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Mastrogiovanni N, Byrow Y, Nickerson A. The Development and Validation of a Measure of Mental Health, Help-Seeking Beliefs in Arabic-Speaking Refugees. Assessment 2024; 31:1359-1377. [PMID: 38159035 PMCID: PMC11408969 DOI: 10.1177/10731911231220482] [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] [Indexed: 01/03/2024]
Abstract
Despite reporting elevated rates of posttraumatic stress disorder (PTSD), refugees are less likely than other groups to seek psychological treatment. Relatively little attention has been paid to the role of negative help-seeking beliefs in influencing treatment uptake. The current study sought to develop and psychometrically validate a novel measure indexing negative help-seeking beliefs for refugees (Help-Seeking Beliefs Scale [HSBS]). In this study, 262 Arabic-speaking refugee participants completed an online survey consisting of the HSBS along with measures indexing similar constructs (self-stigma of PTSD and help-seeking, perceived stigma, negative help-seeking attitudes, and help-seeking intentions). Factor analysis revealed a three-factor structure aligning with key themes identified in the literature: (a) Fear of Negative Consequences, (b) Inappropriateness, and (c) Perceived Necessity. The scale demonstrated excellent internal consistency, convergent validity, and predicted reduced help-seeking intentions. Results support the utility of a novel measure capturing a prominent help-seeking barrier in a population with high psychopathology and low treatment uptake.
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Madsen J, Jobson L, Slewa-Younan S, Li H, King K. Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis. Soc Sci Med 2024; 346:116718. [PMID: 38489937 DOI: 10.1016/j.socscimed.2024.116718] [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: 07/01/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024]
Abstract
While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.
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Affiliation(s)
- Julian Madsen
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Laura Jobson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Shameran Slewa-Younan
- Macarthur Clinical School, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 275, Australia.
| | - Haoxiang Li
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Kylie King
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Building 17, 18 Innovation Walk, Wellington Road, Clayton, VIC, 3800, Australia.
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Bowling AR, Klein AB, Sheikh IS, Dolezal ML, Alsubaie MK, Rosencrans PL, Walker RS, Bentley JA, Zoellner LA, Feeny NC. Perceived Need for a Faith-Based Trauma-Focused Treatment in a Sample of Forcibly Displaced Muslims. COGENT MENTAL HEALTH 2024; 3:1-18. [PMID: 38550624 PMCID: PMC10972603 DOI: 10.1080/28324765.2024.2305417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024]
Abstract
Forcibly displaced Muslims, including refugees, internally displaced persons, and asylum seekers who have fled their homes to escape violence, conflict, and persecution, often have inequitable access to quality mental health services, despite substantial trauma exposure and high rates of posttraumatic stress disorder (PTSD). Understanding factors associated with domains of perceived need (i.e., community, individual, friends/family) for culturally-responsive, trauma-focused mental health interventions among forcibly displaced Muslims may provide insight into those most likely to seek psychological treatment. A sample of 108 forcibly displaced Muslims endorsed moderate to high perceived need across all three domains for a trauma healing group tailored for Muslim refugees. PTSD severity related to perceived individual need, regardless of locus of displacement. Among participants with minimal PTSD symptoms, those who were externally displaced had higher perceived community and friends or family need than those who were internally displaced. Findings highlight a need for culturally responsive, trauma-focused mental health services to facilitate access to mental health care for forcibly displaced Muslims.
