1
|
Kleinschmitt A. Research on psychotherapy for refugees in Germany: A systematic review on its transdisciplinary and transregional opening. Transcult Psychiatry 2024; 61:151-167. [PMID: 38234182 PMCID: PMC10996299 DOI: 10.1177/13634615231187255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Recently, an increasing amount of research has focused on adapting psychotherapy concepts for refugees moving to Germany. For a long time, research from disciplines like anthropology and cultural studies has problematized the eurocentrism of psychology's theoretical premises and methodologies. Currently, scholarship around Global Mental Health and decolonization emphasizes how knowledge production from various disciplines and regions relates to this topic and could contribute to improving respective approaches. Consequently, this review aims at evaluating the actual transdisciplinary and transregional opening of studies on psychotherapeutic interventions for refugees in Germany. It provides a theoretically as well as empirically informed basis for looking at disciplinary premises, practices, and boundaries as well as the regional locatedness of respective research. Fourteen relevant studies, published between January 1, 2007 and March 4, 2022, were identified by systematically searching the databases PubPsych and Web of Science. The studies were reviewed regarding study design, choice and characterization of target groups, regional origin and target group specific adaptations of the therapeutic concepts, integration of elements from and connections to other disciplines, and use of references to scholarship from the Global South. The findings show a pronounced focus on the development of trauma therapy approaches and moreover a broad variety of concept adaptations in response to the assumed characteristics, situations, and needs of the target groups. While the findings reveal a complex transregional pattern of development and adaptation of the therapeutic concepts, transdisciplinary opening and reference to the Global South appear scarce.
Collapse
|
2
|
Kim JW, Nam CS, Choi H. The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea. Eur J Psychotraumatol 2024; 15:2328505. [PMID: 38502029 PMCID: PMC10953780 DOI: 10.1080/20008066.2024.2328505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/29/2024] [Indexed: 03/20/2024] Open
Abstract
Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (β = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (β = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (β = .26, p = .005) were associated with poverty, and both CPTSD symptoms (β = -.52, p < .001) and poverty (β = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.
Collapse
Affiliation(s)
- Jae-Woong Kim
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Chan Seob Nam
- Department of Social Welfare, Dong-A University, Busan, South Korea
| | - Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| |
Collapse
|
3
|
Nordbrandt MS, Vindbjerg E, Mortensen EL, Carlsson J. Chronicity of posttraumatic stress disorder and comorbid pain as predictors of treatment response for trauma-affected refugees. J Trauma Stress 2022; 35:1393-1404. [PMID: 35446986 DOI: 10.1002/jts.22839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022]
Abstract
Predictors of treatment outcomes have received limited attention in the field of trauma-affected refugees. Symptom chronicity is potentially a particularly relevant predictor, as it would instruct earlier interventions for a population less familiar with psychiatric treatment options, and its identification may also reduce or delay the onset of comorbidities, such as chronic pain. Accordingly, this study examined the impacts of posttraumatic stress disorder (PTSD) chronicity and baseline comorbid pain on treatment response in trauma-affected refugees. Multiple regression was used to analyze data from a randomized controlled trial of 318 trauma-affected refugees with PTSD that was conducted at a specialized psychiatric clinic in Denmark. Treatment response was measured by changes in symptoms of PTSD (Harvard Trauma Questionnaire) and depression (Hopkins Symptom Checklist-25). Duration of functional impairment was found to be a significant predictor of PTSD outcomes, p = .003, ΔR2 = .02, f2 = .03; it was not predictive of outcomes for depression. Baseline pain severity was a significant predictor of outcomes for both PTSD, p = .009, ΔR2 = .02, f2 = .02, and depression, p = .041, ΔR2 = .01, f2 = .01. These findings suggest that trauma-affected refugees with long-lasting functional impairment and a high pain score are likely to show less improvement from treatments for PTSD and depression. This points to a need for early intervention to prevent chronic functional impairment and suggests comorbid pain is an important therapeutic target.
