Perceived need for a faith-based trauma-focused treatment in a sample of forcibly displaced Muslims

ABSTRACT

Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e. community, individual, friends/family) for culturally responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.

KEYWORDS:

• Muslim
• forcibly displaced
• posttraumatic stress disorder (PTSD)
• perceived need
• culturally responsive mental health treatment

Introduction

Trauma exposure is common among refugees, asylum seekers, and internally displaced persons, many of whom come from Muslim majority countries. Indeed, over a fourth of forcibly displaced persons worldwide come from Afghanistan, Myanmar, Somalia, and Syria alone (UNHCR, 2022). These populations are disproportionally affected by posttraumatic stress disorder (PTSD) and other trauma-related symptomatology (3–88%; Aluh et al., 2019; Morina et al., 2018; Richa et al., 2020), likely due to exposure to multiple traumatic events (Steel et al., 2017). Additionally, internally (i.e., those forcibly displaced within their own country) and externally (i.e., those who migrate to a different country) displaced refugees face difficulties during and post-migration such as economic and social strain, discrimination, and unstable political environments (e.g., Morina et al., 2018; Tekeli-Yesil et al., 2018), which may further contribute to the development of PTSD symptoms (e.g., Sheikh et al., 2022).

Although effective treatments exist for PTSD (e.g., Kline et al., 2018; Watts et al., 2013), these Western-conceptualized treatments ignore the centrality and impact of the Islamic faith on mental health among forcibly displaced Muslims (Bentley & Owens, 2008; Bettmann et al., 2015; Grupp et al., 2019; Weatherhead & Daiches, 2010). Many forcibly displaced Muslims turn to the Qur’an, the wisdom of their Imams, and traditional medicine over Western treatment methods (Grupp et al., 2019; Slewa-Younan et al., 2014; Weatherhead & Daiches, 2010). Further, mental health stigma, lack of mental health literacy, lack of trust in mental health providers, and unfamiliarity with services have been identified as barriers to forcibly displaced Muslims seeking mental health services (Amri & Bemak, 2013; Byrow et al., 2020). Structural barriers such as lack of available formal mental health services, housing and financial insecurity, and immigration status also prevent many from seeking or receiving mental health care (Byrow et al., 2020). Identifying and addressing barriers that limit access is particularly important given that, when untreated, PTSD is chronic and associated with a range of negative health and functioning outcomes (Koenen et al., 2017; Priebe et al., 2009).

Perceived need for mental health treatment (i.e., whether a person believes they or someone else need[s] such services) is associated with utilization of mental health services (Andersen, 1995), and thus may be a modifiable target to improve treatment utilization. However, there is currently a dearth of literature identifying predictors of perceived need in forcibly displaced Muslim samples. Research has primarily focused on other non-modifiable predictors (e.g., gender, age) of mental health care utilization and attitudes towards mental illness. Overall, in Muslim and forcibly displaced samples, women have been found to be more likely to utilize both traditional and non-traditional mental health services than men (Al-Krenawi et al., 2001; Fenta et al., 2006). Further, in a sample of Omani individuals, younger, relative to older individuals, trended toward endorsing more favorable attitudes towards individuals with mental health problems (Al-Adawi et al., 2002). However, despite more favorable views on mental health conditions, younger individuals may not necessarily utilize mental health services more frequently (Fenta et al., 2006). Having more favorable attitudes towards psychological difficulties may not be the only factor associated with increased utilization. It is possible that in addition to having favorable attitudes towards mental health treatment, perceiving a need for services may be associated with utilizing care.

