Major depressive disorder prevalence and risk factors among Syrian asylum seekers in Greece

Background: Over one million Syrian asylum seekers have travelled to Greece with the ultimate aim of reaching other countries in western Europe. Depression prevalence and associated sociodemographic and displacement characteristics have been reported for resettled migrants. However, the prevalence of major depressive disorder (MDD) and its risk factors have not been described among migrants engaged in the asylum process ensuing from the Syrian crisis. This study provides new data about the mental health status of migrants in transition in the context of protracted asylum procedures. Methods: We conducted a cross-sectional survey in a Syrian refugee camp in the Attica region of Greece from January 16-31, 2017. Individuals >= 18 years of age with verbal Arabic or English language skills were eligible to participate. The Patient Health Questionnaire-8 (PHQ-8), an eight-item validated diagnostic and severity measure, was used to screen for MDD. We analysed the relationships between MDD and sociodemographic and displacement characteristics using multivariable logistic regression. Results: A total of 135 surveys were completed, representing 40% of the adult population in the refugee camp. The mean age of the participants was 30 years (18-61 years); women comprised 41% of the sample; 74% of the participants had ever married; 67% had children; and 33% of participants had not attended secondary school, including 11% who had never attended school. Median time since departing the country of origin was 12 months (< 1-74 months). Median time spent in the asylum process in Greece was 10 months (< 1-49 months). MDD was detected in 44% (95% CI: 37-50) of participants. Being a woman (Adjusted Odds Ratio [AOR]: 3.23, p = 0.019), each additional child (AOR: 1.61, p = 0.006), and increased time in the asylum process in Greece (AOR: 1.15, p = 0.043) were significant risk factors for MDD. Ever being married was associated with reduced odds of MDD (AOR: 0.23, p = 0.042). Conclusions: Syrian migrants face an extraordinarily high burden of MDD as they seek asylum. Incorporation of screening and treatment into service provision within refugee camps is urgently needed, particularly as migrants spend extended periods of time in transition due to protracted asylum procedures.