Background
Methods
Sampling
Consent and approval for study
Questionnaires
Socioeconomic status (SES)
Screening for mental disorder
Social support
PTSD
Other questions
Data process
Avoidance | Arousal | Re-experience | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Negative(n = 910) - % | Positive (n = 1040) - % | P value | Negative (n = 693) - % | Positive (n = 1257) - % | P value | Negative (n = 800) - % | Positive (n = 1150) - % | P value | P value# | |||||||
Gender | ||||||||||||||||
Male | 247 | 27.1% | 280 | 26.9% | NS | 208 | 30.0% | 319 | 25.4% | 0.073 NS | 239 | 29.9% | 288 | 25.0% | 0.051 NS | NS |
Female | 663 | 72.9% | 760 | 73.1% | 485 | 70.0% | 938 | 74.6% | 561 | 70.1% | 862 | 75.0% | ||||
Consanguinity | ||||||||||||||||
No | 656 | 72.1% | 759 | 73.0% | NS | 496 | 71.6% | 919 | 73.1% | NS | 591 | 73.9% | 824 | 71.7% | NS | NS |
Third-degree relatives | 134 | 14.7% | 166 | 16.0% | 103 | 14.9% | 197 | 15.7% | 111 | 13.9% | 189 | 16.4% | ||||
Fourth-degree relatives | 53 | 5.8% | 44 | 4.2% | 42 | 6.1% | 55 | 4.4% | 47 | 5.9% | 50 | 4.3% | ||||
Distant relatives | 67 | 7.4% | 71 | 6.8% | 52 | 7.5% | 86 | 6.8% | 51 | 6.4% | 87 | 7.6% | ||||
Marital status | ||||||||||||||||
Single | 750 | 82.5% | 866 | 83.4% | NS | 574 | 82.9% | 1042 | 83.0% | NS | 661 | 82.7% | 955 | 83.2% | NS | NS |
Engaged | 47 | 5.2% | 39 | 3.8% | 31 | 4.5% | 55 | 4.4% | 31 | 3.9% | 55 | 4.8% | ||||
Married | 97 | 10.7% | 120 | 11.6% | 78 | 11.3% | 139 | 11.1% | 94 | 11.8% | 123 | 10.7% | ||||
Divorced | 10 | 1.1% | 11 | 1.1% | 6 | 0.9% | 15 | 1.2% | 9 | 1.1% | 12 | 1.0% | ||||
Widowed | 5 | 0.6% | 2 | 0.2% | 3 | 0.4% | 4 | 0.3% | 4 | 0.5% | 3 | 0.3% | ||||
Educational level | ||||||||||||||||
Primary School | 2 | 0.2% | 23 | 2.3% | < 0.0001 | 2 | 0.3% | 25 | 1.9% | < 0.0001 | 5 | 0.6% | 22 | 1.8% | 0.004 | 0.001 |
High School | 45 | 4.9% | 81 | 7.8% | 30 | 4.3% | 96 | 7.6% | 44 | 5.5% | 82 | 7.1% | ||||
University or any high institute | 807 | 88.7% | 864 | 83.2% | 624 | 90.0% | 1047 | 83.4% | 700 | 87.5% | 971 | 84.5% | ||||
Masters or PhD | 56 | 6.2% | 70 | 6.7% | 37 | 5.3% | 89 | 7.1% | 51 | 6.4% | 75 | 6.5% | ||||
SES | ||||||||||||||||
Lower | 14 | 1.5% | 16 | 1.5% | 8 | 1.2% | 22 | 1.8% | 9 | 1.1% | 21 | 1.8% | ||||
Upper Lower | 199 | 21.9% | 283 | 27.2% | 0.028 NS | 136 | 19.6% | 346 | 27.5% | 0.003 | 176 | 22.0% | 306 | 26.6% | 0.055 NS | 0.005 NS |
Middle | 490 | 53.8% | 554 | 53.3% | 393 | 56.7% | 651 | 51.8% | 435 | 54.4% | 609 | 53.0% | ||||
Upper | 207 | 22.7% | 187 | 18.0% | 156 | 22.5% | 238 | 18.9% | 180 | 22.5% | 214 | 18.6% | ||||
