The Impact of Social Marginalization on Mental Health in Middle Eastern Conflict Zones
DOI:
https://doi.org/10.57213/839st337Keywords:
Conflict Zones, Mental Health, Middle East, Psychosocial Trauma, Social MarginalizationAbstract
This systematic review aims to comprehensively evaluate the consequences of social marginalization on the mental health conditions of populations in Middle Eastern conflict zones, utilizing data from 2015 to 2024. Through a critical examination of 47 studies that met the inclusion criteria, a markedly high prevalence of mental disorders within this population was identified, namely post-traumatic stress disorder (PTSD) at 42.8% (95% CI = 38.4–47.2), major depression at 37.6% (95% CI = 33.2–42.0), and generalized anxiety disorder at 35.3% (95% CI = 31.1–39.5). Furthermore, the results of the meta-analysis revealed a very strong and statistically significant correlation between social marginalization and the severity of mental health disorders (r = 0.73, p < 0.001), indicating that the more intensely an individual experiences various forms of social marginalization, the more severe the psychological disorders they endure. Moreover, the three most dominant determinants of social marginalization were identified as limited access to healthcare services (OR = 3.82, 95% CI = 3.14–4.50), the persistence of systemic discrimination (OR = 3.45, 95% CI = 2.87–4.03), and widespread social isolation (OR = 3.21, 95% CI = 2.66–3.76). These findings not only expand upon the prior research outcomes of Al-Krenawi and Graham (2009) and Amsalem et al. (2025), which were confined to the aspect of PTSD but also provide new empirical evidence concerning a broader spectrum of mental disorders as well as specific patterns of social marginalization within the conflict landscape of the Middle East. Finally, this study contributes significantly to the academic literature by elaborating on the complex interactive mechanisms between practices of social marginalization and mental health deterioration while offering a framework for community-based interventions that are responsive and adaptive to the socio-political conditions characteristic of Middle Eastern conflict zones.
References
Abbasi, K. (2022). Understanding the Complexity of Conflict Trauma: A Systematic Review. South Asian Journal of Social Sciences & Humanities, 3(5).
Al-Awlaqi, S., Dureab, F., & Tambor, M. (2022). The National Health Cluster in Yemen: assessing the coordination of health response during humanitarian crises. Journal of International Humanitarian Action, 7(1), 9.
Al-Krenawi, A., & Graham, J. R. (2009). Cross-National Comparison of Middle Eastern University Students: Help-Seeking Behaviors, Attitudes Toward Helping Professionals, and Cultural Beliefs About Mental Health Problems. Journal of Contemporary Psychotherapy, 45(1), 26–36.
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392-407.
Altawil, A., El-Asam, A., & Khadaroo, A. (2023). Impact of chronic war trauma exposure on PTSD diagnosis from 2006–2021: A systematic review. Middle East Current Psychiatry, 30(1), 14.
Amsalem, D., Haim-Nachum, S., Lazarov, A., Levi-Belz, Y., Markowitz, J. C., Bergman, M., ... & Neria, Y. (2025). The effects of war-related experiences on mental health symptoms of individuals living in conflict zones: a longitudinal study. Scientific Reports, 15(1), 889.
Baingana, F. K., Bannon, I., & Thomas, R. (2005). Mental health and conflicts: Conceptual framework and approaches. Washington: World Bank.
Barrera Jr, M., Castro, F. G., Strycker, L. A., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: a progress report. Journal of Consulting and Clinical Psychology, 81(2), 196.
Bollwerk, M., Wetzel, E., Schlipphak, B., & Back, M. D. (2024). Who feels marginalized? A latent class analysis of perceived societal marginalization. Group Processes & Intergroup Relations, 27(3), 597-618.
Bürgin, D., Anagnostopoulos, D., Vitiello, B., Sukale, T., Schmid, M., & Fegert, J. M. (2022). Impact of war and forced displacement on children's mental health—multilevel, needs-oriented, and trauma-informed approaches. European Child & Adolescent Psychiatry, 31(6), 845-853.
Chikovani, I., Makhashvili, N., Gotsadze, G., Patel, V., McKee, M., Uchaneishvili, M., ... & Roberts, B. (2015). Health service utilization for mental, behavioural and emotional problems among conflict-affected population in Georgia: a cross-sectional study. PloS One, 10(4), e0122673.
