The Moderating Role of Perceived Social Support in the Relationship between the Impact of Events and Post-Traumatic Growth among Syrian Refugees

Abstract

The internal disturbances that have occurred in Syria since 2011 have led to the displacement of many Syrians and their exposure to stressful life events. In this context, this study aimed to examine the amplifying dimension of suffering experienced by Syrian refugees in terms of various variables. Within this scope, the moderating role of perceived social support on the impact of events on post-traumatic growth among Syrian refugees was investigated. This descriptive study, designed according to the relational survey model, was conducted on 448 Syrian refugees in Turkey, who were included using a random sampling method. The data collection tools in this study included the Impact of Events Scale, the Multidimensional Scale of Perceived Social Support, and the Post-traumatic Growth Scale. According to the analysis of the results, it was found that in Syrian refugees, the impact of events on post-traumatic growth is significantly moderated by family support, support from friends, and support from a significant other. Additionally, it was observed that the event impact variable has a positive and significant effect on the post-traumatic growth among Syrian refugees.

1. Introduction

The internal disturbances that erupted in Syria in 2011 have subjected Syrian refugees to challenging experiences due to conflicts and war. Syrian refugees have retained the distinction of being the largest displaced population group due to a single conflict in the past 40 years [1,2]. The chaotic situation in the country has led to the displacement of nearly half of Syria’s population, which had a population of 22 million before the onset of the war in 2011 [3]. Additionally, the internal turmoil, conflict, and war have resulted in the tragic loss of many refugees’ lives. Although the exact number of undocumented deaths is believed to be much higher [4], it can be stated that over half a million Syrians have lost their lives due to the Syrian war, according to various sources [5,6]. For Syrian refugees who managed to escape from the war and survive, their migration journey is filled with as much suffering as the war itself. Indeed, in order to sustain their lives, Syrian refugees have collectively diverted their routes to safe countries, and Turkey has been one of the first countries they sought refuge in [7,8,9]. Turkey hosts approximately 3.7 million Syrian refugees who were forced to leave their countries due to the Syrian war [2,10]. Moreover, Syrians have become the largest ethnic group within Turkey and are dispersed across almost every province in the country [10].

Syrian refugees have been forced to embark on an uncertain journey, leaving behind their homes, professions, economic assets, social roles, relatives, and friends, in order to survive [11,12]. Moreover, it is widely recognized that a considerable number of Syrian refugees have directly experienced war and conflict [13]. The documents show that a significant portion of them have witnessed the death or injury of their loved ones before migration, or have personally experienced injury themselves [14,15,16]. These experiences are known to have inflicted profound damage on Syrian refugees. Indeed, despite the association of all these traumatic experiences with pre-migration experiences, their effects are observed to persist with the refugee individual during migration and post-migration periods [15,17].

In the arduous journey of Syrian refugees, they encounter a myriad of challenges, including inadequate healthcare, limited access to nutrition, loss of family members or loved ones during transit, and exposure to violence, torture, and incarceration [18,19,20,21]. These experiences entail profound psychological and physiological trauma for refugees [22]. Overcoming the enduring impact of these experiences, both prior to and following migration, poses significant difficulties. The plight of Syrian refugees extends beyond survival; upon seeking refuge in safe havens, they encounter a myriad of uncertainties. The ambiguity surrounding their ability to return home, precipitated by events such as war, fosters a profound sense of uncertainty regarding their future [23]. Despite the dissolution of familiar comforts, established societal structures, and accustomed ways of life, Syrian refugees are expected to acclimate to the norms and conditions of their host countries [24,25]. Given the cultural disparities, adapting to this new environment proves challenging. Additionally, accessing fundamental necessities such as security, shelter, healthcare, and education presents formidable obstacles for Syrian refugees [26,27]. Economic anxieties, stemming from resource limitations, exacerbate the challenges faced by refugees, permeating various facets of their lives. Concurrently, Syrian refugees may encounter marginalization, hostility, and ostracization from host communities [28]. In light of these circumstances, it becomes evident that the trials faced by refugees persist not only during pre-migration and migration phases but also post-migration.

Regardless of the stage of the migration process, Syrian refugees who have been displaced and forced to migrate due to reasons such as war are acknowledged to be exposed to numerous traumatic experiences [29,30]. However, it is observed that Syrian refugees have significantly low rates of seeking psychological help. Among the reasons for this are concerns about stigma, fear of deportation, perceived high risk of disclosure, and psychological and cultural differences [14,31]. Another significant factor, alongside these factors, is the dysfunctional nature of social support mechanisms among Syrian refugees. One of the most influential factors in this regard is cultural differences. Unlike Western cultures, where individualism ranks high, Eastern cultures exhibit a collective perspective due to the active communal lifestyle [32,33,34]. Although the phenomenon of migration necessitates adaptation to a new environment, it should be remembered that refugee individuals carry their cultures along with them. Especially when exposed to severe stressors, such as war, refugees tightly hold onto their cultures [35]. In this context, social support can reach both positive and negative dimensions. For instance, obtaining social support from family members who fled from the war together may exacerbate the negative impact of social support, as they have experienced the same traumatic situations. Moreover, it can overshadow Syrian refugees’ access to mental health services [36].

Syrian refugees, who belong to a collective culture, often seek solutions to the problems arising from severe traumatic situations such as war within their own communities. Their cultural structures may lead to the perception that certain psychological symptoms are not problematic and, consequently, to their neglect. However, despite the well-known effectiveness of social support in overcoming psychological conditions such as anxiety and depression [37], the provision of social support by individuals who have experienced the same traumatic experiences can negatively impact the benefits derived from social support. Considering the communal and insular lifestyles of Syrian refugees, it is believed that they may experience harm rather than benefit from their social support networks.

