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Denkinger JK, Junne F, Erschens R. Creating Safety-The Importance of Providing Psychosocial Support for Refugee Children and Adolescents After Resettlement. JAMA Netw Open 2023; 6:e235777. [PMID: 37022692 DOI: 10.1001/jamanetworkopen.2023.5777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, University Hospital Magdeburg, Magdeburg, Germany
- German Center for Mental Health, Site Jena-Magdeburg-Halle, Germany
| | - Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
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Denkinger JK, Rometsch C, Murray K, Schneck U, Brißlinger LK, Rahmani Azad Z, Windthorst P, Graf J, Hautzinger M, Zipfel S, Junne F. Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people. Eur J Psychotraumatol 2022; 13:2066458. [PMID: 35646296 PMCID: PMC9132417 DOI: 10.1080/20008198.2022.2066458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film 'Coping with Flight and Trauma' was developed as a brief online intervention. OBJECTIVE The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. METHOD The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. RESULTS A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. CONCLUSIONS Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. HIGHLIGHTS Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people.Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services.
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Affiliation(s)
- J K Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - C Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - K Murray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - U Schneck
- refugio stuttgart e.v., Stuttgart, Germany
| | - L K Brißlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Z Rahmani Azad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - P Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Hospital Havelhöhe, Berlin, Germany
| | - J Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - M Hautzinger
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - S Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - F Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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Denkinger JK, Rometsch C, Engelhardt M, Windthorst P, Graf J, Pham P, Gibbons N, Zipfel S, Junne F. Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence. JAMA Netw Open 2021; 4:e2111120. [PMID: 34047793 PMCID: PMC8164098 DOI: 10.1001/jamanetworkopen.2021.11120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking. OBJECTIVE To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019). EXPOSURES Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State. MAIN OUTCOMES AND MEASURES Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised. RESULTS A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms. CONCLUSIONS AND RELEVANCE These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.
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Affiliation(s)
- Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Alice Salomon University Berlin, University of Applied Science, Berlin, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Hospital Havelhöhe, Berlin, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - 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
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Nikendei C, Zipfel S, Junne F. Care providers' views on burden of psychosomatic symptoms of IS-traumatized female refugees participating in a Humanitarian Admission Program in Germany: A qualitative analysis. PLoS One 2020; 15:e0239969. [PMID: 33017408 PMCID: PMC7535032 DOI: 10.1371/journal.pone.0239969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Traumatized refugees often suffer from diverse psychosomatic symptoms. Female Yazidi refugees from Northern Iraq who survived attacks of the so-called "Islamic State" were brought to Germany to receive special medical and psychotherapeutic treatment in a unique worldwide humanitarian admission program (HAP). Here, we report on their psychosomatic symptoms and helpful strategies from the perspective of care providers. METHODS Care providers (N = 84) in this HAP were interviewed in an individual setting as well as in focus groups to gather information about the HAP beneficiaries' psychosomatic symptoms. Data analysis followed Qualitative Content Analysis by Mayring. RESULTS The care providers reported five main psychological burdens of the Yazidis: 1) insecurity regarding loss, 2) worries about family members, 3) ambivalence about staying in Germany or returning to Iraq, 4) life between two worlds and 5) re-actualization of the traumatic experiences. The predominant psychological symptoms the care providers noticed were fear, depressive symptoms, feelings of guilt, and sleep and eating disorders. Regarding somatic symptoms, the care providers mainly received complaints about pain in the head, back, chest and stomach. Helpful strategies for providing adequate health care were care providers' cooperating with physicians, precise documentation of beneficiaries' symptoms, and additional support in directing the beneficiaries through the health care system. Regarding psychotherapy, interpreters help to overcome language barriers, onsite psychotherapy, flexible therapy appointments, psychoeducational methods, time for stabilization, and support in coping with daily life aspects. In the care providers' experience, psychotherapists have to build a relationship of trust. After grief therapy, a trauma-specific therapy in a culturally adapted way is possible. CONCLUSION The HAP is a unique model health care program to offer highly traumatized refugees medical and psychological help. Care providers reported on several (psycho-)somatic symptoms of the traumatized women. The strategies the HAP care providers perceived as helpful can be recommended for similar projects in the future.