A qualitative study on resilience in adult refugees in Germany

Background: Because refugees face significant adversities before, during, and after resettlement, resilience is of central importance to this population. However, strengths-based research on post-migration refugee experiences is sparse. Methods: We conducted semi-structured interviews with 54 adult refugee participants who arrived in Germany between 2013 and 2018 in their preferred language. We analyzed different aspects of resilience in these interviews using thematic analysis. Results: Nine themes were identified. Four themes manifest resilience in different ways and encompass cognitive as well as behavioral strategies for facing adversity, self-ascriptions of resilience as a personal trait or lasting characteristic, and the role of volunteering, work, and activism for refugee causes. Five themes capture factors that facilitate resilience: social support, experiencing migration as an opportunity generally and for women in particular, being a parent, and being young. Conclusions: This study adds to a growing body of knowledge about resilience among adult refugees. It may support clinicians working with refugees by making them aware of specific manifestations of resilience and factors promoting positive adaptation specific to this client group. It also contributes to a more strengths-based view on refugee mental health and processes of integration

Mental Health and Integration: A Qualitative Study on the Struggles of Recently Arrived Refugees in Germany

Introduction: Forcibly displaced people are at particular risk of mental health problems and also face specific integration challenges upon resettlement. Existing literature suggests that there may be a bidirectional relationship between mental health and integration. The present study seeks to understand the relationship between integration processes and mental health problems or significant negative emotional experiences among adult refugees in Germany. Method: Applying a qualitative approach, we conducted 54 semi-structured interviews with refugees and asylum seekers who arrived in Germany between 2013 and 2018 currently residing in Berlin, Leipzig, or the Duisburg area in North Rhine-Westphalia. Data was collected between December 2018 and September 2019. We analyzed transcripts inductively using thematic analysis. Results: Five themes covering the various links between integration and mental health problems or significant negative emotional experiences were identified. First, we found that the mental health consequences of past adverse experiences, as well as ongoing worries about those left behind in the homeland, can seriously impede refugees' ability to pursue activities key to integration. Second, the process of applying for and securing asylum can result in uncertainty and fear, which, in turn, burden the individual and may impact motivation for integration. Third, many of our participants described mental health ramifications related to feeling stuck and thwarted in the pursuit of building a life, especially in securing employment. Fourth, some participants described feeling so overwhelmed by fundamental tasks throughout the integration process, namely, language learning and bureaucratic processes, that these take a psychological toll. Fifth, we identified several forms of social disconnection between refugees and members of the host community due to xenophobia, social and cultural differences, physical and emotional isolation in refugee camps, as well as with co-nationals and fellow refugees. Negative emotions, mistrust, and socio-cultural differences that emerge throughout the integration processes seem to erode social cohesion among refugee communities, potentially further threatening mental health. Conclusion: Mental health problems and integration processes appear to be closely related across different areas of integration. Innovative solutions to challenges identified by members of the refugee community in Germany stand to benefit mental health and integration outcomes simultaneously

Artikulationen des Affektiven und die Formierung transkultureller Emotionsrepertoires im Vietnamesischen Berlin