Collapse
Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| |
Collapse
|
4
|
Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [DOI: https:/doi.org/10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 06/22/2023]
|
5
|
Im H, Swan LET. Factors Influencing Improvement of Trauma-Related Symptoms Among Somali Refugee Youth in Urban Kenya. Community Ment Health J 2022; 58:1179-1190. [PMID: 35013831 DOI: 10.1007/s10597-021-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
Somali refugee youth present with a heightened risk for common mental disorders (CMDs), and yet few studies have discussed factors influencing mental health outcomes after psychosocial interventions. This study aimed to identify key factors that contribute to the improvement of CMD symptoms among Somali youth displaced in urban Kenya. Logistic regression analyses revealed that trauma exposure and emotional coping predict overall symptom improvement, pointing to a differential intervention effect on those with differing levels of religious belief and attitudes toward violence. This study provides insights into how psychosocial factors likely contribute to positive intervention outcomes in Somali refugee youth.
Collapse
Affiliation(s)
- Hyojin Im
- School of Social Work, Virginia Commonwealth University, 1000 Floyd Ave., 3rd Floor, Richmond, VA, 23284, USA.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St., Madison, WI, 53726, USA
| |
Collapse
|
6
|
Opaas M, Wentzel-Larsen T, Varvin S. Predictors of the 10 year course of mental health and quality of life for trauma-affected refugees after psychological treatment. Eur J Psychotraumatol 2022; 13:2068910. [PMID: 35957631 PMCID: PMC9359185 DOI: 10.1080/20008198.2022.2068910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Trauma-affected refugee patients benefit from psychological treatment to different degrees. Only a handful of studies has investigated potential predictors of treatment outcome that could throw light on the great variability in outcomes reported for this group. Such knowledge may be vital to better tailor prevention and treatment efforts to the needs of different individuals and subgroups among these patients. Objective: In a naturalistic and longitudinal study, the aim was to analyse demographics and traumatic exposure as potential predictors of the participants' long-term trajectories of mental health symptoms and quality of life. Method: A group of 54 multi-origin adult refugee patients with complex traumatic exposure, such as armed conflicts, persecution, torture, and childhood adversities, were interviewed face to face over up to 10 years; at therapy admittance, and at varying points in time during and after psychotherapy. Checklists of war-related and childhood trauma, mental health symptoms, and quality of life were included in the interviews. In linear mixed effects analyses, interaction was analysed with potential predictors included separately because of the sample size. Time was modelled as continuous from inclusion into the study. Results: Gender predicted the course of symptoms of post-traumatic stress, anxiety, and depression, and of quality of life in physical health and social relationships. Childhood family violence and experiences of torture predicted the course of depression, whereas the extent of exposure to war-related trauma events and having experienced torture predicted the course of anxiety. Conclusions: The results indicated greater chronicity in male refugees, in refugees who had experienced domestic violence during childhood, in refugees who had experienced torture, and in refugees with more numerous types of potentially traumatic war-related experiences. The findings highlight the need for gender-sensitive research, rehabilitative efforts, and treatment. HIGHLIGHTS In a 10 year longitudinal and naturalistic therapy follow-up study of traumatized refugees, female gender, childhood trauma, war trauma, and torture predicted mental health and quality of life outcomes.Male participants responded less than females to therapy.
Collapse
Affiliation(s)
- Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Sverre Varvin
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
7
|
Kim E, Yun M, von Denkowski C. Violence Against North Korean Refugee Women: Doubly Victimized By Repatriation and Premigration Traumatic Experiences. Violence Against Women 2021; 28:2424-2447. [PMID: 34657523 DOI: 10.1177/10778012211032706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigates the influence of traumatic events on the mental health of North Korean refugee women by examining the prevalence and severity of posttraumatic stress disorder (PTSD), depression, and anxiety in comparison with their male counterparts (women = 496; men = 131). Our results suggest that women are at greater risk of developing mental health problems than men. In particular, symptoms of PTSD and anxiety were higher among women who experienced forced repatriation to North Korea, which is operationalized as a constellation of gendered traumatic incidents such as sexual abuse, rape, witnessing infanticides, and forced abortion. The policy implications of our results and suggestions for future studies are discussed.
