57 research outputs found
Untersuchung der BeduÌrfnisse und Entwicklung eines diagnostischen Instruments fuÌr die psychische Gesundheit und das Wohlbefinden arabischsprachiger GefluÌchteter
In the last decade, the number of distressed Arabic-speaking refugees and displaced persons has risen significantly as a result of ongoing political turmoil, war, and conflict in their homes. Pre, during and post- migratory stressors have led to an increase in untreated psychological symptoms that contrast only with limited culturally-sensitive research output and available mental health care services. Furthermore, this specific population have been identified as at-risk due to substantial cultural, linguistic, economic, and social challenges, leading to their marginalization, which further hampers their ability to access and benefit from effective and efficient culturally relevant mental health care systems. As far as the authorâs knowledge, the present dissertation represents the first comprehensive project aiming to address an existing gap in the understanding, access to and delivery of mental health care services for Arabic-speaking refugees in three host settings (Germany, Jordan and the Kurdistan Region of Iraq). The current thesis summarizes the work carried out in five separate publications, each with its own set of research questions touching upon the psychosocial needs of Arabic-speaking refugees in three different host settings. While some of the selected studies explore unique, first-hand perspectives and experiences of Arabic-speaking refugees, symptom representations, mental health stigma, and their evaluation of existing services, others shed light on specific dimensions of Arabic-speaking refugee mental health that deepen our understanding of their cultural and religious needs.
Furthermore, this thesis also offers insights, clinical applications, and diagnostic solutions, which can address several barriers to the access and effectiveness of mental healthcare by making the process easier for all beneficiaries within the system. Each publication covers a different aspect of refugee mental health; however, combined all studies can inform mental health providers and address the needs of struggling refugee communities and burdened healthcare systems alike. Our findings can promote the culturally specific needs of Arabic-speaking refugees and lead to a more cost-efficient use of available services and resources in refugee host countries and humanitarian aid settings that need assistance.Im vergangenen Jahrzehnt konnte aufgrund von anhaltenten politischen Turbulenzen,
Krieg und Konflikten in den jeweiligen HeimatlÀndern, ein signifikanter Anstieg der Anzahl
arabischsprachiger GeflĂŒchteter und Vertriebener verzeichnet werden. Stressoren vor, wĂ€hrend
oder nach der Migration fĂŒhrten zu einer hohen Anzahl unbehandelter, psychiatrisch relevanter
Symptome in dieser Population. Erschwert wird die Behandlung besonders durch
unzureichende, kultursensible Forschungsvorhaben und -erkenntnisse sowie die geringe
VerfĂŒgbarkeit und Erreichbarkeit von spezialisierten Einrichtungen der psychischen
Gesundheitsversorgung. Zudem fĂŒhren erhebliche kulturelle, linguistische, ökonomische und
soziale Herausforderung zu einer zunehmenden Marginalisierung, welche die Möglichkeiten
fĂŒr eine effektive und effiziente Nutzung bestehender Gesundheitsversorgungssysteme
erschwert und so das Risiko schwerer KrankheitsverlĂ€ufe fĂŒr diese Population deutlich erhöht.
Nach dem Wissensstand der Autorin kann die vorliegende Dissertation als das erste,
umfassende Projekt verstanden werden, welches zum Ziel hat, die bestehenden LĂŒcken bei
Erkenntnissen, VerfĂŒgbarkeit und Angebot von psychischer Gesundheitsversorgung fĂŒr
arabischsprachige GeflĂŒchtete in drei Aufnahmegesellschaften (Deutschland, Jordanien und
die irakische Region Kurdistan) zu adressieren. HierfĂŒr werden in dieser Arbeit fĂŒnf separate
Publikationen zusammengefasst, die mit ihren individuellen Forschungsfragen die
psychosozialen BedĂŒrfnisse arabischsprachiger GeflĂŒchteter in verschiedenen LĂ€ndern
thematisieren. WĂ€hrend einige dieser Studien die Perspektiven und Erfahrungen der
arabischsprachigen GeflĂŒchteten selbst in den Mittelpunkt stellen und Erkenntnisse ĂŒber die
ReprĂ€sentation psychischer Symptome, Stigmatisierung und die EinschĂ€tzung von verfĂŒgbaren
Diensten liefern, werden in anderen die spezifischen Dimensionen der psychischen Gesundheit
von arabischsprachigen GeflĂŒchteten untersucht und leisten so einen Beitrag zu einem besseren
VerstĂ€ndnis ihrer kulturellen und religiösen BedĂŒrfnisse.