Aus anthropologisch-psychiatrischer Perspektive thematisiert unser Beitrag die Formierung transkultureller Emotionsrepertoires in den Lebensentwürfen vietnamesischer Migrant_innen der ersten Generation in Berlin. Konkret gilt unser empirisches Interesse den affektiven Anstrengungen von Migration, die sich im Leben von vietnamesischen Patient_innen abzeichnen, die psychiatrisch- psychotherapeutische Hilfe in Anspruch nehmen, sowie von deren Angehörigen. Zum einen möchten wir der Frage nachgehen, wann genau affektive Krisenerfahrungen zu Belastungen werden, die auf Basis bisheriger Emotionsrepertoires nicht länger zu bewältigen sind und zu einer Inanspruchnahme psychiatrisch-psychotherapeutischer Hilfe führen. Zum anderen möchten wir Antworten auf die Frage geben, inwiefern diese Inanspruchnahme zu einer Herausbildung neuer und dezidiert transkultureller Emotionsrepertoires beiträgt, die Beheimatungsprozesse begünstigen können, welche in neue und multiple Zugehörigkeiten und/oder Nichtzugehörigkeiten münden (Pfaff-Czarnecka 2012, Scheer 2014, Lähdesmäki et al. 2016, Röttger-Rössler 2016). Die Relevanz der letzteren Frage spiegelt sich in der zunehmenden Akzeptanz vietnamesisch- sprachiger und transkulturell sensibler psychiatrischer Versorgungsan-gebote im Rahmen der Eröffnung zweier Spezialambulanzen in Berlin wider (Ta et al. 2015,Hahn et al. 2016). Diese Versorgungsangebote sind eingebettet in ein aktives Netzwerk, welches die Förderung der seelischen Gesundheit von vietnamesischen Migrant_innen in Deutschland dient und dabei Träger sozialer Hilfen miteinander in Beziehung setzt und auch transnationale psychiatrische Perspektiven miteinbezieht (Ta et al. 2016b). Aus unseren ethnographischen Begegnungen, Beobachtungen und Gesprächen geht hervor, dass das erwähnte Setting in den Spezialambulanzen für unsere Gesprächspartner_innen einen einzigartigen Artikulationsraum darstellt, in dem in bislang ungewohnter Weise und jenseits von Stigmatisierungsängsten über affektive Erfahrungen, Anstrengungen und Belastungen gesprochen werden kann. Wer sich in Vietnam in psychiatrische Behandlung begebe oder in eine psychiatrische Klinik „eingewiesen“ werde, habe es laut unserer Gesprächspartner_innen nicht nur in Bezug auf die Qualität der Versorgung schlechter als in Deutschland: Der-/diejenige werde schnell als điên bezeichnet und müsse mit Diskriminierung und Stigmatisierung in Form eines Gesichtsverlusts rechnen, der sich auch auf das familiäre Umfeld ausweite. Das Wort điên bedeute „verrückt sein“, umgangssprachlich steht es für den medizinischen Ausdruck „an einer psychischen Krankheit leiden“ (bị bệnh tâm thần). Jedoch birgt es durchweg negative Konnotationen in sich, da Menschen, die als điên bezeichnet werden, nicht länger ernst genom-men und aus ihrem sozialen Umfeld ausgegrenzt würden. Affektive Belastungen werden aus diesem Grund häufig verdeckt, um einerseits nicht gegen die Gebote der Wahrung sozialer Harmonie zu verstoßen und andererseits, um eine individuelle und familiäre Stigmatisierung zu vermeiden (Lauber & Rössler 2007, Machleidt 2013). Selbstverständlich gibt es auch in Vietnam vielfältige Bewältigungsstrategien. In Migrationserfahrungen fußende affektive Belastungen beinhalten unserer Meinung nach aber andere Herausforderungen, welche die vertrauten Strategien in dem veränderten sozialen, politischen und wirtschaftlichen Kontext oftmals an ihre Grenzen stoßen lassen. Im Folgenden erläutern wir zunächst, inwiefern wir Affekte von Emotionen im Kontext von Migration konzeptuell unterscheiden und was unter einem transkulturellen Emotionsrepertoire zu verstehen ist. Des Weiteren wird die psychiatrische Ambulanz als ein besonderer Artikulationsraum des Affektiven vorgestellt, sowie auch als Forschungsraum unseres interdisziplinären Projektes. Sodann gewähren wir Einblicke in die Lebensentwürfe von zwei Gesprächspartnern, die beide der ersten Generation vietnamesischer Migrant_innen angehören. Um auch eine transgenerationale Sicht auf Affekte und Emotionen in der Migration zu ermöglichen, beschließen wir unseren empirischen Teil mit einer Beschreibung der Ansichten einer Gesprächspartnerin der zweiten Generation, deren Mutter in psychiatrisch- psychotherapeutischer Be-handlung ist. Unser Beitrag endet mit einer Diskussion, in der wir gängigen Vorstellungen widersprechen, die die Inanspruchnahme psychiatrisch-psychotherapeutischer Hilfe als ein Zeichen von Hilflosigkeit werten und insbesondere Patient_innen mit migrationsbezogenem Hintergrund Handlungsmacht und Kompetenz absprechen (Pratt Ewing 2005, Kirmayer 2007)

The Challenged Sense of Belonging Scale (CSBS) - a validation study in English, Arabic, and Farsi/Dari among refugees and asylum seekers in Germany

This study introduces and investigates the validity of a brief scale measuring a challenged sense of belonging. The sense of belonging as well as challenges to this sense are important, albeit neglected aspects of social integration and of significance to migration and refugee studies as well as to virtually all other social science contexts. Assessing a challenged or eroded sense of belonging provides important insights into how individuals relate to their environment and whether they feel socially connected or disconnected from it. The construct goes beyond national or cultural identity, instead emphasizing the dynamic processes of emotional attachment. Reviewing the substantial theoretical literature on belonging, we identify four of its key elements: connection, participation, identification, and congruence. Drawing on existing measurement instruments, we propose a brief Challenged Sense of Belonging Scale (CSBS) that addresses each of the four elements and investigate its validity in a unique, multi-lingual random sample of 3783 adult refugees in Germany from various national and cultural backgrounds. We provide evidence for the scale's validity separately for three main survey languages (English, Arabic, Farsi/Dari) using confirmatory factor analysis, a test of measurement invariance, item test and rest correlations, and correlation analysis to explore convergent validity. Our findings suggest that the scale is a suitable instrument for the assessment of a challenged sense of belonging in a heterogeneous population of refugees

Compassion-based approaches:a systematic review of their effectiveness and acceptability in schizophrenia spectrum disorders

The purpose of this systematic literature review is to provide an exhaustive summary of current research to explore the prospects of compassion-based approaches in treating persons with Schizophrenia Spectrum Disorders (SSD). Thereby, studies investigating the relationship between clinical parameters and self-compassion in SSD, as well as the acceptability, feasibility, and effects of compassion-based approaches for individuals with SSD were considered. The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Eight studies were included for qualitative synthesis. The results indicate an important role of self-compassion for several clinical parameters, including negative associations to positive symptoms, negative symptoms, cognitive disorganization, and emotional distress. All studies reported good acceptability and feasibility. Regarding the clinical effectiveness of compassion-based approaches, a variety of clinical benefits, such as improvements of mood, affect regulation, positive symptoms, negative symptoms, cognitive disorganization, and variables relating to psychological recovery were found in individuals with SSD. It is concluded that compassion-based approaches are a promising form of intervention in the treatment of SSD. However, further research, especially randomized controlled trials, in this field is needed to understand the full potential of compassion-based approaches for individuals with SSD.</p

Prevalence, predictors and types of unpleasant and adverse effects of meditation in regular meditators: international cross-sectional study

Background: Meditation is commonly implemented in psychological therapies since the ‘third wave’ of cognitive–behavioural therapy has increased the focus on mindfulness-based interventions. Although extensive research literature demonstrates its benefits, little is known about potential adverse effects. Aims: The aim of this study is to report the prevalence, type and severity of particularly unpleasant meditation-related experiences in the largest cross-sectional study on this topic to date, with 1370 regular meditators. Method: The participants were asked whether they ever encountered particularly unpleasant experiences as a result of their meditation experience. For the first time, the type and severity of those experiences were assessed and the association with several predictors, such as pre-existing mental disorders, were explored via logistic and linear regression. Results: Similar to previous studies, 22% of participants (95% CI 20–24) reported having encountered unpleasant meditation-related experiences, and 13% of participants (95% CI 3–5) reported experiences that were categorised as adverse. Those were mostly of affective, somatic and cognitive nature. Unpleasant meditation-related experiences were more likely to occur in participants with pre-existing mental illnesses (P = 0.000, 95% CI 1.25–2.12). Conclusions: This study demonstrates that unpleasant meditation-related experiences are prevalent among meditators and, to a relevant extent, severe enough to warrant further scientific inquiry. Longitudinal studies are needed to examine whether the unpleasant meditation-related experiences are merely negative and thus should be avoided, or are an inherent part of the contemplative path

Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders-A Qualitative Approach

In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). High symptom burden, long durations of hospitalization and high rehospitalization rates demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "non-judgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line with recent findings on MBIs amongst patients with psychotic disorders from other countries. Results lay the ground for future research to focus on the systematic study of MBIs in large samples, its treatment processes, outcomes, and effectiveness for in-patients with SSDs

