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Psychiatr Prax 2019; 46(04): 191-199
DOI: 10.1055/a-0806-3568
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Psychische Symptombelastung bei Asylsuchenden in Abhängigkeit vom Aufenthaltsstatus

The Influence of Residence Status on Psychiatric Symptom Load of Asylum Seekers in Germany
Johanna G. Winkler
1   Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus Berlin
,
Eva J. Brandl
1   Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus Berlin
3   Berlin Institute of Health (BIH)
,
H. Joachim Bretz
1   Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus Berlin
,
Andreas Heinz
2   Klinik für Psychiatrie und Psychotherapie, CCM, Charité – Universitätsmedizin Berlin
,
Meryam Schouler-Ocak
1   Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
12. Dezember 2018 (online)

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Zusammenfassung

Ziele der Studie Untersuchung der Sicht von Asylbewerbern auf rechtliche Situation, Asylverfahren und Lebensbedingungen und deren Einfluss auf psychische Belastungen.

Methode 650 Asylbewerber in Berlin erhielten einen Fragebogen.

Ergebnisse 76,3 % (N = 496) beantworteten den Fragebogen vollständig. Von diesen hatten 74,6 % Symptome einer psychischen Erkrankung, und dies mit signifikantem Zusammenhang zu unsicherem Aufenthaltsstatus. Sehr belastete Personen nahmen Hilfsangebote, integrationsfördernde Maßnahmen und ihre Rechte im Asylverfahren weniger wahr. In unserer Stichprobe befanden sich nur 11,6 % der Asylbewerber mit krankheitswertiger psychischer Symptomatik in psychiatrischer Behandlung.

Schlussfolgerung Die Daten zeigen die hohe Relevanz psychischer Belastungen bei Geflüchteten.

Abstract

Background The aim of this study was to assess asylum seekersʼ views on their legal situations, asylum procedures and living conditions, and the relationship of these factors towards psychological stress.

Methods 650 asylum seekers in Berlin received a questionnaire.

Results 76,3 % (N = 496) completed the questionnaires in full. According to psychological test criteria, 74,6 % (N = 370) of these respondents indicated symptoms of mental disorders. There were significant correlations between insecure residency status and these symptoms. Respondents with higher symptom load took less advantage of support, participated less in measures designed to assist integration, and described more difficulties in their hearing. Only 11.6 % out of the asylum seekers with mental Illness indicating symptoms in our sample were under psychiatric treatment.

Conclusion Our data emphazise the high relevance of mental health burden among refugees.

Schlüsselwörter

Geflüchtete/Asylbewerber - psychiatrische Erkrankung - psychosozialer Stress - Asylstatus - Suizidalität

Keywords

refugees/asylum seekers - psychiatric disorder - psychosocial stress - asylum status - suicidality
 

