Impairments in psychological functioning in refugees and asylum seekers.

Refugees are at increased risk for developing psychological impairments due to stressors in the pre-, peri- and post-migration periods. There is limited knowledge on how everyday functioning is affected by migration experience. In a secondary analysis of a study in a sample of refugees and asylum seekers, it was examined how aspects of psychological functioning were differentially affected. 1,101 eligible refugees and asylum seekers in Europe and Türkiye were included in a cross-sectional analysis. Gender, age, education, number of relatives and children living nearby, as well as indicators for depressive and posttraumatic symptoms, quality of life, psychological well-being and functioning, and lifetime potentially traumatic events were assessed. Correlations and multiple regression models with World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 12-item version's total and six subdomains' scores ('mobility', 'life activities', 'cognition', 'participation', 'self-care', 'getting along') as dependent variables were calculated. Tests for multicollinearity and Bonferroni correction were applied. Participants reported highest levels of impairment in 'mobility' and 'participation', followed by 'life activities' and 'cognition'. Depression and posttraumatic symptoms were independently associated with overall psychological functioning and all subdomains. History of violence and abuse seemed to predict higher impairment in 'participation', while past events of being close to death were associated with fewer issues with 'self-care'. Impairment in psychological functioning in asylum seekers and refugees was related to current psychological symptoms. Mobility and participation issues may explain difficulties arising after resettlement in integration and exchange with host communities in new contexts.

Individual costs and community benefits: Collectivism and individuals' compliance with public health interventions.

Differences in national responses to COVID-19 have been associated with the cultural value of collectivism. The present research builds on these findings by examining the relationship between collectivism at the individual level and adherence to public health recommendations to combat COVID-19 during the pre-vaccination stage of the pandemic, and examines different characteristics of collectivism (i.e., concern for community, trust in institutions, perceived social norms) as potential psychological mechanisms that could explain greater compliance. A study with a cross-section of American participants (N = 530) examined the relationship between collectivism and opting-in to digital contact tracing (DCT) and wearing face coverings in the general population. More collectivistic individuals were more likely to comply with public health interventions than less collectivistic individuals. While collectivism was positively associated with the three potential psychological mechanisms, only perceived social norms about the proportion of people performing the public health interventions explained the relationship between collectivism and compliance with both public health interventions. This research identifies specific pathways by which collectivism can lead to compliance with community-benefiting public health behaviors to combat contagious diseases and highlights the role of cultural orientation in shaping individuals' decisions that involve a tension between individual cost and community benefit.

A Central Clearing Clinic to Provide Mental Health Services for Refugees in Germany.

Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living within berlin, language and region of origin were assessed in a refugee cohort from 63 nationalities speaking 36 languages. Findings: Within 18 months, a total of 3,096 cases with a mean age of 29.7 years (11.7) have been referred from all 12 districts and 165 of 182 subdistricts of Berlin to the CCC. 33.7% of the patients were female. The three most frequent diagnoses were unipolar depression (40.4%), posttraumatic stress disorder (24.3%), and adjustment disorder (19.6%). Conclusion: The present data gives insight into the distribution of mental disorders in a large sample of refugees and provides evidence that a CCC is an effective service to quickly and broadly provide psychiatric consultations and thus to overcome classical barriers refugees usually experience in the host communities. In Berlin, Germany, and Europe treatment resources for this population should focus on stress and trauma related disorders.

Establishing a Mental Health Surveillance in Germany: Development of a framework concept and indicator set.

In the course of the recognition of mental health as an essential component of population health, the Robert Koch Institute has begun developing a Mental Health Surveillance (MHS) system for Germany. MHS aims to continuously report data for relevant mental health indicators, thus creating a basis for evidence-based planning and evaluation of public health measures. In order to develop a set of indicators for the adult population, potential indicators were identified through a systematic literature review and selected in a consensus process by international and national experts and stakeholders. The final set comprises 60 indicators which, together, represent a multidimensional public health framework for mental health across four fields of action. For the fifth field of action 'Mental health promotion and prevention' indicators still need to be developed. The methodology piloted proved to be practicable. Strengths and limitations will be discussed regarding the search and definition of indicators, the scope of the indicator set as well as the participatory decision-making process. Next steps in setting up the MHS will be the operationalisation of the single indicators and their extension to also cover children and adolescents. Given assured data availability, the MHS will contribute to broadening our knowledge on population mental health, supporting a targeted promotion of mental health and reducing the disease burden in persons with mental disorders.

