Mental Health of Syrian Refugee Mothers in Greater Beirut and Its Association with Food Security, Diet, and Nutritional Status

Abstract

Background: Syrian refugee mothers living in protracted crisis settings face vulnerabilities related to displacement, poverty, food insecurity, and poor mental health. While mental health disorders and malnutrition are each highly prevalent in refugee populations, limited research has examined their associations within the same population. The objective of this study is to assess the mental health status of Syrian refugee mothers living in urban Lebanon, and its association with food security, dietary intake, and nutritional status.

Methods: A secondary data analysis of a cross-sectional study was conducted among Syrian refugee mothers attending Primary Healthcare Centers (PHCs) in Great Beirut, Lebanon in 2018 (n = 432). Post-Traumatic Stress Disorder (PTSD) and depression were used to assess maternal mental health status. Food insecurity was measured using the global Food Insecurity Experience Scale at the individual level of the mothers, and the dietary intake was measured using the 24-hour dietary recall approach. Nutritional status indicators, including anemia and anthropometric measurements (body mass index, waist circumference, mid-upper arm circumference (MUAC)), were also collected. Socioeconomic characteristics were considered as potential confounders. Mental health status was categorized into four groups: no PTSD or depression, PTSD only, depression only, and comorbid PTSD and depression. Kruskal–Wallis and Chi-square tests were used to compare continuous and categorical variables across mental health groups, respectively. Point-biserial correlations assessed associations between food insecurity and mental health status. Multinomial logistic regression models examined associations between mental health status and dietary intake and nutritional status, with results expressed as crude (OR) and adjusted odds ratios (aOR) with 95% confidence intervals.

Results: Among 432 Syrian refugee mothers, 27% suffered from poor mental health: 13.9% had depression, 6.9% had PTSD, and 6.3% had comorbid PTSD and depression. Mothers with comorbid mental health conditions were significantly older and lived in more crowded households. Mothers reporting flu-like symptoms had higher odds of PTSD (aOR = 5.08, 95% CI: 1.70-15.13) and comorbid PTSD and depression (aOR = 5.58, 95% CI: 1.80-17.32). Daily breakfast consumption was associated with lower odds of depression (aOR = 0.38, 95% CI: 0.21-0.70) and comorbid PTSD and depression (aOR = 0.35, 95% CI: 0.14-0.84). Similarly, higher daily snack consumption was also associated with lower odds of comorbid mental health conditions (aOR = 0.55,3 95% CI: 0.32-0.96), while micronutrient supplement use was associated with lower odds of depression (aOR = 0.36, 95% CI: 0.16-0.78). Food insecurity was positively associated with mental health indicators, with weak but statistically significant correlations observed for PTSD, depression, and combined mental health status (r = 0.175-0.247, P < 0.01). The strongest association was found between overall mental health status and moderate-to-severe food insecurity (r = 0.247, P < 0.000). Nutrient inadequacy was highly prevalent, with most mothers failing to meet requirements for several key micronutrients. Mothers with comorbid PTSD and depression had the lowest mean energy intake, lowest absolute intakes of fiber and lower intakes of several micronutrients, including vitamin E, zinc, magnesium, potassium, and selenium, with intakes falling below estimated average requirements for most of these nutrients. Undernutrition based on MUAC was associated with 9 times higher odds of PTSD (aOR = 9.33, 95% CI: 2.13-40.90), while anemia, BMI, and waist-to-hip ratio were not significantly associated with mental health status.

Conclusion: Poor mental health among Syrian refugee mothers is associated with food insecurity, suboptimal dietary intake and meal patterns, physical health-related symptoms and undernutrition. These findings highlight the need for integrated interventions addressing both mental health and nutritional vulnerabilities in vulnerable populations living in protracted crisis settings. The results also highlight the need for further longitudinal studies to better examine the relationships between mental health, dietary intake, and nutritional status.

Keywords: Syrian refugees; mental health; PTSD; depression; determinants; food insecurity; dietary intake; nutritional status; anemia.