Despite the passage of 12 years since the onset of the Syrian war and the fact that Syrian refugees have somehow managed to sustain their lives in the countries they migrated to, it is known that they have managed to cling onto life and overcome certain situations. This brings the concept of post-traumatic growth to mind. Post-traumatic growth is highly significant for Syrian refugees known to have been exposed to situations such as war, death, and injury and can be influenced by various circumstances [38]. It is stated that the level of traumatic experiences affects post-traumatic growth [39,40,41,42]. Studies conducted on Syrian refugees support this situation. In studies conducted by Acar et al. [43] and Kheirallah et al. [44], it is observed that PTSD positively affects PTG. One of the main reasons for this may be having to make new beginnings after traumatic experiences. In particular, forced displacement can be an incentive for refugees to make new beginnings [45]. In addition, individuals exposed to traumatic situations may have the opportunity to think more deeply about the event and make sense of it. This can make them see new dimensions that they were not aware of before [46]. In other words, traumatic events may be at the center of the post-traumatic growth experienced by Syrian refugees as they discover new strengths [47]. Similar findings have also been obtained in Somali [48], Burmese [49], and Liberian [50] refugees. Nevertheless, the complex relationship between PTSD and PTG should not be forgotten because it is also possible to see studies that found a negative relationship between PTSD and PTG in refugees [51]. For example, the study conducted by Kurt et al. indicates a negative relationship between PTSD and PTG among Syrian refugees [52]. The reasons for this may include latent factors, such as coping skills, personality traits, and the severity and nature of the traumatic situation. In addition, the perception of social support also has an important role [53]. In this respect, the relationship between PTSD and PTG in Syrian refugees constitutes the basic structure of this study and it is an issue that needs to be investigated in more detail on Syrians.

In addition, the perceived level of social support can influence both the levels of stressful life events experienced [36,54,55] and post-traumatic growth [44,56]. For example, social support is known to alleviate traumatic symptoms and facilitate post-traumatic growth in refugees [53,57]. However, traumatic situations, such as being subjected to torture, which are common among Syrian refugees, can reduce the strength of this positive effect. For example, in a study conducted on the Syrian refugees in Sweden, it was observed that although high social support alleviated the PTSD symptoms, this effect was significantly reduced in cases of exposure to torture [58]. In addition, it is thought that the provision of social support by Syrian refugees with a similar traumatic history may influence the differential effects of social support on PTSD and PTG [59,60]. In order to understand the direction of these effects, it is necessary to consider social support in detail, as the source of social support and whether it is functional or not are very important factors ignored in many studies. In this context, it is necessary to look at the effects of the sub-dimensions of social support, such as family support, support from friends, and support from a special person on this relationship.

It is widely accepted that social support is usually provided by family, friends, and a special person. Family support is the most preferred type of social support among Syrian refugees [36,61]. Establishing profound connections with others, particularly understanding the predictive factors of post-traumatic growth, holds significant importance. It is known that individuals seek social support within networks that resonate with their identities, aiming to overcome traumatic situations and achieve post-traumatic growth [46,62]. In this regard, family support occupies a crucial position in enabling individuals to express their traumatic experiences more comfortably and exhibit more adaptive behaviors [63]. Stated differently, the functionality of relationships established by individuals with others can be a primary determinant of post-traumatic growth. However, dysfunctional family support can negatively impact individuals’ post-traumatic growth [64]. The reasons for this are that Syrian refugees migrate with their families, they have strong cultural characteristics related to family ties, and they do not trust other people [59,65]. Therefore, family members may influence each other in exacerbating traumatic symptoms and post-traumatic growth [46,66]. As for the support of friends, it offers Syrian refugees opportunities to establish a new order, find a job, feel safe and adapt [67,68]. Support from friends occupies a crucial position in facilitating Syrian refugees’ access to social support networks. Studies underscore that support from friends serves as a conduit for Syrian refugees in accessing novel opportunities and resources [65,69]. Having endured various traumatic wounds from the Syrian conflict and seeking refuge in new territories, Syrians are compelled to rebuild their lives and establish a semblance of order to navigate their survival [68]. This quest for stability encompasses multifaceted dimensions, including, but not limited to, access to healthcare information, housing provisions, future projections, employment avenues, and the fulfilment of social needs [67,70,71,72]. Given the prevalent sense of insecurity and apprehensions about social stigmatization among Syrian refugees, the imperative for dependable support networks to address these exigencies is evident [28,73,74]. These networks predominantly comprise fellow Syrian refugees who have traversed similar trajectories of flight from the conflict and triumphed over its adversities. This substantiates the notion that Syrian refugees predominantly draw support from compatriot friends who share analogous experiential journeys beyond familial realms [75]. Research illustrates that Syrian refugees derive benefits from friendship support networks in accessing healthcare services, securing employment, and addressing housing exigencies [72]. It is recognized that Syrian refugees often gravitate towards seeking medical attention at facilities where they feel secure and where their friends also go. Similarly, they tend to seek employment in sectors where their friends are employed and reside in vicinities where their friends live, emblematic of such patterns [76,77]. Although all of these can have a positive impact on the alleviation of PTSD and the realization of PTG, they can also overshadow the personal strengths of individuals [65,69,78]. Finally, a special type of human support consists of support networks outside of family and friends. Support from a significant other, beyond the fundamental support provided by family and friends, encompasses individuals from social networks, such as romantic partners, supervisors, neighbors, employers, or healthcare providers [53,79]. This term denotes individuals whom individuals prioritize in their lives apart from indispensable family and friends. Prioritizing significant others before family and friends in meeting one’s social support needs may overshadow family and support from friends [80,81,82]. Focusing too much on a support from a significant other can diminish the therapeutic effect of the main sources of support: family and friends [80,83]. Syrian refugees’ resentment towards their families and friends may affect their perceptions of social support [84,85,86,87]. This can cause them to feel traumatic symptoms more severely, preventing them from fully benefiting from social support [79,88].

All these reveal the multifaceted and complex structure of social support and its impact on the relationship between PTSD and PTG in Syrian refugees arouses curiosity. This research was conducted to satisfy this curiosity and to express the function of social support in a more comprehensive way. When all these factors are associated with the experiences Syrian refugees go through, a detailed picture is revealed. Indeed, the effects of stressful life events, expressed through traumatic experiences, bring post-traumatic growth to mind over a span of 12 years. Especially considering that Syrian refugees, who possess collective cultural values, continue their lives collectively, the dimensions of the perceived social support during this process emerge as a topic that needs to be researched. In this context, the moderating effect of perceived social support on the relationship between the stressful life events experienced by Syrian refugees and their post-traumatic growth emerges as a complex issue that needs to be illuminated, with all its sub-dynamics. The model created to test this relationship is shown below (Figure 1).