  • Literatur

  • 1 Richter K, Lehfeld H, Niklewski G. Waiting for Asylum: Psychiatric Diagnosis in Bavarian Admission Center. Gesundheitswesen 2015; 77: 834-838
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 2 Ben Farhat J, Blanchet K, Juul Bjertrup P. et al. Syrian refugees in Greece: experience with violence, mental health status, and access to information during the journey and while in Greece. BMC Medicine 2018; 16: 40
    CrossrefPubMedGoogle Scholar
  • 3 Belz M, Belz M, Özkan I. et al. Posttraumatic stress disorder and comorbid depression among refugees: Assessment of a sample from a German refugee reception center. Transcult Psychiatry 2017; 54: 595-610
    CrossrefPubMedGoogle Scholar
  • 4 Craig T, Jajua PM, Warfa N. Mental health care needs of refugees. Psychiatry 2009; 8: 351-354
    CrossrefPubMedGoogle Scholar
  • 5 Steel Z, Chey T, Silove D. et al. Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis. JAMA 2009; 302: 537-549
    CrossrefPubMedGoogle Scholar
  • 6 Ullmann E, Barthel A, Taché S. et al. Emotional and psychological trauma in refugees arriving in Germany in 2015. Molecular Psychiatry 2015; 20: 1483
    CrossrefPubMedGoogle Scholar
  • 7 Teodorescu D-S, Heir T, Siqveland J. et al. Chronic pain in multi-traumatized outpatients with a refugee background resettled in Norway: a cross-sectional study. BMC Psychol 2015; 3: 7
    CrossrefPubMedGoogle Scholar
  • 8 Nejad RM, Klöhn-Saghatolislam F, Hasan A. et al. Seelische Spuren der Flucht. MMW – Fortschritte der Medizin 2017; 159: 64-66
    PubMedGoogle Scholar
  • 9 Böttche M, Heeke C, Knaevelsrud C. Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsbl 2016; 59: 621-626
    CrossrefPubMedGoogle Scholar
  • 10 Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights 2015 15. Im Internet: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624599/
    PubMedGoogle Scholar
  • 11 Dapunt J, Kluge U, Heinz A. Risk of psychosis in refugees: a literature review. Transl Psychiatry 2017; 7: e1149
    CrossrefPubMedGoogle Scholar
  • 12 Georgiadou E, Morawa E, Erim Y. High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany. Int J Environ Res Public Health 2017; 14 DOI: 10.3390/ijerph14060612.
    CrossrefPubMedGoogle Scholar
  • 13 Heeren M, Mueller J, Ehlert U. et al. Mental health of asylum seekers: a cross-sectional study of psychiatric disorders. BMC Psychiatry 2012; 12: 114
    CrossrefPubMedGoogle Scholar
  • 14 Tinghög P, Malm A, Arwidson C. et al. Prevalence of mental ill health, traumas and postmigration stress among refugees from Syria resettled in Sweden after 2011: a population-based survey. BMJ Open 2017; 7: e018899
    CrossrefPubMedGoogle Scholar
  • 15 Chen W, Ling L, Renzaho AMN. Building a new life in Australia: an analysis of the first wave of the longitudinal study of humanitarian migrants in Australia to assess the association between social integration and self-rated health. BMJ Open 2017; 7: e014313
    CrossrefPubMedGoogle Scholar
  • 16 Firenze A, Aleo N, Ferrara C. et al. The Occurrence of Diseases and Related Factors in a Center for Asylum Seekers in Italy. Zdr Varst 2016; 55: 21-28
    PubMedGoogle Scholar
  • 17 Zimbrean P. Risk Factors and Prevalence of Mental Illness in Refugees. In: Annamalai A. Hrsg. Refugee Health Care: An Essential Medical Guide. New York, NY: Springer; 2014: 149-162 Im Internet: https://doi.org/10.1007/978-1-4939-0271-2_11
    CrossrefGoogle Scholar
  • 18 Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet 2005; 365: 1309-1314
    CrossrefPubMedGoogle Scholar
