Journal of Psychosocial Nursing and Mental Health Services

Original Article 

Determining the Correlation Between Social Support and Hopelessness of Syrian Refugees Living in Turkey

Hilal Yildirim, PhD, RN; Kevser Isik, PhD, RN; Tuba Yildirim Firat, MD; Rukuye Aylaz, PhD, RN

Abstract

The current descriptive cross-sectional study was conducted to determine the correlation between perceived social support and hopelessness of 609 Syrian refugees age ≥16 residing in Gaziantep City, Turkey. A sociodemographic questionnaire, the Multidimensional Scale of Perceived Social Support, and Beck Hopelessness Scale were used for data collection. Descriptive statistics, analysis of variance, and regression and correlation analyses were used to analyze the data. Syrian refugees had high levels of hopelessness, particularly motivation loss, and moderate levels of perceived social support. As perceived social support increased, hopelessness, feelings, expectations about the future, and motivation loss decreased. In accordance with these results, hopes of Syrian refugees for the future can be increased by improving their social support system. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

Abstract

The current descriptive cross-sectional study was conducted to determine the correlation between perceived social support and hopelessness of 609 Syrian refugees age ≥16 residing in Gaziantep City, Turkey. A sociodemographic questionnaire, the Multidimensional Scale of Perceived Social Support, and Beck Hopelessness Scale were used for data collection. Descriptive statistics, analysis of variance, and regression and correlation analyses were used to analyze the data. Syrian refugees had high levels of hopelessness, particularly motivation loss, and moderate levels of perceived social support. As perceived social support increased, hopelessness, feelings, expectations about the future, and motivation loss decreased. In accordance with these results, hopes of Syrian refugees for the future can be increased by improving their social support system. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx–xx.]

An increasing number of wars are breaking out across the world in the 21st century, and these wars have forced people to leave their motherlands and take refuge in other countries (United Nations High Commissioner for Refugees [UNHCR], 2016; Woltin et al., 2018). The UNHCR (2016) announced that 65.6 million people (corresponding to approximately 1% of the world population) were refugees in 2016. Today, the Middle East is one of the regions most affected by wars. For this reason, people living in this region have been migrating at a high rate. Specifically, individuals migrating from Iraq, Syria, and Yemen represent more than 30% of global migrants (Dator et al., 2018; Woltin et al., 2018). Due to the Syrian civil war that broke out in 2011, more than 300,000 people lost their lives and 6.6 million people were forced to migrate. Syrian refugees migrated to neighboring countries, such as Jordan, Lebanon, Egypt, and Turkey. At the end of 2016, 4.8 million Syrian refugees were forced to migrate abroad (Chica & Acosta, 2018; Hémono et al., 2018). Turkey hosts the highest number of refugees in the world. According to the data of Turkey Directorate General of Migration Management for 2018, Turkey hosted more than 3.5 million Syrian refugees (Akcapar & Simsek, 2018).

Due to migration, refugees experience stressful and traumatic conditions before, during, and after the migration (Aktas, 2018). These stressful and traumatic conditions primarily include deteriorated family structure, loss of close relatives, insecure environment, and physical and sexual abuse (Alzoubi et al., 2019). Refugees may also experience social exclusion and discrimination, loss of social status, unemployment, and financial difficulties after migration (Aktas, 2018; Alzoubi et al., 2019). Social support is of prime importance in coping with these stressful conditions.

Social support is emotional and informative support systems provided by family members, friends, and relatives of the individual. Migrants lose their basic social ties when they leave their own country. These individuals are faced with the challenge of recreating social support systems in their new environment (Ra et al., 2019). Social support is a key factor for coping with stressful events caused by migration and maintaining mental health. High social support is associated with low depressive symptoms (Ra et al., 2019; Stewart et al., 2010). In brief, social support provides positive energy for life, facilitates coping with stressful events, and reduces depressive symptoms (Arslantas et al., 2010). In addition to social support, the feeling of hopelessness experienced by individuals also affects all aspects of life. In particular, individuals who experience war and its adverse effects may develop negative and hopeless expectations for the future (Apak, 2015; Arslantas et al., 2010).

Per review of the literature, no previous studies have investigated social support systems and hopelessness levels of refugees. Based on this deficiency, the current study was conducted to determine the correlation between social support and hopelessness among Syrian refugees living in Turkey.

Method

Design and Participants

A cross-sectional study was conducted in Gaziantep City, Turkey. The study population comprised Syrian refugees who were age ≥16 years, could speak Turkish, had no communication difficulties or mental health issues, agreed to participate in the study, and were residing in southeastern Turkey. The sample comprised 609 Syrian refugees who agreed to participate in the study.

Data Collection

A questionnaire regarding demographic data was prepared by the researchers upon review of the literature. The Turkish versions of the Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) were used to measure the dependent variables. Data were collected by the researcher reading questions to Syrian refugees and recording their answers through face-to-face interviews. Interviews lasted an average of 25 to 30 minutes.

