Resettled refugees are at high risk of trauma-related mental health problems, yet there is low uptake of mental health care in this population. Evidence suggests poor mental health literacy (MHL) may be a major factor influencing help-seeking behaviour among individuals with mental health problems. This study sought to examine the MHL of resettled Afghan refugees in Adelaide, South Australia. Specifically, levels of problem recognition, beliefs about severity of problem, beliefs about helpfulness of treatment and treatment providers, help-seeking behaviours and stigmatising attitudes were measured. Further, associations between specific aspects of MHL as outlined above, and individuals' demographic characteristics (e.g. age, gender, religion, and ethnicity) and symptom levels were examined. Methods: Face-to-face interviews using a validated protocol were conducted with 150 participants (74 males, mean age = 32.8 years, SD = 12.2). A culturally appropriate vignette describing a fictional person suffering from post-traumatic stress disorder (PTSD) was presented, followed by a series of questions addressing participants' knowledge and understanding of the nature and treatment of the problem described. Self-report measures of PTSD symptoms and co-morbid psychopathology were also administered. Follow-up qualitative interviews, with the aim of gaining a richer, in-depth and inductive understanding of participants' MHL, were conducted with 24 of these participants (13 females, aged 18-46). Results: Thirty-one per cent of the participants identified the problem depicted in the vignette as PTSD, while 26% believed that the main problem was "fear"-. Eighteen per cent of participants believed that "getting out and about more/finding some new hobbies"- would be the most helpful form of treatment for the problem described, followed by "improving their diet"- and "getting more exercise"- (16%). A majority reported that they would utilise more introspective activities such as reading the Koran and prayers. In terms of treatment, approximately a third chose readily available remedies, primarily "over-the-counter"- non-pharmaceuticals, including vitamins, minerals and herbal medicine. As with other informal help-seeking pursuits, life style choices allowed for a measure of privacy. If deemed necessary, participants elected to see a psychiatrist (43.3%) rather than a general practitioner (15.3%) or psychologist (14.7%). A family member was considered the least favourable option. Participants recognised that the most likely cause of the problem in the vignette was coming from a war-torn country (31.3%), followed by equal numbers who stated that experiencing traumatic events (20.7%) and family problems (20.7%) were the most likely causes. Half of the participants felt that the problem would be very distressing and very difficult to treat. Interestingly more than half reported that they would be sympathetic towards someone experiencing this problem but believed that others would discriminate against the individual. Thematic analysis of qualitative interviews confirmed that many participants clearly identified the following as contributing to their mental illness: trauma as a consequence of pre-arrival exposure to war and persecution, loss of loved ones, ongoing persecution as an ethnic minority, and loss of identity. These difficulties were further complicated by post-arrival challenges associated with learning a new language and finding employment, which prevented them from feeling part of the wider Australian community and contributed to a sense of disconnectedness. Participants implied that they were sensitive to the possible criticism of others if they sought help for mental illness. They noted the presence of shame, humiliation, stigma and fear of gossip within the community, which created barriers to help-seeking. More specifically, the fear of being the subject of gossip led participants to avoid treatment, which further exacerbated the mental illness. Some participants preferred to seek help outside the family, preferring their general practitioner, who would protect their privacy. This secrecy appeared to protect attendees from the associated stigma and shame. A substantial portion described how their religion and their faith in God were effective coping mechanisms. Others described religion as a source of oppression. Conclusion: This is, to our knowledge, the first systematic study of MHL undertaken within the Afghan refugee community. The results demonstrate aspects of MHL that appear to be specific to Afghan refugees who have resettled in Australia. They indicate the need for health promotion, early intervention programs, and mental health services, to recognise that variation in MHL may be a function of both the cultural origin of the refugee population and their resettlement country. Such recognition is needed in order to bridge the gap between Western, biomedical models of mental health care and the knowledge and beliefs of resettled refugee populations. Therefore, further research should explore how best to tailor and develop educational and health/psycho-social intervention programs.
| Date of Award | 2017 |
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| Original language | English |
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