Mental health in refugees and asylum seekers (MEHIRA): study design and methodology of a prospective multicentre randomized controlled trail investigating the effects of a stepped and collaborative care model.

The sudden arrival of culturally diverse asylum seekers and refugees into Germany has created a strong demand for recognizing and appropriately treating those suffering from mental health issues. Due to many systemic, organizational, cultural and socio-linguistic barriers, psychiatric treatment of refugees is posing a major challenge to Germany's mental health care system. Thus, there is a need for alternative models that allow for increased access to adequate, effective and efficient culturally sensitive mental health care services. Here, we describe the Mental Health in Refugees and Asylum Seekers (MEHIRA) project, a multicentre randomized controlled trial investigating a stepped collaborative care model (SCCM) for providing mental health treatment in this vulnerable population. The proposed SCCM aims to decrease the aforementioned barriers. Adult and adolescent participants will be screened for depressive symptoms and matched to appropriate psychological interventions, including group-level interventions (START intervention, Empowerment/Gender-sensitive/Peer to peer), and other innovative, digital treatment approaches (Smartphone application). The therapeutic effect of the SCCM will be compared to TAU (treatment-as-usual). All interventions have been designed to be culturally sensitive, and offered in two different languages: Arabic and Farsi. The outcome of this study may contribute significantly to future clinical and legal guidelines in developing parallel and efficient new structures of treatment. Collected data will inform primary and secondary mental health care providers with recommendations concerning the design and implementation of effective treatment models and programmes. Guidelines and recommendations may also potentially be adopted by other host countries, developing countries and also in humanitarian aid programmes.

[Diagnosis of Obsessive Compulsive Disorder in Refugees: Are We Asking The Right Questions?] / Diagnosestellung von Zwangsstörungen bei geflüchteten Patienten. Stellen wir die richtigen Fragen?

Obsessive Compulsive Disorder (OCD) is a severe and disabling clinical condition that usually arises in late adolescence or early adulthood and, if left untreated, has a chronic course. The concept of OCD has considerably varied across history and cultures. Among refugees from arab cultures; religious and contamination obsessions were found to be the commonest kind of obsessive thoughts. This makes diagnosing OCD even more challenging due to associated shame and guilt which delays help-seeking behavior. The use of culturally sensitive diagnostic instruments is important to correctly identify obsessive compulsive symptoms in refugee populations. We propose adapting the Zohar-Fineberg Obsessive Compulsive Screen (ZF-OCS) in its Arabic version to address religious and contamination obsessions safely and explicitly.