Contributors to Mental Health and Illness in Lebanon's Shatila Palestinian Refugee Camp

Background/ Purpose: Refugees and other populations exposed to armed conflict and displacement are at elevated risk for poor mental health and have evidenced high rates of acute stress and chronic mental disorders. Socio-economic disadvantage another risk-factor associated with poor mental health outcomes particularly in protracted conflict-effected situations, often characterizes the refugee situation. In Middle Eastern countries, conflict has impacted 85% of the population. The Shatila Palestinian Refugee Camp (“Shatila”) in Lebanon has seen a range of armed conflicts since its establishment in 1949.  Shatila houses 25,000 people in a single square kilometer, 60-80% living below the poverty line.  There are no municipal services, insufficient housing, Lebanese legal restrictions on employment opportunities, and prohibitions against owning property. This study seeks to improve our understanding of those factors contributing to the mental health status of the burgeoning worldwide population of refugees by specifying the role of contributors to the mental health status of individuals seeking medical care in the Shatila Palestinian Refugee Camp in Lebanon.

Methods: Data collection (2012-13) involved researcher-administered-structured-surveys of primary healthcare-clinic patients (n=254) that assessed participant mental health using the K6, the PC-PTSD, and the Modified-MINI screens. Chi. Sq. and ANOVA were used to provide descriptive statistics; Principal Component analysis to create summary socio-economic status (SES) and health measures; OLS and Logistic regressions to evaluate the contributions to participant mental health and illness of exposure to war events, social circumstances, refugee status, medical history, health behavior, and demographics.

Results: The sample (n=254) included 63.4% Palestinians refugees, 18.5% Syrian refugees and, 18.1% non-refugees. Participants included: 55% females and 45% males; aged 18-89, M=40.4(±13); 73.9% were married; 72.5% reported less than a high school education; 18% reported no education at all. On average people lived in the camp for 21.1years (±17) and were more likely to report having stable housing (63.4%) than not. A majority, 78% reported war event exposure.

Mental illness prevalence was: 51.6%, total; 34.8%, Serious Mental Illness (SMI)-alone; 5.2%, PTSD-alone; 10.8%, co-morbid-SMI/PTSD, and 0.08% co-morbid-psychotic-spectrum-disorder-SMI-PTSD.  War event exposure increased one’s chance of screening positive for SMI by 2.3 times (EXP. B=2.31; CI: 1.06-5.06), being female by 2.5 times (EXP. B=2.47; CI: 1.36-4.49), each additional year of residence in Shatila reduced ones risk of a positive screen by 3% (EXP. B=.97; CI: .95-.99), and a half point increase in SES reduced ones’ chance of a positive SMI screen by 40% (EXP. B=.60; CI: .44-.82). War-event exposure alone accounted for a fivefold increase in risk of screening positive for PTSD (EXP. B=5.02; CI: 1.08-23.29).

Conclusions: Increased protection against war exposure, allowance for expanded socio-economic opportunity and human rights protections, increased mental health resources, and insurance of the stability of living situations seem the most important considerations in ensuring the future improvement of the mental health status of this population.