Working | ||||||||||||||||
No | 497 | 65.0% | 600 | 67.6% | NS | 385 | 67.2% | 712 | 66.0% | NS | 433 | 64.5% | 664 | 67.8% | NS | NS |
Yes | 267 | 35.0% | 287 | 32.4% | 188 | 32.8% | 366 | 34.0% | 238 | 35.5% | 316 | 32.2% | ||||
Age groups | ||||||||||||||||
14–18 | 24 | 2.6% | 27 | 2.6% | 15 | 2.2% | 36 | 2.9% | 14 | 1.8% | 37 | 3.2% | ||||
19–25 | 720 | 79.1% | 818 | 78.7% | < 0.0001 | 563 | 81.2% | 975 | 77.6% | < 0.0001 | 639 | 79.9% | 899 | 78.2% | < 0.0001 | 0.066 NS |
26–45 | 147 | 16.2% | 186 | 17.9% | 102 | 14.7% | 231 | 18.4% | 128 | 16.0% | 205 | 17.8% | ||||
46–65 | 19 | 2.1% | 9 | 0.9% | 13 | 1.9% | 15 | 1.2% | 19 | 2.4% | 9 | 0.8% | ||||
Losing someone close due to war | ||||||||||||||||
No | 351 | 38.6% | 346 | 33.3% | 0.039 NS | 270 | 39.0% | 427 | 34.0% | 0.067 NS | 339 | 42.4% | 358 | 31.1% | < 0.0001 | 0.001 |
Yes | 559 | 61.4% | 694 | 66.7% | 423 | 61.0% | 830 | 66.0% | 461 | 57.6% | 792 | 68.9% | ||||
A relative being endangered by the war | ||||||||||||||||
No | 138 | 15.2% | 146 | 14.0% | NS | 113 | 16.3% | 171 | 13.6% | NS | 132 | 16.5% | 152 | 13.2% | NS | NS |
Yes | 772 | 84.8% | 894 | 86.0% | 580 | 83.7% | 1086 | 86.4% | 668 | 83.5% | 998 | 86.8% | ||||
Distressed from war noises | ||||||||||||||||
Negative | 195 | 21.4% | 211 | 20.3% | NS | 185 | 26.7% | 211 | 17.6% | < 0.0001 | 196 | 24.5% | 210 | 18.3% | 0.001 | 0.003 |
Positive | 715 | 78.6% | 829 | 79.7% | 508 | 73.3% | 1036 | 82.4% | 604 | 75.5% | 940 | 81.7% | ||||
Changing place of living due to war | ||||||||||||||||
No | 495 | 54.4% | 482 | 46.3% | 361 | 52.1% | 616 | 49.0% | 413 | 51.6% | 564 | 49.0% | ||||
Within the same city | 195 | 21.4% | 233 | 22.4% | 0.004 | 138 | 19.9% | 290 | 23.1% | NS | 173 | 21.6% | 255 | 22.2% | NS | 0.010 NS |
With changing city | 195 | 21.4% | 293 | 28.2% | 172 | 24.8% | 316 | 25.1% | 191 | 23.9% | 297 | 25.8% | ||||
Both | 25 | 2.7% | 32 | 3.1% | 22 | 3.2% | 35 | 2.8% | 23 | 2.9% | 34 | 3.0% | ||||
Number of times changing places of living due to war | ||||||||||||||||
Never | 495 | 37.8% | 482 | 31.5% | 361 | 38.0% | 616 | 32.5% | 413 | 36.4% | 564 | 33.1% | ||||
Once | 123 | 22.7% | 101 | 16.7% | < 0.0001 | 103 | 23.8% | 121 | 17.2% | 0.001 | 107 | 22.4% | 117 | 17.6% | 0.016 NS | < 0.0001 |
Twice | 87 | 13.5% | 124 | 15.9% | 63 | 11.7% | 148 | 16.5% | 91 | 14.8% | 120 | 14.8% | ||||
Thrice and more | 205 | 25.9% | 333 | 35.9% | 166 | 26.6% | 372 | 33.8% | 189 | 26.5% | 349 | 34.5% | ||||
The main reason declared of stress in the last period:a | ||||||||||||||||
Educational | 197 | 39.5% | 191 | 31.0% | 155 | 43.9% | 233 | 30.6% | 173 | 41.2% | 215 | 30.9% | ||||
