Bowes Lucy L Gardner Frances F

Prevention science : the official journal of the Society for Prevention Research 20190701 5

Exposure to war trauma increases the risk of negative individual and family-level outcomes. However, not all trauma-exposed individuals exhibit mental health or family dysfunction, and some function better than expected given their level of trauma exposure. Research with at-risk populations, including refugees, suggests that social support may promote positive mental health and parenting behavior in the face of adversity. We used cross-sectional data from 291 Syrian refugee mothers to test the r ...[more]

PMID: 30684214

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Project description:AimsChildren's responses to war and displacement are varied; many struggle, while others appear resilient. However, research into these outcomes disproportionately focuses on cross-sectional data in high-income countries. We aimed to (1) investigate change in resilience across two timepoints in a highly vulnerable sample of Syrian refugee children in Lebanon, and (2) explore predictors of their mental health problems across time.MethodsIn total, 982 Syrian child-caregiver dyads living in refugee settlements in Lebanon completed questionnaires via interview at baseline and follow-up one year later. We categorised children into groups based on their risk for mental health problems across both timepoints (stable high risk/SHR, deteriorating, improving, stable low risk) according to locally validated cut-offs on measures of post-traumatic stress disorder (PTSD), depression and behavioural problems. Analyses of covariance identified how the groups differed on a range of individual and socio-environmental predictors, followed up by cross-lagged panel models (CLPMs) to investigate the directionality of the relationships between significantly related predictors and symptoms.ResultsThe sample showed a meaningful amount of change in mental health symptoms from baseline to follow-up. Over half (56.3%) of children met SHR criteria and 10.3% deteriorated over time, but almost one-quarter (24.2%) showed meaningful improvement, and 9.2% were consistently at low risk for mental health problems at both timepoints. Several predictors differentiated the groups, particularly social measures. According to CLPMs, maternal acceptance (β = -0.07) predicted child mental health symptoms over time. Self-esteem (β = -0.08), maternal psychological control (β = 0.10), child maltreatment (β = 0.09) and caregiver depression (β = 0.08) predicted child symptoms and vice versa (βse = -0.11, βb = 0.07, βmpc = 0.08, βcm = 0.1, βcd = 0.11). Finally, child symptoms predicted loneliness (β = 0.12), bullying (β = 0.07), perceived social support (β = -0.12), parent-child conflict (β = 0.13), caregiver PTSD (β = 0.07), caregiver anxiety (β = 0.08) and the perceived refugee environment (β = -0.09).ConclusionsOur results show risk and resilience are dynamic, and the family environment plays a key role in children's response to war and displacement. Conversely, children also have a significant impact on the family environment and caregiver's own mental health. Interventions to promote resilience in refugee children should therefore consider family-wide mechanisms.