Collapse
Affiliation(s)
- Eunyoung Kim
- Department of Police Administration and Criminal Justice, 26724Catholic Kwandong University, Gangneug, South Korea
| | - Minwoo Yun
- Department of Police Science and Security Studies, 65440Gachon University, Seongnam, South Korea
| | - Cordula von Denkowski
- Studiendekanin Abteilung Soziale Arbeit, 40242Hochschule Hannover, Hannover, Germany
| |
Collapse
|
8
|
Cratsley K, Brooks MA, Mackey TK. Refugee Mental Health, Global Health Policy, and the Syrian Crisis. Front Public Health 2021; 9:676000. [PMID: 34414156 PMCID: PMC8369241 DOI: 10.3389/fpubh.2021.676000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
The most recent global refugee figures are staggering, with over 82.4 million people forcibly displaced and 26.4 million registered refugees. The ongoing conflict in Syria is a major contributor. After a decade of violence and destabilization, over 13.4 million Syrians have been displaced, including 6.7 million internally displaced persons and 6.7 million refugees registered in other countries. Beyond the immediate political and economic challenges, an essential component of any response to this humanitarian crisis must be health-related, including policies and interventions specific to mental health. This policy and practice review addresses refugee mental health in the context of the Syrian crisis, providing an update and overview of the current situation while exploring new initiatives in mental health research and global health policy that can help strengthen and expand services. Relevant global health policy frameworks are first briefly introduced, followed by a short summary of recent research on refugee mental health. We then provide an update on the current status of research, service provision, and health policy in the leading destinations for Syrians who have been forcibly displaced. This starts within Syria and then turns to Turkey, Lebanon, Jordan, and Germany. Finally, several general recommendations are discussed, including the pressing need for more data at each phase of migration, the expansion of integrated mental health services, and the explicit inclusion and prioritization of refugee mental health in national and global health policy.
Collapse
Affiliation(s)
- Kelso Cratsley
- Department of Philosophy & Religion, American University, Washington, DC, United States
| | | | - Tim K. Mackey
- Global Health Program, Department of Anthropology, University of California, San Diego, La Jolla, CA, United States
| |
Collapse
|
9
|
Sonne C, Mortensen EL, Silove D, Palic S, Carlsson J. Predictors of treatment outcomes for trauma-affected refugees - results from two randomised trials. J Affect Disord 2021; 282:194-202. [PMID: 33418367 DOI: 10.1016/j.jad.2020.12.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Treatment effects in trials with trauma-affected refugees vary considerably between studies, but the variability in outcome between individual patients is often overlooked. Consequently, we know little about why some patients benefit more from treatment than others. The aim of the study was therefore to identify predictors of treatment outcome for refugees with Posttraumatic Stress Disorder (PTSD). METHODS Data was derived from two randomised trials including 321 refugees, who had all participated in a 6-7 months bio-psycho-social treatment programme. Outcome measures were the Harvard Trauma Questionnaire (PTSD, self-rating), Hopkins Symptom Checklist-25 (depression and anxiety, self-rating) and Hamilton Depression and Anxiety rating scales (observer-ratings). Using hierarchical regressions models, associations were analysed between pre- to post treatment score changes (dependent variable) and a range of variables including sociodemographics, pre-migration trauma, post-migratory stressors, baseline symptom scores and level of functioning. RESULTS A high baseline score (=more symptoms) and a high level of functioning were found to be associated with improvement on all ratings. Additionally, the following variables were associated with symptom improvement on at least one outcome measure: short time in host country, full time occupation, young age and status as family reunified (in contrast to refugee status). Being Muslim was inversely correlated with improvement. LIMITATIONS Translated self-ratings were used, which could impact reliability. CONCLUSION These results call for screening and early interventions for arriving refugees. For clinical populations, level of functioning should be included in assessments of refugees, to possibly begin stratifying samples to different interventions based on their likelihood of responding.