[Poverty, migration and mental health]. / Armut, Migration und psychische Gesundheit.

Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations.

Explanatory models of suicidality among women of Turkish descent in Germany: A focus group study.

Women of Turkish descent in Germany show higher rates of suicidal behavior compared to their host populations and men of Turkish descent. This indicates a demand for a better understanding of suicidality in this group. Nine focus groups ( N = 61) were conducted to assess explanatory models including patterns of distress, perceived causes, course/consequences of and reactions towards a suicidal crisis, help-seeking behavior, and potential intervention and prevention strategies. All participants were of Turkish descent living in Berlin, Germany. The focus groups included two with professionals such as psychiatrists or psychotherapists, two with Community Mothers, three with women from the community (ages: 18 -34, 35 -49, 50+), and of three suicide attempters (ages: 18 -33, 38 -66). Data were analyzed using the methodology of thematic analysis. Results show that suicide-related behaviors, attitudes, and help-seeking behavior have gender and culture-specific characteristics. Two central themes were identified: the impact of family and community and the impact of German society. Participants stated that they believe that family and community pressures as well as discrimination and lack of acceptance cause social isolation. Fear of stigmatization and dishonoring themselves or their family, as well as shame and self-stigma decrease the likelihood of reaching out for help. Recommended strategies are community and family interventions, promotion of integration and social inclusion, awareness campaigns to destigmatize suicidality and the use of mental health services, empowerment of women, as well as the improvement of cultural sensitivity and competency of services.

[The (Refugee) Crisis in the Psychotherapeutic Treatment Room]. / Die (Flüchtlings-) Krise im psychotherapeutischen Behandlungszimmer.

OBJECTIVE: Aim of the study was to examine how discourses of refugees in the media influence the perspective of independent psychotherapists working with refugees. METHODS: 20 problem-centered interviews were carried out across Germany with independent psychotherapists, and were analyzed using the principles of Grounded Theory. RESULTS: 4 portrayals of refugees were identified: 'The problematic Other' (1), 'No Other' (2), 'The advantageous Other' (3) and 'The excluded subject' (4). CONCLUSION: The impact of discourses about refugees in the media can contribute to understand the findings in this study. Further explanations for the findings could be the differing access to knowledge about the situation of refugees, difficult living conditions of refugees in Germany and a psychotherapeutic approach focusing mainly on mental disorders.

Patterns and Determinants of Treatment Seeking among Previously Untreated Psychotic Patients in Aceh Province, Indonesia: A Qualitative Study.

Immediate treatment of first-episode psychosis is essential in order to achieve a positive outcome. However, Indonesian psychiatric patients often delay accessing health services, the reason for which is not yet fully understood. The current study aimed to understand patterns of treatment seeking and to reveal determinants of the delay in accessing psychiatric care among first-time user psychotic patients. Qualitative interviews were conducted with sixteen family members who accompanied the patients to a psychiatric hospital. Many families expressed beliefs that mental illness appertains to village sickness and not hospital sickness; therefore, they usually take the patients to traditional or religious healers before taking them to a health professional. They also identified various factors that potentially delay accessing psychiatric treatment: low literacy and beliefs about the cause of the illness, stigmatisation, the role of extended family, financial problems, and long distance to the psychiatric hospital. On the other hand, the family mentioned various factors related to timely help seeking, including being a well-educated family, living closer to health facilities, previous experience of successful psychotic therapy, and having more positive symptoms of psychosis. The findings call for mental health awareness campaigns in the community.

Mental health in Aceh--Indonesia: A decade after the devastating tsunami 2004.

The province of Aceh has suffered enormously from the perennial armed conflict and the devastating Tsunami in 2004. Despite the waves of external aid and national concern geared toward improving healthcare services as part of the reconstruction and rehabilitation efforts after the Tsunami, mental health services still require much attention. This paper aims to understand the mental healthcare system in Aceh Province, Indonesia; its main focus is on the burden, on the healthcare system, its development, service delivery and cultural issues from the devastating Tsunami in 2004 until the present. We reviewed those published and unpublished reports from the local and national government, from international instances (UN bodies, NGOs) and from the academic literature pertaining to mental health related programs conducted in Aceh. To some extent, mental health services in Aceh have been improved compared to their condition before the Tsunami. The development programs have focused on procurement of policy, improvement of human resources, and enhancing service delivery. Culture and religious beliefs shape the pathways by which people seek mental health treatment. The political system also determines the development of the mental health service in the province. The case of Aceh is a unique example where conflict and disaster serve as the catalysts toward the development of a mental healthcare system. Several factors contribute to the improvement of the mental health system, but security is a must. Whilst the Acehnese enjoy the improvements, some issues such as stigma, access to care and political fluctuations remain challenging.

