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Grochtdreis T, König HH, Dams J. Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP). BMC Public Health 2024; 24:1965. [PMID: 39044148 PMCID: PMC11264381 DOI: 10.1186/s12889-024-19489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Germany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany. METHODS The sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions. RESULTS The different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one's country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one's country of origin were both associated with higher MCS scores. CONCLUSIONS The economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one's living situation, discrimination due to one's origin and a feeling of missing people from one's country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.
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Affiliation(s)
- Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Marchetti F, Preziosi J, Zambri F, Tambascia G, Di Nolfi A, Scardetta P, Splendore F, Colaceci S, Coia M, Caredda E, Masi L, De Luca V, Perra A, Giusti A. Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study. Front Public Health 2023; 11:1125125. [PMID: 37124798 PMCID: PMC10130403 DOI: 10.3389/fpubh.2023.1125125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Background Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. Methods The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. Results The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. Discussion and conclusions ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.
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Affiliation(s)
- Francesca Marchetti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Jessica Preziosi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Francesca Zambri
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Gabriella Tambascia
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Annachiara Di Nolfi
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Paola Scardetta
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | - Flavia Splendore
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Sofia Colaceci
- Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy
| | - Maura Coia
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Emanuele Caredda
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
- General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Loredana Masi
- Maternal and Child Department, Local Health Authority “Roma 5”, Rome, Italy
| | - Vittorio De Luca
- Department of Mental Health and Addiction, Local Health Authority “Roma 5”, Rome, Italy
| | - Alberto Perra
- Department of Prevention, Local Health Authority “Roma 5”, Rome, Italy
| | - Angela Giusti
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
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3
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Khouani J, Blatrix L, Tinland A, Jego M, Gentile G, Fond G, Loundou A, Fromentin M, Auquier P. Health status of recently arrived asylum seekers in their host country: results of a cross-sectional observational study. BMC Public Health 2022; 22:1688. [PMID: 36068557 PMCID: PMC9450400 DOI: 10.1186/s12889-022-14095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background The World Health Organization (WHO) considers that the heterogeneity of concepts and definitions of migrants is an obstacle to obtaining evidence to inform public health policies. There is no recent data on the health status of only asylum seekers who have recently arrived in their Western host country. The purpose of this study was to determine the health status of asylum seekers and search for explanatory factors for this health status. Methods This cross-sectional observational study screened the mental and somatic health of adult asylum seekers who had arrived in France within the past 21 days and went to the Marseille single center between March 1 and August 31, 2021. In order to study the explanatory factors of the asylum seekers' health status, a multivariate analysis was performed using a logistic regression model to predict the health status. Factors taken into account were those significantly associated with outcome (level < 0.05) in univariate analysis. Results In total, 419 asylum seekers were included and 96% CI95%[93;97.3] had at least one health disorder. Concerning mental health, 89% CI95% [85.1;91.4] had a mental disorder and in terms of somatic health exclusively, 66% CI95% [61.4;70.6] had at least one somatic disorder. Women were more likely to have a somatic disease OR = 1.80 [1.07; 3.05]. We found a statistically significant association between the presence of at least one disorder and sleeping in a public space OR = 3.4 [1.02;11.28] p = 0.046. This association is also found for mental disorders OR = 2.36 [1.16;4.84], p = 0.018. Conclusions Due to the high prevalence of health disorders our study found, asylum seekers are a population with many care needs when they arrive in their host country. The main factors linked to a poor health status seem to be related to a person’s sex, geographical origin and sleeping in a public space.
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Affiliation(s)
- Jérémy Khouani
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France. .,Department of General Practice, Aix-Marseille Univ, Marseille, France.
