Indo- and Afro-Trinidadian women’s experience of domestic violence, somatization disorder and help-seeking: a mixed methodological analysis

In Trinidad, negative attitudes towards mental health and unwillingness to access mental health care because of cultural restrictions and stigma deter some women with somatization disorder and experiences of domestic violence from seeking help (Hadeed & El Bassel, 2006; Kassiram & Maharajh, 2010; Maharajh, 2010). Several theoretical explanations for these interrelated issues are discussed in this thesis; grounded in considerations of the influence of culture and ethnicity. Somatization disorder appears to be more prevalent among Asian populations, and has a higher comorbidity with domestic violence within this ethnicity (Bhui, 2002; DSM-IV-TR, 2002; Fernando, 2002; Hardin, 2002) with some even stating that somatization disorder may be a culture bound ailment (Kassiram & Maharajh, 2010; Schrag & Trimble, 2005; Samelius, Wijma, Wingren & Wijma, 2008). In many Asian cultures emotional distress is still stigmatized compared to medical problems, resulting in delayed help-seeking (Hardin, 2002). To date, no research has been conducted regarding the possible links between somatization disorder, domestic violence experiences and help-seeking in Trinidad. This thesis utilized a mixed methods approach to explore the occurrence of somatization disorder and domestic violence among Indo- and Afro-Trinidadian women and their help-seeking choices. Drawing on data gathered from a combination of questionnaires (250; 150 with women and 100 with religious leaders and medical doctors) and interviews (12 participants; employing an Interpretative Phenomenological Approach) the key findings were that Indo-Trinidadian women were three times more likely to have symptoms associated with somatization disorder if they had domestic violence experiences compared to Afro-Trinidadian women. Both Indo-and Afro-Trinidadian women appear to internalize their distress as a means of coping. The women also reported mixed opinions about assistance received from both religious leaders and medical doctors when they sought help for their somatic symptoms and domestic violence experiences. Finally, despite medical doctors being more knowledgeable and reporting that they possessed better resources for assessing and intervening for both somatization disorder and domestic violence compared to religious leaders, they were less inclined to explore these intersecting issues with women patients. These findings are congruent with international research: culture emerged as the crucial component for the manifestation, reporting, and assistance sought for both somatization disorder and domestic violence experiences specifically in Trinidad, West Indies.