Prevalence patterns and associated factors of psychological distress among Syrian refugees in middle eastern host countries: a scoping review.

Since 2011, the Syrian conflict has generated one of the largest displacement crises globally, with most Syrian refugees hosted in neighboring Middle Eastern countries. These host settings differ substantially in legal, social, settlement, and service conditions, which shapes both refugee experiences and the interpretation of mental health evidence. Protracted displacement, cumulative trauma, and post- migration adversity have contributed to a substantial burden of psychological distress, yet distress may be expressed not only through post-traumatic stress, depression, and anxiety symptoms, but also through culturally embedded experiences such as somatic complaints, grief, family disruption, role loss, stigma, uncertainty, and reduced dignity. This scoping review mapped prevalence patterns of psychological distress and associated risk and protective factors among Syrian refugees residing in Middle Eastern host countries, including Jordan, Lebanon, Turkey, Iraq, and Egypt. Following the Arksey and O'Malley framework and reported in accordance with PRISMA ScR, we searched PubMed, Web of Science Core Collection, and Scopus for peer-reviewed English language studies published between 2011 and 2025, with searches last updated in December 2025. Records were screened at title and abstract and full text stages using predefined criteria. Screening and data extraction were conducted by a single reviewer using standardized forms, with decisions and extracted data reviewed and discussed with a second author to enhance consistency. Eighteen studies met inclusion criteria, most conducted in Jordan, Lebanon, and Turkey, with fewer in Iraq and Egypt. Psychological distress was consistently substantial, most commonly reflected in elevated post-traumatic stress, depressive, and anxiety symptoms, while reported prevalence patterns varied widely by host country context, living setting, subgroup, sampling frame, and instruments or cut offs. Distress was repeatedly associated with trauma exposure and post-migration living difficulties, including economic hardship, legal insecurity, and daily stressors, whereas social connectedness and perceived support emerged as protective correlates. Findings highlight the need for scalable, culturally responsive psychosocial interventions and service models that reduce structural barriers to access, address stigma, and account for culturally embedded expressions of distress in protracted displacement settings. Systematic review registration: https://osf.io/vmju8/overview.