Barriers to Care: Factors Associated with Unmet Need for Mental Health Care Among Syrian Refugee Women in Jordan

Background/purpose: The Syrian refugee conflict has left approximately 1.3 million displaced Syrians and refugees residing in Jordan. Syrian refugees contend with elevated rates of mental illness, and Syrian refugee women face further vulnerabilities related to mental health given the exacerbation of gendered inequities of health that often occur in times of conflict and instability. As Jordan works to meet the complex mental health needs of Syrian refugee women, it is imperative to understand barriers driving poor use of mental health systems. The purpose of this analysis is to identify barriers to care associated with Syrian refugee women’s unmet need for mental health care.

Methods: Data from the Women ASPIRE study – a cross-sectional assessment, which examined health concerns of Syrian refugee women living in non-camp settings in Jordan (N=507) – were used for the present analyses. Study participants were recruited from four health clinics in Jordan using clinic-based systematic sampling. Study participants answered survey questions on perceived barriers to medical care services, and unmet need for mental health care services, defined as women who 1) identified their need for mental health services, 2) were aware of service availability, but 3) were not receiving these services at time of survey. Descriptive, and logistic regression analyses were used to examine associations between barriers to medical care and unmet need for mental health care. Multivariable logistic regression models were adjusted for past 30-day food insecurity, household characteristics, age, education, mental health disorders, past year physical and/or sexual intimate partner violence (IPV), years residing in Jordan, previous residence governorate in Syria, and recruitment clinic.

Results: On average, participants were 33.6 years of age (SD: 11), and the majority reported experiencing food insecurity (73.4%), and IPV (51.3%). The most common barriers to medical care were related to concerns over medical finances, transportation, and timing (clinic hours, time to go to clinic, and not having childcare). Participants who endorsed not knowing where to get medical care (aOR: 1.80; 95% CI: 1.11, 2.93), did not want to be seen at the health clinic (aOR: 4.13; 95% CI: 1.70, 10.16), or felt that their refugee status was a barrier to care (aOR: 1.91; 95% CI: 1.14, 3.21) were more likely to have an unmet need for mental health services. Women reporting IPV were less likely to report unmet need for mental health services (aOR: 0.46; 95% CI: 0.27, 0.78) relative to those who had no history of IPV.

Conclusions/implications: Findings highlight the complex and numerous barriers experienced by Syrian refugee women in engaging in mental health care services. The present findings indicate the need for outreach to Syrian refugee women on mental health service access, as well as addressing potential stigma associated with being seen at health clinics, and refugee status. The negative associations between women’s history of IPV, and unmet need for mental health services may be due to the fact that IPV programming is often provided within mental health services, which may support the argument for integrated models of mental health and IPV care.