The Relationship Between Mindfulness, Depression, Anxiety, and Quality of Life in Individuals With Schizophrenia Spectrum Disorders

Background: Schizophrenia spectrum disorders (SSD) are frequently accompanied by comorbid depressive and anxiety symptoms, as well as impaired quality of life (QoL). A growing body of evidence has demonstrated the relevance of mindfulness for SSD in recent years. The study examined the association between mindfulness, depression, anxiety, and QoL. Materials and Methods: A total of 83 participants with SSD were recruited at the in- and outpatient psychiatric hospital care. Participants completed the Southampton Mindfulness Questionnaire, Comprehensive Inventory for Mindful Experiences, and Freiburger Mindfulness Inventory, the Depression, Anxiety, Stress Scale to assess depression and anxiety, and the WHO-QoL Questionnaire. Multiple regression analyses examined the relationship between mindfulness and QoL and the mediating role of depression and anxiety. Results: Mindfulness had a significant statistical positive effect on QoL domains physical health, psychological, and environmental QoL in patients with SSD. Depression was identified as a significant mediator of this relationship. Conclusion: This study provides novel insight into mindfulness' mechanisms and paves the way for a process-oriented approach to treat SSD. The results provide first evidence for the process-based value of mindfulness for SSD; future studies can focus on the role of mindfulness for central therapeutic processes of change by employing longitudinal designs

Mental Health Determinants Among a Psychiatric Outpatient Sample of Vietnamese Migrants in Germany

Background: Mental health risk-factors for Asian migrants have been studied almost exclusively in the US, Canada, and Australia but not in European countries. Therefore, we aimed to identify sociodemographic, clinical, and migration-surrounding factors associated with experienced mental distress among Vietnamese migrants in Germany. Method: 305 Vietnamese migrants utilizing Germany's first Vietnamese psychiatric outpatient clinic filled out at admission the Brief-Symptom-Inventory 18 (BSI-18) as well as a questionnaire on 22 potential mental health determinants. Using a multiple linear regression model, we identified those sociodemographic, clinical, and migration-surrounding factors that were significantly related to the Global Severity Index (GSI) of the BSI-18. Results: The factors unemployment (B = -6.32, p = 0.014), financial problems (B = -10.71, p < 0.001), no or only little religious involvement (B = -3.23, p = 0.002), no psychiatric precontact (B = -7.35, p = 0.004), previous migration experiences (B = 8.76, p = 0.002), and perceived discrimination (B = 6.58, p = 0.011) were found to significantly increase the level of mental distress according to the BSI-GSI. Conclusion: Based on these results, we were able to construct a mental health risk-profile for Vietnamese migrants in Germany, which aims to detect candidates for psychiatric problems earlier and supply them with customized prevention and therapy options

Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public Survey in Odisha State, India

Background: Integration of psychiatric care with public health services and offering mental health care services to patients from lower socioeconomic status remains a global challenge. Scarcity of funds and professional workforce in psychiatric hospitals contribute to this situation. However, negative attitudes in the population are also a known impediment to patients seeking mental health services. This study aimed to assess the attitudes toward psychiatric hospitals among the urban and rural population in India. Subjects and Methods: The study was carried out amongst the general population in Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-setting, and 492 respondents from rural parts of the district. Participants were selected by using simple random-sampling from the Asian Institute of Public Health (AIPH) data base. A standardized seven-item questionnaire was adopted, with responses indicated on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face. Results: Level of education (B = -0.192, ss = -0.320, p < 0.000) and urban-rural comparison (B = -0.272, ss = -0.189, p < 0.000) significantly influenced attitudes toward psychiatric hospitals. Gender, age, and religious beliefs did not show any significant effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with lower education levels showed more negative attitudes toward psychiatric hospitals. Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural areas as well as those with lesser education may be reflective of the lack of availability, accessibility, affordability, and credibility of such mental health services. The Mental Health Care Act in India is a progressive legislation which might improve the situation of the provided services and, consequently, reduce negative attitudes in the years to come