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Affiliation(s)
- Alexandra R. Bowling
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Alexandra B. Klein
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
| | - Ifrah S. Sheikh
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Michael L. Dolezal
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | | | | | | | - Jacob A. Bentley
- Seattle Pacific University, Department of Clinical Psychology, Seattle, WA, USA
| | - Lori A. Zoellner
- University of Washington, Department of Psychology, Seattle, WA USA
| | - Norah C. Feeny
- Case Western Reserve University, Department of Psychological Sciences, Cleveland, OH, USA
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Bayrakçeken E, Alkan Ö, Abar H. Psychological Help-Seeking Status for Living with Mental Health Conditions in Türkiye: Using a Multivariate Probit Model. Healthcare (Basel) 2023; 11:2837. [PMID: 37957982 PMCID: PMC10649634 DOI: 10.3390/healthcare11212837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND/AIM Mental disorders constitute a significant public health concern, contributing significantly to the overall disease burden. Individuals experiencing mental distress often delay or avoid seeking psychological help or do not seek help due to varying factors. This study examines the factors affecting individuals' preferences, particularly young people, in seeking psychological help in Türkiye. METHODS This study utilized microdata from the Türkiye Health Survey conducted by TURKSTAT in 2016 and 2019. The factors influencing decisions to consult with a psychologist, psychotherapist, or psychiatrist were determined by multivariate probit regression analysis. The Türkiye Health Survey employed a stratified two-stage cluster sampling method, surveying 17,242 individuals over the age of 15 in 9470 households in 2016 and 17,084 individuals over the age of 15 in 9470 households in 2019. RESULTS The analysis findings indicated that, in the entire sample, women are more likely to seek psychological help, while younger women are less likely to do so. In the entire sample, as the education level increased, the probability of individuals receiving psychological help increased, while it decreased for young people. It was determined that people who use tobacco and alcohol are more likely to receive psychological help than others. It was also determined that individuals who perceive their health status as good, especially those who are both young and perceive their health status as good, are less likely to seek psychological help. CONCLUSIONS The significance and impact of the variables on the probability of individuals seeking psychological help vary for both the entire sample and young people. There may be various restrictions in getting psychological help, and people may resort to informal methods instead of professionals to cope with their existing problems. In developing preventive strategies to safeguard mental health, factors related to young people's and individuals' psychological help-seeking status should be prioritized, and more attention should be paid to them.
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Affiliation(s)
- Esra Bayrakçeken
- Department of Medical Services and Techniques, Vocational School of Health Services, Ataturk University, Erzurum 25030, Türkiye;
| | - Ömer Alkan
- Department of Econometrics, Faculty of Economics and Administrative Sciences, 2nd Floor, Number 222, Ataturk University, Erzurum 25030, Türkiye
- Master Araştırma Eğitim ve Danışmanlık Hizmetleri Ltd., Şti., Ata Teknokent, Erzurum 25240, Türkiye
| | - Hayri Abar
- Department of Economics, Faculty of Business and Economics, Gaziantep University, 1st Floor, Number 132, Gaziantep 27310, Türkiye;
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Nyikavaranda P, Pantelic M, Jones CJ, Paudyal P, Tunks A, Llewellyn CD. Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a "feminisms" systematic review. Int J Equity Health 2023; 22:196. [PMID: 37752502 PMCID: PMC10523615 DOI: 10.1186/s12939-023-01990-8] [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: 04/23/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Recent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe. METHODS The review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied. RESULTS Eight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access. CONCLUSIONS The design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive. REGISTRATION The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021235571.
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Affiliation(s)
- Patrick Nyikavaranda
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK.
| | - Marija Pantelic
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
| | - Christina J Jones
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, Surrey, UK
| | - Priyamvada Paudyal
- Institute for Global Health and Wellbeing School of Medicine, Keele University, Keele, Staffordshire, ST5 5GB, UK
| | - Alice Tunks
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
| | - Carrie D Llewellyn
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
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The cultural perceptions on mental health and post-resettlement challenges among Rwandan refugees in the U.S. Psychiatry Res 2022; 313:114642. [PMID: 35609498 DOI: 10.1016/j.psychres.2022.114642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/20/2022]
Abstract
Refugees are likely to arrive with significant mental health needs due to traumatic situations experienced prior to resettlement. Unsurprisingly, resettlement exacerbates the poor mental health of refugees. However, minimal evidence exists on the experiences of resettled Rwandan refugees suggesting a need to explore their lived experiences to fill the gap in the literature. Hence, the current study utilized a descriptive phenomenological design to uncover Rwandan refugees' experiences. The snowball technique was used to recruit thirteen Rwandan refugees. Data collection consisted of in-depth interviews and analysis revealed two themes: (1) cultural perceptions and beliefs around mental health; (2) post-resettlement lived experiences that negatively influenced mental health. Although mental health services are available, participants voiced their lack of awareness on mental health symptoms, cultural and resettlement barriers hinder people from seeking help and there are important gaps in cultural interpretations of mental health. Findings from this study underscore unique challenges that call for holistic, collaborative, and integrative approaches in addressing the multifaceted needs of refugees.
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Lechner-Meichsner F, Comtesse H. Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees. Front Psychiatry 2022; 13:852714. [PMID: 35479495 PMCID: PMC9037322 DOI: 10.3389/fpsyt.2022.852714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees. Method We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis. Results In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help. Conclusion Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.
