24P
Trauma-Informed Psychoeducation (TIP) for Refugee Mental Health: An Intervention with Pre-Resettlement Refugee Youth
High prevalence of mental disorders is common among refugees and yet mental health care and psychosocial support for them is meager during migration process. In fact, a majority of refugees experience prolonged displacement in low-resource settings where mental health is often deprioritized and neglected, which tends to exacerbate mental health issues and vulnerability of refugees. To address such gaps, the current study developed and implemented a culturally relevant, trauma-informed psychoeducation (TIP) intervention in the urban Somali refugee community in Kenya. This research took a community-based participatory research (CBPR) approach, partnering with local clinics and community leaders. After the two phases of needs assessment with key stakeholders and capacity building training of local staff and youth leaders, the current study focuses on the effectiveness of TIP intervention on mental health symptom reduction among refugee youth. The project was funded by USAID – Kenya between 2012 and 2013.
Methods:
The study employed time-space sampling and respondent-driven sampling strategies to recruit participants of 12 sessions of TIP workshop. Total 250 young Somali refugees (143 females and 107 males) participated in the study and they were aged between 15 and 35 (M=20.45, SD=3.69). To identify trauma experiences, this study modified the Child War Trauma Questionnaire and created a 20 items of traumatic events (including one open-ended) that are relevant to the context. This study adopted Posttraumatic Diagnostic Scale (PDS) and Hopkisn Symptom Checklist-25 (HSCL-25) to assess PTSD and depression symptoms respectively and used a locally identified somatic symptom list that was developed with community health workers and clinicians working with urban refugees in Kenya.
Results:
The results corroborated the high prevalence of trauma exposure and mental health symptoms. Total 89.2% have experienced at least one type of trauma and average participant reported 5.18 types of traumas (SD=4.08). Also, mental health symptoms (i.e., 39.8% reporting moderate to severe PTSD and 25.8% for depression). A hierarchical logistic regression was used in order to explore the risk and preventive factors for mental disorders. The most salient risk factor for PTSD was experience of living in refugee camp (OR =8.86, 95% CI=1.32-59.57), while separation from parents most increased the risk for depression (OR=4.35, 95% CI=1.72-1.97). The TIP led to positive outcomes but the areas of impact differed according to baseline mental health status. Participants with moderate to severe PTSD symptoms reported significant decrease in PTSD (t=6.820, df=39, p=.000), depression (t=4.839, df=46, p=.000), and somatic symptoms (t=2.393, df=47, p=.021). In the meantime, those with none to mild PTSD showed improvement in help-seeking intention (t=2.299, df=78, p=.024), sense of community (t=3.121, df=86, p=.002), and emotional coping (t=2.104, df=81, p=.038), while no reduction in mental health symptoms.
Implications:
Although limited by the absence of a control group and random sampling, this research supports the efficacy and importance of culturally and contextually relevant psychoeducation in addressing complex needs of the refugee community for mental health and psychosocial support. This study also implies the importance of a tiered intervention model based on baseline mental health status and symptom severity.