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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

Clinical Encounters with refugees suffering from mental health problems

Alternative title: Kliniske møter med flyktninger som har psykiske helseplager

Awarded: NOK 11.1 mill.

Many refugees coming to Norway suffer from mental health problems due to stressful experiences before, during, and after the flight. Refugees, particularly from certain areas, tend to underutilize specialized mental health services relative to the majority population. The project?s main objective is to build a research-based platform to tailor mental health services to meet the needs of refugees and guide social and policy actions. Specifically, the project will provide knowledge about mechanisms impacting their access and use of mental health services, focusing on the General Practitioner (GP). The first subproject examines how refugees from Syria, Afghanistan, and Somalia understand and prefer to manage mental health problems, preferred help-seeking sources, and their experiences with GPs. This part consists of focus group interviews (N=58, 13 groups) and surveys (N= ca 450). Participants were presented with a vignette describing a man/female (gender-matched to respondent) with symptoms of depression or post-traumatic stress disorder (PTSD) based on criteria in DSM and ICD, and the respondent answered questions with reference to this fictive person about possible explanations for the condition and appropriate coping mechanisms. The results suggest that PTSD tended to be regarded as a normal reaction to extreme experiences common to most refugees, and clearly different from ?being crazy?. Afghan women diverged from the other groups in that they more often linked PTSD with domestic violence, and social control. In all refugee groups, depression was often attributed to conditions after settling in Norway, centering around social isolation, uncertainty, loss of social network, and integration difficulties (including problems entering the job market). Additionally, spiritual explanations were highlighted by the Somali refugees. Men emphasized problems with integration in Norwegian society as the main explanation for mental health problems. In all groups, the majority preferred to first seek help/advice from parents/partners in the event of mental health problems and that their point of view is given great weight regarding further help-seeking from public health services. Analyzes of survey data from Syrian refugees (N = 92) show that God / Alla was ranked first, followed by mother, and partner as sources of help. The most significant barriers to seeking help from a GP were language problems, experienced long waiting times, that it would not help and that the GP would not understand. Social integration and perceived belonging to Norwegian society were related to the experience of the GP as a good source of help. Many participants pointed out the possible value of treatment from psychologists and the importance of the psychologists themselves having a refugee/immigrant background. Beyond the mentioned common features, the results show variations in explanatory models and coping/help-seeking based on gender, generation, country of origin, rural/urban origin, and Norway vs. country of origin. The second subproject focused on the clinical consultation between GPs and refugee patients and the possible implications of the patients? background (native-born vs. refugee) and gender for diagnosis, recommended treatment, and reference to specialist health services. Interviews with GPs (N=15) were conducted to examine their experiences with conditions that hinder or facilitate judgments about diagnosis and treatments of this patient group. Interviews were analyzed thematically. The main challenges presented by GPs related to language barriers, mismatched expectations, different understandings of health and illness, and the GP feeling unprepared to work with this patient group. The main facilitating themes related to establishing trust and finding the work meaningful. The next step of the second sub-project was an ongoing online, experimental study consisting of film clips with patients (differing in ethnicity and gender) presenting mental health problems. Following watching the film clips GP were asked about diagnostic and treatment evaluations as well as their feelings of confidence in their clinical judgments. The GPs were randomized into four groups that are presented with patients presenting the same symptoms but varying in gender (male, female) and background (Norwegian, refugee). Findings suggested somewhat less consensus among GPs regarding the first prioritized diagnosis for Somali characters vs. Norwegian characters. GPs also endorsed sick leave more often for the Norwegian than thee the Somali characters. The latter also received PTSD diagnoses where Norwegian characters did not. There were, however, no substantial differences in GPs? self-reported uncertainty regarding the Somali vs. Norwegian vignette characters. The results from the project will be integrated into an interactive web-based training program for GPs and health professionals working with public mental health services.

Providing efficient mental health services for an increasing refugee population represents a challenge for the Norwegian society. Statistics show large differences between immigrants and natives in contact with specialist mental health services, with noticeably low use among immigrants from Somalia and Asia. This project aims to build a research-based platform to enhance and tailor mental health services to meet the needs of refugees. Specifically, it will provide knowledge about mechanisms impacting their access and use of mental health services, with a focus on the general practitioner (GP). The project will include two parts. Essential to the first part is building more research-based knowledge on how refugees interpret and prefer to cope with mental health problems, including their experience with public health services. Refugees from Somalia, Syria and Afghanistan will participate in focus-group interviews and a survey in which they are introduced to a vignette character with symptoms of depression or PTSD, and asked about efficient coping strategies and help-seeking behaviour. The second project part will examine how mental health problems presented by refugee patients are perceived, diagnosed, and handled by GPs. Focus-group interviews with GPs will assess frequently occurring challenges experienced in medical encounters with refugee patients. Next, we will produce video films of patients (case stories) with symptoms of post-traumatic stress disorders or depression, based on the narratives from the interviews and the survey. For each patient, GP?s will fill out questionnaires on diagnosis, recommended therapy, referral to mental health services, sickness leave, and medications. The project will also evaluate the potential impact of patient?s gender and background (refugee vs. native-born) on GPs? judgments. The results will be integrated into training programs for GPs and other health care professions, thus strengthening the foundation for knowledge-based practice.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester