Patterns of somatic distress among internally displaced persons in Ukraine: analysis of a cross-sectional survey

Abstract

Purpose: There are often high rates of mental disorders in low-and middle-income countries during humanitarian crises but the prevalence of somatic distress (SD) is underreported in existing health services research. We aim to examine patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. Methods: The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. Results: Over half of respondents (n=1142, 55%) were identified as being at risk of SD (PHQ-15 score≥6) and the prevalence of moderate (n=377, 18%) and high severity SD risk (n=275, 13%) was substantial. There were significant associations (p<0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. Conclusions: There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health services research and regional programs to ensure that mental health needs are appropriately met.

Somatic distress among Syrian refugees in Germany: analysis of a cross-sectional register-based study

“…This is fully consistent with the results of a systematic review among chronic pain in refugees with PTSD (55). Further, almost half of the participants (49.1%) were at least at risk of SOD which is in line with previous studies among SOD in refugees (17,31). However, one in four respondents of the presented study (24.1%) experienced moderate to severe SOD which is much less than in comparable research using the PHQ-15 in a Syrian refugee sample in Turkey (43%) (17).…”

“…In contrast, in a study among Kosovar civilian war survivors only 12.9% of participants met the criteria for SOD (56). More similar prevalence rates to our results have been reported in studies of con ict-affected adults in Georgia with 18%, 31% in the Ukraine and a study among refugees recently arrived in Germany with 31% suffering from somatization (15,31,46). In the German general population however, the prevalence of somatization at a moderate to severe level is considerably lower, at 9.3% (57).…”

“…The mean PHQ-15 score in our sample was 6.35 and thus lower than in the Syrian refugee sample in Turkey (M = 8.9) or a sample among internally displaced persons in Ukraine (M = 7.4) but higher than in con ict-affected persons in the Republic of Georgia (M = 5.39) (17,31,46). Most frequently, participants reported pain in arms, legs and joints, back pain, and headaches.…”

“…The cut-off score of 10 was adopted to separate participants with high or low SOD, since it was identi ed as optimal for predicting the diagnosis of somatoform disorder (45). We also added a cutoff score of 6 to identify participants being at risk for SOD (17,31,46). Furthermore, participants were asked how much these symptoms caused di culties in doing their work, their household and interacting with people on a 4-point scale from 0 (not di cult at all) to 3 (very di cult).…”

“…In addition to these ndings, researchers showed that being female, higher age, having low language pro ciency, low economic status, and low education levels are signi cant and common sociodemographic risk factors for SOD among refugees (17,(30)(31)(32). However, factors that have hardly been considered in studies of SOD are acculturative stressors such as discrimination or homesickness.…”