Date of Award

January 2020

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Kaveh Khoshnood

Second Advisor

Elizabeth Claus


Nearly 700,000 Syrian refugees currently reside in Jordan. Chronic disease and depression are primary contributors to morbidity among displaced and local populations. To provide evidence for appropriate mental health intervention planning, we conducted a cross-sectional mixed methods study to investigate the burden and determinants of depression among female Syrian refugees and Jordanians with chronic disease. A total of 272 female Syrian refugees and Jordanians of child-bearing age with chronic disease were recruited from clinics across Amman, Jordan from June to August 2017. Through questionnaires, we compared demographic and health characteristics by nationality and depression level and identified predictors of depression via multivariable ordinal regression. We also conducted interviews with 40 participants to better understand the bidirectional relationship between chronic illness and comorbid depression. Moderate to high levels of depression were reported in 55.9% of the total study population, with a prevalence of 41.1% and 70.6% among Jordanians and Syrians, respectively. Syrians had 2.73 times the odds of higher levels of depression than their Jordanian peers without controlling for other variables. After adjusting for age, income, spouse employment status, gastrointestinal or genitourinary disorder status, and perceived self-efficacy, we found that Syrians were not at significantly greater odds of reporting higher levels of depression than Jordanians. Through interviews, most Syrian women endorsed a relationship between their chronic disease and depression. Some women felt too depressed to take medication for their chronic conditions, while others felt their depression contributed to chronic illnesses. Syrian women reported less perceived social support than Jordanian women. This study highlights the importance of screening and providing necessary treatment for depression and chronic conditions. Mental health interventions and chronic disease management tailored to differences among local and displaced communities may reduce disease burden and disability.


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