Collapse
Affiliation(s)
- Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevaenget 21, 2750 Ballerup, Denmark.
| | - Erik Lykke Mortensen
- Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark
| | - Derrick Silove
- School of Psychiatry, University of New South Wales, Australia
| | - Sabina Palic
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Maglevaenget 21, 2750 Ballerup, Denmark
| | - Jessica Carlsson
- University of Copenhagen/Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Denmark
| |
Collapse
|
10
|
van der Boor CF, Amos R, Nevitt S, Dowrick C, White RG. Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries. Confl Health 2020; 14:48. [PMID: 32699551 PMCID: PMC7370437 DOI: 10.1186/s13031-020-00292-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
The stressful experiences that many asylum seekers and refugees (AS&R) are exposed to during forced migration, and during resettlement in host countries, can have a profound impact on their mental health. Comparatively less research attention has been allocated to exploring other indices of quality of life (QoL) in AS&R populations. This review aimed to (i) synthesize the predictors and correlates of QoL of AS&R populations in high-income countries, and (ii) to identify the methodological strengths and weaknesses of this body of research. Fourteen databases were systematically searched (Medline, PsychINFO, CINAHL, Cochrane Library, Health Technology Assessment, National Health Service Economic Evaluation, Educational Resource Index and Abstracts, BiblioMap, Scopus, Social Sciences Citation Index, Evidence Aid, DARE, Web of Science and PubMed). Eligibility criteria included: adults seeking asylum or refuge in a high-income country, primary quantitative data, the use of a measure based on the WHO's definition of QoL, published in a peer-reviewed journal. A narrative synthesis approach was used, and the quality was assessed using the AXIS tool for cross-sectional studies and the CASP tool for longitudinal studies. Of the 13.656 papers identified, 23 met the eligibility criteria. A wide range of factors were found to have significant associations with QoL. Both positive and negative correlates of QoL were largely dominated by social (e.g. social networks) and mental health factors (e.g. depression). Although all of the cross-sectional studies met over half of the quality criteria, only 12 met 75% or more of these criteria. For the longitudinal studies, for all but one study lacked statistical precision and the results cannot be applied to the local population. Key findings across the various forms of QoL (overall, physical, psychological, social and environmental) were that having established social networks and social integration were associated with higher QoL, whereas having mental disorders (i.e. PTSD or depression) was strongly associated with reduced QoL. More research is needed into physical and environmental predictors and correlates of QoL. The findings of the review can be used to inform policies and interventions aimed at supporting AS&R and promoting the integration and wellbeing of these populations.
Collapse
Affiliation(s)
- Catharina F van der Boor
- Institute of Life and Human Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX UK
| | - Rebekah Amos
- Institute of Life and Human Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX UK
| | - Sarah Nevitt
- Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX UK
| | - Christopher Dowrick
- Institute of Life and Human Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX UK
| | - Ross G White
- Institute of Life and Human Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX UK.,University of Liverpool, G.10, Ground floor, Whelan Building, Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| |
Collapse
|
11
|
Kaltenbach E, Hermenau K, Schauer M, Dohrmann K, Elbert T, Schalinski I. Trajectories of posttraumatic stress symptoms during and after Narrative Exposure Therapy (NET) in refugees. BMC Psychiatry 2020; 20:312. [PMID: 32552778 PMCID: PMC7298826 DOI: 10.1186/s12888-020-02720-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 06/09/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Trauma-focused therapy approaches are recommended as treatment for posttraumatic stress disorder (PTSD). This includes the treatment of trauma-related suffering in refugee populations. However, there is a lack of knowledge about symptom trajectories in refugees living in volatile conditions. This has led to fear of "retraumatisation" and general skepticism in clinicians concerning the use of exposure therapy. METHODS To test the relevance of this concern, we investigated PTSD symptom trajectories and potentially influencing factors during the course of Narrative Exposure Therapy (NET) in a refugee sample living in Germany. Refugees filled out the PTSD Checklist prior to each treatment session and also during follow-up interviews. Therapists continuously documented positive and negative life events as well as the content of the treatment sessions. Additionally, structured clinical interviews were conducted pre-treatment and at follow-up time points. RESULTS On average, clients presented with substantial decreases in PTSD symptoms already during and after NET. However, symptom trajectories differed and ranged from fast responders to slow responders to no immediate response during treatment. Importantly, a persistent worsening of symptoms was not observed, also not after exposure to the most distressing events. In contrast, stressful life experiences seemed to aggravate PTSD symptoms. CONCLUSIONS Consistent with earlier studies, NET leads to clinically and behaviorally relevant reductions in PTSD symptoms both throughout and following treatment in refugees living in volatile conditions. Concerns about imaginal exposure in refugees were not substantiated. While stressful life events contributed to transient symptom increases, they weren't found to prevent the overall effectiveness of NET. TRIAL REGISTRATION NCT02852616.