It is plausible that individuals with more severe psychopathology may endorse greater perceived need. Relative to native-Dutch individuals, Turkish immigrants had higher perceived need for mental health services, with this effect being driven by higher depression and anxiety symptom severity among Turkish immigrants (Fassaert et al., 2009). Among forcibly displaced Muslim individuals, exposure to traumatic events may be compounded by difficulties associated with migration, contributing to more severe psychological symptoms (Bentley et al., 2019; Tekeli-Yesil et al., 2018). Internally and externally displaced persons face shared and unique post-migration difficulties, with no two individuals having the same displacement experience. Although both groups experience discrimination and food, housing, financial, and employment insecurity (Porter & Haslam, 2005; Siriwardhana & Stewart, 2013), those who are externally displaced may be more likely to face challenges related to cultural continuity, such as learning a new culture and language and separation from family (Steel et al., 2017; von Haumeder et al., 2019). Internally displaced refugees likely also experience challenges as a result of unstable political and economic conditions within their country (Porter & Haslam, 2005; Siriwardhana & Stewart, 2013). Studies examining differences in PTSD severity for externally versus internally displaced persons have produced mixed results. Although some studies have found that externally displaced persons endorse poorer mental health outcomes compared with internally displaced persons (Dolezal et al., 2021; Hunt & Gakenyi, 2005), other studies have found the opposite (Porter & Haslam, 2005; Schmidt et al., 2008; Tekeli-Yesil et al., 2018). It is possible that locus of displacement may interact with psychopathology to affect one’s perceived need for mental health care, though the pattern is, at present, unclear.

Little research has examined factors that may enhance access to mental health care among Muslim refugees. Mental health treatments that are more accessible and consistent with forcibly displaced Muslims’ culture and religion may be more widely perceived as needed and utilized. Accordingly, Islamic Trauma Healing (ITH) is a previously developed group intervention that is delivered in mosques, uses the term “trauma healing” instead of “treatment” or “intervention,” acknowledges the impact of the collective effects of refugee-related trauma, and emphasizes community building and healing (Bentley et al., 2021). ITH has demonstrated initial efficacy and feasibility in Somali Muslim samples in the US (Zoellner et al., 2018) and in Somaliland, Somalia (Zoellner et al., 2021). In a sample of Somali Muslim refugees who attended an educational event about ITH (N = 39), higher perceived individual need was associated with male gender and the presence of PTSD avoidance and hyperarousal symptoms, but not with age or possible PTSD diagnosis. Gender, age, and PTSD symptoms were not significantly correlated with perceived community need (Zoellner et al., 2018). Further examination of correlates of various perceived need domains among forcibly displaced Muslims from other countries is needed to more comprehensively understand beliefs about the utility of culturally responsive mental health services like ITH.

The overarching goal of this study was to identify predictors of different domains of perceived need (i.e., community, individual, friends or family) for a culturally responsive, faith-based, trauma-focused group treatment among a global sample of forcibly displaced Muslims. Our first aim was to evaluate differences in the extent of perceived need for a faith-based, trauma-focused group for participants’ communities, selves, and friends or families. Given the commonality of collectivistic values and potential stigma of seeking mental health treatment among forcibly displaced Muslims (Amri & Bemak, 2013; Byrow et al., 2020), we hypothesized that participants would perceive greater community and friends/family need than perceived individual need. Our second aim was to examine the association between the three domains of perceived need and age, gender, displacement status, PTSD severity, and well-being. Consistent with work suggesting that women and younger individuals endorsed more frequent utilization and favorable attitudes about mental illness (Al-Adawi et al., 2002; Al-Krenawi et al., 2001; Fenta et al., 2006), we hypothesized that women and younger individuals would endorse higher perceived need across all three domains. Further, given that refugees with more severe psychopathology tend to endorse a greater perceived need for mental health services (Fassaert et al., 2009), we hypothesized that those with greater PTSD severity and lower overall well-being would report higher perceived need across domains. Our final aim was to examine the role of displacement status as a moderator of the relationship between PTSD severity and perceived community, individual, and friends or family need. Given differences in post-migration stressors and mental health symptoms for externally and internally displaced refugees (Porter & Haslam, 2005; Tekeli-Yesil et al., 2018), we hypothesized that internally and externally displaced persons would differ in their levels of perceived need across domains. However, given the inconsistent literature, we did not have a priori hypotheses regarding direction. Similarly, we did not expect these associations to differ depending upon the type of perceived need examined (i.e., community, individual, friends/family).

Materials and methods

Participants

Participants were recruited through Amazon Mechanical Turk (MTurk), an international website where workers are paid for completing online tasks. Inclusion criteria for the study were: 18 years or older; identified as Muslim; English or Arabic speaking; and self-identified as either a refugee, asylum seeker, or internally displaced person, following UNHCR’s (2019) definition.

