1155810

research-article2023
ISP0010.1177/00207640231155810International Journal of Social PsychiatryHosseini et al.

E CAMDEN SCHIZOPH

Original Article

International Journal of

Predictors of depression among Syrian Social Psychiatry

1­–8
© The Author(s) 2023
refugee women: A socio-culturally relevant Article reuse guidelines:
sagepub.com/journals-permissions

analysis DOI: 10.1177/00207640231155810

https://doi.org/10.1177/00207640231155810
journals.sagepub.com/home/isp

Zainab Hosseini1 , Talah Bakdash2, Sadena Ahmad3

and Rania Awaad1

Abstract
Objectives: Syrian refugee women have faced myriad adversities as they have navigated the realities of war, increasing
the risk for mental health concerns such as depressive symptomatology. This study explores the nuances of relevant
sociocultural factors that can contribute to depressive symptomatology among widowed Syrian refugee women who
live in an institutionalized care setting. We explored the impact of past trauma exposure, perceived independence, and
a desire to leave the current place of displacement and the interplay between them.
Methods: The PCRF Traumatic Events Questionnaire and Patient Health Questionnaire (PHQ-9) were administered
to 57 Syrian refugee women in Lebanon (Mage = 37; M number of children = 3) to measure levels of trauma exposure and
depressive symptoms, respectively. Perceived independence and a desire to leave their current place of residence were
measured using 1-item measures.
Results: Using hierarchical regression models, past trauma exposure (B = 1.51, p = .002) and perceived independence
(B = 0.33, p = .04) significantly predicted depressive symptoms. A desire to travel (B = 0.84, p = .07) marginally predicted
depressive symptoms. Past trauma exposure attenuated the impact of perceived independence on depressive symptoms
such that at lower levels of past trauma exposure, higher perceptions of independence predicted higher depression
(simple slope = 0.29, t = 2.13, p = .05), while at higher levels of past trauma higher perceptions of independence predicted
lower depressive symptoms (simple slope = -0.16, t = -2.21, p = .04). Trauma exposure did not moderate the impact of a
desire to leave on depression, but age did.
Conclusion: These findings suggest that sociocultural factors may influence women’s experiences with depressive
symptoms differently, and this heterogeneity must be accounted for when treatment programs are proposed. Further,
Syrian refugee women who have lost primary family members may pose different profiles of depressive symptoms than
other groups of women.

Keywords
Refugee mental health, Syrian refugee women, depression, socio-cultural factors