DarĂŒber hinaus liefert diese Dissertation Einblicke, klinische Anwendungen und
diagnostische Lösungen, um bestehende Barrieren bei Zugang und EffektivitÀt von psychischer
Gesundheitsversorgung abzuschwĂ€chen, indem Prozesse fĂŒr alle im System beteiligten
vereinfacht werden. Zwar adressiert jede Studie einen anderen Aspekt psychischer Gesundheit
arabischsprachiger GeflĂŒchteter, doch zusammen können alle Studien wichtige Informationen
fĂŒr psychische Gesundheitsdienstleistende liefern und sowohl die BedĂŒrfnisse belasteter
FlĂŒchtlingsgemeinschaften als auch ĂŒberlasteter Gesundheitssysteme in den Blick nehmen.
Unsere Erkenntnisse tragen dazu bei, die kulturspezifischen BedĂŒrfnisse arabischsprachiger
GeflĂŒchteter zu fördern und ebnen damit den Weg fĂŒr die kosteneffiziente Nutzung verfĂŒgbarer Dienstleistungen und Ressourcen in Aufnahmegesellschaften und zur UnterstĂŒtzung
humanitÀrer Hilfsangebote
Boscoville and social adjustment
This thesis reports data on a study of the attitudes of juvenile delinquents committed to a reform school in Quebec called "Boscoville." It also considers the rehabilitation policies associated with these attitudes and the problem of social adjustment of juveniles following their release from the centre. The chief aim of the investigation was the generation of a grounded theory of commitment to delinquency. -- The phenomenon of juvenile delinquency is approached from the point of view of the subjective career; men create special realities through a process of interpretation of events directly connected with their major identities. Using .this principle as a starting point, one can clearly distinguish between two basic types of delinquency. -- 1. Drift: the life of the individual is not organized around crime nor does lawbreaking become part of his identity. Juveniles in drift do not share the background traits that characterize most delinquents in Boscoville such as inadequate family relations, failure in school, and repeated deviant activities. Lawbreaking to them is not a permanent solution to life's problems. -- 2. Commitment: the individual becomes aware of his association with deviance when he recognizes that he is forced into a career within it. Juveniles who identify thus deviance share certain attitudes towards their major life experiences (some of which were investigated in this study). They internalize the community definitions of deviance and live up to that image, so that regardless of the differences in their personal identities, they share a social identity based on the deviant role they play. -- The attitudes of juvenile delinquents in drift differ from the attitudes of juveniles who are attached to deviance. An investigation of those attitudes and their causes may help guide rehabilitation favourable to the inmate's social adjustment. Indeed, Boscoville eliminates the deviant identities of its inmates, by offering them the possibility of reentering the conventional world by enhancing their self-images and by engendering an awareness of the world and its time-space relationships. -- Rehabilitation in Boscoville, however, does not necessarily eliminate lawbreaking activities motivated by for financial gain. In fact, an awareness of the consequences of one's action also makes one more conscious of the implications of one's criminal action. Boscoville can help an individual become better adjusted to the world he lives in, even though it may help some become better thieves
On Perceived Stress and Social Support: Depressive, Anxiety and Trauma-Related Symptoms in Arabic-Speaking Refugees in Jordan and Germany
Current literature points toward several challenges in the access to sufficient and effective
psychosocial care for Syrian refugees in host settings. This study is a comparative
investigation into the relationship between âperceived social stressâ and âperceived
social supportâ on three of the most prevalent symptom dimensions in Syrian refugees
across two host capitals, Berlin and Amman. Eighty nine Syrians refugees were recruited
between January 2017 and March 2018. Participants were contacted through local
institutions and organizations collaborating with the CharitĂ©âUniversitĂ€tsmedizin Berlin.
