Background: Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental health’s reciprocal, dynamic relationship with post-migration living conditions and social support. Methods: The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses. Results: Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment. Conclusion: Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration.

The number of distressed refugees from the Arab world is relatively high in Germany and other host countries worldwide. For this specific population, substantial challenges and barriers have already been identified that hamper access to Germany's health care system. This study aims to contribute to this line of research by exploring the representation of depressive symptoms, both somatic and psychological, in order to inform clinicians about the most prevalent symptoms reported by Arabic-speaking refugee outpatients. Furthermore, this paper investigates the longstanding claim that mental health stigma fosters the expression of bodily distress. For these purposes, a total of 100 Arabic-speaking refugee outpatients, mostly Syrians, were recruited in Berlin, Germany. Somatic and psychological symptoms were assessed with the Patient Health Questionnaire (PHQ) 15 and 9, while stigma was assessed with the Brief Version of the Internalized Stigma of Mental Illness Scale (ISMI-10). Study results show that both somatic and psychological symptom severity was moderate while sleeping problems and energy loss were the most reported symptoms across both scales. Stigma was low and showed no association with somatic complaints in a multiple regression analysis, but was associated with more psychological symptoms. A principal factor extraction on the PHQ-15 items revealed five independent, somatic symptom clusters that were interpreted considering the rich poetic resources of the Arabic language. In conclusion, both somatic and psychological symptoms were commonly reported by Arabic-speaking refugees with symptoms of depression. Whereas, stigma does not seem to influence the expression of somatic symptoms, the present results provide first empirical indications for the relationship of symptom expression with the use of explanatory models and conceptualizations of mental illness within the Arabic culture and language. Future research efforts should be dedicated to enhancing our understanding of mental health care needs in this population as well as to exploring other mediators that might help explain the varying degree of somatic symptoms in depression across cultures.

Zusammenfassung Ziel der Studie Trotz des erheblichen Bedarfs nach einer schnellen und effizienten Diagnostik aufgrund von aktuellen humanitären Krisen in der arabischen Welt, steht bisher keine validierte, hocharabische Version des Mini International Neuropsychiatric Interview (MINI) für die Versorgungsforschung zur Verfügung. Das Ziel der vorliegenden Pilotstudie war es daher, eine Übersetzung und kultursensible Adaptation des MINI ins Hocharabische zur Verfügung zu stellen sowie erste Validierungsversuche in einer arabischsprachigen Geflüchtetenstichprobe vorzunehmen.Methodik An dem mehrstufigen Adaptationsprozess waren mehrere psychiatrisch-psychotherapeutische ExpertInnen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut sind. N = 20 arabischsprachige geflüchtete PatientInnen nahmen an der Pilotstudie teil, die an der Clearingstelle der Charité, Universitätsmedizin Berlin rekrutiert werden konnten. Für die Feststellung der Kriteriumsvalidität wurden Diagnosen von ExpertInnen, die gegenüber den MINI Diagnosen ‚verblindet’ waren und Screeninginstrumente für Depression (Patient Health Questionnaire 9, PHQ-9) und die posttraumatische Belastungsstörung (PTBS) (Harvard Trauma Questionnaire, HTQ) herangezogen.Ergebnisse Aufgrund der ausführlichen Dokumentation kann der Prozess der kulturellen Adaptation detailliert nachvollzogen werden. Kappa Werte zeigten keine Übereinstimmung der MINI Diagnosen mit den ExpertInnendiagnosen, jedoch konnten hohe Übereinstimmungen zwischen den MINI Diagnosen und dem PHQ-9 (κ = .69) und dem HTQ (κ = .68) festgestellt werden. Schlussfolgerungen Die Ergebnisse der Pilotstudie werden als erste Hinweise für die Validität der hocharabischen Übersetzung des MINI gewertet und bilden die Grundlage für weitere, ausführliche Validierungsstudien. Darüber hinaus zeigt diese Studie einen Modellprozess für die kulturelle Adaptation psychometrischer Instrumente auf.