Post-traumatic stress disorders among Syrian refugees residing in non-camp settings in Jordan

Iman A. Basheti; Shahnaz Mohammed Ayasrah; Rajaa Ali Al-Qudah

doi:10.15537/smj.2023.44.1.20220701

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1
- The effect of physical symptoms or psychological problems on social activities among participants during the last 4 weeks’ time frame.

Tables

Figures

View popup

Table 1

- Socio-demographics for the study participants based on being a case of PTSD or not* (N=279).

Characteristics	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-value
Age group (years)
Young (18-30)	47 (31.8)	135 (68.2)	182 (56.2)	χ2=9.19 p=0.01
Middle-aged (31-45)	36 (42.3)	45 (57.7)	45 (34.8)
Old-aged (45)	6 (48.0)	10 (52.0)	10 (9.0)
Gender
Males	61 (41.8)	85 (58.2)	146 (52.3)	χ2=13.8 p<0.001
Females	28 (31.6)	105 (68.4)	133 (47.7)	χ2=13.8 p<0.001
Educational level
Illiterate	1(33.3)	2(66.7)	3 (1.1)	χ2=0.68 p=0.878
Primary	45 (34.1)	87 (65.9)	132 (47.3)
Secondary	26 (30.9)	58 (69.0)	84 (30.1)
University	17 (28.3)	43 (71.7)	60 (21.5)
Marital status
Single	26 (27.7)	68 (72.3)	94 (33.7)	χ2=2.84 p=0.42
Married	58 (33.5)	115 (66.5)	173 (62.0)
Divorced	3 (60.0)	2 (40.0)	5 (1.80)
Widowed	2 (28.6)	5 (71.4)	7 (2.50)
Employment status
Unemployed	57 (28.0)	147 (72.0)	204 (73.0)	χ2= 5.47 p=0.019
Employed	32 (42.7)	43 (57.3)	75 (27.0)	χ2= 5.47 p=0.019
Having a family member died in the conflict
No	64 (51.6)	60 (48.4)	124 (44.4)	χ2= 39.9
Yes	25 (16.1)	130 (83.9)	155 (55.6)	p<0.001
If peace restore, you would go back to your country
No	8 (14.0)	49 (86.0)	57 (20.4)	χ2= 10.5
Yes	81 (36.5)	141 (63.5)	222 (79.6)	p=0.001

Values are presented as number and percentage (%). *Mean score >2.5 on the Harvard Trauma Questionnaire (HTQ)-16’s sub-items or entire scale (HTQ-45) indicated a case of post-traumatic stress disorders (PTSD), χ2: Chi-square, p: significant level

View popup

Table 2

- Type of traumatic events reported by the study participants based on being a case of post-traumatic stress disorders (PTSD) or not* (N=279).

