Mental Health Among Lebanese Refugees in Syria
Ahmad Al-Bitar, Israa Tellawi, Omran Janoud, Kinda Al Issa, Haya Deeb, Hassan Fawaz, Youssef Latifeh

TL;DR
This study examines mental health issues like anxiety, depression, and sleep problems among Lebanese refugees in Syria.
Contribution
It provides insights into the mental health status of a specific refugee population in Syria.
Findings
The study identifies high prevalence rates of anxiety and depression among the refugees.
Sleep disturbances are commonly reported, indicating poor mental health outcomes.
Abstract
This cross-sectional study assesses anxiety, depression, and sleep disturbance among a population of Lebanese refugees in Syria.
Genes, proteins, chemicals, diseases, species, mutations and cell lines named across the full text — each resolved to its canonical identifier and authoritative record.
| Characteristic | Value (N = 305) |
|---|---|
| Age, mean (SD), y | 36.3 (14.5) |
| Sex, No. (%) | |
| Female | 170 (55.7) |
| Male | 135 (44.3) |
| Educational level, No. (%) | |
| Secondary school or less | 66 (21.6) |
| Completed secondary school | 115 (37.7) |
| University degree or higher | 124 (40.7) |
| Work status, No. (%) | |
| Not working | 149 (48.9) |
| Working | 156 (51.1) |
| Marital status, No. (%) | |
| Single | 112 (36.7) |
| Married | 172 (56.4) |
| Divorced or widowed | 21 (6.9) |
| Current smoker, No. (%) | 180 (59.0) |
| Displacement-related factors, No. (%) | |
| Residency | |
| Private house | 71 (23.3) |
| Shelter | 66 (21.6) |
| With relatives | 168 (55.1) |
| Housing status | |
| Safe | 32 (10.5) |
| Dangerous or destroyed | 273 (89.5) |
| Relative injured or killed | |
| No | 64 (21.0) |
| Yes | 241 (79.0) |
| Mental health | |
| Clinically significant anxiety (GAD-7 ≥10) | 216 (70.8) |
| Clinically significant depression (PHQ-9 ≥10) | 227 (74.4) |
| Clinically significant insomnia (ISI ≥15) | 141 (46.2) |
| Variable | Adjusted OR (95% CI) | |
|---|---|---|
| Model 1: moderate to severe anxiety (GAD-7) | ||
| Work in an office (vs not working) | 2.75 (1.25-6.04) | .01 |
| Residing with relatives (vs private house) | 1.99 (0.98-4.02) | .06 |
| Model 2: moderate to severe depression (PHQ-9) | ||
| Age (per 1-y increase) | 1.03 (1.00-1.07) | .04 |
| Work in an office (vs not working) | 3.14 (1.33-7.42) | .009 |
| Residing with relatives (vs private house) | 2.31 (1.09-4.89) | .03 |
| Model 3: clinically meaningful insomnia (ISI) | ||
| Work in an office (vs not working) | 2.98 (1.54-5.76) | .001 |
| Widower (vs single) | 8.08 (1.33-48.99) | .02 |
| Residing with relatives (vs private house) | 2.14 (1.11-4.14) | .02 |
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Taxonomy
TopicsMigration, Health and Trauma · Middle East Politics and Society · Posttraumatic Stress Disorder Research
Introduction
The October 2024 escalation of the conflict between Israel and Lebanon displaced many civilians in southern Lebanon, with some seeking refuge in neighboring Syria, a setting of prolonged instability. Refugees may face compounding premigration trauma and postdisplacement adversity,^1,2^ yet mental health among Lebanese refugees in Syria has not been quantified. We assessed anxiety, depression, and sleep disturbance in this population.
Methods
This cross-sectional study was approved by the ethics committee of Damascus University, and all participants provided written informed consent. The study adhered to the STROBE reporting guideline.
We conducted a survey among Lebanese adults (aged ≥18 years) who had been displaced to Syria and resided in Damascus after the October 2024 escalation. Surveys were conducted from October 1 to November 15, 2024. Using Arabic-validated versions, we measured anxiety via the 7-item Generalized Anxiety Disorder scale, depression via the 9-item Patient Health Questionnaire, insomnia via the Insomnia Severity Index, and sleep quality via the Pittsburgh Sleep Quality Index (PSQI). We summarized sample characteristics and outcomes and used χ^2^ tests and 1-way analysis of variance for bivariate comparisons. Multivariable logistic regression models estimated adjusted odds ratios (AORs) and 95% CIs for dichotomized outcomes, adjusting for sex, age, educational level, marital status, employment, current housing, and war-related exposures. Two-sided P < .05 indicated statistical significance. Analyses were conducted using SPSS, version 26 (SPSS Inc). Detailed methodological information is provided in the eMethods in Supplement 1.
