Asylum Seekers In Germany Research Articles

Syrian refugees in Germany: Perspectives on mental health and coping strategies

ObjectiveSyrians have been the largest group among asylum seekers in Germany since 2014. Refugees are exposed to various risks along the migration process, indicating the need for adequate psychosocial support. Following the advice of the United Nations High Commissioner for Refugees to consult the target group, this is the first study qualitatively investigating the perspectives on mental health and coping strategies of Syrian refugees in Germany. MethodsA qualitative design with semi-structured focus group discussions was applied. Three focus groups with a total of N = 20 participants were conducted. Focus group discussions were analyzed using content-structuring content analysis. ResultsHopelessness, fear, and worries were reported most frequently as emotional consequences of war, fleeing, and resettlement, along with cognitive, physical, social, and behavioral consequences. Among the reported consequences, symptoms of PTSD were identified. Contrary to depression and schizophrenia, PTSD was not explicitly mentioned. Possibilities of coping and support referred to meeting basic needs (e.g., mental health care), fostering participation and personal coping, with the social network stated as most important source of support. Barriers of accessing mental health and psychosocial support (MHPSS) services included poor information, stigma, and language difficulties. ConclusionIn contrast to earlier research, Syrian refugees reported numerous emotional symptoms as well as mental disorders as consequences of war, fleeing, and resettlement, indicating awareness of mental health sequelae. However, PTSD was not reported as possible consequence. The findings indicate the need for adequate psychoeducation, matching the participants' wish for improved information on mental health to reduce barriers accessing MHPSS.

Waiting as a site of subject formation: examining collective prayers by Ethiopian asylum seekers in Germany

In this article I look at collective payers by Ethiopian asylum seekers to explore how religious narratives are mobilized to deal with temporal angst in the context of waiting. I posit that waiting is a site of multifaceted struggles in which subjectivities are constituted, in response to both the violence waiting imposes and the anticipated freedom it carries with it. Asylum seekers confront life in waiting in various ways until they attain what they wait for and ‘settle’ in the host country. To settle is imagined as living in Europe as independent and self-reliant workers who could generate their own income which is contingent on waiting for the acceptance of their applications for asylum. Whether people attain what they wait for or not, their subjectivities are formed through a certain idea of themselves, an understanding of their situation and their practices, all of which are located within histories and structures of power relations. My analysis draws on ethnographic data generated from fieldwork conducted in 2016–2017 among Oromo asylum seekers in the city of Nuremberg, Germany.

Effects of introducing a walk-in clinic on ambulatory care sensitive hospitalisations among asylum seekers in Germany: a single-centre pre–post intervention study using medical records

ObjectiveMeasuring the effect of introducing a walk-in clinic on ambulatory care sensitive (ACS) hospitalisations among asylum seekers in a large state reception- and registration centre.Design and settingPre–post intervention study using...

‘Only God can promise healing.’: help-seeking intentions and lay beliefs about cures for post-traumatic stress disorder among Sub-Saharan African asylum seekers in Germany

ABSTRACT Background: Epidemiological studies have reported high rates of post-traumatic stress disorder (PTSD) among asylum seekers from Sub-Saharan Africa. In order to provide appropriate and culturally sensitive mental health care for this group, further knowledge about treatment preferences might be necessary. Objective: We aimed to provide insights into help-seeking intentions and lay beliefs about cures for PTSD held by asylum seekers from Sub-Saharan Africa living in Germany. Methods: To address this objective, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the quantitative part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the General Help-Seeking Questionnaire (GHSQ). In the qualitative part, asylum seekers (n = 26) reviewed the results of the questionnaire survey within eight focus group discussions sampled from groups of the three main countries of origin. Results: Asylum seekers showed a high intention to seek religious, medical, and psychological treatment for symptoms of PTSD. However, asylum seekers indicated a higher preference to seek help from religious authorities and general practitioners, as well as a lower preference to enlist psychological and traditional help sources than Germans without a migration background. Furthermore, asylum seekers addressed structural and cultural barriers to seeking medical and psychological treatment. Conclusion: To facilitate access to local health care systems for asylum seekers and refugees, it might be crucial to develop public health campaigns in collaboration with religious communities. When treating asylum seekers and refugees from Sub-Saharan Africa, practitioners should explore different religious and cultural frameworks for healing and recovery in order to signal understanding and acceptance of varying cultural contexts.

