Johns Hopkins Bloomberg School of Public Health, Department of International Health, USA.
Arizona State University, Southwest Interdisciplinary Research Center, USA.
Soc Sci Med. 2022 Jan;292:114563. doi: 10.1016/j.socscimed.2021.114563. Epub 2021 Nov 11.
After decades of refugee displacement, Somalis are at increased risk for poor mental health. However, uptake of treatment referrals in primary care is low among Somalis compared to other refugee groups. The objective of this analysis was to understand specific resistances to US mental health care contributing to this gap in coverage. One hundred and sixty-eight Somali men and women over the age of 14, participated in 28 focus group from October 2017 to November 2018 discussing wellbeing and healthcare in the US. Transcripts were analyzed based on critical discourse theory, informed by the theoretical work of Michel Foucault. This study identified two primary discourses, one biomedical and the other driven by Somali community mental health knowledge and social practice. Mental health as an object of Muslim faith, nosological fusion of psychiatric illness terms, and stigmatization and internal social control to limit disclosure were discussed. US mental health services were described as giving off a bad vibe, and represented external institutions of power, exacerbated by perceived discrimination. Somali youth occupied social bridging positions between cultural vs. US knowledge and practice. Three negotiating discourses emerged wherein participants created discursive solutions to these sites of resistance, including 1) how the social acceptability of seeking psychological care might be increased while maintaining Somali emotional resilience, 2) stressing the need to seek medical care as a practical supplement to spiritual care, and 3) highlighting the need for Somali youth to enter health fields. Findings suggest that intervention strategies not only ensure that services are culturally appropriate and sensitive to religion, but also consider that services are potentially seen as both an extension of US institutional power and an affront to Somali identity making. Overcoming these challenges may involve nurturing the negotiating discourses taken up by communities.
经过几十年的难民流离失所，索马里人面临着更高的心理健康风险。然而，与其他难民群体相比，索马里人在初级保健中接受治疗推荐的比例较低。本分析的目的是了解导致这一覆盖差距的对美国心理健康护理的具体抵制。168 名年龄在 14 岁以上的索马里男性和女性参加了 2017 年 10 月至 2018 年 11 月的 28 个焦点小组，讨论美国的幸福感和医疗保健。根据批判性话语理论，结合米歇尔·福柯的理论工作对抄本进行了分析。本研究确定了两个主要的话语，一个是生物医学的，另一个是由索马里社区心理健康知识和社会实践驱动的。心理健康作为穆斯林信仰的对象、精神病学疾病术语的分类融合、污名化和内部社会控制以限制披露等问题都进行了讨论。美国心理健康服务被描述为散发着不良氛围，代表着外部权力机构，加剧了人们对歧视的看法。索马里青年在文化与美国知识和实践之间占据着社会桥梁地位。出现了三种谈判话语，参与者在这些抵制点创造了话语解决方案，包括 1）如何在保持索马里情感韧性的同时提高寻求心理保健的社会可接受性，2）强调寻求医疗保健的必要性，作为对精神保健的实际补充，3）强调索马里青年进入卫生领域的必要性。研究结果表明，干预策略不仅要确保服务具有文化适宜性，对宗教敏感，还要考虑到服务可能被视为美国机构权力的延伸，以及对索马里身份的侮辱，从而带来挑战。克服这些挑战可能需要培养社区采用的谈判话语。