Perceived ethnic discrimination, acculturation, and psychological distress in women of Turkish origin in Germany.

PURPOSE: Discrimination is linked to various health problems, including mental disorders like depression and also has a negative effect on the access to mental health care services. Little is known about factors mitigating the association between ethnic discrimination and mental distress. METHODS: The present study examined the extent of the relationship between perceived ethnic discrimination and psychological distress among women of Turkish origin residing in Berlin, and explored whether this association is moderated by acculturation strategies while controlling for known predictors of distress in migrant populations. RESULTS: A total of 205 women of Turkish origin participated in the study. 55.1% of the participants reported some degree of ethnic discrimination. The degree of reported discrimination varied according to acculturation. The highest level of ethnic discrimination was found in the second generation separated group and both generations of the marginalized group. Further, the results indicate an association between ethnic discrimination and distress while adjusting for known socio-demographic predictors of distress, migration-related factors, and neuroticism (B = 5.56, 95% CI 2.44-8.68, p < 0.001). However, the relationship did vary as a function of acculturation strategy, showing an association only in the separated group. CONCLUSIONS: The findings highlight the effects of ethnic discrimination beyond the influence of known risk factor for psychological distress in migrants, such as unemployment, being single, having a limited residence permit or the presence of personality structures that may increase vulnerability for stress responses and mental disorders.

Metabolic syndrome among psychiatric inpatients with schizophrenia in Indonesia.

Despite the fact that antipsychotic medication increases the risk of metabolic syndrome (MetS), the rate of MetS among psychiatric patients in Indonesia is rarely reported. This study aimed to investigate the prevalence of MetS among inpatients with schizophrenia in Indonesia. Eighty-six hospitalised psychiatric patients with schizophrenia were randomly recruited, and underwent physical examination including a blood test. MetS was assessed based on the International Diabetes Federation (IDF) criteria for South Asia. Among the sample, only eight patients (9.3%) met the IDF criteria for MetS. Women have a higher rate of MetS than men (23.8% vs 4.6%; p=0.02). Reduced high-density lipoprotein (HDL) cholesterol was the most frequent (81.4%) metabolic abnormality among them, followed by central obesity (29.1%), raised triglycerides (23.3%), raised fasting plasma glucose (12.8%), and raised blood pressure (10.5%). Among the various antipsychotics, no differences in MetS prevalence were observed in this population. The rate of MetS among the psychiatric inpatients in this study is lower compared both to the previously reported rate in the general population and to the findings among psychiatric patients with schizophrenia in developed countries. Several factors related to the reduced rate of MetS in this psychiatric inpatient population will be discussed.

Low rate of obesity among psychiatric inpatients in Indonesia.

OBJECTIVE: A vast majority of psychiatric medication causes weight gain, however the rate of obesity in psychiatric patients has yet to be thoroughly studied in Indonesia. The present study aims to assess the prevalence of obesity among psychiatric inpatients in Indonesia. METHODS: This cross sectional study was conducted in Banda Aceh Psychiatric Hospital, Indonesia from December 2012 to January 2013. The Body Mass Index (BMI) and blood pressure of a total 242 inpatients was measured, and data on their demographic information and medication were collected from the patient's chart. RESULTS: The prevalence rate of obesity among psychiatric inpatients was 5% (95% CI = 2.6-8.5%), and overweight was 8% (95% CI = 5.1-12.4). The mean BMI was 21.44 kg/m² (SD: 3.43). Stage I hypertension and stage II hypertension was found among 7% (95% CI = 4.1-11), and 2% (95% CI = 0.9-5.3%) inpatients, respectively. CONCLUSIONS: The findings suggest that the rate of overweight, obesity and hypertension in the present study population was relatively low compared to rates of the general population. The inpatients have limited access to food and only eat meals that are provided to them by the hospital.

[Depressive symptoms and health service utilisation among persons 50 years or older in Germany. A population-based cross-sectional study]. / Depressive Symptomatik und Inanspruchnahme von Gesundheits- und Pflegeleistungen bei Personen im Alter ab 50 Jahren in Deutschland. Ergebnisse einer bevölkerungsbasierten Querschnittstudie.

