Somali Depression Profile METHODS:
Written by: Christine Perez, MD
Reviewed by: Mohamed Ali Roble
Interpreters and healthcare providers who work with Somali patients were recruited to help learn about depression in the Somali community. All interviews were one-on-one except for one focus group of interpreters. In total, two health care providers and five interpreters were interviewed regarding their knowledge of this topic including common beliefs, traditional treatments, and advice for other healthcare providers. The profile was then reviewed by Refugee and Immigrant Health Promotion Program staff, including Carey Jackson, MD, director of the International Medicine Clinic at Harborview Medical Center, Seattle. A Somali community leader/educator and a consulting psychiatrist of the International Medicine Clinic then did further review. EPIDEMIOLOGY:
It is established that an average of more than 50% of refugees present mental health problems ranging from chronic mental disorders to trauma, distress and great deal of suffering. CLINICAL FEATURES:
In Somalia, mental state is divided into two categories: the mentally ill and the mentally healthy. Some may call the groups sane and insane. There is no continuum of mental illness as there is in the United States. There is still a major stigma and shame associated with mental illness. For this reason, this illness is often hidden from family, friends, and physicians. The general belief is that once a person has depression or another mental illness, s/he will never get back to their mentally healthy baseline. Some say their mental stability can never be trusted again.
Many Somalis believe depression was not a serious issue in the health of the Somali population in Somalia or that it did not exist there until the start of the civil war in the 1990s. Others believe it existed but was not recognized or treated. With war came relocation, refugee camps, malnutrition, trauma, and death. Their clan-based and family centered society was largely destroyed, as many people were killed and/or separated from their families, lacked financial support and were forced to adapt life from a nomadic society to Western society. For these reasons, their social support was greatly disrupted. It is believed that as a result of all these changes, people started experiencing depression.
Causes of sadness or depression include separation from family, loss of community and country, trauma including rape and torture, guilt from survival, economic hardships, housing instability, and assimilation difficulties including language and work.
In the US, parents are also finding they have lost their power in their family, as they often have to rely on their English-speaking children to translate, pay the bills, and generally help them get along in their new country. In addition, the Americanization of their school-going children is also a big source of worry, as their children are taking part in behaviors and beliefs not supported by their parents.
In Somalia it is commonly accepted that parents discipline their children in a more physical manner that what is acceptable in the United States. As a result parents are finding it difficult to discipline their children.
Many Somali feel that depression and other forms of mental illness are not a problem until it begins to interfere with their daily lives. For this reason, Somalis exhibiting crying spells and some trouble sleeping will not seek any help if they are able to carry on their responsibilities. Consequently, not functioning well is a sign of depression. This can include not eating, sleeping, interacting, concentrating, or taking care of family and children and staying at home. Patients will complain of being tired, not functioning well and various somatic complaints. Common somatic complaints include headaches, abdominal pain, and general body aches.
The Somalis are deeply religious, and the Muslim faith greatly affects their response to traumas and sadness. Firstly, they often see traumas as “God's will.” They are chosen by Allah to deal with these traumas. Secondly, the Koran states that a person who commits suicide will go to hell. As a result, it is believed that suicide ideation and suicide attempts happen less frequently than we see in the general population.
To be continued.....