Mental Health

Afghanistan has been subjected to 3 decades of drought and over 2 decades of war. The 1979-89 Soviet invasion and occupation of Afghanistan generated 6 million refugees and 1 million deaths. The emergence of the Taliban regime in 1994 imposed new rules and restrictions, especially affecting the lives of female Afghan people.

Even after the end of Taliban rule in 2001, conditions in Afghanistan have deteriorated – due in part to the large influx of refugees from Pakistan and Iran, and a shortage of support resources to sustain them (Cardozo et al., 2004).

The mental health facilities within Afghanistan are poor. In fact, the major psychiatric hospital in Kabul was demolished during the recent war, and many other community mental health centers have discontinued operations. In addition, there is a shortage of mental health providers in Afghanistan – chronic conditions have gone untreated for many in the country (Cardozo et al., 2004).

Depression and Post traumatic stress disorder (PTSD) are common within the North American Afghan society. Many Afghan immigrants have experienced war-related trauma at some point in their life; including near-death experiences, forced separation from family members, witnessing the murder of close friends and relatives, or living with a lack of shelter, food or water (Mghir et al., 1995). And as numerous studies have confirmed, 20% to 30% of citizens in populations affected by war and civil conflict, go onto develop some form of mental distress and illness (Lopes et al., 2000, in Cardozo et al., 2004). Feelings of loss, occupational and economic difficulties, cultural conflict, and social isolation, are frequently reported by Afghan immigrants (Lipson & Omidian, 1992; Morikoka-Douglas et al., 2004). Many describe suffering from additional symptoms, such as high blood pressure, nightmares, sleep disorders, somatic conditions, and feelings of loneliness and hopelessness, after migration (Lipson, 1991; Lipson & Omidian, 1992).
Learning English can be a primary step towards the client’s well-being and bettered mental health.

Women

Afghan women constitute 75% of the (American) refugee population (Giger & Davidhizar, 2002). In a survey conducted by the Centers for Disease Control and Prevention (CDC), 62% of Afghan immigrant women reported previous experiences of multiple (4 or more) traumatic events (Cardozo et al., 2005).
Female Afghan immigrants exhibit a higher prevalence towards depression (73% vs. 59%), anxiety (84% vs. 59%), and PTSD (48% vs. 32%) than their male counterparts (Cardozo et al., 2005).

This sub-population has a high incidence of mental health problems, and are at high risk of committing suicide: they are likely to have been affected by war-related psychological and physical abuse; sexual violence — compounded by the absence of a support system; denied freedoms of movement; and restricted access to healthcare and education (Cardozo et al., 2005).

Though women’s liberties in Afghanistan improved after the end of the Taliban regime, any actions against social order were/are still punished (Cardozo et al., 2005). The life traumas experienced by Afghan origin women (and men) may result in intense feelings of hatred and resentment (Cardozo et al., 2005). Afghan females report feelings of extreme hatred and strong desires for revenge (Cardozo et al., 2005). (Afghan men discuss similar feelings, but have a stronger desire to take revengeful action.) With little ability to act on these feeling, such burdens, contribute to chronic stress, and put these individuals at high risk of developing psychological ailments (Cardozo et al., 2005).

Youth

Special attention must be paid to Afghan refugee children. Research has shown that among boys, common behaviour patterns are frustration, anger, aggression and resistance to rules. Whereas young girls tend to withdraw, show signs of depression, and have difficulty imagining a brighter future. Community support programs are encouraged to lessen the loss of family and social networks (cal.org/co/afghan/acult.html).

Cervical Cancer screening

Most Afghans are Sunni Muslims (84%) or Shi’ite Muslims (15%), (1% belonging to other cultural groups) (Giger & Davidhizar, 2002).
Barriers to obtaining adequate health care for Muslim women include common obstacles such as language, transportation, and family pressures, but other factors include resistance towards standard western disease screening practices, which threaten cultural and religious values of Muslim women, Islamic beliefs and customs (Matin & LeBaron, 2004). For example, the general recommendation for cervical cancer screening followed by most North American health care providers is to begin screening patients within three years after the onset of sexual activity, but no later than age 21 (Matin & LeBaron, 2004). For young Muslim women that adhere to the Islamic valuation of virginity, adhering to this policy may be challenging.

Although Afghan origin women may be concerned about gynecological health care, some avoid going to the doctor because of the fear that their physicians will be ignorant or disrespectful about Muslim values regarding modesty and virginity (Matin & LeBaron, 2004). In addition, Muslim women may feel too embarrassed or uncomfortable to discuss female-sensitive topics, and consequently may resist any form of treatment or preventative screening (Matin & LeBaron, 2004).

References:
Cardozo, B.L., Oleg, O. Bilukha, C. Gotway, C., Irshad, S. Wolfe, M. Gerber, M. & Anderson, M. (2004). Mental Health, Social Functioning and Disability in Postwar Afghanistan. Journal of the American Medical Association, 292, (5), 575-584.
Cardozo, B.L., Oleg, O., Bilukha, C., Gotway, A. Wolfe, M.I., Gerber, L. & Anderson, M. (2005). Report from CDC: Mental Health of Women in Postwar Afghanistan, Journal of Women’s Health, 14, 285-293.
Giger, J. & Davidhizar, R. (2002). Culturally competent care: emphasis on understanding the people of Afghanistan, Afghanistan Americans, and Islamic culture and religion. International Nursing Review, 49, 79-86.
Lipson, J.G. (1991). Afghan refugee health: some findings and suggestions. Qualitative Health Research, (1), 349-369.
Lipson, J.G. & Omidian, P.A. (1992). Cross-cultural medicine a decade later: Health issues of Afghan refugees in California. West Journal of Medicine, 157, 271-275.
Lipson, J.G. Omidian, P.A., & Paul, S.M. (1995). Afghan health education project: A community survey. Public Health Nursing, 12, 143-150.
Matin, M. & LeBaron, S. (2004). Attitudes Toward Cervical Cancer Screening Among Muslim Women: A Pilot Study. Women & Health, 39, 63-77.
Mghir, R., Freed, W. Raskin, A. & Katon, W. (1995). Depression and Posttraumatic Stress Disorder Among a Community Sample of Adolescent and Young Adult Afghan Refugees. The Journal of Nervous and Mental Disease, 183, (1), 24-30.
Morioka-Douglas, N., Sacks, T. & Yeo, G. (2004). Issues in Caring for Afghan American Elders: Insights from Literature and a Focus Group. Journal of Cross-Cultural Gerontology, 19, 27-40.