Assessments include the PHQ-9, GAD-7, HTQ, MSPSS, and PSS. Primary analyses
consist of non- or parametric tests and multiple linear regression analyses. Subsample
analyses showed relevant depressive, anxiety and trauma-related symptoms. Significant
differences in PTSD symptoms (p < 0.04) were found. Participants reported high
perceived stress and moderate to high social support. Linear regressions revealed that
perceived stress had a significant negative effect (p < 0.01) on clinical outcomes in both
subsamples. Perceived social support had a positive influence on depressive (p = 0.02)
and PTSD symptoms (p = 0.04) for participants in Berlin. Analyses revealed significant
positive effects of âsignificant othersâ (p = 0.05) on depressive- in Berlin and âfamilyâ (p =
0.03) support for PTSD symptoms in Amman. Study results show that levels of âperceived
stressâ appear to be the same across different host countries, whereas types of social
support and their effect onmental health differ significantly depending on the host setting.
Outcomes may guide future comparative study designs and investigations to promote
well-being, integration, and the development of effective social support structures for the
diverse needs of Arabic-speaking refugees
Faith-Based Coping Among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study
Background: The benefits of faith-based coping or using religious and spiritual beliefs as a stabilizing force for interpreting stressful or distressing events are largely unexplored among the exodus of Arabic-speaking refugee populations from Muslim-majority countries, particularly those resettled in Europe. The present study aimed to explore the manifestation of faith-based coping strategies among Arabic-speaking refugee adults seeking mental healthcare services in Berlin, Germany and explore how favorable faith-based coping strategies can be optimized from a mental health service-delivery and broader integration perspective.
Methods: A total of 17 qualitative interviews were conducted with Arabic-speaking refugee adults (six females, 11 males) seeking mental health services at the Charite Universitaetsmedizin in Berlin. Research questions aimed to solicit comprehensive perspectives from refugee adults on their mental health, with an emphasis on faith-based coping, and how this facilitated or impeded their integration into German society. Interview transcripts were translated to English from Arabic and analyzed using MAXQDA (2018) to highlight thematic patterns using a grounded theory approach.
Results: Findings were structured into four themes, including: (I) faith-based coping methods during flight, (II) changes in faith practices upon arrival, (III) faith-based coping methods to address distress during integration, and (IV) advice for German mental healthcare providers. Participants who demonstrated a stronger commitment to faith were more likely to utilize faith-based coping strategies when seeking mental health services and facing the challenges of displacement and integration. Examples of faith-based coping included prayer, supplication, reciting scripture, and seeking help from a local religious leader.
Conclusion: The findings suggest how faith and faith practices play a significant role in the mental health and integration of refugee populations in Germany and provide insight on how mental healthcare can be delivered in a culturally-sensitive manner, providing alternatives to the social, cultural, and linguistic barriers posed by the German health system. These findings are particularly relevant for mental health professionals, non-governmental organizations, and humanitarian aid agencies providing mental healthcare to Arabic-speaking populations recently resettled in Western contexts
Psychotherapy in Jordan: An Investigation of the Host and Syrian Refugee Community's Perspectives
Little is known about patient satisfaction, bias, stigma, and the effects of psychotherapy within the Kingdom of Jordan or the Arab world in general. The purpose of this study was to explore the perceptions of both the Jordanian host and refugee community members from the psychotherapeutic services offered at various mental health care settings in Jordan. A sample of 100 patients who received psychosocial expert interventions was recruited between October and December 2017 in Amman, Jordan. Participants were either from the host or Syrian refugee community or contacted through multiple organizations working in the mental health field. The Patient Satisfaction Questionnaire, which consists of four subscales covering 1) patient satisfaction, 2) bias toward therapy, 3) effects of therapy, and 4) stigma, was administered. As a means of investigation and exploration, descriptive statistics of participant responses are displayed. Results revealed overall high rates of satisfaction with provided services and perceived benefits of psychotherapeutic interventions. However, respondents showed ambivalence regarding bias and stigma. Subsample analyses indicated no significant differences between both communities. These findings give an understanding of perceptions surrounding psychotherapy in Jordan and some insights on therapeutic processes that may be useful for clinical applications and future research
Development of a culturally sensitive Arabic version of the Mini International Neuropsychiatric Interview (M.I.N.I.-AR) and validation of the depression module
Background: Arabic represents one of the most frequently spoken languages worldwide, especially among refugee populations. There is a pressing need for specialized diagnostic tools corresponding to the DSM-5 criteria in Modern Standard Arabic, which can be administered on Arabic speakers in the West and Arab region alike.
