Transkulturelle Aspekte der Psychotherapie: Psychotherapiemotivation und die Erfassung von Depressivität bei Patienten mit Migrationshintergrund

The present dissertation focuses on issues of transcultural clinical psychology and comprises three separate studies. There is one study on measurement methodological basics, one cultural comparison study and one study regarding migrant and minority health. All studies focus on Turkish immigrants, which represent the largest ethnic minority in Germany (17.6% of all immigrants). The first study investigates the cross-cultural and cross-linguistic comparability of the PHQ-9, one of the most frequently used screening questionnaires on depression worldwide. Item Response Theory-models are used to examine whether the German and Turkish versions of the PHQ-9 are comparable between Turkish immigrants and Germans without a migration background. For this purpose, data from previous studies is collected and reanalyzed. The analyses show that there are some differences in item functioning between groups. However, these differences do not have a significant influence on scale level. Hence, PHQ-9 sum scores can be compared between Turkish immigrants and Germans without a migration background without any adjustments, regardless of whether they complete the German or the Turkish version. The second and third study are concerned with motivation for psychotherapy. Since there have been complaints about difficulties in the psychotherapeutic treatment of patients with a Turkish migration background, this is an especially relevant topic. Consequently, these studies are conducted with clinical samples of inpatients with a primary depressive, somatoform, anxiety, or adjustment disorder. Study II is a cultural comparison study examining differences in motivation for psychotherapy and illness beliefs between inpatients with a Turkish migration background and inpatients without a migration background. The results show that motivation for psychotherapy and internal control beliefs are lower in Turkish immigrant inpatients than in the control group, while external-fatalistic control beliefs and fatalistic and supernatural illness attributions are higher in Turkish immigrant inpatients compared to the control group. Based on these findings, the third study aims at the development of a culturally adapted intervention to engage Turkish immigrant inpatients in psychotherapy at the beginning of treatment. The intervention is web-based and applies principles of Motivational Interviewing and Ethnographic Interviewing. A pilot RCT assesses feasibility and usefulness of the engagement intervention in Turkish immigrant inpatients. The engagement intervention is rated better than the control condition (web-based progressive muscle-relaxation). In particular, participants feel better prepared for therapy after working with the engagement intervention. By working with the engagement intervention, self-efficacy increases and external-fatalistic control beliefs diminish. By using methodologically diverse studies, the present work contributes novel findings to transcultural clinical psychology as it offers an intercultural validation of the German and Turkish versions of the PHQ-9, and presents first encouraging results regarding the feasibility and usefulness of a culturally adapted engagement intervention.