Factors associated with psychosocial distress among Rohingya refugees in Coxs Bazar, Bangladesh: a representative household survey

The protracted Rohingya refugee crisis continues to deteriorate with approximately 1.2 million refugees currently sheltering in Coxs Bazar, Bangladesh. This study aimed to estimate the prevalence and identify factors associated with psychosocial distress among Rohingya refugees. Data were sourced from the 2023 Joint Multi-Sectoral Needs Assessment - a representative cross-sectional household survey conducted across the 33 Rohingya refugee camps of Coxs Bazar. Households were selected using stratified (by camp) random sampling. Psychosocial distress was assessed via proxy report by an adult household respondent and defined as the presence of at least one of eleven symptoms in the two weeks preceding the survey. Binary logistic regression was conducted to investigate household characteristics and individual factors associated with psychosocial distress status. The prevalence of psychosocial distress was 14.9% (95%CI: 14.1%-15.7%) among 16,455 Rohingya refugees sampled from 3,400 households. After adjustment, psychosocial distress was associated with individuals from aid-dependent households (aOR= 1.42 [95%CI: 1.21-1.67]), stress livelihood coping strategies (aOR= 3.03 [95%CI: 1.94-4.74]), crisis livelihood coping strategies (aOR= 4.40 [95%CI: 2.81-6.89]), emergency livelihood coping strategies (aOR= 4.15 [95%CI: 2.58-6.66]), individuals who required and received healthcare (aOR= 1.27 [95%CI: 1.12-1.43]), individuals who required and did not receive healthcare (aOR=1.49 [95%CI: 1.16-1.91]), individuals aged 18-34 years (aOR= 8.38 [95%CI: 6.99-10.04]), aged 35-59 years (aOR= 10.33 [95%CI: 8.44-12.65]), and aged 60+ years (aOR= 13.31 [95%CI: 10.25-17.30]). Psychosocial distress among Rohingya refugees was highly prevalent and associated with increasing age groups, aid dependency, negative livelihood coping strategies, and healthcare needs. The findings emphasise the need for comprehensive mental health and psychosocial support services in protracted humanitarian emergencies. Additional validation studies may be required to measure both the prevalence and severity of psychosocial distress to better inform humanitarian programming.