Verbesserung der psychischen Gesundheit von Geflüchteten im Kontext von Postmigration und Pandemie

Refugee movements and migrations are considered global phenomena worldwide. Germany, specifically, is one of the most receiving host countries for refugees and migrants in Europe. Since 2015 and after the Syrian war, people from diverse linguistic and cultural backgrounds fled to Germany. Refugees are at high risk of developing symptoms of general mental disorders such as depression, anxiety and PTSD. However, the mental health care system in Germany was not well prepared and several barriers prevented refugees from using its services, including cultural misunderstanding, language and administrative barriers. In addition, in March 2020, the WHO declared the COVID-19 outbreak in Wuhan, China as a pandemic and various strict measure had to be taken by the governments worldwide. This led to the exacerbation of mental illnesses in the general population, especially in disadvantaged groups such as refugees. With the 1978 Alma Ata declaration, community participation and empowerment were brought to the forefront as a key component of PHC. Therefore, such empowerment interventions offered in the early stages of refugee resettlement were developed to help refugees arriving in Germany. The aim of this dissertation, within the framework of three publications was first to assess a cost-effective, cultural compatible P2P self-help intervention for refugees that was established at the Charité. This intervention was administered to refugees suffering from depression and was related to other help initiatives such as that from the Civil Society Engagement. Secondly, the dissertation shed light on the impact of the COVID-19 disease on the mental health status of refugees, aiming to improve interventions during the present pandemic and beyond. The results of the three publications suggest that integrating culturally sensitive interventions in mental health services and primary care is an important step to achieve better health outcomes among refugees. Integrating mental health care and empowerment in PHC are two important approaches in health care as regards to prevention of mental illnesses, promotion, access and quality of care delivered. These observations are relevant to the discussion on improving care for disadvantaged refugee groups and must be properly considered by the German health care system.Flüchtlingsbewegungen und Migrationen gelten weltweit als globale Phänomene. Deutschland im Speziellen ist eines der am meisten aufnehmenden Gastländer für Geflüchtete und Migranten in Europa. Seit 2015 und nach dem Syrien-Krieg sind Menschen mit unterschiedlichen sprachlichen und kulturellen Hintergründen nach Deutschland geflohen. Geflüchtete haben ein hohes Risiko, Symptome allgemeiner psychischer Störungen wie Depressionen, Ängste und PTBS zu entwickeln. Das psychische Versorgungssystem in Deutschland war jedoch nicht gut vorbereitet und mehrere Barrieren hinderten Geflüchtete daran, die Angebote zu nutzen, darunter kulturelle Missverständnisse, sprachliche und administrative Barrieren. Hinzu kam, dass die WHO im März 2020 den COVID-19-Ausbruch in Wuhan, China, zur Pandemie erklärte und verschiedene strenge Maßnahmen von den Regierungen weltweit ergriffen werden mussten. Dies führte zu einer Verschärfung der psychischen Erkrankungen in der Allgemeinbevölkerung, insbesondere bei benachteiligten Gruppen wie Geflüchteten. Mit der Alma-Ata-Deklaration von 1978 wurde die Beteiligung und Befähigung der Bevölkerung als Schlüsselkomponente von PHC in den Vordergrund gerückt. Daher wurden solche Empowerment-Interventionen, die in der frühen Phase der Flüchtlingsansiedlung angeboten wurden, entwickelt, um den in Deutschland ankommenden Geflüchteten zu helfen. Ziel dieser Dissertation war es, im Rahmen von drei Publikationen zuerst eine kosteneffektive, kulturkompatible P2P-Selbsthilfe-Intervention für Geflüchtete zu evaluieren, die an der Charité etabliert wurde. Diese Intervention wurde bei an Depressionen erkrankten Geflüchteten durchgeführt und mit anderen Hilfsinitiativen, z.B. aus dem zivilgesellschaftlichen Engagement, in Beziehung gesetzt. Zum anderen beleuchtete die Dissertation die Auswirkungen der COVID-19-Erkrankung auf den psychischen Gesundheitszustand von Geflüchteten mit dem Ziel, Interventionen während der aktuellen Pandemie und darüber hinaus zu verbessern. Die Ergebnisse der drei Publikationen legen nahe, dass die Integration von kultursensiblen Interventionen in die psychische Gesundheitsversorgung und die Primärversorgung ein wichtiger Schritt ist, um bessere gesundheitliche Ergebnisse bei Geflüchteten zu erzielen. Die Integration von psychischer Gesundheitsversorgung und Empowerment in der PHC sind zwei wichtige Ansätze in der Gesundheitsversorgung im Hinblick auf die Prävention von psychischen Erkrankungen, die Förderung, den Zugang und die Qualität der erbrachten Leistungen. Diese Beobachtungen sind relevant für die Diskussion über die Verbesserung der Versorgung von benachteiligten und geflüchteten Gruppen und müssen vom deutschen Gesundheitssystem angemessen berücksichtigt werden

Spatiality of Social Stress Experienced by Refugee Women in Initial Reception Centers

This study takes an interdisciplinary approach to understanding the multi-dimensionality of social stress within the spatiality of initial refugee reception centers in Berlin. By focusing particularly on the experiences of women who fled from Syria and Afghanistan, it situates this humanitarian issue within an analytical framework of gender-sensitive and culturally sensitive research and policymaking. Through qualitative interviews with 11 refugee women, the connection between the spatiality of initial reception centers and social stress is explored. This is done by thematically coding the data collected in the context of nine different initial reception centers across various districts in the city of Berlin. The study shows that in terms of the intercultural needs and practices of these women, social stress is triggered by a lack of essential privacy within the spatiality of these structures. However, privacy is not limited to a physical enclosure—it is about having control/freedom over different aspects of everyday life. This article highlights intercultural gaps in gender-sensitive and protection considerations during humanitarian responses.Charité - Universitätsmedizin Berlin (3093)Peer Reviewe

Spatiality of Social Stress Experienced by Refugee Women in Initial Reception Centers

This study takes an interdisciplinary approach to understanding the multi-dimensionality of social stress within the spatiality of initial refugee reception centers in Berlin. By focusing particularly on the experiences of women who fled from Syria and Afghanistan, it situates this humanitarian issue within an analytical framework of gender-sensitive and culturally sensitive research and policymaking. Through qualitative interviews with 11 refugee women, the connection between the spatiality of initial reception centers and social stress is explored. This is done by thematically coding the data collected in the context of nine different initial reception centers across various districts in the city of Berlin. The study shows that in terms of the intercultural needs and practices of these women, social stress is triggered by a lack of essential privacy within the spatiality of these structures. However, privacy is not limited to a physical enclosure-it is about having control/freedom over different aspects of everyday life. This article highlights intercultural gaps in gender-sensitive and protection considerations during humanitarian responses