Questionnaire. The questionnaire comprises 16 questions about demographic data, including age, gender, education, marital status, age at time of marriage, having a child(ren), number of children, giving birth in Turkey, reason for giving birth in Turkey, working status, working status in their own country, reason for choosing Turkey, satisfaction with residing in Turkey, willingness to live in another country, number of people living with, and duration of residency in Turkey.

Multidimensional Scale of Perceived Social Support. The MSPSS was developed by Zimet et al. (1988). Turkish validity and reliability of the scale was conducted by Eker and Arkar (1995). The Turkish version of the scale was revised in 2001 by Eker et al. The scale has 12 items and three subscales, including family (four items), friends (four items), and significant other (four items), and is scored using a 7-point Likert-type scale, where 1 = absolutely no and 7 = absolutely yes. Total scores range from 12 to 84, with higher scores indicating higher perceived social support. Cronbach's alpha was between 0.80 and 0.95 (Eker et al., 2001). Cronbach's alpha in the current study was 0.91.

Beck Hopelessness Scale. The BHS was developed by Beck et al. in 1961. Turkish validity and reliability of the scale was conducted by Seber et al. (1993). The BHS has a total of 20 items and three subscales: feelings and expectations about the future (five items), loss of motivation (eight items), and hope (seven items). The BHS is scored using a 2-point Likert-type scale, where 0 = yes and 1 = no, with total score ranging between 0 and 20. Higher scores signify a higher level of hopelessness. Cronbach's alpha was 0.85 (Aras, 2011; Seber et al., 1993; Yigiter & Kuru, 2016). Cronbach's alpha in the current study was 0.75.

Data Analysis

All answers were coded and entered using SPSS version 17. Descriptive analysis was presented as number, percentage, mean, standard deviation, and range. Analysis of variance (ANOVA) and t test were used to compare sociodemographic characteristics with scores on the MSPSS and BHS. Pearson's correlation coefficient was used to examine the correlation between scales. Finally, multiple regression analysis was used to determine significant factors associated with hopelessness and social support. Prior to the regression analysis, multicollinearity among independent variables was checked, and no issues were found. Statistical analyses were evaluated at the confidence interval of 95% and significance level of p < 0.05.

Ethical Approval

Approval to conduct the study was obtained from the Noninvasive Clinical Trials Ethics Committee of the university overseeing the research.

Results

Of 609 participants, 51.2% were female, 39.6% were secondary school graduates, 77% were married, 76% had children, and 38.3% gave birth in Turkey. Mean age of participants was 36.94 (SD = 15.63) years, mean age at the time of marriage was 21.98 (SD =3.83) years, and the mean length of residence in Turkey was 2.62 (SD = 0.64) years (Table 1).

Participant Sociodemographic Characteristics (N = 609)Participant Sociodemographic Characteristics (N = 609)

Table 1:

Participant Sociodemographic Characteristics (N = 609)

Mean scores of perceived social support and hopelessness are presented in Table A. Significant differences (p ≤ 0.05) were found for perceived social support mean scores in regard to gender, marital status, employment status, and satisfaction with residing in Turkey. Significant differences (p ≤ 0.05) were found for hopelessness mean scores in regard to employment status only. Perceived social support scores of participants who selected the option “others” (e.g., having no other option, language appropriateness, having relatives in Turkey, high level of welfare) as the reason for choosing Turkey were high (p ≤ 0.05). Hopelessness was high for participants who stated the reason for choosing Turkey was being safe (p ≤ 0.05).

Comparison of Sociodemographic Characteristics and Mean Scores of the Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) (N = 609)Comparison of Sociodemographic Characteristics and Mean Scores of the Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) (N = 609)

Table A:

Comparison of Sociodemographic Characteristics and Mean Scores of the Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) (N = 609)

Participants' mean score on the MSPSS was 48.95 (SD = 15.74), indicating a moderate level of perceived social support. Participants' mean score on the BHS was 14.23 (SD = 2.95), indicating a high level of hopelessness (Table 2).

Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) Scores (N = 609)

Table 2:

Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) Scores (N = 609)

A negative correlation was found between perceived social support and motivation—as perceived social support increased, loss of motivation decreased (p ≤ 0.05) (Table B).

Correlation Between Hopelessness and Perceived Social Support Levels

Table B:

Correlation Between Hopelessness and Perceived Social Support Levels

Participants' sociodemographic characteristics had a cumulative effect of 22% on social support and 23% on hopelessness (Table C).

