a systematic review

Background: Interpreters often play a crucial role in the health care of refugees. Although interpreters working with refugees are regularly confronted with emotionally stressful content, little is known about their work-related stress and psychological well-being. Primarily qualitative studies indicate increased emotional stress in interpreters, and difficulties in handling the traumatic content from their clients. Additionally, the working conditions of interpreters appear to be demanding, due to low payment and a lack of supervision or adequate preparation

Psychological distress, exhaustion, and work-related correlates among interpreters working in refugee care: results of a nationwide online survey in Germany

Background Due to language barriers, interpreters are crucial for refugee care in the countries of resettlement. However, interpreters are often faced with distressing working conditions, such as precarious work circumstances, lack of supervision, or exposure to their clients’ traumatic experiences. Recent studies examining interpreters’ mental health focussed primarily on secondary traumatic stress. The present study aimed to gain a better understanding of psychological distress and exhaustion among interpreters in refugee care by examining these factors in the work context as well as their possible work-related correlates. Method: An online survey was carried out in Germany, which included several standardized questionnaires regarding distress, work- and client-related exhaustion, job satisfaction, and trauma exposure (BSI-18, CBI, JSS, HTQ, PCL-5). Interpreters were recruited primarily through psychosocial treatment centres and interpreter pools in Germany. Results: In total, 164 interpreters were included in the analyses. The participants showed increased psychological distress, and around 7% screened positive for posttraumatic stress disorder (PTSD). In an exploratory regression analysis, younger age (β = −.25, p = .004) emerged as correlate of psychological distress, whereas dissatisfaction with payment (β = −.21, p = .04) and a higher amount of traumatic content (β = .22, p = .001) were associated with work-related exhaustion, and dissatisfaction with recognition was associated with client-related exhaustion (β = −.35, p = .001). Conclusion: The results point to increased stress levels among interpreters for refugees. Moreover, they indicate that interpreters’ distress is primarily correlated with work-related circumstances, thus suggesting the need for a greater work-related support structure for interpreters

a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples

Background: The World Health Organization recently proposed significant changes to the posttraumatic stress disorder (PTSD) diagnostic criteria in the 11th edition of the International Classification of Diseases (ICD-11). Objective: The present study investigated the impact of these changes in two different post-conflict samples. Method: Prevalence and rates of concurrent depression and anxiety, socio-demographic characteristics, and indicators of clinical severity according to ICD-11 in 1,075 Cambodian and 453 Colombian civilians exposed to civil war and genocide were compared to those according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Results: Results indicated significantly lower prevalence rates under the ICD-11 proposal (8.1% Cambodian sample and 44.4% Colombian sample) compared to the DSM-IV (11.2% Cambodian sample and 55.0% Colombian sample). Participants meeting a PTSD diagnosis only under the ICD-11 proposal had significantly lower rates of concurrent depression and a lower concurrent total score (depression and anxiety) compared to participants meeting only DSM-IV diagnostic criteria. There were no significant differences in socio- demographic characteristics and indicators of clinical severity between these two groups. Conclusions: The lower prevalence of PTSD according to the ICD-11 proposal in our samples of persons exposed to a high number of traumatic events may counter criticism of previous PTSD classifications to overuse the PTSD diagnosis in populations exposed to extreme stressors. Also another goal, to better distinguish PTSD from comorbid disorders could be supported with our data

A comparison of interpreters’ wellbeing and work-related characteristics in the care of refugees across different work settings

Background Interpreters in the care of refugees work in various different settings. Qualitative studies suggest that interpreters are confronted with a variety of demands depending on the context in which they work, which may in turn influence their wellbeing. To date, no larger-scale study has investigated differences between work settings regarding interpreters’ work-related characteristics or wellbeing. Objective The aim of this study was to compare the work-related characteristics and possible changes in the wellbeing of interpreters between four main work settings (psychotherapy, counselling, medical setting, and authorities) in the care of refugees. Method Interpreters in refugee care were recruited for a nationwide online survey in Germany with two measurement time points. Participants provided socio-demographic data and answered questions about the working conditions in their respective main work setting. In addition, psychological distress (Brief Symptom Inventory, BSI-18), work-related exhaustion (Copenhagen Burnout Inventory, CBI), and compassion satisfaction (Professional Quality of Life, ProQOL) were assessed. Results Overall, 158 interpreters were included at t1, of whom 63 were also included at t2. Significantly more traumatic content was interpreted in counselling settings and psychotherapy than in medical and authorities settings (H (3) = 26.09, p < .001). The highest proportion of interpreters with an interpreting degree worked in the authorities setting (Fisher’s exact test, p = .002). Significant differences between the four settings were found for psychological distress (Kruskal–Wallis-test, H (3) = 12.02, p = .01) and work-related exhaustion (Kruskal–Wallis-test, H (3) = 8.10, p = .04) but not for compassion satisfaction. Conclusion The presented results indicate differences regarding working conditions, psychological distress, and work-related exhaustion between different work settings of interpreters. Future studies may explore each setting in greater detail and include a larger sample size to reach a better understanding of the relationship between setting-specific challenges and interpreters’ wellbeing

Acute short-term multimodal treatment for newly arrived traumatized refugees: Reflections on the practical experience and evaluation