Housing facilities for asylum seekers in Germany: Ethical concerns regarding social exclusion, othering and negative effects on health

Abstract Background Asylum seekers face many barriers in accessing health care and their well-being is impaired in manifold ways. According to Public Health research the impact on health of social determinants is much higher than the influence of access to health care. Therefore, it is important to take other living conditions like accommodation into serious consideration. Methods The focus will be on how housing conditions allow or prevent opportunities for social participation and autonomy. As a philosophical-ethical paper this contribution attempts to identify moral concerns and ethical questions regarding housing situations under the lens of inclusion and exclusion. This will lead to the question whether they constitute forms of othering. In a first step it will be clarified how inclusion and exclusion are used as analytic frame, particularly whether and how far they are not only descriptive terms but also normative ones. Exemplary cases of housing facilities for asylum seekers in Germany will be given and questioned regarding practices of inclusion and exclusion and how this affects participation and autonomy. Conclusions Apart from contributing to barriers in accessing health care different types of “exclusive” housing for asylum seekers often impedes on social participation and disempowers autonomous choices. Since social exclusion is known to affect (mental) health this raises concerns for health and well-being as well as several other ethical questions. Questions for further discussion: What is the responsibility of Public Health regarding the housing conditions of asylum seekers and the negative effects of othering on health? How do we perceive this in the light of solidarity?

Surveillance of health and primary care of asylum seekers in reception centers: concept and results

Abstract Background Reliable data on health and primary care among asylum seekers in reception centers are essential for the planning and provision of medical services, but haphazard care provision and lack of standards for health information systems in these centers preclude routine health monitoring. We aimed to establish a routine surveillance system in reception centers for asylum seekers in Germany, generating multi-center data on key health indicators. Methods To enable routine health surveillance, we established an electronic medical records system (RefCare©), a research network, and an IT-infrastructure for the automated analysis of health data in German reception centers. Within the network, 64 health and health care indicators on morbidity, care processes, quality of care and syndromic surveillance were identified. In November 2018, we analyzed 33 indicators using routine health data from nine centers in three federal states. We calculated single-center prevalence and pooled estimates for selected morbidity indicators stratified by age and sex, and process and quality indicators stratified by center. Results A total of 8,406 patients and 39,449 patient contacts were analyzed, with mean utilization of health services ranging from 2.33 (Standard deviation, SD: 2.0) to 11.49 (SD: 22.82). The morbidities with the highest prevalence were respiratory, digestive and certain infectious diseases, followed by consequences of external causes, musculoskeletal and mental health conditions. Irrational use of antibiotics was below the threshold for primary care settings. Conclusions For the first time in Germany, a harmonized infrastructure for the automated, anonymized surveillance of the health and health care of asylum seekers in reception centers was established in several federal states. The analysis of morbidity indicators shows a primary care-typical disease profile, with special needs regarding mental health and consequences of external causes, such as physical trauma. Key messages Routine health surveillance of asylum seekers in reception centers can be achieved through an innovative harmonized, cross-regional, multi-center, anonymous and automated surveillance system. Health issues of asylum seekers in reception centers in Germany mainly consist of primary care conditions with special vulnerabilities regarding mental health and consequences of external causes.

The potential of economic evaluation studies to improve health screening and assessment policies for asylum seekers in Germany

Abstract This presentation will discuss the potential for conducting economic evaluation studies in the field of migration and health, by focusing on health screening and assessment for newly arriving asylum seekers. We use three economic case studies from Germany to illustrate this potential, reflecting on the benefits of an economic approach, the contribution of modelling studies, the quality and reliability of the underlying data sources and other lessons learnt in the research process. Screening for illness among newly arriving individuals has the potential to expand access to essential services and overcome access barriers, thus improving efficiency by preventing costs of late presentations. This is demonstrated by a recent modelling study on the cost-utility of screening for depression. However, an overview of different screening policies in Germany shows that unnecessary procedures which are not supported by sound scientific evidence may lead to inefficiencies in excess of €3.1 million, which could be more effectively invested in other parts of the health system. Finally, efficiency gains could be made by assessing who benefits most from screening, and designing targeted screening approaches for these groups, as in the case of targeted screening for active tuberculosis by country of origin. We will end the presentation by reflecting on the potential role for economic evaluations health policy-making, and the challenges of communicating and translating the nuances of economic evidence into practice.

