Psychological Distress and Social Support among Conflict Refugees in Urban, Semi-rural and Rural Settlements in Uganda: Burden and Mechanisms of Association

Abstract Background: Recent research shows that psychological distress is on the rise globally as a result of the COVID-19 pandemic and restrictions imposed on populations to manage it. We estimated the burden of psychological distress and scrutinized the role that social support may play in moderating psychological distress among conflict refugees in urban, semi-rural and rural settlements in Uganda during the COVID-19 pandemic.Methods: Cross-sectional survey data on psychological distress, social support, demographics, socio-economic and behavioral variables was gathered from 1014 adult refugees randomly sampled from urban, semi-rural and rural refugee settlementsin Uganda, using two-staged cluster sampling. Research instruments were checked for reliability using Cronbach’s Alpha. T-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression were applied to analyse the data in SPSS-version 22. Statistical significance was assumed at p<0.05.Results: Refugees resident in rural/semi-rural settlements exhibited higher levels of psychological distress, lower levels of social interaction and lower levels of social attachment than peers resident in urban settlements. However, they reported, on the other hand, higher adequacy of social interaction and higher adequacy of social attachment than peers resident in urban settlements. Adequacy of social interaction and attachment were directly associated with psychological distress and acted as stress buffers in the relationship between psychological distress and rural/urban settlement. Conclusions: There is a settlement-inequality (i.e. rural vs. urban) in psychological distress and social support among conflict refugees in Uganda. Both the direct and buffering effects of adequacy of social interaction and attachment can explain the rural/urban discrepancy in psychological distress, with important implications for Mental Health and Psychosocial Support (MHPSS) interventions.