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Psychoses, PTSD, and depression in Somali refugees in Minnesota

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Introduction

Initial clinical observation of Somali patients seen at a busy inner-city community clinic (CUHCC) suggested that, in addition to the expected pictures of Posttraumatic Stress Disorder (PTSD) and depression previously seen in the clinic’s Southeast Asian refugee population from 1980 to 2000, there was an unusually high number of young Somali men presenting with acute psychotic disturbances.

Objectives

The aim of this study of health care utilization of Somali refugees (N = 600) seen in the mental health unit of the clinic from 2001 to 2009 was to investigate the major patterns of psychiatric disorders in this outpatient population and compare these findings with a cohort of non-Somali patients (N = 3,009) seen at the same outpatient clinic during the years 2007–2009. If the results supported the initial clinical observations that the rate of psychoses was higher among young Somali men than non-Somali men attending CUHCC clinic, then several areas of further research would recommend itself. First, since this study was not a study of prevalence of mental illness in the Somali community, the next step would be to undertake a study of community prevalence of mental illness among different age and gender cohorts. Second, further research should look into likely causative and contributory risk factors to explain the development of psychoses among Somali young men.

Methods

Somali and non-Somali patients were diagnosed according to DSM-IV-R criteria. Main outcome measures (diagnoses, age cohort, sex) were analyzed by Chi-square tests. Patterns of illness and adjustment varied significantly by age and gender cohorts, reflecting the relevance of age and gender at time of trauma on different trauma and loss experiences and cultural and religious shaping of subsequent adjustment and symptoms.

Results

The study confirmed that almost half of the Somali male patients are under age 30, 80% of whom presented with psychoses, compared with the rate of psychosis (13.7%) in the non-Somali control group of same-aged males at the clinic. The older male, and the majority of Somali female patients, show predominantly depressive and PTSD symptomatology.

Conclusions

War trauma experienced in childhood, early malnutrition from famines, head trauma, and excess Khat use in male adolescents provide partial explanations for the large number of young psychotic Somali men seen in the clinic from 2001 to 2009.

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Acknowledgments

This study was approved by the IRB Human Subjects Committee of the University of Minnesota Medical School. Dr. Fujiwara was supported in part by shared resources through the NIDA grant R21DA024626 (Khat Research Program: Neurobehavioral Impact of Long-Term Use; PI: Mustafa al’Absi). The authors thank Auke Tellegen, Ph.D. and Mustafa al’Absi, Ph.D. for discussion and analysis of the manuscript, Essa Hassan, Awo Qasim, Aisha Mohamed, Tahir Hassan, and Abdulahi Mohamed for dedicated involvement in this project and in the care of their patients at all times, and Amy Shellabarger for organizing the data retrieval of the control group.

Conflict of interest statement

The authors report no conflict of interest in this research project.

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Authors and Affiliations

  1. Community-University Health Care Clinic, University of Minnesota Medical School, 2001 Bloomington Avenue South, Minneapolis, MN, 55404, USA

    Jerome Kroll & Ahmed Ismail Yusuf

  2. Duluth Medical Research Institute, University of Minnesota Medical School, Duluth, MN, USA

    Koji Fujiwara

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  1. Jerome Kroll
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Correspondence to Jerome Kroll.

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Kroll, J., Yusuf, A.I. & Fujiwara, K. Psychoses, PTSD, and depression in Somali refugees in Minnesota. Soc Psychiatry Psychiatr Epidemiol 46, 481–493 (2011). https://doi.org/10.1007/s00127-010-0216-0

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