Posttraumatic stress and depression among traumatized, treatment-seeking, Arabic-speaking refugees and non-refugees in Southwest Asia and North Africa (SWANA)

Background Countries in Southwest Asia and North Africa (SWANA) have been particularly affected by numerous conflicts for the last few decades, a development which has had an influence on the mental health of both refugee and non-refugee populations. Simultaneously, there is comparably less provision of and access to mental health services in SWANA. Given these circumstances, the present study implements a cross-country comparative design to investigate the mental health of treatment-seeking individuals in the region and compare the mental health of refugees and non-refugees. Methods Treatment-seeking refugees and non-refugees originating from and residing in the SWANA region were examined regarding post-traumatic stress disorder (PTSD; PCL-5) and depression (PHQ-9). Participants were recruited from an open-label dissemination study between 2021 and 2025 ( N = 19,198; n (refugees) = 888; n (non-refugees) = 18,310). A refugee ( n = 888) and a non-refugee subsample ( n = 888) were created using propensity score matching for comparability (i.e., using gender, education status, employment status, type of residence, family status, and country of origin and residence as matching variables). Prevalence rates were compared between groups, and moderation models were computed to assess the differential impact of protective and risk factors on the mental health of the two groups. Results Significant differences were found for PTSD (refugees: 84%; non-refugees: 78%) and depression prevalence (refugees: 77%; non-refugees: 70%), with further above-chance differences regarding the number of traumatic event types (refugees: 7.35; non-refugees: 4.77). Linear regression models indicated that social support and trauma load were associated with symptom load across groups and outcomes but did not differentiate between groups. Having previously been in psychological or psychiatric treatment was associated with higher depression symptom load for refugees only. Conclusion The PTSD prevalence rate was higher for treatment-seeking refugees across the SWANA region, emphasizing the heightened vulnerability of this population even relative to a traumatized, treatment-seeking non-refugee comparison group. Moreover, an association of previous treatment was found for refugees, potentially indicating a threshold mechanism by which refugees with comparably higher depressive symptom load are more likely to receive treatment. The results underline the need for increased access to mental health care services for both groups across SWANA.