Posttraumatic stress disorder and comorbid depression among refugees: Assessment of a sample from a German refugee reception center

Belz, Maria; Belz, Michael; Özkan, İbrahim; Graef-Calliess, Iris Tatjana

doi:10.1177/1363461517745473

Cited by 35 publications

(22 citation statements)

References 33 publications

(47 reference statements)

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“…Interestingly, mental health conditions were not highly prevalent in our refugee population despite the many reports indicating their prevalence among refugees, especially the ones displaced by wars [37–41]. Post-Traumatic Stress Disorder (PTSD) [38, 39], anxiety, depression [40], and somatization [41] were among the common conditions afflicting refugees. In a meta-analysis by Bogic et al, the prevalence of depression ranged between 2.3–80%; PTSD was found in 4.4–86%, and anxiety disorder fell in the 20.3–88% range [37].…”

Section: Discussionmentioning

confidence: 91%

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them

Adel

Bernstein

Tcheyan³

et al. 2019

PLoS ONE

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Objective The recent refugee crisis has resulted in the largest burden of displacement in history, with the US being the top resettlement country since 1975. Texas welcomed the second most US-bound refugees in 2016, with a large percentage arriving in San Antonio. Yet, the composition of the San Antonio refugees has not been described and their healthcare needs remain ill-defined. Through this study, we aim at elucidating their demographics and healthcare profiles, with the goal of devising recommendations to help guide refugee program development and guide other refugee resettlement programs. Methods Data from 731 charts belonging to 448 patients at the San Antonio Refugee Health Clinic (SARHC) were extracted and analyzed. Data included age, gender, country of origin, first language, interpretation need, health insurance status, medical history, vital signs, diagnoses, and prescribed medications. Results Women constituted the majority of patients (n = 267; 56.4%), and the median age of all patients was 39 (Q1:26, Q3:52). Nepali-speaking Bhutanese patients were the most represented group (n = 107, 43.1%), followed by Iraqi (n = 35, 14.1%), Burmese (n = 30, 12.1%), and Iranian (n = 19, 7.7%) refugees. Of those who responded, 200 (86.6%) did not have any form of health insurance. Additionally, 262 (50.9%) had a body-mass index (BMI) in the overweight or obese range. Further, 61.4% (n = 337) had blood pressures in the hypertensive range, while 9.3% (n = 51) had an elevated blood pressure. On average, each patient had 1.9 complaints, with abdominal pain, headaches, and cough being the predominant complaints. Allergic rhinitis, viral upper respiratory infections, and elevated blood pressure were the most common diagnoses. However, the list of common diagnoses differed per country of origin. Conclusion The SARHC demographics were different from those of other Texas refugees. The rate of the uninsured and the burden of non-communicable diseases were high. Furthermore, each refugee subgroup had a different set of common problems. These findings reveal important considerations for refugee healthcare providers and the unique approach that may be required for different communities.

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Section: Discussionmentioning

confidence: 91%

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them

Adel

Bernstein

Tcheyan³

et al. 2019

PLoS ONE

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“…Therefore, the relatively low amount of mental health problems in our sample is likely an underestimation. Studies that used screening instruments for mental health problems estimated a much higher prevalence of depression, PTSD, and somatisation in asylum seekers [ 5 , 33 ]. Although the investigated PCWC was deemed “low-threshold” in terms of availability of GPs and interpreters, we propose that personal barriers of refugee seekers could also play a role.…”

Section: Discussionmentioning

confidence: 99%

Episodes of care in a primary care walk-in clinic at a refugee camp in Germany – a retrospective data analysis

