Perceived discrimination among Syrian refugees in Germany and its associations with mental health

The association of migration-related stress with poor mental health among recently resettled Afghan refugees

Background

The resettlement of Afghan refugees in Oklahoma City, OK, provides a critical context for examining the mental health challenges faced by this population due to post-migration stressors.

Methods

This study utilized online surveys to recently resettled Afghan refugees in Oklahoma City, with support provided by bilingual research assistants to accommodate low literacy rates. Surveys, initially in English, were professionally translated into Dari and Pashto and validated through back-translation.

Results

Participants (N = 348) were majority of Pashtun ethnicity. High rates of mental health issues were evident, with 62.1 % of participants screening positive for depression and 20.1 % for probable GAD. Logistic regression analysis revealed that lower pre-migration socioeconomic status (SES) and high post-migration stressors such as discrimination and loss of homeland were significantly associated with increased mental health problems. Stress related to the worry for and loss of their homeland was a substantial predictor of high distress (AOR = 2.71, p < 0.001), anxiety (AOR = 1.99, p = 0.001) and depression (AOR = 2.65, p<.001). Experiences of discrimination post-resettlement was also associated with anxiety (AOR 4.92, p < 0.001).

Discussion

The findings highlight the profound impact of post-migration stressors on the mental health of Afghan refugees. This study underscores the need for targeted interventions to address the specific challenges faced by refugees, such as language barriers, employment, legal support, and anti-discrimination measures, to facilitate better integration and improve mental health outcomes.

Conclusion

Enhanced community integration programs and comprehensive support services are essential to mitigate the mental health challenges faced by Afghan refugees, suggesting a broader application for such approaches in similar resettlement contexts globally.

The psychosocial impacts of the 15 March terrorist attack on the Christchurch Muslim community: A descriptive, cross-sectional assessment

OBJECTIVE

On 15 March 2019, a white supremacist terrorist carried out sequential attacks on two mosques in Christchurch, New Zealand during Friday prayers. This resulted in the loss of 51 lives, 40 others sustained gunshot injuries, and there were approximately 250 survivors. This study aimed to evaluate the impacts on community members, assess clinical needs, facilitate access to appropriate interventions and provide insights into working with a traumatised and diverse population.

METHODS

This cross-sectional study used semi-structured clinical interviews and self-report measures to assess social and demographic factors, mental health disorders and well-being for adult Muslims 11-32 months post-attack.

RESULTS

A total of 189 participants completed assessments. The sample was diverse, representing 34 different ethnicities and participant proximity to the attack was complex, with personal and familial exposures. Elevated levels of psychological distress and psychopathology were found with 38% of participants reporting moderate/severe psychological distress on the Kessler-10, 39% reporting post-traumatic stress disorder on the post-traumatic stress disorder checklist-5, and 40% reporting poor well-being or possible depression on the World Health Organization-5 Well Being Index. Secondary stressors were also documented, as well as high scores for post-traumatic growth and the importance of faith.

CONCLUSION

This study provides valuable insights into the repercussions of the Christchurch mosque attack on the affected community, describing the complexity of exposure and the substantial burden of morbidity experienced. It also highlights the high levels of social connectedness and the role of faith in promoting positive outcomes in the recovery process for this population.

Suicide among post-Arabellion refugees in Germany

BACKGROUND

Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality.

AIMS

To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015.

METHOD

Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately.

RESULTS

Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48).

CONCLUSIONS

Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany

Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (β = -0.17, p = .033) and active harm was positively associated (β = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (β = -0.35, p < .001), posttraumatic stress (β = -0.77, p < .001), and somatic symptoms (β = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.

Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study

Background

There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway.

Methods

Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05.

Results

Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization.

Conclusion

Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.

Mental healthcare access among resettled Syrian refugees in Leipzig, Germany

Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02-2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.