Introduction Turkey, Lebanon, Jordan, Iraq, and Egypt, with Lebanon

In recent years there have been increasing rates of people
leaving their home countries due to ongoing conflicts, per-
secution, war, and human rights violations. The world saw
the highest displacement rate in 2021, with 89.3 million
people forced to leave their homes, and women accounting
for 49% of this number (approximately 43.8 million peo-
ple; United Nations High Commissioner for Refugees
[UNHCR] USA, 2022). The UNHCR reports 27.1 million
refugees worldwide at the end of 2021–more than dou-
bling from a decade ago. Of this number, over 25%, at
6.8 million people, came from Syria, ranking it as the ori-
gin country with the highest number of refugees (UNHCR
USA, 2022). Most Syrian refugees have resettled in
hosting about 14.8% of the Syrian population, where 1 in
4 individuals are Syrian refugees (UNHCR, 2022). The
displacement of people of such a magnitude raises con-
cerns for refugees’ psychological and physical well-being.
Refugees are frequently subjected to traumatic events such
1
Stanford University, CA, USA
2
University of Kansas School of Medicine, Kansas City, USA
3
University of Albany, State University of New York, USA
Corresponding author:
Zainab Hosseini, Stanford University, 485 Lasuen Mall, Stanford, CA
94305-6104, USA.
Email: zainabh@stanford.edu
2 International Journal of Social Psychiatry 00(0)
as death threats, torture, starvation, severe injury, and the
loss of family and friends (Acaturk et al., 2018). Refugee
women tend to experience compounding adversities due to
gender-based traumas, including rape, forced impregna-
tion, forced abortion, sexual trafficking, sexual slavery,
and the purposeful spread of sexually transmitted illnesses
(Martín et al., 2021; UNHCR, 2009). The multifold expe-
riences of refugee women with the adversities of forced
displacement call for a nuanced consideration of sociocul-
tural and environmental factors that can underpin the onset
of potential mental health symptoms throughout the forced
migration. In this study, we explore rates of depressive
symptoms among a group of Syrian refugee women who
have unique experiences as widowed individuals, and we
delve into the interplay of factors that can contribute to
their symptomatology.
Mental health challenges of Syrian
refugees
For Syrians, more than a decade of conflict and ongoing
instability has increased the vulnerability of individuals to
negative psychological and physical consequences. About
26.5 million people require assistance, including half a
million pregnant women and adolescent girls among the
estimated 11.7 million displaced individuals (United
Nations Population Fund, 2022). It has been particularly
challenging to address mental health concerns among this
population due to the complex influence of sociocultural
and environmental factors and the limited number of
trained individuals familiar with this population’s unique
needs. In addition, the host of stressors this population has
faced across their forced migration, including traumatic
adversities during the pre-migration phase and the stress of
settling into a new location with few resources during the
post-migration phase, contribute to heightened levels of
vulnerability among Syrian refugees (Song & Teichholtz,
n.d.). In Syria, mental health was still considered a new
field before the war and refugee crisis; scholars argue that
society had not yet acknowledged the idea of mental health
or its diagnosis and treatment, making psychopathology
heavily stigmatized (Hedar, 2017). Studies have found
noticeably high rates of psychotic disorders, depression,
anxiety, and suicidality from prior to the refugee crisis
(Lama et al., 2016). The estimated prevalence of these dis-
orders varies between studies, but rates of emotional disor-
ders in adult Syrian refugees may have been as high as
54% and psychotic disorders at 11% (Hijazi & Weissbecker,
2017). With the ongoing war and refugee crisis, mental
health issues emerged as a critical health concern among
Syrian refugees in Lebanon and neighboring countries (El
Arnaout et al., 2019; Naal et al., 2021). The restricted
access to proper healthcare, education, and employment
opportunities exacerbated the negative psychological con-
sequences, and this was particularly prevalent in Lebanon,
where systematic exclusions limited the integration of
Syrian refugees who were faced with higher levels of dis-
crimination and hostility (Kerbage et al., 2020; Naal et al.,
2021). To this date, depressive disorders are a grave con-
cern, with The Institute for Health Metrics and Evaluation
(IHME) listing them as the seventh top cause of death and
disability in 2019. A study conducted by Acaturk et al.
(2018) found the prevalence of PTSD among Syrian refu-
gees to be as high as 83.5%. High-risk groups, such as
older adults, women, and widowed individuals, should be
given special attention, – especially those with a history of
neurological or mental health conditions (Naal et al.,
2021).
Experiences of female refugees with
depression
Despite the substantial body of evidence documenting the
prevalence of mental health challenges among Syrian refu-
gees, few studies have explored the nuances of how unique
sociocultural and demographic factors can influence
Syrian refugees’ experiences with specific mental health
challenges. The paucity of this approach to the study of
mental health challenges among refugees is especially
concerning given the emerging scholarship advocating for
a recognition of the complex interplay between environ-
mental factors in predicting different profiles of psychopa-
thology (Uher & Zwicker, 2017). For example, gender as a
sociodemographic factor can have a significant effect on
the presence of psychopathology, and the literature has
been particularly robust in elucidating the higher presence
of depression among Syrian refugee women (Acaturk et
al., 2018; Alshawashreh & Alkhalil, 2019; Porter &
