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Mental disorders among Somali refugees: developing culturally appropriate measures and assessing socio-cultural risk factors.

BACKGROUND
There are few mental health data for Somali people. This is due to the absence of culturally validated appropriate assessment instruments and methodological challenges. We aimed to develop a culturally appropriate instrument, and address the methodological challenges and assess some risk factors for mental disorder among Somalis in London.


METHODS
Following a comprehensive process of cultural adaptation of the MINI Neuropsychiatric Interview, we assessed ICD-10 mental disorders among 143 Somalis recruited from GP registers and community sites. Associations with demographic and economic characteristics, sampling venues, cultural and migration related risk factors are reported.


RESULTS
A higher risk of mental disorders was found among Somalis who used Khat (OR = 10.5, 1.1-98.3) claimed asylum at entry to the UK (OR = 12.8, 2-81.4) and recruits from primary care rather than from community sites (OR = 5.9, 1.4-25.8). A lower risk of mental disorders was found amongst Somalis in employment (OR = 0.03, 0.01-0.61), and those receiving education in the UK and in Somalia (OR = 0.13, 0.02-0.92). Over a third of subjects had any mental disorder (36.4%, 28.4-44.4), mainly common mental disorders (CMD) (33.8%, 26-41.5) and post-traumatic stress disorder (PTSD) (14%, 8.8-20.8). CMD were found among 80% of those with PTSD.


CONCLUSION
Public health interventions for Somalis should focus on CMD as well as PTSD, khat use and mental health screening for suicide risk and mental disorders on arrival.