BACKGROUND Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. METHODS A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees' community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. RESULTS Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. CONCLUSION Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.

中文翻译：

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基于社区的系统动力学方法，用于了解影响黎巴嫩贝鲁特和贝卡地区的心理健康和寻求健康行为的因素。

背景技术关于黎巴嫩心理健康和社会心理问题的现有证据有限。最近的定量数据表明，叙利亚难民及其黎巴嫩收容社区中的患病率很高，两个人群的治疗差距都很大。这项研究旨在确定黎巴嫩收容和叙利亚难民社区如何看待心理健康，并在两种脆弱的对比情况下确定寻求健康的行为和获得健康的障碍。方法采用了比较定性研究设计，对黎巴嫩东道国和叙利亚难民社区成员进行了36次半结构化访谈，随后进行了四次参与式团体模型构建（GMB）会议。参与者是从两个相对脆弱的环境中招募的：贝鲁特和贝卡地区。在这些会议期间，得出因果关系图，描绘对促使精神健康和社会心理问题发作的因素的共同理解；还确定了影响健康改善和维持率的寻求健康的行为，途径和要素。结果在这两种情况下，社区成员对有助于心理健康的因素的看法相似。参加者将遭受战争的长期影响，冲突的政治和社会影响以及家庭层面的经济困难列为促使精神健康和心理压力源发作的诱发因素。社区之间与性别和融合相关的挑战被确定为影响病情发作和相关护理寻求的因素。寻求健康的途径被信任所塑造，亲人的建议和支持，以及确保受影响个人的机密性的需要。讨论中反复出现的主题突出表明了获得医疗保健的主要障碍，包括从正规医疗系统寻求医疗服务的重大延迟，广泛的社会污名，难以承受的服务费用，缺乏医疗覆盖，对精神卫生服务可用性的认识有限以及对医疗质量的信任有限。服务可用。结论心理健康和社会心理支持策略需要对性别和融合敏感，主要侧重于疾病预防和意识提高，以加强寻求健康的行为。讨论中反复出现的主题突出表明了获得医疗保健的主要障碍，包括从正规医疗系统寻求医疗服务的重大延迟，广泛的社会污名，难以承受的服务费用，缺乏医疗覆盖，对精神卫生服务可用性的认识有限以及对医疗质量的信任有限。服务可用。结论心理健康和社会心理支持策略需要对性别和融合敏感，主要侧重于疾病预防和意识提高，以加强寻求健康的行为。讨论中反复出现的主题突出表明了获得医疗保健的主要障碍，包括从正规医疗系统寻求医疗服务的重大延迟，广泛的社会污名，难以承受的服务费用，缺乏医疗覆盖，对精神卫生服务可用性的认识有限以及对医疗质量的信任有限。服务可用。结论心理健康和社会心理支持策略需要对性别和融合敏感，主要侧重于疾病预防和意识提高，以加强寻求健康的行为。