"I am not that trauma": recognition of and response to domestic and family violence mental health presentations among South Asian migrant and refugee women in primary care in Melbourne, Australia

Abstract

Domestic and family violence (DFV) is a major driver of mental health distress among women. Despite the growing population of migrant and refugee women in Australia, there is limited understanding of how they engage with, access or are supported by Australia’s mental health care pathways. This study explores South Asian migrant women’s experiences of mental health support in primary care settings and examines patterns of Mental Health Care Plan provision and DFV identification using routine clinic data. A multi-methods approach was employed, combining in-depth interviews with 11 South Asian migrant and refugee women with descriptive analysis of aggregated data from general practice clinics participating in the Harmony trial. Interviews were analysed using Interpretive Phenomenological Analysis, and clinic data were used to assess Mental Health Care Plan provision and DFV identification among South Asian and non–South Asian female patients. Qualitative findings revealed complex help-seeking shaped by migration, social stigma, and systemic barriers. Women described both supportive and dismissive responses from healthcare providers, with trauma and stress often manifesting through somatic symptoms. Quantitative data showed South Asian women comprised 17% (7,874/45,438) of the total clinic population, yet only 9% (317/3590) of Mental Health Care Plan (MHCP) recipients were South Asian, indicating under-representation relative to their clinic population share. Among women who received a MHCP ( n = 3590), DFV was documented in 7% ( n = 21) of South Asian women and 8% ( n = 257) of non–South Asian women. DFV identification rates were consistently low among women with a MHCP (7–8%), and South Asian women were underrepresented among MHCP recipients relative to their share of the clinic population. Qualitative findings highlighted the complex interplay of migration, social stigma, somatic trauma presentations, and systemic barriers that shape women's help-seeking and disclosure in primary care. Together, these findings suggest that both mental health care at the rates that would be expected given known prevalence, highlighting the need for culturally safe, trauma-informed approaches and improved access pathways to ensure equitable care for migrant and refugee women experiencing or recovering from violence. ACTRN12618001845224 on 13/11/2018.