Collapse
Affiliation(s)
- Elisa Kaltenbach
- Department of Psychology, University of Konstanz, Konstanz, Germany. .,Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada. .,Vivo International e.V., Konstanz, Germany.
| | - Katharin Hermenau
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Konstanz, Germany ,Vivo International e.V., Konstanz, Germany
| | - Maggie Schauer
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Konstanz, Germany ,Vivo International e.V., Konstanz, Germany
| | - Katalin Dohrmann
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Konstanz, Germany ,Vivo International e.V., Konstanz, Germany
| | - Thomas Elbert
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Konstanz, Germany ,Vivo International e.V., Konstanz, Germany
| | - Inga Schalinski
- grid.9811.10000 0001 0658 7699Department of Psychology, University of Konstanz, Konstanz, Germany ,Vivo International e.V., Konstanz, Germany ,Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
| |
Collapse
|
12
|
de la Rie SM, Smid GE, van der Aa N, van Est LAC, Bisseling E, Boelen PA. Feasibility of narrative exposure therapy in an outpatient day treatment programme for refugees: improvement in symptoms and global functioning. Eur J Psychotraumatol 2020; 11:1759983. [PMID: 33029303 PMCID: PMC7473203 DOI: 10.1080/20008198.2020.1759983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Refugees are at high risk for developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an evidence-based treatment of PTSD, designed for patients exposed to (multiple) traumatic events and recommended for patients with culturally diverse backgrounds. In clinical practice, adherence to the NET-protocol has been challenged because of psychosocial complexities and comorbid disorders. . OBJECTIVE The current study investigated the feasibility of NET embedded in an outpatient day treatment programme for refugees and examined reduction in PTSD symptoms and improvement of global functioning as well as correlates of change. . METHOD Participants were patients who consecutively entered an outpatient daytreatment programme from 2013-2017. The majority had a history of prior unsuccessful treatment. PTSD was assessed with the Clinically Administered PTSD Scale (CAPS) before and after finishing NET. Global Assessment of Functioning (GAF) was used to examine changes in functioning. Changes in PTSD scores and functioning were analyzed using paired t-tests and reliable change indices. Patients showing significant improvement were compared to those who did not, on patient and treatment characteristics, including sex, age, region of origin, childhood trauma and treatment duration and dosage of NET. . RESULTS Of 97 patients, 76 (78.4%) completed NET. Completers had a longer residency and were more likely to have a partner. Significant reductions in PTSD symptoms and improvements in global functioning were observed. Twenty-eight percent showed reliable improvement with large effect sizes. Four patients did no longer meet the criteria for PTSD. No strong moderators for changes were found. Patients who did not improve more often had a history of childhood trauma. CONCLUSIONS NET embedded in an outpatient day treatment programme appears to be feasible. In those who improved, a substantial decline in symptoms and improvement of functioning were observed. The findings suggest that a socially supportive living environment enhances acceptability of trauma-focused treatment in refugees.
