Beyond Comorbidity: Mapping Trauma-Related Symptom Networks In Somali Refugee Youth Living In Urban Displacement

Background and Purpose:
Refugee populations experience disproportionately high rates of trauma-related common mental disorders (CMDs). Dominant diagnostic frameworks conceptualize PTSD, depression, and anxiety as discrete conditions. This categorical approach is limiting in refugee contexts, where symptoms frequently co-occur and are shaped by culturally specific expressions of distress. Among Somali refugees, somatic idioms, including bodily heaviness or paralysis-like sensations, are central to lived experiences of psychological suffering but are often excluded from standard assessments. This study advances the field by applying a network analytic approach to reconceptualize CMDs as interconnected systems of symptoms rather than independent disorders. By identifying central and co-occurring symptoms, this study aims to generate actionable insights for culturally responsive, transdiagnostic mental health interventions in refugee populations.

Methods:
Data were collected from 336 Somali refugee youth (ages 15–34) residing in Eastleigh, Nairobi, using community-engaged snowball sampling. Participants completed validated measures of PTSD (PCL-C; α=0.91), depression and anxiety (HSCL-25; α=0.92 and 0.89), and a culturally adapted 7-item somatic symptom scale (α=0.86). A regularized partial correlation network was estimated using the EBICglasso method with Spearman correlations to model conditional dependencies while minimizing spurious associations. Symptom communities were identified using the Walktrap algorithm, and strength centrality metrics were calculated to determine the relative influence of each symptom within the network. Robustness was evaluated through perturbation-based sensitivity analyses, with Adjusted Rand Index (ARI) values used to assess stability across 100 iterations.

Results:
The network revealed a structured and interpretable system of five symptom communities: (1) anxiety and PTSD hyperarousal symptoms, (2) depressive symptoms with restlessness, (3) PTSD re-experiencing and avoidance, (4) PTSD emotional numbing and detachment, and (5) culturally specific somatic symptoms. The community structure demonstrated moderate-to-strong stability (ARI range=0.47–1.00; mean=0.745), supporting robustness of the identified clusters. Centrality analysis identified a set of highly influential symptoms spanning domains, including low energy, feeling trapped, worrying excessively, panic, and nervousness. Notably, the culturally specific somatic symptom “feeling like a stone” emerged as the most central node in the network, underscoring the critical role of culturally embedded expressions of distress. Descriptive findings further indicated a high burden of trauma-related symptoms, with 26.1% of participants meeting a conservative cutoff for probable PTSD, increasing to 39% under a lower threshold. These findings demonstrate that distress is not confined within diagnostic boundaries but instead organized through interconnected symptom clusters that cut across traditional categories.

Conclusions and Implications:
This study offers both conceptual and methodological contributions by shifting focus from disorder-based frameworks to symptom-level systems in refugee mental health research. Findings suggest that targeting central symptoms (e.g., those bridging psychological and somatic domains) may yield more efficient and culturally congruent intervention strategies. For social work practice, this underscores the importance of integrating culturally grounded assessments and moving beyond Western diagnostic categories. For research, the study highlights the value of network analysis as a tool for uncovering hidden structures of distress and informing transdiagnostic, resource-sensitive interventions. Future work should extend this approach longitudinally and across diverse refugee populations to examine how symptom networks evolve and respond to intervention.