Project description:BackgroundSince 2011, the protracted Syrian war has had tragic consequences on the lives of the Syrian people, threatening their stability, health, and well-being. The most vulnerable are children, who face interruption of schooling and child labor. This study explored the relationship between social capital and the physical health and emotional well-being of Syrian refugee working children in rural areas of Lebanon.Methods and findingsIn this cross-sectional study, we surveyed 4,090 Syrian refugee children working in the Bekaa Valley of Lebanon in 2017. Children (8-18 years) gave direct testimony on their living and social environment in face-to-face interviews. Logistic regressions assessed the association of social capital and social cohesion with the health and emotional well-being of Syrian refugee working children; specifically, poor self-rated health, reporting a health problem, engaging in risky health behavior, feeling lonely, feeling optimistic, and being satisfied with life. Of the 4,090 working children in the study, 11% reported poor health, 16% reported having a health problem, and 13% were engaged in risky behaviors. The majority (67.5%) reported feeling lonely, while around 53% were optimistic and 59% were satisfied with life. The study findings suggest that positive social capital constructs were associated with better health. Lower levels of social cohesion (e.g., not spending time with friends) were significantly associated with poor self-rated health, reporting a physical health problem, and feeling more lonely ([adjusted odds ratio (AOR), 2.4; CI 1.76-3.36, p < 0.001], [AOR, 1.9; CI 1.44-2.55, p < 0.001], and [AOR, 0.5; CI 0.38-0.76, p < 0.001], respectively). Higher levels of social support (e.g., having good social relations), family social capital (e.g., discussing personal issues with parents), and neighborhood attachment (e.g., having a close friend) were all significantly associated with being more optimistic ([AOR, 1.5; CI 1.2-1.75, p < 0.001], [AOR, 1.3; CI 1.11-1.52, p < 0.001], and [AOR, 1.9; CI 1.58-2.29, p < 0.001], respectively) and more satisfied with life ([AOR, 1.3; CI 1.01-1.54, p = 0.04], [AOR, 1.2; CI 1.01-1.4, p = 0.04], and [AOR, 1.3; CI 1.08-1.6, p = 0.006], respectively). The main limitations of this study were its cross-sectional design, as well as other design issues (using self-reported health measures, using a questionnaire that was not subject to a validation study, and giving equal weighting to all the components of the health and emotional well-being indicators).ConclusionsThis study highlights the association between social capital, social cohesion, and refugee working children's physical and emotional health. In spite of the poor living and working conditions that Syrian refugee children experience, having a close-knit network of family and friends was associated with better health. Interventions that consider social capital dimensions might contribute to improving the health of Syrian refugee children in informal tented settlements (ITSs).

Project description:Conflict-affected women and girls living in protracted forced displacement settings are vulnerable to sexually transmitted infections (STIs). Yet, little is known about the risk factors for and lived experiences of STIs in complex humanitarian settings, particularly in the Middle East and North Africa, where STIs have long been understudied. This qualitative study adapts the social ecological model to characterize the multi-level risks for and lived experiences of STIs among Syrian refugee women resettled in an urban refugee camp in Beirut, Lebanon. Adopting a community-based sampling strategy, community health workers, who were refugee women from the camp, recruited and conducted in-depth interviews (IDIs) with 30 adult Syrian refugee women. Data were analyzed using an interpretative phenomenological approach and thematically organized according to the levels of the social ecological model. We identified a confluence of individual, interpersonal, community-based, and societal vulnerabilities to STIs, including extreme poverty and insecurity, patriarchal gender norms, stigma, sexual exploitation and trafficking, poor healthcare accessibility, intimate partner violence, including marital rape, transactional sex, sexual harassment, social isolation, and internalized stigma. Participants described experiencing bothersome symptoms and sequelae of advanced and untreated STIs in the setting of limited access to health services and challenges with engaging their partners in STI treatment, largely due to STI stigma. These novel findings suggest dynamic, interrelated social and health disparities across all social ecological levels influencing refugee women's sexual health, including their risk of STIs. Comprehensive, multi-sectorial interventions, which transcend traditional public health methods and which adopt a sexual well-being approach, are urgently needed to address systemic and intrapersonal violence against refugee women, examine and mitigate the burden of STIs, and ensure sexual justice and health equity in this protracted forced displacement setting.

