The Effects of COVID-19 Continuous Traumatic Stress on Mental Health: The Case of Syrian Refugees in Turkey

Abstract

COVID-19 presents continuous cumulative multilayered traumatic stressors that have a significant mental health impact on refugees and especially Syrian refugees. A sample of 417 Syrian refugees in Turkey participated in an online survey that included measures for COVID-19 traumatic stress (COVID-19TS), cumulative stressors and traumas, posttraumatic stress disorder (PTSD), depression, generalized anxiety, and existential death and status anxieties. We conducted an independent samples t test between those hospitalized due to COVID-19 infection (N = 47) and the others. Further, we conducted path analysis supplemented by PROCESS macro to identify the mediators. The path model included cumulative stressors and traumas and COVID-19TS as independent variables, existential status and death anxieties as mediating variables, and PTSD, depression, and anxiety as outcome variables. We conducted multigroup invariance to test the path model equivalence across genders and tortured and nontortured groups. Results indicated that the participants are highly traumatized and include a relatively high number of torture survivors (N = 102). Being tortured was a decisive risk factor for being hospitalized for COVID-19, with over 75% of the hospitalized been torture survivors. The sample participants have high rates of PTSD, depression, and anxiety, especially among those hospitalized due to COVID-19 and those with a history of torture. COVID-19TS has the highest association with its economic trauma. COVID-19TS is directly associated with elevated PTSD, depression, and anxiety comorbid symptoms and indirectly via existential death and status anxieties as mediators. The path model was strictly invariant across genders and tortured and nontortured groups.