Online surveys were distributed in multiple groups, covering Syrians from different countries. Only Syrians were included, either living in Syria or had lived in Syria, but had to travel due to war regardless of the method and Visa status. No participants living in camps were included. This study was conducted in the period between 06/04/2020 to 13/04/2019. The questionnaires were posted online multiple times throughout the previous period at different times in online groups that were concerned with different topics. For each participant living outside Syria, a matching case was chosen randomly from participants who responded to the questionnaires. We only matched for age and gender as other variables will vary between countries such as the salary and SES. Scores were used rather than cut-off points in their study to add to the accuracy as it was an online-based survey not conducted by professionals or in a controlled centre.
2) Consent and approval for study:
Informed consent was taken before doing the survey. The informed consent was also taken for using and publishing the data. Confidentiality was assured by not asking or publishing any data that may referee to the individual identity. Our study did not include any participant under the age of 16 years.
Our study ethical aspect was approved by the Damascus University deanship in Damascus, Syria.
The Screen for Posttraumatic Stress Symptoms (SPTSS) tool was used for PTSD assessment. It is a screening tool based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV. This tool contains avoidance, arousal, and re-experience clusters with five answers. The first two responses of “Not at all” and “1 or 2 times” had a score of 0 while the other responses had the score 1. It was considered positive when scoring for avoidance 3 or more, for arousal 2 or more, and for re-experience 1 or more. Although SPTSS was based on DSM-IV, not DSM-V which is the current version, it can be reliable, particularly it has a resemblance to the International Classification of Disease 11 (ICD-11) criteria.
- Socioeconomic status (SES):
It was assessed based on owning the house they live in, or it was rented, or living in friends’ houses or it was given by the government. Due to differences between countries, monthly income was assessed based on being adequate for needs rather than numbers.
Multidimensional Scale of Perceived Social Support (MSPSS) (6, 7) was used. It is a self-reported scale to assess social support. MSPSS has 12 questions with each four questions assessing support from friends, significant other, or family.
- Screening for mental disorder:
Arabic Kessler 10 was used for psychological distress (8-10), which is a self-reported measure that has ten questions for anxiety and depression assessment in the previous four weeks. For the final scores, it ranges from 10 to 50.
We used translated questions from The CoRonavIruS Health Impact Survey (CRISIS) V0.1 Adult Self-Report Baseline Form (11) and are demonstrated in (Table 2).
Basic demographic questions were included (Table 1).
IT work category involved any work that depended on computer science, IT, or communication engineering that required programming. The engineering work category involved civil, electrical, and mechanical engineering in addition to architecture. The retail worker was the type of job that required selling customer products, either in stores, online, or in person. Medical engineering was considered in “other health workers” category. Working in television, radio, show business, or journalism was categorised into “media” work type. “Office” work category involved working in a company office, or a private practice such as accounting and law. “Art and music” category involved working as a photographer, musician, painter, or designer except for a web designer.
Nearby countries category involved countries that surround Syria which are Lebanon, Jordan, Turkey, Iraq, and Iran.
4) Data Process:
Data were processed using IBM SPSS software version 26 for Windows (SPSS Inc, IL, USA). Chi-square, one-way analysis of variance (ANOVA), Binary regression, and independent t-tests were performed to determine statistical significance between the groups. Pearson correlation was also calculated. Values of less than 0.05 for the two-tailed P values were considered statistically significant.