Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment‐Seeking Refugees

Nickerson, Angela; Schick, Matthis; Schnyder, Ulrich; Bryant, Richard A.; Morina, Naser

doi:10.1002/jts.22205

Cited by 46 publications

(38 citation statements)

References 38 publications

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“…Hence, in comparison to other widely used screening tools (e.g., K10 and PTSD-8), the STAR-MH screens for both PTSD and MDD. The high comorbidity of PTSD and depression in forced migrant populations [ 80 – 82 ], necessitates a tool that can efficiently screen for both disorders. Unlike the K10 and RHS-15, the STAR-MH has clinical predictive validity, having been validated against a diagnostic instrument in both primary health and community settings.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH

2018

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BackgroundThere is no screening tool for major depressive disorder (MDD) or post-traumatic stress disorder (PTSD) in asylum-seekers or refugees (ASR) that can be readily administered by non-mental health workers. Hence, we aimed to develop a brief, sensitive and rapidly administrable tool for non-mental health workers to screen for MDD and PTSD in ASR.MethodsThe screening tool was developed from an extant dataset (n = 121) of multiply screened ASR and tested prospectively (N = 192) against the M.I.N.I. (Mini International Neuropsychiatric Interview) structured psychiatric interview. Rasch, Differential Item Functioning and ROC analyses evaluated the psychometric properties and tool utility.ResultsA 9-item tool with a median administration time of six minutes was generated, comprising two ‘immediate screen-in’ items, and a 7-item scale. The prevalence of PTSD &/or MDD using the M.I.N.I. was 32%, whilst 99% of other diagnosed mental disorders were comorbid with one or both of these. Using a cut-score of ≥2, the tool provided a sensitivity of 0.93, specificity of 0.75 and predictive accuracy of 80.7%.ConclusionsA brief sensitive screening tool with robust psychometric properties that was easy to administer at the agency of first presentation was developed to facilitate mental health referrals for asylum-seekers and new refugees.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1660-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH

2018

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“…Currently, there are no representative data on the state of mental health of refugees and asylum seekers in Switzerland. Besides studies that report the rates of particular mental health disorders among refugees and asylum seekers who are seeking treatment or are already in treatment [24][25][26][27][28], only a few studies have been published on this topic so far. However, they are all limited by their small sample sizes [29][30][31][32][33][34][35].…”

Section: Situation In Switzerlandmentioning

confidence: 99%

Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist’s view

et al. 2020

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Background: More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. Methods: An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chisquared tests were conducted to analyze the data. Results: Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. Conclusions: Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

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“…Although the prevalence rates of mental disorders in refugees worldwide varies widely among different studies, a large meta-analytic review recently identified prevalence rates of 30.6% for post-traumatic stress disorder (PTSD) and rates of 30.8% for depressive disorder among refugees ( 3 , 4 ). In this context and in general, man-made traumas such as torture and especially sexual violence are a strong predictor for developing PTSD ( 5 , 6 ) and comorbid depression ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Extreme Violence by the “Islamic State”

Jk¹,

Windthorst²,

C³

et al. 2018

Front. Psychiatry

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Introduction: Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. Systematic violence, as committed against the Yazidi minority in Northern Iraq by the terror organization known as the Islamic State (IS), can be seen as a particularly traumatic burden to the victims, but also to caregivers providing treatments and assistance to them. The intense exposure to traumatic content may cause secondary traumatization in respective caregivers. This study aims (1) to identify the prevalence of secondary traumatization in caregivers working with traumatized women and children from Northern Iraq; (2) to determine the specific distressing factors and resources of the caregivers; as well as (3) to analyze whether caregivers' personal history of trauma or flight, attachment styles, working arrangements as well as support offers qualify as risk or resilience factors for secondary traumatization.Materials and Methods: In this cross-sectional study, N = 84 caregivers (social workers, psychotherapists/physicians, and interpreters) in the context of a Humanitarian Admission Program (HAP) for women and children traumatized by the so called IS were investigated about their work-related burdens and resources. Secondary traumatization was assessed with the Questionnaire for Secondary Traumatization (FST). To identify relevant determinants for secondary traumatization multiple linear regression analyses were performed.Results: Secondary traumatization was present in 22.9% of the participating caregivers, with 8.6% showing a severe symptom load. A personal history of traumatic experiences, a personal history of flight, a higher number of hours per week working in direct contact with refugees as well as a preoccupied attachment style were detected as risk factors for secondary traumatization. A secure attachment style could be identified as a resilience factor for secondary traumatization.Discussion: Caregivers working with traumatized refugees are at high risk of developing secondary traumatization. Based on the findings of this study and theoretical considerations, a framework of classification for different types of trauma-associated psychological burdens of caregivers working with traumatized refugees is proposed. Implications for the training and supervision of professionals in refugee- and trauma-care are discussed.

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Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment‐Seeking Refugees

Cited by 46 publications

References 38 publications

Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH

Development and validation of a mental health screening tool for asylum-seekers and refugees: the STAR-MH

Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist’s view

Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Extreme Violence by the “Islamic State”

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