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Al-Khalil Z, Attarian H, Dunietz GL, Gavidia Romero R, Knutson K, Johnson DA. Sleep health inequities in vulnerable populations: Beyond sleep deserts. Sleep Med X 2024; 7:100110. [PMID: 38623559 PMCID: PMC11017343 DOI: 10.1016/j.sleepx.2024.100110] [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: 12/24/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Despite the importance of sleep to overall health and well-being, there is a high prevalence of undiagnosed sleep disorders and adverse sleep health, particularly among vulnerable populations. Such vulnerable populations include people experiencing homelessness (PEH), refugees, and incarcerated individuals. In this narrative review, we provide an overview of the literature on sleep health and disorders among key and vulnerable populations (e.g., PEH, refugees, and incarcerated individuals). The limited research among these populations indicated a high prevalence of sleep disorders, mainly insomnia, short sleep duration, and fatigue. Substance abuse and PTSD were commonly found among PEH and refugee populations, respectively, which were was related to poor sleep. Similar across the included vulnerable populations, the individuals reside in environments/facilities with inopportune light exposure, noise disruption, inadequate bedding, and forced sleep schedules. Studies also found a high prevalence of psychosocial stress and reports of threats to safety, which were associated with poor sleep health outcomes. Additionally, several studies reported environmental barriers to adherence to sleep disorder treatment. This paper highlighted the conditions in which these vulnerable populations reside, which may inform interventions within these various facilities (homeless shelters, refugee camps, prisons/jails). The improvement of these facilities with a sleep equity focus may in turn improve quality of life and daily functioning.
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Affiliation(s)
| | - Hrayr Attarian
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Galit Levi Dunietz
- Department of Neurology, School of Medicine, University of Michigan, USA
| | | | - Kristen Knutson
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
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Blackie M, De Boer K, Seabrook L, Bates G, Nedeljkovic M. Digital-Based Interventions for Complex Post-Traumatic Stress Disorder: A Systematic Literature Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241238760. [PMID: 38533796 DOI: 10.1177/15248380241238760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Research has shown that complex post-traumatic stress disorder (cPTSD) differs from post-traumatic stress disorder (PTSD) on core symptoms relating to the individual's sense of self, and this has driven the need for treatment approaches to address these specific features of cPTSD. The COVID-19 pandemic has led to the increased use of digital-based interventions (DBIs) to treat mental illnesses, including trauma-related disorders. However, while evidence for the use of DBIs for PTSD has previously been synthesized, the current review is the first synthesis of research on the use of DBIs for cPTSD. A systematic search of Scopus, PsychINFO, and EBSCOhost was conducted, using search terms targeting "cPTSD" and "DBIs," to identify research on the use of DBIs to treat cPTSD symptoms. Ten papers were identified, which provided preliminary evidence for the efficacy of DBIs to reduce cPTSD symptoms. Further, DBIs were reported as acceptable by individuals with a history of complex trauma. The paper also provides insight into the therapeutic approaches adopted, digital modalities utilized, safety measures included, and whether/to what degree support was provided. While DBIs show promise for treating cPTSD, there is substantial room for advancement of the empirical evidence base for these approaches. Both clinical and research-based recommendations are provided separately.