Objectives: To develop and validate the culturally-adapted version of the most recent M.I.N.I. 7.0.2 into Modern Standard Arabic-a form of Arabic commonly used across all Arab countries.
Methods: 102 participants were recruited between April 2019 to March 2020 at the Charite - Universitatsmedizin in Berlin. Symptoms were assessed with Arabic versions of rater-based and self-rated measures, including Mini International Neuropsychiatric Interview (M.I.N.I.), Patient Health Questionnaire (PHQ-9), and Harvard Trauma Questionnaire (HTQ). Arabic-speaking psychiatrists saw participants for diagnostic assessment.
Results: Cohen's kappa (kappa) values were moderate for major depression, and slight for post-traumatic stress disorder, as well as generalized anxiety disorder. Moreover, kappa values indicated moderate agreement between M.I.N.I.-AR and PHQ-9 for depression, as well as HTQ for post-traumatic stress disorder, respectively.
Conclusion: The translated and culturally adapted version of the M.I.N.I. addresses an existing need for a reliable, efficient, and effective comprehensive diagnostic tool using the most recent DSM-5 criteria in Modern Standard Arabic (MSA). Based on the obtained results, only a validation of the depression module (Module A) of the M.I.N.I-AR was possible. Study outcomes also show evidence for the validation of Module H covering Post-Traumatic Stress Disorder. Potential valuable contributions can be extended to this translation and validation
Exploring the Representation of Depressive Symptoms and the Influence of Stigma in Arabic-Speaking Refugee Outpatients
The number of distressed refugees from the Arab world is relatively high in Germany and other host countries worldwide. For this specific population, substantial challenges and barriers have already been identified that hamper access to Germany's health care system. This study aims to contribute to this line of research by exploring the representation of depressive symptoms, both somatic and psychological, in order to inform clinicians about the most prevalent symptoms reported by Arabic-speaking refugee outpatients. Furthermore, this paper investigates the longstanding claim that mental health stigma fosters the expression of bodily distress. For these purposes, a total of 100 Arabic-speaking refugee outpatients, mostly Syrians, were recruited in Berlin, Germany. Somatic and psychological symptoms were assessed with the Patient Health Questionnaire (PHQ) 15 and 9, while stigma was assessed with the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). Study results show that both somatic and psychological symptom severity was moderate while sleeping problems and energy loss were the most reported symptoms across both scales. Stigma was low and showed no association with somatic complaints in a multiple regression analysis, but was associated with more psychological symptoms. A principal factor extraction on the PHQ-15 items revealed five independent, somatic symptom clusters that were interpreted considering the rich poetic resources of the Arabic language. In conclusion, both somatic and psychological symptoms were commonly reported by Arabic-speaking refugees with symptoms of depression. Whereas, stigma does not seem to influence the expression of somatic symptoms, the present results provide first empirical indications for the relationship of symptom expression with the use of explanatory models and conceptualizations of mental illness within the Arabic culture and language. Future research efforts should be dedicated to enhancing our understanding of mental health care needs in this population as well as to exploring other mediators that might help explain the varying degree of somatic symptoms in depression across cultures
A house is not a home: a network model perspective on the dynamics between subjective quality of living conditions, social support, and mental health of refugees and asylum seekers
Background:
Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental healthâs reciprocal, dynamic relationship with post-migration living conditions and social support.