The pathway denoted by H₉ in Figure 1 illustrates the straightforward relationship between the impact of stressful life events and post-traumatic growth. Additionally, pathway H₁₀ delineates the moderating role of family support in the relationship between the impact of events and post-traumatic growth, pathway H₁₁ portrays the moderating role of support from friends, while pathway H₁₂ illustrates the moderating role of support from significant others in the relationship between the impact of events and post-traumatic growth.

2. Materials and Methods

2.1. Research Model

This study is a descriptive research endeavor aimed at examining the moderating role of perceived social support in the relationship between the impact of events and post-traumatic growth among the Syrian refugees in Turkey. The research design follows a correlational survey model. Data were collected from Syrian refugees residing in Turkey, focusing on variables such as post-traumatic stress disorder, perceived social support, and post-traumatic growth. This study specifically delves into the moderating role of various sub-factors of perceived social support, including family support, support from friends, and support from a significant other.

2.2. Participants

This study focuses on Syrian refugees aged 18 and above who migrated to Turkey due to the Syrian civil war in 2011, constituting the population [10]. To ensure impartiality in the sampling process, data were collected using a random sampling method from the Syrian refugees residing in Turkey. The sample primarily comprises individuals from Samsun province and neighboring regions. A total of 461 Syrian refugees aged between 18 and 70 were initially included in this study. During preliminary data evaluation, 13 incomplete or erroneous forms were excluded, resulting in the analysis being conducted on data from 448 participants, including 138 females and 310 males. Before the analysis, missing values in the dataset were checked, and no missing values were found. Subsequently, single and multiple outliers were examined. Z-score values were computed for each scale, and no single outliers were identified based on a threshold value of 3.29. Multiple outliers were assessed using Mahalanobis distances, revealing 41 observations with multiple outliers, at a significance level of 0.1%. These outliers were excluded, leaving 407 observations for analysis. This ensured the adequacy of the sample size for analysis purposes [89]. Demographic variables pertaining to the sample are detailed in the table of demographic variables provided below

Table 1. Demographic variables.

Demographic Variables		n	%
Gender	Female	120	29.5
	Male	287	70.5
Age	18–30 years	266	65.4
	31–40 years	68	16.7
	41 years and above	73	17.9
Marital Status	Married	165	40.5
	Single/Widowed	242	59.5
Education Level	Elementary school and below	66	16.2
	Middle school	69	17.0
	High school	204	50.1
	University and above	68	16.7
Income Level	0–2000 TL	190	46.7
	2001–4000 TL	91	22.4
	4001–6000 TL	63	15.5
	6001 TL ve üzeri	63	15.5
Duration of Stay in Turkey	1–6 years	61	15.0
	7–9 years	104	25.5
	10 years and above	242	59.5
Employment Status	Yes	296	72.7
	No	111	27.3

Sample size n = 407.

.

2.3. Data Collection Tools

Impact of Event Scale-Revised (IES-R). The Impact of Event Scale-Revised (IES-R), developed by Weiss and Marmar [90], was adapted for Syrian refugees by Grassi et al. [91], who translated it into Syrian Arabic. The Revised Impact of Event Scale (IES-R) is commonly utilized as a self-report instrument to evaluate symptoms of post-traumatic stress disorder (PTSD). It has been affirmed that the IES-R is applicable for the Syrian refugees fleeing war-related violence [91]. Consisting of 22 items, the IES-R employs a 5-point Likert scale. Respondents are prompted to rate the severity of symptoms experienced in the preceding 7 days on a scale ranging from 0 to 4. Elevated scores on the IES-R denote a heightened level of PTSD symptoms in respondents. The internal consistency reliability coefficients, as measured by Cronbach’s alpha, were calculated as 0.81 for re-experience, 0.80 for avoidance, 0.80 for hyperarousal, 0.74 for sleep problems, and 0.92 for the total score. The Confirmatory Factor Analysis (CFA) findings on the dataset from this study indicated that all 22 items in the measurement instrument were statistically significant at the 0.001 level. The factor model demonstrated acceptable and superior fit indices (x²(54) = 370.728***[0.000], GFI = 0.926, IFI = 0.951, TLI = 0.942, CFI = 0.950, x²/SD = 1.863, AGFI = 0.907, NFI = 0.897, RMSEA = 0.045, RMR = 0.053). This suggests that the scale items significantly and adequately contribute to the scale’s measurement precision. Consequently, it can be inferred that the Impact of Event Scale is an exceptionally reliable measurement instrument.

Multidimensional Scale of Perceived Social Support (MSPSS). The Multidimensional Scale of Perceived Social Support (MSPSS), developed by Zimet et al. [79], was adapted for Syrian refugees in an Arabic version by Aroian et al. [92]. Comprising 12 items, the MSPSS is organized into three subscales, each consisting of four items, and employs a 7-point Likert scale. The internal consistency reliability coefficients, assessed using Cronbach’s alpha, were computed as 0.80 for family support, 0.87 for support from friends, 0.84 for support from a significant other, and 0.87 for the total score. The Confirmatory Factor Analysis (CFA) conducted on the dataset from this study revealed that all 12 items in the instrument were statistically significant at the 0.001 level. The factor model exhibited acceptable and superior fit indices (x²(30) = 90.697***[0.000], GFI = 0.964, IFI = 0.981, TLI = 0.974, CFI = 0.981, x²/SD = 1.890, AGFI = 0.942, NFI = 0.961, RMSEA = 0.047, RMR = 0.108). Based on the results of the Confirmatory Factor Analysis and Cronbach’s Alpha reliability analysis applied to the Multidimensional Scale of Perceived Social Support, it can be concluded that the scale, with its 12 items and three subscales, demonstrates structural validity and high reliability for assessing social support among Syrian refugees.