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Affiliation(s)
- Meg Blackie
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | | | - Liz Seabrook
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Glen Bates
- Swinburne University of Technology, Hawthorn, VIC, Australia
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Mabil-Atem JM, Gumuskaya O, Wilson RL. Digital mental health interventions for the mental health care of refugees and asylum seekers: Integrative literature review. Int J Ment Health Nurs 2024. [PMID: 38291740 DOI: 10.1111/inm.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 11/18/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
This study aimed to provide a critical analysis of the current literature on the use of digital mental health interventions (DMHIs) for the management and treatment of mental health disorders among refugees and asylum seekers. These groups are among the most disadvantaged compared to the general population in terms of health and socio-economic status, due to conflicts and wars. The number of refugees fleeing their home countries is growing exponentially, and refugees experience trauma, torture, persecution and human right abuses, which have a profound effect on their mental health and overall well-being. The researchers conducted an integrative literature review from electronic databases Medline, CINAHL and Google Scholar, selecting articles published in English from 2010 to 2023. The thematic analysis of the 10 articles identified in the review revealed four main themes and two sub-themes: (1) types of digital health intervention/apps used; (2) barriers encountered in digital health intervention; (3) user experience of the digital health intervention and (4) mapping gaps. Two sub-themes were identified located in Theme 2: (2.1) Language and demographic barriers and (2.2) Structural barriers. The study showed that the use of DMHIs was associated with positive experiences among refugees and asylum seekers. Limited mental health care is offered to refugees and asylum seekers due to a range of logistical, political, economic, geographical, language, cultural and social barriers. DMHIs have the potential to overcome and/or moderate these barriers. The study concludes that the scaled implementation of effective DMHIs holds the possibility to improve the wider distribution of mental health care among refugees and asylum seekers. However, further research is needed to confirm the effectiveness of DMHIs and to scale up studies for their utilisation among this group. In summary, this study highlights the potential of DMHIs in improving the mental health care of refugees and asylum seekers. The results of this study have important implications for mental health service providers, policymakers and researchers to address the mental health needs of this vulnerable/priority group.
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Affiliation(s)
| | - Oya Gumuskaya
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rhonda L Wilson
- University of Newcastle, Callaghan, New South Wales, Australia
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Hynie M, Oda A, Calaresu M, Kuo BCH, Ives N, Jaimes A, Bokore N, Beukeboom C, Ahmad F, Arya N, Samuel R, Farooqui S, Palmer-Dyer JL, McKenzie K. Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review. J Immigr Minor Health 2023; 25:1171-1195. [PMID: 37407884 PMCID: PMC10509103 DOI: 10.1007/s10903-023-01521-1] [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] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.
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Affiliation(s)
- Michaela Hynie
- Department of Psychology, York University, Toronto, Canada.
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada.
| | - Anna Oda
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada
| | - Michael Calaresu
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Ben C H Kuo
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Nicole Ives
- School of Social Work, McGill University, Montreal, Canada
| | - Annie Jaimes
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Nimo Bokore
- School of Social Work, Carleton University, Ottawa, Canada
| | | | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rachel Samuel
- Counseling Psychology, Yorkville University, Fredericton, Canada
| | | | | | - Kwame McKenzie
- Wellesley Institute, Toronto, Canada
- Division of Health Equity, CAMH, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Baskaran A, Marogi E, Bitar R, Attarian H, Saadi A. Improving Sleep Health Among Refugees: A Systematic Review. Neurol Clin Pract 2023; 13:e200139. [PMID: 36936393 PMCID: PMC10022726 DOI: 10.1212/cpj.0000000000200139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/05/2022] [Indexed: 03/15/2023]
Abstract
Purpose of Review Sleep disorders among refugees are common yet understudied. Interventions are difficult in resource-limited settings where most of these populations live. A systematic review of sleep disorders in refugee populations is warranted to identify prevalence, comorbidities, and the limitations of the current state of sleep health among refugees. Recent Findings Sleep disturbances, particularly insomnia and nightmares, occur with a higher prevalence among refugees. Diseases associated with insomnia in this population included fibromyalgia, posttraumatic stress disorder, depression, and anxiety. Risk factors include trauma, migration, lower socioeconomic status, lower educational level, and settlement in areas with a high influx of new residents or proximity to conflict. Only a few partially successful therapies were identified. Summary This review identifies the high prevalence of the disturbed sleep in this population and its risk factors. It proposes ways of increasing awareness of it in this vulnerable population as a first step toward remediation.
