Covid-19 Public Health Measures and Their Impact on Mental Health Among Older Syrian Refugees in Lebanon: A Cross-Sectional Study

Abstract

Background The COVID-19 epidemic has impacted every aspect of life and increased the incidence of domestic violence globally, making already vulnerable populations, namely older Syrian refugees, more susceptible to negative mental health outcomes. The main objectives were to assess how the variation in adherence to COVID-19 preventive measures is associated with mental health outcomes and to explore the potential effect of domestic violence and whether this modifies or mediates the association between adherence to preventive measures and mental health in older Syrian refugees in Lebanon. Methods This was a cross-sectional study based on secondary data from the AUB-NRC-ELRHA study which investigated changing vulnerabilities of older Syrian refugees across Lebanon based on data from waves 1 and 2 spanning from September 2020 to January 2021. The sampling frame included a probability sample of Syrian households with at least one adult aged 50 years or older. The data was collected via telephone interviews. Participants A total of 3,322 Syrian refugees older than 50, currently residing in Lebanon, and who participated in the initial study were selected using a beneficiary list from a humanitarian organization and constituted the sample size. Analysis Using a directed acyclic graph (DAG), a theoretical framework was composed to highlight associations between various risk factors and the association between the main exposure, adherence to COVID-19 preventive measures, the effect modifier domestic violence, with mental health. Descriptive and univariate analyses, along with ten multiple variable logistic regression models stratified by domestic violence were conducted. Due to multiple testing, an adjusted p-value of 0.01 was used to assess significance. Five separate interaction terms between each adherence measure with domestic violence were assessed. Five path diagrams were modeled based on logistic regression and evaluated the direct, indirect, and total effects of each adherence measure with domestic violence on mental health. Results nearly 70% of the participants reported poor mental health outcomes and 10.5% reported experiencing verbal or physical violence. Adhering to COVID-19 preventive measures was not associated with poor mental health. Domestic violence did not modify the association between each adherence measure with mental health; it did account for 7.14% of the indirect effect of receiving visitors at home on mental health and was significantly associated with receiving visitors at home (OR 1.42, p-value= 0.003). Conclusions Further studies are needed to highlight the role of COVID-19 measures on mental health, define the prevalence of mental disorders and domestic violence, and provide needs and services for older Syrian refugees in Lebanon.