[Mental Disorders among Refugees]. / Psychische Störungen bei MigrantInnen.

Mental Disorders among Refugees Abstract. Children and adolescents with migration and refugee backgrounds are subject to various health-related, psychosocial, sociocultural, and economic burdens that may influence the prevalence, manifestation, course, and treatment as well as prognosis of mental disorders. In addition, they are particularly disadvantaged by numerous barriers to accessing the mental healthcare and treatment granted natives. The so-called transition gap only exacerbates the situation. As a solution, we provide recommendations for improving the mental healthcare of children and adolescents with a migration and refugee background analogous to the situation for adults. For inpatient settings, where mental healthcare is inadequate, we recommend the establishment of so-called adolescent wards under child and adolescent and adult psychiatric-psychotherapeutic management, with appropriate nursing and therapeutic staffing as well as a special "transition management" including the training of intercultural competence.

Posttraumatic stress disorder and comorbid depression among refugees: Assessment of a sample from a German refugee reception center.

In 2015, a large number of refugees arrived in Germany, mostly driven to emigrate by devastating circumstances in their countries of origin. Arriving refugees are distributed to reception centers within the German federal states, frequently facing marginal conditions in terms of overcrowding or waiting time of several months until their application for asylum is processed. Most of these refugees underwent numerous traumatizing experiences-both in their country of origin and while fleeing from their country of origin. Furthermore, they faced and will likely continue to face various access barriers to mental health care. In this study, we assessed a sample of 85 refugees from a reception center in Germany selected due to their observed psychological strain. Results showed that the majority suffered from posttraumatic stress disorder, mostly with symptoms of intrusion, hyperarousal, avoidance, and dissociation. Most refugees also suffered from comorbid depression. We discuss implications of these findings for reception services and the need for more preventive psychiatric care.

Acculturation and severity of depression among first-generation Vietnamese outpatients in Germany.

BACKGROUND: Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population. AIMS: Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression. METHODS: A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)). RESULTS: Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression. CONCLUSIONS: The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.

EPA guidance on cultural competence training.

The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.

How much orientation towards the host culture is healthy? Acculturation style as risk enhancement for depressive symptoms in immigrants.

AIMS: As the specific acculturative tasks and challenges involved in the migration process can lead to an increased risk for depressive symptoms, the study was designed to gain further insight into the interrelation between acculturation styles and mental health. METHODS: A total of n = 90 patients with different ethnic backgrounds from an outpatient consultation service for immigrants at the Hannover Medical School were investigated by the Hannover Migration and Mental Health Interview (HMMH), the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Frankfurt Acculturation Scale (FRAKK). RESULTS: The majority of the subjects (84.4%) had a clinically significant depression. The extent of depressive symptoms was determined by the selected acculturation style (1) (F = 3.29, p = .025): Subjects with integration as acculturation style showed less depressive symptoms than subjects with assimilation as acculturation style. Furthermore, subjects with segregation as acculturation style also showed less depressive symptoms than subjects with assimilation. CONCLUSION: The results suggest that even when undergoing extreme emotional distress, eventually leading to mental disorder, integration, as an acculturation style, seems to serve as a protective resource and possibly prevents further decline.