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Affiliation(s)
- Franziska Lechner-Meichsner
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Hannah Comtesse
- Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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Grupp F, Moro MR, Skandrani S, Mewes R. Coping with Trauma and Symptoms of Post-Traumatic Stress Disorder: Exploring Intentions and Lay Beliefs about Appropriate Strategies among Asylum-Seeking Migrants from Sub-Saharan Africa in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1783. [PMID: 35162807 PMCID: PMC8834703 DOI: 10.3390/ijerph19031783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022]
Abstract
Asylum-seekers are at high risk of developing post-traumatic stress disorder (PTSD) due to frequent exposure to trauma. We investigated the coping intentions and lay beliefs about appropriate coping strategies among asylum-seekers from Sub-Saharan Africa in Germany. The study applied a methodological triangulation strategy with a vignette describing symptoms of PTSD. In a quantitative part, asylum-seekers (n = 119) that were predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a native comparison sample (n = 120) responded to questionnaires assessing coping, traumatic events, and post-traumatic symptoms. In a qualitative part, asylum-seekers (n = 26) discussed coping strategies in focus groups. In the quantitative part, asylum-seekers displayed higher intentions for religious coping, emotional support, and denial compared to the native participants. Asylum-seekers with a higher symptom load expressed lower intentions to seek instrumental support. Asylum-seekers with a lower educational level and those with a higher symptom load expressed higher intentions for substance use. In the qualitative part, we identified three superordinate themes: (a) religion, (b) social support systems, and (c) cognitive strategies. Asylum-seekers expressed coping intentions that are associated with an adaptive response to trauma. Less-educated asylum-seekers with a higher symptom load might constitute a particularly vulnerable group.
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Affiliation(s)
- Freyja Grupp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, 35032 Marburg, Germany;
| | - Marie Rose Moro
- AP-HP, Hospital Cochin, University of Paris, Unité Inserm 1018, CESP, 75014 Paris, France;
| | - Sara Skandrani
- Hospital Cochin Paris, University of Paris Nanterre UR4430, 75014 Paris, France;
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
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Mewes R, Giesebrecht J, Weise C, Grupp F. Description of a Culture-Sensitive, Low-Threshold Psychoeducation Intervention for Asylum Seekers (Tea Garden). CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e4577. [PMID: 36405677 PMCID: PMC9670830 DOI: 10.32872/cpe.4577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Asylum seekers often suffer from high levels of mental distress. However, as a result of a lack of knowledge about mental health and health care, as well as cultural and language barriers, the utilization of mental health care in Western host countries is often difficult for these individuals. Reducing these barriers may thus be a crucial first step towards appropriate mental health care. Previous research showed that psychoeducation may be helpful in this regard. Method The current manuscript describes a short, low-threshold and transdiagnostic intervention named 'Tea Garden (TG)'. The TG aims to increase specific knowledge about mental health problems and available treatments, and may improve psychological resilience and self-care. In this manuscript, we specifically focus on culturally sensitive facets, following the framework proposed by Heim and colleagues (2021, https://doi.org/10.32872/cpe.6351), and lessons learned from three independent pilot evaluations (Ns = 31; 61; 20). Results The TG was found to be feasible and quantitative results showed that it was helpful for male and female asylum seekers from different countries of origin (e.g., Afghanistan, Syria, Pakistan, Iraq) and with different educational levels. Interestingly, even asylum seekers who had already been in Germany or Austria for three or more years benefited from the TG. Conclusion The TG specifically aims to be culture-sensitive rather than culture-specific, to be transdiagnostic rather than focused on specific mental disorders, and to be suitable for asylum seekers who are still in the insecure process of applying for asylum. It may also be helpful for distressed asylum seekers who do not fulfill the criteria for a mental disorder, and for healthy asylum seekers who could use the knowledge gained in the TG to help others.