The survey title, “Faith and the Refugee Experience,” and the pre-screening items were worded in an open-ended manner to prevent the tailoring of responses to be eligible (e.g., identify your religion), asking about their religious preferences and current displacement status. Of the 3,174 participants screened for eligibility, 130 participants met the inclusion criteria and were given the primary survey to complete. Eighteen were excluded from analyses for either not finishing the survey, responding with the same answer for all items, or failing to correctly answer a question assessing quality control (i.e., did not answer “agree” or “strongly agree” to the question “The sun is hot”), leaving a sample of 112. To increase the likelihood that the sample included participants who were forcibly displaced (i.e., did not voluntarily migrate), those who reported a country of origin with no sociopolitical conflict for at least 50 years (e.g., Austria) prior to data collection (the oldest study participant was 44) were removed for the purposes of this study (n = 4), creating a final sample of N = 108.

Participant characteristics are presented in Table 1. A majority of the participants were, on average, in their late twenties, predominantly male (71.3%), and had experienced a DSM-5 Criterion A traumatic event (88.0%). Over two-thirds of the participants (69.4%) were externally displaced (i.e., refugee or asylum seeker). The most common countries of family origin were as follows: India (25.9%), Pakistan (9.3%), Afghanistan (8.3%), Syria (8.3%), Iran (5.6%), Bangladesh (5.6%), Sri Lanka (3.7%), Saudi Arabia (3.7%), Palestinian Territories (3.7%), Iraq (3.7%), United Arab Emirates (2.8%), and Algeria (2.8%). Participants mostly reported India (35.2%), United Kingdom (15.7%), Canada (9.3%), Pakistan (5.6%), Germany (3.7%), and United Arab Emirates (2.8%) as their current countries of residence.

Table 1. Descriptive statistics for forcibly displaced Muslims (N = 108)

	M (SD) or n (%)	Range
Age	28.32 (4.8)	18–44
Gender (% female)	31 (28.7%)
Experienced traumatic event	95 (88%)
Displacement status Internal External	33 (30.6%) 75 (69.4%)
Probable PTSD (PC-PTSD-5)	84 (77.8%)
PTSD severity (PC-PTSD-5)	3.44 (1.68)	0–5
Well-being (WHO-5)	13.18 (5.59)	0–25
Perceived need for trauma healing group Community need Individual need Friends/family need	4.27 (1.29) 3.81 (1.47) 4.32 (1.30)	0–6 0–6 0–6

Note. PC-PTSD-5: Primary Care PTSD Screen for DSM-5; WHO-5: World Health Organization Well-being Index. A probable PTSD diagnosis was assigned to participants who endorsed experiencing a traumatic event and received a total score of 3 or greater on the PC-PTSD-5

Measures

Displacement status

Participants who reported their country of origin and current country of residence as being identical were categorized as internally displaced (−1), and those with differing countries of origin and residence were categorized as externally displaced (1).

Perceived need for culturally responsive trauma mental health care

Participants read the following brief description of a faith-based trauma healing intervention:

If there was a 6-session men’s or women’s trauma healing group at your mosque that helped people adjust after the refugee experience by discussing the lives of prophets and individual time in dua …

Following this description, three study-specific items assessed participants’ perceived need for the group-based program for trauma-related symptoms: 1) “How much need is there for a trauma healing group like this in your community?”; 2) “Are you or a friend interested in participating in a trauma healing group like this for Muslims?”; and 3) “Would you recommend a trauma healing group to friends or family you know?” Items were rated on a Likert scale ranging from 0 (no need, interest, or likelihood, respectively) to 6 (high need, interest, or likelihood, respectively). Higher scores are indicative of greater perceived 1) community need, 2) individual need, and 3) friends or family need.

PTSD and well-being

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5; Prins et al., 2016) is a brief screening measure based on DSM-5 criteria for PTSD and was used to assess probable diagnostic status. The first item assesses DSM-5 trauma exposure (i.e., Criterion A). Participants who endorsed this item then completed five items that queried symptoms from each of the PTSD symptom clusters (e.g., Cluster E; alterations in arousal and reactivity; “been constantly on guard, watchful, or easily startled”). Items are dichotomized (e.g., “yes” or “no”). Total severity scores were calculated by summing all positive endorsements to the five items assessing PTSD symptoms, with scores ranging from 0 to 5. A cutoff score of 3 was utilized to indicate probable PTSD diagnosis (Prins et al., 2016). The measure has demonstrated good convergent validity with the Posttraumatic Stress Disorders Checklist for the DSM-5 (total r = .79; Lathan et al., 2023).