Workshop: Bringing economics, health and migration together: a mutual learning experiment

Abstract Acknowledging the role of economic arguments in political discourses and decision-making, researchers have begun to pay more attention to the fiscal implications of different health policy options for migrants. As yet, empirical evidence on economic effects of policy responses to migration and the societal costs or cost-effectiveness of competing strategies to address migrants’ health needs is scarce. Methodological challenges such as limited availability and accessibility of decent data often impede the generation of robust evidence. Further, little is known as to how evidence can effectively be moved into policy; e.g., the actual clout of economic arguments in migration policies debates, as opposed to other evidence- or value-based arguments, hitherto remains unclear. In other social policy domains such as educational and labour market integration, economic evaluations have become routine components of policy assessments. And under the title of, e.g., knowledge translation, strategies for the introduction of research evidence into political decision-making processes have been developed. The combination of similar goals and challenges suggests that there are opportunities to build bridges across sectors and disciplines - e.g., public health, social epidemiology, economics, social policy, data science - as well as across research-practice-divides, for the purposes of mutual learning and the joint improvement of research outcomes. The goal of this workshop is to start such learning processes by bringing together researchers and professionals from different fields, by sharing existing knowledge, and by jointly exploring the following questions: What are the thematic intersections, tensions and synergies between the different disciplines? What are common goals and questions? Which kinds of different knowledge complement each other towards those goals?Where are options for mutual learning, methodological transfer and/or synthesis? How can they help to overcome current challenges in estimating the costs of divergent migrant health policies?What can be learnt from existing knowledge translation strategies as regards the role of research for migrant health policy making?What challenges and open questions remain? The workshop will start with a brief introduction of key concepts and objectives. The first presentation will use three case studies to reflect on the potential of economic evaluation for improving health screening and assessment policies for asylum seekers in Germany. The second presentation will provide input from seminal research on public policy in migration contexts. A third presentation will summarize previous activities and insights of the work group “Economic arguments in migrant health policy making”. The following discussion will examine the above noted questions by tapping into the presenters’ expertise and the audience’s experience. The workshop will be closed with a summary of lessons learnt and directions for future research. Key messages Economic arguments play a central role in policy-making; but economic analyses of different migrant health policy options are hampered by various methodological challenges and tensions. Seminal research in other social policy domains offers potential for mutual learning, toward the end of generating valid economic evidence on the cost-benefits of migrants’ greater in-/exclusion.

Institutionalization of a Formalized Intergovernmental Transfer Scheme for Asylum Seekers in Germany: TheKönigstein Keyas an Indicator of Federal Justice

AbstractCrisis-induced refugee migration raises questions of fair responsibility-sharing among political territories. This is relevant for nation states and for subnational territories alike. Theories addressing this problem have mainly been developed with regard to international responsibility-sharing. They assume collective action problems when it comes to organising intergovernmental transfer schemes, something which cannot be easily overcome. It is not well understood how effective transfer schemes can be institutionalised when no hierarchical decision-making is in place. Complementary to that perspective, this paper builds upon constructivist institutional theories that suggest paying more attention to guiding ideas, which can be called upon when intergovernmental transfer schemes are at stake, and to criteria of rationality that can legitimately claim to embody this idea. Legitimate criteria of rationality are typically the result of “investments in form”, i.e. social practices which imbue material objects with certain qualities so that they stand for particular guiding ideas. The article tests this assumption empirically by tracing the institutionalisation process of the Königstein key (Königsteiner Schlüssel) as a dynamic formula for determining state quotas in Germany's refugee federalism. While important precedents of physical intergovernmental responsibility-sharing in refugee matters had already existed in West Germany, their translation to the territorial dispersal of non-German asylum seekers was highly controversial in the 1970s. In this case, resorting to the Königstein key proved to be feasible in part because, by then, the formula had already become a symbol of the idea of federal justice through its use in a variety of different and far less controversial policy fields. However, during the recent wave of refugee immigration it has increasingly become the object of critique.