Collapse
Affiliation(s)
- Simone M de la Rie
- ARQ National Psychotrauma Centre, ARQ Centrum'45, Diemen, The Netherlands
| | - Geert E Smid
- ARQ National Psychotrauma Centre, ARQ Centrum'45, Diemen, The Netherlands.,University of Humanistic Studies, Utrecht, The Netherlands
| | - Niels van der Aa
- ARQ National Psychotrauma Centre, ARQ Centrum'45, Diemen, The Netherlands
| | - Leanne A C van Est
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.,Reinier van Arkel, Psychotraumacentrum Zuid Nederland, 's Hertogenbosch, The Netherlands
| | - Eef Bisseling
- ARQ National Psychotrauma Centre, ARQ Centrum'45, Diemen, The Netherlands
| | - Paul A Boelen
- ARQ National Psychotrauma Centre, ARQ Centrum'45, Diemen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
13
|
Goodman A, Bergbower H, Perrotte V, Chaudhary A. Survival after Sexual Violence and Genocide: Trauma and Healing for Yazidi Women in Northern Iraq. Health (London) 2020. [DOI: 10.4236/health.2020.126046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
14
|
Žagar M, Rotar Pavlič D, Švab I, Maksuti A, Ilić B, Smrekar M, Kovačević I. Through health workers' eyes: a qualitative study of health service provision for migrants at Schengen border. Int J Equity Health 2019; 18:117. [PMID: 31357991 PMCID: PMC6664722 DOI: 10.1186/s12939-019-1022-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/21/2019] [Indexed: 12/05/2022] Open
Abstract
Background Croatia and Slovenia were the transit countries on the Balkan route for migrants and refugees from Middle East countries in 2015 and 2016. They had to optimize health care delivery in the special circumstances in refugee camps and transit centres. Little is known about health care provision in border camps where a large number of migrants stay for only couple of hours. Previous studies emphasize that language barriers and cultural differences play a central part in the relationship between health workers and migrants inside the transit zone. The aim of the study was to identify specific characteristics of health care provision experienced by primary healthcare providers in order to prepare solutions on how to organise health care in refugee settings. Methods Twelve thematic interviews were conducted in the middle of the most intense migration movements to the North-West Europe between November and December 2015 with health workers from Croatia and Slovenia. Interview transcripts were read, coded, reviewed, and labelled. We used qualitative content analysis. Results Four themes about the health service provision for refugees at Schengen border were identified. The circumstance when mutual understanding is poor and the consultation not successful, cultural differences represent a central barrier. Participants highlighted that the importance of respecting human dignity is crucial for the provision of basic medical care for migrants in transit. Conclusion Successful overcoming language barriers, respecting cultural differences, humanity, susceptibility to social deprivation and traumatic experiences are the key factors important for organisation of health care in transit centers and camps. This article gives some useful tips for healthcare workers and policy makers who are participating in health services provision for migrants and other refugees. Health workers should be prepared to work in special working conditions with a lack of resources. Their work would require timely planning and reflection on the organization of more transit camps. Trial registration Ethical Committee of the Republic of Slovenia approved the study as a project number 112/02/16.
