Mental health service utilization and perceived barriers to treatment among adult refugees in Germany

Background: Prevalence rates of posttraumatic stress disorder and depression are high among refugees in Germany. However, knowledge on subjective as well as objective need for psychotherapy and utilization of psychotherapeutic treatment is scarce. Both structural and personal barriers regarding utilization of mental health services must be addressed in order to increase treatment efficiency. Objective: The aim of this study was to determine the objective as well as the perceived need for treatment, the utilization of mental health care among refugees in the past 12 months, and the perceived barriers to treatment. Method: By means of face-to-face interviews, an unselected convenience sample of 177 adult refugees were interviewed in either Arabic, Farsi, Kurmancî, English, or German. The general sample was reached through social workers. In addition to the Refugee Health Screener-15 (RHS-15), utilization of psychotherapeutic and psychiatric care as well as the subjective needs and barriers to treatment were assessed. Results: According to the RHS-15 54.8% of participants (n = 97) suffered from relevant mental health problems. However, although 28 (28.9%) of the 97 participants who scored above the RHS-15 cut-off perceived a need for therapy, none of them had received psychotherapy as recommended by the German S3 Guidelines. Missing information about mental health and language difficulties were the most frequently cited barriers to mental health services. Conclusions: Psychologically distressed refugees do not receive sufficient treatment. The reduction of barriers to treatment as well as extension of mental health services to lower thresholds should be considered in the future.

Couples Adjusting to Multimorbidity: A Dyadic Study on Disclosure and Adjustment Disorder Symptoms

Background

Multimorbidity is challenging not only for the patient but also for the romantic partner. Strategies for interpersonal emotion regulation like disclosing to the partner are supposed to play a major role in the psychosocial adjustment to multimorbidity. Research has often focused on disease-related disclosure, even though disclosing thoughts and feelings related to mundane, everyday life occurrences might also play a role in coadjustment. The current dyadic study aimed at investigating the association between these two types of interpersonal regulation strategies and adjustment disorder symptoms, following the new ICD 11 criteria in multimorbid patients and their partners.

Methods

Shortly after being hospitalized due to an acute health crisis, N = 28 multimorbid patients (average age 70 years) and their partners filled in questionnaires on disclosure in the couple, adjustment disorder criteria of the ICD 11 (“preoccupation,” “failure to adapt”), and sleep problems.

Results

Both patients and their partners did show similarly high levels of preoccupation and failure to adapt indicating adjustment problems to the complex health situation. The adjustment symptoms of both partners correlated between r = 0.22 and 0.45. Regression based on Actor-Partner Interdependence-Models revealed that own mundane disclosure was related to less adjustment symptoms in the patients. Beyond that, a partner effect was observed, revealing a negative association between partners’ illness-related disclosure and the patients’ level of preoccupation. For the partners, mundane disclosure of the partner was associated with less preoccupation, failure to adapt, and reported sleep problems above and beyond own disclosure reports. Furthermore, there was an actor effect of disease-related disclosure on less sleep problems for the partners.

Conclusion

These results support an interpersonal view on adjustment processes to physical disease. Disclosure as a way of regulating the relationship and emotional responses might play a relevant role here, which seems to be different for patients and their partners. Further research is needed to shed more light on the differential role of disease-related and mundane everyday disclosure for psychosocial adjustment in couples confronted with health challenges.