Moderation Effect of Employment Status on the Relationship between Post-Traumatic Stress and Depression Symptoms in Jordan

Background

The Syrian crisis is considered one of the worst refugee crises since World War Ⅱ displacing over 6 million Syrians to other countries. Jordan is among the countries with the largest influx of displaced Syrians. The inundation of Syrian refugees has put a strain on social structures in Jordan, such as schools, sanitation, housing, food, and water. Especially, many refugees have experienced multiple traumas due to conflict exposure which puts them at high risk for mental health symptoms. Trauma exposure also puts Syrian refugees at risk for other mental health issues such as depression, psychosis, and severe emotional disturbance. Despite the high co-morbidity of PTS symptom and depression and the impact these disorders have on a person’s functioning, few studies have investigated moderating factors that might alleviate these effects until now. Previous literature has indicated that employment may play a role in alleviating mental health symptoms. In this paper, our primary research aim is to investigate whether employment status can attenuate the associated risk of PTS and depression symptoms. We also examined how socio-economic characteristics differ by employment status among Jordanians and Syrians and the association of PTS with depressive symptoms.

Method

The data included in this study is the first wave of data in a longitudinal intervention study measuring the impact of a health and mental health awareness project in Irbid, Jordan. Data were collected in April 2017 with 600 participants in three local primary care health clinics. The short form of the PTSD Checklist-Civilian Version was used to screen for PTSD symptoms (range: 6-30). A modified sub-scale of the Duke Health Profile was used to assess the depression symptom (range: 0-60). Current employment status (0=unemployed, 1=employed) was used as a moderator. Gender, race/ethnicity, marital status, age, education, the number of trauma experiences were used as covariates. The descriptive analysis examined the demographic characteristics of the sample. Chi-square and independent sample t-tests tested differences between demographic characteristics and employment status. We then conducted a moderation analyses using the PROCESS macro for SPSS.

Results

The majority of the sample was between 40-59 years old (54.6%), female (70.3%) and married (84.6%). Over half of the sample had less than high school education (53.2%). Bivariate correlations indicated that higher PTS symptoms were positively associated with higher depression symptoms (r=0.43, p<.001). Moderation analyses illustrated that higher PTS symptoms (B = 1.07, p<0.001) and unemployment (B = -3.56, p<0. 1) were associated with higher depression symptoms. The interaction term of PTS symptoms and employment status indicated that employment had a buffering effect between PTS symptoms and depression symptoms (B = 0.50, p<0.1).

Conclusion

Our results indicated that employment moderated the relationship between post-traumatic stress and depression symptoms. The protective impact of employment on the relationship between PTS and depression symptoms may be attributed to the association between employment and resilience. By considering the unique characteristics of Jordan society, the future social program and service established with the adequate cultural components of the Jordan will be discussed.