Collapse
Affiliation(s)
- Mateja Žagar
- Medical faculty, Department of family medicine, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | - Danica Rotar Pavlič
- Medical faculty, Department of family medicine, Poljanski nasip 58, 1000, Ljubljana, Slovenia
| | - Igor Švab
- Medical faculty, Department of family medicine, Poljanski nasip 58, 1000, Ljubljana, Slovenia
| | - Alem Maksuti
- Medical faculty, Department of family medicine, Poljanski nasip 58, 1000, Ljubljana, Slovenia
| | - Boris Ilić
- University of Applied Health Sciences Zagreb, Mlinarska cesta 38, 10 000, Zagreb, Croatia
| | - Martina Smrekar
- University of Applied Health Sciences Zagreb, Mlinarska cesta 38, 10 000, Zagreb, Croatia
| | - Irena Kovačević
- University of Applied Health Sciences Zagreb, Mlinarska cesta 38, 10 000, Zagreb, Croatia
| |
Collapse
|
15
|
Nordin L, Perrin S. Pre-treatment pain predicts outcomes in multimodal treatment for tortured and traumatized refugees: a pilot investigation. Eur J Psychotraumatol 2019; 10:1686807. [PMID: 31762955 PMCID: PMC6853218 DOI: 10.1080/20008198.2019.1686807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Chronic pain is a common comorbid complaint in traumatized refugees seeking treatment for posttraumatic stress disorder (PTSD) and depression. However, the effect of comorbid pain on treatment remains under investigated. Objective: To investigate whether pre-treatment pain (severity/interference) predicts outcomes in a multimodal treatment targeting PTSD, depression, anxiety, somatic complaints, and health-related disability in refugees exposed to torture and organized violence. Additional predictors were gender, age, and number of treatment sessions. Method: Participants were active cases at a specialist outpatient clinic for tortured refugees (n = 276; 170 men, 106 women) who were either on a treatment waitlist (mean length = 7.4 months, SD = 4.5), in treatment (mean length = 12.2 months, SD = 6.5), or who completed treatment and had (or were waiting for) a follow-up assessment. Participants completed symptom measures at referral, pre- and post-treatment, and 9-month follow-up. Multi-level mixed modelling was used to assess whether outcomes at post-treatment and 9-months were predicted by pain, gender, age, or the number of treatment sessions. Results: Treatment yielded significant pre-to-post-treatment reductions in PTSD, depression, anxiety, and number of pain locations, but no reductions in pain severity/interference, or health-related disability, except for societal participation. Gains for PTSD, depression, and societal participation were maintained at the 9-month follow-up. Higher levels of pain interference (but not severity) predicted poorer outcomes (PTSD, depression, and anxiety). Age, gender and number of treatment sessions did not predict outcomes, except for a small negative effect of (older) age on PTSD. Conclusions: A growing body of literature suggests that pain and PTSD symptoms interact in ways to increase the severity and impact of both disorders in refugee and non-refugee populations alike. The present study suggests interference from pain can lessen the effectiveness of standard multi-modal treatments for refugees.
Collapse
Affiliation(s)
- Linda Nordin
- Rehabilitation Department, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark.,Department of Psychology, Lund University, Lund, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| |
Collapse
|
16
|
Denkinger JK, Windthorst P, Rometsch-Ogioun El Sount C, Blume M, Sedik H, Kizilhan JI, Gibbons N, Pham P, Hillebrecht J, Ateia N, Nikendei C, Zipfel S, Junne F. Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Extreme Violence by the "Islamic State". Front Psychiatry 2018; 9:234. [PMID: 29922186 PMCID: PMC5996169 DOI: 10.3389/fpsyt.2018.00234] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/15/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. Systematic violence, as committed against the Yazidi minority in Northern Iraq by the terror organization known as the Islamic State (IS), can be seen as a particularly traumatic burden to the victims, but also to caregivers providing treatments and assistance to them. The intense exposure to traumatic content may cause secondary traumatization in respective caregivers. This study aims (1) to identify the prevalence of secondary traumatization in caregivers working with traumatized women and children from Northern Iraq; (2) to determine the specific distressing factors and resources of the caregivers; as well as (3) to analyze whether caregivers' personal history of trauma or flight, attachment styles, working arrangements as well as support offers qualify as risk or resilience factors for secondary traumatization. Materials and Methods: In this cross-sectional study, N = 84 caregivers (social workers, psychotherapists/physicians, and interpreters) in the context of a Humanitarian Admission Program (HAP) for women and children traumatized by the so called IS were investigated about their work-related burdens and resources. Secondary traumatization was assessed with the Questionnaire for Secondary Traumatization (FST). To identify relevant determinants for secondary traumatization multiple linear regression analyses were performed. Results: Secondary traumatization was present in 22.9% of the participating caregivers, with 8.6% showing a severe symptom load. A personal history of traumatic experiences, a personal history of flight, a higher number of hours per week working in direct contact with refugees as well as a preoccupied attachment style were detected as risk factors for secondary traumatization. A secure attachment style could be identified as a resilience factor for secondary traumatization. Discussion: Caregivers working with traumatized refugees are at high risk of developing secondary traumatization. Based on the findings of this study and theoretical considerations, a framework of classification for different types of trauma-associated psychological burdens of caregivers working with traumatized refugees is proposed. Implications for the training and supervision of professionals in refugee- and trauma-care are discussed.
