Study indicates importance of post-settlement supports to address depression in Syrian refugees

More attention is needed on the impact of post-migration conditions on depression-level symptoms for Syrian refugees in Canada, according to new research out of York University.

A paper published in the Journal of Mental Health on May 21 studies the prevalence of depression-level symptoms in a sample of participants in Canada’s Syrian Refugee Resettlement Initiative to inform relevant programs and policies. Canada's initiative launched in 2015 and resettled more than 40,000 refugees in 15 months.

Farah Ahmad

Farah Ahmad

The eruption of civil war in Syria forced millions of people to flee their homes in search of safety. Evidence shows that refugees from a war-stricken country experience traumatizing events in the country, when fleeing and while in asylum, which could affect their health and well-being. This can contribute to high rates of common mental health problems including depression, says one of the study’s authors York University Faculty of Health Professor Farah Ahmad. However, she adds, only a few studies specific to the recent wave of resettled Syrian refugees exist especially with a focus on depression.

Using data collected by structured interviews, the study “Depression-level symptoms among Syrian refugees: findings from a Canadian longitudinal study” analyzes the prevalence of depression-level symptoms at baseline and one-year post-resettlement. The symptoms of depression were measured using the Patient Health Questionnaire 9 (PHQ-9), and analysis for associated factors was executed through multinomial logistic regression.

Michaela Hynie

Michaela Hynie

Ahmad and Postdoctoral Visiting Fellow, Nasih Othman, examined data drawn from the Syrian Refugee Integration and Long-term Health Outcomes study (SyRIA.lth), a longitudinal survey and qualitative assessments of 1,924 Syrian refugees who arrived in Canada between 2015 and 2017. The study, funded by the Canadian Institutes of Health Research (CIHR), is led by Professors Michaela Hynie (Health) and Susan McGrath (Faculty of Liberal Arts & Professional Studies) from York University and Dr. Kwame McKenzie from the Center for Addictions and Mental Health and the Wellesley Institute.

The authors found the prevalence of depression-level symptoms increased from 15 per cent at baseline to 18 per cent in year two. The significant predictors of depression-level symptoms at year two were baseline depression, sponsorship program, province of resettlement, poor language skills, lack of satisfaction with housing conditions and with health services, lower perceived control, lower perceived social support and longer stay in Canada.

“The existence of baseline depression-level scores increased the risk of depression-level scores at year two by 10-fold. Indeed, it signifies the importance of early detection and treatment of depression among refugees soon after arrival,” said Ahmad. However, the increasing rate of depression with length of time in Canada reinforces the importance of addressing post-migration conditions to promote refugee mental health.

Other studies using SyRIA.lth data, said Othman, have shown that a significant proportion of them seem to have unmet needs and that they rarely access mental health services.

Also important to note is the rate of depression found for Canadian Syrian refugees in this study are much lower than the rates reported for Syrian refugees in countries neighbouring Syria or among those who sought asylum in some European countries.

“The relatively low prevalence of depression among resettled Canadian Syrian refugees at this initial stage of their resettlement may be partially attributed to stability that permanent residency status offers them,” said Hynie.

The results also shed light on the significance of language skills and social support in reducing the risk of depression at year two. For example, privately sponsored refugees – a group with more social connections, better language skills and higher levels of education – had a 60 per cent lower risk of depression-level scores at year two compared to government-assisted refugees. Also, those who continued to have a need for interpreter at year two had increased risk of depression-level scores at year two.

Collectively, the study’s findings emphasize the need for improved access to appropriate housing and language and health services for the settlement of refugees.

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