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Kurdish Men's Experiences of Migration- Related Mental Health Issues

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Kurdish Men's Experiences of Migration- Related Mental Health Issues Primary Health Care Research & Development 2011; 12: 335–347 doi:10.1017/S1463423611000156 RESEARCH Kurdish men’s experiences of migration- related mental health issues Marina Taloyan1, Ahmad Al-Windi1,2, Leena Maria Johansson1 and Nuha Saleh-Stattin1 1Center for Family and Community Medicine, Karolinska Institute, Stockholm, Sweden 2Department of Family and Community Medicine, College of Medicine, Sulaimani University, Kurdistan, Iraq Background: The migration process may impose stress on the mental health of immigrants. Aim: To describe the experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden with regard to mental health issues. Method: Using the grounded theory method, we conducted a focus group interview with four Kurdish men and in-depth individual interviews with 10 other Kurdish men. Findings: A model with two major themes and interlinked categories was developed. The themes were (1) protective factors for good mental health (sense of belonging, creation and re-creation of Kurdish identity, sense of freedom, satisfaction with oneself) and (2) risk factors for poor mental health (worry about current political situation in the home country, yearning, lack of sense of freedom, dissatisfaction with Swedish society). Implications: The study provides insights into the psychological and emotional experiences of immigrant men of Kurdish ethnicity during and after migration to Sweden. It is important for primary health care providers to be aware of the impact that similar migration-related and life experiences have on the health status of immigrants, and also to be aware that groups are comprised of unique individuals with differing experiences and reactions to these experiences. The findings highlight the common themes of the men’s experiences and suggest ways to ameliorate mental health issues, including feeling like one is seen as an individual, is a full participant in society, and can contribute to one’s own culture. Key words: grounded theory; Kurdish men; mental health issue; migration; protective factors; risk factors Received 15 January 2009; accepted 24 March 2011; first published online 24 May 2011 Introduction The whole migration process affects different individuals in different ways and results in dif- Migration is a process of displacement, stress, and ferent individual responses (Bhugra and Arya, loss in time and space (Bhugra and Becker, 2005). 2005). The migration process may cause poor Migration includes multiple stresses and factors mental health before, during, and after migration. that may affect the mental health of individuals. The health consequences of forced migration can The areas that might be affected are, for example, be different from those of voluntary migration the social support system, changes in identity, (Silove et al., 1997; Araya et al., 2007). Reasons concept of self, and adjustment to a new culture. and preparedness for migration differ, and These factors play an important role in the although the social contexts migrants face in a increasing rates of mental illness among immigrants new country may be similar, each individual has (Bhugra, 2004). unique experiences and adapts uniquely to the new social contexts. Furthermore, cultural and social adjustments that each person must make Correspondence to: Dr Marina Taloyan, Department of Neurobiology, Care Sciences and Society, Center for Family are also factors that have an important influence and Community Medicine, Alfred Nobel Alle´ 12, Huddinge, on the mental health of immigrants (Bhugra and Stockholm 141 83, Sweden. Email: [email protected] Arya, 2005). A study investigating the mental r Cambridge University Press 2011 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 29 Sep 2021 at 10:33:00, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1463423611000156 336 Marina Taloyan et al. health of immigrants from Poland and Vietnam in they come. Registration by ethnicity is absent Germany showed that both groups have a higher from official Swedish statistics. prevalence of anxiety and depression than the native German population. However, the nature of the problems reported by the two groups of Snowball sampling immigrants differed (Wittig et al., 2008). Other The first contact person was a member of a factors known to be associated with psychological Kurdish cultural network who was asked to list distress and mental health problems in immi- others with similar characteristics, and these persons grants include under-employment or unemploy- were approached for interviews. This procedure, ment (Jafari et al., 2010) and job dissatisfaction called snowball sampling (Biernacki, 1981), was (de Castro et al., 2008). repeated from one participant to the next and so Trauma and torture before migration may have on. Snowball sampling is particularly useful in a significant influence on health, even after many research populations that can be difficult to find in years of resettlement in a new country (Mollica other ways, such as via official records (Khavarpour et al., 2001; Marshall et al., 2005). Kurdish immi- and Rissel, 1997). The interviews and analyses were grants to Western countries have almost always conducted between 2005 and 2007. We used pseu- been exposed to persecution, forced assimilation, donyms in the presentation of quotes in this study. and forced resettlement in their home countries for many years (Gunter, 1990; McDowall, 1992; Focus group Bozarslan, 2000). Kurdish political refugees began Initial data were collected in a focus group arriving in Sweden in the early 1970s. interview that was conducted by the first author and This qualitative study was an effort to further an observer. Four potential focus group participants explore findings of earlier quantitative studies and were found via snowball sampling. Each of them ethnographic observation by members of this received a letter with information and a semi- research group. In these quantitative studies, we structured interview guide that listed open ques- found higher prevalence of anxiety and psycholo- tions that they would be asked to discuss freely gical distress in Kurds in Sweden than in Swedes during the interview. Topics included the men’s (Taloyan et al., 2006; 2008). Moreover, the first experiences in Sweden, values and norms, and cul- author’s ethnographic observations suggested that tural identity, and started with the question ‘How Kurdish men felt misjudged on the basis of negative do you feel?’. In response to the open questions, stereotypes,andKurdswhomigratedtoSwedenfor each participant described his own perceptions and political reasons were more often men than women. opinions. Participants listened to each other and We also believed that the findings of this qualitative responded in a lively back-and-forth discussion. study on Kurdish men would be applicable to other They agreed about some matters and disagreed immigrant groups from countries with wars and/or about others. The interview, led by the first author other conflicts, especially groups who might be (MT), was held in Swedish. The outside observer stereotyped in their new country. We planned to was present to gather information about the inter- start investigating the mental health issues of viewer’s objectivity and additional information Kurdish immigrants by studying the experiences of about the interview, such as the mood and body Kurdishmenandthentocontinuebystudyingthe language of the participants. The outside observer is experiences of Kurdish women. a usual feature of focus group interview metho- dology (Barbour, 2001). Copies of the transcript were sent to all participants to check whether they Methods thought the transcript was in agreement with the original conversation. All participants sent the Participants copies back with their approval. Identifying Kurds in Sweden It is impossible to identify Kurds in Sweden In-depth individual interviews using official records. In Sweden, immigrants are The focus group discussion showed that each registered as citizens of the countries from which participant wished to tell his own story about his Primary Health Care Research & Development 2011; 12: 335–347 Downloaded from https://www.cambridge.org/core. IP address: 170.106.40.40, on 29 Sep 2021 at 10:33:00, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1463423611000156 Kurdish men’s experiences 337 experiences of the migration process. Further- Analysis more, it was clear that not all of the participants The method used for data analysis was the were comfortable with talking about deeper qualitative, inductive, constant comparative method explanations and definitions of events and feel- known as Grounded Theory (GT) (Strauss, 1990). ings in the context of a focus group. After dis- In accordance with GT methodology, in-depth cussion within our research team and consultation interviews and analyses of data from the in-depth with several researchers knowledgeable about interviews occurred concurrently. qualitative methods, we decided to continue data Two members of the research team (MT and gathering via in-depth interviews. Questions that NSS) performed data analyses; NSS has a great arose from the focus group interview were used as deal of experience with the GT method (Saleh- a guide for the initial in-depth interviews. A semi- Stattin, 2001). The data analyses began with structured interview guide was designed
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