Collapse
Affiliation(s)
- Jana K Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | | | - Michael Blume
- Department of Non-Christian Religions, Values, Minorities and Northern Iraq Projects, Ministry of State of Baden-Württemberg, Stuttgart, Germany
| | - Hes Sedik
- Department of Non-Christian Religions, Values, Minorities and Northern Iraq Projects, Ministry of State of Baden-Württemberg, Stuttgart, Germany
| | - Jan I Kizilhan
- Department of Mental Health and Addiction, Baden-Württemberg Cooperative State University Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States
| | - Jennifer Hillebrecht
- Rehabilitation Psychology and Psychotherapy, Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Nora Ateia
- Department of Child and Adolescence Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
17
|
Munz D, Melcop N. The psychotherapeutic care of refugees in Europe: treatment needs, delivery reality and recommendations for action. Eur J Psychotraumatol 2018; 9:1476436. [PMID: 29963296 PMCID: PMC6022238 DOI: 10.1080/20008198.2018.1476436] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/25/2018] [Indexed: 11/06/2022] Open
Abstract
The special issue of the European Journal of Psychotraumatology released on 7 November 2017 focused on traumatized refugees and on the mental health burden, screening instruments and interventions in different groups of refugees. This contribution takes up this discussion on the needs and challenges for mental healthcare of traumatized refugees from the point of view of the practitioners. It reports on the findings of a survey on the treatment situation and the delivery reality of healthcare for refugees in 14 European countries, identifies treatment gaps, and sets recommendations for action at the political and therapeutic levels. The survey was conducted by the Federal Chamber of Psychotherapists with the assistance of the Network for Psychotherapeutic Care in Europe. The findings underline the need for appropriate mental healthcare for this population.
Collapse
Affiliation(s)
- Dietrich Munz
- Bundes Psychotherapeuten Kammer (BPtK), Berlin, Germany
| | | |
Collapse
|
18
|
Knaevelsrud C, Stammel N, Olff M. Traumatized refugees: identifying needs and facing challenges for mental health care. Eur J Psychotraumatol 2017; 8:1388103. [PMID: 29152160 PMCID: PMC5678445 DOI: 10.1080/20008198.2017.1388103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In the past few years the number of refugees worldwide has increased dramatically. Many of them were traumatized in their homelands due to violent conflict or persecution, as well as during their flight, and are confronted with ongoing stressors in the exile countries. In order to contribute to enhancing the clinical knowledge, this special issue of the European Journal of Psychotraumatology focuses on traumatized refugees. It includes three review articles as well as four original articles on the mental health burden, screening instruments and interventions in different groups of refugees. The articles published in this special issue focus on important aspects of better understanding the needs of traumatized refugees, as well as on identifying and offering appropriate mental health care for this population. Future research recommendations are provided in the hope to contribute to improving mental health care strategies of this still underserved population.
Collapse
Affiliation(s)
- Christine Knaevelsrud
- European Journal of Psychotraumatology, Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany
| | - Nadine Stammel
- European Journal of Psychotraumatology, Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Germany.,Center Überleben (former Center for Torture Victims), Berlin, Germany
| | - Miranda Olff
- European Journal of Psychotraumatology, Department of Psychiatry, Academic Medical Center, University of Amsterdam.,Arq Psychotrauma Expert Group, Diemen, The Netherlands
| |
Collapse
|