The Impact of the Number of Trauma Types on the Mental Health of Female Somali Refugee Youth

Background & Purpose: Refugees experience tremendous trauma including war, exposure to violence, family separation, and more. Prolonged exposure to multiple traumas is associated with increased health and mental health issues, which tends to cause cumulative harm to refugees, particularly among vulnerable populations, such as women and children, especially in urban, low-resource settings. In fact, urban refugees often face dual negligence and challenges from both local and international communities due to limited resources, lack of legal protection, and politically-adverse sentiment in the host community. Despite the need for adequate assessment and intervention to address mental health issues experienced by urban refugees, little research has been conducted to look at the trauma sequelae among female youth in urban Kenya. This study seeks to explore the impact of multiple traumas on the mental health of refugees.

Methods: This study used a snowball sampling method to recruit 133 female Somali refugee youth residing in Nairobi, Kenya. Participants were aged 14 to 35 (M=20.27, SD=3.21), following the definition of youth by African Union. In order to assess the association between multiple traumas and mental health outcomes, this study used a cross-sectional survey. A 19-item trauma checklist, based on the Childhood War Trauma Questionnaire, was developed to measure exposure to multiple traumas relevant to the Somali refugee community in Kenya. Mental health outcomes, such as PTSD (measured with the PTSD Checklist-Civilian Version), depression and anxiety (measured with the Hopkins Symptom Checklist-25), somatic symptoms, and substance abuse were measured.

Results: The participants reported multiple trauma exposures (M=5.15, SD=4.23), which were categorized into four different types of trauma to explore the impact of each type on common mental disorders (CMDs): 1) pre-migration trauma (ex. war); 2) post-migration trauma (ex. community violence); 3) family trauma (ex. domestic violence); and 4) personal incidents (ex. injury). Trauma exposure was highly associated with PTSD, depression, and anxiety. Those who experienced more than two types of trauma reported significantly higher mental health issues, such as PTSD (t=-3.774, p<.001), somatization, (t=-3.875, p<.001), anxiety (t=-4.666, p<.001), depression (t=-3.169, p=.002), and substance use (t=-3.183, p=.002). A series of ANCOVA were conducted to examine how the number of trauma types was associated with CMDs, after controlling the effect of age. There was a significant difference in PTSD [F(4,130)=4.578, p=.002], depression [F(4,128)=4.623, p=.002], and anxiety [F(4,130)=6.305, p=.000], though the effect was not linear (ex. those with a single type of trauma showed higher depression and anxiety than those with two types of trauma, though much lower than those with three and four types of trauma exposure).

Conclusion & Implications: This study reveals how different types of trauma impact CMDs in female refugee youth and how exposure to multiple traumas needs to be approached in the context of low-resource urban settings. This research emphasizes the need for specialized interventions to address the mental health needs of refugees who have experienced multiple traumas. Further research could explore protective factors with this population as well as effective practice interventions to address the needs of urban refugees who have experienced multiple traumas.