Christensen, K. M. (2021). A Systematic Review and Meta-Analysis of the Effects of After-School Programs on Academic, Social, Behavioral, Mental Health, and Identity Outcomes Among Youth With Marginalized Identities (Doctoral dissertation, University of Massachusetts Boston).
Cleary, M., Horsfall, J., & Escott, P. (2014). Marginalization and associated concepts and processes in relation to mental health/illness. Issues in Mental Health Nursing, 35(3), 224–226.
Comoretto, A., Crichton, N., & Albery, I. (2015). Resilience in humanitarian aid workers: understanding processes of development. IIE Transactions on Occupational Ergonomics and Human Factors, 3(3-4), 197-209.
Debarre, A. (2022). Hard to reach: Providing healthcare in armed conflict. International Peace Institute.
Dumke, L., van der Haer, R., Koos, C., & Hecker, T. (2021). Patterns of conflict-related trauma exposure and their relation to psychopathology: a person-centered analysis in a population-based sample from eastern DRC. SSM-Mental Health, 1, 100005.
Fluit, S., Cortés-García, L., & von Soest, T. (2024). Social marginalization: A scoping review of 50 years of research. Humanities and Social Sciences Communications, 11(1), 1-9.
Giacaman, R., Rabaia, Y., Nguyen-Gillham, V., Batniji, R., Punamäki, R. L., & Summerfield, D. (2011). Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Global Public Health, 6(5), 547–559.
Hashemi, B., Ali, S., Awaad, R., Soudi, L., Housel, L., & Sosebee, S. J. (2017). Facilitating mental health screening of war-torn populations using mobile applications. Social Psychiatry and Psychiatric Epidemiology, 52, 27-33.
Hendrickx, M., Woodward, A., Fuhr, D. C., Sondorp, E., & Roberts, B. (2020). The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighboring countries: a systematic review. Journal of Public Health, 42(3), e299-e310.
Holmes, R. (2011). The role of social protection programmes in supporting education in conflict-affected situations. Prospects, 41, 223–236.
Hynie, M., Crooks, V. A., & Barragan, J. (2011). Immigrant and refugee social networks: determinants and consequences of social support among women newcomers to Canada. Canadian Journal of Nursing Research Archive, 26–47.
Jan, M. S., Hammad, M., Javeid, U., & Ajaz, M. H. (2024). The Interplay of Psychological Wellbeing, Social Support, and Resilience in Conflict Zones. Social Science Review Archives, 2(2), 1195-1211.
Jayawardana, J., Priyantha, R., Magni, M., & Marincioni, F. (2019). Disaster resilience among war-affected people resettled in Northern Sri Lanka: challenges revisited. International Journal of Disaster Risk Reduction, 34, 356-362.
Jordans, M. J., & Tol, W. A. (2013). Mental health in humanitarian settings: shifting focus to care systems. International Health, 5(1), 9-10.
Karadzhov, D. (2015). Assessing resilience in war-affected children and adolescents: A critical review. Journal of European Psychology Students, 6(3), 1-13.
Kohrt, B. A., & Kaiser, B. N. (2021). Measuring mental health in humanitarian crises: a practitioner's guide to validity. Conflict and Health, 15, 1-10.
Lobanov-Rostovsky, S., & Kiss, L. (2022). The mental health and wellbeing of internally displaced female Yazidis in the Kurdistan Region of Iraq: a realist review of psychosocial interventions and the impact of COVID-19. Global Mental Health, 9, 508-520.
Lordos, A., & Hyslop, D. (2021). The assessment of multisystemic resilience in conflict-affected populations. Multisystemic Resilience: Adaptation and Transformation in Contexts of Change, 417.
Martin, L. S., & Evans, D. P. (2015). Conflict as a social determinant of health. SM J Public Health Epidemiol, 1(2), 1008.
Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7-16.
Mowafi, H. (2011). Conflict, displacement and health in the Middle East. Global Public Health, 6(5), 472–487.
Naworska, W. (2024). Enduring trauma at a distance: A literature review of intergenerational trauma and community-based coping strategies among Palestinian youth in occupied Palestinian territories and its implications for sustainable peace.
Nguyen, A. J., Lasater, M. E., Lee, C., Mallawaarachchi, I. V., Joshua, K., Bassett, L., & Gelsdorf, K. (2023). Psychosocial support interventions in the context of forced displacement: A systematic review and meta-analysis. Journal of Migration and Health, 7, 100168.
Nguyen, T. P., Al Asaad, M., Sena, M., & Slewa-Younan, S. (2024). Loneliness and social isolation amongst refugees resettled in high-income countries: A systematic review. Social Science & Medicine, 117340.
