Explanatory models of post-traumatic stress disorder (PTSD) and depression among Afghan refugees in Norway.

BACKGROUND: The current situation in Afghanistan makes it likely that we are facing a new wave of Afghan refugees, warranting more knowledge about how to deal with mental health problems among them. This study aims to gain more knowledge on Explanatory Models (EM) of depression and post-traumatic stress disorders (PTSD) among Afghan refugees resettled in Norway. METHODS: We conducted six gender-separated, semi-structured focusgroup interviews based on vignettes with Afghan refugees (total N = 27). The vignettes described a fictional character with symptoms of either depression or PTSD symptoms in line with DSM-5 and ICD-10 criteria. RESULTS: The findings showed that EM varied with gender, age, generation, and migration stories. Participants suggested different potential causes, risk factors, and ways of managing symptoms of depression and PTSD depending on the context (e.g., in Norway vs. Afghanistan). In describing the causes of the depression/PTSD in the vignettes, females tended to emphasize domestic problems and gender issues while males focused more on acculturation challenges. The younger males discussed mostly traumatic experiences before and during flight as possible causes. CONCLUSION: The practice of condensing a single set of EMs within a group may not only be analytically challenging in a time-pressed clinical setting but also misleading. Rather, we advocate asking empathic questions and roughly mapping individual refugee patients' perceptions on causes and treatment as a better starting point for building trusting relationships and inviting patients to share and put into practice their expertise about their own lives.

What Do Immigrants From Various Cultures Think Is the Best Way to Cope With Depression? Introducing the Cross-Cultural Coping Inventory.

The aim of this study is to introduce a domain-specific instrument, the Cross-Cultural Depression Coping Inventory (CCD-CI), to assess ways in which people from different cultures prefer to cope with depression. Part 1 of this paper describes the development of CCD-CI. A combined etic and emic approach in generating items was used. Principal component analysis on data from a heterogeneous sample of immigrants (N = 458) supported a three-factor solution labeled: Engagement, disengagement, and spiritual coping. In Part 2 confirmatory factor analysis were conducted to test if the factors replicated in a mixed ethnic sample of immigrants from Russia (n = 164), Poland (n = 127), Pakistan (n = 128), Somalia (n = 114), and Norwegian students (n = 248). The three-factor model fits the data well and differentiated between the ethnic groups. Most significantly, Somali followed by the Pakistani immigrants scored higher on disengagement and spiritual coping. Inspection of item-level differences showed the largest ethnic variations in coping behavior of communal or social nature. The CCD-CI factors were validated against the Vancouver Index of Acculturation. Adoption to majority culture correlated positively with engagement and negatively with spiritual Coping. Maintenance of origin culture was positively associated with both spiritual coping and disengagement. In Part 3 the construct validity of the CCD-CI was tested in relation to the Brief Cope. The magnitude of the correlations was small to moderate. Taken together results indicate that CCD-CI is a reliable and valid measure of coping strategies related to depression, suitable for adults from different ethnic groups. Implications for research and clinical practice are discussed.

Immigration, acculturation, and preferred help-seeking sources for depression: comparison of five ethnic groups.

BACKGROUND: Immigrants are more likely than the majority population to have unmet needs for public mental health services. This study aims to understand potential ethnic differences in preferred help-seeking sources for depression in Norway, and how such preferences relate to acculturation orientation. METHODS: A convenience sample of immigrants from Russia (n = 164), Poland (n = 127), Pakistan (n = 128), and Somalia (n = 114), and Norwegian students (n = 250) completed a survey. The sample was recruited from social media platforms, emails, and direct contact. The survey consisted of a vignette describing a moderately depressed person. Respondents were asked to provide advice to the person by completing a modified version of the General Help-Seeking Questionnaire. The immigrant sample also responded to questions about acculturation orientation using the Vancouver Index of Acculturation Scale. RESULTS: Significant differences were found in the endorsement of traditional (e.g., religious leader), informal (e.g., family), and semiformal (e.g., internet forum) help-sources between immigrant groups, and between immigrant groups and the Norwegian respondent group. Immigrants from Pakistan and Somalia endorsed traditional help sources to a greater extent than immigrants from Russia and Poland, and the Norwegian student sample. There were no ethnic differences in endorsement of formal mental help sources (e.g., a medical doctor). Maintenance of the culture of origin as the acculturation orientation was associated with preferences for traditional and informal help sources, while the adoption of mainstream culture was associated with semiformal and formal help-seeking sources. CONCLUSION: Ethnic differences in help-seeking sources need to be considered when designing and implementing mental health services.

Lay Explanatory Models of Depression and Preferred Coping Strategies among Somali Refugees in Norway. A Mixed-Method Study.

Objective: Refugees are at high risk of experiencing mental health problems due to trauma in their pasts and to acculturation stress as they settle in a new country. To develop efficient health services that meet the needs of refugees from different regions, an understanding is required of how they make sense of and prefer to cope with mental health problems. This study aims to investigate lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. Methods: The study used a mixed-method design with a vignette describing a moderately depressed person based on ICD-10 criteria. Firstly, a survey study was performed among Somali refugees (n = 101). Respondents were asked to give advice to the vignette character and complete the Cross-Cultural Depression Coping Inventory and the General Help-Seeking Questionnaire. Secondly, focus group interviews (n = 10) were conducted separately with males and females to examine the relationship between the explanatory models of depression and the preferred coping strategies. Results: The participants showed a strong preference for coping with depression by religious practices and reliance on family, friends, and their ethnic/religious community, rather than by seeking professional treatment from public health services (e.g., medical doctors, psychologists). Depressive symptoms were conceptualized as a problem related to cognition (thinking too much) and emotion (sadness), but not to biological mechanisms, and they were thought to result from spiritual possession, stress as a result of social isolation, and/or past trauma. Independently of time in exile, the participants showed a strong identification with their ethnic origin and associated values. Because participants emphasized the need to obey and follow the views of elders, fathers, and spiritual leaders, these authorities seemed to be "gatekeepers" for access to mental health services. Conclusion: The results highlight that mental health programs for Somali refugees should actively involve the ethnic community, including spiritual leaders, in order to reach patients in need and to foster treatment compliance.