Type of traumatic event	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-value
“Oppressed because of ethnicity, religion, or sect”
No	52 (31.3)	114 (68.7)	166 (59.5)	χ2=0.010
Yes	36 (31.9)	77 (68.1)	113 (40.5)	p=0.921
“Present while someone searched for people or things in your home”
No	8 (26.7)	22 (73.3)	30 (10.8)	χ2=0.370
Yes	80 (32.1)	169(67.9)	249 (89.2)	p=0.543
“Searched”
No	33 (28.0)	85 (72.0)	118 (42.3)	χ2=1.21
Yes	55 (34.2)	106 (65.8)	161 (57.7)	p=0.271
“Property looted or confiscated or destroyed”
No	21 (30.9)	50 (69.0)	71 (30.1)	χ2=0.170
Yes	67 (28.3)	141 (71.7)	208 (21.5)	p=0.680
“Forced to leave your hometown and settle in a different part of the country with minimal services”
No	12 (27.3)	32 (72.7)	44 (15.8)	χ2=.441
Yes	76 (32.3)	159 (67.7)	235 84.2)	p=0.507
“Imprisoned”
No	77 (33.3)	154 (66.6)	231 (82.8)	χ2=1.99
Yes	11 (22.9)	37 (77.1)	48 (17.2)	p=0.158
“Suffered ill health without access to medical care or medicine”
No	33 (31.7)	71 (68.3)	104 (37.3)	χ2=0.003
Yes	55 (31.4)	120 (68.6)	175 (62.7)	p=0.958
“Suffered from lack of food and cleaned water”
No	33 (30.3)	76 (69.7)	109 (39.1)	χ2=0.133
Yes	55 (32.4)	115 (67.6)	170 (60.9)	p=0.716
“Forced to flee your country”
No	39 (14.0)	76 (86.0)	115 (20.4)	χ2=0.510
Yes	49 (36.5)	115 (63.5)	164 (79.6)	p=0.475
“Expelled from your country based on ancestral origin, religion, or sect”
No	6 (24.0)	19 (76.0)	25 (9.0)	χ2=0.723
Yes	82 (32.3)	172 (67.7)	254 (91.0)	p=0.395
“Lack shelter”
No	19 (14.0)	34 (86.0)	53 (20.4)	χ2=0.562
Yes	69 (36.5)	157 (63.5)	226 (79.6)	p=0.453
“Witnessed the desecration or destruction of religious shrines or places of religious instruction”
No	9 (23.1)	30 (76.9)	39 (14.0)	χ2=1.50
Yes	79 (32.9)	161 (67.1)	240 (86.0)	p=0.220
“Witnessed the arrest, torture, or execution of religious leaders or important members of tribe”
No	24 (39.3)	37 (60.7)	61 (21.9)	χ2= 2.20
Yes	64 (29.4)	154 (70.6)	218 (78.1)	p=0.138
“Witnessed mass execution civilians”
No	70 (40.7)	102 (59.3)	172 (61.6)	χ2=17.4
Yes	18 (16.8)	89 (83.2)	107 (38.4)	p<0.001
“Witnessed shelling, burning, or razing of residential areas or marshlands”
No	28 (70.0)	12 (30.0)	40 (14.3)	χ2= 32.0
Yes	60 (25.1)	179 (74.9)	239 (85.7)	p<0.001
“Witnessed chemical attacks on residential areas or marshlands”
No	79 (35.7)	142 (64.3)	221 (79.2)	χ2=8.71
Yes	9 (15.5)	49 (84.5)	58 (20.8)	p<0.001

Type of traumatic event	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-value
“Exposed to combat situation (explosions, artillery fire, shelling) or landmine”
No	5 (21.7)	18 (78.3)	23 (08.2)	χ2=1.12
Yes	83 (32.4)	173 (67.6)	256 (91.8)	p=0.291
“Serious physical injury from combat situation or landmine”
No	82 (32.9)	167 (67.1)	249 (89.2)	χ2=2.10
Yes	6 (20.0)	24 (80.0)	30 (10.8)	p=0.150
“Used as a human shield”
No	76 (32.8)	156 (67.2)	232 (83.2)	χ2=. 950
Yes	12 (25.5)	35 (74.5)	47 (16.8)	p=0.331
“Serious physical injury of family member or friend from combat situation or landmine”
No	44 (43.6)	57 (56.4)	101 (36.2)	χ2=10.60
Yes	44 (24.7)	134 (75.3)	178 (63.8)	p=0.001
“Witnessed rotting corpses”
No	62 (38.3)	100 (61.7)	162 (58.1)	χ2=8.10
Yes	26 (22.2)	91 (77.8)	117 (41.9)	p=0.004
“Confined to home because of chaos and violence outside”
No	10 (47.6)	11 (52.4)	21 (07.5)	χ2=2.72
Yes	78 (30.2)	180 (69.8)	258 (92.5)	p=0.099
“Witnessed someone being physically harmed (beating, knifing, and so on)”
No	35 (39.3)	54 (60.7)	89 (31.9)	χ2=3.67
Yes	53 (27.9)	137 (72.1)	190 (68.1)	p=0.055
“Witnessed sexual abuse or rape”
No	78 (34.5)	148 (65.5)	226 (81.0)	χ2=4.87
Yes	10 (18.9)	43 (81.1)	53 (19.0)	p=0.027
“Witnessed torture”
No	49 (40.2)	73 (59.8)	122 (43.7)	χ2 =7.47
Yes	39 (24.8)	118 (75.2)	157 (56.3)	p=0.006
“Witnessed murder”
No	55 (39.3)	85 (60.7)	140 (50.2)	χ2=7.81
Yes	33 (23.7)	106 (76.3)	139 (49.8)	p=0.005
“Forced to inform on someone placing them at risk of injury or death”
No	84 (31.8)	180 (68.2)	264 (94.6)	χ2=0.174
Yes	4 (26.7)	11 (73.3)	15 (05.4)	p=0.676
“Forced to destroy someone’s property”
No	86 (32.2)	181 (67.8)	267 (95.7)	χ2=0.961
Yes	2 (16.7)	10 (83.3)	12 (04.3)	p=0.327
“Forced to physically harm someone (beating, knifing, and so on)”
No	87 (32.1)	184 (67.9)	271 (97.1)	χ2=1.38
Yes	1 (12.5)	7 (87.5)	8 (02.9)	p=0.240
“Murder or violent death of family member (child, spouse, and so on)”
No	49 (39.2)	76 (60.8)	125 (44.8)	χ2=6.15
Yes	39 (25.3)	115 (74.6)	154 (55.2)	p=0.013
“Received the body of a family member (child, spouse, and so on) and prohibited from mourning them and performing burial rites”
No	77 (38.3)	124 (61.7)	201 (72.0)	χ2=15.2
Yes	11 (14.1)	67 (85.9)	78 (28.0)	p<0.001
“Disappearance of a family member (child, spouse, and so on) or disappearance of a friend”
No	63 (40.6)	92 (59.4)	155 (55.6)	χ2 =13.4
Yes	25 (20.2)	99 (79.8)	124 (44.4)	p<0.001

