Comorbid Common Mental Disorders and Associated Psychosocial Factors Among Somali Refugees in Displacement

Background: Comorbid common mental disorders (CMDs) are pervasive in refugee populations. However, limited research has investigated psychosocial factors for mental disorder comorbidity in Somali refugee samples. In order to fill these gaps in research, this study explores potential risk and protective factors for comorbid Post-Traumatic Stress Disorder (PTSD), depression, and anxiety symptoms by investigating associations between trauma exposure, psychosocial factors, and mental health symptoms among a sample of Somali refugees displaced in urban Kenya. Specifically, this study examines the relationships among trauma exposure, key demographic factors, and comorbid CMDs and tests differential effects of risk and preventive psychosocial factors on the comorbid CMDs, with demographics and trauma exposure controlled.

Methods: We used snowball sampling to recruit Somali youth aged 15 to 35 years (N=250, n=143 female, n=88 male, n=19 unknown gender), who are displaced in urban Kenya. We measured 16 common types of trauma exposure and three psychosocial factors (endorsing violence, willingness to share problems, and symptom awareness) and used the 25 items of Hopkins Symptom Checklist (HSCL-25) and PTSD Checklist – Civilian Version (PCL-C) to capture individual and comorbid CMD symptoms, using established cutoff points and 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: A series of hierarchical logistic regression analyses showed that increased trauma exposure and psychosocial variables predicted symptoms of individual and comorbid CMD symptoms. For example, comorbid depression-PTSD was significantly predicted by female gender (OR = 0.379), increased education (OR = 1.777), and being born in Kenya/other (OR = 2.146; step 1); female gender (OR = 0.291), increased education (OR = 1.805), being born in Kenya/other (OR = 2.518), and increased trauma exposure (OR = 1.280; step 2); and increased trauma exposure (OR = 1.294) and increased symptom awareness (OR = 1.229; step 3). Increased symptom awareness and endorsement of violence predicted comorbid depression-PTSD and anxiety-depression symptoms, respectively. Findings indicated that psychosocial factors are intertwined with exposure to traumatic events and trauma-related symptoms, although 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. High CMD comorbidity in this study implies that local experiences and expressions of mental health issues (i.e., idioms of distress) that cut across Western diagnostic categories may lead to comorbid diagnosis and suggests the need for more locally- and culturally-responsive and -relevant items to aid in better understanding the heightened mental health needs in refugee populations. This study also offers preliminary insights on potentially adverse and protective psychological factors for comorbid CMDs and a need for transdiagnostic approaches or common elements treatment approaches that seek to understand and treat the underlying biopsychosocial processes for the refugee population.