The World Health Organization Well-being Index (WHO-5; Topp et al., 2015) is a five-item measure that assesses perceived psychological well-being over the last two weeks (e.g., “I have felt calm and relaxed”). Participants responded on a Likert scale ranging from 0 (at no time) to 5 (all of the time). Using the raw scoring (0–25), higher scores are indicative of greater well-being. The WHO-5 has shown convergent validity (Topp et al., 2015). Internal consistency for the sample was good (α = .84).

Procedure

This study was approved by the University of Washington’s Institutional Review Board (STUDY00004378). Participants were given the option to complete the survey, administered through Qualtrics, in English or Arabic. Potential participants completed a screening survey; those eligible were given an information sheet about the purpose of the study, procedures, and eventual payment before filling out the primary survey. Those who consented answered 65 items, which included demographic questions and measures of perceived need, PC-PTSD-5, and WHO-5. Participants who completed the screening survey were paid $0.10 (USD), and those who completed the main survey were compensated $1.00 (USD).

Data analysis

Data analyses were conducted in RStudio version 4.2.2 (R Core Team, 2012). For our first aim, a repeated measures ANOVA examined the difference between mean scores for perceived community, individual, and friends/family need. For our second aim, we conducted independent samples t-tests that examined differences in perceived need domains based on gender and displacement status. Correlations were conducted to examine associations between age, PTSD severity (PC-PTSD-5), and well-being (WHO-5) with the three perceived need domains. For our final aim, we conducted multiple regression analyses using the R stats function in R (R Core Team, 2012), examining displacement status, mean-centered PTSD severity, and their interaction as predictors of each type of perceived need.

Results

Means and standard deviations for continuous variables and percentages for categorical variables are presented in Table 1. Eighty-four individuals (77.8%) met criteria for probable PTSD diagnostic status on the PC-PTSD-5, and on average reported moderate quality of life (WHO-5). Overall, participants endorsed a moderate-to-high perceived need for a faith-based, trauma healing group for their community, themselves, and friends/family.

Difference in means for perceived community, individual, and friends/family need

A repeated measures ANOVA determined that mean scores for perceived community, individual, and friends/family need were significantly different, F(2, 214) = 9.058, p < .001, partial η² = .125. A post-hoc pairwise comparison using a Bonferroni correction revealed that mean scores for perceived individual need (M = 3.81, SD = 1.47) were significantly lower than the mean scores for both perceived community need (M = 4.27, SD = 1.29, d = 0.34) and perceived friends/family need (M = 4.32, SD = 1.30, d = 0.34), ps < .005. Mean scores between perceived community need and perceived friends/family need were not significantly different, p = 1.00.

Correlates of perceived need for trauma healing intervention

Results from independent samples t-tests and Pearson correlations are included in Tables 2 and 3, respectively. There were no significant differences in perceived need based on gender. Age, PTSD severity, and WHO-5 well-being were not significantly correlated with perceived community, individual, or friends/family need (ps ≥ .08). Those who were externally displaced reported significantly higher perceived individual need (p = .048, d = 0.42) and friends/family need (p = .027, d = 0.41) relative to those who were internally displaced; perceived community need did not differ by locus of displacement.