Niederkrotenthaler, T., Mittendorfer-Rutz, E., Saboonchi, F., & Helgesson, M. (2020). The role of refugee status and mental disorders regarding subsequent labour market marginalisation: a register study from Sweden. Social Psychiatry and Psychiatric Epidemiology, 55, 697-704.
Noubani, A., Diaconu, K., Loffreda, G., & Saleh, S. (2021). Readiness to deliver person‐focused care in a fragile situation: the case of Mental Health Services in Lebanon. International Journal of Mental Health Systems, 15, 1-13.
Omiyefa, S. (2025). Global mental health policy innovations: investigating trauma-informed care, housing-first models, and refugee interventions. Int Res J Mod Eng Technol Sci, 7(3), 2582–5208.
Osman, O. T., Nasir, L., Mollica, R. F., Zoubeidi, T., Lavelle, J., & Amawi, N. (2017). Trauma-informed care survey of psychiatrists and primary care physicians in the Middle East. The Primary Care Companion for CNS Disorders, 19(5), 24931.
Østergaard, M. L. D., Aponte-Canencio, D. M., Barajas Ortiz, Y., Velez Botero, H. J., Simon Modvig, J., & Brasholt, M. (2023). Vulnerability factors in conflict-related mental health. Medicine, Conflict and Survival, 39(1), 63-80.
Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. Jama, 294(5), 602-612.
Roberts, B., & Fuhr, D. C. (2019). Scaling up mental health interventions in conflict zones. The Lancet Public Health, 4(10), e489-e490.
Roberts, B., Odong, V. N., Browne, J., Ocaka, K. F., Geissler, W., & Sondorp, E. (2009). An exploration of social determinants of health amongst internally displaced persons in northern Uganda. Conflict and Health, 3, 1-11.
Rozanov, V., Frančišković, T., Marinić, I., Macarenco, M. M., Letica-Crepulja, M., Mužinić, L., ... & Pagkalos, G. (2019). Mental health consequences of war conflicts. Advances in Psychiatry, 281-304.
Seidi, P., & Jaff, D. (2019). Mental health in conflict settings. The Lancet, 394(10216), 2237–2238.
Sierau, S., Schneider, E., Nesterko, Y., & Glaesmer, H. (2019). Alone, but protected? Effects of social support on mental health of unaccompanied refugee minors. European Child & Adolescent Psychiatry, 28, 769-780.
Somasundaram, D., & Sivayokan, S. (2013). Rebuilding community resilience in a post-war context: developing insight and recommendations-a qualitative study in Northern Sri Lanka. International Journal of Mental Health Systems, 7, 1-25.
Summerfield, D. (2000). War and mental health: a brief overview. BMJ, 321(7255), 232-235.
Taha, S. M. (2022). Literature Review of the Factors Influencing Access to Mental Health Treatment Services Among Adults in Conflict-Affected Areas in the Eastern Mediterranean Region.
Tol, W. A., Barbui, C., Galappatti, A., Silove, D., Betancourt, T. S., Souza, R., ... & Van Ommeren, M. (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. The Lancet, 378(9802), 1581–1591.
Torre, C. (2019). Psychosocial support (PSS) in war-affected countries: a literature review.
UNHCR. (2023). Global Trends Report 2023. United Nations High Commissioner for Refugees.
Uysal, B., Yanik, M., Tastekne, F., Tuzgen, E., Altinisik, E., & Acarturk, C. (2022). Psychological problems and resilience among Syrian adolescents exposed to war. European Journal of Trauma & Dissociation, 6(3), 100258.
Verhagen, I. L., Noom, M. J., Lindauer, R. J., Daams, J. G., & Hein, I. M. (2022). Mental health screening and assessment tools for forcibly displaced children: a systematic review. European Journal of Psychotraumatology, 13(2), 2126468.
Weine, S. M. (2011). Developing preventive mental health interventions for refugee families in resettlement. Family Process, 50(3), 410–430.
World Health Organization. (2023). Delivering effective and accountable mental health and psychosocial support (MHPSS) during emergencies and beyond.
World Health Organization. (2023). Mental health of refugees and migrants: risk and protective factors and access to care.
World Health Organization. Regional Office for the Eastern Mediterranean. (2008). Social determinants of health in countries in conflict: a perspective from the Eastern Mediterranean Region (Vol. 32). World Health Organization.
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