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Affiliation(s)
- Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Julia Giesebrecht
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Freyja Grupp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
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Weise C, Grupp F, Reese JP, Schade-Brittinger C, Ehring T, Morina N, Stangier U, Steil R, Johow J, Mewes R. Efficacy of a Low-threshold, Culturally-Sensitive Group Psychoeducation Programme for Asylum Seekers (LoPe): study protocol for a multicentre randomised controlled trial. BMJ Open 2021; 11:e047385. [PMID: 34649846 PMCID: PMC8522658 DOI: 10.1136/bmjopen-2020-047385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/16/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Despite high levels of mental distress, accessing psychological treatment is difficult for asylum seekers in Western host countries due to a lack of knowledge about mental disorders, and the health system, as well as due to cultural and language barriers. This study aims to investigate whether brief culturally sensitive and transdiagnostic psychoeducation is effective in increasing mental health literacy. METHODS AND ANALYSIS The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either culturally sensitive, low-threshold psychoeducation ('Tea Garden' (TG)) or a waitlist (WL) control group. It takes place at four study sites in Germany. A total of 166 adult asylum seekers who report at least mild mental distress will be randomly assigned. The TG consists of two 90 min group sessions and provides information about mental distress, resources and mental health services in a culturally sensitive manner. The primary outcome is the percentage of participants in the TG, as compared with the WL, achieving an increase in knowledge concerning symptoms of mental disorders, individual resources and mental healthcare from preintervention to postintervention. The further trajectory will be assessed 2 and 6 months after the end of the intervention. Secondary outcomes include changes in mental distress, openness towards psychotherapy and resilience. Furthermore, healthcare utilisation and economics will be assessed at all assessment points. ETHICS AND DISSEMINATION The study has been approved by the Ethics Commission of the German Psychological Society (ref: WeiseCornelia2019-10-18VA). Results will be disseminated via presentations, publication in international journals and national outlets for clinicians. Furthermore, intervention materials will be available, and the existing network will be used to disseminate and implement the interventions into routine healthcare. TRIAL REGISTRATION NUMBER DRKS00020564; Pre-results. PROTOCOL VERSION 2020-10-06, version number: VO2F.
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Affiliation(s)
- Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Freyja Grupp
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Jens-Peter Reese
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Carmen Schade-Brittinger
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Thomas Ehring
- Department of Psychology, Clinical Psychology and Psychological Treatment, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Nexhmedin Morina
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
| | - Ulrich Stangier
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Regina Steil
- Department of Psychology, Clinical Psychology and Psychotherapy, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Johannes Johow
- Coordinating Centre for Clinical Trials Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
| | - Ricarda Mewes
- Faculty of Psychology, Outpatient Unit for Research, Teaching and Practice, University of Vienna, Vienna, Austria
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Rayes D, Karnouk C, Churbaji D, Walther L, Bajbouj M. Faith-Based Coping Among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study. Front Psychiatry 2021; 12:595979. [PMID: 33633605 PMCID: PMC7901912 DOI: 10.3389/fpsyt.2021.595979] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The benefits of faith-based coping or using religious and spiritual beliefs as a stabilizing force for interpreting stressful or distressing events are largely unexplored among the exodus of Arabic-speaking refugee populations from Muslim-majority countries, particularly those resettled in Europe. The present study aimed to explore the manifestation of faith-based coping strategies among Arabic-speaking refugee adults seeking mental healthcare services in Berlin, Germany and explore how favorable faith-based coping strategies can be optimized from a mental health service-delivery and broader integration perspective. Methods: A total of 17 qualitative interviews were conducted with Arabic-speaking refugee adults (six females, 11 males) seeking mental health services at the Charité Universitaetsmedizin in Berlin. Research questions aimed to solicit comprehensive perspectives from refugee adults on their mental health, with an emphasis on faith-based coping, and how this facilitated or impeded their integration into German society. Interview transcripts were translated to English from Arabic and analyzed using MAXQDA (2018) to highlight thematic patterns using a grounded theory approach. Results: Findings were structured into four themes, including: (I) faith-based coping methods during flight, (II) changes in faith practices upon arrival, (III) faith-based coping methods to address distress during integration, and (IV) advice for German mental healthcare providers. Participants who demonstrated a stronger commitment to faith were more likely to utilize faith-based coping strategies when seeking mental health services and facing the challenges of displacement and integration. Examples of faith-based coping included prayer, supplication, reciting scripture, and seeking help from a local religious leader. Conclusion: The findings suggest how faith and faith practices play a significant role in the mental health and integration of refugee populations in Germany and provide insight on how mental healthcare can be delivered in a culturally-sensitive manner, providing alternatives to the social, cultural, and linguistic barriers posed by the German health system. These findings are particularly relevant for mental health professionals, non-governmental organizations, and humanitarian aid agencies providing mental healthcare to Arabic-speaking populations recently resettled in Western contexts.