Results
Among 305 participants (mean [SD] age, 36.3 [14.5] years; 170 [55.7%] female, 135 [44.3%] male), 48.9% were unemployed, 89.5% lived in hazardous or destroyed housing, and 59.0% reported smoking (Table 1). Current housing was associated with anxiety (χ^2^6 = 22.59; P = .001), depression (χ^2^6 = 25.41; P = .001), and insomnia (χ^2^6 = 15.29; P = .02), with lower anxiety and insomnia among those in private housing and the highest distress among those living with relatives. Participants with an injured close relative had higher PSQI scores than those without (mean [SD], 11.82 [5.86]; P = .04), and those whose homes were destroyed had the highest PSQI scores (mean [SD], 12.47 [5.46]; P = .02). Family injury status was associated with depression (χ^2^8 = 21.02; P = .007), with the highest prevalence of severe depression among those reporting an injured distant relative.
In adjusted models (Table 2), compared with unemployed participants, office workers had higher odds of moderate to severe anxiety (AOR, 2.75; 95% CI, 1.25-6.04), clinically meaningful insomnia (AOR, 2.98; 95% CI, 1.54-5.76), and moderate to severe depression (AOR, 3.14; 95% CI, 1.33-7.42). Living with relatives (vs private housing) was associated with higher odds of moderate to severe depression (AOR, 2.31; 95% CI, 1.09-4.89) and clinically meaningful insomnia (AOR, 2.14; 95% CI, 1.11-4.14). Each additional year of age was associated with higher odds of moderate to severe depression (AOR, 1.03; 95% CI, 1.00-1.07). Other variables were not associated with outcomes.
Discussion
High psychological distress was observed among Lebanese refugees in Syria, exceeding rates reported among resettled European refugees.^1,2^ This likely reflects postdisplacement adversity, including unemployment and precarious housing. Sleep quality was poorest among participants from destroyed homes. Shared housing was associated with greater depression and anxiety than private accommodations, consistent with evidence that overcrowding exacerbates distress.^3^ Conflict exposure remained associated with depression, and injury to a distant family member was linked to worse mental health, underscoring the diffuse impact of war exposure.^4^ The elevated distress stems from the interaction of premigration trauma with structural adversities, including economic collapse and limited mental health care access. The high smoking rate suggests maladaptive coping.^5^ An urgent, 2-pronged response is needed: individual trauma-informed care and structural solutions.
Study limitations include the cross-sectional design, single-city convenience sampling, and self-reported measures, which may limit causal inference and generalizability. International agencies must bolster support for host countries.^6^ Scalable responses that integrate trauma-informed mental health care with improvements to housing and livelihoods may help mitigate the mental health risks for Lebanese refugees in Syria.
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1Diab J. The unmovable borderland: war, home, and the decision against displacement in South Lebanon. J Int Humanit Action. Published online October 15, 2025. doi:10.1186/s 41018-025-00177-w · doi ↗
- 2Nuwayhid I, Zurayk H, Sibai AM. Lebanon: a humanitarian crisis in a complex geopolitical context. Lancet. 2024;404(10470):2416-2417. doi:10.1016/S 0140-6736(24)02432-2 39617027 · doi ↗ · pubmed ↗
- 3Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet. 2002;360(9339):1056-1062. doi:10.1016/S 0140-6736(02)11142-1 12383986 · doi ↗ · pubmed ↗
- 4Thomson MJ. The invisible burdens of burden-sharing. Front Hum Dyn. Published online April 5, 2022. doi:10.3389/fhumd.2022.668321 · doi ↗
- 5Mental health and psychosocial support for displaced populations in Syria: guidelines and field practices. Syrian Arab Red Crescent & International Federation of Red Cross and Red Crescent Societies. 2020. Accessed September 13, 2025. https://mhpsshub.org/
- 6Guidance on mental health and psychosocial support for refugees. World Health Organization. 2020. Accessed September 13, 2025. https://www.who.int/publications
