Stepped, evidence-based and integrated care service model vs. usual care for mental disorders: A randomized controlled trial (RECOVER).

Stepped, evidence-based and integrated care service models have the potential to be used as a reference for mental health services. RECOVER aimed to evaluate cost savings, effectiveness, and cost-effectiveness of such a model within a two arm, assessor- and data analysist-blinded RCT in Hamburg, Germany. Participants aged 16-79 years with mental disorders were randomly assigned either to RECOVER or treatment as usual (TAU). Primary outcomes comprised costs, effectiveness (combined symptoms, functioning, quality of life), and cost-effectiveness, hierarchically ordered. Outcomes were evaluated according to the ITT principle, group differences regarding costs with adjusted generalized linear models, effectiveness with ANCOVA models, and cost-effectiveness with the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curves (CEACs). Between 1/1/2018 and 12/31/2020, n = 891 were finally included (n = 477 in RECOVER, n = 444 in TAU). RECOVER was associated with significantly lower annual total costs (-22 %), health and social care costs (-25 %) and hospital costs (-50 %). Effectiveness analyses showed a significantly better outcome for RECOVER with the fully imputed data . The CEACs descriptively demonstrated that RECOVER was cost-effective with a probability of >95 %. Treatment in RECOVER resulted in substantial cost reductions with better cost-effectiveness. RECOVER can be recommended as a reference model for comprehensive and integrated mental health services.

Uncovering multi-level mental healthcare barriers for migrants: a qualitative analysis across China, Germany, Netherlands, Romania, and South Africa.

BACKGROUND: Forced displacement is a significant issue globally, and it affected 112 million people in 2022. Many of these people have found refuge in low- and middle-income countries. Migrants and refugees face complex and specialized health challenges, particularly in the area of mental health. This study aims to provide an in-depth qualitative assessment of the multi-level barriers that migrants face in accessing mental health services in Germany, Macao (Special Administrative Region of China), the Netherlands, Romania, and South Africa. The ultimate objective is to inform tailored health policy and management practices for this vulnerable population. METHODS: Adhering to a qualitative research paradigm, the study centers on stakeholders' perspectives spanning microsystems, mesosystems, and macrosystems of healthcare. Utilizing a purposive sampling methodology, key informants from the aforementioned geographical locations were engaged in semi-structured interviews. Data underwent thematic content analysis guided by a deductive-inductive approach. RESULTS: The study unveiled three pivotal thematic barriers: language and communication obstacles, cultural impediments, and systemic constraints. The unavailability of professional interpreters universally exacerbated language barriers across all countries. Cultural barriers, stigmatization, and discrimination, specifically within the mental health sector, were found to limit access to healthcare further. Systemic barriers encompassed bureaucratic intricacies and a conspicuous lack of resources, including a failure to recognize the urgency of mental healthcare needs for migrants. CONCLUSIONS: This research elucidates the multifaceted, systemic challenges hindering equitable mental healthcare provision for migrants. It posits that sweeping policy reforms are imperative, advocating for the implementation of strategies, such as increasing the availability of language services, enhancing healthcare providers' capacity, and legal framework and policy change to be more inclusive. The findings substantially contribute to scholarly discourse by providing an interdisciplinary and international lens on the barriers to mental healthcare access for displaced populations.

Community interpreting in Germany: results of a nationwide cross-sectional study among interpreters.