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Affiliation(s)
- Diana Rayes
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Dana Churbaji
- Institute of Psychology, University of Münster, Münster, Germany
| | - Lena Walther
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Germany
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Grupp F, Skandrani S, Moro MR, Mewes R. Relational Spirituality and Transgenerational Obligations: The Role of Family in Lay Explanatory Models of Post-traumatic Stress Disorder in Male Cameroonian Asylum Seekers and Undocumented Migrants in Europe. Front Psychiatry 2021; 12:621918. [PMID: 33959046 PMCID: PMC8093444 DOI: 10.3389/fpsyt.2021.621918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Context: Diasporic Cameroonians are increasingly leading a transnational life in which family members are sustained through networks of relations and obligations. However, before arriving in Europe, the vast majority of African migrants who take the Mediterranean route are exposed to trauma and hardship. Moreover, the joint occurrence of forced displacement, trauma, and extended separation from families has a significant impact on mental health. Objectives: This study explores the role of culture-specific conceptualizations of family structures and transnationalism in explanatory models of post-traumatic stress disorder (PTSD) among male Cameroonian asylum-seekers and undocumented migrants in Europe. Methods: An in-depth study of two samples of Cameroonian migrants with a precarious residency status in Europe was conducted. Focus group discussions and interviews were carried out with asylum seekers in Germany (n = 8) and undocumented migrants and failed asylum seekers in France (n = 9). The verbatim transcripts of these interviews served as the data for interpretative phenomenological analyses. Results, Analysis, and Discussion: Family was conceptualized in religious and spiritual terms, and relational spirituality appeared to be a crucial element of family cohesion. Explanatory models of PTSD were mainly based on an intersection of family and spirituality. The disrespect of transgenerational, traditional, and spiritual obligations toward parents and ancestral spirits represented a crucial causal attribution for post-traumatic symptoms. Conclusions: Conceptualizations of post-traumatic stress were based on a collective family and spiritual level instead of an individualized illness-centered perception. The Western psychological and psychiatric perspective on post-traumatic stress might conflict with traditional, religious, and spiritual practices in the context of family conceptualizations of Cameroonian forced migrants with a precarious residency status.
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Affiliation(s)
- Freyja Grupp
- Division of Clinical Psychology, Department of Psychology, University of Marburg, Marburg, Germany
| | - Sara Skandrani
- University of Paris Nanterre, Hospital Cochin Paris, Paris, France
| | - Marie Rose Moro
- University of Paris, Hospital Cochin AP-HP, Unite Inserm 1018, CESP, Paris, France
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching, and Practice, Faculty of Psychology, University of Vienna, Wien, Austria
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Is depression comparable between asylum seekers and native Germans? An investigation of measurement invariance of the PHQ-9. J Affect Disord 2020; 262:451-458. [PMID: 31744740 DOI: 10.1016/j.jad.2019.11.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/18/2019] [Accepted: 11/10/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Asylum seekers show high prevalence of depressive disorders compared to native populations. For the assessment of depression, the Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument that has shown high validity and reliability. However, it is largely unknown whether PHQ-9 scores are comparable between asylum seekers living in Western countries and native populations, and whether results can be interpreted without reservation. METHOD Data from asylum seekers living in Germany (n = 243) and Germans without a migration background (n = 171) were used to analyze measurement invariance of the PHQ-9. Configural, scalar, and metric invariance was investigated, and test functioning was determined. RESULTS The PHQ-9 was not measurement invariant across Germans without a migration background and asylum seekers living in Germany. Differences were found regarding metric invariance and scalar invariance. The items anhedonia, depressed mood, appetite changes, psychomotor changes, and suicidal ideation had lower loadings and lower thresholds in asylum seekers compared to Germans without a migration background. That led to an overestimation translated into approximately one point on the sum-score. LIMITATIONS The study limitations include a heterogeneous sample of asylum seekers regarding countries of origin, and the utilization of the different language versions of the PHQ-9. CONCLUSION Our results may have implications for studies comparing levels of depression between asylum seekers and native Western samples. Even with the same latent level of depression, asylum seekers may have higher scores on several items and consequently a higher sum score. Therefore, the present results suggest a new determination or differentiation of the cut-off scores that were derived from Western samples.
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