Regression Analysis of Sociodemographic Characteristics, Multidimensional Scale of Perceived Social Support (MSPSS) Scores, and Beck Hopelessness Scale (BHS) Scores (N = 609)

Table C:

Regression Analysis of Sociodemographic Characteristics, Multidimensional Scale of Perceived Social Support (MSPSS) Scores, and Beck Hopelessness Scale (BHS) Scores (N = 609)

Discussion

In 2018, 70.8 million people were forced to leave their countries due to various reasons (UNHCR, 2019). In Turkey, which has the highest rate of migration among European countries, the number of Syrian refugees in 2019 was approximately 3.6 million (UNHCR, 2019). Approximately 10% of Syrian refugees living in Turkey reside in camps. The remaining refugees struggle to survive on their own (Akcapar & Simsek, 2018; UNHCR, 2019). Major issues faced by these Syrian refugees include hopelessness; lack of a solution to living in a camp; difficult living conditions; insufficient humanitarian aid; and limited social support networks, income, and education opportunities (Aktas, 2018). Adapting to the living conditions of the host country can bring physical and psychological problems (Labys et al., 2017). The increasing number of refugees has also led to legal and administrative issues in Turkey. In addition, Turkish citizens experience problems socially accepting Syrian refugees, whereas Syrian refugees have adaptation problems (Akcapar & Simsek, 2018). The disharmony of cultural lifestyles, language problems, and the reactions of locals toward the aid and employment of refugees drives these displaced individuals to hopelessness (Akpinar, 2017; Aktas, 2018). Therefore, the current study is thought to be important in terms of (a) revealing the social support networks and hopelessness levels that may lead Syrian refugees to experience depression and (b) planning possible interventions for this population.

In the current study, participants had an average of five children who were mostly born in Turkey; found Turkey to be safe and appropriate for childbearing; and 90.5% were satisfied with living in Turkey. However, their levels of hopelessness, particularly loss of motivation, were high. This finding is similar to a study of Afghan refugees who were also found to have high levels of hopelessness (Katouli et al., 2016). Labys et al. (2017) found that refugees living in Durban, South Africa had anxiety, fear, emotional pain, anger, weakness, hopelessness, worthlessness, and thoughts of passive suicide. Results from the current study are consistent with other studies reporting high levels of hopelessness among refugees, which was triggered by their poor living conditions (Katouli et al., 2016; Labys et al., 2017; Procter et al., 2018). Not having any other choice but escaping from war and taking refuge in Turkey, being separated from their nation and motherland, having decreased hope of returning to their home country, and having limited financial support and other opportunities could be factors increasing the hopelessness levels of Syrian refugees.

Moderate levels of perceived social support were found among Syrian refugees in the current study. Kim (2018) found high levels of perceived social support among migrant women living in Korea, which may be due to the fact that these migrants were not forced to leave their countries as refugees. Hanley et al. (2018) also found high levels of family and friend social supports of Syrian refugees living in Canada, making it easier for them to settle and gain employment. In a study conducted with Syrian female refugees in 2011 in Turkey, their perceived social support level was low. This finding may have been affected by the fact that the war just broke out and the majority of Syrian refugees had not yet settled (Çankaya et al., 2018). The moderate level of perceived social support found in the current study may be due to the fact that some participants had been settled in Turkey for 5 years. During this time, their social networks may have improved, as they were able to facilitate relationships, thus increasing their chances of survival.

As perceived friend support increased, hopelessness, feelings and expectations about the future, and loss of motivation decreased. In addition, loss of motivation decreased as perceived social support increased. Similar results were found in the study by Çankaya et al. (2018), who reported that hopelessness levels of refugees decreased as their perceived social support increased. Social support is the most important factor in promoting the psychological well-being of refugees and ensuring that refugees with similar characteristics bond. Social support will also help increase their hope levels (Teodorescu et al., 2012).

Sociodemographic characteristics of refugees affect their hopelessness and perceived social support (Demirbaa & Bekaroglu, 2013; Kirmayer et al., 2011). Disappointment and frustration develop when refugees' hopes and expectations about the host country do not come to fruition (Teodorescu et al., 2012). In addition, social support loss may occur due to broken families or lost relatives after the war.

Male refugees had lower feelings and expectations about the future and hope levels and higher perceived social support than female refugees. Among refugees forced to take refuge in another country, men lose their social status and women gain the status men lose (Warfa et al., 2012). Warfa et al. (2012) found that this role reversal adversely affected men's mental health. In a study conducted with refugees coming from Chechnya, Afghanistan, and West Africa to Australia, women used concentrating on their children and performing various home activities as coping strategies, whereas men preferred job seeking and socialization (Renner & Salem, 2009). Syrian male refugees have limited opportunities for realizing roles such as earning a livelihood and strengthening the family and this situation may have increased their hopelessness. On the other hand, seeking a job, working, or performing out-of-home tasks may increase men's social support networks.