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Affiliation(s)
- Archit Baskaran
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Emily Marogi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Ricardo Bitar
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Hrayr Attarian
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
| | - Altaf Saadi
- Department of Neurology (AB), University of Chicago, IL; Department of Internal Medicine (EM), University of California San Francisco, CA; American University of Beirut (RB), Lebanon; Department of Neurology (HA), Northwestern University, Chicago, IL; Department of Neurology (AS), MGH Asylum Clinic, Harvard Medical School, Boston, MA
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Kim SH, Kim KA, Baek J, Choi J, Chu SH. e-Health for Traumatized Refugees: A Scoping Review. Telemed J E Health 2022; 29:635-645. [PMID: 36169628 DOI: 10.1089/tmj.2022.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: High prevalence of post-traumatic stress disorder (PTSD) is reported among refugees exposed to traumatic experiences, while escaping from their home country, entering a third country, and adjusting to a new society. Electronic health (e-health) treatments have been utilized to overcome challenges such as high costs, limited access to care, and a shortage of resources faced by traumatized refugees. Objective: The aim of this scoping review was to summarize the current science on e-health to screen and treat PTSD in traumatized refugees, examine its benefits and challenges, and suggest strategies for future research. Methods: We conducted a scoping review guided by Arksey and O'Malley's 6-stage scoping review framework. Results: Of the 2,782 articles identified, 8 studies were included for the final analysis. Due to the heterogeneity of studies, the synthesis of results was not feasible. However, the findings of individual studies were examined. The most commonly used technology modality was the smartphone (n = 5). One study revealed the possibility of telephonic screening of PTSD to be equally efficacious as in-person screening, and all interventions through smartphone and the internet reported high feasibility and acceptability. Conclusion: e-Health is suggested to be a novel and scalable platform to provide mental health care in settings with limited resources. Larger and highly robust studies in refugee populations with PTSD-targeted, theory-based approaches and diverse technological formats such as video conferencing and virtual reality are warranted.
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Affiliation(s)
- Soo Hyun Kim
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea
| | - Kyoung-A Kim
- Department of Nursing, Gachon University College of Nursing, Incheon, Korea
| | - Jiwon Baek
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - JiYeon Choi
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
| | - Sang Hui Chu
- Department of Nursing, Yonsei University College of Nursing, Seoul, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Korea
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Nikendei C, Dinger-Ehrenthal U, Schumacher F, Bugaj TJ, Cranz A, Friedrich HC, Herpertz SC, Terhoeven V. Medical students' mental burden and experiences of voluntary work in COVID-19 patient support and treatment services: a qualitative analysis. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc120. [PMID: 34957325 PMCID: PMC8675374 DOI: 10.3205/zma001516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 06/14/2023]
Abstract
Aim: Medical training is undergoing a dramatic shift toward alternative training methods due to the SARS-CoV-2 pandemic. This study is the first to examine medical students' expectations, experiences, and mental burden related to volunteering in COVID-19 patient support and treatment services using semi-structured interviews. Methods: In May 2020, all 194 Heidelberg University Medical School students involved in volunteer COVID-19 support and treatment services were invited to participate in a cross-sectional, qualitative interview study. The semi-structured interviews were digitally recorded, transcribed, and then analyzed using Mayring's principles for content analysis. Results: We interviewed 12 medical students (8 female, mean age 23.2 years, mean medical training 3.7 years) working in Heidelberg COVID-19 crises management services, i.e., the Heidelberg Medical Hospital COVID-19 inpatient and outpatient units. The analysis revealed two key themes: "Expectations and structural barriers" and "Experiences and mental burden". The participants reported uncertainty and apprehension before starting their voluntary work. Although they initially found volunteering to be somewhat disorganized, their roles became clearer with time. In addition, they reported good team cohesion, which helped reduce initial concerns and uncertainties. The participants also felt that working in the field had helped them maintain their professional identification while standard medical classes and bedside learning were suspended due to the COVID-19 crises. Overall, they reported little volunteer work-related mental burden. Conclusions: The participants felt that volunteering during the COVID-19 crisis had benefited their professional development. A designated liaison person, psychosocial support, and introductory and accompanying courses could help alleviate initial concerns and interim difficulties in future crisis-related assignments.