Post-traumatic Growth Inventory (PTG). The Post-traumatic Growth Inventory (PTG), developed by Tedeschi and Calhoun [93], underwent Arabic adaptation by Kira et al. [94]. Assessing the perceived positive life changes following stressful experiences, the PTG comprises 21 items organized into five subscales [93]. Moreover, the PTG was found to be positively associated with variables such as social support, religious involvement, extraversion, openness to experience, agreeableness, optimism, and conscientiousness. In this study, the internal consistency reliability coefficients of the PTG subscales were calculated as 0.61 for relating to others, 0.64 for new possibilities, 0.63 for personal strength, 0.58 for spiritual change, 0.73 for appreciation of life, and 0.84 for the total score. The Confirmatory Factor Analysis (CFA) conducted on the dataset from this study revealed that the path coefficients of the scale items were statistically significant, and the standardized path coefficients were acceptable. However, upon examination of the error term covariance matrix, it was observed that there was considerably high covariance between the error terms of items belonging to different subscales. This situation indicates closer relationships among items within different subscales compared to those within their own subscales and negatively affects the model fit indices. After removing the items containing close relationships across different subscales, the scale demonstrated structural validity. Furthermore, according to the results of the confirmatory factor analysis, the scale exhibited acceptable levels of fit indices (x²(32) = 94.525***[0.000], GFI = 0.961, IFI = 0.955, TLI = 0.926, CFI = 0.954, x²/SD = 2.780, AGFI = 0.924, NFI = 0.931, RMSEA = 0.066, RMR = 0.062). Based on the findings of the Confirmatory Factor Analysis and Cronbach’s Alpha reliability analysis applied to the Post-traumatic Growth Inventory, it can be concluded that the scale, with its 11 items and five subscales, demonstrates structural validity and high reliability for measuring post-traumatic growth effectively.

2.4. Procedures

To ensure robust responses from participants within this cohort of Syrian refugees, prior authorization was sought via email from researchers who had adapted or developed scales suitable for Syrian refugees in their native language. Additionally, the commencement and continuation of this research were contingent upon obtaining approval from the Ondokuz Mayıs University Social and Human Sciences Ethics Committee. Furthermore, requisite research permits were secured from the Turkish Ministry of Interior Directorate General of Migration Management and the Samsun Provincial Directorate of Migration Management. Consequently, the data collection process commenced in November 2022 and was concluded in November 2023. During the implementation of the data collection instruments, prior to presenting the forms to Syrian refugees, participants were apprised of the content of the informed consent form pertaining to this study. Simultaneously, participants were prompted to indicate their voluntary participation in this research by marking a designated box before initiating the forms. All data collection instruments were formulated in Arabic, the mother tongue of Syrians. Each participant was tasked with responding to a total of 70 questions, with each participant averaging 20 min to complete all forms. Throughout the duration of this study, adherence to voluntarism and confidentiality principles was upheld, with these principles factored into every phase of this research. Subsequent to organizing the data garnered from the measurement instruments administered to participants in the research cohort, the data analysis phase ensued.

2.5. Data Analysis

This study investigates the moderating role of the variables family support, support from friends, and support from a significant other on the relationship between the impact of events and post-traumatic growth among Syrian refugees. To elucidate this scenario, a moderated mediation model was examined. Confirmatory Factor Analyses were conducted using the IBM SPSS AMOS 25.0 package for the measurement instruments. The data obtained from the demographic information form were analyzed using the IBM SPSS 25.0 package. Finally, a moderation analysis was performed using the Hayes Process macro plugin for IBM SPSS 25.0. In the section following the Introduction, Materials and Methods, demographic and descriptive statistics regarding the research sample were presented. The next section includes descriptive statistics and tests for normal distribution for the variables included in this research. The subsequent section encompasses hypothesis testing, aimed at examining the research hypotheses. In this context, four of the research hypotheses pertain to direct effects, while three involve examining moderating effects.

Predictor of the Model and Assumptions. In models where moderating effects are statistically significant, it is recommended to examine how direct effects change for different levels of the moderating variables [95,96]. In this regard, following the moderation effect models, direct effects were transformed into three categorical variables for different levels of the moderating variable—below one standard deviation, within one standard deviation, and above one standard deviation. Slope coefficients were calculated for low, moderate, and high groups and compared. Additionally, regression-based moderation effect models were examined using the Least Squares (LS) method, and LS assumptions, including the absence of autocorrelation (tested using the Durbin-Watson test) and constant variance (tested using the White’s Heteroskedasticity Test), were checked. In case of deviations from these assumptions, Huber-White Robust Standard Errors were utilized to prevent efficiency losses. The near-collinearities caused by the interaction terms were mitigated by centering variables around their means.

3. Results

In the context of this study, which examines the moderating effect of perceived social support on the relationship between the impact of events and post-traumatic growth among Syrian refugees, the hypotheses concerning the moderator effect model were observed within three separate effect models. Accordingly, the moderation effect models were analyzed using Hayes Process Macro. In this scenario, it is suggested to investigate how the coefficients differ in three separate regressions, which examine the effects of the independent variable on the dependent variable for different levels of the moderating variable.

Based on the aforementioned explanations, the findings of the first Hayes Process Macro moderation effect analysis are presented in

Table 2. Findings of the first Hayes Process Macro moderation effect analysis.

