Psychische Belastungen bei Geflüchteten - Prävalenzen, Prädiktoren und Behandlungsansätze

The overall goal of this doctoral thesis is to provide the reader with comprehensive insight into the scientific field of mental health in refugees and thus to derive specific implications for prevention and targeted treatment measures. First we conducted a meta analyses on symptoms of PTSD and depression among refugees in Germany (Study I). Reported prevalence rates were notably large and by far exceeded the prevalence in the general population. However, heterogeneity was large within and between subgroups. To reduce this heterogeneity and identify high-risk subgroups we compared unaccompanied refugee minors (URM) to accompanied refugee minors (ARM) regarding depressive symptoms and mental distress (Study III). Results confirmed URM as a high-risk subgroup within the refugee population, which should receive particular attention and more targeted measures by health authorities. To gain broad insight in the driving forces of symptomdevelopment among URM, we evaluated and summarized findings on associated factors to URM mental health by conducting a systematic review (Study II). Qualitative synthesis revealed the number of stressful life events to be the most evaluated and verified risk factor. Social support, on the other hand, can protect UMR from developing poor mental health. Besides that, several other influencing factors were pointed out, such as type of accommodation, family contact, gender and cultural competences. In a next step, we aimed to investigate all relevant associated factors and sequence them according their impact on the basis of a large sample of URM in Germany (Study III). To achieve this, we created a screening tool (MEHIRA-SQ) comprising all relevant associated factors identified in our previous systematic review. Results indicate that mental health measures should comprise a rapid promotion of family contact, school attendance, language acquisition and the fast processing of asylum applications. Despite the epidemiological relevance, the access and success of psychological treatment has been shown to be very challenging. To address the increasing demand for suitable mental health services, we investigated whether a culturalsensitive stepped care model (SCM) will reduce symptoms of depression and PTSD in young refugees more effectively and efficiently than treatment as usual (Study IV). Although our SCM did not prove to be more effective in symptom change, it represented a more cost-efficient treatment alternative. In addition, subgroup-analyses revealed disorder-specific intervention effects. Thus, our findings contribute to the optimization of clinical productivity and the improvement of therapeutic care for mentally burdened adolescent refugees.