"I Go up to the Edge of the Valley, and I Talk to God": Using Mixed Methods to Understand the Relationship between Gender-Based Violence and Mental Health among Lebanese and Syrian Refugee Women Engaged in Psychosocial Programming

Lebanon's intersecting economic and political crises exacerbate complex public health issues among both host and refugee populations. This mixed-methods study by a Lebanese service provider, in partnership with an international research institute, seeks to better understand how experiences of gender-based violence (GBV) and mental health intersect in the lives of Syrian and Lebanese women, and how to better meet these needs. It employs a randomized cross-sectional survey of 969 Abaad service users and focus groups with community members and service providers. There were significant associations between GBV and ill mental health; notably, respondents reporting transactional sex had 4 times the likelihood of severe distress (aOR 4.2; 95% CI 1.2-14.8; p ≤ 0.05). Focus groups emphasized less-visible forms of violence, such as emotional violence, and the importance of environmental factors in one's ability to cope, noting "it always came back to the economy". Recommendations include providing a more holistic and coordinated approach between GBV, mental health, livelihood, and basic assistance sectors; and sensitive, accessible, and higher-quality mental health services informed by GBV response actors' experience putting in place survivor-centered programming and made available to both host and refugee community members.