OBJECTIVE: To examine the association between depressive symptoms and the use of health services among people aged 50 years or older in Germany. METHODS: Data came from the German subsample of the "Survey of Health, Ageing and Retirement in Europe (SHARE)", comprising a nationally representative sample of 2890 German residents aged 50 years or older (mean age 65 years, 55 % women). The cross-sectional association between depressive symptoms (EURO-D scale ≥ 4 points) and health service use was examined by multivariable regression analysis. RESULTS: Depressive symptoms were found in 21 % of respondents and were associated with a higher utilisation of health care services (odds ratio [OR] 2.3, 95 % confidence interval [CI] 1.2 - 4.3) and social care services (OR 2.6, 95 % CI 1.5 - 4.7) even after adjusting for sociodemographic and psychosocial factors, cognitive function and indicators of physical health. CONCLUSION: Participants with depressive symptoms had a higher service utilisation independent of somatic comorbidity and other potential confounders.

Psychometric properties of a Russian version of the General Health Questionnaire-28.

BACKGROUND: The 28-item General Health Questionnaire (GHQ-28) is a scaled version of the General Health Questionnaire that has been used internationally to screen for mental disorders in nonpsychiatric populations. There is great need to validate international screening instruments in the Russian language for their use in post-Soviet countries. METHODS: 200 persons were surveyed in a deprived area of Almaty, Kazakhstan using the Russian version of the GHQ-28 and socioeconomic measures (income level, employment situation and education). We calculated the median and the mean GHQ-28 scores for different socioeconomic subgroups. The internal reliability was tested using Cronbach's α coefficient and intersubscale correlations. We conducted an exploratory factor analysis using varimax rotation. RESULTS: The median score of the GHQ-28 was 2 (mean = 3.56; SD = 5.09) for the total sample. Higher age, unemployment and female gender were significantly associated with high mean GHQ-28 scores. Cronbach's α coefficient was 0.92 for the total scale. Exploratory factor analysis revealed four factors explaining 50.07% of the variance. The factor Anxiety/Insomnia accounted for 14.87%, Severe Depression for 13.74%, Social Dysfunction for 13.47% and Somatic Symptoms for 8.81% of the variance. CONCLUSIONS: The test showed good internal consistency. The median GHQ-28 score was relatively low compared to other countries. The subscale Severe Depression including items on suicidal ideation may have a lower acceptance than the other subscales Somatic Symptoms, Anxiety/Insomnia and Social Dysfunction.

Random sampling for a mental health survey in a deprived multi-ethnic area of Berlin.

The aim of the study was to assess the response to random sampling for a mental health survey in a deprived multi-ethnic area of Berlin, Germany, with a large Turkish-speaking population. A random list from the registration office with 1,000 persons stratified by age and gender was retrieved from the population registry and these persons were contacted using a three-stage design including written information, telephone calls and personal contact at home. A female bilingual interviewer contacted persons with Turkish names. Of the persons on the list, 202 were not living in the area, one was deceased, 502 did not respond. Of the 295 responders, 152 explicitly refused(51.5%) to participate. We retained a sample of 143 participants(48.5%) representing the rate of multi-ethnicity in the area (52.1% migrants in the sample vs. 53.5% in the population). Turkish migrants were over-represented(28.9% in the sample vs. 18.6% in the population). Polish migrants (2.1 vs. 5.3% in the population) and persons from the former Yugoslavia (1.4 vs. 4.8% in the population)were under-represented. Bilingual contact procedures can improve the response rates of the most common migrant populations to random sampling if migrants of the same origin gate the contact. High non-contact and non-response rates for migrant and non-migrant populations in deprived urban areas remain a challenge for obtaining representative random samples.

Prescription patterns of patients diagnosed with schizophrenia in mental hospitals in Tashkent/Uzbekistan and in four German cities.