Understanding environmental terrorism in times of climate change: Implications for asylum seekers in Germany

With an increasing global population and undeniable climate change, environmental terrorism is causing unprecedented levels of human insecurity. The use of resources as weapons of armed conflict is particularly effective on vulnerable societies, triggering large-chain global migration-related issues. This research advances the understanding of environmental terrorism, addresses the connections of resources and conflict, and the effects of climatic events on these phenomena. The existing related body of literature was scrutinized and complemented with an in-depth empirical study of 100 asylum seekers from 17 countries hosted in German facilities. The results point to the use of environmental terrorism by governments or opposition groups, or both, in Syria, Iraq and Afghanistan. Interviewees provided accounts of how perpetrators oppressed and harmed their enemies and civilians by attacking, drastically reducing or cutting the supply of resources, such as water or electricity, and by contaminating water with disease-causing agents. This paper elaborates on the conflict in Syria by presenting empirical evidence on the climate's contribution to the armed conflict in order to demonstrate that environmental terrorism is particularly effective on populations living in drought-stressed regions. Considering that 81% of interviewees reported observing water or electricity scarcity – or both – in their place of origin, this research claims that mounting climate pressure on resources is likely to increase the use of environmental terrorism, thereby contributing to migration and human insecurity across regions. The purpose of this research is to inform academia and policy makers on the strategic importance of monitoring and preventing resource related threats and violence.

Refugees in Germany: Amongst Culture of Welcome and Xenophobia

The refugee crisis in Germany is a part of the European migrant crisis in connection with the immigration of high numbers of people arriving in the European Union (EU) from across the Mediterranean Sea or overland through Southeast Europe. This period reached its’ summit in 2015/2016 with over a million protection seekers arriving in Germany.The high influx of protection seekers in such a short time has caused a social debate in Germany on how to handle the high numbers of immigrants and arrange the political asylum. There are different views on the reception of migrants that range from the culture of welcome to xenophobia. This can be observed in the society, where a part of the population gets involved with the refugees’ integration, whereas another (increasing) part foments anti-immigrant sentiments. Between those beliefs, many different attitudes and behaviors towards refugees can be found.This article discusses the situation of refugees and asylum seekers in Germany, concerning the divided opinions reaching from a culture of welcome to xenophobia. It addresses the transformation that Germany is currently undergoing and gives several examples of incidents of and against refugees that affect the mindset of the German population.

Who Wants to Talk About Refugees and Why? Foreign Interventions in German Elections

We use this the crisis set off by the arrival of asylum-seekers in Germany to test a theory of the use of propaganda as a strategy by a non-democratic state against a democratic state. We argue that a non-democracy on a collision course with a democracy will use propaganda discourse to punish recalcitrant elite, and will do so especially near elections while promoting frames that weaken the opponent’s institutions. We test these propositions on a corpus of half a million publications, covering Kremlin-backed media channels broadcasting in German, and German media. We find that Kremlin-backed channels are more likely to publish refugee stories near elections in Germany and that they push conspiracy theories at the expense of discussing economic or crime-related aspects of immigration. Our work has implications for the rise of propaganda discourse in Europe and beyond, and for democratic politics under foreign autocratic pressure.

A prospect of staying? Differentiated access to integration for asylum seekers in Germany

ABSTRACTThis paper investigates the normative permissibility of differential inclusion policies, taking Germany as a case study. In the face of mounting asylum applications, Germany introduced new administrative rules differentiating access to integration for asylum seekers. The paper normatively examines whether this practice is consistent with two conventional liberal concepts: special obligations grounding the moral commitments of the liberal state towards its own citizens and the principle of legal certainty grounding its moral commitments towards everyone under its jurisdiction, including asylum seekers. Combining these two usually separately employed perspectives, it argues that while differential inclusion is in principle consistent with these liberal principles, the crude criterion of the country of origin does not comply with both perspectives. The paper contributes to the debate on the ethics of immigration by scrutinizing this real-world instrument of differential inclusion from a political philosophy perspective.

