Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abraham, R., Lien, L., & Hanssen, I. (2018). Coping, resilience and posttraumatic growth among Eritrean female refugees living in Norwegian asylum reception centres: A qualitative study. International Journal of Social Psychiatry, 64(4), 359–366. https://doi.org/10.1177/0020764018765237
Acquaye, H. E. (2017). PTSD, optimism, religious commitment, and growth as post-trauma trajectories: A structural equation modeling of former refugees. Professional Counselor, 7(4), 330–348. https://doi.org/10.15241/hea.7.4.330
African Union Commission. (2006). African Youth Charter. https://www.un.org/en/africa/osaa/pdf/au/african_youth_charter_2006.pdf
Anderson, C. A., Benjamin, A. J., Jr., Wood, P. K., & Bonacci, A. M. (2006). Development and testing of the Velicer attitudes toward violence scale: Evidence for a four-factor model. Aggressive Behavior: Official Journal of the International Society for Research on Aggression, 32(2), 122–136.
Augustinavicius, J. L., Greene, M. C., Lakin, D. P., & Tol, W. A. (2018). Monitoring and evaluation of mental health and psychosocial support programs in humanitarian settings: A scoping review of terminology and focus. Conflict and Health, 12(1), 9. https://doi.org/10.1186/s13031-018-0146-0
Barawi, K. S., Lewis, C., Simon, N., & Bisson, J. I. (2020). A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder. European Journal of Psychotraumatology, 11(1), 1774240. https://doi.org/10.1080/20008198.2020.1774240
Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of the effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health, 13(1), 835. https://doi.org/10.1186/1471-2458-13-835
Betancourt, T. S., Abdi, S., Ito, B., Lillenthal, G. M., Agalab, N., & Ellis, H. (2015). We left one war and came to another: Resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultural Diversity & Ethnic Minority Psychology, 21(1), 114–125. https://doi.org/10.1037/a0037538
Betancourt, T. S., Meyers-Ohki, M. S. E., Charrow, M. A. P., & Tol, W. A. (2013). Interventions for children affected by war: An ecological perspective on psychosocial support and mental health care. Harvard Review of Psychiatry, 21(2), 70–91. https://doi.org/10.1097/hrp.0b013e318283bf8f
Betancourt, T. S., Newnham, E. A., Brennan, R. T., Verdeli, H., Borisova, I., Neugebauer, R., Bass, J., & Bolton, P. (2012). Moderators of treatment effectiveness for war-affected youth with depression in northern Uganda. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 51(6), 544–550. https://doi.org/10.1016/j.jadohealth.2012.02.010
Bosqui, T. J., & Marshoud, B. (2018). Mechanisms of change for interventions aimed at improving the wellbeing, mental health and resilience of children and adolescents affected by war and armed conflict: A systematic review of reviews. Conflict and Health, 12(1), 15. https://doi.org/10.1186/s13031-018-0153-1
Brown, F. L., de Graaff, A. M., Annan, J., & Betancourt, T. S. (2017). Annual research review: Breaking cycles of violence—A systematic review and common practice elements analysis of psychosocial interventions for children and youth affected by armed conflict. Journal of Child Psychology and Psychiatry, 58(4), 507–524. https://doi.org/10.1111/jcpp.12671
Carlson, B. E., Cacciatore, J., & Klimek, B. (2012). A risk and resilience perspective on unaccompanied refugee minors. Social Work, 57(3), 259–269. https://doi.org/10.1093/sw/sws003
Catani, C., Kohiladevy, M., Ruf, M., Schauer, E., Elbert, T., & Neuner, F. (2009). Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka. BMC Psychiatry, 9, 22. https://doi.org/10.1186/1471-244x-9-22
Center for Victims of Torture. (2008). Education and support group for war trauma survivors: A manual for facilitators. Center for Victims of Torture.