  • 19 Priebe S, Giacco D, El-Nagib R. Public Health Aspects of Mental Health Among Migrants and Refugees: A Review of the Evidence on Mental Health Care for Refugees, Asylum Seekers and Irregular Migrants in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2016. Im Internet: http://www.ncbi.nlm.nih.gov/books/NBK391045/
    Google Scholar
  • 20 Keller A, Joscelyne A, Granski M. et al. Pre-Migration Trauma Exposure and Mental Health Functioning among Central American Migrants Arriving at the US Border. PLoS One 2017 12. Im Internet: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5224987/
    PubMedGoogle Scholar
  • 21 Kalt A, Hossain M, Kiss L. et al. Asylum Seekers, Violence and Health: A Systematic Review of Research in High-Income Host Countries. Am J Public Health 2013; 103: e30-e42
    PubMedGoogle Scholar
  • 22 Jesuthasan J, Sönmez E, Abels I. et al. Female Refugee Study (FRS) Investigators. Near-death experiences, attacks by family members, and absence of health care in their home countries affect the quality of life of refugee women in Germany: a multi-region, cross-sectional, gender-sensitive study. BMC Med 2018; 16: 15
    CrossrefPubMedGoogle Scholar
  • 23 Hynie M. The Social Determinants of Refugee Mental Health in the Post-Migration Context: A Critical Review. Can J Psychiatry 2018; 63: 297-303
    CrossrefPubMedGoogle Scholar
  • 24 Bouhenia M, Farhat JB, Coldiron ME. et al. Quantitative survey on health and violence endured by refugees during their journey and in Calais, France. Int Health 2017; 9: 335-342
    CrossrefPubMedGoogle Scholar
  • 25 Li M, Anderson JG. Pre-migration Trauma Exposure and Psychological Distress for Asian American Immigrants: Linking the Pre- and Post-migration Contexts. J Immigrant Minority Health 2016; 18: 728-739
    CrossrefPubMedGoogle Scholar
  • 26 Coffey GJ, Kaplan I, Sampson RC. et al. The meaning and mental health consequences of long-term immigration detention for people seeking asylum. Soc Sci Med 2010; 70: 2070-2079
    CrossrefPubMedGoogle Scholar
  • 27 Laban CJ, Gernaat HBPE, Komproe ICH. et al. Postmigration living problems and common psychiatric disorders in Iraqi asylum seekers in the Netherlands. J Nerv Ment Dis 2005; 193: 825-832
    CrossrefPubMedGoogle Scholar
  • 28 Erim Y, Morawa E. Psychotherapy with Immigrants and Traumatized Refugees. Psychother Psychosom Med Psychol 2016; 66: 397-409
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 29 Müller MJ, Zink S, Koch E. The Negative Impact of an Uncertain Residence Status: Analysis of Migration-Related Stressors in Outpatients with Turkish Migration Background and Psychiatric Disorders in Germany Over a 10-Year Period (2005–2014). J Immigr Minor Health 2018; 20: 317-326
    CrossrefPubMedGoogle Scholar
  • 30 Bellamy K, Ostini R, Martini N. et al. Access to medication and pharmacy services for resettled refugees: a systematic review. Aust J Prim Health 2015; 21: 273-278
    CrossrefPubMedGoogle Scholar
  • 31 Aichberger MC, Bromand Z, Rapp MA. et al. Perceived ethnic discrimination, acculturation, and psychological distress in women of Turkish origin in Germany. Soc Psychiatry Psychiatr Epidemiol 2015; 50: 1691-1700
    CrossrefPubMedGoogle Scholar
  • 32 Stotz SJ, Elbert T, Müller V. et al. The relationship between trauma, shame, and guilt: findings from a community-based study of refugee minors in Germany. Eur J Psychotraumatol 2015; 6: 25863
    PubMedGoogle Scholar
  • 33 Chu T, Keller AS, Rasmussen A. Effects of post-migration factors on PTSD outcomes among immigrant survivors of political violence. J Immigr Minor Health 2013; 15: 890-897
    CrossrefPubMedGoogle Scholar
  • 34 Böttche M, Heeke C, Knaevelsrud C. Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsbl 2016; 59: 621-626
