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

Abstract

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.

A Walk-In Clinic for Newly Arrived Mentally Burdened Refugees: The Patient Perspective

“…The symptoms described by the respondents can be seen as part of their mental illnesses, such as PTSD, depression, and adjustment disorder. Especially somatic symptoms, like heart pain or heart excitement (see Reference [ 36 ]), can often be somatic manifestations of the patient’s world of affective experience. Our data suggests that our interviewees had a high awareness of mental illness as well as good symbolization abilities and did not seem impeded by the various reasons previously named to explain high somatization rates in refugee populations, which include social and cultural acceptability, fear of stigma, somatic rather than psychological symptom expression, somatization as a cultural sign of distress, and alexithymia [ 38 ].…”

“…This is in line with previous findings in which refugees have named past and flight-related experiences as well as stressful aspects of the current life situation as causes for their poor mental health [ 35 , 39 , 40 , 41 , 42 ]. For instance, in Zbidat et al’s study [ 36 ], symptoms of insomnia or fatigue were linked to events like loss of one’s family, possessions, and home. Further, post-migratory distress factors were associated with enhanced vulnerability for mental health problems [ 43 , 44 , 45 ].…”

Traumatized Syrian Refugees with Ambiguous Loss: Predictors of Mental Distress

“…Given that the whereabouts of many family members of Syrian refugees is unclear, family separation and ambiguous loss are probably closely connected in this population. Family separation was described as important mental health stressor before [ 5 , 6 ], hence, an investigation of the relationship between family separation and boundary ambiguity could contribute to a better understanding of AL in refugee populations. A group comparison between refugees who have experienced confirmed loss and ambiguous loss would be a further step towards understanding the impact of AL on mental health.…”

“…A link between separation from marital partners and lower quality of life is reported in a study of Syrian refugees in Germany [ 5 ]. In addition, some affected persons describe the separation from the family as “traumatizing” [ 6 ]. However, to our knowledge, there are no reliable figures on how many refugees in Germany have missing relatives.…”

Somatic distress among Syrian refugees in Germany: analysis of a cross-sectional register-based study

“…Syrian refugees represent the largest refugee population in Germany and have already been subject of several studies regarding common mental disorders, except for SOD (9,13,35,36). A major result of a qualitative study by our working group on Syrian refugees was evidence of somatization in half of the participants (37). Based on this nding, we expected that SOD occurs frequently in this refugee population.…”