Prolonged grief disorder among asylum seekers in Germany: the influence of losses and residence status

ABSTRACT Background: Besides the high exposure to traumatic events, many refugees to Europe experienced tremendous interpersonal losses. Objective: The aim of this study was to investigate the rate and potential risk factors of prolonged grief disorder (PGD) in recently fled asylum seekers who lived in collective accommodations in Germany. Method: Three groups of asylum seekers from different countries (N = 99) completed the Traumatic Grief Inventory Self-Report Version (TGI-SR), Posttraumatic Stress Disorder Checklist-5 (PCL-5), and Patient Health Questionnaire depression module (PHQ-9). Individuals in Group 1 were waiting for asylum decisions (n = 29), Group 2 members were in appeal against rejected asylum claims (n = 32), and Group 3 members had been permitted temporary residence status (n = 38). Results: The loss of a loved person was reported by 92% of participants. The criteria for provisional PGD diagnosis according to Prigerson criteria were met by 20% of participants, 16% fulfilled the criteria for DSM-5 persistent complex bereavement disorder. Probable posttraumatic stress disorder (45%) and depression (42%) rates were high. The total number of lost nuclear family members and PTSD symptoms were associated with higher and temporary residence status was predicted lower PGD symptom levels. Conclusions: These results show that a substantial proportion of asylum seekers suffer from PGD. This points to the need to screen for problematic grief in the current refugee population in Europe.

Not in My Backyard: Do Increases in Immigration Cause Political Violence?

While far-right parties profit electorally from rising immigration, we know very little about how increases in immigration mobilize opposition outside the electoral arena. Using fine-grained, classified data from the Federal Criminal Office in Germany, we estimate the causal effect of a sizable increase in asylum-seekers in a community on the probability of xenophobic hate crimes. Exploiting county-level quota regimes governing the allocation of asylum-seekers in Germany, we find that when immigration levels rise nationally, an increase in asylum-seeker arrivals in a community causes an increase in xenophobic hate crimes. We also document that these crimes are directed against asylum-seekers and not other non-natives, which suggests that they are instrumental actions intended to dispel and deter asylum-seekers from local communities.

Intergenerational Mobility and Self-Selection of Asylum Seekers in Germany

We exploit a novel survey of recently arrived asylum seekers in Germany in order to estimate the degree of intergenerational mobility in education among refugees and compare it to the educational mobility of similar-aged individuals in their region of origin. The findings show that the refugees in our sample display high rates of educational mobility, and that their upward mobility is rather high when compared to the reference group in their region of origin. These results suggest that there exists positive skill selection among recently arrived refugees in Germany.

Qualifications, Potentials and Life Courses of Syrian Asylum Seekers in Germany

English Abstract: This contribution outlines some of the main findings of the “Qualifications, potentials and life courses of Syrian asylum seekers in Bavaria” study conducted in the second half of 2017. Our study adds to the literature on asylum seekers in several ways. First, in addition to collecting information on educational qualifications we assess human capital stock using aptitude tests. We also gauge German language abilities using objective tests and interviewer assessments. Second, we assess labor market capabilities by tracing migrants’ work experiences with a special focus on evaluating skill levels and skill acquisition over the years. Moreover, we measure subjective expectations to understand the investments migrants undertake in the host country. Lastly, we look at traumatic events which may hinder the successful structural integration of asylum seekers', given their often arduous journey to a host country. Therefore, we attempt to offer a broader understanding of Syrian asylum seekers in Germany. German Abstract: In diesem Beitrag werden einige der wichtigsten Ergebnisse der Studie „Qualifikationen, Potenziale und Lebensverlaufe syrischer Asylbewerber in Bayern“, welche im zweiten Halbjahr 2017 durchgefuhrt wurde, skizziert. Unsere Studie erganzt die Literatur zu Asylbewerbern in mehrfacher Hinsicht. Zum einen wird zusatzlich zur Erfassung von Informationen zu Bildungsabschlussen der Humankapitalbestand anhand von Eignungstests bewertet. Auserdem beurteilen wir anhand objektiver Tests und Einschatzungen durch die Interviewer die Deutschkenntnisse der Studienteilnehmer. Zum anderen bewerten wir die Arbeitsmarktfahigkeiten, indem wir die Arbeitserfahrungen von Migranten mit einem besonderen Schwerpunkt auf die Bewertung des Qualifikationsniveaus und des Qualifikationserwerbs im Laufe der Jahre zuruckverfolgen. Daruber hinaus messen wir subjektive Erwartungen, um zu verstehen, welche Investitionen Migranten im Aufnahmeland tatigen. Zuletzt betrachten wir traumatische Ereignisse, welche die erfolgreiche strukturelle Integration von Asylbewerbern aufgrund ihrer oft schweren Reise in das Aufnahmeland behindern konnten. Insofern versuchen wir ein breiteres Verstandnis uber syrische Asylbewerber in Deutschland zu vermitteln.

