Investing in mental health in Somalia: harnessing community mental health services through task shifting

Medical Returnees: Somali Canadians Seeking Psychosocial and Spiritual Care in East Africa

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.

The unmet need for mental health support among persons with disabilities in Somalia: Principal correlates and barriers to access

Disability and mental ill-health may be especially prevalent in Somalia, largely due to a protracted armed conflict and its consequent humanitarian crises. Little, if any, research to date, however, has simultaneously explored disability- and mental health-related factors in the Somali context. Using both descriptive and regression analytical techniques, we aimed to determine how increasing levels of functional impairment reported across different disability domains (i.e., visual, hearing and cognition), number of concomitant disabilities, and other empirically supported variables (such as employment and sex) are associated with the likelihood of self-identifying the need for mental health support among a sample (N = 1,355) of Somalis with disabilities, as well as identify the common barriers to such support. Despite most participants self-identifying a need for mental health support, only 15% were able to access it, with the most common barriers being the cost of services and the unavailability of local services. Being female, married, and having increasing levels of functional difficulty in the cognitive, mobility and self-care domains of disability were each significantly associated with an increased likelihood of the self-identified need for mental health support. This study's findings highlight potential points of prioritisation for mental health policy and programming in Somalia. A Somali version of this abstract can be found in the Supplementary Material.

Prevalence of mental disorders and psychological trauma among conflict- affected population in Somalia: a cross-sectional study

Background

Despite the longstanding psychosocial impact of the interactable conflict in Somalia for the last 30 years, there is lack of epidemiological studies of mental health conditions, especially at the population level.

Objectives

The aim of this study is to fill the epidemiological gap and provide population based data on mental health conditions in the South-Central region of Somalia. The specific objectives were: (1) To determine the epidemiological patterns of mental disorders in three sites; Baidoa, Dolow and Kismayo, (2) Understand the socio-demographic characteristics associated with mental health conditions in the study sites, and (3) To assess the correlates between psychological trauma and the mental wellbeing of the population.

Methods

This was a cross-sectional study of 713 respondents recruited from the three sites namely Dolow, Baidoa and Kismayo. Data on sociodemographic characteristics and mental disorders were collected using the MINI and sociodemographic questionnaire. Basic descriptive statistics were used to summarize sociodemographic characteristics. Univariable and multivariable logistic regressions were used to examine factors associated with common mental disorders. Statistical significance was considered at a value of p <0.05.

Results

Participants' mean age was 32.6 (±10.7) years. More than half (58.5%) of the respondents were male. The overall prevalence of common mental disorders was 557 (78.1%) with panic disorder (39.3%), generalized anxiety disorders (34.9%), major depressive episode current (32.1) and PTSD (29.9%). According to the multivariable logistic regression analysis, being male AOR = 1.74 (95%CI = 1.25, 2.42), having a family size of more than 10 members AOR =1.37 (95% CI = 1.00, 1.89), being unemployed AOR = 1.90 (95%CI = 1.18, 3.06), experienced starvation AOR =3.46 (95%CI = 2.23, 5.37), khat use AOR = 5.87 (955 CI, 1.75-19.65), were identified as predicting factors for the common mental disorders among the study participants.

Conclusion

There is a high prevalence of mental disorders with anxiety disorders being the commonest. Findings reflect earlier studies that showed higher rates in conflict and post-conflict settings. It also aligns with past studies in Somalia. As such, there is an urgent need to integrate mental health and psychosocial support within the primary healthcare and other service sectors such as education considering the vast majority of the population are young.

COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: impact on livelihood, food security and mental health

BACKGROUND

Somalia has over 2.6 million internally displaced people (IDP) that depend on daily wages and humanitarian assistance for their livelihoods. This study investigated the impact of COVID-19 on livelihoods, food security and mental health of Somalia's IDPs.

METHODS

A questionnaire was conducted with "breadwinners" (n = 585) residing in 15 randomly selected IDP camps. Mental health was assessed using the 5-item World Health Organization Wellbeing Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect of depressive symptoms on soap use and ability to pay for food/medicine/rent.

RESULTS

Knowledge of COVID-19 symptoms, transmission and prevention was relatively high, however only 55% reported using soap for hand washing. Around one third perceived that prohibition of public gatherings had negatively impacted weekly earnings. Participants reported difficulty buying food (85%), medicine (82%) and paying rent (51%) because of COVID-19. The majority were assessed as having low wellbeing and high depressive symptoms (mean WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they felt worse than before the pandemic. Compared to people with low depressive symptoms, people with high depressive symptoms were less likely to use soap (aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02).

CONCLUSION

COVID-19 and associated restrictions have negatively impacted Somalia's internally displaced population. Livelihood and mental health support is urgently needed in the recovery phase of the pandemic and should be factored into future pandemic planning.