Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study

Abstract

BackgroundThe year 2016 has marked the highest number of displaced people worldwide on record. A large number of these refugees are women, yet little is known about their specific situation and the hurdles they have to face during their journey. Herein, we investigated whether sociodemographic characteristics and traumatic experiences in the home country and during the flight affected the quality of life of refugee women arriving in Germany in 2015–2016.MethodsSix hundred sixty-three women from six countries (Afghanistan, Syria, Iran, Iraq, Somalia, and Eritrea) living in shared reception facilities in five distinct German regions were interviewed by native speakers using a structured questionnaire. Sociodemographic data and information about reasons for fleeing, traumatic experiences, symptoms, quality of life, and expectations towards their future were elicited. All information was stored in a central database in Berlin. Descriptive analyses, correlations, and multivariate analyses were performed.ResultsThe most frequent reasons cited for fleeing were war, terror, and threat to one’s life or the life of a family member. Eighty-seven percent of women resorted to smugglers to make the journey to Europe, and this significantly correlated to residence in a war zone (odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.4–4.6, p = 0.003) and homelessness prior to fleeing (OR = 2.1, 95% CI = 1–4.3, p = 0.04). Overall the described quality of life by the women was moderate (overall mean = 3.23, range of 1–5) and slightly worse than that of European populations (overall mean = 3.68, p < 0.0001). The main reasons correlating with lower quality of life were older age, having had a near-death experience, having been attacked by a family member, and absence of health care in case of illness.ConclusionsRefugee women experience multiple traumatic experiences before and/or during their journey, some of which are gender-specific. These experiences affect the quality of life in their current country of residence and might impact their integration. We encourage the early investigation of these traumatic experiences to rapidly identify women at higher risk and to improve health care for somatic and mental illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-1003-5) contains supplementary material, which is available to authorized users.

Psychische Symptombelastung bei Asylsuchenden in Abhängigkeit vom Aufenthaltsstatus

“…Am häufigsten lag eine krankheitswertige depressive Symptomatik vor. Diese Ergebnisse entsprechen denen von Zimbrean [22] und liegen deutlich über den Resultaten der Untersuchung von van Melle et al [17,69].…”

Differences in pregnancy outcomes and obstetric care between asylum seeking and resident women: a cross-sectional study in a German federal state, 2010–2016

“…Several factors across the migration trajectory, ranging from pre- and peri-migration factors to the conditions in the destination country can be associated with the high level of abortions and stillbirths. The lack of adequate health services in the country of origin, perilous migration journeys and near-death experiences, as well as the living conditions in reception centers are experienced as very stressful for asylum seeking women in Germany, affecting their health-related quality of life [ 14 ]. Frequent dispersals before reaching the final reception center may also contribute to adverse outcomes and interrupt the continuity of care leading to severe consequences for health and well-being of pregnant women seeking asylum [ 15 , 16 ].…”

“…A higher risk of abortive outcomes and stillbirths in asylum seeking women that goes unnoticed by the health system can be regarded as an uncounted toll of forced migration. A wide range of individual circumstances (such as socio-economic status), but also adverse experiences before and during flight [ 14 ] can be associated with such negative birth outcomes. However, the post-migration phase is a critical period in which individual risk factors and prior experiences can be mitigated or exacerbated.…”

Psychiatrische Begutachtung in asyl- bzw. ausländerrechtlichen Verfahren

“…Doch zum einen kann die Diagnose einer PTBS allenfalls nur ein Indiz für eine Traumatisierung im Heimatland sein, denn sie kann auch auf ein anderes Traumaerlebnis zurückgehen bzw. auch während oder nach der Migration erfolgt sein [7]. Die Gewichtung dieses Indizes ist die Aufgabe der Behörde bzw.…”