Associations between Intimate Partner and Family Violence, Mental Health Status and Suicidal Ideation Among Syrian Refugee Women in Jordan

Background and purpose: Since 2011, an unprecedented number of Syrian refugees have been displaced. Stress and vulnerability created by displacement exacerbate violence against women and contribute to adverse mental health outcomes. This analysis seeks to examine the relationship between experiencing multiple forms of violence from intimate partners and family members, mental health status and suicidal ideation among Syrian refugee women in Jordan.

Methods: Syrian refugee women (n=507) were recruited into the Women ASPIRE study using time and venue-based random sampling from non-governmental health clinics in four cities in Jordan in 2018. Eligibility criteria included: being a female Syrian refugee, living in non-camp settings, and being >=18 years. Study participants answered a wide range of survey topics, including experiences of IPV and family violence (Conflict Tactics Scale) over the past year, mental health screeners for depression (CES-D), anxiety (GAD-7), post-traumatic stress disorder (PTSD; PCL-5), and suicidal ideation in the past 6 months. Using cross-sectional data, we examined a dose-response relationship between experiencing multiple forms of physical (range: 0-6) and sexual (range: 0-2) violence from intimate partners (IPV) and family members in the past year, and current mental health status and suicidal ideation. Multivariable logistic regression models were adjusted for age, literacy, food insecurity, and number of children in the household.

Results: On average, women were 33.6 years of age (SD: 11), nearly half were fully literate (46%), the majority experienced food insecurity (73%), and, on average, had 3.4 (SD: 2.1) children residing within the household. Approximately one-third (34%) experienced at least one form of IPV, and 7.4% experienced at least one form of family violence in the past year. Nearly two-thirds (63%), 89%, and 52% met the criteria for depression, anxiety and PTSD, respectively; and 9% expressed suicidal ideation within the 6 months prior. Every additional form of physical IPV was associated with a 44% increase [aOR: 1.44; (95% CI: 1.21, 1.71)] in the odds of depression. Similarly, each additional form of physical IPV was associated with a greater odds of anxiety [aOR: 2.61; (95% CI: 1.35, 5.04)], PTSD [aOR: 1.74; (95% CI: 1.46, 2.09)] and suicidal ideation [aOR: 1.40; (95% CI: 1.18, 1.66)]. Experiencing multiple forms of physical family violence was associated with increased odds of depression [aOR: 2.85; (95% CI: 1.12, 7.25)], PTSD [aOR: 1.93; (95% CI: 1.03, 3.61)] and suicidal ideation [aOR: 2.01; (95% CI: 1.23, 3.29)]. Similarly, sexual IPV was associated with nearly a 9-fold increase in PTSD [aOR: 8.86; (95% CI: 1.57, 49.87);] and sexual family violence was associated with a 3.5 fold increase in suicidal ideation [aOR: 3.48; (95% CI: 1.04, 11.58)].

Conclusions and implications: Findings highlight high rates of IPV and adverse mental health outcomes in this population. Findings also suggest a dose-response between violence and mental health status, that is especially pronounced among those experiencing physical IPV and family violence. Violence prevention programs for Syrian refugee women should also consider screening for and addressing mental health.