Abstract
BackgroundMental illness is common amongst refugees and can differ depending on cultural background, experiences, and access to care. Given significant risk factors including high rates of exposure to sexual violence and different barriers to seeking adequate health care, refugee mothers are uniquely at risk.MethodsIn 2012–2013, surveys were administered to a convenience sample of Somali and systematic random sample of Iraqi refugee mothers to identify differences in mental health between the populations. The Hopkins Symptom Checklist (HSCL-25) identified respondents with major depression and emotional distress. We used multivariable logistic regression to compare these populations and identify variables associated with mental illness.Results198 Somali and 219 Iraqi women were included. Most Iraqis (60.27%) had not seen a mental health provider while most Somalis (62.63%) had. On average, Iraqis scored 0.34 points higher (worse) on the HSCL-25 compared to Somalis (95% CI, 0.22–0.46; P < 0.001). Iraqis were more likely to have major depression (OR = 2.62, 95% CI 1.50–4.57, P = 0.001). On multivariable analysis accounting for the country of origin, those who saw a mental health provider were less likely to have major depression or emotional distress (OR 0.42, 95% CI 0.22–0.82, P = 0.011; OR 0.43, 95% CI 0.22–0.85, P = 0.015, respectively).DiscussionIraqi refugee mothers were more likely to have depression compared to Somalis. Refugee mothers who saw a mental health provider were less likely to have depression or emotional distress. These results suggest the cultural background and access to health services among refugee mothers’ impact on mental health.
Highlights
Refugees are at high risk of mental illness; both the United Nations High Commissioner for Refugees have recognized mental health services as imperative for relocated refugees (UNHCR Mental Health 2018; WHO2012)
The Somali respondents felt they had improved social and financial status in the USA compared to their prior country of origin, both populations had a small proportion of respondents who felt they could meet their financial needs “very well” (< 1% of Iraqis and 6% of Somalis)
0.014 respectively) that would introduce instability into the multivariable model. In this cross-sectional study of refugee mothers relocated to San Diego, we found that Iraqi refugees were significantly more likely to have major depression, less likely to seek a mental health care provider, and more likely to suffer stigma of mental illness compared to Somali refugees
Summary
Refugees are at high risk of mental illness; both the United Nations High Commissioner for Refugees have recognized mental health services as imperative for relocated refugees (UNHCR Mental Health 2018; WHO2012). Women have unique barriers to seeking adequate care for mental illness, previously shown to include poor language proficiency, reluctance to disclose emotional distress outside the family, unwillingness to partake in medical treatment, and fear of shame or losing one’s children to authorities (Dennis and Chung-Lee 2006; Takeuchi et al 2007). Even after they are resettled in their adopted country, this trauma continues to inflict damage on their mental well-being (Fazel et al 2005). Given significant risk factors including high rates of exposure to sexual violence and different barriers to seeking adequate health care, refugee mothers are uniquely at risk
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