Somatic distress among Syrian refugees in Istanbul, Turkey: a cross-sectional study

Abstract

Background: Syrian refugees have experienced extensive trauma and ongoing post-displacement challenges, placing them at increased risk of both psychological and physical health problems. While depression, anxiety, and post-traumatic stress disorder (PTSD) have been widely investigated, somatic distress has received comparatively little attention, particularly among Syrian refugees living in Turkey.

Objective: This study aimed to determine the prevalence and patterns of somatic distress among Syrian refugees residing in Istanbul and to examine its associations with sociodemographic characteristics, post-displacement stressors, and common mental disorders.

Methods: A cross-sectional survey was conducted with 1,678 adult Syrian refugees registered for temporary protection in the Sultanbeyli district of Istanbul. Somatic distress was assessed using the Patient Health Questionnaire-15 (PHQ-15), while depression, anxiety, and PTSD symptoms were measured using the Hopkins Symptom Checklist-25 (HSCL-25) and the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics, correlation analyses, and multivariable logistic regression models were used to identify factors associated with somatic distress.

Results: High somatic distress was reported by 41.7% of participants, with moderate-to-severe symptom severity observed in a substantial proportion of the sample. The most frequently reported symptoms included pain in the arms, legs or joints, back pain, and headaches. Somatic distress was significantly more common among women and was strongly associated with symptoms of depression, anxiety, and PTSD. Greater somatic symptom severity was also associated with chronic illness or disability, lower educational attainment, poorer household economic conditions, and having a family member with mental health problems. In contrast, post-displacement perceived needs and previous mental health treatment were not independently associated with somatic distress after adjustment.

Conclusions: Somatic distress represents a major health burden among Syrian refugees living in Istanbul and is closely linked to common mental disorders and socioeconomic vulnerability. These findings highlight the importance of integrating mental health and primary healthcare services to improve early recognition, assessment, and treatment of somatic symptoms in refugee populations, ultimately reducing both individual suffering and pressure on healthcare systems.