Displacement in the body: A mixed-methods study of the syndemic interaction of mental distress and musculoskeletal disorders among Afghan immigrants.

BACKGROUND AND METHODOLOGY: Forced displacement exposes refugees to intersecting psychological, physical, and structural stressors that can exacerbate mental distress and chronic pain. This mixed-methods study explored the co-occurrence of mental distress and musculoskeletal pain among Afghan immigrants living in Peshawar, Pakistan, using a syndemics-informed framework. Data were collected by combining survey questionnaire results from 200 participants with 17 interview responses and ethnographic observations of immigrants.

RESULTS: The researchers examined quantitative data through descriptive statistics with regression analyses, together with qualitative thematic analysis, which adopted the syndemic model. Depressive symptoms affected 62.1% of participants, and chronic musculoskeletal pain occurred in 58% of participants with mental distress, producing statistically significant correlations to physical discomfort (p < .001). Regression analyses indicated that depressive symptoms were significantly associated with higher levels of musculoskeletal pain, with women reporting greater symptom burden. It was found that people have certain beliefs about illness linked to their culture, often sacrifice their health for their gender roles, use informal methods to cope, and encounter barriers when accessing care. They made sense and supported the statistical trends seen in the data. Study findings suggest a syndemic pattern of co-occurring mental distress and musculoskeletal health problems among Afghan immigrants, shaped by structural inequalities and cultural factors affecting care.

CONCLUSION: Findings underscore the importance of integrated, culturally responsive health approaches for Afghan immigrants living in protracted displacement, while highlighting the need for cautious interpretation given the exploratory design.