BACKGROUND: Community interpreters (CIPs) play a crucial role in various community services, including healthcare, when service providers and users do not share a common language. However, there is a lack of evidence-based data on this population globally. This explorative cross-sectional study aims to gain a better understanding of CIPs and their work in Germany. METHODS: A nationwide online survey was conducted among CIPs in Germany to collect data on their qualification background, working conditions, mental health, interpreting-related psychosocial distress and sociodemographics. Participants were recruited through interpreting pools, training institutions and migrant organizations. Data were analyzed descriptively, dependent t-test, multiple logistic and hierarchical stepwise regression analyses were performed to predict participation in interpreting-specific training, interpreting competence and interpreting-related psychosocial distress. RESULTS: Across all 16 federal states, N = 873 responses were used for analysis. Most participants are female (74%), born abroad (77%) and have a high level of education (69%). The vast majority interpret occasionally in their leisure time (44%) and are self-employed/freelance (51%). 34% interpret solely or additional on a voluntary basis (unpaid). The median hours of interpreting per month are 10 h, 75% do not exceed 30 h. On average interpreters work in four different settings. 69% attended any kind of interpreting training with a median of 25 h in total. Interpreting in more settings emerged as an associated factor with participation in training. Of those who have never attended any training, 69% consider themselves as rather/very competent in interpreting. Interpreting more frequently, having less severe anxiety symptoms, getting higher and more often paid and being less satisfied with the payment is associated with self-reported interpreting competence. In total, 36% reported moderate or severe psychosocial distress regarding interpreting. Higher general psychosocial distress and depressive symptoms, higher interpreting frequency and lower payment satisfaction were found to be associated with higher distress regarding interpreting. Additionally, factors such as precarious work conditions, lack of recognition and discrimination (e.g. racism and sexism) were reported as distressing. CONCLUSION: This study provides a first comprehensive evidence-based national database on CIPs in Germany. The findings can be valuable for the development of qualifications, guidelines, policies and the process of professionalizing the field of CIPs.

Usability of technological tools to overcome language barriers in health care: a scoping review protocol.

INTRODUCTION: In many healthcare contexts globally, where the languages of care providers and patients do not match, miscommunication or non-communication can lead to inaccurate diagnoses and subpar treatment outcomes. In order to bridge these language barriers, a range of informal practices are used, such as family members or staff acting as interpreters, 'receptive multilingualism' or machine translation. The development and use of technological tools are increasing, but factors such as translation quality for complex health-related texts vary widely between languages. The objective of this scoping review is to (1) identify and describe the technological tools used in direct patient-provider communication to overcome a language barrier in a healthcare setting, (2) identify how the usability of these tools was evaluated and (3) assess the usability of the technological tools. METHODS AND ANALYSIS: The scoping review will follow the Joanna Briggs Institute methodology. A search strategy using variations of the keywords 'technological tools', 'language barrier' and 'healthcare' will be applied in the following databases and research platforms: PubMed, PsycArticle, Scopus, EBSCOhost, ProQuest and Web of Science. All literature where individuals use a technological tool to overcome a language barrier in a healthcare context will be included and exported into the screening assistant software Rayyan. The search will be limited to articles written in German or English. Two independent reviewers will screen the articles, and all relevant extracted data will be presented in a descriptive summary. ETHICS AND DISSEMINATION: This scoping review does not require ethical approval, as the study's methodology consists of collecting data from publicly available sources. The findings will be disseminated through publication in an open-access, peer-reviewed journal and presentations at scientific conferences. The scoping review results will also guide future research in a multinational project investigating multilingualism in providing (mental) healthcare to migrants.

Barriers to use of interpreters in outpatient mental health care: Exploring the attitudes of psychotherapists.

The support of professional interpreters is an essential component of adequate mental health care for migrants with limited language proficiency. Nevertheless, for varied reasons, only a small proportion of outpatient psychotherapists provide interpreter-mediated psychotherapy for migrants. This study explored the perspectives of psychotherapists who have not worked with professional interpreters in outpatient mental health care to identify factors that may prevent the use of interpreters in outpatient care and explore possible incentives to provide interpreter-mediated psychotherapy for migrants with limited language proficiency. Semi-structured interviews were conducted with 13 outpatient psychotherapists in Northern Germany who had not yet worked with professional interpreters in outpatient care. The interviews were audio recorded, transcribed and analysed using a structured content analysis approach. The psychotherapists named structural as well as subjective barriers and concerns. Findings suggest that improving structural factors, such as secure funding, minimal additional work, better preparation and training could facilitate the integration of professional interpreters into everyday treatment. Psychotherapists also mentioned concerns about their own confidence (e.g., insecurities regarding the triadic situation), the patient (e.g., reduced openness), the interpreter (e.g., doubts about suitability, motivation and empathy), as well as the therapeutic process (e.g., unclear allocation of roles). However, positive aspects and opportunities of interpreter-mediated psychotherapy were also described. These could be enhanced by the presence of conducive factors, such as existing trust between all parties and professional cooperation between interpreter and psychotherapist.

A balancing act: how interpreters affect the therapeutic alliance in psychotherapy with trauma-affected refugees-a qualitative study with therapists.