Countering Right-Wing Populism: Transgressive Cosmopolitanism and Solidarity Movements in Europe

Countering Right-Wing Populism:Transgressive Cosmopolitanism and Solidarity Movements in Europe Kim Rygiel (bio) and Feyzi Baban (bio) Over the past several years, right-wing populist movements have emerged and strengthened across Europe and North America. Yet, at the same time, in response to growing xenophobia and racism, political mobilizations by refugees and migrants, as well as citizens working in solidarity with them, have also emerged, demanding human and labor rights, fair asylum processes, and mobility rights. We examine the emergence of grassroots solidarity initiatives in cities and towns such as Berlin, Copenhagen, Riace, Istanbul, and Gaziantep, which include arts and museum projects, kitchen hubs, and flat-sharing that foster pluralism and open community to newcomers. This essay examines these as transnational forms of solidarity, informed by notions of "transgressive cosmopolitanisms."1 It investigates these alternative sites as disruptive of hierarchical borders of belonging between newcomers (recently arrived migrants and refugees) and locals (nonmigrant residents), which thereby foster more inclusionary ways of living together. In the European context (e.g., Denmark, Germany, Italy, and Turkey), these movements are significant because they challenge the rigidity of thinking about national identities and belonging, coupled with restrictive immigration and refugee policies, both of which make it difficult for newcomers to establish themselves as members of the larger society. These movements provide much-needed social and cultural spaces where newcomers can establish networks with nonmigrant residents. The radical impact of these movements stems, first, from their resistance to the idea of homogeneous national identities, championed by right-wing movements but also prevalent in mainstream understandings about what it means to be German, Danish, Italian, or Turkish; and second, their ability to provide spaces and activities through which newcomers and locals can create new understandings of belonging. [End Page 1069] Countering Right-Wing Populism through Solidarity across Borders The "long summer of migration" to Europe in 20152—which included the arrival of over 3.5 million Syrians in Turkey and almost 1 million asylum seekers in Germany, many of whom were Syrian—has spurred two opposing movements. The first is the rise of right-wing populism fueling xenophobia and racism across Europe, and the second, the emergence of transnational solidarity movements with refugees and migrants that demand greater social justice and freedom of movement. In the first case, right-wing populist parties and movements across Europe have contributed to racism, antimigrant and refugee discourse, and xenophobia more broadly. The March 2018 Italian election saw the populist Five Star Movement win 32 percent of the vote, while the hard-right, antimigrant, Eurosceptic Northern League won another 18 percent.3 This election follows the ascendance of other far-right parties and movements, including France's Front National, Hungary's Fidesz Party, Austria's Freedom Party, and in Germany, the rise of the Alternative for Germany (AfD) and PEGIDA (the Patriotic Europeans Against the Islamisation of the West). Confronted with shocking images of thousands of refugees and migrants marching through the Balkan countries of Slovenia, Croatia, and Serbia in 2015, Hungary erected a barbed wire fence along its southern border with Serbia. The rise of antirefugee/antimigrant right-wing populism is not limited to Europe, however, as far-right groups are creating linkages between transnational white supremacy4 and "radical Europeanism."5 Ironically, however, despite making transnational linkages, such networks call for maintaining borders, whether national, racial, cultural, or religious. This ideology has led to violent attacks against others perceived to be different for reasons of race, religion, or sexuality, as seen, for example, in the nearly daily attacks on refugee shelters in response to German chancellor Angela Merkel's welcoming of refugees into Germany in 2015.6 Such movements can, therefore, no longer be dismissed as simply local or as existing on the margins of society; rather, this is a phenomenon we must contend with as activists, academics, and progressive citizens committed to fostering open and pluralistic communities. The second counter, cross-border movement is a strengthening of political mobilization by refugees and migrants, as well as citizens organizing in solidarity, demanding human rights and social justice, whether labor rights, housing, health care, and freedom of mobility, including the right to asylum.7 As part of...