Project description:BackgroundPatients with diabetes require knowledge and skills to self-manage their disease, a challenging aspect of treatment that is difficult to address in humanitarian settings. Due to the lack of literature and experience regarding diabetes self-management, education and support (DSMES) in refugee populations, Medecins Sans Frontieres (MSF) undertook a DSMES survey in a cohort of diabetes patients seen in their primary health care program in Lebanon.MethodsStructured interviews were conducted with diabetes patients in three primary care clinics between January and February 2015. Scores (0-10) were calculated to measure diabetes core knowledge in each patient (the DSMES score). Awareness of long-term complications and educational preferences were also assessed. Analyses were conducted using Stata software, version 14.1 (StataCorp). Simple and multiple linear regression models were used to determine associations between various patient factors and the DSMES Score.ResultsA total of 292 patients were surveyed. Of these, 92% had type 2 diabetes and most (70%) had been diagnosed prior to the Syrian conflict. The mean DSMES score was 6/10. Having secondary education, previous diabetes education, a 'diabetes confidant', and insulin use were each associated with a higher DSMES Score. Lower scores were significantly more likely to be seen in participants with increasing age and in patients who were diagnosed during the Syrian conflict. Long-term complications of diabetes most commonly known by patients were vision related complications (68% of patients), foot ulcers (39%), and kidney failure (38%). When asked about the previous Ramadan, 56% of patients stated that they undertook a full fast, including patients with type 1 diabetes. Individual and group lessons were preferred by more patients than written, SMS, telephone or internet-based educational delivery models.ConclusionsDSMES should be patient and context appropriate. The variety and complexities of humanitarian settings provide particular challenges to its appropriate provision. Understanding patient baseline DSMES levels and needs provides a useful basis for humanitarian organizations seeking to provide diabetes care.

Project description:BackgroundSyrian refugees in Lebanon have endured increasing hardships since the onset of the Syrian war in 2011, with many resorting to child labor. Working refugee children endure socioeconomic deprivation and harsh working conditions. This study explores the relationship between working conditions and the reporting of injuries among male and female Syrian refugee children in Lebanon and the related gender differences.Methods and findingsA cross-sectional survey of Syrian refugee children working in the Bekaa Valley of Lebanon was conducted in 2017. Face-to-face interviews with children (8 to 18 years) collected sociodemographic information and testimonies of their work experiences. Logistic regression tested the association between reporting of injuries and risk factors including school enrolment, field of work, means of transportation to work, age started working, number of working hours, multiple jobs, work pressure and hazards, and abuse. Analyses were stratified by gender. Of the 4090 surveyed working children, the majority reported working in agriculture (75.8%). Around a third (31.4%) reported being injured at work with a higher proportion in males. The most common reported injuries were cuts and wounds (44.9%), with males showing a higher proportion for all types of injuries compared to females. Nearly one fifth of reported injuries (19.8%) required medical attention in a hospital, with males reporting higher proportions than females for most types of injuries. The study findings revealed the association of multiple risk factors with an increased odds of reporting an injury, which included working in more than one job (AOR, 1.71; CI, 1.20-2.43; p = 0.003), working under pressure (AOR, 1.64; CI, 1.36-1.97; p<0.001), the use of sharp or heavy objects (AOR, 1.88; CI, 1.58-2.24; p<0.001), and experiencing physical abuse at work (AOR, 2.46; CI, 1.97-3.08; p<0.001). The odds of reporting an injury increased with every additional hour of work per day (AOR 1.08; CI, 1.02-1.14; p = 0.006). Most of these findings persisted in the male and female stratified models, with few exceptions. Males who went to work in a pickup truck had significantly lower odds of being injured than those who walked (AOR, 0.65; CI, 0.51-0.83; p = 0.001); this finding did not reach significance for females. Having longer work hours per day was significantly linked to higher odds of injury for females (AOR, 1.07; CI, 1.02-1.12; p = 0.008); but not for males. The main limitations of this study were its cross-sectional design and the use of self-reported variables.ConclusionsThis study is the first to obtain direct testimony on work-related injuries and working conditions, exploring gender differences, among Syrian refugee children in Lebanon. Results demonstrated the association between the occurrence of injury and multiple risk factors highlighting their strenuous working conditions, with some differences detected between males and females. Many injuries can be prevented through direct safety interventions and proper implementation of child labor policies. Multidimensional interventions are essential to address the complex evolving challenges facing refugees.

Dataset Information

The Promotive Effects of Social Support for Parental Resilience in a Refugee Context: a Cross-Sectional Study with Syrian Mothers in Lebanon.

Publications

The Promotive Effects of Social Support for Parental Resilience in a Refugee Context: a Cross-Sectional Study with Syrian Mothers in Lebanon.

Similar Datasets

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