JMIR Publications

ABSTRACT

Background:

The conflict in Syria has produced the largest forced displacement crisis since the second world war. As a result, Syrian asylum seekers and refugees have experienced various stressors across the migratory process including bombings, torture, bereavement, smugglers and unsafe means of transport, as well as immigration detention and a prolonged asylum process. Their experiences have put them at an increased risk of developing mental health issues including, crucially, suicidal ideation (SI). Despite the prevalence of SI among Syrian asylum seekers and refugees across Europe, there still remains various barriers to accessing treatment. A possible solution is the use of culturally adapted digital interventions which have already shown potential to increase access for other minorities in Western countries. In order to culturally adapt the intervention, further research is needed to better understand Syrian asylum seekers' and refugee's cultural conceptualisations, coping-strategies and help-seeking behaviour for SI in relation to their lived experiences with the migratory process. To do so, this study will employ a unique cultural adaptation framework that seeks to identify points of lived experience with the migratory process at which Syrian culture and signs of psychopathology converge. Likewise, co-design events will seek to identify points of experience with the intervention at which Syrian culture and the intervention's core mechanisms of change conflict. As the first cultural adaption of a digital suicidal ideation intervention for Syrian asylum seekers and refugees, this study will hopefully encourage further development of culturally sensitive interventions for the largest refugee population in the UK and the world.

Objective:

The first phase of the study will involve one-to-one semi-structured interviews: 1. To identify touchpoints, momements that make a difference in the experiences of Syrian asylum seekers and refugees in the UK across the three stages of migration, pre-, peri-, and post-migration. 2. To explore how they conceptualize, cope with and seek help for mental health and SI. 3. To identify cultural, linguistic and structural barriers and enablers for seeking help for mental health and suicidal ideation. 4. To understand their perceptions of digital mental health interventions. The second phase will include community panel discussions and co-design events: 5. To prioritize touchpoints and themes extracted from interviews with a community panel to adapt the intervention. 6. To conduct co-design events to collaboratively identify touchpoints to culturally adapt the intervention. 7. To prioritize touchpoints and themes from the co-design events with the community panel to adapt the intervention.

Methods:

The study will use experience-based co-design (EBCD), an action research method, to collaboratively culturally adapt a digital intervention to reduce SI for Syrian asylum seekers and refugees in the UK. This will involve conducting 20-30 interviews to understand their lived experiences with the migratory process; cultural conceptualizations of mental health and SI; coping-strategies; mental health help-seeking behaviour; and perceptions of digital mental health interventions. In addition, 3 co-design events with 6 participants in each will be held to collaboratively adapt the intervention. Touchpoints and themes extracted from each phase will be prioritized by a community panel before adapting the intervention.

Results:

The study began in November 2022 and will continue until the last co-design event in August 2023. The results of the study will then be published by December 2023.

Conclusions:

Access to treatment for some of the most severe mental health issues such as suicidal ideation is still limited for Syrian asylum seekers and refugees in the UK. Cultural adaptations of digital interventions developed for general populations have the potential to increase access to treatment for this population. Specifically, adapting the intervention for Syrian asylum seekers’ and refugees’ experiences with SI in relation to their lived experience with the migratory process may enable greater recruitment and adherence for users of different cultural and ethnic subgroups, and levels of SI.