Type of traumatic event	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-values
“Family member (child, spouse, and so on) or friend kidnapped”
No	76 (39.3)	135 (60.7)	211 (21.9)	χ2 =10.8
Yes	12 (29.4)	54 (70.6)	66 (78.1)	p=0.001
“Family member (child, spouse, and so on) or friend taken as a hostage”
No	76 (36.0)	135 (64.0)	211 (75.6)	χ2 =7.38
Yes	12 (18.2)	54 (81.8)	66 (78.1)	p=0.007
Someone informed on you placing you at risk of injury or death
No	80 (33.5)	159 (66.5)	239 (85.7)	χ2 =2.65
Yes	8 (20.0)	32 (80.0)	40 (14.3)	p=0.103
Physically harmed (beaten, knifed, and so on)
No	69 (31.1)	153 (68.9)	222 (79.6)	χ2=0.093 p=0.760
Yes	19 (33.3)	38 (66.7)	57 (20.4)	χ2=0.093 p=0.760
Kidnapped
No	88 (32.6)	182 (67.4)	270 (96.8)	χ2= 4.29 p=0.038
Yes	0 (0)	9 (100)	9 (03.2)	χ2= 4.29 p=0.038
Taken as a hostage
No	83 (31.4)	181 (68.6)	264 (94.6)	χ2=0.02 p=0.878
Yes	5 (33.3)	10 (66.7)	15 (05.4)	χ2=0.02 p=0.878
Sexually abused or raped (such as forced sexual activity)
No	88 (39.3)	165 (60.7)	253 (90.7)	χ2=12.72
Yes	0 (0)	26 (100)	26 (09.3)	p<0.001
Tortured (such as while in captivity you received deliberate and systematic infliction of physical and/or mental suffering)
No	79 (35.1)	146 (64.9)	225 (80.6)	χ2= 6.86 p=0.009
Yes	9 (16.7)	45(83.3)	54 (19.4)	χ2= 6.86 p=0.009

Values are presented as number and percentage (%). *Mean score >2.5 on the Harvard Trauma Questionnaire (HTQ)-16’s sub-items or entire scale (HTQ-45) indicated a case of PTSD, χ2: Chi-square, p: significant level

View popup

Table 3

- Physical symptoms experienced by the study participants based on being a case of PTSD or not* (N= 279).

