Psychological impact of COVID-19 in a refugee camp in Iraq

The worldwide spread of COVID‐19 is especially causing a humanitarian catastrophe in refugee camps in crisis regions.1 For example, currently over 350 000 survivors of Islamic State of Iraq and Syria (ISIS) terrorism in the Kurdistan region of Iraq live in more than 20 refugee camps. These communities, which had already been traumatized, are now confronted with further adversities that exacerbate the ongoing psychological suffering and lead to increased suicide rates2; however, medical and psychological care is limited,3 and the work of humanitarian actors is restricted.4 Moreover, social distancing is almost impossible in high‐density camps, and hygiene practices are often simply not applicable.5 The objective of our pilot study was to briefly examine for the very first time the development of mental health of a cohort of Yazidis in a refugee camp in Iraq using selective psychometric measures before and shortly after the COVID‐19 outbreak. The participants were aged between 18 and 58 years (N = 68; mean age = 45.72 years, SD = 3.52 years; 38 females). They had fled from ISIS in 2014 and have since been living in a refugee camp near the city of Duhok, Iraq. This cohort was interviewed in October 2019 prior to the COVID‐19 pandemic and, having adapted the study to challenging circumstances, again in April 2020 during the spread of COVID‐19 through demographic questionnaires, the revised Impact of Event Scale (IES‐R),6 and the Composite International Diagnostic Interview (CIDI).7 Descriptive data are illustrated as the mean values of the standard deviation, and categorical parameters are presented as percentages. The presented comparison of both investigated groups was calculated with χ2‐tests, t‐tests, and a univariate two‐factor analysis of variance. Questionnaires in Kurdish were read by native Kurdish interviewers who had been trained by the research team at the Institute for Psychotherapy and Psychotraumatology at the University of Duhok under the leadership of the first author of this correspondence. The investigation was approved by the University Review Board of the University of Duhok; all subjects gave informed consent. The refugees had not been taken captive but had friends or family members who had been murdered. They lived in small tents together with 8–12 other people and their educational level ranged from 0 to 12 years of school attendance (mean = 6.8 years, SD = 2.61 years). Approximately 88% of the respondents were victims of a terror attack, 34% had witnessed a person being beaten or tortured, and 69% had lost at least one sibling. The mean initial IES‐R total score for females was 9.2/15 (SD = 2.6, Mdn = 11, range = 10–15) and that for males was 6.2/15 (SD = 2.4, Mdn = 10, range = 10–15). Yazidi who had individually experienced rape or torture were excluded from this investigation because they evidenced markedly high post‐traumatic stress disorder (PTSD) rates and comorbidities even before the COVID‐19 pandemic.8 The different psychometric prevalence rates of mental disorders in October 2019 and April 2020 according to CIDI were calculated and then sex‐matched compared (Table 1). (...

Transgenerational Transmission of Trauma across Three Generations of Alevi Kurds

Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping strategies used. The first generation is the generation which directly suffered the genocidal actions. The second generation consists of children of those parents who survived the genocidal actions. Together with their family (children, partner, relatives), this generation suffered forced displacement. Members of the third generation were born in the diaspora where they also grew up. Results: Participants reported traumatic memories, presented in examples in this publication. The most severe traumatic memories included the Dersim massacre in 1937–1938 in Turkey, with 70,000–80,000 victims killed, and the enforced resettlement in western Turkey. A content analysis revealed that the transgenerational transmission of trauma continued across three generations. SCID and PDS data indicated high rates of distress in all generations. Conclusions: Genocidal environments such as that of the Kurdish Alevis lead to transgenerational transmission mediated by complex factors

