Suicidal Behavior Among Health-Seeking Syrian Refugee Women Living in Non-Camp Settings in Jordan

Background and Purpose: Jordan hosts approximately 1.3 million (registered and unregistered) Syrians refugees, making it one of the largest per capita refugee hosting countries in the world. Refugees face an increased risk of mental illness due to multiple stressors before, during and after forced migration; with women facing additional vulnerabilities. Mental health disorders, lack of social support, and post-migration stressors have been associated with suicidal behaviors among refugee populations; however, little is known among Syrian refugee women in Jordan. To contribute to this understudied area, we examined: 1) the prevalence of suicidal ideation and attempts among a sample of Syrian refugee women living in non-camp settings, and 2) the correlates of suicidal ideation to known risk factors in the literature.

Methods: We recruited a sample of 507 Syrian refugee women from health clinics of NGOs in four different governorates/cities in Jordan: Amman, Ramtha, Mafraq and Zarqa. Participants were enrolled using a clinic-based systematic sampling methodology. Interviewer administered surveys were completed between April-November 2018. Provisional mental health diagnosis was completed using validated screening tools for anxiety(GAD-7), depression(CESD), and PTSD(PCL-5). We employed a penalized multivariable regression to assess associations between number of post-migration stressors, number of mental health diagnosis, number of social supports from friends as well as from family, and suicidal ideation in the past 6 months.

Results: Syrian refugee women age ranged from 18 to 74 years, with a mean age of 33 years (SD=11) and an average displacement time of 5.2 years (SD=1.4) in Jordan. Almost one-tenth (9.1%) of women surveyed reported suicidal ideation in the past 6 months, while 2.8% reported a suicide attempt in the past 6 months. Almost all women (95.5%) who reported suicidal ideation in the past 6 months met the provisional diagnosis for either anxiety, depression or PTSD. Almost three quarters of those who reported suicidal ideation (72.7%) as well as suicidal attempts (75.0%) met the criteria for all three diagnosis (anxiety, depression and PTSD).

Women who met criteria for all three mental health diagnosis (depression, anxiety and PTSD) were more likely to present with suicidal ideation during the past 6 months (aOR:5.71, 95% CI:1.32, 24.60) as compared to those without any mental health diagnosis. We did not find significant association between women who reported no support from friends and no support from family with suicidal ideation in the past 6 months, as compared to woman who had 1 or more social supports. No significant associations were also found between number of post-migration stressors and suicidal ideation in the past 6 months.

Conclusions and Implications: suicidal behaviors among refugee populations is an understudied research area that needs greater attention. The strong association between suicidal ideation and mental health disorders among our sample of Syrian refugee women highlight the role of psychological pain and the need to screen for and act to improve the mental health and suicidal behaviors in healthcare settings. Future research should examine the prevalence of completed and attempted suicides to understand the prevalence of suicidal behaviors and associated risk-factors.