et al. 2020

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Background From 2015 to 2016 Germany faced an influx of 1.16 million asylum seekers. In the state of Hamburg Primary Care walk-in clinics (PCWC) were commissioned at refugee camps because the high number of residents (57,000 individuals) could not be provided with access to regular healthcare services. Our study aims were (1) to describe the utilization of a PCWC by camp residents, (2) to compare episodes of continuous care with shorter care episodes and (3) to analyse which diagnoses predict episodes of continuous care in this setting. Methods A retrospective longitudinal observational study was conducted by reviewing all anonymized electronic medical records of a PCWC that operated from 4th November 2015 to 22nd July 2016 at a refugee camp in Hamburg. Episodes of care (EOC) were extracted based on the international classification of primary care-2nd edition (ICPC-2). Outcome parameters were episode duration, principal diagnoses, and medical procedures. Results We analysed 5547 consultations of 1467 patients and extracted 4006 EOC. Mean patient age was 22.7 ± 14.8 years, 37.3% were female. Most common diagnoses were infections (44.7%), non-communicable diseases (22.2%), non-definitive diagnoses describing symptoms (22.0%), and injuries (5.7%). Most patients (52.4%) had only single encounters, whereas 19.8% had at least one EOC with a duration of ≥ 28 days (defined as continuous care). Several procedures were more prevalent in EOC with continuous care: Blood tests (5.2 times higher), administrative procedures (4.3), imaging (3.1) and referrals to secondary care providers (3.0). Twenty prevalent ICPC-2-diagnosis groups were associated with continuous care. The strongest associations were endocrine/metabolic system and nutritional disorders (hazard ratio 5.538, p < 0.001), dermatitis/atopic eczema (4.279, p < 0.001) and psychological disorders (4.056, p < 0.001). Conclusion A wide spectrum of acute and chronic health conditions could be treated at a GP-led PCWC with few referrals or use of medical resources. But we also observed episodes of continuous care with more use of medical resources and referrals. Therefore, we conclude that principles of primary care like continuity of care, coordination of care and management of symptomatic complaints could complement future healthcare concepts for refugee camps.

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“…In a recent study, a prevalence rate of 40% for PTSD was observed among asylum seekers in Germany [10]. Another recent study of refugees in a German reception facility showed that the vast majority of participants suffer from PTSD, which is often comorbid with depression [11]. Another study in a reception facility detected one or more mental disorders (especially PTSD and depression) among refugees [12].…”

Section: Introductionmentioning

confidence: 98%

“…In German-speaking countries, there are hardly any studies on the highly heterogeneous refugee populations. Existing studies focus mainly on the prevalence rates of depression, PTSD, and generalized anxiety disorder [10][11][12][13]. There is, however, a major research deficit in the area of qualitative studies and coping strategies.…”

Section: Introductionmentioning

confidence: 99%

The Perceptions of Trauma, Complaints, Somatization, and Coping Strategies among Syrian Refugees in Germany—A Qualitative Study of an At-Risk Population

Zbidat

Georgiadou

Borho

et al. 2020

IJERPH

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Background: A high prevalence of mental distress, especially posttraumatic stress disorder, has been widely confirmed among refugees. In order to establish adequate interventions in psychotherapy, however, it must first be examined whether refugees have similar ideas and concepts of stress, trauma, and healing. This study, therefore, aimed to analyze the representations of trauma, self-reported complaints, indications of somatization, and coping strategies among a refugee population. Methods: Semi-structured interviews based on the Cultural Formulation Interview (CFI) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were conducted with Syrian refugees who have residence permission in Germany. The interviews were audio-recorded, transcribed, and analyzed according to the qualitative content analysis of Mayring. The foci of interest were determined on the basis of the predefined interview guideline, and inductive subcategories were extracted from the transcripts. Results: Sixteen refugees participated (50% women; mean age: 35.5 years, SD = 11.2; the mean duration of stay in Germany: 23.3 months, SD = 6.6). War experiences were the most frequently reported subjective perceptions of trauma. Frequently reported complaints included sleeping disturbance, cardiovascular symptoms, rumination, and pain. Among half of the participants, we found indications of somatization. We identified the following coping strategies: Activity, cognitive coping, social coping, religious coping, avoidance, and emotional coping. Conclusions: War-related traumatic events are the most common trauma perceptions among Syrian refugees. The self-reported complaints demonstrate somatoform, depressive, and posttraumatic symptoms. Syrian refugees should be screened for somatization, depression, and posttraumatic stress disorder and should receive targeted interventions that consider and support individual coping resources.

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Posttraumatic stress disorder and comorbid depression among refugees: Assessment of a sample from a German refugee reception center

Cited by 35 publications

References 33 publications

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them

San Antonio refugees: Their demographics, healthcare profiles, and how to better serve them

Episodes of care in a primary care walk-in clinic at a refugee camp in Germany – a retrospective data analysis

The Perceptions of Trauma, Complaints, Somatization, and Coping Strategies among Syrian Refugees in Germany—A Qualitative Study of an At-Risk Population

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