Variable	β	S.H	t	p	%95 Low	%95 Up
Constant Term	0.352	0.51	0.692	[0.489]	−0.649	1.351
IES	0.719	0.205	3.506 ***	[0.001]	0.316	1.222
Family S.	0.472	0.096	4.902 ***	[0.000]	0.283	0.661
IES × Family S.	−0.089	0.038	−2.322 **	[0.021]	−0.164	−0.014
Descriptive Statistics
Determination	R2 = 0.272			D.R2 = 0.267
F Test	F(3, 403) = 28.508 ***			[0.000]
D.W. Autocorrelation Test	D.W = 1.741
White’s Heteroscedasticity Test	F(3, 403) = 223.296 ***			[0.000]
Conditional Effects for Moderator Variable Levels
Family Support	β	S.H	t	p	%95 Low	%95 Up
Low Level	0.409	0.087	4.696 ***	[0.000]	0.238	0.580
Moderate Level	0.290	0.062	4.688 ***	[0.000]	0.168	0.411
High Level	0.171	0.073	2.343 **	[0.020]	0.028	0.314

*** (%1), ** (%5) significance levels denote significance, where parentheses include the degrees of freedom of the test and square brackets contain the significance values of the test; %95 lower: lower bound of the 95% confidence interval from 2000 resampled bootstrap; %95 upper: upper bound of the 95% confidence interval from 2000 resampled bootstrap.

below. In this analysis, the Impact of Event Scale-Revised (IES-R) is designated as the independent variable, the family support subscale serves as the moderator variable, and the Post-traumatic Growth Inventory is defined as the dependent variable.

When examining the estimated coefficients presented in Table 2, it becomes evident that the effect of the variable representing the impact of events on post-traumatic growth is statistically significant at the 1% significance level (β₁ = 0.719, p < 0.01). This indicates that an escalation in the levels of event impact among Syrian refugees corresponds to a heightened level of post-traumatic growth. Hence, this finding corroborates the first hypothesis of this study, which posits that “the level of event impact significantly influences post-traumatic growth among Syrian refugees”. Furthermore, the effect of the variable denoting family support on post-traumatic growth is also statistically significant at the 1% significance level (β₂ = 0.472, p < 0.01). More precisely, the increase in the perception levels of Syrian asylum-seekers regarding the support they receive from their families results in an increase in their levels of post-traumatic growth.

The analysis of the interaction variable reveals a statistically significant effect on post-traumatic growth at the 5% significance level (β₃ = −0.089, p < 0.05), indicating that the influence of event impact levels on post-traumatic growth among Syrian refugees varies based on their perceptions of family support. This finding supports the hypothesis that “the level of event impact significantly affects post-traumatic growth among Syrian refugees, with the moderating role of family support” in the initial model. Furthermore, to explore this variation further, the coefficients were calculated for individuals with low, moderate, and high levels of family support. Among those perceiving low or moderate levels of family support, the effect of the event impact variable on post-traumatic growth remains statistically significant at the 1% level and positive (β1 = 0.409, p < 0.01 for low support; β₁ = 0.290, p < 0.01 for moderate support). However, for individuals perceiving high levels of family support, while the effect is still statistically significant, it is positive at the 5% significance level (β₁ = 0.171, p < 0.05). These findings indicate that as family support increases, the impact of events on post-traumatic growth diminishes among Syrian refugees, suggesting a nuanced relationship between the event impact, family support, and post-traumatic growth in this population.

The second Hayes Process Macro moderator effect analysis findings are presented in

Table 3. Findings of the second Hayes Process Macro moderation effect analysis.

Variable	β	S.H	t	p	%95 Low	%95 Up
Constant Term	1.525	0.493	3.093 ***	[0.002]	0.556	2.494
IES	0.492	0.197	2.490 **	[0.013]	0.103	0.880
Friend S.	0.302	0.098	3.084 ***	[0.002]	0.110	0.495
IES × Friend S.	−0.065	0.039	−1.685 *	[0.093]	−0.141	0.011
Descriptive Statistics
Determination	R2 = 0.147		D.R2 = 0.140
F Test	F(3, 403) = 10.839			[0.000]
D.W. Autocorrelation Test	D.W = 1.823
White’s Test for Heteroscedasticity	F(3, 403) = 49.705 ***			[0.000]
Conditional Effects for Moderator Variable Levels
Support from Friends	β	S.H	t	p	%95 Low	%95 Up
Low Level	0.303	0.101	2.997 ***	[0.003]	0.104	0.502
Moderate Level	0.206	0.072	2.863 ***	[0.004]	0.065	0.347
High Level	0.109	0.082	1.320	[0.188]	−0.053	0.271

*** (%1), ** (%5), * (%10) significance levels denote significance, where parentheses include the degrees of freedom of the test and square brackets contain the significance values of the test; %95 lower: lower bound of the 95% confidence interval from 2000 resampled bootstrap; %95 upper: upper bound of the 95% confidence interval from 2000 resampled bootstrap.

. In this analysis, the Impact of Event Scale serves as the independent variable, the dimension of social support from friends acts as the moderator variable, and the Post-traumatic Growth Inventory is defined as the dependent variable.

Upon examining the estimated coefficients, it is observed that the effect of event on post-traumatic growth is statistically significant at the 5% significance level (β₁ = 0.492, p < 0.05). In other words, the increase in the level of impact from events on Syrian refugees results in an increase in the level of post-traumatic growth. This finding confirms the hypothesis that “there is a significant effect of the level of impact from events on post-traumatic growth among Syrian refugees” in the second model. Additionally, upon reviewing the estimated coefficients in Table 3, it is noted that the effect of support from friends on post-traumatic growth is statistically significant at the 1% significance level (β₂ = 0.302, p < 0.01). In simpler terms, the increase in the perceived level of support from friends among Syrian refugees leads to an increase in the level of post-traumatic growth.

The effect of the interaction variable on post-traumatic growth was found to be statistically significant at the 10% significance level (β₃ = −0.065, p < 0.10). This indicates that the influence of events on post-traumatic growth among Syrian refugees varies depending on their perceptions of support from friends. This result supports the hypothesis that “there is a moderating role of support from friends in the effect of the level of impact from events on post-traumatic growth among Syrian refugees”. Additionally, to explore this variation, the coefficients were computed for individuals with low, moderate, and high levels of support from friends. Specifically, for individuals perceiving low support from friends, the effect of the event variable on post-traumatic growth is statistically significant at the 1% significance level (β₁ = 0.303, p < 0.01). Similarly, for those perceiving moderate support from friends, the effect of the event variable on post-traumatic growth is statistically significant at the 1% significance level (β₁ = 0.206, p < 0.01). However, for individuals perceiving high support from friends, the effect of the event variable on post-traumatic growth is not statistically significant even at the 10% significance level (β₁ = 0.109, p > 0.10). Furthermore, the comparison of the coefficients reveals that as support from friends increases, the impact of events on post-traumatic growth diminishes, and in cases of high support from friends, this impact completely disappears. In essence, the positive effect of event levels on post-traumatic growth among Syrian refugees decreases with higher perceptions of support from friends. Notably, in individuals with the highest support from friends, the statistically significant effect of events on post-traumatic growth is no longer observed.