Characteristics	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-value
Stomach pain
Not bothered at all	44 (41.5)	62 (58.5)	106 (38.0)	χ2=9.1 p=0.011
Bothered a little	29 (28.7)	72 (71.3)	101 (36.0)
Bothered a lot	15 (20.8)	57 (79.2)	72 (26.0)
Back pain
Not bothered at all	34 (39.1)	53 (60.9)	87 (31.2)	χ2=7.99 p=0.018
Bothered a little	37 (34.6)	70 (65.4)	107 (38.3)
Bothered a lot	17 (20.0)	68 (80.0)	85 (30.5)
Pain in your arms, legs, or joints (knees, hips, and so on)
Not bothered at all	45(46.4)	52(53.6)	97 (34.8)	χ2=23.0 p<0.001
Bothered a little	29 (33.7)	57 (66.3)	86 (30.8)
Bothered a lot	14 (14.6)	82 (85.4)	96 (34.4)
Menstrual cramps or other problems with periods (female, n=133)
Not bothered at all	15 (28.3)	38 (71.7)	53 (39.9)	χ2=5.53 p=0.063
Bothered a little	10 (23.3)	33 (76.7)	43 (32.3)
Bothered a lot	3 (08.1)	34 (91.9)	37 (27.8)
Headaches
Not bothered at all	30 (50.0)	30 (50.0)	60 (21.5)	χ2=25.9 p<0.001
Bothered a little	44 (37.3)	74 (62.7)	118 (42.3)
Bothered a lot	14 (13.9)	87 (86.1)	101 (36.2)
Chest pain
Not bothered at all	27 (18.4)	90 (61.2)	147 (52.7)	χ2= 7.54 p=0.023
Bothered a little	20 (23.8)	64 (76.2)	84 (30.1)
Bothered a lot	11 (22.9)	37 (77.1)	48 (17.2)
Dizziness
Not bothered at all	54 (42.5)	73 (57.5)	127 (45.5)	χ2= 17.3 p<0.001
Bothered a little	24 (29.6)	57 (70.4)	81 (29.1)
Bothered a lot	10 (14.1)	61 (85.9)	71 (25.4)
Fainting spells
Not bothered at all	68 (32.1)	144 (67.9)	212 (76.0)	χ2=0.255 p=0.880
Bothered a little	14 (28.6)	35 (71.4)	49 (17.6)
Bothered a lot	6 (33.3)	12 (66.7)	18 (6.4)
Feeling your heart pound or race
Not bothered at all	53 (40.2)	79 (59.8)	132 (47.3)	χ2=9.23 p=0.003
Bothered a little	27 (25.7)	78 (74.3)	105 (37.6)
Bothered a lot	8 (19.0)	34 (81.0)	42 (15.1)
Shortness of breath
Not bothered at all	47 (42.7)	63 (57.3)	110 (39.4)	χ2=21.6 p<0.001
Bothered a little	35 (33.7)	69 (66.3)	104 (37.3)
Bothered a lot	6 (9.2)	59 (90.8)	65 (23.3)
Pain or problems during sexual intercourse
Not bothered at all	54 (37.8)	89 (62.2)	143 (51.2)	χ2=11.3 p=0.004
Bothered a little	27 (32.9)	55 (67.1)	82 (29.4)
Bothered a lot	7 (13.0)	47 (87.0)	54 (19.4)
Constipation, loose bowels, or diarrhea
Not bothered at all	47 (37.9)	77 (62.1)	124 (44.4)	χ2=7.92 p=0.019
Bothered a little	33 (31.4)	72 (68.6)	105 (37.6)
Bothered a lot	8 (16.0)	42 (84.0)	50 (18.0)
Nausea, gas, or indigestion
Not bothered at all	42 (32.6)	87 (67.4)	129 (46.2)	χ2=4.07 p=0.131
Bothered a little	36 (36.0)	64 (64.0)	100 (35.8)
Bothered a lot	10 (20.0)	40 (80.0)	50 (18.0)

Characteristics	Non-case of PTSD n (%)	A case of PTSD n (%)	Total n (%)	χ2 P-value
Feeling tired or having low energy
Not bothered at all	29 (41.4)	41 (58.6)	70 (25.1)	χ2=31.7 p<0.001
Bothered a little	50 (43.5)	65 (56.5)	115 (41.2)
Bothered a lot	9 (9.6)	85 (90.4)	94 (33.7)
Trouble sleeping
Not bothered at all	37 (46.8	42 (53.2)	79 (28.3)	χ2=37.1 p<0.001
Bothered a little	43 (41.3)	61 (83.9)	104 (37.3)
Bothered a lot	8 (08.3)	88 (91.7)	96 (34.4)

View popup

Table 4

- Predicting the likelihood of being of a case of PTSD using a multivariate logistic regression* (n= 279).