"It's That Route That Makes Us Sick": Exploring Lay Beliefs About Causes of Post-traumatic Stress Disorder Among Sub-saharan African Asylum Seekers in Germany.

Many asylum seekers have been confronted with traumatizing events, leading to high prevalence rates of post-traumatic stress disorder (PTSD). Within the diagnostic context, clinicians should take into account patients' culturally shaped presentation of symptoms. Therefore, we sought to provide insights into beliefs about causes of PTSD held by Sub-Saharan African asylum seekers living in Germany. To this aim, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the first part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the Revised Illness Perception Questionnaire (IPQ-R). In the second part, asylum seekers reviewed the results within eight focus group discussions (n = 26), sampled from groups of the three main countries of origin. Descriptive analyses of the first part demonstrated that asylum seekers predominantly attributed PTSD symptoms to psychological and religious causes, and rather disagreed with supernatural causes. In comparison to the German sample without a migration background, asylum seekers attributed symptoms less strongly to terrible experiences, but more strongly to religious and supernatural causes. Within the focus group discussions, six attribution categories of participants' causal beliefs were identified: (a) traumatic life experiences, (b) psychological causes, (c) social causes, (d) post-migration stressors, (e) religious causes, and (f) supernatural causes. Our findings suggest that the current Western understanding of PTSD is as relevant to migrants as to non-migrants in terms of psychological causation, but might differ regarding the religious and supernatural realm. While awareness of culture-specific belief systems of asylum seekers from Sub-Saharan Africa regarding PTSD is important, our findings do underline, at the same time, that cultural differences should not be overstated.

Validation of the Protect Questionnaire: A tool to detect mental health problems in asylum seekers by non-health professionals

Introduction: Prevalence rates of trauma-related mental disorders such as posttraumatic stress disorder (PTSD) or major depression (MD) are high in asylum seekers. The PROTECT Questionnaire (PQ) was designed to detect indications of those disorders in asylum seekers. Empirical data are needed to evaluate the PQ psychometrically. The objective of this study is to investigate the reliability, validity, sensitivity, and specificity of the PQ.
 Method: The PQ and validated questionnaires for PTSD (Posttraumatic Diagnostic Scale, PDS) and depression (Patient Health Questionnaire-9, PHQ- 9) were filled in by a sample of recently arrived asylum seekers in Germany (n=141). A sub-sample of 91 asylum seekers took part in a structured clinical interview to diagnose PTSD or MD (SCID-I).
 Results: The PQ showed a one-factor structure and good reliability (Cronbach’s ⍺= .82). It correlated highly with the PDS and the PHQ-9 (rs=.53-.77; ps≤.001). Diagnostic accuracy with regard to PTSD (AUC=.74; SE=.06; p<.001; 95%-CI=.63-.84) and MD (AUC=.72; SE=.06; p<.001; 95%-CI=.61- .83) was adequate, suggesting an optimal cut-off of 8 or 9. By categorizing participants into a low- and high-risk category, the PQ differentiated well between asylum seekers who fulfilled a PTSD or MD diagnosis and those who did not.
 Discussion: The results support the use of the PQ as a reliable and valid instrument for the purpose of detecting signs and symptoms of the two most common mental disorders in asylum seekers. Persons found to be at risk of mental disorders should be referred to a clinical diagnostic procedure.