Economical | 58 | 11.6% | 69 | 11.2% | 0.014 NS | 39 | 11.0% | 88 | 11.5% | 0.0001 | 54 | 12.9% | 73 | 10.5% | 0.001 | 0.001 |
Social | 212 | 42.5% | 292 | 47.4% | 143 | 40.5% | 361 | 47.4% | 164 | 39.0% | 340 | 48.9% | ||||
War-related | 20 | 4.0% | 30 | 4.9% | 8 | 2.3% | 42 | 5.5% | 17 | 4.0% | 33 | 4.7% | ||||
Medical | 8 | 1.6% | 25 | 4.1% | 5 | 1.4% | 28 | 3.7% | 11 | 2.6% | 22 | 3.2% | ||||
Other | 4 | 0.8% | 9 | 1.5% | 3 | 0.8% | 10 | 1.3% | 1 | 0.2% | 12 | 1.7% | ||||
Do you consider that the crisis was the main cause of your distress lately?a | ||||||||||||||||
No | 155 | 22.4% | 107 | 12.6% | 133 | 25.6% | 129 | 12.6% | 127 | 20.9% | 135 | 14.5% | ||||
Kind of | 326 | 47.2% | 336 | 39.6% | < 0.0001 | 150 | 45.5% | 426 | 41.7% | < 0.0001 | 294 | 48.4% | 368 | 39.4% | < 0.0001 | < 0.0001 |
Yes totally | 210 | 30.4% | 210 | 47.8% | 319 | 28.9% | 466 | 45.6% | 186 | 30.6% | 430 | 46.1% |
Characteristic | K10 score | MSPSS Score | ||||||
---|---|---|---|---|---|---|---|---|
Mean | SD | P value | F | Mean | SD | P value | F | |
Gender | ||||||||
Female | 29.3 | 9.8 | < 0.001 | 21.8 | 51.3 | 18.2 | NS | 0.9 |
Male | 27.0 | 9.7 | 50.5 | 18.4 | ||||
Consanguinity | ||||||||
No | 28.8 | 9.9 | 51.0 | 18.4 | ||||
Yes third-degree relatives | 28.7 | 9.5 | 0.038 NS | 2.8 | 50.5 | 18.6 | NS | 1.9 |
Yes fourth-degree relatives | 26.1 | 9.4 | 55.4 | 16.9 | ||||
Yes but not close relatives | 29.7 | 9.9 | 50.6 | 16.4 | ||||
Marital status | ||||||||
Single | 28.7 | 9.8 | NS | 0.2 | 50.7 | 18.2 | 0.002 | 4.4 |
Engaged | 28.0 | 10.1 | 58.5 | 15.7 | ||||
Married | 28.7 | 10.1 | 52.1 | 19.0 | ||||
Widowed | 28.9 | 9.6 | 51.6 | 16.5 | ||||
Divorced | 29.8 | 11.6 | 45.8 | 17.9 | ||||
Educational level | ||||||||
Primary School | 39.7 | 9.3 | 39.5 | 19.9 | ||||
High School | 30.5 | 8.9 | < 0.001 | 13 | 50.2 | 18.4 | 0.011 NS | 3.7 |
University or any high institute | 28.4 | 9.8 | 51.3 | 18.1 | ||||
Masters or PhD | 29.1 | 9.7 | 51.6 | 18.9 | ||||
SES | ||||||||
Lower | 32.0 | 11.1 | 38.2 | 17.8 | ||||
Upper Lower | 30.4 | 9.8 | < 0.001 | 8.5 | 48.0 | 18.1 | < 0.001 | 15.9 |
Middle | 28.3 | 9.7 | 51.4 | 18.3 | ||||
Upper | 27.4 | 10.0 | 55.0 | 17.1 | ||||
Working | ||||||||
No | 28.9 | 9.8 | NS | 1.0 | 51.1 | 18.0 | NS | 0.1 |
Yes | 28.4 | 9.8 | 51.3 | 18.5 | ||||
Age groups | ||||||||
14–18 | 31.7 | 9.6 | 50.5 | 17.0 | ||||
19–25 | 28.6 | 9.8 | < 0.001 | 8.1 | 51.2 | 18.1 | NS | 0.3 |
26–45 | 29.3 | 10.1 | 50.7 | 18.7 | ||||
46–65 | 20.8 | 6.7 | 48.5 | 22.2 | ||||
Losing someone close due to war | ||||||||