The results of the third Hayes Macro Process moderating effect analysis are presented in

Table 4. Findings of the third Hayes Process Macro moderation effect analysis.

Variable	β	S.H	t	p	%95 Low	%95 Up
Constant Term	1.009	0.449	2.245 **	[0.025]	0.125	1.892
IES	0.690	0.179	3.853 ***	[0.000]	0.338	1.042
Significant Other S.	0.397	0.087	4.559 ***	[0.000]	0.226	0.568
IES × Significant Other S.	−0.100	0.035	−2.903 ***	[0.004]	−0.168	−0.032
Descriptive Statistics
Determination	R2 = 0.184		D.R2 = 0.1805
F Test	F(3, 403) = 15.257			[0.000]
D.W. Autocorrelation Test	D.W = 1.823
White’s Test for Heteroscedasticity	F(3, 403) = 84.642 ***			[0.000]
Conditional Effects for Moderator Variable Levels
Support from a Significant Other	β	S.H	t	p	%95 Low	%95 Up
Low Level	0.410	0.094	4.348 ***	[0.000]	0.224	0.595
Moderate Level	0.258	0.064	4.025 ***	[0.000]	0.132	0.383
High Level	0.106	0.069	1.526	[0.128]	−0.030	0.242

*** (%1), ** (%5) significance levels denote significance, where parentheses include the degrees of freedom of the test and square brackets contain the significance values of the test; %95 lower: lower bound of the 95% confidence interval from 2000 resampled bootstrap; %95 upper: upper bound of the 95% confidence interval from 2000 resampled bootstrap.

below. In this analysis, the Impact of Events Scale is treated as the independent variable, the support from a significant other subscale serves as the regulatory variable, and the Post-traumatic Growth Scale is defined as the dependent variable.

Upon reviewing the estimated coefficients, it becomes apparent that the impact of the events variable on post-traumatic growth is statistically significant at the 1% significance level (β₁ = 0.690, p < 0.01). This suggests that heightened exposure to events among Syrian refugees corresponds to increased levels of post-traumatic growth. Such findings confirm the hypothesis posited by this study, affirming a significant effect of event exposure on post-traumatic growth among Syrian refugees in the third model. Additionally, a detailed examination of the estimated coefficients in Table 4 reveals the significance of the effect of the support from a significant other variable on post-traumatic growth at the 1% significance level (β₂ = 0.397, p < 0.01). In essence, an elevation in the perception of support from a particular individual among Syrian refugees correlates with heightened levels of post-traumatic growth.

Moreover, the interaction variable exhibits a statistically significant effect on post-traumatic growth at the 1% significance level and is positive (β₃ = −0.100, p < 0.01). Put differently, the influence of stressful life events on post-traumatic growth levels among Syrian refugees is subject to variation contingent upon their perceptions of support from a significant other. This observation substantiates this study’s hypothesis that the effect of event exposure on post-traumatic growth among Syrian refugees is moderated by support from a significant other in the third model. Furthermore, to delve deeper into this variability, the coefficients were computed for individuals with low, moderate, and high levels of support from a significant other. In this context, it is noted that for Syrian refugees perceiving low levels of support from a significant other, the effect of the events variable on post-traumatic growth is statistically significant at the 1% significance level (β₁ = 0.410, p < 0.01). Similarly, for those perceiving moderate levels of support, the effect remains statistically significant at the 1% significance level (β₁ = 0.258, p < 0.01). However, for those perceiving high levels of support, the effect is not statistically significant, even at the 10% significance level (β₁ = 0.109, p > 0.10).

In conclusion, as support levels increase, the impact of events on post-traumatic growth diminishes. In instances of high levels of support from a significant other, the effect dissipates. Thus, the positive effect of event exposure on post-traumatic growth among Syrian refugees attenuates with heightened perceptions of support from a significant other. Additionally, among Syrian refugees with the highest level of support from a significant other, no statistically significant effect of event exposure on post-traumatic growth is discernible.

4. Discussion

4.1. The Impact of Events’ Effect on Post-Traumatic Growth

The analysis results have indicated a significant influence of event exposure on post-traumatic growth among Syrian refugees. Moreover, the findings suggest that heightened levels of event exposure among Syrian refugees correspond to increased levels of post-traumatic growth.

These research outcomes are corroborated by studies in the field. For instance, Acar et al. [43] explored the effects of adverse life events on post-traumatic growth involving 528 Syrian refugees in Turkey. Their results suggested a low but significant positive relationship between past traumatic experiences and post-traumatic growth among Syrian refugees. Additionally, they highlighted a stronger and more significant indirect relationship between trauma experience and post-traumatic growth, with post-migration stress factors identified as determinants of this indirect effect. However, although post-migration stressors may strengthen post-traumatic growth, different outcomes may occur when social support is involved in the process. For instance, Kheirallah et al. [44] found, in their study on Syrian refugees, a significant impact of participants’ traumatic experiences on their post-traumatic growth. They also noted generally low levels of post-traumatic growth among Syrian refugees following traumatic experiences, with 88% of participants experiencing low levels of post-traumatic growth. When explaining the reasons for this finding, the lack of broad social support networks, especially family support, was mentioned. Although both the study by Kheirallah et al. [44] and this study give similar results, there is a fundamental difference. The findings of this study indicate that high levels of social support reduce post-traumatic growth. However, as Kheirallah et al. [44] argue, this is not due to lack of social support, but dysfunctional social support. This is because Syrian refugees live collectively as part of a collective culture and usually get their social support from each other [97,98]. This causes individuals with a similar trauma history to provide social support to each other, bringing dysfunctional social support to mind.