Objective: The therapeutic alliance (TA) has the highest predictive value concerning the success of psychotherapy. The presented study aimed to explore how the presence of an interpreter affects the TA when working with trauma-affected refugees. Method: Semi-structured interviews were conducted with seven psychologists working in an outpatient clinic specialized in mental health care for migrant and refugee patients with trauma-related mental health problems in Denmark. Interviews were transcribed verbatim and analyzed using a structuring content analysis approach. Results: TA has been described as a dynamic therapist-interpreter-patient alliance triangle consisting of three distinct but highly intertwined and mutually influential dyadic alliances. Specific factors affecting the quality of the TA were identified, e.g., interpreter being emotionally attuned yet not overly involved; interpreter being barely visible yet present as a human being. Characteristics of trauma-affected refugee patients affecting the TA formation were also identified, e.g., a high level of personal distrust, different understandings of mental disorders and psychotherapy, stigmatization, perceptions of authorities. Conclusion: The presence of interpreters was perceived ambivalently and the formation of a good TA seems to be a balancing act. Based on the findings, recommendations for forming and maintaining a good TA in interpreter-mediated psychotherapy are provided.

Assessing the psychosocial work environment of migrant and non-migrant workers in inpatient mental health centres: A feasibility study.

The number of migrant workers in Germany has increased over the last decades and will probably further increase in the context of a growing cultural diversity of the population and shortage of skilled professionals. Since migrant workers face different challenges, they may experience poorer psychosocial work environments than non-migrants. A negative psychosocial work environment can increase burnout and depression symptoms. To this date no study has investigated differences in the perceived psychosocial work environment in the mental health field. The aim of this study is to evaluate the feasibility of a cross sectional study comparing the perceived psychosocial work environment of migrants and non-migrant workers in inpatient mental health centres in Germany. The study was conducted in four inpatient mental health centres in Germany using the Copenhagen Psychosocial Questionnaire. All staff members (N = 659) categorized in seven professional groups were invited to participate in the study. The feasibility of the study was determined by four criteria (1) Implementation of the study in inpatient mental health centres (2) Representativity of the sample (3) Reliability and usability of the questionnaire and (4) Variability of collected data. Three of four feasibility criteria were achieved. The study was successfully implemented in four mental health centres, the usability of the used questionnaire was confirmed as well as the variability of the data. The targeted response rate was partially met, and the total number of migrant workers could not be provided, which limits the representativity of the sample. In conclusion, a main study is feasible, but an effort must be put in an effective recruitment strategy to obtain valid results.

Review: Universal mental health interventions for young students in adverse environments - a systematic review of evaluated interventions.

BACKGROUND: Universal classroom-based interventions are a useful method to increase the mental health and resilience in children. Resilience describes the process that leads to a positive development despite adversities. It comprises the seven resources access to material resources, relationships, identity, power and control, cultural adherence, social justice and cohesion. Yet there is a paucity of studies evaluating interventions that enhance resilience in children exposed to adverse childhood experiences. METHOD: This systematic review investigates whether universal classroom-based interventions can increase the seven resilience-related resources in children that live in adverse environments. Search strings were formulated based on an adapted version of the PICO criteria. The risk of bias of the individual studies was assessed using the ROBINS-I tool. RESULTS: Seventeen studies were included in the review, of which 15 found an increase in resilience. The resource power and control was targeted in every intervention. Not one intervention included all seven resources. Intervention outcomes related mostly to just two of the resources (power and control and identity) and were rarely linked to what was being trained in the intervention. CONCLUSION: The results of this review show that classroom-based interventions are suitable for promoting resilience in children living in adverse environments. Yet more high-quality studies are needed that evaluate the effectiveness of universal interventions on children living in adverse environments and specifically the effectiveness of training each of the seven resources. Future developments of school-based interventions should be careful to target and assess all resilience-related resources.

[Barriers and Resources in Inpatient Psychosomatic Rehabilitative Care of Migrant Patients]. / Barrieren und Ressourcen in der Behandlung von Patient/innen mit Migrationshintergrund in der psychosomatischen Rehabilitation.