Perceived post-migration discrimination: the perspective of adolescents with migration background

Discrimination has a negative impact on mental health and wellbeing of persons affected. The aim of the present study was to investigate perceived discrimination of migrant adolescents. Focus groups with migrant adolescents were conducted, audio-recorded and transcribed verbatim. The transcripts were analyzed using the manifest qualitative content analysis by Mayring. The foci of interest (persons discriminated against and by whom, where and how the discrimination took place, which behavioral and emotional reactions the affected persons showed to the experiences and which reasons they assumed for the discrimination) were determined based on the pre-defined guideline, and inductive subcategories were extracted from the transcripts and grouped into main categories. Five focus groups with students with migration background (n = 35, 13 females, mean age: 18.78, SD = 2.26, range 16-24) were conducted. The adolescents in our focus groups and their acquaintances (families and friends) experienced discrimination in Germany in several forms (verbal and non-verbal), places and on an individual as well as institutional level, with an impact on their emotional well-being. To combat discrimination, culturally sensitive information must be provided on the part of those affected as well as their perpetrators.

Challenges in substance use treatment as perceived by professionals and Arabic-speaking refugees in Germany

BACKGROUND

Substance use (SU) and substance use disorders (SUDs) have been recently documented among forcibly displaced populations as a coping mechanism to migration and postmigration stressors. Although the literature exploring substance use among refugees has grown recently, little is known about SU among Arabic-speaking refugees and, more specifically, on the challenges and experiences in regards to SU treatment. This study investigates this topic from the perspectives of Arabic-speaking refugees and professionals in Germany.

METHODS

Design and participants To expand our knowledge on this topic, a qualitative approach was employed by conducting in-depth and semi-structured interviews among 26 participants (13 refugees and 13 professionals) in Germany during 2020-2021. Purposive sampling was used to recruit Arabic-speaking refugees in two rehabilitation centers in Berlin. Data and analysis Interviews were conducted with 26 participants of which 13 were refugees and 13 professionals. Refugees were interviewed individually in the rehabilitation centers, they ranged from 21 to 52 years of age, and their average time in Germany was 6.3 years. An open-ended survey was conducted among the professionals via the SoSci-survey platform, and they ranged from 22 to 66 years of age, with an average of 5 to 9 years of work experience. Data were analyzed using thematic analysis.

RESULTS

Three themes resulted from the thematic analysis: (1) The treatment is facilitated by institutional and emotional support; (2) The affected refugees struggle with complex contextual barriers to access SUD treatment; and (3) Individual and community preventive strategies are needed.

CONCLUSIONS

This study provides insight into the support and challenges of accessing effective SU treatment and prevention among Arabic-speaking refugees in Germany. Collaborative efforts by the community, professionals, and policymakers are needed to facilitate access to effective treatment and implement culturally and linguistically sensitive approaches for the treatment and prevention of SU among refugees.

Which Protective Factors Are Associated with the Mental Health of Syrian Students in Germany? A Register-Based Cross-Sectional Study

The aim of this online, register-based cross-sectional study was to investigate the frequency of psychological distress and protective factors among 136 Syrian students in Germany. The survey measured depression and anxiety (Patient Health Questionnaire-4), post-traumatic stress (Impact of Event-Scale-6), as well as resources social support (ENRICHD Social Support Instrument), optimism (Optimism-Pessimism-2 Scale) and religiosity (Duke Religion Index). A total of 26.50% of the sample were female. A total of 38.93% met criteria for clinically relevant depressive respectively generalized anxiety symptoms and 15.72% showed prominent PTSD scores. Participants screened positive for mental distress reported significantly less social support (p = 0.001) and less optimism (p = 0.002) than participants without mental distress. In multiple regression analyses, higher levels of feeling welcome in Germany, social support and intrinsic religiosity were significantly associated with lower levels of depression and generalized anxiety. Significant associations with lower PTSD levels were found with higher levels of social support and optimism. The results show that Syrian students in Germany are more psychologically burdened compared to other Syrian refugee samples, except for PTSD. This suggests that besides the stress caused by flight and trauma, stressors such as studying and social isolation could be considered as additional impediments for mental health and require intervention measures.