Winter 2020 Issue
Authors: Aaliyah Joseph, BA; Brynn Sheehan, PhD; Lydia Cleveland, MPH; Ibrahim Maroof, MPH; Alexandra Leader, MD, MPH
Eastern Virginia Medical School
Background: How do you define “culture”? Some will refer to the food, clothing, or music that differentiates one group of people from another. However, culture also distinguishes us in ways that aren’t so tangible. It affects our self-expression, the way we interact with others, and how we view the world and ourselves. Studies show that one’s culture also influences the way one discusses her/his mental illness. Specifically, individuals from collectivist cultures - cultures that emphasize conformity and group cohesion, such as those from Afghanistan and Syria - have been shown to endorse more somatic than psychological symptoms when discussing mental illness in healthcare settings. Lack of awareness of such cultural differences can lead to misdiagnosis, mistrust, a break in the patient-physician relationship, and poor health outcomes for the patient.
This phenomenon inspired my research project, which tested if having origins in a collectivist culture influenced the endorsement of more somatic symptoms vs. psychological symptoms among adult refugees in Hampton Roads, VA. Cultural differences are important to be mindful of during any patient encounter, but they become especially important when working with groups such as refugees who are at a higher risk of developing mental illnesses such as depression, anxiety, and PTSD compared to the general population.
Method: A retrospective study was conducted on 497 individuals who recently immigrated to Hampton Roads, VA and completed the Refugee Health Screener-15 (RHS-15). All participants were from countries that are traditionally collectivist. Analyses were conducted to assess whether somatic or psychological symptoms are experienced more frequently, the association between both types of symptoms, and whether individuals from different countries endorse similar somatic and psychological symptoms.
Results: A paired-samples t-test revealed that more psychological symptoms (M= 0.77, SD = 0.77) were reported than somatic symptoms (M = 0.68, SD = 0.82), t = -3.59, p <.0001. A strong positive association (χ2 (1) = 49.65, p <.0001) was found between psychological and somatic symptoms, suggesting that endorsing one type of symptom was associated with endorsing the other type of symptom. Individuals from three of the four most represented countries in the sample shared the most reported symptom, “too much thinking/too many thoughts”, which is a diagnostic proxy for depression on the RHS-15 scale.
Conclusion: Contrary to study predictions, findings suggest that refugees in this sample do not present more somatic symptoms but rather present more psychological symptoms associated with mental illness, with both symptom types being reported concurrently rather than independently. These results suggest that somatic symptoms don’t serve as an independent marker for mental illness in this population. Furthermore, the endorsement of the same depressive symptom among refugees from different countries highlights the need to expand research to better understand the contributing factors. This understanding is important for clinical practice among the growing refugee population in Virginia.
February 19-20, 2021
Hilton Downtown Richmond
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