Patients from migrant descent access inpatient psychosomatic rehabilitative care less and achieve less treatment success than patients from the host populations. They are confronted with different process barriers in the healthcare system which combined with individual barriers can inhibit successful treatment. Studies have shown that working with migrant patients may also be challenging for healthcare providers.This study aims to assess and compare barriers and resources faced by migrant and non-migrant patients during their treatment in inpatient psychosomatic rehabilitative care. Also, the aim is to assess and compare barriers and resources faced by healthcare providers in treating migrant and non-migrant patients in order to identify barriers and resources specific to working with migrant patients.A total of 77 semi-structured interviews were conducted (20 migrant and 19 non-migrant patients as well as 14 migrant and 24 non-migrant healthcare providers). Data were transcribed and analyzed applying the method of qualitative content analysis (Mayring) with inductive categories.Migrant and non-migrant patients stated that they profit from the treatment in inpatient psychosomatic rehabilitative care. The greatest barriers for both migrant patients and healthcare providers are language barriers, cultural differences, differences in expectations regarding the treatment and limited organizational cultural competences. As far as organizational cultural competences are implemented, they are profitable for migrant patients and non-migrant healthcare providers. However, migrant healthcare workers seem responsible for implementing culturally competent care and suffer from increased workload.

Process- and outcome evaluation of an orientation programme for refugee health professionals.

BACKGROUND: Refugee health professionals experience several barriers on their path to re-entering their original occupations in host countries. Several training programmes exist in order to address these barriers and enable a successful labour market integration.Objective: This study aims to evaluate a specific orientation programme for the labour market integration of refugee health professionals in Germany. The programme lasts three months and comprises three elements (German technical terminology language course, cross-cultural coaching and a job shadowing).Design: A mixed-methods design was implemented to evaluate the programme. To assess participants' skills improvement and satisfaction, self-developed questionnaires were used. For in-depth-evaluation of individual experiences, qualitative interviews were conducted at four time points (pre, half-time, post, follow-up) with both programme participants and programme providers about their experiences.Results: Participants described impacts on their personal situation and improvement of their language, professional and formal skills. Some participants also described negative effects mostly due to unsupervised shadowing. Additional barriers, such as cost of travel were identified as challenges for participation.Conclusion: Training programmes may affect language skills, professional skills and formal resources. However, programme providers need to anticipate negative effects and introduce actions for preventing negative outcomes. Moreover, programmes should be designed to reduce work-related fear and anxiety amongst participants.

Mental health and cultural and linguistic diversity as challenges in school? An interview study on the implications for students and teachers.

Mental health and cultural and linguistic diversity in classrooms are part of students' lives. Both factors can lower the achievements of students and classrooms and pose a challenge for teachers. Yet, little is known about the effects on other areas of school life besides achievements. Also, the consequences for classmates and teachers as well as possible resources are mostly disregarded. Semi-structured interviews were held to investigate the diverse effects of mental health issues and cultural and linguistic diversity on students, classmates and teachers. In total 20 interviews were conducted, seven with teachers, seven with external professionals and six with students. Recordings were transcribed and analysed using qualitative text analysis. Results show that especially externalizing symptoms of mental health issues are a burden to classmates and teachers. Teachers face time management problems and emotional stress. Linguistic diversity constitutes a serious challenge at school for students, classmates and teachers. Yet, cultural and linguistic diversity also imports several resources like fostering openness and integration. Future research should expand this research to older children and investigate the specific needs of teachers.

Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER).

INTRODUCTION: Healthcare systems around the world are looking for solutions to the growing problem of mental disorders. RECOVER is the synonym for an evidence-based, stepped and cross-sectoral coordinated care service model for mental disorders. RECOVER implements a cross-sectoral network with managed care, comprehensive psychological, somatic and social diagnostics, crisis resolution and a general structure of four severity levels, each with assigned evidence-based therapy models (eg, assertive community treatment) and therapies (eg, psychotherapy). The study rationale is the investigation of the effectiveness and efficiency of stepped and integrated care in comparison to standard care. METHODS AND ANALYSIS: The trial is conducted in accordance to the Standard Protocol Items: Recommendations for Interventional Trials Statement. The study aims to compare the RECOVER model with treatment as usual (TAU). The following questions are examined: Does RECOVER reduce healthcare costs compared with TAU? Does RECOVER improve patient-relevant outcomes? Is RECOVER cost-effective compared with TAU? A total sample of 890 patients with mental disorders will be assessed at baseline and individually randomised into RECOVER or TAU. Follow-up assessments are conducted after 6 and 12 months. As primary outcomes, cost reduction, improvement in symptoms, daily functioning and quality of life as well as cost-effectiveness ratios will be measured. In addition, several secondary outcomes will be assessed. Primary and secondary outcomes are evaluated according to the intention-to-treat principle. Mixed linear or logistic regression models are used with the direct maximum likelihood estimation procedure which results in unbiassed estimators under the missing-at-random assumption. Costs due to healthcare utilisation and productivity losses are evaluated using difference-in-difference regressions. ETHICS AND DISSEMINATION: Ethical approval from the ethics committee of the Hamburg Medical Association has been obtained (PV5672). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER AND REGISTRY NAME: ClinicalTrials.gov (NCT03459664), RECOVER PROTOCOL VERSION: 19 March 2020 (V.3.0).