Table 2. Descriptive statistics and comparisons in perceived need for trauma healing groups

	Perceived Need M (SD)	t	p	d
Perceived community need
Gender Male Female	4.32 (1.25) 4.13 (1.41)	0.71	.480	0.15
Displacement status Internal External	3.91 (1.16) 4.43 (1.33)	−1.94	.055	0.41
Perceived individual need
Gender Male Female	3.81 (1.57) 3.84 (1.24)	−0.11	.915	0.02
Displacement status Internal External	3.39 (1.35) 4.00 (1.50)	−2.00	.048	0.42
Perceived friends/family need
Gender Male Female	4.40 (1.27) 4.13 (1.36)	0.99	.323	0.21
Displacement status Internal External	3.91 (1.33) 4.51 (1.25)	−2.25	.027	0.47

Table 3. Pearson correlations for perceived community, individual, and friends/family need

Predictor	1	2	3	4	5	6
1. Age	-
2. PTSD severity (PC-PTSD-5)	−.04	-
3. Well-being (WHO-5)	−.13	−.02	-
4. Perceived community need	−.07	−.03	−.14	-
5. Perceived individual need	−.17	−.00	−.07	.53**	-
6. Perceived friends/family need	.02	−.03	.05	.54**	.42**	-

Note. ** = p < .001.

Moderating effects of PTSD status and locus of displacement on perceived need

Community need

Multiple regression results for perceived community need can be found in Table 4. The overall model was statistically significant, F(3,104) = 3.28, p = .024, uniquely predicting 6.0% of the variance in perceived community need. The direct effect of displacement status was not significant when controlling for PTSD severity (p = .100). The direct effect of PTSD severity on perceived community need was also not significant (p = .340) after accounting for displacement status. There was a statistically significant interaction between displacement status and PTSD severity (β = −.24, p = .017). On below average levels of PTSD severity, there was a strong relationship between displacement status and perceived community need, such that those externally displaced had higher perceived community need than those internally displaced (−2 SD B = 0.85, 95% CI = [0.30, 1.40]; −1 SD B = 0.54, 95% CI = [0.19, 0.88]); for PTSD severity at or above its mean, this relationship between displacement status and perceived community need disappeared.

Table 4. Moderation analysis examining the relationship between locus of displacement, PTSD severity, and perceived community need for a culturally responsive trauma healing group

Predictor	Standardized β	SE	t	p	Adjusted R^2
Model				.024	.060
Displacement status	.16	0.13	1.66	.100
PTSD severity (PC-PTSD-5)	.10	0.08	1.00	.340
Displacement X PTSD severity	−.24	0.08	−2.43	.017

Note. Coding of direction of displacement status (−1 = internal, 1 = external). PC-PTSD-5 scores were centered around its mean. PC-PTSD-5: Primary Care PTSD Screen for DSM-5.

Individual need

Multiple regression results for perceived individual need can be found in Table 5. The overall model was statistically significant, F(3,104) = 2.75, p = .046, uniquely predicting 4.7% of the variance in perceived individual need. The direct effect of displacement status was not significant after controlling for PTSD severity (p = .105). The direct effect of PTSD severity on perceived individual need was significant (β = 0.20, p = .045), in that higher levels of PTSD severity related to higher perceived individual need after accounting for displacement status. The interaction between displacement status and PTSD severity was not significant (p = .384).

Table 5. Moderation analysis examining the relationship between locus of displacement, PTSD severity, and perceived individual need for a culturally responsive trauma healing group

Predictor	Standardized β	SE	t	p	Adjusted R^2
Model				.046	.047
Displacement status	.16	0.15	1.64	.105
PTSD severity (PC-PTSD-5)	.20	0.09	2.03	.045
Displacement X PTSD severity	−.09	0.09	−0.88	.384

Note. Coding of direction of displacement status (−1 = internal, 1 = external). PC-PTSD-5 scores were centered around its mean. PC-PTSD-5: Primary Care PTSD Screen for DSM-5.

Friends or family need

Multiple regression results for perceived friends/family need can be found in Table 6. The overall model was statistically significant, F(3,104) = 3.45, p = .019, uniquely predicting 6.4% of the variance in perceived friends/family need. The direct effect of displacement status maintained significance after controlling for PTSD severity (β = 0.19, p = .045). The direct effect of PTSD severity on perceived friends/family need was not significant (p = .540) after accounting for displacement status. There was a statistically significant interaction between displacement status and PTSD severity (β = −.22, p = .026). On average and below average levels of PTSD severity, there was a strong relationship between displacement status and perceived friends/family need, such that those externally displaced had higher perceived friends/family need than those internally displaced (−2 SD B = 0.85, 95% CI = [0.30, 1.41]; −1 SD B = 0.56, 95% CI = [0.21, 0.91]; 0 SD B = 0.27, 95% CI = [0.01, 0.53]); for above average levels of PTSD severity, this relationship between displacement status and perceived friends/family need disappeared.