Hope levels of refugees with lesser education were low. However, perceived significant other support of university graduate refugees was high. Other studies have shown that low education levels of refugees increased the unemployment rate, negatively affected quality of life, and increased the severity of psychological symptoms such as hopelessness (Teodorescu et al., 2012). Low education levels of the Syrian refugees in the current study might have forced them to simultaneously face complex problems for which they were ill-equipped to manage, such as communication difficulties, health issues, economic weakness, lack of social networking skills, and failure to adapt to living standards in Turkey. On the other hand, a high education level provides refugees with the opportunity to improve their self-expression skills and welfare and social status. The ability of highly educated refugees to plan their lives may have resulted in their high level of perceived social support. In fact, in the study by Hung et al. (2012), graduation from higher education institutions had a positive effect on refugees' social support. Parallel to the increase in educational status, refugees with higher education were reported to reach cultural, social, and economic welfare (Çankaya et al., 2018).

Unmarried refugees had higher levels of perceived social support than married refugees. This finding contrasts with results of other studies reporting that married refugees perceived more social support compared to unmarried refugees (Güçlü et al., 2016; Softa et al., 2016). The fact that communication of married refugees may be limited to their immediate family and the people they live with, family support networks may weaken as a result of external stresses, whereas unmarried refugees are more able to establish new social networks, thus possibly increasing their perceived social support.

Refugees whose social support includes family members, significant others, and friends may cope with stress and adapt to new conditions more easily. Refugee families with children had high social support levels but low hopelessness levels (Çankaya et al., 2018). Having a family with children can provide refugees with a good social support network and help them better cope with challenges. Therefore, having children can also increase perceived significant other support. However, having children in a foreign country and culture can bring economic difficulties for refugees, hence the likelihood of motivation loss may increase.

Refugees who were not satisfied with living in Turkey had higher perceived social support. Having a high number of Syrian peers in the same situation might have increased the perceived social support of refugees with large families and poor living standards. Cooperation and solidarity among family members have been reported to be factors of emotional intimacy under stress-related conditions (Schweitzer et al., 2006). However, the struggle of living with a large family may have resulted in their dissatisfaction with residing in Turkey and triggered their desire to live elsewhere. In fact, results in the current study showed that refugees who wanted to live in another country had higher motivation loss. Regarding the reason for choosing to migrate to Turkey, those who had no other choice, had familiarity with the language, had relatives in Turkey, and viewed Turkey as a developed country with a higher living standard had high perceived social support. Hopelessness levels of refugees who chose Turkey due to its close proximity were lower compared to those who had other reasons for choosing Turkey.

Limitations

A limitation of the current study concerns the generalizability of results. Syrian refugees live in different cities throughout Turkey; however, only those residing in one city were included. Therefore, a multicenter study should be conducted including other refugees throughout Turkey and beyond.

Nursing Implications

Nurses, particularly psychiatric–mental health nurses (PMHNs), are of prime importance in protecting and maintaining the mental health of refugees and providing appropriate treatment and care for those with mental disorders. PMHNs should identify stressors experienced by refugees, establish interventions for strengthening social bonds, provide mental health services, and offer suggestions for effective coping. PMHNs should also provide psychological support by increasing refugees' awareness of depression and other psychosocial problems and the development of suitable coping skills (Asilar & Yildirim, 2018; Korkmaz, 2016). In addition, nurses should evaluate social support levels of refugees.

Conclusion

Syrian refugees considered Turkey a safe and appropriate country; were satisfied with living in Turkey; had high levels of hopelessness, especially loss of motivation; and had moderate levels of perceived social support. Their levels of hopelessness, feelings and expectations about the future, and loss of motivation decreased with increasing perceived social support. Sociodemographic characteristics, including gender, education, marital status, number of children, satisfaction with living in Turkey, and the reason for choosing Turkey, affected their hopelessness and perceived social support. Therefore, designing political interventions that can improve social support systems of Syrian refugees in Turkey may improve their hopes for the future. Providing opportunities for refugees to further their education can help them gain skills to obtain better living conditions. Preventive interventions addressing the risk factors that increase hopelessness in these individuals should be performed by health care professionals.

