This study will identify improved pathways to mental health care for Somali women, a vulnerable population of refugee and immigrant women in the United States historically unengaged in mental health services. The World Health Organization?s 2016 guidelines on female genital cutting/mutilation (FGC/M), practiced in Somalia nearly universally, strongly encourage research on psychological wellbeing in this population. Somali women are at risk for mental distress given their histories of trauma, yet rarely seek services. There is a significant unmet need in the population. The parent study of this project, funded by the United States Department of Health and Human Services Office of Women?s Health, aims to increase health services to women affected by FGC/M. This NRSA pre-doctoral study is a sequential mixed methods design to specifically address mental health issues. The study is community-based, in line with NIMH objectives to establish partnerships with key stakeholders. First, a secondary analysis of cross-sectional quantitative data from over 2,000 Somali women living in Arizona will be completed. Data includes the Refugee Health Screen 15 (RHS- 15), a widely used screener for mental distress. In refugee clinics and agencies, a positive screen is followed by referral to mental services, however, this system has proven inadequate to usher Somali women to care. Validation of the RHS-15 will include factor analysis and examination of external construct validity. Further, the prevalence of positive mental health screens will be captured along with multivariate statistics to explore factors related to mental distress and care seeking. Next, community forums and focus groups will discuss the findings of the survey in order to provide qualitative explanatory data as well as additional information on mental health and medical decision making. Discourse analysis, an underutilized tool in global mental health research, will be used to analyze the results, exploring how varying discourses in women?s social environments impact their mental health and care seeking.
The final aim will use the results of aim 1 and 2 to create an ethics-based intervention strategy. This will be accomplished by creating a set of ethical considerations based on known ethical frameworks as well as the community?s own ethical dialogue and reconciling these considerations against evidence based solutions. This final strategy will be communicated to existing agencies and service providers working in the Somali community. The NIMH is devoted to the development of strategies to make evidence-based practices available, deliverable, effective and scalable in non-specialty settings where significant unmet needs exist. This research is also responsive to the NIMH objective to suggest improvements to the efficiency and effectiveness of existing systems. Ms. Michlig?s work has focused on outreach, engagement and adherence to health services among vulnerable groups and she hopes to continue collaboration with the NIMH to create innovative intervention strategies for diverse, hard to reach populations.
Mental distress is not only experienced and acted on at the individual level; rather, individuals with distress exist within communities with their own cultural boundaries; the culture of the community can both encourage and dissuade care seeking behavior. This pre-doctoral NRSA research seeks to understand psychological distress and care seeking among a highly vulnerable population of Somali women in the United States through a mixed methods design. The results of this project will increase providers? understanding of the community?s role in mental health care and care seeking and inform the development of an ethical approach to mental health programming for this population.
