Mental health of refugees following state-sponsored repatriation from Germany

von Lersner U, Elbert T, Neuner F. Mental health of refugees following state-sponsored repatriation from Germany. BMC Psychiatry. 2008;8(1): 88.BACKGROUND: In recent years, Voluntary Assisted Return Programmes (VARPs) have received increasing funding as a potential way of reducing the number of refugees in EU member states. A number of factors may affect the mental well-being of returnees. These include adjustment to the home country following return, difficult living conditions, and long-term effects resulting from the severe traumatic stress that had originally driven the affected out of their homes. Little is known about the extent to which these and other factors may promote or inhibit the willingness of refugees to return to their country of origin. The present pilot study investigated refugees who returned to their country of origin after having lived in exile in Germany for some 13 years. METHODS: Forty-seven VARP participants were interviewed concerning their present living conditions, their views of their native country, and their attitudes towards a potential return prior to actually returning. 33 participants were interviewed nine months after returning to their country of origin. Mental health and well-being were assessed using the questionnaires Posttraumatic Stress Diagnostic Scale (PDS) and EUROHIS and the structured Mini International Neuropsychiatric Interview (M.I.N.I.).Our objectives were to examine the mental health status of refugees returning to their home country following an extended period of exile. We also aimed to assess the circumstances under which people decided to return, the current living conditions in their home country, and retrospective returnee evaluations of their decision to accept assisted return. RESULTS: Prior to returning to their home country, participants showed a prevalence rate of 53% for psychiatric disorders. After returning, this rate increased to a sizeable 88%. Substantial correlations were found between the living situation in Germany, the disposition to return, and mental health. For two thirds of the participants, the decision to return was not voluntary. CONCLUSION: Psychological strain among study participants was of a considerable magnitude. As a result of traumatic stress experienced during war and refuge, victims were vulnerable and not well equipped to cope with either post-migration stressors in exile or with a return to their country of origin. It is noteworthy that the majority returned under pressure from immigration authorities. Living conditions after return (such as housing, work, and health care) were poor and unstable. Participants also had great difficulty readapting to the cultural environment after having lived abroad for an average of 13 years. Current VARPs do not take these factors into account and are therefore not able to assist in a humanitarian reintegration of voluntary returnees

Mental health of returnees: refugees in Germany prior to their state-sponsored repatriation

von Lersner U, Wiens U, Elbert T, Neuner F. Mental health of returnees: refugees in Germany prior to their state-sponsored repatriation. BMC International Health and Human Rights. 2008;8(1): 8

Paying Refugees to Leave

States are increasingly paying refugees to repatriate, hoping to decrease the number of refugees residing within their borders. Drawing on in-depth interviews from East Africa and data from Israeli Labour Statistics, I provide a description of such payment schemes and consider whether they are morally permissible. In doing so, I address two types of cases. In the first type of case, governments pay refugees to repatriate to high-risk countries, never coercing them into returning. I argue that such payments are permissible if refugees’ choices are voluntary and if states allow refugees to return to the host country in the event of an emergency. I then describe cases where states detain refugees, and non-governmental organisations provide their own payments to refugees wishing to repatriate. In such cases, non-governmental organisations are only permitted to provide payments if the funds are sufficient to ensure post-return safety and if providing payments does not reinforce the government’s detention policy

Psychische Belastung von Jugendlichen: Welchen Einfluss haben ein türkischer Migrationshintergrund, Akkulturationsstress und wahrgenommene Diskriminierung?

Background: The psychological strain of migrants has been increasingly discussed in recent years. A special emphasis should be put on adolescents of second-generation immigrants, as they account for one third of the immigrant population in Germany. Objective: What is the degree of behavioral and emotional problems among Turkish migrant and German adolescents? Do perceived discrimination and acculturative stress have an impact on behavioral and emotional problems? Method: N1 = 522 and N2 = 91 adolescents (age = 14 - 17 years) were assessed regarding behavioral and emotional problems (Studies 1 and 2), acculturative stress, and perceived discrimination (Study 2). Results: In both studies, internalizing problems were reported significantly more often by girls than by boys. This finding was also observed for the Turkish group in the interview mode of Study 2. Perceived discrimination mediated the correlation between acculturative stress and behavioral and emotional problems. Conclusion: In the form of perceived discrimination, the cultural background of adolescents in Germany has an indirect impact on their mental health. ___ Theoretischer Hintergrund: Das psychische Belastungsniveau von Migranten wird seit einigen Jahren verstärkt diskutiert. Jugendliche der zweiten Einwanderergeneration sollten besondere Berücksichtigung finden, da sie bereits ein Drittel aller Personen dieser Altersgruppe in Deutschland darstellen. Fragestellung: Wie hoch ist die psychische Belastung von türkischen und deutschen Jugendlichen? Welchen Einfluss haben hierbei Akkulturationsstress und Diskriminierungswahrnehmung? Methode: N1 = 522 bzw. N2 = 91 Jugendliche (14 - 17 Jahre) wurden zu psychischer Belastung (Studie 1 & 2), Akkulturationsstress und Diskriminierungswahrnehmung (Studie 2) untersucht. Ergebnisse: Mädchen berichteten signifikant häufiger internalisierende Probleme als Jungen, im Interviewmodus galt dies für türkische Jugendliche insgesamt. Diskriminierungswahrnehmung wirkte als Mediatorvariable zwischen psychischer Gesundheit und Akkulturationsstress. Schlussfolgerungen: Der kulturelle Hintergrund von Jugendlichen in Deutschland hat in Form wahrgenommener Diskriminierung indirekt einen Einfluss auf deren psychische Gesundheit

The importance of developing therapies targeting the biological spectrum of metastatic disease

Great progress has been made in cancer therapeutics. However, metastasis remains the predominant cause of death from cancer. Importantly, metastasis can manifest many years after initial treatment of the primary cancer. This is because cancer cells can remain dormant before forming symptomatic metastasis. An important question is whether metastasis research should focus on the early treatment of metastases, before they are clinically evident ("overt"), or on developing treatments to stop overt metastasis (stage IV cancer). In this commentary we want to clarify why it is important that all avenues of treatment for stage IV patients are developed. Indeed, future treatments are expected to go beyond the mere shrinkage of overt metastases and will include strategies that prevent disseminated tumor cells from emerging from dormancy

Changes in mental disorder prevalence among conflict-affected populations: a prospective study in Sri Lanka (COMRAID-R).

BACKGROUND: Longitudinal data are lacking on mental health trajectories following conflict resolution and return migration. COMRAID-R is a follow-up study of Muslims displaced by conflict from Northern Sri Lanka 20 years ago who are now beginning to return. METHODS: Of 450 participants in displacement interviewed in 2011, 338 (75.1%) were re-interviewed a year later, and a supplementary random sample (n = 228) was drawn from return migrants with a comparable displacement history. Common mental disorder (CMD; Patient Health Questionnaire) and post-traumatic stress disorder (CIDI-subscale) were measured. RESULTS: A CMD prevalence of 18.8% (95%CI 15.2-22.5) at baseline had reduced to 8.6% (5.6-11.7) at follow-up in those remaining in displacement, and was 10.3% (6.5-14.1) in return migrants. PTSD prevalences were 2.4%, 0.3% and 1.6% respectively. CONCLUSIONS: We observed a substantial decrease in CMD prevalence in this population over a short period, which may reflect the prospect of return migration and associated optimism following conflict resolution