No | 28.0 | 9.7 | 0.013 NS | 6.2 | 51.7 | 18.1 | NS | 1.3 |
Yes | 29.1 | 9.9 | 50.7 | 18.3 | ||||
A relative being endangered by the war | ||||||||
No | 28.1 | 9.6 | NS | 1.4 | 50.2 | 18.4 | NS | 0.7 |
Yes | 28.8 | 9.9 | 51.2 | 18.2 | ||||
Distressed from war noises | ||||||||
Negative | 27.1 | 9.9 | < 0.001 | 13.5 | 50.2 | 18.5 | NS | 1.3 |
Positive | 29.1 | 9.8 | 51.3 | 18.2 | ||||
Changing place of living due to war | ||||||||
No | 28.0 | 9.6 | 52.2 | 18.3 | ||||
Within the same city | 29.6 | 9.8 | 0.005 NS | 4.2 | 50.9 | 18.1 | 0.027 NS | 3.1 |
Changing the city | 29.5 | 10.2 | 49.3 | 18.3 | ||||
Doing both | 28.4 | 9.4 | 48.8 | 16.1 | ||||
Number of times changing places of living due to war | ||||||||
No | 28.0 | 9.6 | < 0.001 | 8.8 | 52.2 | 18.3 | 0.011 NS | 3.7 |
Once | 27.5 | 10.3 | 51.8 | 17.3 | ||||
Twice | 29.3 | 9.6 | 50.6 | 17.8 | ||||
Thrice and more | 30.4 | 9.9 | 49.0 | 18.5 | ||||
The reason declared of stress in the last period:a | ||||||||
Educational | < 0.001 | 7.3 | 54.2 | 17.4 | 0.001 | 4.4 | ||
Economical | 27.6 | 9.3 | 52.8 | 17.3 | ||||
Social | 29.5 | 10.2 | 49.7 | 18.0 | ||||
War-related | 30.4 | 10.2 | 49.9 | 19.8 | ||||
Medical | 30.2 | 9.7 | 54.1 | 19.8 | ||||
Other | 32.9 | 8.4 | 38.5 | 20.8 | ||||
Do you consider that the crisis was the main cause of your distress lately?a | ||||||||
No | 26.2 | 9.5 | < 0.001 | 28.3 | 53.2 | 18.8 | 0.054NS | 2.9 |
Kind of | 28.5 | 9.9 | 51.2 | 18.1 | ||||
Yes totally | 31.3 | 9.8 | 50.0 | 18.0 |
Family Support | Friends support | Significant Other Support | |||||||
---|---|---|---|---|---|---|---|---|---|
Mean | SD | P value | Mean | SD | P value | Mean | SD | P value | |
K 10 | |||||||||
No | 21.0 | 6.6 | < 0.001 | 17.2 | 7.0 | < 0.001 | 19.6 | 7.3 | < 0.001 |
Low | 19.0 | 6.8 | 15.1 | 7.3 | 17.9 | 7.6 | |||
Medium | 18.3 | 7.2 | 14.3 | 7.3 | 17.3 | 7.7 | |||
High | 17.7 | 7.2 | 14.0 | 7.3 | 16.6 | 7.9 | |||
SPTSS | |||||||||
No | 20.2 | 6.6 | < 0.001 | 16.5 | 7.1 | < 0.001 | 19.2 | 7.3 | < 0.001 |
Avoidance | 17.4 | 7.2 | 13.4 | 7.2 | 16.1 | 7.9 | |||
No | 20.0 | 6.6 | < 0.001 | 16.3 | 7.1 | < 0.001 | 18.9 | 7.4 | < 0.001 |
Arousal | 18.0 | 7.2 | 14.1 | 7.3 | 16.8 | 7.9 | |||
No | 20.1 | 6.5 | < 0.001 | 16.3 | 6.9 | < 0.001 | 18.8 | 7.3 | < 0.001 |
Re-experience | 17.8 | 7.3 | 13.9 | 7.5 | 16.7 | 8.0 | |||
None | 20.6 | 6.4 | < 0.001 | 17.1 | 6.9 | < 0.001 | 19.4 | 7.0 | < 0.001 |
One SPTSS symptom | 20.1 | 6.6 | 16.4 | 6.8 | 19.1 | 7.5 | |||
Two SPTSS symptoms | 18.7 | 7.0 | 14.5 | 7.3 | 17.6 | 7.7 | |||
Three SPTSS symptoms | 16.9 | 7.4 | 13.1 | 7.3 | 15.7 | 7.9 |
Results
