Idioms of distress: Feasibility trial findings on reducing somatic symptoms through a community-based, culturally integrated intervention in Somaliland

Abstract

Background Somatic complaints play a central role in the posttraumatic psychological symptom presentation among people within many cultural contexts. One theory about the function of somatic symptoms suggests that diffuse bodily complaints serve as idioms of distress. However, few studies have examined the effect of culturally adapted trauma interventions on reducing somatic symptoms specifically implemented in a low-income country. Methods We examined the effects of Islamic Trauma Healing – a brief, group- and mosque-based, lay-led intervention – on somatic symptom reduction in a pre-post feasibility study conducted in Somaliland. Inclusion criteria were DSM-5 trauma exposure and DSM-5 re-experiencing or avoidance. Participants (N = 26; 12 men, 14 women) reported large intervention effects for somatic symptoms ( g = 2.74, SSS-8). Higher pre-intervention somatic symptoms showed moderate to large associations with higher overall PTSD symptoms ( r = .43, P = .03). At post-intervention, somatic symptoms were only significantly associated with higher PTSD avoidance symptoms ( r = .41, P = .04) and lower well-being ( r = -.49, P = .01). No gender effects on total somatic symptom scores were observed. Discussion Results of this feasibility trial bring into focus overlap between mental health symptom reporting and somatic concerns as conceptualized within the context of cultural idioms of distress. Moreover, these findings suggest that diffuse transdiagnostic somatic symptoms could offer opportunity to learn about the intersections among culture, posttraumatic stress, and idioms of distress as mechanisms in global mental health intervention development.