The psychological impact of genocide on the Yazidis

Background: The genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the Sinjar area of Northern Iraq has costed many lives and has also caused a psychological long-term impact in this minority. This impact can be seen among individual survivors. Additionally, there is a large number of direct and indirect victims and for this reason, the impact can also be observed on the level of the group and society in this region at large. Methodology: The research examines three different population groups (Yazidis members who had been exposed to violence by terrorist group actions, those not exposed to this experience as they were living in an area not directly exposed to ISIS violence, and a control group of non – Yazidi general population members). In total, 425 participants (age range 15-78) took part in the study and participated in interviews using standard scales to measure general physical and mental health. Results: The results demonstrate that psychological stress and suicidality are higher among the Yazidis survivors of violence than in the other Yazidi participants. Conclusions: Psychological Disorders after a genocide and war in post-conflict populations should receive more attention in the planning of mental health care and prevention and should be seen as a major problem, especially in camp settings and displaced persons besides the usual increased prevalence of posttraumatic stress and other disorders covered by research so far in this context

Changes in Disease Perception, Coping Strategies and Diagnoses in the Case of First and Fourth Generations of Turkish Migrants in Germany

This study examines to what extent subjective illness concepts and symptoms of Turkish patients in Germany have changed over 40 years. Two groups of patients of Turkish origin from psychosomatic clinics in Germany took part in the study, the first group made up of 690 patients from the "first generation" of migrants and the second group comprising 350 patients from the "fourth generation". The study was conducted using standardised interviews (The sociodemographic questionnaire, IPQ, COPE, BDI, SCL-90-R). Differences were found in essential aspects of subjective illness perception and illness coping strategies as well as in the diagnosis of psychological illness. The fourth generation of Turkish patients that were born and have grown up in Germany showed more problem-oriented behaviour regarding their coping strategies and less use of dysfunctional strategies for treatment than patients of the first generation. The findings of the present study are important for treating Turkish patients and patients of Turkish origin suffering from psychological disorders since they indicate that their disease perception, coping strategies and diagnoses undergo changes in the course of generations. Hitherto these differences were not taken into account in treatment; in the future we should be moving towards customised treatment in order to achieve better therapeutic effects

Understanding and treatment of diffuse aches and pains of patients from tradition-bound cultures

Patients from collective cultures with a tradition-bound cultural background (e.g., people from the Middle East and some south European countries such as Italy and Greece), have a different perception of pain and different conceptions of healing, which up till now have not been sufficiently appreciated in modern multimodal therapeutic approaches. Inadequate knowledge of anatomy and bodily functions and traditional perceptions of pain (magic, curse, punishment, etc.) have a substantial influence on diagnostics. The pain experience is regarded holistically in relation to the body, rather than being confined to a particular part of the body. Limited access to psychological complains treatment often leads to diffuse pain. The ailing body expresses its state in social, collective, economic, migration historical, psychological and cultural terms. A multimodal interdisciplinary and culture-sensitive approach is required for the effective pain treatment of patients from a tradition-bound background

Trauma and Pain in Family-Orientated Societies

People from family-oriented societies in particular, in addition to having a post-traumatic stress disorder (PTSD) suffer from chronic pain and physical complaints. Such people have a different understanding of physical illness and pain and, compared to patients from western societies, have different ideas on healing, even when confronted with the therapist. Hitherto, these factors have not been sufficiently taken into account in modern, multi-module therapy approaches. Trauma can be perceived via pain and physical complaints, whereby the pain is not restricted to one part of the body but is seen as covering the body as a whole. Therefore, in the treatment and above all in the patient-therapist relationship, it is necessary to understand what importance is attached to the perceived pain in relation to the trauma. The afflicted body expresses the trauma in the shape of its further-reaching consequences such as the patient’s social, collective, economic and cultural sensitivity. Therefore, for the effective treatment of trauma and chronic pain, it is necessary to use a multi-modal, interdisciplinary, and culture-sensitive approach when treating patients from traditional cultural backgrounds

Posttraumatic stress disorder and related disorders among female Yazidi refugees following Islamic State of Iraq and Syria attacks : a case series and mini-review

Following the severe attacks by the so-called “Islamic State of Iraq and Syria” on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women’s responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required

Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks—A Case Series and Mini-Review

Following the severe attacks by the so-called “Islamic State of Iraq and Syria” on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women’s responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required