Table 6. Moderation analysis examining the relationship between locus of displacement, PTSD severity, and perceived friends/family need for a culturally responsive trauma healing group

Predictor	Standardized β	SE	t	p	Adjusted R^2
Model				.01	.064
Displacement status	.19	0.34	2.20	.03
PTSD severity (PC-PTSD-5)	.06	0.19	1.54	.12
Displacement X PTSD severity	−.22	0.19	−2.25	.03

Note. Coding of direction of displacement status (−1 = internal, 1 = external). PC-PTSD-5 scores were centered around its mean. PC-PTSD-5: Primary Care PTSD Screen for DSM-5.

Discussion

Across domains of perceived need, Muslim individuals who reported being displaced endorsed a moderate to high need for a faith-based trauma healing group-based intervention. Interestingly, participants endorsed slightly higher perceived need for such a group for their communities and friends or families than for themselves. With the exception of displacement status, none of the variables that we examined as correlates of perceived need were significantly associated with any of the three domains; however, when controlling for displacement status, PTSD severity predicted perceived individual need. While understanding that forcibly displaced persons have diverse experiences, individuals who were externally displaced from their home country were moderately more likely to perceive higher individual or friends/family need for a faith-based trauma healing group than those who were internally displaced. Further, among individuals with PTSD severity at or below its mean, those who were externally displaced perceived greater community and friends/family need for a faith-based trauma healing group than those who were internally displaced. Taken together, among forcibly displaced Muslims, results from this study suggest that there may be widespread perceived need for faith-based trauma healing groups and similar culturally responsive, trauma-focused mental health services. Additionally, perceived community and friends/family need may vary more as a function of contextual and psychological factors associated with displacement rather than general demographic characteristics. Perceived individual need, on the other hand, may be more impacted by psychological factors and less so by contextual factors, like locus of displacement.

Perceived need may be an important precursor to utilization (e.g., Andersen, 1995), and thus important to consider when addressing mental health inequity among underserved populations. Western mental health treatments are often either not available or sought in Muslim and refugee populations (Slewa-Younan et al., 2014). It is possible that one reason for this is incongruence between these treatment models and the Islamic faith (Bentley & Owens, 2008; Bettmann et al., 2015; Weatherhead & Daiches, 2010). As participants endorsed moderate to high levels of perceived need for a faith-based trauma healing group, culturally relevant interventions that resonate with one’s Islamic faith may facilitate improved mental health service utilization for those suffering from the impacts of trauma exposure (Byrow et al., 2020). Indeed, the language describing the group in this study (e.g., discussion of prophet stories from the Qur’an and time for individual prayer [dua]) may have increased perceived need or helpfulness of the group intervention. Further, it is possible that in addition to the individual and contextual factors examined in this study, other structural and cultural factors such as lack of access to mental health services and providers and potential stigma of mental health disorders (e.g., Byrow et al., 2020; Weatherhead & Daiches, 2010) may contribute to perceived need. Although the group was described as being embedded within a mosque and employed the term “trauma healing,” culturally responsive treatments like Islamic Trauma Healing may not fully address components that impact treatment utilization for all forcibly displaced Muslims. Understanding factors that influence perceived need, especially need for culturally responsive care, will inform how to optimally address access-to-care barriers.

Interestingly, those who were externally displaced reported moderately greater perceived individual and friends/family need than those who are internally displaced; however, when controlling for PTSD severity, displacement status was only associated with perceived friends/family need. Perhaps a range of negative post-migration contextual factors (Siriwardhana & Stewart, 2013; Steel et al., 2017; von Haumeder et al., 2019) are more commonly experienced among those who are externally displaced and contribute to an enhanced perceived need for their friends and family to heal from trauma-related wounds. For example, externally displaced refugees may struggle with assimilation stressors, worries about family, and a lack of awareness of available mental health services as a result of living in a foreign country (Norredam et al., 2005; Steel et al., 2017). Importantly, internally displaced persons also experience stressors related to a rupture in social support, financial instability, and lack of access to health care (Siriwardhana & Stewart, 2013).