    CrossrefPubMedGoogle Scholar
  • 35 Schick M, Zumwald A, Knöpfli B. et al. Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees. Eur J Psychotraumatol 2016; 7: 28057
    PubMedGoogle Scholar
  • 36 Hocking DC, Kennedy GA, Sundram S. Social factors ameliorate psychiatric disorders in community-based asylum seekers independent of visa status. Psychiatry Res 2015; 230: 628-636
    CrossrefPubMedGoogle Scholar
  • 37 Lamkaddem M, Essink-Bot M-L, Devillé W. et al. Health changes of refugees from Afghanistan, Iran and Somalia: the role of residence status and experienced living difficulties in the resettlement process. Eur J Public Health 2015; 25: 917-922
    CrossrefPubMedGoogle Scholar
  • 38 Hanewald B, Gieseking J, Vogelbusch O. et al. Asylum Law and Mental Health: An Interdisciplinary Analysis of the Coaction of Medical and Legal Aspects. Psychiat Prax 2016; 43: 165-171
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 39 Schaffrath J, Schmitz-Buhl M, Gün A. et al. Psychiatrisch-psychotherapeutische Versorgung von Geflüchteten am Beispiel eines großen psychiatrischen Versorgungskrankenhauses im Rheinland. PPmP – Psychotherapie · Psychosomatik · Medizinische Psychologie 2016; 67: 126-133
    PubMedGoogle Scholar
  • 40 Steel Z, Momartin S, Silove D. et al. Two year psychosocial and mental health outcomes for refugees subjected to restrictive or supportive immigration policies. Social Science & Medicine 2011; 72: 1149-1156
    CrossrefPubMedGoogle Scholar
  • 41 Lindert J, Schouler-Ocak M, Heinz A. et al. Mental health, health care utilisation of migrants in Europe. Eur Psychiatry 2008; 23 (Suppl. 01) 14-20
    CrossrefPubMedGoogle Scholar
  • 42 Ward C, Rana-Deuba A. Acculturation and Adaptation Revisited. Journal of Cross-cultural Psychology – J CROSS-CULT PSYCHOL 1999; 30: 422-442
    PubMedGoogle Scholar
  • 43 Hopkins Symptom Checklist (HSCL). Harvard Program in Refugee Trauma 2011. Im Internet: http://hprt-cambridge.org/screening/hopkins-symptom-checklist/ Stand: 18.06.18
    Google Scholar
  • 44 Petermann F, Brähler E. HSCL-25. Hopkins-Syptom-Checkliste-25. Deutsche Version. Manual. Göttingen, Bern, Wien: Hogrefe; 2013: 7
    Google Scholar
  • 45 Franke G. SCL-90®-S Symptom-checkliste-90®-Standard: Manual. Göttingen, Bern, Wien: Hogrefe; 2014: 17-19
    Google Scholar
  • 46 Franke G. SCL-90®-S Symptom-checkliste-90®-Standard: Manual. Göttingen, Bern, Wien: Hogrefe; 2014: 25-35
    Google Scholar
  • 47 Nosikov A, Gudex C. EUROHIS – developing common instruments for health surveys. WHO Europe. Amsterdam, Berlin, Oxford: IOS Press; 2003: VII, 5
    Google Scholar
  • 48 Power M. Development of a common instrument for quality of life. In: Nosikov A, Gudex C. EUROHIS – Developing Common Instruments For Health Surveys. WHO Europe. Amsterdam, Berlin, Oxford: IOS Press; 2003: 145-152
    Google Scholar
  • 49 Foa E. Posttraumatic stress diagnostic scale. Manual. Minneapolis, MN: Pearson; 1995. 1 u 15
    Google Scholar
  • 50 McCarthy S. Post-traumatic Stress Diagnostic Scale (PDS). Occup Med (Lond) 2008; 58: 379
    CrossrefPubMedGoogle Scholar
  • 51 Harvard Trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma 2011. Im Internet: http://hprt-cambridge.org/screening/harvard-trauma-questionnaire/ Stand: 16.03.2017
    Google Scholar
  • 52 Home | Psychotraumadiagnostics Stichting Centrum ’45. Im Internet: http://www.psychotraumadiagnostics.centrum45.nl/en/home Stand: 17.03.2017
  • 53 BAMF – Bundesamt für Migration und Flüchtlinge. Publikationen – Das Bundesamt in Zahlen 2016. Im Internet: http://www.bamf.de/SharedDocs/Anlagen/DE/Publikationen/Broschueren/bundesamt-in-zahlen-2016.pdf?__blob=publicationFile Stand 23.09.2017