PURPOSE: Little is known about psychopharmacological prescription practice in low-income countries. The present study aimed for an analysis of pharmacological treatment strategies for inpatients with schizophrenia in Tashkent, the capital city of Uzbekistan, facing a low-income situation as compared with four German cities in a high-income Western situation. METHODS: We conducted a cross-sectional quantitative survey of age, gender, diagnoses, and psychotropic medication of 845 urban psychiatric inpatients of the Tashkent psychiatric hospital and of 922 urban psychiatric inpatients in four German cities on 1 day in October 2008. We compared the current treatment strategies for specific diagnostic categories between the two settings. RESULTS: In Tashkent, patients diagnosed with schizophrenia were treated with clozapine (66%), haloperidol (62%), or both (44%). More than one-third of the patients treated for schizophrenia were prescribed amitriptyline. The usual treatment strategy for schizophrenia was the combination of two or more antipsychotics (67%). In German cities, the preferred antipsychotics for the treatment of schizophrenia were olanzapine (21%), clozapine (20%), quetiapine (17%), risperidone (17%), and haloperidol (14%); the most common treatment strategy for patients with schizophrenia was the combination of antipsychotics and benzodiazepines; 44% of the patients were treated with two or more antipsychotics at a time. CONCLUSIONS: In both settings, psychotropic combination treatments are common for the treatment of schizophrenia contrasting current guideline recommendations. Its rationale and effectiveness needs to be tested in further studies.

[Association between migrant status and depressive symptoms in the older population in Germany]. / Der Zusammenhang zwischen Migrationsstatus und depressiven Symptomen in der älteren Bevölkerung in Deutschland.

OBJECTIVE: To assess the association between migrant status and depressive symptoms among the older population in Germany. METHODS: In a cross-sectional study with the German subsample of the Survey of Health, Ageing and Retirement in Europe (SHARE), a population-based sample of 2890 German residents aged 50 years or older (mean age 65 years, 55 % women), the association between migrant status (defined as being born outside of, and having immigrated to Germany) and depressive symptoms (≥ 4 points on the EURO-D scale) was examined by multiple logistic regression analysis. RESULTS: A total of 539 respondents (19 %) were migrants. Prevalence of depressive symptoms was higher in migrants (28 %) than in non-migrants (19 %, p < 0.001). Migrant status remained associated with depressive symptoms (odds ratio 1.50, 95 % confidence interval 1.11-2.01) in logistic regression analysis adjusting for sociodemographic factors, indicators of physical health, and cognitive function. CONCLUSIONS: The results suggest an association between migrant status and depressive symptoms in the older population in Germany that was independent of other predictors of late-life depression included in this analysis.

Use of psychiatric inpatient capacities and diagnostic practice in Tashkent/Uzbekistan as compared to Berlin/Germany.

OBJECTIVES: The present study shows a comparison of diagnoses used for the treatment of urban psychiatric inpatients in Tashkent/Uzbekistan and Berlin/Germany. Differential diagnostic practices related to different traditions in psychopathology between the two settings are analysed to explain part of the difference in relative frequencies of the diagnoses. METHODS: We conducted a cross-sectional survey of diagnoses used for the treatment of 845 inpatients including 17 out of 18 wards of the Tashkent psychiatric hospital and of all 2,260 psychiatric and psychotherapeutic inpatients in Berlin in October 2008. Relative frequencies of diagnostic categories were calculated for each setting and compared between the two settings using the Chi-square test. A descriptive analysis of differential diagnostic practice is used to explain differences in relative frequencies. RESULTS: Patients diagnosed with schizophrenia (59.3 vs. 21.0%), with organic mental disorders (20.5 vs. 8.3%), with mental retardation (6.9 vs. 0.2%) and with neurasthenia (1.4 vs. 0.0%) had larger relative frequencies of the psychiatric inpatient population in Tashkent than in Berlin. Patients diagnosed with unipolar depression (24.1 vs. 0.9%), substance use disorder (17.4 vs. 6.4%), adjustment disorder (6.0 vs. 0.4%), schizoaffective disorder (4.9 vs. 0.0%), mania and bipolar disorder (5.3 vs. 0.4%), personality disorder (3.2 vs. 2.0%) and anxiety disorder (3.1 vs. 0.1%) had larger relative frequencies in Berlin than in Tashkent. The diagnostic concept of schizophrenia in Tashkent includes patients with affective psychoses, schizoaffective psychoses and delusional disorders. In Tashkent, mental disorders are more readily associated with organic brain disease such as head trauma or vascular disease than in Berlin. CONCLUSIONS: In Tashkent, most of the psychiatric inpatient capacities are used for the treatment of schizophrenia and organic mental disorders, whereas in Berlin patients with affective disorders, schizophrenia and substance use disorders are most commonly treated as inpatients. The differences can in part be explained by differential diagnostic traditions between the Russian/post-Soviet nosology and the use of the ICD.