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Affiliation(s)
- Christoph Nikendei
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Ulrike Dinger-Ehrenthal
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Florian Schumacher
- University of Heidelberg, Medical Faculty, Dean's Office, Heidelberg, Germany
| | - Till J. Bugaj
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Anna Cranz
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hans-Christoph Friedrich
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Sabine C. Herpertz
- University of Heidelberg, Medical Faculty, Dean's Office, Heidelberg, Germany
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Psychiatry, Heidelberg, Germany
| | - Valentin Terhoeven
- Heidelberg University Hospital, Centre for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg, Germany
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Zehetmair C, Kindermann D, Tegeler I, Derreza-Greeven C, Cranz A, Friederich HC, Nikendei C. A Qualitative Evaluation of a Mother and Child Center Providing Psychosocial Support to Newly Arrived Female Refugees in a Registration and Reception Center in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094480. [PMID: 33922525 PMCID: PMC8122916 DOI: 10.3390/ijerph18094480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Female refugees are frequently exposed to sexualized, gender-based violence and harassment before, during, and after their flight. Yet female refugee-specific care and protection needs are rarely addressed in host countries. This study aimed to evaluate a mother and child center (MUKI) for female refugees in a reception and registration center in Germany. In 2017, we conducted semi-structured qualitative interviews with 16 female refugees attending the MUKI and with its five main staff members. We asked the participants about the MUKI’s relevance, encountered difficulties, and suggestions for improvement. The interviewees appreciated the MUKI’s sheltered environment, care services, and socializing opportunities, as well as its women-only concept. Overall, the participants saw overexertion, social engagement-related difficulties, and the MUKI’s noisy environment as key attendance barriers. Interviewed staff primarily reported problems regarding the working conditions, including the high staff and attendee turnover and low general service awareness. The participants advocated an expansion of the MUKI program. The MUKI project underlines that providing newly arrived, vulnerable female refugees with sheltered surroundings and psychosocial services is an essential step toward addressing female refugees’ specific care needs.
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Zehetmair C, Zeyher V, Cranz A, Ditzen B, Herpertz SC, Kohl RM, Nikendei C. A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052275. [PMID: 33668936 PMCID: PMC7956492 DOI: 10.3390/ijerph18052275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022]
Abstract
Providing refugees with psychosocial support is particularly important considering the high level of mental health problems prevalent in this population. A psychosocial walk-in clinic operating within a state reception and registration center in Germany has been supporting mentally burdened refugees since 2016. This study focused on patients' perspectives on their mental health burden, the psychosocial walk-in clinic, and future help seeking. We conducted interviews with n = 22 refugees attending the walk-in clinic from March to May 2019. Qualitative analysis focused on the following four topics: (1) mental burden from the patients' perspective, (2) access to the psychosocial walk-in clinic, (3) perception of counseling sessions, and (4) perception of follow-up treatment. The results show that the majority of interviewees were burdened by psychological and somatic complaints, mostly attributed to past experiences and post-migratory stress. Therapeutic counseling and psychiatric medication were found to be particularly helpful. Most of the participants felt motivated to seek further psychosocial support. Key barriers to seeking psychosocial help included shame, fear of stigma, and lack of information. Overall, the psychosocial walk-in clinic is a highly valued support service for newly arrived refugees with mental health issues.
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Affiliation(s)
- Catharina Zehetmair
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
- Correspondence: ; Tel.: +49-6221-56-3873
| | - Valentina Zeyher
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Anna Cranz
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Sabine C. Herpertz
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University Hospital, 69115 Heidelberg, Germany;
| | - Rupert Maria Kohl
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, 69115 Heidelberg, Germany; (B.D.); (R.M.K.)
| | - Christoph Nikendei
- Center for Psychosocial Medicine, Department for General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69115 Heidelberg, Germany; (V.Z.); (A.C.); (C.N.)
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