When examining the moderating role of PTSD severity on the relationship between displacement status and perceived need, externally displaced Muslims reported a greater perceived friends/family and community need than internally displaced Muslims at average and/or lower levels of PTSD severity. Internally displaced individuals with average to below average PTSD symptoms may not see as high of a need for their friends, family, and community to participate in a faith-based mental health group as those who are externally displaced. As mentioned above, perhaps externally displaced Muslims with lower levels of PTSD symptoms have additional stressors that heighten their perceived need for their community and others close to them to receive services. Moderation analyses also revealed that perceived individual need was higher when participants reported more severe PTSD symptoms, regardless of locus of displacement. Thus, unsurprisingly, culturally responsive mental health services (e.g., Bentley et al., 2021) may enhance access to trauma-related healing for forcibly displaced Muslims.

These findings should be interpreted while considering some important limitations. First, a large percentage of the sample (51.8%) originated from India, Pakistan, Syria, or Afghanistan, which may limit the generalizability to other regions. Despite this, this study is one of a few with displaced persons from multiple countries around the globe. Further, the crowdsourcing method used to recruit participants limited the sample to those with access to internet and knowledge of MTurk, likely resulting in an over-representation of men with higher socioeconomic statuses in the sample (Qureshi et al., 2022). Additionally, perceived need was measured for a specific faith-based group for trauma-related symptoms, limiting generalizability to other types of culturally responsive and/or more traditional Western-developed treatments. While perceived need for Western PTSD treatment methods may have been equally preferred among at least some of the participants, this type of need was not measured nor compared. Future research should compare forcibly displaced Muslims’ perceived need for various intervention types and examine predictors of treatment preference, including more detailed intervention details and rationales for the interventions.

This study had several considerable strengths. Research is limited on forcibly displaced Muslims’ perceived need for mental health care (Bonabi et al., 2016; Edlund et al., 2006; Prins et al., 2008), let alone need for culturally responsive services as investigated in this study. The results expand upon findings from one previous study that examined perceived need for Islamic Trauma Healing among a specific subgroup of forcibly displaced Muslims. The emphasis on group-level “trauma healing” may have lessened stigma against endorsing a personal need for the described intervention. Additionally, the questioning of need for both oneself and others allowed for a more nuanced understanding of perception of need for culturally relevant trauma healing interventions. Alternative wording and varying salient contexts (e.g., location, contents of the intervention, etc.) may help further in understanding modulation of perceived mental health needs. Finally, there is a paucity of work that has examined differences in displacement status; most studies have looked at either internally or externally displaced persons, and thus have not drawn comparisons between them. This study builds on the understanding of how these displaced peoples may generally differ in their perceived need for culturally responsive mental health services. It is important to note that these results do not automatically generalize to all forcibly displaced Muslims; as such, future research is needed on the moderating effects of various personal, contextual, and structural variables on perceived need.

Despite low rates of mental health care utilization amongst forcibly displaced Muslims (Grupp et al., 2019; Slewa-Younan et al., 2014; Weatherhead & Daiches, 2010), the present study showed a clear perceived need for culturally responsive, trauma-related mental health care. In particular, forced migration and related post-migration adjustment may contribute to perceived need for mental health treatment. However, current Western mental health services may not align well with some forcibly displaced Muslims’ cultural and religious beliefs. Given that this group represents one of the largest groups of forcibly displaced persons, addressing the need for and increasing utilization of treatment likely requires novel, culturally relevant treatment modalities like Islamic Trauma Healing. To promote equity, mental health care should be tailored to individuals’ attitudes, values, and social practices.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Access to the data may be provided to qualified researchers engaging in independent scientific research. Data will be provided to the requesting party following review and approval of a research proposal, statistical analysis plan and execution of a Data Sharing Agreement. Shared data will be coded, with no PHI included. Data request can be submitted starting 9 months after the article publication and data will be accessible for up to 24 months. Extensions will be considered on a case-by-case basis.

Additional information

Funding

This work was supported by the University of Washington Population Health Initiative (PI: Zoellner); and The National Institute of Mental Health under Grant R34MH112756 (PI: Zoellner).