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.
Highlights
In recent years, the number of individuals who have been forcibly displaced as a consequence of persecution, conflict, and violence around the world has risen to nearly 70 million
The present study aimed to explore the representation of depressive symptoms in a sample of Arabic-speaking refugee outpatients
The main results of this research show that Arabic-speaking refugee outpatients express a moderate level of both somatic and psychological symptoms of depression, and that stigma does not seem to be associated with somatic symptoms, but rather with psychological symptoms
Summary
The number of individuals who have been forcibly displaced as a consequence of persecution, conflict, and violence around the world has risen to nearly 70 million. This number accounts for the highest total ever recorded by the United Nations High Commissioner for Refugees [1]. In 2018, most refugees arrived from Syria (27.1%), followed by Iraq (10.0%), Nigeria (6.4%), Iran (6.3%), Turkey (6.3%), and Afghanistan (6.3%) [3]. Since Arabic-speaking countries currently constitute the largest number of displaced people, Arabic is considered by far the most frequently spoken native language within the refugee population in Germany [4, 5]
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