It is worth noting that a potential inverse relationship between event impact and post-traumatic growth may also exist among Syrian refugees [52]. As time progresses after displacement, the level of exposure to traumatic situations may decrease, alongside a reduction in stressors [99]. The duration of stay in the resettlement country following displacement may also be a determining factor [43]. These experiences of Syrian refugees are believed to be correlated with the time elapsed since the war. Among these experiences, various variables, such as social support, particularly, can influence the level and direction of this relationship. Additionally, it is observed that as the effects of stressful life events increase among Syrian refugees, post-traumatic growth also increases. A review of the literature reveals a significant positive relationship between post-traumatic stress disorder and post-traumatic growth [41,42]. However, it is also possible for this relationship to weaken over time and even reverse [56]. Considering all these factors, further investigation into the latent factors and moderating effects that may exist between event impact and post-traumatic growth among Syrian refugees is warranted. In this context, it is necessary to discuss this relationship separately with the sub-dimensions of social support (family support, support from friends, support from a significant other), which is the moderator variable of this study.

4.2. The Moderating Role of Family Support

The conducted analyses indicate that the impact of events among Syrian refugees plays a significant role in post-traumatic growth, moderated by perceived family support. The findings from this research suggest that for Syrian refugees perceiving low, moderate, or high levels of family support, the impact of the variable events significantly and positively affects post-traumatic growth. Furthermore, the results of this research demonstrate that as the level of family support increases, the impact of events on post-traumatic growth decreases. Understanding the dynamics between traumatic experiences and post-traumatic growth is crucial to elucidate the aforementioned phenomenon.

In this study, as the level of family support increased, the positive relationship between PTSD and PTG decreased. Therefore, a decline was observed in the PTSD level. This is because the Syrian war has significantly disrupted family roles and functionality among Syrian refugees [100]. Traumatic experiences not only negatively affect the psychological well-being of individuals, but also challenge family dynamics [101].

Nonetheless, several studies indicate that Syrian refugees primarily live with family members and mostly rely on them for social support [36,61,69,102]. Reasons for this could include concerns about trusting others and stigmatization. Moreover, it has been observed that they often confide in family members and fulfil their social support needs within their families [59,60]. Namely, Syrian refugees meet their social support needs with family members who have undergone similar traumatic experiences and struggle with similar symptoms. This situation renders the social support provided by the family dysfunctional. Reviewing the literature reveals that support networks characterized by autonomy, functionality, fulfilment, and healthy relationships contribute to individuals’ post-traumatic growth [103]. However, the situation appears to be the opposite for Syrian refugees. Furthermore, while family support may alleviate the impact of traumatic experiences, it is recognized that support from a family with pathological and pathogenic relationship patterns can cause more harm than good in this process [104].

Syrian refugees frequently make decisions based on familial dynamics, often resorting to various familial routines as coping mechanisms for their traumatic experiences [65]. Nevertheless, it is evident that family units comprise individuals who have also undergone significant trauma [44]. Consequently, it can be posited that Syrian refugees must adjust to the psychological states of their families and may demonstrate resistance to novel opportunities. Research indicates that post-traumatic growth levels in individuals subsequent to traumatic experiences are notably influenced by the post-traumatic growth observed in their family members [66]. Furthermore, individuals benefiting from functional family support tend to exhibit fewer symptoms of post-traumatic stress disorder [81]. Thus, familial resilience in the face of trauma is positively associated with post-traumatic growth [46]. It is therefore suggested that mutual social support among family members with similar traumatic experiences and coping mechanisms may mitigate the level of post-traumatic growth in Syrian refugees. All of this suggests that family support has an important role in moderating the impact of events on post-traumatic growth in Syrian refugees.

4.3. The Moderating Role of Support from Friends

The analysis conducted has elucidated the moderating role of support from friends in moderating the influence of events on post-traumatic growth among Syrian refugees. Moreover, it has been observed that as support from friends increases, the impact of events on post-traumatic growth diminishes, and in cases of high support from friends, this impact becomes negligible. In essence, the positive correlation between the impact of events and post-traumatic growth among individuals tends to attenuate with heightened perceptions of support from friends. Notably, among individuals with the highest level of support from friends, the statistical significance of the impact of events on post-traumatic growth is nullified.

While support from friends is perceived to contribute to the well-being of Syrian refugees, there exists a concern that it may exert a dampening effect on their personal resilience and autonomy [44]. This apprehension is grounded in the notion that directives emanating from friend circles may coerce Syrian refugees into making constrained decisions. Such tendencies, rooted in the need for security, could adversely impede the receptivity of Syrian refugees to novel opportunities [78]. The propensity for openness to new opportunities constitutes a pivotal dimension of post-traumatic growth. These observations cohesively align with the outcomes of extant research, as in this study, it was observed that the level of post-traumatic growth decreased as peer support increased. Even at the highest level of peer support, the relationship between the impact of traumatic events and post-traumatic growth was disrupted. In other words, post-traumatic growth has become meaningless. Additionally, Syrians often traverse resource pathways such as employment avenues, healthcare selections, enrolment of their children in educational institutions, and choices of shopping locations through referral networks, with minimal individual exertion. In a study by Matos et al. [65], Syrian participants articulated their aspiration for absolute self-sufficiency in employment acquisition and the prioritization of self-directed efforts and skills. However, the prevalent sentiments of insecurity and recurrent experiences of societal ostracization present formidable obstacles [105]. Consequently, such circumstances could eclipse individual agency in decision-making and the exploration of fresh opportunities. Such situations contribute to weakened levels of post-traumatic growth among Syrian refugees. This also explains the results, which reveal that as peer support increases, post-traumatic growth becomes insignificant.

