The dynamics of discrimination, resilience, and social support in the mental health of migrants with and without citizenship.

Perceived discrimination has a significant negative impact on indices of mental health. One potential buffering factor in this is psychological resilience, which encompasses the ability to recover from or adapt successfully to adversity and use coping strategies, such as positive reappraisal of adverse events. This study examines the role of resilience as well as social support in buffering these effects in groups of migrants both with and without local residence permits. We conducted a non-experimental observational study with a cross-sectional design, collecting a variety of health variables in migrant groups in a naturalistic setting, during the COVID-19 period. The total sample consisted of 201 subjects, 88 of whom had a German residence title and 113 did not. These two groups were compared on the following variables of interest: social support, resilience, discrimination, and general mental health. There was no evidence for a difference in mental health between migrants with and without citizenship. However, our results suggested that migrants without citizenship reported less social support, less resilience, and more discrimination, which continued to have a distinct effect on mental health beyond resilience and social support. Psychological resilience mediated the link between social support and mental health, as well as being related to the perception of discrimination in the migrant group without citizenship. In conclusion, our models of migrants with and without citizenship showed that resilience specifically directly affected perceived discrimination in those without citizenship. The high levels of discrimination and lack of social support, particularly in the migrant group without citizenship, are concerning and suggest a focus for future interventions.

Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic.

Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.

The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients - A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany.

The COVID-19 pandemic could have major effects on already vulnerable individuals with psychiatric disorders. It is important to assess how different patient groups respond to stress related to the pandemic, and what additional factors influence it, including family-related stress, migration background, and sex. We conducted a survey in a sample of 294 psychiatric patients in a large outpatient clinic in Berlin, measuring level of distress in relation to COVID-19 lockdown as well as family-related distress. We also measured potential influencing factors such as media consumption and medical support. In the migration background group, we found that women had more lockdown related psychological distress than men. This was not apparent in those patients with a German background. We found that females were more strongly affected by family-related distress, particularly those with a migration background. People with PTSD were most strongly affected by family-related distress, whereas people with psychotic disorders and addiction reported the least distress. There were no effects of media consumption. There were no differences in ability to abide by the lockdown related restrictions across diagnoses. Our results support earlier findings on differential vulnerability of diagnostic groups to these stressors. Thus, clinicians can optimize treatment by taking family-related stressors into account particularly for females and people with a migrant background.

[Psychological stress during the COVID-19 pandemic: consequences for psychiatric patients and therapeutic implications]. / Psychische Belastung während der COVID-19-Pandemie: Konsequenzen für psychiatrisch Erkrankte und therapeutische Implikationen.

BACKGROUND: The outbreak of the COVID-19 disease and the rapid spread of the inducing coronavirus SARS-CoV­2 threatens not only people's physical health but also their mental health. Its influence on incidence and course of existing illnesses in the psychiatric outpatient sector in Germany is still unknown. METHODS: The medical reports of 682 persons in psychiatric treatment were retrospectively investigated, regarding their subjective response to this pandemic and its clinical relevance. RESULTS: Of the patients 60.5% (n = 378) experienced greater psychological stress, 14.5% (n = 99) reported fear of the SARS-CoV­2 and the possible danger of infection, 25.5% (n = 174) reported fear resulting from the protective measures taken (lock down) and 4.3% (n = 29) reported fear of both. This differed significantly across diagnoses: people with anxiety disorders reported significantly greater stress as well as greater fear of the virus, whereas people with psychoses were significantly less affected than the other patients. Of the participants 43.7% (n = 132) were so strongly affected that acute treatment had to be implemented and 6.0% (n = 18) had to be referred to inpatient care. DISCUSSION: People with mental illnesses are particularly vulnerable to the psychological strain of the COVID-19 pandemic. Long-term studies on the further course of disease will be necessary. Additional studies that test interventions to build resilience in this population will also be needed.