Psychische Symptombelastung bei Asylsuchenden in Abhängigkeit vom Aufenthaltsstatus

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
• 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
• 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
• 4 Craig T, Jajua PM, Warfa N. Mental health care needs of refugees. Psychiatry 2009; 8: 351-354
• 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
• 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
• 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
• 8 Nejad RM, Klöhn-Saghatolislam F, Hasan A. et al. Seelische Spuren der Flucht. MMW – Fortschritte der Medizin 2017; 159: 64-66
• 9 Böttche M, Heeke C, Knaevelsrud C. Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsbl 2016; 59: 621-626
• 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/
• 11 Dapunt J, Kluge U, Heinz A. Risk of psychosis in refugees: a literature review. Transl Psychiatry 2017; 7: e1149
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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/
• 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/
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 28 Erim Y, Morawa E. Psychotherapy with Immigrants and Traumatized Refugees. Psychother Psychosom Med Psychol 2016; 66: 397-409
• 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
• 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
• 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
• 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
• 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
• 34 Böttche M, Heeke C, Knaevelsrud C. Sequenzielle Traumatisierungen, Traumafolgestörungen und psychotherapeutische Behandlungsansätze bei kriegstraumatisierten erwachsenen Flüchtlingen in Deutschland. Bundesgesundheitsbl 2016; 59: 621-626
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 42 Ward C, Rana-Deuba A. Acculturation and Adaptation Revisited. Journal of Cross-cultural Psychology – J CROSS-CULT PSYCHOL 1999; 30: 422-442
• 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
• 44 Petermann F, Brähler E. HSCL-25. Hopkins-Syptom-Checkliste-25. Deutsche Version. Manual. Göttingen, Bern, Wien: Hogrefe; 2013: 7
• 45 Franke G. SCL-90®-S Symptom-checkliste-90®-Standard: Manual. Göttingen, Bern, Wien: Hogrefe; 2014: 17-19
• 46 Franke G. SCL-90®-S Symptom-checkliste-90®-Standard: Manual. Göttingen, Bern, Wien: Hogrefe; 2014: 25-35
• 47 Nosikov A, Gudex C. EUROHIS – developing common instruments for health surveys. WHO Europe. Amsterdam, Berlin, Oxford: IOS Press; 2003: VII, 5
• 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
• 49 Foa E. Posttraumatic stress diagnostic scale. Manual. Minneapolis, MN: Pearson; 1995. 1 u 15
• 50 McCarthy S. Post-traumatic Stress Diagnostic Scale (PDS). Occup Med (Lond) 2008; 58: 379
• 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
• 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
• 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
• 55 Böttche M, Stammel N, Knaevelsrud C. Psychotherapeutic treatment of traumatized refugees in Germany. Nervenarzt 2016; 87: 1136-1143
• 56 Schouler-Ocak M. [Mental health care for immigrants in Germany]. Nervenarzt 2015; 86: 1320-1325
• 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
• 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
• 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
• 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
• 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
• 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
• 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; [download am 01.12.2018]
• 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
• 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
• 66 Wagner B. Online-Therapie – eine neue Perspektive in der Psychotherapie für Flüchtlinge und Asylbewerber?. Psychotherapie Forum 2016; 21: 124-131
• 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
• 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
• 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