Chibanda, D., Bowers, T., Verhey, R., Rusakaniko, S., Abas, M., Weiss, H. A., & Araya, R. (2015). The Friendship Bench programme: A cluster randomised controlled trial of a brief psychological intervention for common mental disorders delivered by lay health workers in Zimbabwe. International Journal of Mental Health Systems, 9(1), 21. https://doi.org/10.1186/s13033-015-0013-y
Conybeare, D., Behar, E., Solomon, A., Newman, M. G., & Borkovec, T. D. (2012). The PTSD Checklist-Civilian Version: Reliability, validity, and factor structure in a nonclinical sample. Journal of Clinical Psychology, 68(6), 699–713. https://doi.org/10.1002/jclp.21845
Davaasambuu, S., Hauwadhanasuk, T., Matsuo, H., & Szatmari, P. (2020). Effects of interventions to reduce adolescent depression in low-and middle-income countries: A systematic review and meta-analysis. Journal of Psychiatric Research, 123, 201–215. https://doi.org/10.1016/j.jpsychires.2020.01.020
Dawson, K. S., Bryant, R. A., Harper, M., Tay, A. K., Rahman, A., Schafer, A., & Van Ommeren, M. (2015). Problem Management Plus (PM+): A WHO transdiagnostic psychological intervention for common mental health problems. World Psychiatry, 14(3), 354. https://doi.org/10.1002/wps.20255
de Jong, J. T., & van Ommeren, M. (2002). Toward a culture-informed epidemiology: Combining qualitative and quantitative research in transcultural contexts. Transcultural Psychiatry, 39(4), 422–433. https://doi.org/10.1177/136346150203900402
Dickson, K., & Bangpan, M. (2018). What are the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies? A qualitative evidence synthesis. Global Mental Health. https://doi.org/10.1017/gmh.2018.12
Dybdahl, R. (2001). Children and mothers in war: An outcome study of a psychosocial intervention program. Child Development, 72(4), 1214–1230. https://doi.org/10.1111/1467-8624.00343
Ertl, V., Pfeiffer, A., Saile, R., Schauer, E., Elbert, T., & Neuner, F. (2011). Validation of a mental health assessment in an African conflict population. International Perspectives in Psychology: Research, Practice, Consultation, 1(S), 19–27. https://doi.org/10.1037/2157-3883.1.s.19
Gupta, L., & Zimmer, C. (2008). Psychosocial intervention for war-affected children in Sierra Leone. The British Journal of Psychiatry: The Journal of Mental Science, 192(3), 212–216. https://doi.org/10.1192/bjp.bp.107.038182
Halcón, L. L., Robertson, C. L., Savik, K., Johnson, D. R., Spring, M. A., Butcher, J. N., Westermeyer, J. J., & Jarranson, J. M. (2004). Trauma and coping in Somali and Oromo refugee youth. Journal of Adolescent Health, 35(1), 17–25. https://doi.org/10.1016/j.jadohealth.2003.08.005
Hamber, B., Gallagher, E., Weine, S., Agger, I., Bava, S., Gaborit, M., Murthy, R. S, & Saul, J. (2015). Exploring how context matters in addressing the impact of armed conflict. In B. Hamber & E. Gallagher (Eds.), Psychosocial perspectives on peacebuilding. Springer.
Haroz, E. E., Nguyen, A. J., Lee, C. I., Tol, W. A., Fine, S. L., & Bolton, P. (2020). What works in psychosocial programming in humanitarian contexts in low-and middle-income countries: A systematic review of the evidence. Intervention, 18(1), 3–17.
Herman, J. L. (1992). Trauma and recovery. Basic Books.
Hooberman, J., Rosenfeld, B., Rasmussen, A., & Keller, A. (2010). Resilience in trauma-exposed refugees: The moderating effect of coping style on resilience variables. American Journal of Orthopsychiatry, 80(4), 557–563. https://doi.org/10.1111/j.1939-0025.2010.01060.x
Human Rights Watch. (2013, May 29). “You are all terrorists”: Kenyan police abuse of refugees in Nairobi. https://www.hrw.org/report/2013/05/29/you-are-all-terrorists/kenyan-police-abuse-refugees-nairobi#
Human Rights Watch. (2014, March 26). Kenya: Plan to force 50,000 refugees into camps. https://www.hrw.org/news/2014/03/26/kenya-plan-force-50000-refugees-camps#
Ichikawa, M., Nakahara, S., & Wakai, S. (2006). Cross-cultural use of the predetermined scale cutoff points in refugee mental health research. Social Psychiatry and Psychiatric Epidemiology, 41(3), 248–250. https://doi.org/10.1007/s00127-005-0016-2
Im, H., Ferguson, A. B., Warsame, A. H., & Isse, M. M. (2017). Mental health risks and stressors faced by urban refugees: Perceived impacts of war and community adversities among Somali refugees in Nairobi. International Journal of Social Psychiatry, 63(8), 686–693.