Haslam, 2005). The increased prevalence of psychopathol-
ogy–specifically depression– among women has been
widely documented in other groups of refugees as well.
According to a study conducted by Cardozo et al. (2004)
exploring mental health outcomes amongst Karenina refu-
gees living on the Thai-Burma border, rates of depression
were 41.8% higher among refugees when compared to
non-refugees, and women were at higher risk for anxiety
and depression than men. Moreover, a study of depressive
symptomatology and its predictors among Somali refugees
in southern Ethiopia revealed that Somali women are more
likely than men to be exposed to the negative mental health
consequences of migration and settlement stressors,
including depression (Feyera, 2015). The higher preva-
lence of depression among refugee women may be due to
an increased vulnerability to sexual and gender-based vio-
lence, as well as post-migration shifts in family dynamics
and gender responsibilities (Kisilu & Darras, 2018; Porter
& Haslam, 2005).
Some scholars refute this hypothesis, however, by
pointing to the lack of culturally-relevant questionnaires
tailored specifically to refugee populations. Current
Hosseini et al.
research might not accurately capture depressive symp-
tomatology among Syrian men with different clinical pres-
entations than these measures can detect (Hassan et al.,
2015). This theory may require further exploration, but a
robust body of evidence buttresses the fact that refugee
women are an especially vulnerable group for exposure to
stressors that can undergird the onset of psychopathology,
especially manifested through depression. There are vary-
ing risk factors related to the increased odds of mental
health conditions, including individual (biological and
temperamental), interpersonal, sociocultural, and environ-
mental factors (Brooks et al., 2022). Refugee women face
an increased risk of struggling with depressive symptoma-
tology during various stages of their forced displacement
due to their intersecting identities and experiences with a
variety of these risk factors (Brooks et al., 2022; Jansen,
2006; UN Women, 2013; Ward, 2002).
Capturing the etiology of depressive symptomatology
among Syrian refugee women necessitates a recognition
of the heterogeneity among them. Current literature points
to immense variation in the experiences of Syrian women
during their forced migration, particularly informed by
the diverse sociocultural and environmental contexts they
must navigate. For Syrian refugee women, a particularly
potent and socioculturally relevant factor in informing
mental health outcomes is relationship status, with major
differences reported between women who were forcibly
displaced together with their partners versus those whose
partners were killed or left behind (hereon referred to as
widows, informed by the jargon used by participants in
our study). For instance, exposure to gender-based vio-
lence amongst female refugees varies based on their mari-
tal status. In one study, married women had a 64%
decrease in odds of PTSD and a 59% decrease in depres-
sion when compared to those whose husbands were not
present (Brooks et al., 2022). Unmarried or recently wid-
owed Syrian refugee women are also especially vulnera-
ble to sexual violence, assault, and poor mental health
outcomes (Yasmine & Moughalian, 2016). Women who
have lost their partners during the war may be tasked with
fulfilling traditional gender roles while taking on new
responsibilities within the family, such as the burdens of
being the new breadwinner, childcare, and restrictions of
not having a male present within the household. The
absence of their partners may limit their ability to inte-
grate within host communities, which could in turn
increase their sense of instability (Collins et al., 2011).
Importantly, El Masri et al. (2013) have explored the het-
erogeneity of how Syrian refugee women navigate the
new demands of their forced displacement, including
increased levels of independence. While a newly-emerg-
ing sense of independence and increased responsibilities
were common themes among most women, their responses
to these changes varied. Some women were receptive to
3
these changes, perceiving them as new and empowering
opportunities to exercise control. Others, however, found
them to be overwhelming and destructive to their femi-
nine identity. These findings highlight the complex inter-
play of different sociocultural factors, such as gender,
relationship status, cultural attitudes towards independ-
ence, and perceptions of stability, in influencing the onset
or exacerbation of depressive symptoms among this pop-
ulation. It may be possible, for example, that worldviews
about the value of independence and the extent of social
stability may influence levels of depression directly, as
well as by impacting other potent predictors such as past
trauma exposure. Therefore, it is imperative for current
explorations into the etiology of depression among refu-
gee populations to be intentional about accounting for the
intersecting sociocultural and environmental factors at
play. The current study aims to employ this nuanced lens
by exploring factors that could be uniquely relevant to the
lives of widowed Syrian refugee women who live in insti-
tutionalized settings in impacting their levels of depres-
sive symptoms.
The present study
The current study aimed to explore relevant predictors of
depressive symptomatology among widowed Syrian ref-
ugee women living in institutionalized settings. We use
the term ‘widowed’ because participants in this study
refer to themselves using this language. Informed by
scholarship on the influential role of past exposure to
trauma (Brooks et al., 2022) as well as the pertinence of
a sense of independence (El Masri et al., 2013) and a
desire for stability (Collins et al., 2011) for Syrian refu-
gee widows, we explored the following research ques-
