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For a better understanding of the mental health problems of patients whose cultural background differs from their clinicians, the Diagnostic and Statistical Manual for Mental Disorders includes the Cultural Formulation of Diagnosis. One of its components is cultural identity that as a concept remains unclear, yet a case study of a Somalian patient showed the relevance and utility of exploring cultural identity for a better understanding of the mental health problems. In this study, the concept of cultural identity is explored among traumatized Afghan and Iraqi refugees who were referred for specialized mental health care at De Evenaar, Center for Transcultural Psychiatry. In a qualitative analysis of Brief Cultural Interviews with these refugee patients, cultural identity was subdivided in personal identity, ethnic identity and social identity that each could be related to stress and migration issues. In a mixed methods analysis, post-migration stress and acculturation were included in the relationship between experienced traumatic events, cultural identity and trauma, anxiety and depression symptoms. Post-migration stress appeared to be associated with these symptoms. All of the risk factors to develop mental health problems appeared to contribute to cultural identity confusion. When patients were compared to non-patients, the norms and values of their resilience not to be needing mental health care were interrelated with norms and values of their cultural identity. These new insights are converted to recommendations to enhance the cultural competence of clinicians by means of exploring the cultural identity of their patients to better understand their mental health problems. |