Im, H., Jettner, J. F., Warsame, A. H., Isse, M. M., Khoury, D., & Ross, A. I. (2018). Trauma-informed psychoeducation for Somali refugee youth in urban Kenya: effects on PTSD and psychosocial outcomes. Journal of Child & Adolescent Trauma, 11(4), 431–441.
Im, H., Swan, L. E., Warsame, A. H., & Isse, M. M. (2020). Risk and protective factors for comorbidity of PTSD, depression, and anxiety among Somali refugees in Kenya. International Journal of Social Psychiatry. https://doi.org/10.1177/0020764020978685
Jakobsen, M., Meyer DeMott, M. A., & Heir, T. (2017). Validity of screening for psychiatric disorders in unaccompanied minor asylum seekers: Use of computer-based assessment. Transcultural Psychiatry, 54(5–6), 611–625. https://doi.org/10.1177/1363461517722868
Jakupcak, M., & Tull, M. T. (2005). Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men. Violence and Victims, 20(5), 589–598. https://doi.org/10.1891/088667005780927494
Jordans, M. J., Pigott, H., & Tol, W. A. (2016). Interventions for children affected by armed conflict: A systematic review of mental health and psychosocial support in low-and middle-income countries. Current Psychiatry Reports, 18(1), 9. https://doi.org/10.1007/s11920-015-0648-z
Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., Saxena, S., & Scheffler, R. M. (2011). Human resources for mental health care: Current situation and strategies for action. The Lancet, 378(9803), 1654–1663. https://doi.org/10.1016/s0140-6736(11)61093-3
Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M. J., Mutamba, B. B., Nadkarni, A., Pedersen, G., Singla, D., & Patel, V. (2018). The role of communities in mental health care in low-and middle-income countries: A meta-review of components and competencies. International Journal of Environmental Research and Public Health, 15(6), 1279. https://doi.org/10.3390/ijerph15061279
Kohrt, B. A., Rasmussen, A., Kaiser, B. N., Haroz, E. E., Maharjan, S. M., Mutamba, B. B., de Jong, J. T., & Hinton, D. E. (2014). Cultural concepts of distress and psychiatric disorders: Literature review and research recommendations for global mental health epidemiology. International Journal of Epidemiology, 43(2), 365–406. https://doi.org/10.1093/ije/dyt227
Kroo, A., & Nagy, H. (2011). Posttraumatic growth among traumatized Somali refugees in Hungary. Journal of Loss and Trauma, 16(5), 440–458. https://doi.org/10.1080/15325024.2011.575705
Lindley, A. (2007). Protracted displacement and remittances: The view from Eastleigh, Nairobi. The UN Refugee Agency. https://www.unhcr.org/en-us/research/working/46ea519d2/protracted-displacement-remittances-view-eastleigh-nairobi-anna-lindley.html?query=eastleigh
Milner, J. (2014). Protracted refugee situations. In E. Fiddian-Qasmiyeh, G. Loescher, K. Long, & N. Sigona (Eds.), The Oxford handbook of refugee and forced migration studies (pp. 151–162). Oxford University Press. https://doi.org/10.1093/oxfordhb/9780199652433.013.0038
Momartin, S., Silove, D., Manicavasagar, V., & Steel, Z. (2004). Comorbidity of PTSD and depression: Associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. Journal of Affective Disorders, 80, 231–238. https://doi.org/10.1016/S0165-0327(03)00131-9
Murray, L. K., Hall, B. J., Dorsey, S., Ugueto, A. M., Puffer, E. S., Sim, A., Ismael, A., Bass, C., Akiba, C., Lucid, L., Harrison, J., Erikson, A., & Bolton, P. A. (2018). An evaluation of a common elements treatment approach for youth in Somali refugee camps. Global Mental Health. https://doi.org/10.1017/gmh.2018.7