tions: (1) What are the main effects of past exposure to
trauma, perceived levels of independence, and a desire
to leave current place of residence in search of stability
on levels of depressive symptoms and (2) what is the
moderating role of a perceived sense of independence
and a desire to leave current place of residence in search
of stability on the association between past trauma expo-
sure and depressive symptoms. This study utilized sec-
ondary data from an international Non-Governmental
Organization (NGO) serving Syrian refugee widows in
Lebanon (we have redacted their names to maintain the
confidentiality of the women under their care). The NGO
houses women and children who have lost primary fam-
ily members due to the war. The NGO collected this data
as part of ongoing screenings of mental health chal-
lenges among their constituents. With the permission of
the NGO, we used deidentified data to explore the
research questions for this study. The Institutional
Review Board approved the procedures for this research
analysis at Stanford University.
4 International Journal of Social Psychiatry 00(0)
Methods
Participants
Participants included 57 Syrian refugee women
(Mage = 36.9, SD = 5.8, range = 25–58; M years since dis-
placement = 4.8, SD = 1.6, range = 0.6–7) who have experi-
enced the loss of primary male family members. Most
women were widowed in addition to losing other family
members. Most women were primary caregivers to chil-
dren (M number of children = 3, SD = 1.3, range = 1–6),
although they did not necessarily all live together as some
children had fled to neighboring countries or were killed.
The women lived in institutionalized settings in three shel-
ters in Lebanon.
Procedures
Researchers at the NGO had obtained verbal informed
consent due to the limited literacy levels of participants
and administered measures of depression and trauma
exposure. Next, women completed a short survey captur-
ing the variability in themes relating to their life in
Lebanon, including their levels of social independence as
well as their desire to leave Lebanon. All surveys were
completed anonymously to maintain utmost confidential-
ity. We used these anonymous data to conduct secondary
data analysis for the purposes of this study.
Measures
PCRF Traumatic Events Questionnaire. The PCRF (Hashemi
et al., 2017) was designed by the Palestine Children’s
Fund as a trauma screening tool. The questionnaire is a
17-item scale with binary response options that inquire
about exposure to traumatic events, most of which are spe-
cific to armed conflict settings. Sample questions include,
‘have you been beaten by occupied forces?’ with response
options including ‘yes’ (1) or ‘no’ (0). This scale has been
translated from English and adapted for and implemented
with Syrian refugees in Jordanian camps. The senior
author of this study oversaw this adaptation process. The
items were divided into two subcategories: (1) questions
about a direct threat to the physical safety of the individ-
ual, such as being shot at with ammunition and (2) indirect
threats, such as being denied medical care. A global score
ranging between 0 and 1 was obtained by averaging items
and higher scores indicated higher exposure rates.
The Patient Health Questionnaire (PHQ-9). The PHQ-9
(Kroenke & Spitzer, 2002) is a widely-used scale across
various settings to gauge depressive symptomatology and
suicidal ideation within the past 2 weeks. The question-
naire measures the frequency of symptoms such as ‘little
interest or pleasure in doing things’, and response options
are on a 4-point scale ranging between 0 (never) to 3
(almost daily). NGO staff used the Arabic version of this
scale (AlHadi et al., 2017) and assessed its interpretability
by clinical staff prior to administration. This scale has been
validated for use among Syrian refugees (Demir et al.,
2020), including those in Lebanon (Naal et al., 2021).
Internal consistency in this population was α = .83. Items
were averaged with higher scores indicating more depres-
sive symptomology.
Post survey
Participants responded to a variety of questions regarding
their experiences as refugees in Lebanon. Items of interest
for the purposes of this study include ‘I feel a sense of
independence in Lebanon’ (M = 1.7, SD = 1.4) and ‘I would
like to leave Lebanon to find asylum elsewhere’ (M = 2.79,
SD = 1.26). Response options were on a 4-point Likert
scale ranging between 0 (strongly disagree) to 4 (strongly
agree).
Data analysis
We used R (Version 1.4.1106; R Core Team, 2021) to com-
plete all analyses for this paper. We first screened our vari-
ables of interest to explore missing data, outliers, and
abnormalities in distributions. Hierarchical regression
models were used to elucidate our research questions, and
models were assessed to explore whether they met the
required assumptions for interpreting our results, for
example, normality, multicollinearity, and homoscedastic-
ity. Following recommendations by Fairchild and
McQuillin (2010), reported coefficients are unstandard-
ized in our models since we include interaction effects.
Results
Descriptive statistics
The overall mean trauma exposure score in this population
was 0.6 (SD = 0.2, range = 0–1), indicating that the women
on average had been exposed to over half of the threats
listed on the scale. The PHQ-9 scores reflected the wom-
en’s experiences with depressive symptoms and suicide
ideation across a two-week period. On average, women’s
scores on this scale were 1.00 (SD = 0.06, range = 0–3). A
sense of independence (M = 1.7, SD = 1.4; range = 0–4) and
a desire to travel (M = 2.79, SD = 1.26; range = 0–4) were
also explored.
Main effects
Using a hierarchical linear regression approach (see Table
1), we assessed the main effects of perceived independ-
ence, a desire to leave Lebanon and seek stability else-
where, and past trauma exposure on depressive
symptomatology while controlling for the impact of age.
Hosseini et al. 5

