Examining the Mediating Role of Depression and Anxiety in the Relationship between PTSD and Somatic Symptoms Among Somali Refugee Youth

Background: Somali refugees in urban displacement settings often endure high levels of trauma, violence, and resource loss, contributing to the emergence of high common mental disorders (CMDs) including depressio, anxiety, and post-traumatic stress disorder (PTSD). However, the interrelationships among different constructs of CMD symptoms remain unclear and have received limited attention in previous research. Moreover, somatic pains, frequently reported among Somali refugees, have been substantially underinvestigated regarding their association with depression, anxiety, and PTSD symptoms. Understanding these complex relationships is imperative for the development of effective interventions aimed at supporting the mental well-being of Somali refugees. This study aims to investigate the associations among PTSD symptoms, depression, anxiety symptoms, and somatic symptoms among Somali refugees. Additionally, it seeks to explore the total effect of multiple constructs of PTSD symptoms on somatic symptoms and the potential mediation role of depression and anxiety symptoms.

Method: Survey data were collected via snowball sampling to recruit Somali refugee youth (aged 15–35 years) residing in Eastleigh, Kenya. Participants' mental health symptoms, including depression, anxiety, and PTSD sypmtoms, were assessed using established measures: the Hopkins Symptom Checklist-25 (HSCL-25) for depression and anxiety symptoms, and the PTSD Check List–Civilian Version(PCL-C) for PTSD symptoms. Responses were recorded on a 5-point Likert-type scale, with high internal consistency (Cronbach’s alpha) observed for depression symptoms(α=0.899), anxiety symptoms(α=0.842), and PTSD symptoms (α=0.898). Additionally, a seven-item measure of somatic symptoms specific to the population was developed, with a high internal consistency(α=0.868), offering a comprehensive assessment of mental health among the participants. We analyzed the mediating model using Structural Equation Modeling(SEM) to examine paths from PTSD to somatic symptoms, through depression, anxiety, and covariates of gender and education.

Results: The model fit indices were desirable: (χ²(27)=3410.650, p<.001, CFI=.995, TLI=.992, RMSEA=.038, SRMR=.056). Findings showed that significant direct associations. First, PTSD symptoms exhibited a significant positive relationship with depression and anxiety symptoms (β=0.541, p<.001) and somatic symptoms (β=0.642, p<.001). Additionally, depression and anxiety symptoms significantly predicted somatic symptoms (β=0.272, p<.001). The observed variables collectively explained a considerable amount of variance in PTSD symptoms (R²=0.880), depression, anxiety symptoms (R²=0.296), and somatic symptoms (R²=0.676). Furthermore, the total effect from PTSD symptoms to somatic symptoms was significant (β=0.789 p<.001), with a total indirect effect via depression and anxiety symptoms also being significant (β=0.147, p <.001), indicating partial mediation by depression and anxiety symptoms in the relationship between PTSD symptoms and somatic symptoms.

Conclusions: This study highlights the complex relationship between PTSD, depression, anxiety, and somatic symptoms among Somali refugee youth in urban displacement settings. Our findings emphasize the mediating role of depression and anxiety symptoms in the link between PTSD and somatic symptoms, suggesting partial contributions to somatic complaints. Recognizing the interconnectedness of mental health symptoms underscores the importance of comprehensive interventions addressing various domains. The development of culturally relevant measures for assessing somatic symptoms offers valuable insights into the mental health needs of Somali refugees. These findings call for future policies and practices to prioritize holistic approaches in supporting the mental well-being of refugee youth in similar contexts.