Nickerson, A., Bryant, R. A., Silove, D., & Steel, Z. (2011). A critical review of psychological treatments for posttraumatic stress disorder. Clinical Psychology Review, 31, 399–417. https://doi.org/10.1016/j.cpr.2010.10.004
Nickerson, A., Schick, M., Schnyder, U., Bryant, R. A., & Morina, N. (2017). Comorbidity of posttraumatic stress disorder in tortured, treatment-seeking refugees. Journal of Traumatic Stress, 30, 409–415. https://doi.org/10.1002/jts.22205
Nocon, A., Eberle-Sejari, R., Unterhitzenberger, J., & Rosner, R. (2017). The effectiveness of psychosocial interventions in war-traumatized refugee and internally displaced minors: Systematic review and meta-analysis. European Journal of Psychotraumatology, 8(sup2), 1388709. https://doi.org/10.1080/20008198.2017.1388709
O’Sullivan, C., Bosqui, T., & Shannon, C. (2016). Psychological interventions for children and young people affected by armed conflict or political violence: A systematic literature review. Intervention, 14(2), 142–164. https://doi.org/10.1097/wtf.0000000000000110
Pacione, L., Measham, T., & Rousseau, C. (2013). Refugee children: Mental health and effective interventions. Current Psychiatry Reports, 15(2), 341. https://doi.org/10.1007/s11920-012-0341-4
Pfeiffer, E., & Goldbeck, L. (2017). Evaluation of a trauma-focused group intervention for unaccompanied young refugees: A pilot study. Journal of Traumatic Stress, 30(5), 531–536. https://doi.org/10.1002/jts.22218
Pfeiffer, E., Sachser, C., Tutus, D., Fegert, J. M., & Plener, P. L. (2019). Trauma-focused group intervention for unaccompanied young refugees: “Mein Weg”—Predictors of treatment outcomes and sustainability of treatment effects. Child and Adolescent Psychiatry and Mental Health, 13(1), 18. https://doi.org/10.1186/s13034-019-0277-0
Purgato, M., Tedeschi, F., Betancourt, T. S., Bolton, P., Bonetto, C., Gastaldon, C., Gordon, J., O’Callaghan, P., Papola, D., Peltonen, K., Punamaki, R., Richards, J., Staples, J. K., Unterhitzenberger, J., de Jong, J., Jordans, M. J. D., Gross, A. L., Tol, W. A., & Barbui, C. (2020). Mediators of focused psychosocial support interventions for children in low-resource humanitarian settings: Analysis from an Individual Participant Dataset with 3,143 participants. Journal of Child Psychology and Psychiatry, 61(5), 584–593. https://doi.org/10.1111/jcpp.13151
Reed, R. V., Fazel, M., Jones, L., Panter-Brick, C., & Stein, A. (2012). Mental health of displaced and refugee children resettled in low-income and middle-income countries: Risk and protective factors. The Lancet, 379, 250–265. https://doi.org/10.1016/S0140-6736(11)60050-0
Robertson, C. L., Halcon, L., Savik, K., Johnson, D., Spring, M., Butcher, J., Westermeyer, J., & Jaranson, J. (2006). Somali and Oromo refugee women: Trauma and associated factors. Journal of Advanced Nursing, 56(6), 577–587. https://doi.org/10.1111/j.1365-2648.2006.04057.x
Scharpf, F., Kaltenbach, E., Nickerson, A., & Hecker, T. (2020). A systematic review of socio-ecological factors contributing to risk and protection of the mental health of refugee children and adolescents. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2020.101930
Schauer, E. (2008). Trauma treatment for children in war: Build-up of an evidence-based large-scale mental health intervention in north-eastern Sri Lanka (Thesis). University of Konstanz.