Table 1. Predictors of depressive symptoms among Syrian refugee women.

Dependent variable

Depressive Sxs

(1) (2) (3) (4)

Age −0.03 −0.03* −0.03 0.03
p = .11 p = .09 p = .15 p = .42
Independence −0.01 0.01 −0.06 0.33**
p = .89 p = .93 p = .35 p = .05
Desire to leave 0.10 0.05 0.84*
p = .14 p = .44 p = .07
Past trauma exposure 0.68* 1.52***
p = .07 p = .002
Interaction of age and desire to leave −0.02*
p = .08
Interaction of trauma and independence −0.58**
p = .02
Constant 2.00*** 1.75*** 1.30* −1.14
p = .003 p = .01 p = .08 p = .36
R2 .07 .13 .32 .55
Adjusted R2 .02 .05 .20 .42
Residual SE 0.53 (df = 36) 0.52 (df = 35) 0.38 (df = 22) 0.33 (df = 20)
F statistic 1.37 (df = 2; 36) 1.71 (df = 3; 35) 2.59* (df = 4; 22) 4.14*** (df = 6; 20)

*p < .1. **p < .05. ***p < .01.

In the first two models including independence (B = -0.01,
p = 89) and a desire to leave (B = 0.1, p = .14), we did not
see any significant results nor a major explanation of the
variance (R2 = .13). In the third model, past trauma expo-
sure had a marginally significant main effect (B = 0.68,
p = .07) and made a significant change to the amount of
variance explained (R2 = .32).
Moderators
While we found no significant interaction between desire
to travel and the impact of past trauma exposure on depres-
sive symptoms (B = 0.22, p = .42; not shown in Table 1), we
found a significant interaction between perceiving inde-
pendence and past trauma exposure (B = -0.58, p = .02)
with significant main effects of both variables. The impact
of perceived independence on depressive symptoms was
significantly moderated by levels of past trauma exposure.
We explored simple slopes for participants who were at the
25th percentile of trauma exposure levels (25th % = .06;
simple slope = 0.29, t = 2.13, p = .05), at the mean level
(simple slope = -0.02, t = -0.35, p = .73), and at the 75th per-
centile (75th% = 0.84; simple slope = -0.16, t = -2.21,
p = .04). These simple slopes analyses suggest that for indi-
viduals at the lowest levels of trauma exposure, higher per-
ceptions of independence leads to higher levels of
depressive symptomatology, but for people at the highest
levels of trauma exposure, this association is reversed and
higher perceptions of independence actually contributes to
lower levels of symptoms. We further explored the impact
of a desire to leave Lebanon on depressive symptomatol-
ogy by interacting it with age and found a marginally sig-
nificant result (B = -0.02, p = .08). Simple slopes analyses
suggest that the significant moderating effect may be at
between the ages of 25 (simple slope = 0.29, t = 1.95,
p = .07) and 30 (simple slope = 0.18, t = 1.87, p = .08).
Beyond this age group, the desire to leave Lebanon is not
associated with depressive symptoms.
Discussion
This study explored relevant sociocultural factors that can
influence levels of depression among Syrian refugee women
who have been widowed due to armed conflict and who
reside in institutionalized care settings. We were intentional
in exploring factors that are particularly relevant to the inter-
secting identities of these refugee women, and we consid-
ered the role of past trauma exposure, perceived
independence, and a desire to leave Lebanon in search of
stability in a different country. In our final model explaining
over 50% of the variance in depressive symptomatology
among our population, we found that past trauma exposure
and perceptions of independence significantly influence
levels of depressive symptomatology. Additionally, a desire
to leave Lebanon to find stability elsewhere was a margin-
ally significant predictor. We also found support for the
6 International Journal of Social Psychiatry 00(0)
moderating role of perceived independence in the associa-
tion between trauma exposure and depressive symptoms, as
well as the moderating role of age in the association between
a desire to leave and depressive symptoms.
Our results lend support to previous scholarship on the
potency of exposure to past traumatic adversities in
impacting experiences with depression (Acaturk et al.,
2018; Alshawashreh & Alkhalil, 2019). Previous experi-
ences with toxic levels of stress can interfere with Syrian
refugee women’s baseline capacities to regulate their neg-
ative emotional reactions to the stressors, which in turn
can contribute to heightened levels of depression (Demir et
al., 2020). Further, in our final model where we explored
the main and moderating effects of perceived independ-
ence, we found that women who report higher levels of
independence may actually experience more depressive
symptoms. While these findings may seem counterintui-
tive in a western and stable sociocultural context, they are
informative and expected given Syrian refugee women’s
unique sociocultural environment (El Masri et al., 2013).
The experience of becoming a widow suddenly gives
women added responsibility and independence in a non-
volitional way (Lenette, 2014). Some women may per-
ceive this independence to be a new opportunity while
others perceive it to be a form of abandonment and burden.
A robust body of literature contends that autonomy is not
valued similarly across sociocultural groups, and people
with more individualistic self-concepts may be more likely
