The mental health of refugees and asylum seekers in Germany - Applying transcultural methods and considering intersectional aspects in clinical research
Background: Among immigrants in Germany, refugees and asylum seekers represent a particularly vulnerable sub-population that is at high risk of developing depression and symptoms of post-traumatic stress disorder (PTSD). Research on culturally sensitive mental health care for this group is urgently...
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|Summary:||Background: Among immigrants in Germany, refugees and asylum seekers represent a particularly vulnerable sub-population that is at high risk of developing depression and symptoms of post-traumatic stress disorder (PTSD). Research on culturally sensitive mental health care for this group is urgently needed but still limited.
The general aim: The present dissertation focuses on the mental health of refugees and asylum seekers in Germany by conducting three different studies. The research questions are concerned with the assessment of depression among refugees and asylum seekers (study I), and the investigation of explanatory models of PTSD among asylum seekers from Sub-Saharan Africa (studies II & III).
Methods: To this end, the studies apply key methodological approaches of transcultural clinical research, such as a measurement invariance analysis (study I), a qualitative-quantitative methodological triangulation, the combined emic–etic approach, and the explanatory model approach (studies II & III). Intersectional aspects such as gender, education, age, and religion were taken into consideration while analyzing the data (studies II & III).
Study I: The first study investigates the measurement invariance of the Patient Health Questionnaire-9 (PHQ-9), a widely used screening instrument for depression. Data from asylum seekers living in Germany and Germans without a migration background was analyzed. Configural, scalar, and metric invariance was investigated, and test functioning was determined. The analyses show that the PHQ-9 is not measurement invariant across both groups and differences were found regarding metric and scalar invariance. The results demonstrate that, even with the same latent level of depression, asylum seekers may have higher scores on several items and, consequently, a higher sum score.
Studies II & III: The second and third studies are concerned with explanatory models of PTSD among asylum seekers from Sub-Saharan Africa, predominantly asylum seekers from Eritrea, Somalia, and Cameroon. Following the combined emic-etic approach, quantitative and qualitative methodological triangulation strategies were applied in both studies, analyzing data derived from a questionnaire survey and focus group discussions. In study II, we focused on beliefs about causes of PTSD. Quantitative analyses demonstrated that asylum seekers predominantly attributed symptoms to psychological and religious causes, and rather disagreed on supernatural causes. Compared to the sample of
Germans without a migration background, asylum seekers attributed symptoms less strongly to terrible experiences, but more strongly to religious and supernatural causes. Qualitative analyses identified six attribution categories of participants’ causal beliefs: (a) traumatic life experiences, (b) psychological causes, (c) social causes, (d) post-migration stressors, (e) religious causes, and (f) supernatural causes. In study III, we focused on help-seeking intentions and lay beliefs about cures. Quantitative analyses demonstrated that asylum seekers showed high intentions to seek religious, medical, and psychological treatment. They indicated higher preferences for seeking help from religious authorities and general practitioners, and lower preferences for enlisting psychological and traditional help sources compared to the German group. Moreover, asylum seekers addressed structural and cultural barriers to seeking medical and psychological treatment.
Concluding remarks: By considering thematically multifaceted and methodologically diverse studies, the present dissertation emphasizes that refugees and asylum seekers need special consideration in transcultural clinical research and mental health care. The findings underline that special awareness for the needs of refugees and asylum seekers is important in terms of the culturally-sensitive adaptation of assessment instruments and treatment practices. When diagnosing and treating asylum seekers and refugees of diverse cultural backgrounds, practitioners should explore different demographic, religious, and cultural frameworks for healing and recovery in order to signal understanding and acceptance of varying cultural contexts and the intersectionality of influences on mental health and illness.|
|Physical Description:||85 Pages|