Abstract
Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self , Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t = 2.65, p = 0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma (β = 0.18, p = 0.044), controlling for sociodemographic covariates.Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.
Highlights
Around the globe, the number of individuals forcibly displaced from their homes due to persecution, violence, conflict and human rights violations has risen to 79.5 million by the end of 2019 [1]
We aimed to provide an explorative analysis of mental health self-stigma among adult Syrian refugees with mild to moderate posttraumatic stress symptoms residing in Germany, drawing on cross-sectional baseline data from the Sanadak trial [26]
Our objectives were: (I) to describe the level of mental health self-stigma among Syrian refugees according to the progressive model of self-stigma, (II) to investigate possible differences in mental health self-stigma according to age, gender, education and family status, and (III) to determine whether individuals were more prone to self-stigmatization if they had more psychopathological comorbidities
Summary
The number of individuals forcibly displaced from their homes due to persecution, violence, conflict and human rights violations has risen to 79.5 million by the end of 2019 [1]. Germany has been a major host for refugees for many years especially for individuals from Syria [2]. As a consequence of the distressing experiences before, during and after the escape from the origin country, a substantial proportion of individuals seeking asylum often experience posttraumatic stress and related mental ill-health. A study on mental health in Syrian refugees residing in Germany found that more than 30% met the criteria for at least one mental disorder [5]. The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. We aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. We investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization
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