to perceive independence as an ideal state while those
from more collectivist backgrounds may prefer a sense of
social harmony and interconnectedness as opposed to
agency (Hamedani et al., 2011; Hamedani & Markus,
2019). Syrian refugee women may have been previously
socialized to value interconnected communal lives, and the
non-volitional shift in these patterns may be disruptive to
their well-being. Interestingly, our results suggest that the
degree to which perceived independence can impact
depressive symptoms is attenuated by past exposure to
trauma. Women at the lowest levels of trauma exposure
(25th percentile) tend to exhibit a positive association
between their perceived independence and depressive
symptoms. The reasoning described above may be only
relevant to women who have not faced high levels of
adverse life events, where more agency is actually disrup-
tive to well-being. On the contrary, for women with higher
levels of past trauma exposure (75th percentile), perceived
independence is actually protective such that more inde-
pendence indicates lower levels of depressive symptoms.
Given the common lost sense of autonomy and control in
the face of traumatic adversities (Spaaij et al., 2021), the
newly found sense of independence may be crucial for
women who have faced extreme traumas while hurting
women who do not have such histories.
In our final model, we also found a marginally signifi-
cant main effect of a desire to travel, with higher inclina-
tions to leave Lebanon associated with higher depressive
symptomatology. We consider the desire to leave Lebanon
in search of stability elsewhere as a proxy for the current
sense of integration and comfort. This finding is consist-
ent with previous studies which have shown that percep-
tions of displacement and the new cultural contexts
people find themselves in may impact their ability to
cope with their new situations (Lenette, 2014; Ozkaleli,
2021). It is understandable that women who experience
lower levels of satisfaction with their place of displace-
ment and hope to find asylum elsewhere may experience
higher levels of depression. We also found age to be a
significant moderator of this association, such that the
desire to leave was only a significant predictor of depres-
sion for the youngest group of women between the ages
of 25 and 30 years. These findings support previous
scholarship on the role of age and developmental stages
in influencing the mental health challenges of refugees
(Porter & Haslam, 2005). It is possible that for younger
refugee women, the desire to immigrate elsewhere but
not be able to is especially challenging given the additive
burden of being young mothers with less experience than
other women. Older women may have more robust social
connections and feel more comfortable under the care of
NGOs. Importantly, our results undergird the necessity of
exploring the nuances of how various sociocultural fac-
tors and their interplay could influence refugee women’s
mental health challenges differently (Ozkaleli, 2018).
Limitations
The strength of our results can be augmented by increasing
the number of participants in our study. Future studies
must engage more significant numbers of participants to
provide more statistical power required for a more thor-
ough understanding of the factors associated with depres-
sion in this population. Additionally, while the PHQ-9
exhibited high reliability, the scale may have limited con-
struct validity in capturing clinical depression in our sam-
ple because the items do not reflect all the daily challenges
of refugee women in institutional settings. Future research
should validate culturally and contextually relevant items
to how depression manifests in this population. Finally, the
precise directionality of our results must be further
explored with longitudinal studies that can control for
baseline levels of predictors. For instance, we cannot
deterministically ascertain whether perceptions of inde-
pendence cause higher levels of depression, or if higher
levels of symptoms lead women to feel more limited and
less agentic.
Conclusion
In this study, we explored how relevant sociocultural fac-
tors can contribute to varying levels of depressive symp-
toms among Syrian refugee widows. We found support for
the idea that even among groups of refugees with similar
Hosseini et al.
backgrounds, that is, gender, ethnicity, marriage status,
there is heterogeneity in how unique sociocultural back-
grounds interact to contribute to psychopathology. We
encourage future studies to employ similarly nuanced
frameworks to thoroughly explore the interplay of socio-
cultural and environmental factors that could impact refu-
gees’ well-being. These studies can also benefit from
distinguishing what may contribute to the onset versus
exacerbation of symptomatology. We encourage the aug-
mentation of measures used to capture psychopathology to
accurately reflect the lived experiences of individuals
within their unique contexts.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iDs
Zainab Hosseini https://orcid.org/0000-0001-7057-8922
Sadena Ahmad https://orcid.org/0000-0002-2389-1374
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