References

  • Akcapar, S. K. & Simsek, D. (2018). The politics of Syrian refugees in Turkey: A question of inclusion and exclusion through citizenship. Social Inclusion (Lisboa), 6, 176–187 doi:10.17645/si.v6i1.1323 [CrossRef]
  • Akpinar, T. (2017). The problems of Syrian refugee children and women in Turkey in the context of social policy. Balkan ve Yakin Dogu Sosyal Bilimler Dergisi, 3, 16–29.
  • Aktas, M. (2018). Syrians in Turkey: Problems and solutions. Yüzüncü Yil Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 42, 129–154.
  • Alzoubi, F. A., Al-Smadi, A. M. & Gougazeh, Y. M. (2019). Coping strategies used by Syrian refugees in Jordan. Clinical Nursing Research, 28, 396–421 doi:10.1177/1054773817749724 [CrossRef] PMID:29276842
  • Apak, H. (2015). Future prospects of Syrian immigrants: An example of Mardin. Birey ve Toplum Sosyal Bilimler Dergisi, 5, 125–142 doi:10.20493/bt.53521 [CrossRef]
  • Aras, A. (2011). Determining the hopelessness level of Hacettepe University Ankara state conservatoire music undergraduates. Gazi University Journal of Gazi Educational Faculty, 31, 509–524.
  • Arslantas, H., Adana, F., Kaya, F. & Turan, D. (2010). Hopelessness and social support level in the inpatients and factors affecting them. Florence Nightingale Hemsirelik Dergisi, 18, 87–97.
  • Asilar, R. H. & Yildirim, A. (2018). Social and mental effects of immigration and nursing. In Avci, A. (Ed.), Migration and migrant health (pp. 10–20). Clinical Turkey.
  • Beck, A. T., Ward, C., Mendelson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 561–571 doi:10.1001/archpsyc.1961.01710120031004 [CrossRef] PMID:13688369
  • Çankaya, S., Alan Dikmen, H. & Dereli Yilmaz, S. (2018). Investigation of social support perceptions and hopelessness levels of refugee women in Turkey. International Social Work, 61, 1–14 doi:10.1177/0020872818798002 [CrossRef]
  • Chica, N. & Acosta, P. (2018). Psychosocial support to foster social cohesion between refugee and host communities in Jordan. Intervention (Amstelveen, Netherlands), 16, 147–153 doi:10.4103/INTV.INTV_40_18 [CrossRef]
  • Dator, W., Abunab, H. & Dao-Ayen, N. (2018). Health challenges and access to health care among Syrian refugees in Jordan: A review. Eastern Mediterranean Health Journal, 24, 680–686 doi:10.26719/2018.24.7.680 [CrossRef] PMID:30215478
  • Demirbaa, H. & Bekaroglu, E. (2013). Being away from home: Psychological problems and preventions of refugees. Journal of Crisis, 21, 11–24.
  • Eker, D. & Arkar, H. (1995). The factorial structure, validity and reliability of the multidimensional scale of perceived social support. Turkish Journal of Psychology, 34, 45–55.
  • Eker, D., Arkar, H. & Yaldiz, H. (2001). Factorial structure, validity, and reliability of revised form of the multidimensional scale of perceived social support. Türk Psikiyatri Dergisi, 12, 17–25.
  • Güçlü, S., Degirmen, N. & Uncu, B. (2016). The relationship between social support, anxiety and self-perception in adults. Journal of Current Researches on Health Sector, 6, 13–22.
  • Hanley, J., Al Mhamied, A., Cleveland, J., Hajjar, O., Hassan, G., Ives, N., Khyar, H. & Hynie, M. (2018). The social networks, social support and social capital of Syrian refugees privately sponsored to settle in Montreal: Indications for employment and housing during their early experiences of integration. Canadian Ethnic Studies, 50, 123–148 doi:10.1353/ces.2018.0018 [CrossRef]
  • Hémono, R., Relyea, B., Scott, J., Khaddaj, S., Douka, A. & Wringe, A. (2018). “The needs have clearly evolved as time has gone on”: A qualitative study to explore stakeholders' perspectives on the health needs of Syrian refugees in Greece following the 2016 European Union-Turkey agreement. Conflict and Health, 12, 2–9 doi:10.1186/s13031-018-0158-9 [CrossRef]
  • Hung, C. H., Wang, H. H., Chang, S. H., Jian, S. Y. & Yang, Y. M. (2012). The health status of postpartum immigrant women in Taiwan. Journal of Clinical Nursing, 21, 1544–1553 doi:10.1111/j.1365-2702.2011.03999.x [CrossRef] PMID:22443368
  • Katouli, M. B., Ahadi, M., Afzoun, J., Parooi, M., Heyrati, H. & Shahsavarani, A. M. (2016). Comparison of hopelessness and self-efficacy of refugee/immigrant Afghan youth with native Persian cohorts: A preliminary study. International Journal of Humanities and Cultural Studies, 1, 2523–2533.
  • Kim, J. S. (2018). Social support, acculturation stress, and parenting stress among marriage-migrant women. Archives of Psychiatric Nursing, 32, 809–814 doi:10.1016/j.apnu.2018.06.004 [CrossRef] PMID:30454621
  • Kirmayer, L. J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A. G., Guzder, J., Hassan, G., Rousseau, C. & Pottie, K.the Canadian Collaboration for Immigrant and Refugee Health. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. Canadian Medical Association Journal, 183, E959–E967 doi:10.1503/cmaj.090292 [CrossRef] PMID:20603342
  • Korkmaz, A. Ç. (2016). Refugees and asylum seekers' health problems: The nursing approach. Middle East Journal of Refugee Studies, 1(2), 75–89 doi:10.12738/mejrs.2016.1.2.0002E [CrossRef]
  • Labys, C. A., Dreyer, C. & Burns, J. K. (2017). At zero and turning in circles: Refugee experiences and coping in Durban, South Africa. Transcultural Psychiatry, 54(5–6), 696–714 doi:10.1177/1363461517705570 [CrossRef] PMID:28452611
  • Procter, N. G., Kenny, M. A., Eaton, H. & Grech, C. (2018). Lethal hopelessness: Understanding and responding to asylum seeker distress and mental deterioration. International Journal of Mental Health Nursing, 27, 448–454 doi:10.1111/inm.12325 [CrossRef] PMID:28322492
  • Ra, C. K., Huh, J., Finch, B. K. & Cho, Y. (2019). The impact of perceived discrimination on depressive symptoms and the role of differentiated social support among immigrant populations in South Korea. International Journal for Equity in Health, 18, 7 doi:10.1186/s12939-019-0910-9 [CrossRef] PMID:30634987
  • Renner, W. & Salem, I. (2009). Post-traumatic stress in asylum seekers and refugees from Chechnya, Afghanistan, and West Africa: Gender differences in symptomatology and coping. The International Journal of Social Psychiatry, 55, 99–108 doi:10.1177/0020764008092341 [CrossRef] PMID:19240200
  • Schweitzer, R., Melville, F., Steel, Z. & Lacherez, P. (2006). Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. The Australian and New Zealand Journal of Psychiatry, 40, 179–187 doi:10.1080/j.1440-1614.2006.01766.x [CrossRef] PMID:16476137
  • Seber, G., Dilbaz, N., Kaptanoglu, C. & Tekin, D. (1993). Hopelessness scale: Validity and reliability. Journal of Crisis, 1, 139–142.
  • Softa, H., Bayraktar, T. & Uguz, C. (2016). Elders' perceived social support systems and factors effecting their healthy life-style behaviour. Yasli Sorunlari Arastirma Dergisi, 9, 1–12.
  • Stewart, M. J., Makwarimba, E., Beiser, M., Neufeld, A., Simich, L. & Spitzer, D. (2010). Social support and health: Immigrants' and refugees' perspectives. Diversity in Health & Care, 7, 91–103.
  • Teodorescu, D. S., Siqveland, J., Heir, T., Hauff, E., Wentzel-Larsen, T. & Lien, L. (2012). Posttraumatic growth, depressive symptoms, posttraumatic stress symptoms, post-migration stressors and quality of life in multi-traumatized psychiatric outpatients with a refugee background in Norway. Health and Quality of Life Outcomes, 10, 84 doi:10.1186/1477-7525-10-84 [CrossRef] PMID:22824521
  • United Nations High Commissioner for Refugees. (2016). UNHCR global trends—Forced displacement in 2016. https://www.unhcr.org/globaltrends2016/
  • United Nations High Commissioner for Refugees. (2019). UNHCR Turkey stats. https://www.unhcr.org/tr/en/unhcr-turkey-stats
  • Warfa, N., Curtis, S., Watters, C., Carswell, K., Ingleby, D. & Bhui, K. (2012). Migration experiences, employment status and psychological distress among Somali immigrants: A mixed-method international study. BMC Public Health, 12, 749–760 doi:10.1186/1471-2458-12-749 [CrossRef] PMID:22954304
  • Woltin, K. A., Sassenberg, K. & Albayrak, N. (2018). Regulatory focus, coping strategies and symptoms of anxiety and depression: A comparison between Syrian refugees in Turkey and Germany. PLoS One, 13, e0206522 doi:10.1371/journal.pone.0206522 [CrossRef] PMID:30359455
  • Yigiter, K. & Kuru, M. (2016). Investigating the hopelessness level of the students attending final year of the high school. Journal of Research in Education and Teaching, 5, 235–239.
  • Zimet, G. D., Dahlem, N. W., Zimet, S. G. & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

