Lay Explanatory Models of Depression and Preferred Coping Strategies among Somali Refugees in Norway. A Mixed-Method Study

Abstract

Objective: Refugees are at high risk of experiencing mental health problems due to trauma in their pasts and to acculturation stress as they settle in a new country. To develop efficient health services that meet the needs of refugees from different regions, an understanding is required of how they make sense of and prefer to cope with mental health problems. This study aims to investigate lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway.Methods: The study used a mixed-method design with a vignette describing a moderately depressed person based on ICD-10 criteria. Firstly, a survey study was performed among Somali refugees (n = 101). Respondents were asked to give advice to the vignette character and complete the Cross-Cultural Depression Coping Inventory and the General Help-Seeking Questionnaire. Secondly, focus group interviews (n = 10) were conducted separately with males and females to examine the relationship between the explanatory models of depression and the preferred coping strategies.Results: The participants showed a strong preference for coping with depression by religious practices and reliance on family, friends, and their ethnic/religious community, rather than by seeking professional treatment from public health services (e.g., medical doctors, psychologists). Depressive symptoms were conceptualized as a problem related to cognition (thinking too much) and emotion (sadness), but not to biological mechanisms, and they were thought to result from spiritual possession, stress as a result of social isolation, and/or past trauma. Independently of time in exile, the participants showed a strong identification with their ethnic origin and associated values. Because participants emphasized the need to obey and follow the views of elders, fathers, and spiritual leaders, these authorities seemed to be “gatekeepers” for access to mental health services.Conclusion: The results highlight that mental health programs for Somali refugees should actively involve the ethnic community, including spiritual leaders, in order to reach patients in need and to foster treatment compliance.

Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden

“…In order to have benefits from the sickness insurance, a certificate from a physician is required. A study from Norway reported that Somalian refugees often rely on family, friends and their ethnic/religious community, rather than seeking healthcare 12. This may apply also to refugees from other countries and might reduce their likelihood of receiving a certificate from a physician.…”

‘Only God can promise healing.’: help-seeking intentions and lay beliefs about cures for post-traumatic stress disorder among Sub-Saharan African asylum seekers in Germany

“…Moreover, medical and psychotherapeutic helpseeking seems to be mediated by religious gatekeepers and authorities. Therefore, it is advisable to offer to incorporate a religious dimension into psychotherapy, which might enhance patients' therapy motivation, engagement in treatment, and their feeling of being understood and accepted (Markova & Sandal, 2016;Slewa-Younan et al, 2017). In this regard, Whitley (2012) equates cultural competence to religious competence.…”

“…Eritrean refugees in Switzerland considered mental health to be related to faith, and described spiritual or church support as a first-line treatment for mental health issues and trips to holy waters as a cure for mental health problems (Melamed, Chernet, Labhardt, Probst-Hensch, & Pfeiffer, 2019). Studies on the help-seeking preferences of Somali refugees living in Western resettlement countries found a reliance on family, friends, and the ethnic and religious community, and a preference for religious sources of help (Ellis et al, 2010;Markova & Sandal, 2016). A large body of research has emphasized the importance of the belief in God's will and religious prohibitions for health care.…”

“…Regarding psychotherapeutic and medical health care, Somali refugees in Norway expected psychologists and general practitioners to provide concrete solutions that would effectively cure mental health problems (Markova & Sandal, 2016) and to immediately prescribe treatment (Pavlish et al, 2010). Furthermore, Pavlish et al (2010) reported that Somali women in the USA expected to develop a personal relationship with their health care providers, which seems rather contradictory to Western health care systems.…”

‘Tell Your Story’: a randomized controlled trial of an online intervention to reduce mental health stigma and increase help-seeking in refugee men with posttraumatic stress

“…). Recognizing that informal sources represent important avenues for help-seeking, particularly amongst individuals from collectivist cultures(Drummond et al 2011;Slewa-Younan et al, 2014;Markova and Sandal, 2016;Yaser et al, 2016), we focused on both formal (i.e. psychologist, GP, community leader) and informal (friend, family member) sources of help.…”