Characteristic | Frequency (n = 1951) | Percentage% |
Age | ||
14–18 | 52 | 2.7 |
19–25 | 1538 | 78.8 |
26–45 | 333 | 17.1 |
46–65 | 28 | 1.4 |
Gender | ||
Male | 527 | 27.0 |
Female | 1424 | 73.0 |
Marital Status | ||
Single | 1617 | 83.0 |
Engaged | 86 | 4.4 |
Married | 217 | 11.1 |
Divorced | 21 | 1.1 |
Widowed | 7 | 0.4 |
Consanguinity | ||
No | 1416 | 72.6 |
Yes third-degree relatives | 300 | 15.4 |
Yes fourth-degree relatives | 97 | 5.0 |
Yes but not close relatives | 138 | 7.1 |
Medical Conditions | ||
Negative | 1008 | 81.9 |
Asthma | 63 | 5.1 |
Hypertension | 23 | 1.9 |
Diabetes | 6 | 0.5 |
Asthma, Hypertension | 6 | 0.5 |
Diabetes, Hypertension | 4 | 0.3 |
Other | 121 | 9.8 |
Being distressed from the war noises | ||
No | 407 | 20.9 |
Yes | 1544 | 79.1 |
Educational level | ||
Primary School | 27 | 1.4 |
High School | 127 | 6.5 |
University or any high institute | 1671 | 85.6 |
Masters or PhD | 126 | 6.5 |
Type of work | ||
At a company | 103 | 6.2 |
Clerk or at a restaurant | 21 | 1.3 |
Education | 104 | 6.3 |
Freelancer | 78 | 4.7 |
Journalism | 4 | 0.2 |
Law | 10 | 0.6 |
Health care | 234 | 14.2 |
Unemployed | 1100 | 66.5 |
SES Level | ||
Lower | 30 | 1.5 |
Upper Lower | 483 | 24.8 |
Middle | 1044 | 53.5 |
Upper | 394 | 20.2 |
Losing someone due to the war | ||
No | 697 | 35.7 |
Yes | 1254 | 64.3 |
Changing area of living due to war | ||
No | 977 | 50.1 |
Yes within the same city | 429 | 22.0 |
Yes with changing the city | 488 | 25.0 |
Yes I had to do both | 57 | 2.9 |
Number of times changing place of living due to war | ||
No | 977 | 50.1 |
Once | 224 | 11.5 |
Twice | 211 | 10.8 |
Thrice and more | 539 | 27.6 |
Place of origin | ||
Damascus, Rif-Dimashq, and Aleppo | 1045 | 53.6 |
Homs and Hama | 354 | 18.1 |
Al-Jazira region | 94 | 4.8 |
Southern Syria | 142 | 7.3 |
Syrian coast | 200 | 10.3 |
Idlib | 82 | 4.2 |
Other | 34 | 1.7 |
A relative being endangered by the war | ||
No | 284 | 14.6 |
Yes | 1667 | 85.4 |
Characteristic (n = 1951) | Frequency (Percentage%) | CI:95% |
Kessler psychological distress Scale (K10) | ||
No | 376 (19.3%) | 17.5–21.0% |
Mild | 381 (19.5%) | 17.8–21.3% |
Moderate | 322 (16.5%) | 14.9–18.1% |
Severe | 872 (44.7%) | 42.6–47.0% |
SPTSS items | ||
Avoidance | 1040 (53.3%) | 51.2–55.6% |
No Avoidance | 910 (46.6%) | 44.3–48.8% |
Arousal | 1257 (64.4%) | 62.4–66.5% |
No Arousal | 693 (35.6%) | 33.4–37.5% |
Re-experience | 1150 (58.9%) | 56.9–61.2% |
No Re-experience | 800 (41.0%) | 38.7–43.0% |
Two or more | 1186 (60.8%) | 58.7–62.7% |
Full SPTSS symptoms | 720 (36.9%) | 35.0–39.1% |
MSPSS Family | ||
