A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany

Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages. Findings: Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%). Conclusion: The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders

Einstellung von Medizinstudenten zur Psychiatrie: Transkulturelle Perspektive

Introduction and objective: Worldwide, there is currently a gap between the high prevalence of psychiatric disorders and psychiatric and psychological care. The negative attitude towards psychiatry among medical students contributes to the low excitement in terms of recruitment in this specialty. The attitude of medical students, as an essential sector of medical manpower, contributes to changing the public views towards psychiatry. Therefore, knowing the role of cultural effect in shaping attitudes towards psychiatry is a field of relevance. Methods: In a cross-sectional survey, we examined and compared various aspects and misconceptions in psychiatry among 105 medical students from Charité University Berlin in Germany and 94 medical students from Ain Shams University in Egypt, using the ‘‘Attitudes Towards Psychiatry’’ (ATP-30) scale and eight additional items developed for the purpose of the study. Furthermore, we examined the students’ will to specialize in psychiatry, as well as the factors that may influence their attitudes towards this specialty. Results: According to the ATP-30 questionnaire, both groups have generally a positive attitude towards psychiatry without a significant difference, with a mean ATP score of 109.70(SD: 11.39) in the Egyptian and 110.48 (SD: 13.03) in the German group. However, we distinguished significant differences in attitudes among German and Egyptian students who did not complete the psychiatric clerkship (Egyptian: 103.79, German 109.79, P= .013). The clinical clerkship in psychiatry contributed significantly to improving the students’ will for a future specialty in psychiatry, and this result was more evident in the Egyptian group. Furthermore, there were significant differences in five out of the eight additional items and in twenty items of the ATP-30, reflecting potential cultural attitudinal differences between the groups. 6.4% of the Egyptian vs 3% of the German students mentioned psychiatry as their first career choice. Conclusion: Attitudinal differences regarding psychiatry are influenced by psychiatric clerkship, and probably by cultural assumptions. Medical students’ general positive views towards psychiatry in either culture do not translate appropriately into improving preferences for psychiatry as career. Further studies will be needed to further investigate and understand the cultural differences in the perceptions of psychiatry.Einleitung und Fragestellung: Weltweit gibt es zurzeit eine Lücke zwischen der hohen Prävalenz von psychiatrischen Störungen und dem Mangel an psychiatrischer und psychologischer Versorgung. Die negative Einstellung von Medizinstudenten zur Psychiatrie trägt zu der geringen Begeisterung für diese Fachrichtung bei. Die Einstellung der Medizinstudenten, die einen wesentlichen Sektor des medizinischen Personals darstellen, beeinflusst die Veränderung der öffentlichen Meinung zur Psychiatrie. Der Einfluss der kulturellen Faktoren auf die Gestaltung der Einstellung zur Psychiatrie ist ein wesentlicher Untersuchungsbereich. Methoden: In einer Querschnittstudie untersuchten und verglichen wir verschiedene Aspekte und Missverständnisse in der Psychiatrie von 105 Medizinstudenten der Charité-Universität Berlin in Deutschland und 94 Medizinstudenten der Ain Shams-Universität in Ägypten anhand den „Attitude Towards Psychiatry Scale“ (ATP-30) und acht weiteren speziell für diese Studie entwickelten Statements. Darüber hinaus untersuchten wir ihre aktuellen Wünsche zur Spezialisierung in diesem Bereich sowie die Faktoren, die ihre Einstellung zur Psychiatrie beeinflussen können. Ergebnisse: Nach dem ATP-30 Fragebogen haben beide Gruppen eine positive Einstellung zur Psychiatrie ohne signifikanten Unterschied mit einem durchschnittlichen ATP-30 Score von 109.70 (SD = 11.39) in der ägyptischen Gruppe und 110.48 (SD = 13.03) in der deutschen Gruppe. Wir fanden allerdings einen signifikanten Unterschied in der Einstellung zwischen den deutschen und ägyptischen Studenten, die das psychiatrische clerkship nicht besucht hatten (Ägyptische: 103.79, Deutsche: 109.79, P: .013). Das psychiatrische clerkship trug signifikant zur Verbesserung der Einstellung zur Psychiatrie bei, insbesondere in der ägyptischen Gruppe. Darüber hinaus gaben es signifikante Unterschiede bei fünf von den acht zusätzlichen Statements und in zwanzig Statements des ATP-30, welche eventuelle kulturelle Unterschiede zwischen den Gruppen widerspiegeln. 6,4% der ägyptischen vs 3% der deutschen Studierenden gab Psychiatrie als ihre erste Berufswahl an. Schlussfolgerung: Einstellungsbezogene Unterschiede hinsichtlich der Psychiatrie werden durch psychiatrische clerkship und möglicherweise kulturelle Faktoren beeinflusst. Die generell positive Einstellung der Medizinstudenten zur Psychiatrie in beiden Kulturen wird nicht angemessen in die Verbesserung der Einstellungspräferenzen in der Psychiatrie einbezogen. Zum besseren Verständnis der kulturellen Unterschiede der psychiatrischen Konzepte sind weitere Studien erforderlich