    Google Scholar
  • 54 Brandl EJ, Dietrich N, Mell N. et al. Clinical and sociodemographic Differences Between Patients with and without Migration Background in a Psychiatric Outpatient Service. Psychiat Prax 2018; 45: 367-374
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 55 Böttche M, Stammel N, Knaevelsrud C. Psychotherapeutic treatment of traumatized refugees in Germany. Nervenarzt 2016; 87: 1136-1143
    CrossrefPubMedGoogle Scholar
  • 56 Schouler-Ocak M. [Mental health care for immigrants in Germany]. Nervenarzt 2015; 86: 1320-1325
    CrossrefPubMedGoogle Scholar
  • 57 Spura A, Kleinke M, Robra B-P. et al. How do asylum seekers experience access to medical care?. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 462-470
    CrossrefPubMedGoogle Scholar
  • 58 Claassen K, Jäger P. Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany. International Journal of Environmental Research and Public Health 2018; 15: 856
    CrossrefPubMedGoogle Scholar
  • 59 Frenk J, Gómez-Dantés O, Moon S. From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence. The Lancet 2014; 383: 94-97
    CrossrefPubMedGoogle Scholar
  • 60 Bäärnhielm S, Jávo C, Mösko M-O. Opening up mental health service delivery to cultural diversity: current situation, development and examples from three northern European countries. Adv Psychosom Med 2013; 33: 40-55
    PubMedGoogle Scholar
  • 61 Ostrander J, Melville A, Berthold S. Working With Refugees in the U.S.: Trauma-Informed and Structurally Competent Social Work Approaches. 1. April 2017; Im Internet: Social Work Faculty Publications [Internet]; http://digitalcommons.sacredheart.edu/socwk_fac/30 Stand: 17.06.2018
    Google Scholar
  • 62 Kaltenbach E, Härdtner E, Hermenau K. et al. Efficient identification of mental health problems in refugees in Germany: the Refugee Health Screener. Eur J Psychotraumatol 2017; 8: 1389205
    PubMedGoogle Scholar
  • 63 Stingl M, Knipper M, Hetzger B. et al. Assessing the special need for protection of vulnerable refugees: testing the applicability of a screening method (RHS-15) to detect traumatic disorders in a refugee sample in Germany. Ethn Health 2017; DOI: 10.1080/13557858.2017.1379598. [download am 01.12.2018]
    CrossrefPubMedGoogle Scholar
  • 64 Morina N, Ewers SM, Passardi S. et al. Mental health assessments in refugees and asylum seekers: evaluation of a tablet-assisted screening software. Confl Health 2017; 11: 18
    CrossrefPubMedGoogle Scholar
  • 65 Bohus M, Missmahl I. Implementation of alternative treatment models for refugees in Germany : What can and what should we learn from Afghanistan?. Nervenarzt 2017; 88: 34-39
    CrossrefPubMedGoogle Scholar
  • 66 Wagner B. Online-Therapie – eine neue Perspektive in der Psychotherapie für Flüchtlinge und Asylbewerber?. Psychotherapie Forum 2016; 21: 124-131
    CrossrefPubMedGoogle Scholar
  • 67 Zellmann H. Niederschwellige psychosoziale Hilfe für Geflüchtete: Ein Projektleitfaden. Medeciens sans Frontieres Ärzte ohne Grenzen; 1. überarb. Aufl. Im Internet: http://fluechtlingsforschung.net/flucht-und-ihre-ursachen Stand: 18.06.2018
    Google Scholar
  • 68 Hynie M, Crooks VA, Barragan J. Immigrant and refugee social networks: determinants and consequences of social support among women newcomers to Canada. Can J Nurs Res 2011; 43: 26-46
    PubMedGoogle Scholar
  • 69 van Melle MA, Lamkaddem M, Stuiver MM. et al. Quality of primary care for resettled refugees in the Netherlands with chronic mental and physical health problems: a cross-sectional analysis of medical records and interview data. BMC Fam Pract 2014; 15: 16
    CrossrefPubMedGoogle Scholar