Predictor variables	B	Wald	p	OR	95% CI
Age
Young (18-30)	0.993	2.51	0.130	2.70	0.746 –9.76
Middle-aged (31- 45)	1.87	7.31	0.007	6.89	1.62 –26.1
Old-aged (>45)	Ref.
Gender
Female	-1.43	9.94	0.002	0.239	0.098–0.582
Male	Ref
Employment status
Unemployed	-0.876	4.54	0.033	0.416	0.186–0.932
Employed	Ref.
A family member died during the conflict
No	1.74	17.0	0.000	5.7	2.49–13.0
Yes	Ref.
If peace restore you will go back home
No	-0.234	0.194	0.660	0.792	0.279–2.24
Yes	Ref.
“Witnessed mass execution for civilians”
No	0.530	1.15	0.285	1.7	0.644–4.48
Yes	Ref.
“Witnessed shelling, burning, or razing of residential areas or marshlands”
No	1.96	12.1	0.001	7.12	2.35–21.6
Yes	Ref.
“Witnessed chemical attacks on residential areas or marshlands”
No	0.747	1.69	0.193	2.11	0.685 – 6.51
Yes	Ref.
“Serious physical injury of family member or friend from combat situation or landmine”
No	0.358	0.694	0.405	1.43	0.616 – 3.32
Yes	Ref.
“Witnessed rotting corpses”
No	0.182	0.136	0.712	1.20	0.457–3.15
Yes	Ref.
“Witnessed sexual abuse or rape”
No	1.04	3.08	0.079	2.82	0.886–9.00
Yes	Ref.

Predictor variables	B	Wald	p	OR	95% CI
“Witnessed torture”
No	0.472	1.12	0.289	1.60	0.670–3.84
Yes	Ref.
“Witnessed murder”
No	-0.123	0.062	0.804	0.884	0.335–2.34
Yes	Ref.
“Murder or violent death of a family member”
No	-.870	3.26	0.071	0.419	0.16 –1.08
Yes	Ref.
“Received the body of a family member and prohibited from mourning or performing burial rites”
No	1.32	5.80	0.016	3.73	1.28 –10.88
Yes	Ref.
“Disappearance of a family member or a friend”
No	.895	3.62	0.057	2.45	0.973 – 6.16
Yes	Ref.
“Family member or friend kidnapped”
No	-.557	1.20	0.273	0.573	0.212 – 1.55
Yes	Ref.
“Family member or friend taken as a hostage”
No	0.479	0.864	0.354	1.61	0.588 – 4.43
Yes	Ref.
“Kidnapped”
No	-2.24	3.61	0.058	0.106	0.011 – 1.07
Yes	Ref.
“Sexually abused or raped (such as, forced sexual activity)”
No	2.05	7.57	0.006	7.75	1.78 – 33.4
Yes	Ref.
“Tortured”
No	0.442	0.447	0.504	1.56	0.426 – 5.69
Yes	Ref

*Mean scores >2.5 in the sub-items (Harvard Trauma Questionnaire [HTQ]-16) or the entire scale HTQ-45 indicated a case of PTSD, B: estimated multinomial logistic regression coefficients, p: significant level, OR: Odds ration, CI: confidence interval Ref.: reference group

View popup

Table 5

- The study participants’ level of satisfaction with the services provided to them during being settled in Jordan (N=279).

Type of service	Bad n (%)	Accepted n (%)	Medium n (%)	Good n (%)	Excellent n (%)
Food	56 (20.1)	106 (38.0)	62 (22.2)	39 (14.0)	16 (5.7)
Housing	88 (31.5)	102 (36.5)	51 (18.3)	32 (11.5)	6 (2.2)
Income	177 (63.4)	56 (20.1)	34 (12.2)	11 (3.9)	1 (0.4)
Environment around in general	66 (23.7)	99 (35.5)	70 (25.1)	37 (13.3)	7 (2.5)
Freedom of religious practice	9 (3.2)	39 (14.0)	31 (11.1)	87 (31.2)	113 (40.5)
Medical care	91 (32.6)	88 (31.5)	56 (20.1)	38 (13.6)	6 (2.2)
Psychological care	112 (40.1)	86 (30.8)	54 (19.4)	25 (9.0)	2 (0.7)
Care of medicine or drugs	97 (34.8)	80 (28.7)	54 (19.4)	45 (16.1)	3 (1.1)
Children general care	67 (24.0)	79 (28.3)	64 (22.9)	51 (18.3)	18 (6.5)
Children teaching	90 (32.3)	59 (21.1)	63 (22.6)	52 (18.6)	15 (5.4)
Children healthcare	65 (23.3)	75 (26.9)	63 (22.6)	60 (21.5)	16 (5.7)
Children feeding	72 (25.8)	73 (26.2)	60 (21.5)	53 (19.0)	21 (7.5)
Provide suitable activities to children	58 (20.8)	74 (26.5)	54 (19.4)	50 (17.9)	43 (15.4)