High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany

Abstract

The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire—depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and/or witnessed traumatic events was 80.4% (n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0–27). Moderate to severe depression (PHQ-9 score ≥ 15) was found in 35.7% (n = 20) of our sample and severe depression (PHQ-9 score ≥ 20) was found in 23.2% (n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0–21), with 26.8% (n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of culturally sensitive psychological interventions. However, more studies are required to improve the understanding of mental health among this particularly vulnerable population.

Mental health and quality of life among asylum seekers and refugees living in refugee housing facilities in Sweden

“…Clinically significant symptoms of anxiety and risk for PTSD were reported by 40% of the individuals with RP and by more than 60% of the asylum seekers. Similar differences due to residence status have been reported previously [19,20], and recent studies based on asylum seekers also show high prevalence [14,16,17]. High levels of anxiety are comprehensible considering the justified fear of repatriation, but PTSD can also be explained by this factor.…”

“…The survey was lengthy and strenuous for the participants to complete due to language-difficulties and reading deficiencies thus there was a need for brief instruments. Although the instruments are not developed specifically for refugees, they have all been used with refugee populations previously and no psychometric difficulties have been reported [17,26,29]. The rigorous translation process and use of monolingual focus groups also serves to strengthen the validity of the instruments.…”

“…A diagnosis is made if five or more of the nine depressive symptoms are scored ≥ 2 and one of these symptoms is anhedonia or depressed mood. The instrument has been used in a wide range of cultures, including both refugee populations [17] and the Swedish general population [10]. Its use with refugee populations is recommended by Sweden's National Board of Health and Welfare [23].…”

“…These groups are scarcely represented in the literature on refugee mental health, which predominantly includes individuals from Southeast Asia [2,3]. Since the outbreak of the war in Syria in 2011, some studies have provided insight in the mental health status of Syrian refugees [12][13][14][15][16][17] and a few recent studies, e.g., Nosè et al [18], have included refugees of various nationalities. However, the broader community of refugees arriving to Europe in 2015 and forward has not yet been thoroughly studied.…”

Trauma, Traumatization and Adverse Environments in War and Armed- Conflict

“…From a database comprised 71,068 individuals, of whom 3139 were war veterans, it was implied that nightmares presented as an independent risk factor for suicide rather than providing a intermediary for history of traumatic experiences [35]. In a German study of asylum seekers from conflicts regions and in comparison with an ordinary German population of volunteers, the observed rates of traumatic events and distress including the prevalence rates of putative PTSD, depression, and anxiety were markedly higher [36]. In a study of 120 school-aged children and younger adolescents (10-15 years of age), whose parents/fathers were the veterans of war, there were markedly stronger differences in competencies, behavior, emotional difficulties and neuroticism with greater problems in activity, social and school conduct as well as in symptoms of behavioral problems between children of fathers presenting PTSD and those not doing so, to the disadvantage of the former [37].…”