Moreover, among the determinants of post-traumatic growth among Syrian refugees, individual dynamics necessitating heightened awareness, such as empathy, courage, receptivity to novel opportunities, personal resilience, awareness, and potential for exploration, exert considerable influence [69]. Conversely, the propensity for collective action among Syrian refugees, often manifested through friend-driven social activities and adherence to collective norms, is well-documented. This propensity underscores Syrian refugees’ predilection for communal well-being over individualistic pursuits [97]. The prevalence of collective behavior patterns founded upon support from friend networks, exemplified by concerted actions based on friend referrals, underscores the potential for such dynamics to impinge negatively on post-traumatic growth among Syrian refugees [15]. Furthermore, it is often observed that Syrian refugees frequently solicit friend advice in navigating solutions to their psychological tribulations and trauma-induced experiences [106]. Such inclinations may foster individual awareness of specific adversities while diminishing self-efficacy [65,78]. Concurrently, they may hinder the exploration of individual coping mechanisms to contend with traumatic experiences. These observations, resonating with the research findings, suggest that beyond a certain threshold, the degree of support from friends elucidates the impact of events on post-traumatic growth.

4.4. The Moderating Role of Support from a Significant Other

The analysis results indicate the moderate role of support from a significant other in mitigating the impact of events on post-traumatic growth among Syrian refugees. Furthermore, it has been observed that, as support from a significant other increases, the influence of events on post-traumatic growth diminishes; indeed, when support from a significant other reaches a high level, the effect becomes negligible. In other words, the positive effect of the impact of events on post-traumatic growth in individuals decreases as the perception of support from a significant other increases. Moreover, when support from a significant other reaches its peak, the statistically significant effect of events on post-traumatic growth disappears.

The reduction in post-traumatic growth due to the increase in support from a significant other may be associated with the concept of social trust, as the increase in social trust primarily stems from enhanced social support from family and friends [107]. The decline in social trust among Syrian refugees may be linked to a shift towards social support from individuals outside the family and friend circle. This decline in social trust may impede the acquisition of essential social support from family and friends, leading individuals to seek support from different sources [80,83,108,109]. That is to say, perceiving high levels of support from one’s partner, fiancé, or romantic interest may hinder communication with other fundamental networks [80,110]. The Syrian refugees turning to different support sources may become more vulnerable when coping with traumatic symptoms and isolation due to a lack of primary support networks [111]. Additionally, dysfunctional support from a significant other may intensify feelings of loneliness, compared to family support and support from friends, potentially contributing to a decline in post-traumatic growth [112]. Consequently, the increasing presence of support from a significant other may lead to a reduction in the positive impact of events on post-traumatic growth. This also explains why post-traumatic growth becomes meaningless as support from a significant other increases.

Furthermore, Syrian refugees may harbor resentment towards their families regarding traumatic experiences related to the war. They might even perceive their family or friends as being responsible for certain negative circumstances [86]. Moreover, their distrust towards family and friends can lead individuals to turn to different support sources [85,87]. It is known that conflicts arising in family and friendship relationships influence individuals’ attitudes towards the social support they receive [113]. This situation may lead Syrian refugees to perceive the social support they receive from their families and friends as inadequate [85,114]. Simultaneously, the existence of this situation is thought to hinder the post-traumatic growth of Syrian refugees. It should be noted that the perception of social support is based on the need for trust. Syrian refugees may seek someone to blame for their traumatic experiences. They may attribute some responsibility for their situation to their close relationships with family and friends [84]. In this context, they may focus their social support needs on a significant other rather than their resentful family and friends. All these factors can contribute to the decrease and disappearance of the effect in the relationship between the impact of events and post-traumatic growth among Syrian refugees.

Lastly, considering that social support buffers the impact of stressful life events [53,92], it can be argued that the lack of social support suppresses the positive effect of these events on post-traumatic growth among Syrian refugees. Indeed, studies on Syrian refugees indicate that the impact of events positively influences post-traumatic growth [65,115,116]. This phenomenon can be expressed as the reinforcing effect of pain. Intense social support provided by a significant other may neutralize the transformative power of pain [88,117]. Specifically, as support from a significant other increases among Syrian refugees, the effect of the variable events on post-traumatic growth seems to decrease. However, it is observed that high levels of support from a significant other renders this relationship meaningless.

Overall, the research findings suggest that high levels of social support received from friends and a significant other, aside from perceived family social support, render the impact of the variable events on post-traumatic growth meaningless. However, family support does not disrupt this dynamic. This may indicate that family support is more functional in terms of the transformative power of pain in Syrian refugees. The emergence of this finding suggests that while individuals’ support from friends and a significant other may vary, the family’s role remains fundamental and more resistant to change. Indeed, support from a significant other or support from friends may undergo changes during life transitions such as relocation or moving, whereas the risk decreases with family support [113]. Additionally, Syrian refugees generally migrate with their families and continue their lives with them [118,119,120]. This situation indicates that family support is more enduring among Syrian refugees. Consequently, it can be said that the significance of the relationship between family support and post-traumatic growth persists with an increase in family support.

4.5. Limitations

One of the primary limitations of this study is the resistance exhibited by Syrian refugees in opening up during survey completion. Additionally, the participants were found to experience trust issues due to concerns about deportation and stigmatization. To address this limitation, participants were reached through trusted referrals. Furthermore, assistance was sought from an interpreter fluent in both languages, as well as from a psychological counsellor, during the pre-interview phase. Thus, language and cultural barriers, which constitute another limitation of this study, were minimized.

4.6. Recommendations

In this study, a significant moderating role of family, friends, and support from a significant other on the impact of events on post-traumatic growth was identified. To interpret this finding more effectively and to better analyze the latent variables encompassed within family, friends, and special support among Syrian refugees in the context of post-traumatic growth, it is recommended to conduct detailed studies examining the family dynamics of Syrian refugees in relation to post-traumatic growth.

Another suggestion pertains to the income levels. Considering this study’s duration and timeframe, prolonged processes may weaken the measurement of income levels, depending on the inflation situation in the countries where this research was conducted. Additionally, research findings related to income levels may complicate the readers’ understanding in future years or require retrospective calculations. In this context, researchers are advised to present income levels in broader ranges on demographic information forms or to express income levels indexed to purchasing power.

Lastly, concerning Syrian refugees, it is believed that the most crucial approach researchers should adopt when conducting studies on refugee groups is a multicultural perspective. In this regard, adopting cultural awareness and knowledge as a priority is strongly recommended.