The Extent of Psychosocial Distress among Immigrant and Non-Immigrant Homecare Nurses-A Comparative cross Sectional Survey.

In times of demographic change, most developed countries are increasingly looking to cover the growing domestic demand for healthcare by hiring nurses from abroad. The evidence concerning the health of immigrant care workers is inconsistent since studies report that it is either better or more impaired than that of their non-immigrant counterparts. This study compared the extent of occupational psychosocial stressors and resources affecting immigrant and non-immigrant homecare nurses. The cross-sectional survey was conducted in the homecare nursing service sector in Hamburg. Psychosocial distress, depressive symptomatology, generalized anxiety, somatic symptom burdens, homecare-specific qualitative stressors, as well as resources, have been measured using a standardized questionnaire. There was no significant difference in the extent of psychosocial distress experienced by immigrant and non-immigrant homecare nurses. Somatic symptom burdens most strongly predicted nurses' psychosocial distress, in general. For immigrant nurses, greater influence and freedom at work, as well as fixed-term employment, was related to increased levels of distress, while age, working full time, and working overtime predicted distress in non-immigrant nurses. A functioning relationship with colleagues and superiors had a declining effect on immigrant nurses' psychosocial distress, while shift work arrangements benefitted non-immigrant nurses. Even though the extent of psychosocial distress experienced by immigrant and non-immigrant nurses did not significantly differ, the nurse's individual explanatory model of psychosocial health should be considered in every occupational and political context.

[Psychosocial Stressors and Resources of Live-in Caregivers in German Households - a Qualitative Study]. / Arbeitsplatzbezogene Belastungen und Ressourcen von ausländischen 24-Stunden-Betreuungskräften in deutschen Privathaushalten ­ eine qualitative Studie.

AIM OF THE STUDY: Live-in caregivers who provide household- and person-related services for the elderly in need of care in German private households mostly come from abroad. These labour conditions generally do not meet any tariff or labour law-related binding regulations. Live-in caregivers are additionally exposed to social isolation and the confusion of work and privacy. The study is full of gaps because the target group cannot be reached easily. The aim of the present study was to qualitatively explore the work and health situation of live-in caregivers with a focus on workplace-related stressors and resources. METHODOLOGY: The recruitment process was carried out via placement agencies, online portals, social network platforms as well as care associations. Nine semi-structured interviews were conducted with live-in care-givers in private households. The evaluation was based on Mayring's content analysis with inductive category formation. RESULTS AND CONCLUSIONS: Permanent presence, communication difficulties and interpersonal conflicts are daily burdens for live-in caregivers. These burdens are associated with impaired mental and physical health in terms of exhaustion, insomnia, increased irritability and depression symptoms. However, live-in caregivers also receive support from third parties and distance themselves emotionally and locally from the direct care situation. The feeling of gratitude, the experience of being accepted and also financial security are mentioned as further relevant resources. While the target group can be made visible through resource-intensive recruiting efforts in the research context, the introduction of a common occupational definition is necessary in the political context.

Qualification programmes for immigrant health professionals: A systematic review.

