Beyond depressive symptoms: conceptualizing social suffering among displaced Syrians in Lebanon

Mental burden is largely conceptualized through mental illness, yet it can manifest beyond diagnostic categories. We contend that social suffering requires separate consideration, as it frames mental burden through intersubjective, collective, and power dynamics, while centering its inextricable link to social and political injustice. Lebanon offers a relevant setting, hosting Syrian refugees amid economic crisis and intermittent armed conflict.

We assess social suffering with the novel feeling broken or destroyed scale (FBD) and compare it with a standard mental health screening instrument for depressive symptoms, namely the patient health questionnaire (PHQ). We contend that both these complementary notions of social suffering and depressive symptoms measure separate, though related, aspects of mental burden and warrant attention.

Using data from the TRANSMIT survey collected among Syrians (N = 1,228) in Lebanon (Oct-Dec 2023), we conducted a regression analysis comparing the predictors FBD and PHQ and explored each construct's sensitivity for the broader socio-political context. Conceptually overlapping items (hope for Syria/Lebanon's future) were excluded from the regression and tested via one-way ANOVA.

Though used for the first time within the Lebanese context and among a displaced sample, the FBD showed good internal consistency (Cronbach's Alpha = 0.822; Omega = 0.838). PHQ and FBD demonstrated moderate positive correlations in our sample (ρ = 0.56, all p < 0.001), indicating that they are sufficiently distinct. Regression analysis indicates that the FBD may be more sensitive to some socio-political factors, such as poverty, poor neighborhood quality, and experiences of discrimination, reflecting more enduring forms of mental burden, including apathy and exhaustion. In contrast, harsh working conditions characteristic of day laborers as well as residence in an area of active armed conflict may foreground acute, somatic and discrete symptoms, such as sleep disturbance or appetite changes, detected by PHQ.

Reframing mental burden among displaced Syrians in Lebanon through the lens of social suffering rather than mental illness can help capture the effects of structural vulnerabilization. This encompasses the cumulative impact of material deprivation, social exclusion, and marginalization, while pointing to resistance as a response to these conditions.