Participant Sociodemographic Characteristics (N = 609)

Characteristicn (%)
Gender
  Female312 (51.2)
  Male297 (48.8)
Education level
  Illiterate69 (11.3)
  Secondary school241 (39.6)
  High school215 (35.4)
  University and higher84 (13.8)
Marital status
  Married471 (77.3)
  Single138 (22.7)
Have a child(ren)
  Yes463 (76)
  No146 (24)
Gave birth in Turkey
  No230 (37.8)
  Yes233 (38.3)
Reason for giving birth in Turkey
  Safe environment161 (68.2)
  Hope for the future45 (19.1)
  Not knowing/using contraception methods20 (8.5)
  Religious beliefs10 (4.2)
Working status
  Yes321 (52.7)
  No288 (47.3)
Working status in own country
  Yes158 (50.3)
  No156 (49.7)
Reason for choosing to migrate to Turkey
  Safe country205 (65.3)
  Muslim country59 (18.8)
  Proximity29 (9.2)
  Othera21 (6.7)
Satisfied with being in Turkey
  Yes551 (90.5)
  No58 (9.5)
Willingness to live in another country
  No439 (72.1)
  Yes170 (27.9)
CharacteristicMean (SD) (Range)
Age (years)36.94 (15.63) (18 to 90)
Age at time of marriage (years)21.98 (3.83) (13 to 40)
Number of children5.10 (2.96) (0 to 16)
Number of people living with6.86 (2.06) (2 to 13)
Duration of residence in Turkey (years)2.62 (0.64) (1 to 5)

Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) Scores (N = 609)

ScaleMean Score (SD) (Range)
MSPSSa
  Family16.27 (5.55)
  Friend16.29 (5.86)
  Significant other16.34 (6.36)
  Total48.95 (15.74) (12 to 84)
BHSb
  Feelings and expectations about the future3.90 (1.19)
  Loss of motivation6.75 (1.63)
  Hope3.57 (0.73)
  Total14.23 (2.95) (0 to 20)

Comparison of Sociodemographic Characteristics and Mean Scores of the Multidimensional Scale of Perceived Social Support (MSPSS) and Beck Hopelessness Scale (BHS) (N = 609)

CharacteristicMean (SD)
MSPSSBHS
FamilyFriendSignificant OtherTotalFeelings and Expectations About the FutureLoss of MotivationHopeTotal
Gender
  Female15.97 (5.67)15.87 (5.89)15.84 (6.37)47.69 (15.68)3.80 (1.22)6.69 (1.64)3.50 (0.74)14.00 (2.97)
  Male16.59 (5.41)16.74 (5.79)16.86 (6.32)50.28 (15.72)4.01 (1.57)6.81 (1.62)3.64 (0.70)14.47 (2.91)
  Test value−1.382a−1.847a−1.980a−2.032a−2.230a−0.899a−2.260a−1.961a
   p value0.0670.0650.0480.0430.0260.3690.0240.050
Education level
  Illiterate15.60 (5.50)15.31 (5.91)15.11 (5.81)46.04 (15.84)4.21 (1.10)6.46 (2.10)3.73 (0.74)14.42 (3.53)
  Secondary school15.92 (5.88)16.33 (6.24)15.85 (6.74)48.11 (16.79)3.82 (1.18)6.68 (1.60)3.48 (0.78)13.99 (2.97)
  High school16.61 (4.97)16.26 (5.08)16.82 (5.72)49.71 (14.00)3.90 (1.22)6.96 (1.42)3.62 (0.67)14.48 (2.62)
  University and higher16.97 (5.95)17.07 (6.47)17.53 (7.01)51.83 (16.41)3.89 (1.19)6.66 (1.77)3.58 (0.68)14.14 (3.15)
  Test value1.381b1.136b2.751b2.132b2.754b2.103b2.820b1.172b
   p value0.2480.3340.0420.0950.1230.0990.0380.319
Marital status
  Married16.10 (5.68)15.92 (5.97)16.00 (6.37)48.07 (16.30)3.93 (1.19)6.78 (1.63)3.58 (0.74)14.29 (2.96)
  Single16.87 (5.05)17.55 (5.30)17.50 (6.20)51.92 (13.33)3.81 (1.97)6.67 (1.65)3.54 (0.67)14.03 (2.93)
  Test value−1.444a−2.896a−2.469a−2.556a1.039a0.645a0.587a0.924a
   p value0.1490.0040.0140.0110.2990.5190.5570.356
Gave birth in Turkey
  Yes16.26 (5.31)16.34 (5.52)16.75 (5.98)49.36 (14.85)3.86 (1.19)6.95 (1.36)3.57 (0.70)14.39 (2.72)
  No15.99 (5.98)15.78 (6.38)15.31 (6.62)47.17 (17.83)3.97 (1.20)6.53 (1.88)3.57 (0.81)14.08 (3.25)
  Test value0.527a1.025a2.480a1.483a−1.019a2.750a0.036a1.114a
   p value0.5980.3060.0130.1390.3090.0060.9720.266
Working status
  Yes16.83 (4.89)16.55 (5.21)17.19 (5.88)50.65 (14.34)4.05 (1.14)6.97 (1.49)3.63 (0.64)14.67 (2.76)
  No15.65 (6.14)16.01 (6.50)15.39 (6.74)47.06 (16.99)3.73 (1.22)6.51 (1.75)3.50 (0.81)13.75 (3.08)
  Test value2.628a1.151a3.524a2.830a3.356a3.551a2.174a3.879a
   p value0.0090.250<0.0010.0050.001<0.0010.030<0.001
Satisfied with being in Turkey
  Yes16.13 (5.63)16.23 (5.92)16.13 (6.37)48.37 (15.82)3.87 (1.20)6.71 (1.67)3.57 (0.73)14.17 (2.97)
  No17.63 (4.56)16.91 (5.16)18.39 (5.88)52.94 (14.46)4.17 (1.11)7.15 (1.21)3.55 (0.67)14.87 (2.64)
  Test value−1.966a−0.840a−2.591a−2.035a−1.784a−1.950a0.252a−1.741a
   p value0.0500.4010.0100.0420.0750.0520.8010.082
Willingness to live in another country
  Yes16.96 (5.39)16.62 (5.40)17.07 (6.35)50.66 (15.42)3.97 (1.19)7.01 (1.36)3.61 (0.73)14.60 (2.73)
  No16.01 (5.59)16.17 (6.02)16.06 (6.35)48.29 (15.83)3.87 (1.19)6.65 (1.72)3.56 (0.73)14.09 (3.02)
  Test value1.905a0.851a1.765a1.668a0.900a2.453a0.778a1.821a
   p value0.0570.3950.0780.0960.3690.0140.4370.069
Reason for choosing Turkey
  Safe country15.60 (5.23)15.75 (5.55)15.87 (6.05)47.23 (15.30)2.81 (0.70)6.03 (1.27)3.11 (0.74)11.97 (1.42)
  Close country19.44 (6.79)18.58 (7.01)15.06 (9.00)53.10 (16.81)2.93 (0.75)4.65 (1.71)3.03 (0.98)10.62 (1.98)
  Muslim country16.74 (5.00)17.20 (5.41)16.18 (5.37)50.13 (12.99)3.20 (0.88)4.57 (1.49)3.27 (0.94)11.05 (2.1)
  Other16.61 (6.92)22.28 (5.86)19.14 (7.18)58.04 (14.00)2.52 (0.81)5.33 (1.95)3.66 (1.06)11.52 (1.73)
   p value0.005<0.0010.1200.0050.001<0.0010.020<0.001