Background:A short-term multimodal acute treatment program of approximately six months' duration for newly arrived refugees at Center ÜBERLEBEN (Berlin Center for Torture Victims) was developed. The purpose of this study was to evaluate this program by examining changes in PTSD, anxiety and depression symptom severity after treatment, and to reflect on practical experiences in carrying out the program. Methods:At the beginning (T1) and following completion of the short term treatment program (T2) patients in a single-group design were assessed with the Posttraumatic Stress Disorder Checklist for PTSD and the Hopkins-Symptom Checklist for depression and anxiety (per-protocol analysis). Results:Of the 92 patients who completed T1, 44 completed T2 assessments. Medium to large effect sizes were found for reductions in overall PTSD (d = 0.88), depression (d = 0.83), and anxiety symptoms (d = 0.67). While at the beginning of treatment (T1) 97.7% (n = 43) fulfilled diagnostic criteria for both PTSD and depression, and 95.5% (n=42) for anxiety, at T2, 70.5% (n = 31) fulfilled the criteria for clinically relevant PTSD, 79.5% (n = 35) for depression and 70.5% (n = 31) for anxiety. Discussion:Despite the high symptom load at the beginning of treatment, uncertainties regarding residence status, and the unstable living conditions, patients seem to benefit from the multidisciplinary short term treatment. This study adds preliminary evidence to the efficacy of multimodal treatment and suggests that improvements in symptom severity can be achieved within the often extremely stressful period after arrival

Lay causal beliefs about PTSD and cultural correlates in five countries

Background To date, cultural clinical research has primarily focused on differences between ethnic groups when investigating causal beliefs about mental disorders. While individual as well as contextual factors are considered important for gaining a better understanding of cultural influences, research on causal beliefs about post-traumatic stress disorder (PTSD) and cultural correlates in laypersons is scarce. Objective This study aimed at gaining a better understanding of the association between causal beliefs about PTSD and cultural aspects, as well as other contextual and individual correlates of causal beliefs. Method We conducted a cross-sectional, vignette-based online survey with 737 laypersons from Mexico, Ecuador, Germany, Greece, and Russia. Participants completed the revised Illness Perception Questionnaire (IPQ-R) and reported several cultural and sociodemographic (e.g. country of residence, gender, personal values) as well as mental health–related variables (e.g. PTSD symptoms, previous seeking of help). Latent class analysis (LCA) was performed to identify subgroups of individuals expressing similar causal beliefs for PTSD. Multinomial logistic regression was used to analyse covariates of class membership. Results LCA resulted in a three-class solution of casual beliefs: a traumatic event–focused class (41.1%); an intrapersonal causes class (40.1%); and a multiple causes class (18.0%). Multinomial logistic regression analysis revealed country of residence, gender, personal value of security, PTSD symptoms, and mental health literacy as significant covariates of class membership. Conclusions Integrating a more diverse concept of culture into cultural clinical research can be a valuable addition to group comparisons based on nationality or ethnicity. Cultural clinical research needs to move towards a more integrated approach that accounts for the complexity of culture. Including additional contextual and sociodemographic factors can help to reach a more accurate understanding of the cultural influences on the development of causal beliefs and mental health

Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia

Background: During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation. Methods: A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI). Results: A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = −0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG. Conclusion: PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions

Do Gender and Country of Residence Matter? A Mixed Methods Study on Lay Causal Beliefs about PTSD

Laypersons’ causal beliefs about mental disorders can differ considerably from medical or psychosocial clinicians’ models as they are shaped by social and cultural context and by personal experiences. This study aimed at identifying differences in causal beliefs about post-traumatic stress disorder (PTSD) by country and gender. A cross-sectional, vignette-based online survey was conducted with 737 participants from Germany, Greece, Ecuador, Mexico, and Russia. Participants were presented with a short unlabeled case vignette describing a person with symptoms of PTSD. Causal beliefs were assessed using an open-ended question asking for the three most likely causes. Answers were analyzed using thematic analysis. Afterwards, themes were transformed into categorical variables to analyze differences by country and by gender. Qualitative analyses revealed a wide range of different causal beliefs. Themes differed by gender, with women tending to mention more external causal beliefs. Themes also differed between the five countries but the differences between countries were more pronounced for women than for men. In conclusion, causal beliefs were multifaceted among laypersons and shared basic characteristics with empirically derived risk factors. The more pronounced differences for women suggest that potential gender effects should be considered in cross-cultural research

Development and Validation of a Questionnaire to Assess Role Conflicts Among Interpreters Working With Refugee Clients: The Role Conflicts Questionnaire

Objectives: The aim of this study was to develop and validate a questionnaire to assess interpreters’ role conflicts and the challenging aspects within the triad of practitioner, interpreter and refugee client. Methods: A questionnaire was developed based on previous literature. Its factor structure and construct validity were assessed in an online survey of 164 interpreters working with refugee clients. Psychological distress (BSI-18), work-related exhaustion (CBI), and secondary traumatic stress (ProQOL) were measured to test the questionnaire’s convergent validity. Results: Exploratory structural equation modeling for categorical variables resulted in 23 items across four subscales. The scores of all subscales had good or excellent reliability (ω = 0.81 to ω = 0.93) and correlation analyses indicated convergent validity. Conclusion: The final questionnaire (RoCo) showed four clearly interpretable subscales and may help to identify emotional distress due to role conflicts among interpreters. Future studies should validate the questionnaire in different samples