BACKGROUND: Immigrant health professionals are a particularly vulnerable group in a host country's labour market, as they face several barriers when re-entering their occupations. International studies indicate that early interventions can increase the employability of immigrants. Qualification programmes are one of these early interventions that can support the re-integration of these health professionals into the labour market. The purpose of this review is to identify international qualification programmes for immigrant health professionals, analyse their content and evaluate their effectiveness. METHODS: Six international databases (PubMed, Web of Science, CINAHL, PsychInfo, EBSCO and ProQuest Social Sciences) were systematically searched. The search terms were identified using the PICOS-framework. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were screened independently by two authors and discussed. Studies included in the final synthesis were assessed with the Mixed Methods Appraisal Tool (MMAT) and Kirkpatrick's Training Evaluation Model. RESULTS: Out of 10,371 findings, 31 articles were included in the final synthesis. The majority of them were addressed to international health care professionals and doctors. Two of them were addressed to refugee doctors. Three types of programme elements were identified: teaching, clinical practise and social support. The programmes' length ranged from 2 days to up to 2.5 years. Despite recommendations in its favour, pre- and post-programme support was scarce. Results also indicate a lack of transparency and quality in terms of evaluation. Effectiveness was mostly observed in the area of language improvement and an increase in self-confidence. CONCLUSION: This review points out the lack of systematically evaluated qualification programmes for immigrant health professionals. Programme providers should focus on implementing programmes for all health professionals as well as for underrepresented groups, such as refugees. In order to generate best practises it is necessary to evaluate these programmes. This requires the development of appropriate instruments when working with immigrant population in the context of educational programmes.

Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision.

BACKGROUND: Culturally and linguistically diverse patients access healthcare services less than the host populations and are confronted with different barriers such as language barriers, legal restrictions or differences in health beliefs. In order to reduce these disparities, the promotion of cultural competence in healthcare organizations has been a political goal. This scoping review aims to collect components and strategies from evaluated interventions that provide culturally competent healthcare for culturally and linguistically diverse patients within healthcare organizations and to examine their effects on selected outcome measures. Thereafter, we aim to organize identified components into a model of culturally competent healthcare provisions. METHODS AND FINDINGS: A systematic literature search was carried out using three databases (Pubmed, PsycINFO and Web of Science) to identify studies which have implemented and evaluated cultural competence interventions in healthcare facilities. PICO criteria were adapted to formulate the research question and to systematically choose relevant search terms. Sixty-seven studies implementing culturally competent healthcare interventions were included in the final synthesis. Identified strategies and components of culturally competent healthcare extracted from these studies were clustered into twenty categories, which were organized in four groups: Components of culturally competent healthcare-Individual level; Components of culturally competent healthcare-Organizational level; Strategies to implement culturally competent healthcare and Strategies to provide access to culturally competent healthcare. A model integrating the results is proposed. The overall effects on patient outcomes and utilization rates of identified components or strategies were positive but often small or not significant. Qualitative data suggest that components and strategies of culturally competent healthcare were appreciated by patients and providers. CONCLUSION: This scoping review used a bottom-up approach to identify components and strategies of culturally competent healthcare interventions and synthesized the results in a model of culturally competent healthcare provision. Reported effects of single components or strategies are limited because most studies implemented a combination of different components and strategies simultaneously.

Work-related barriers and resources of migrant and autochthonous homecare nurses in Germany: A qualitative comparative study.

BACKGROUND: There is substantial research about the occupational health of nurses worldwide. However, empirical evidence about the psychosocial health of migrant and minority nurses in outpatient settings in Germany in comparison to that of autochthonous nurses is lacking. OBJECTIVES: This study aims to identify work-related stressors, resources and the corresponding coping strategies of migrant and minority nurses in comparison to autochthonous nurses. DESIGN: 24 migrant and 24 autochthonous nurses employed in the German homecare sector were interviewed in qualitative explorative manner while a distinction was made between non-commercial and private-commercial services. SETTINGS: The interviews took place in the nursing services' premises or in the nurses' private homes. PARTICIPANTS: Services were randomly chosen among all homecare providers in the second largest German federal city-state Hamburg. Nurses were invited for an interview, once their management agreed to participate in the study. Registered nurses and nursing assistants as well as those with a foreign certificate but validated or in process were eligible to participate. METHODS: Relevant literature findings formed the base for the semi-structured interview guide. Key areas in the interview guide were barriers, resources and coping strategies in the collaboration with colleagues, superiors and clients as well as in the collaboration within a linguistically and culturally diverse team and clients. The conventional approach to qualitative content analysis by Hsieh and Shannon guided the analysis. RESULTS: Regardless of their origin or culture, nurses perceive time pressure, lifting patients, lack of appreciation or the client's personal fate as burdening. In the intercultural context, the divergent understanding of behavioral patterns as well as of nursing care and a non-functioning communication impede the collaboration within a diverse nursing workforce. Migrant and minority nurses suffer prejudices, verbal and sexual harassment proceeding from their clients. However they keep it to themselves and don't broach it to their supervisors or colleagues. The interaction with humans, the verbal exchange with colleagues and supervisors at eye level as well as the sensemaking of being a nurse helps nurses to cope with occupational stressors. CONCLUSIONS: Differences in language is a main stressor which impedes a functioning team collaboration as well as a positive nurse-client relationship. Migrant and autochthonous nurses share similar coping strategies to master occupational burdens. A good collaboration within the team and having an appreciative supervisor are resources that support migrant and minority nurses as well as autochthonous nurses to face the stressors and to cope with those. Migrant nurses of different origin perceive their status as migrants as a sense of community by sharing commonalities. CONTRIBUTION OF THE PAPER: What is already known about the topic?