Methods:
The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses.
Results:
Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment.
Conclusion:
Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration
Culturally sensitive stepped care for adolescent refugees: efficacy and costâutility of a multicentric randomized controlled trial
Adolescent refugees and asylum seekers (ARAS) are highly vulnerable to mental health problems. Stepped care models (SCM) and culturally sensitive therapies offer promising treatment approaches to effectively provide necessary medical and psychological support. To our knowledge, we were the first to investigate whether a culturally sensitive SCM will reduce symptoms of depression and PTSD in ARAS more effectively and efficiently than treatment as usual (TAU). We conducted a multicentric, randomized, controlled and rater-blinded trial across Germany with ARAS between the ages of 14 to 21 years. Participants (Nâ=â158) were stratified by their level of depressive symptom severity and then equally randomized to either SCM or TAU. Depending on their severity level, SCM participants were allocated to tailored interventions. Symptom changes were assessed for depression (PHQ) and PTSD (CATS) at four time points, with the primary end point at post-intervention after 12 weeks. Based on an intention-to-treat sample, we used a linear mixed model approach for the main statistical analyses. Further evaluations included costâutility analyses, sensitivity analyses, follow-up-analyses, response and remission rates and subgroup analysis. We found a significant reduction of PHQ (dâ=â0.52) and CATS (dâ=â0.27) scores in both groups. However, there was no significant difference between SCM and TAU. Costâutility analyses indicated that SCM generated greater costâutility when measured as quality-adjusted life years compared to TAU. Subgroup analysis revealed different effects for the SCM interventions depending on the outcome measure. Although culturally sensitive, SCMs did not prove to be more effective in symptom change and represent a more cost-effective treatment alternative for mentally burdened ARAS. Our research contributes to the optimization of clinical productivity and the improvement of therapeutic care for ARAS. Disorder-specific interventions should be further investigated
Shared sorrow, shared costs: cost-effectiveness analysis of the Empowerment group therapy approach to treat affective disorders in refugee populations
Background
Refugees and asylum seekers (RAS) in Germany need tailored and resource-oriented mental healthcare interventions.
Aims
To evaluate the cost-effectiveness of group psychotherapy for RAS with moderate depressive symptoms.
Method
This is a post hoc cost-effectiveness analysis of Empowerment group psychotherapy that was embedded in a stratified stepped and collaborative care model (SCCM) from the multicentre randomised controlled MEHIRA trial. One hundred and forty-nine participants were randomly assigned to SCCM or treatment as usual (TAU) and underwent Empowerment (i.e. level 3 of the SCCM for adults) or TAU. Effects were measured with the nine-item Patient Health Questionnaire (PHQ-9) and quality adjusted life-years (QALY) post-intervention. Health service and intervention costs were measured. Incremental cost-effectiveness ratios (ICER) were estimated and net monetary benefit (NMB) regressions with 95% confidence intervals were performed. Cost-effectiveness was ascertained for different values of willingness to pay (WTP) using cost-effectiveness acceptability curves for probable scenarios. Trial registration number: NCT03109028 on ClinicalTrials.gov.
Results
Health service use costs were significantly lower for Empowerment than TAU after 1 year. Intervention costs were on average âŹ409.6. Empowerment led to a significant change in PHQ-9 scores but not QALY. Bootstrapped mean ICER indicated cost-effectiveness according to PHQ-9 and varied considerably for QALY in the base case. NMB for a unit reduction in PHQ-9 score at WTP of âŹ0 was âŹ354.3 (âŹ978.5 to ââŹ269.9). Results were confirmed for different scenarios and varying WTP thresholds.
Conclusions
The Empowerment intervention was cost-effective in refugees with moderate depressive symptoms regarding the clinical outcome and led to a reduction in direct healthcare consumption. Concerning QALYs, there was a lack of confidence that Empowerment differed from TAU
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