| | - Léo Blatrix
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Aurélie Tinland
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Maeva Jego
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Gaëtan Gentile
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Guillaume Fond
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marilou Fromentin
- Department of General Practice, Aix-Marseille Univ, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, - CEReSS UR3279-Health Service Research and Quality of Life Center, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Tzogiou C, Spycher J, Bize R, Sanchis Zozaya J, Blaser J, Pahud Vermeulen B, Felappi A, Bodenmann P, Marti J. Detecting and describing heterogeneity in health care cost trajectories among asylum seekers. BMC Health Serv Res 2022; 22:978. [PMID: 35907845 PMCID: PMC9339203 DOI: 10.1186/s12913-022-08346-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 07/14/2022] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND The mechanism underlying the health care cost trajectories among asylum seekers is not well understood. In the canton of Vaud in Switzerland, a nurse-led health care and medical Network for Migrant Health ("Réseau santé et migration" RESAMI) has established a health care model focusing on the first year after arrival of asylum seekers, called the "community health phase". This model aims to provide tailored care and facilitate integration into the Swiss health care system. The aim of this study is to explore different health care cost trajectories among asylum seekers during this phase and identify the associated factors. METHODS We detected different patterns of health care cost trajectories using time-series clustering of longitudinal data of asylum seekers in the canton of Vaud in Switzerland. These data included all adult asylum seekers and recipients of emergency aid who entered the canton between 2012 and 2015 and were followed until 2018. The different clusters of health care cost trajectories were then described using a multinomial logistic regression model. RESULTS We identified a concave, an upward trending, and a downward trending cluster of health care cost trajectories with different characteristics being associated with each cluster. The likelihood of being in the concave cluster is positively associated with coming from the Eastern Mediterranean region or Africa rather than Europe and with a higher share of consultations with an interpreter. The likelihood of being in the upward trending cluster, which accrued the highest costs, is positively associated with 20-24-year-olds rather than older individuals, coming from Europe than any other region and having a mental disorder. In contrast to the other two clusters, the likelihood of being in the downward trending cluster is positively associated with having contacted the RESAMI network within the first month after arrival, which might indicate the potential of early intervention. It is also positively associated with older age and living in a group lodge. CONCLUSIONS Asylum seekers are heterogeneous in terms of health care cost trajectories. Exploring these differences can help point to possible ways to improve the care and supporting services provided to asylum seekers. Our findings could indicate that early and patient-centered interventions might be well-suited to this aim.
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Affiliation(s)
- Christina Tzogiou
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401, Winterthur, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Jacques Spycher
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Raphaël Bize
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Javier Sanchis Zozaya
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Brigitte Pahud Vermeulen
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Andrea Felappi
- Fondation AACTS (Addiction, Community Action, Social Work), Vevey, Switzerland
| | - Patrick Bodenmann
- Department of Vulnerabilities and Social Medicine, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
| | - Joachim Marti
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté) University of Lausanne, Lausanne, Switzerland
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Rosenthal T, Touyz RM, Oparil S. Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome. Curr Hypertens Rep 2022; 24:325-340. [PMID: 35704140 PMCID: PMC9198623 DOI: 10.1007/s11906-022-01194-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW To summarize results of recent studies of migrants in Europe and North America and ongoing efforts to adapt strategies to provide them with inclusive sensitive health care. RECENT FINDINGS Major predisposing factors for developing hypertension, obesity, diabetes, and the metabolic syndrome in migrating populations and refugees were identified. Susceptibility to the metabolic syndrome is predominantly due to environmental factors and psychological stress. Acculturation also contributes to the emergence of cardiovascular (CV) risk factors in first-generation adult immigrants. Increased risk for later development of hypertension and dyslipidemia has also been detected in adolescent immigrants. Targets for public health efforts were based on data that show important differences in CV risk factors and prevalence of the metabolic syndrome among ethnic immigrant groups. Studies in young adults focused on lifestyle and dietary behaviors and perceptions about weight and body image, while the focus for older adults was end-of-life issues. Two important themes have emerged: barriers to health care, with a focus on cultural and language barriers, and violence and its impact on immigrants' mental health.
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Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rhian M Touyz
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Suzanne Oparil
- Vascular Biology & Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-0007, USA.
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6
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Maier K, Konaszewski K, Skalski SB, Büssing A, Surzykiewicz J. Spiritual Needs, Religious Coping and Mental Wellbeing: A Cross-Sectional Study among Migrants and Refugees in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063415. [PMID: 35329106 PMCID: PMC8956029 DOI: 10.3390/ijerph19063415] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
It has been widely proven that resettlement is associated with negative psychological effects (e.g., increased depression and symptoms of post-traumatic stress disorder) among refugees. Therefore, there is an urgent need to improve the psychosocial functioning of migrants. This study assessed associations between negative dysfunctional appraisal (perceiving experiences as stressful), spiritual needs, religious coping and wellbeing. Data from paper-and-pencil questionnaires were collected from 744 refugees (69.8% male) aged 18–67 years (M = 27.99) with diverse backgrounds (including from Mashreq countries) who were resettled in Germany. Bootstrapping mediation analysis revealed that the relationship of dysfunctional appraisal and wellbeing among refugees is mediated by spiritual needs (i.e., existential and religious needs). Additionally, negative religious coping mediates the relationship between spiritual needs and wellbeing. The data obtained suggest the need for practitioners to focus on psychological interventions that strengthen spiritual needs in order to improve mental health among refugees.
