Exploring the Representation of Depressive Symptoms and the Influence of Stigma in Arabic-Speaking Refugee Outpatients

Abstract

The number of distressed refugees from the Arab world is relatively high in Germany and other host countries worldwide. For this specific population, substantial challenges and barriers have already been identified that hamper access to Germany's health care system. This study aims to contribute to this line of research by exploring the representation of depressive symptoms, both somatic and psychological, in order to inform clinicians about the most prevalent symptoms reported by Arabic-speaking refugee outpatients. Furthermore, this paper investigates the longstanding claim that mental health stigma fosters the expression of bodily distress. For these purposes, a total of 100 Arabic-speaking refugee outpatients, mostly Syrians, were recruited in Berlin, Germany. Somatic and psychological symptoms were assessed with the Patient Health Questionnaire (PHQ) 15 and 9, while stigma was assessed with the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). Study results show that both somatic and psychological symptom severity was moderate while sleeping problems and energy loss were the most reported symptoms across both scales. Stigma was low and showed no association with somatic complaints in a multiple regression analysis, but was associated with more psychological symptoms. A principal factor extraction on the PHQ-15 items revealed five independent, somatic symptom clusters that were interpreted considering the rich poetic resources of the Arabic language. In conclusion, both somatic and psychological symptoms were commonly reported by Arabic-speaking refugees with symptoms of depression. Whereas, stigma does not seem to influence the expression of somatic symptoms, the present results provide first empirical indications for the relationship of symptom expression with the use of explanatory models and conceptualizations of mental illness within the Arabic culture and language. Future research efforts should be dedicated to enhancing our understanding of mental health care needs in this population as well as to exploring other mediators that might help explain the varying degree of somatic symptoms in depression across cultures.

Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people

“…This seems to be robust and persistent over time, as self-stigma was higher in people with probable PTSD on all three measurements. This finding is in line with previously found associations between stigma and psychological symptoms (Byrow et al, 2019 ; Kira et al, 2015 ; Lindheimer et al, 2020 ; Livingston & Boyd, 2010 ) and supports the notion that stigma can be seen as a major mental health burden contributing to already existing mental illness (Kira et al, 2014 ). Moreover, since the SSOMI questionnaire asks hypothetical questions (‘if I had a mental illness’), the present results add that self-stigma in people with mental health burdens is even higher than people without mental illness expect it to be.…”

“…Moreover, the majority of participants came from Syria (53.7%) and were male (72.4%). This distribution is similar to the general population of forcibly displaced people in Germany and common for current samples in this research area (Bär et al, 2021 ; Lindheimer et al, 2020 ). Even though, in the present sample and previous research (Livingston & Boyd, 2010 ), no gender differences in self-stigma were found, gender differences in help seeking are a common finding (Maguen et al, 2012 ; Marshall et al, 2006 ).…”

Mental Health Self-Stigma of Syrian Refugees With Posttraumatic Stress Symptoms: Investigating Sociodemographic and Psychopathological Correlates

“…To our knowledge, our work is the first to apply the SSMIS-SF in a refugee sample and further evidence is needed in order to draw conclusions on the severity of mental health self-stigma in different refugee populations. Using the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10) (37), a recent study reported mild mental health selfstigma in a sample of Arabic-speaking (predominantly Syrian) refugee outpatients with depressive symptoms in Germany (38).…”

Examining the validity and reliability of the Arabic translated version of the depression and somatic symptoms scale (A-DSSS) among the Lebanese adults

“…Stigma, in particular, can play an important role in the expression of psychological symptoms, as one study on depression in Arabic-speaking refugees revealed that the expression of psychological symptoms of depression, but not somatic ones, were associated with high levels of stigma 34 . This highlights the importance of socio-cultural contexts in shaping the expression of psychological symptoms.…”