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Psychotherapists' Readiness to Treat Refugee Patients and the Influence of Professional Quality of Life: A Cross-Sectional Vignette Study

BACKGROUND

Previous research has shown that psychotherapists' characteristics influence their readiness to treat refugee patients. The impact of therapists' professional quality of life (ProQOL) regarding their treatment readiness for refugee patients is unknown.

OBJECTIVE

This study aims to evaluate the ProQOL among psychotherapists in Germany. It examines how these factors and previous experience working with refugees affect psychotherapists' treatment readiness for refugee patients with symptoms of post-traumatic stress disorder (PTSD).

METHOD

In our study, we assessed the treatment readiness of licensed psychotherapists (LPTs) and psychotherapists in training (PiTs) using randomized refugee verus nonrefugee vignettes. Participants (N = 821) rated their treatment readiness for the presented case, reported their professional quality of life on the ProQOL questionnaire as well as prior experience with psychotherapy for refugees.

RESULTS

The ProQOL differed significantly between therapists with and without experience treating refugees: Compassion satisfaction was higher, and burnout lowers for those who had already treated refugees. Overall, treatment readiness was lower for refugee than for nonrefugee patients. Therapists with prior experience of working with refugees reported a significantly higher treatment readiness for the refugee vignette. Treatment readiness was not affected by the reported ProQOL.

CONCLUSIONS

Treatment experience with refugees did not negatively impact therapists' ProQOL but fostered their further treatment readiness for this specific patient group. Psychotherapists should be encouraged to gain initial treatment experience with refugees to improve long-term health care for refugees. Encouragement could be achieved by providing supervision or specialist training.

Refugees' integration and emotional distress over the course of 9 months

Background

High prevalence rates of mental disorders are reported in refugees due to experiencing substantial pre-, peri-, and post-migration stress. While long-term studies indicated that emotional distress of refugees either stagnates or ameliorates over time, long-term research on refugees' integration and its' interaction with emotional distress is limited. The examined long-term predictors for refugees' emotional distress and integration in this study were, amongst others, severe physical abuse in childhood, residence status and length of stay.

Methods

The sample included 46 refugees, 91.3% male, mean age 20.8 years. Trained psychologists screened for emotional distress with the use of the Refugee Health Screener in a semi-structured interview. Integration progress was screened using the Integration Index with the subdimensions psychological, economic, political, social, linguistic and navigational integration. Longitudinal differences for emotional distress and integration sub-dimensions were evaluated by sign tests and t-tests. The longitudinal course of integration was evaluated with a Mixed ANOVA. Further, two hierarchical regression analyses were performed to analyze longitudinal predictors of emotional distress and integration.

Results

Overall, emotional distress decreased, and integration increased over time. In particular, the sub-dimensions of social, economic, and linguistic integration increased significantly over time. Two regression analyses determined significant predictors of (a) emotional distresst1 (adjusted R2  = 0.46): psychotherapy (ß = 0.35, p = 0.020), emotional distresst0 (ß = 0.34, p = 0.031), and integrationt0 (ß = -0.29, p = 0.043), and one significant predictor of (b) integrationt1 (adjusted R2  = 0.70): integrationt0 (ß = 0.89, p < 0.001).

Conclusion

This is the first study to longitudinally examine the Integration Index with all subdimensions. Over the course of 9 months refugees' overall integration, and the sub-dimensions of social, economic, and linguistic integration increased. Whilst the emotional distress of initially highly distressed refugees ameliorated over the course of nine months, their symptom severity remained clinically significant. Results emphasize the importance of early integration for the long-term development of mental health and integration in refugees. Refugees' emotional distress and integration are intertwined and need to be addressed promptly after refugees' entry into the host country.

Low access and inadequate treatment in mental health care for asylum seekers and refugees in Germany-A prospective follow-up study over 12 months and a nationwide cross-sectional study

Refugees experience elevated rates of mental health problems, but little is known about mental health service utilization and quality among asylum seekers and refugees in Europe. In a 12-month follow-up study of newly arrived refugees (N = 166, Mage = 32.38 years, 30.7% female) and a nationwide cross-sectional study (N = 579, Mage = 33.89 years, 36.2% female) of refugees who had been living in Germany for an average of 6 years, we examined objective need for mental health treatment, perceived need, access to treatment services, and adequacy of treatment. We defined minimally adequate mental health treatment according to the WHO World Mental Health Survey as ≥8 sessions of psychotherapy (minimally adequate psychotherapy) or pharmacotherapy plus ≥4 medical visits (minimally adequate pharmacotherapy). In both studies, two in three individuals screened for mental health symptoms and additionally perceived a need for professional treatment. Of those, less than half had contact to any service provider, with only 1 in 14 receiving minimally adequate psychotherapy. Overall, no more than one in seven of refugees in need received minimally adequate treatment. Despite a comprehensive mental health-care system, refugees' access to mental health care and the treatment provided are inadequate. Health policies are urgently needed to provide equitable mental health care for all.