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Affiliation(s)
- Kathrin Maier
- Department of Educational Psychology in Social Work, Catholic University of Applied Sciences Munich, 80335 Munich, Germany;
| | - Karol Konaszewski
- Faculty of Education, University of Bialystok, 15328 Bialystok, Poland;
| | | | - Arndt Büssing
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, 58455 Herdecke, Germany;
| | - Janusz Surzykiewicz
- Faculty of Philosophy and Education, Katholische Universität Eichstätt-Ingolstadt, 85072 Eichstätt, Germany
- Faculty of Education, Cardinal Stefan Wyszynski University in Warsaw, 01938 Warsaw, Poland
- Correspondence: ; Tel.: +49-8421-93-21683
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7
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Belau MH, Becher H, Kraemer A. Loneliness as a mediator of social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. BMC Public Health 2021; 21:2233. [PMID: 34879832 PMCID: PMC8656054 DOI: 10.1186/s12889-021-12303-5] [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] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Since 2015, more than one million people fled to Germany – mainly from war-affected countries. Nevertheless, little is known about social determinants in refugees located in Germany. This study aims to test the mediation effect of loneliness between social relationships, comprising social integration and social support, and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. Methods The investigation utilizes data from the FlueGe Health Study (N=326), a cross-sectional study conducted by Bielefeld University. The data was collected between February and November 2018 and included interviews and examinations. Participants were recruited from shared and private accommodation in several cities in North Rhine-Westphalia, Germany. We first analyzed correlations between social integration, social support, loneliness, and physical and mental component of health-related quality of life. We then conducted mediation analyses using structural equation modeling. Results The majority of respondents were socially isolated, perceiving a moderate degree of loneliness and social support. In addition, the physical and mental components of health-related quality of life indicate that participants predominantly experienced mental rather than physical impairments. Results from mediation analyses showed indirect effects of loneliness on the association between social integration and mental health (ß = 0.495, 95% bias-corrected and accelerated confidence interval (BCa CI) = [0.018, 0.972]), and between social support and both physical (ß = 0.022, 95% BCa CI = [0.004, 0.040]) and mental health (ß = 0.067, 95% BCa CI = [0.037, 0.097]). Conclusions Loneliness played a mediating role in the association between social relationships and health-related quality of life among refugees living in North Rhine-Westphalia, Germany. The results provide implications for both, health policy and the host society. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12303-5.
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Affiliation(s)
- Matthias Hans Belau
- School of Public Health, Bielefeld University, Bielefeld, Germany. .,Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Impact of Family Separation on Subjective Time Pressure and Mental Health in Refugees from the Middle East and Africa Resettled in North Rhine-Westphalia, Germany: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111722. [PMID: 34770236 PMCID: PMC8582773 DOI: 10.3390/ijerph182111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees' subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees' mental health and well-being.
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Renner A, Jäckle D, Nagl M, Hoffmann R, Röhr S, Jung F, Grochtdreis T, Dams J, König HH, Riedel-Heller S, Kersting A. Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany. PLoS One 2021; 16:e0254406. [PMID: 34347775 PMCID: PMC8336813 DOI: 10.1371/journal.pone.0254406] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/28/2021] [Indexed: 01/23/2023] Open
Abstract
Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the "Sanadak" randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.
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Affiliation(s)
- Anna Renner
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - David Jäckle
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Susanne Röhr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Franziska Jung
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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10
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Vallejo-Martín M, Sánchez Sancha A, Canto JM. Refugee Women with a History of Trauma: Gender Vulnerability in Relation to Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094806. [PMID: 33946312 PMCID: PMC8125581 DOI: 10.3390/ijerph18094806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
Refugees represent a population whose living conditions have a strong impact on their mental health. High rates of post-traumatic stress disorder (PTSD), more than other mental disorders, have been found in this group, with women having the highest incidence. The objective of the present systematic review was to identify and examine studies from the last fifteen years on the relationship between the impact of traumatic experiences and PTSD psychopathology in refugee women. Twelve studies were included, from which the overall results approved this relation. In addition, six of these studies show that exposure to sexual trauma in refugee women is associated with the high odds of being at risk for PTSD. These findings suggest that gender-related traumatic experiences can explain the high rate of PTSD in refugee women and highlight the unmet need for psychosocial health care in this population.
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Affiliation(s)
- Macarena Vallejo-Martín
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
- Correspondence:
| | - Ana Sánchez Sancha
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
| | - Jesús M. Canto
- Department of Social Psychology, Social Work, Social Anthropology and East Asia Studies, Faculty of Psychology and Speech Therapy, University of Malaga, 29016 Malaga, Spain;
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Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073408. [PMID: 33806051 PMCID: PMC8036810 DOI: 10.3390/ijerph18073408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (−0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.
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