Correlation Between Hopelessness and Perceived Social Support Levels

Beck Hopelessness ScaleMultidimensional Scale of Perceived Social Support
FamilyFriendSignificant OtherTotal
rp Valuerp Valuerp Valuerp Value
Feelings and expectations about the future0.0260.515−0.086*0.0350.0620.1240.0050.908
Loss of motivation−0.0600.138−0.225**<0.0010.0050.903−0.101*0.013
Hope0.0560.165−0.0200.6190.0130.742−0.0190.640
Total−0.0090.829−0.164**<0.0010.0310.441−0.0500.222

Regression Analysis of Sociodemographic Characteristics, Multidimensional Scale of Perceived Social Support (MSPSS) Scores, and Beck Hopelessness Scale (BHS) Scores (N = 609)

CharacteristicMSPSSBHS
Unstandardized CoefficientsStandardized CoefficientsUnstandardized CoefficientsStandardized Coefficients
BSEBetatp ValueBSEBetatp Value
(Constant)70.79426.3122.6910.0088.3442.5593.2610.001
Age0.5520.2390.3662.3090.023−0.0070.023−0.048−0.0070.759
Gender3.7354.1600.1230.8980.3710.0060.4050.0020.0150.988
Education level2.5922.5250.1211.0260.3070.0080.2460.0040.0310.975
Marriage age−0.9480.559−0.223−1.6960.0930.0980.0540.2361.8100.073
Number of children−0.8001.261−0.104−0.6350.527−0.1440.123−0.191−1.1740.243
Having a child in Turkey−4.45811.904−0.038−0.3740.7091.7681.1580.1531.5270.130
Reason for having a child−4.6852.048−0.208−2.2870.0240.5230.1990.2362.6270.010
Number of people living with0.3661.0340.0440.3540.7240.2500.1010.3072.4880.014
Duration of residence in Turkey2.2312.4630.0850.9060.3670.0200.2400.0080.0850.932
Working status in Turkey−4.6943.481−0.157−1.3480.1800.1800.3390.0610.5320.596
Working status in own country6.0034.1360.2001.4510.150−0.1920.402−0.065−0.4780.634
Reason for choosing Turkey1.3501.7810.0700.7580.450−0.0190.173−0.010−0.1110.912
Satisfied with being in Turkey−14.51011.978−0.123−1.2110.228−1.5031.165−0.130−1.2900.200
Desire to live in other country−4.8753.845−0.132−1.2680.208−0.6890.374−0.189−1.8430.068
RR2Fp ValueRR2Fp Value
0.4700.2212.1870.0130.4860.2362.3860.006
Authors

Dr. Yildirim is Research Assistant, and Dr. Aylaz is Professor, Department of Public Health Nursing, Faculty of Nursing, Inonu University, Malatya; Dr. Isik is Assistant Professor, Department of Public Health Nursing, KSÜ, Kahramanmara; and Dr. Firat is Family Physician, Provincial Directorate of Health, Malatya, Turkey.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

The authors thank the refugees who participated in the survey and the institution that allowed the research to be performed.

Address correspondence to Hilal Yildirim, PhD, RN, Research Assistant, Department of Public Health Nursing, Faculty of Nursing, Inonu University, Malatya, 44820, Turkey; email: firat.hilal@inonu.edu.tr.

Received: December 31, 2019
Accepted: March 25, 2020
Posted Online: May 11, 2020

10.3928/02793695-20200506-04

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