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, 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 Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Rometsch C, Denkinger JK, Engelhardt M, Windthorst P, Graf J, Gibbons N, Pham P, Zipfel S, Junne F. Pain, somatic complaints, and subjective concepts of illness in traumatized female refugees who experienced extreme violence by the "Islamic State" (IS). J Psychosom Res 2020; 130:109931. [PMID: 31981895 DOI: 10.1016/j.jpsychores.2020.109931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/21/2019] [Accepted: 01/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Refugees with a history of war or sexual violence often experience somatic symptoms along with mental disorders. After being held in captivity by the so-called "Islamic State" (IS), 1100 especially vulnerable Yazidi women and children (around 400 women) received special medical and psychological support. We report on their (psycho-) somatic complaints and concepts of illness. METHODS Female refugees (N = 116) were surveyed regarding their somatic complaints and concepts of illness. The Impact of Event Scale-Revised (IES-R) and self-developed questionnaire items with ratings on a five-point Likert scale from 0 ("not at all") to 4 ("extremely") were used. Subgroup analyses and a multiple linear regression model were computed. RESULTS Pain (M = 2.43, SD = 1.70) is the main somatic complaint with a moderate rated severity, followed by feelings of suffocation (M = 2.37, SD = 1.53), and movement disorders (M = 1.62, SD = 1.70). In a linear regression model, pain explains variance (R2 = 0.325) in the refugees' self-reported health-related wellbeing. Somatic symptoms are mainly attributed to psychological causes, followed by physical (e.g., physical origin of symptoms), religious, and supernatural causes. Women with pain symptoms attributed their symptoms more to physical causes (M = 1.90, SD = 1.78) than did women without pain symptoms (M = 1.07, SD = 1.59). CONCLUSION Female Yazidi refugees being kept in IS captivity mainly suffer from pain, which is attributed to an explanatory psychological model. The study results show the specific psychosomatic and psychotherapeutic needs and demands for specifically tailored psychotherapy.
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Affiliation(s)
- Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, USA; Harvard Medical School, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
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Rometsch-Ogioun El Sount C, Denkinger JK, Windthorst P, Nikendei C, Kindermann D, Renner V, Ringwald J, Brucker S, Tran VM, Zipfel S, Junne F. Psychological Burden in Female, Iraqi Refugees Who Suffered Extreme Violence by the "Islamic State": The Perspective of Care Providers. Front Psychiatry 2018; 9:562. [PMID: 30467483 PMCID: PMC6236063 DOI: 10.3389/fpsyt.2018.00562] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/17/2018] [Indexed: 01/09/2023] Open
Abstract
Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers. Material and methods: Care providers with various professional backgrounds (N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany. We controlled for potential confounders, namely the care providers' personal experiences of trauma and flight, by using chi-square tests. Results: The mean psychological burden for the whole period in Germany as perceived by care providers was M = 5.51 (SD = 0.94). As the main factors of distress the care providers reported: worries about family members in Iraq (M = 6.69; SD = 0.69), worries about relatives' possibilities to be granted asylum in Germany (M = 6.62; SD = 0.68), and uncertainties regarding their future (M = 5.89; SD = 1.02). The most prominent trauma-related psychological symptoms were nightmares (M = 6.43; SD = 0.54). The care providers reported that somatic complaints have been present among the refugees in the following manifestation: pain (M = 6.24; SD = 1.08), gastrointestinal complaints (M = 4.62; SD = 1.62), and dizziness (M = 4.40; SD = 1.59). The care providers' personal experiences of trauma and flight had no significant influence on their response behavior. Discussion: Care providers working with IS-traumatized female refugees evaluate the psychological burden and trauma-related somatic and psychological symptom loads of their clients as very high. The results of this study provide important information about the perceptions of care providers working in a refugee-services context and may provide insights for the progression of specialized treatment programs and interventions for highly traumatized refugees and culture-sensitive training programs for their care providers.
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Affiliation(s)
| | - Jana Katharina 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
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Viola Renner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy for children and Youth, University Hospital Tübingen, Tübingen, Germany
| | - Johanna Ringwald
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Sara Brucker
- Department of Gynecology, University Hospital Tübingen, Tubingen, Germany
| | - Virginia M. Tran
- Harvard Humanitarian Initiative, Harvard University, Cambridge, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - 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
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