Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya

• Published in: International journal of social psychiatry Vol. 68; no. 1; pp. 134 - 146
• Main Authors: Im, Hyojin, Swan, Laura ET, Warsame, Abdilkadir H, Isse, Maimuna M
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2022; Sage Publications Ltd
• Subjects: Adolescent; Adult; Anxiety; Anxiety - epidemiology; Comorbidity; Cultural sensitivity; Depression - epidemiology; Female; Humans; Kenya - epidemiology; Male; Mental depression; Mental disorders; Mental health; Post traumatic stress disorder; Protective Factors; Psychological aspects; Psychosocial factors; Refugees; Refugees - psychology; Snowball sampling; Somalia; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology; Symptoms; Trauma; Violence; Willingness; Young Adult; Somalia; Kenya; comorbidity; common mental disorders; psychosocial factors; Refugee trauma; mental health
• ISSN: 0020-7640; 1741-2854
• DOI: 10.1177/0020764020978685

Background: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has explored psychosocial factors for mental disorder comorbidity in Somali refugee samples. Aims: This study aims to explore potential risk and protective factors for comorbid depression-anxiety and comorbid depression-PTSD by examining associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. Methods: We used snowball sampling to recruit Somali youth aged 15 to 35years(N = 250,n = 143 female, n = 88 male, n = 19 unknown gender). We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the HSCL-25 and PCL-C to capture individual and comorbid CMD symptoms, using guided cutoff points and/or algorithms. We then ran a series of logistic regression analyses to examine relationships between trauma exposure, psychosocial factors, and individual and comorbid CMD symptoms. Results: Findings showed that increased trauma exposure predicted symptoms of individual and comorbid CMDs. Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and comorbid anxiety-depression symptoms, respectively. Willingness to share problems buffered depressive symptoms but did not predict comorbidity. Conclusions: These findings revealed the high CMD comorbidity prevalence with differential effects of trauma and psychosocial factors on individual or comorbid mental disorders. This study suggests a need for transdiagnostic approaches that cut across Western diagnostic boundaries and consider culturally responsive and relevant items for mental health measures.