Acculturation and other risk factors of depressive disorders in individuals with Turkish migration backgrounds.

BACKGROUND: Acculturation is a long-term, multi-dimensional process occurring when subjects of different cultures stay in continuous contact. Previous studies have suggested that elevated rates of depression among different migrant groups might be due to patterns of acculturation and migration related risk factors. This paper focused on prevalence rates of depressive disorders and related risk factors among individuals with Turkish migration backgrounds. METHODS: A population-based sample of 662 individuals with Turkish migration backgrounds were interviewed by bilingual interviewers using a standardised diagnostic interview for DSM-IV-TR and ICD-10 diagnoses (CIDI DIA-X Version 2.8). Associations between 12-month prevalence rates of depressive disorders with potential risk factors were assessed, including gender, age, socioeconomic status, acculturation status and migration status. RESULTS: 12-month prevalence rates of any depressive disorder were 29.0%, 14.4% of major depressive disorder (MDD) and 14.7% of dysthymia. Older age and low socioeconomic status were most consistently related to higher risks of depressive disorders. Acculturation status showed associations with subtypes of depressive disorder. Associations differed between men and women. Symptom severity of MDD was linked to gender, with females being more affected by severe symptoms. CONCLUSION: The prevalence of depressive disorders is high in individuals with Turkish migration backgrounds, which can be partly explained by older age, low socioeconomic status and acculturation pressures. Only a limited number of risk factors were assessed. Acculturation in particular is a complex process which might not be sufficiently represented by the applied measures. Further risk factors have to be identified in representative samples of this migrant group.

Health situation of migrant and minority nurses: A systematic review.

INTRODUCTION: Globally, life expectancy together with multimorbidity and chronic diseases are increasing. This leads to a growing demand for care and hence for healthcare personnel and nurses. To meet this demand, healthcare workers from abroad are increasingly hired. The nurses' workplace in general is characterized by physically and psychologically demanding tasks, while that of migrant and minority nurses is additionally characterized by discriminatory practices. The present knowledge about the health of migrant and minority nurses and the terminology in this context are diverse. Thus, the purpose of this review is to systematically identify and synthesize international publications that explicitly focus on migrant nurses' health. MATERIALS AND METHODS: A systematic review of relevant studies was undertaken using the databases Medline, PsycINFO, CINAHL and Web of Science. The screening process was conducted in several phases. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines while the methodological quality assessment of the included papers was performed with the Mixed Method Appraisal Tool (MMAT). RESULTS: Out of 11,599 citations initially obtained, 14 empirical studies were included in the final synthesis. The methodological quality of the empirical studies and reviews was diverse. The majority of the studies were conducted in the US and the nurses under study migrated from countries like the Philippines, India, Europe, and Africa. Among migrant nurses of different origins, there are differences in their physiological responses to stress. Migrant nurses and native nurses differ in reporting work-related injuries. DISCUSSION: Migrant and minority nurses are at high risk of work-related injuries and discrimination than native or majority nurses. However, mixed results were obtained, namely that the reported health of migrant nurses either improves over time or it decreases. This review revealed that discrimination is the leading cause of impaired health amongst migrant and minority nurses.

Lifetime prevalence of mental disorders among first and second generation individuals with Turkish migration backgrounds in Germany.

BACKGROUND: This paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject. METHODS: In total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR. RESULTS: The analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder. CONCLUSIONS: Overall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.