Low | 402 (20.6%) | 18.8–22.4% |
Medium | 575 (29.5%) | 27.6–31.5% |
High | 971 (49.8%) | 47.6–52.2% |
Friends | ||
Low | 738 (37.8%) | 35.5–40.2% |
Medium | 666 (34.2%) | 31.7–36.3% |
High | 546 (28.0%) | 26.2–30.2% |
Significant other | ||
Low | 511 (26.2%) | 24.3–28.3% |
Medium | 613 (31.4%) | 29.4–33.5% |
High | 826 (42.4%) | 40.1–44.7% |
Total MSPP | ||
Low | 452 (23.2%) | 21.3–25.1% |
Medium | 830 (42.5%) | 40.3–44.6% |
High | 669 (34.3%) | 32.2–36.5% |
K10 results
Model | R | R2 | Adjusted R2 | Std. Error of the Estimate | Change Statistics | Unstandardized Coefficients β | Standardized Coefficients β | Sig. | |||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
R2 Change | F Change | df1 | df2 | Sig. F Change | |||||||||
K10 score | Number of time changing place of living | .125a | .016 | .015 | 9.757 | .016 | 30.728 | 1 | 1948 | .000 | .838 | .106 | .000 |
Gender | .160b | .026 | .025 | 9.709 | .010 | 20.440 | 1 | 1947 | .000 | −2.098 | −.095 | .000 | |
SES | .191c | .037 | .035 | 9.657 | .011 | 21.896 | 1 | 1946 | .000 | −1.481 | −.107 | .000 | |
Educational level | .207d | .043 | .041 | 9.629 | .006 | 12.350 | 1 | 1945 | .000 | −1.539 | −.067 | .004 | |
Age group | .212e | .045 | .043 | 9.620 | .002 | 4.803 | 1 | 1944 | .029 | −1.100 | −.053 | .022 | |
Being distressed from war noise | .218f | .047 | .044 | 9.610 | .002 | 4.861 | 1 | 1943 | .028 | 1.224 | .051 | .028 | |
MSPSS score | SES | .151a | .023 | .022 | 18.010 | .023 | 45.328 | 1 | 1945 | .000 | 3.865 | .151 | .000 |
Avoidance score | Number of time changing place of living | .106a | .011 | .011 | 1.854 | .011 | 22.114 | 1 | 1947 | .000 | .150 | .100 | .000 |
Educational level | .119b | .014 | .013 | 1.852 | .003 | 5.702 | 1 | 1946 | .017 | −.236 | −.054 | .017 | |
Hyper-arousal score | Being distressed from war noise | .126a | .016 | .015 | 1.455 | .016 | 31.549 | 1 | 1947 | .000 | .419 | .116 | .000 |
SES | .159b | .025 | .024 | 1.449 | .009 | 18.503 | 1 | 1946 | .000 | −.184 | −.089 | .000 | |
Number of time changing place of living | .180c | .032 | .031 | 1.444 | .007 | 14.430 | 1 | 1945 | .000 | .093 | .079 | .000 | |
Educational level | .188d | .035 | .033 | 1.442 | .003 | 5.789 | 1 | 1944 | .016 | −.185 | −.054 | .016 | |
re-experience score | Being distressed from war noise | .114a | .013 | .012 | 1.610 | .013 | 25.648 | 1 | 1947 | .000 | .440 | .110 | .000 |
Losing someone due to war | .153b | .024 | .023 | 1.601 | .011 | 21.020 | 1 | 1946 | .000 | .349 | .103 | .000 | |
Educational level | .173c | .030 | .029 | 1.596 | .007 | 13.063 | 1 | 1945 | .000 | −.306 | −.081 | .000 |