Shehadeh, M. H., Heim, E., Chowdhary, N., Maercker, A., & Albanese, E. (2016). Cultural adaptation of minimally guided interventions for common mental disorders: A systematic review and meta-analysis. JMIR Mental Health, 3(3), e44. https://doi.org/10.2196/mental.5776
Stammel, N., Knaevelsrud, C., Schock, K., Walther, L. C., Wenk-Ansohn, M., & Böttche, M. (2017). Multidisciplinary treatment for traumatized refugees in a naturalistic setting: Symptom courses and predictors. European Journal of Psychotraumatology, 8(sup2), 1377552. https://doi.org/10.1080/20008198.2017.1377552
Starkey, M. T., Lee, H. K., Tu, C. C., Netland, J., Goh, M., Schuchman, D. M., & Yusuf, A. (2008). “Only Allah can heal”: A cultural formulation of the psychological, religious, and cultural experiences of a Somali man. Journal of Muslim Mental Health, 3(2), 145–153. https://doi.org/10.1080/15564900802487550
Thompson, B. L., & Waltz, J. (2010). Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. Journal of Anxiety Disorders, 24(4), 409–415. https://doi.org/10.1016/j.janxdis.2010.02.005
Tol, W. A., Komproe, I. H., Jordans, M. J. D., Vallipuram, A., Sipsma, H., Sivayokan, S., Macy, R. D., & de Jong, J. T. (2012). Outcomes and moderators of a preventive school-based mental health intervention for children affected by war in Sri Lanka: A cluster randomized trial. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 11(2), 114–122. https://doi.org/10.1016/j.wpsyc.2012.05.008
Tol, W. A., Song, S., & Jordans, M. J. (2013). Annual research review: Resilience and mental health in children and adolescents living in areas of armed conflict—A systematic review of findings in low- and middle-income countries. Journal of Child Psychology and Psychiatry, 54(4), 445–460. https://doi.org/10.1111/jcpp.12053
Ungar, M. (2011). The social ecology of resilience: Addressing contextual and cultural ambiguity of a nascent construct. American Journal of Orthopsychiatry, 81(1), 1–17.
Uppendahl, J. R., Alozkan-Sever, C., Cuijpers, P., de Vries, R., & Sijbrandij, M. (2019). Psychological and psychosocial interventions for PTSD, depression and anxiety among children and adolescents in low-and middle-income countries: A meta-analysis. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2019.00933
van Wyk, S., & Schweitzer, R. D. (2014). A systematic review of naturalistic interventions in refugee populations. Journal of Immigrant Minority Health, 16, 968–977. https://doi.org/10.1007/s10903-013-9835-3
Weissbecker, I., Hanna, F., El Shazly, M., Gao, J., & Ventevogel, P. (2019). Integrative mental health and psychosocial support interventions for refugees in humanitarian crisis settings. In An uncertain safety (pp. 117–153). Springer. https://doi.org/10.1007/978-3-319-72914-5_6
Wilhelm, A. K., McRee, A. L., Bonilla, Z. E., & Eisenberg, M. E. (2018). Mental health in Somali youth in the United States: The role of protective factors in preventing depressive symptoms, suicidality, and self-injury. Ethnicity & Health. https://doi.org/10.1080/13557858.2018.1514451
Wind, T. R., van der Aa, N., de la Rie, S., & Knipscheer, J. (2017). The assessment of psychopathology among traumatized refugees: Measurement invariance of the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 across five linguistic groups. European Journal of Psychotraumatology, 8, 1–11. https://doi.org/10.1080/20008198.2017.1321357
Yeomans, P. D., Forman, E. M., Herbert, J. D., & Yuen, E. (2010). A randomized trial of a reconciliation workshop with and without PTSD psychoeducation in Burundian sample. Journal of Traumatic Stress, 23(3), 305–312. https://doi.org/10.1002/jts.20531
Yotebieng, K. A., Syvertsen, J. L., & Kum Awah, P. (2019). Cessation clauses, uncertain futures and wellbeing among Rwandan urban refugees in Cameroon. Journal of Refugee Studies, 32(3), 436–455. https://doi.org/10.1093/jrs/fey037
Acknowledgements
The authors wish to thank Somali refugee community leaders and participants of this study in Eastleigh, Kenya. This research is indebted to generous support from Tawakal Medical Centre (TMC) and USAID—Kenya Transitional Initiative (KTI).
Funding
The intervention was supported by the Kenya Transitional Initiative, USAID (CHXEAS053).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical Approval
This study was approved by IRB approval from the authors’ institution. In addition, the research protocol and materials were reviewed and approved by a locally formed community ethics committee that comprises of Somali community leaders and medical professionals. All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Im, H., Swan, L.E.T. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 58, 1179–1190 (2022). https://doi.org/10.1007/s10597-021-00928-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-021-00928-0