The longitudinal course of posttraumatic stress disorder symptoms in war survivors: Insights from cross-lagged panel network analyses.

Many war survivors suffer from chronic posttraumatic stress disorder (PTSD). Unraveling the complexities of PTSD symptoms over time is crucial for understanding this condition. Going beyond a common pathogenic pathway perspective, we applied the network approach to psychopathology to analyze longitudinal data from war survivors with PTSD in five Balkan countries approximately 8 years after war in the region and a follow-up assessment 1 year later (N = 698). PTSD diagnosis was established using the Mini-International Neuropsychiatric Interview, and PTSD symptoms were assessed using the Impact of Events Scale-Revised. Undirected cross-sectional networks for baseline and follow-up revealed no differences in the overall connectivity between these two networks. The intrusion symptom "I had waves of strong feelings about it" had the strongest expected influence centrality. Directed cross-lagged panel network models indicated that hyperarousal symptoms predicted other PTSD symptoms from baseline to follow-up, whereas several avoidance symptoms were predicted by other PTSD symptoms. The findings underscore the importance of emotional reactions and further suggest that hyperarousal symptoms may influence other PTSD symptoms. Future research should investigate causality and associations between between-person and within-person networks.

Refugees' and non-refugee migrants' regret about migration and confidence in integration: The role of forcedness and perils before and during migration.

Refugees typically experience stronger migration forcedness and higher migration-related perils (harm, adversities and hardship) than do non-refugee migrants. We explored how refugees' and non-refugee migrants' perceptions of their own forcedness of migration and related perils before and during migration are associated with regret about leaving their country of origin and their confidence in integration. In two studies conducted with refugee and non-refugee migrants in Germany (total N = 336), we found correlations between perceived forcedness and premigration perils, and perils during migration, with meaningful differences between groups from different countries. Importantly, regret about migration was predicted by an interaction effect of perceived forcedness and migration perils: Perils encountered during migration increased regret about having migrated when perceived forcedness was low (vs. high). As important potential predictors of confidence in integration and regret, we also assessed discrimination experienced in the receiving society (Study 1) and resilience (Study 2). Importantly, we found that high (vs. low) perceived migration perils buffered negative effects of discrimination experienced in the host country. We discuss implications of our findings for integration in the receiving society, highlighting the role of perceived forcedness in coping with distressing experiences before and after arrival in the host country.

Which psychological characteristics influence therapists' readiness to work with refugees?

Refugee populations show considerably high rates of mental health problems. Yet many mental health professionals may have reservations to work with refugees due to suspected cultural differences, language barriers and the need to provide additional services. However, little is known about psychotherapists' readiness to work with refugees. In a sample of German psychotherapists (N = 111), we explored therapeutic style (neutrality, supportiveness and self-doubt), therapists' basic assumptions (pessimism, rationality and therapy as art), experiences, private and work-related contact with refugees, political interests, openness and practical barriers as potential predictors of readiness to work with refugees. Therapeutic styles of self-doubt and neutrality, rationality as basic assumption, former experiences with refugees in a therapeutic setting, feeling comfortable working with an interpreter in therapy and perceived language barriers emerged as most important predictors of psychotherapists' readiness to work with refugees. Future directions and potential interventions to promote therapists' readiness to work with refugees are discussed.

Depressive and anxiety symptoms in refugees: Insights from classical test theory, item response theory and network analysis.

Screening tools developed for Western populations have produced heterogeneous prevalence estimates for depression and anxiety disorders among refugees. The use of these instruments assumes that psychopathological symptoms are manifested similarly across different cultural groups. Here, we scrutinized whether depressive and anxiety symptoms are manifested similarly between German residents and refugees in Germany. We tested measurement invariance, test information and specifics of symptom interrelations in 200 refugees and 202 German residents with classical test theory (CTT), item response theory (IRT) and network analysis. Participants completed the Patient Health Questionnaire regarding depressive and anxiety symptoms in either Arabic or German. Measurement invariance was only present to a certain extent. Questionnaires were most informative on different spectrums of the latent traits for the two groups. Network analysis demonstrated that symptom interrelations of depressive and anxiety symptoms differed across residents and refugees. This was especially true for core symptoms of common nosological systems, such as losing interest or feeling depressed. Surprisingly, traumatic events in the past were not central in refugees' anxiety networks. Core symptoms of nosological systems seem to be differently pronounced in refugees and residents, which has important implications for our understanding of mental health symptoms in refugees.

The longitudinal relationship between well-being comparisons and anxiety symptoms in the context of uncontrollability of worries and external locus of control: a two-wave study.

BACKGROUND: Anxiety is a prevalent mental health condition. Comparisons of one's own well-being to different aversive standards may contribute to the development and maintenance of anxiety symptoms. OBJECTIVES: Our primary goal was to investigate whether aversive well-being comparisons predict anxiety symptoms and vice versa. Additionally, we aimed at examining exploratorily whether well-being comparisons are reciprocally related to metacognitive beliefs about worrying and external control beliefs. METHODS: In this two-wave longitudinal survey design, 922 participants completed measures of anxiety, metacognitions about the uncontrollability of worries, external locus of control, and the Comparison Standards Scale for Well-being (CSS-W) at two timepoints, three-months apart. The CSS-W assesses the frequency, perceived discrepancy, and affective impact of social, temporal, counterfactual, and criteria-based comparisons. RESULTS: When autoregressive effects were adjusted for, aversive comparison frequency, comparison affective impact, and uncontrollability of worries at the first timepoint predicted subsequent anxiety symptoms. Furthermore, well-being comparison frequency and discrepancy at the second timepoint were predicted by baseline anxiety symptoms. External locus of control predicted comparison frequency and discrepancy. CONCLUSIONS: Well-being comparisons contribute distinct variance to anxiety symptoms and vice versa, pointing to a vicious cirlcle of symptom escalation. These findings have significant implications for future research.

Self-efficacy and locus of control as transdiagnostic factors in Middle Eastern refugees.

Background: Many refugees report high levels of psychopathology. As a countermeasure, some psychological interventions aim at targeting mental health difficulties in refugees transdiagnostically. However, there is a lack of knowledge about relevant transdiagnostic factors in refugee populations.Objective: To inform intervention efforts empirically, we investigated whether self-efficacy and locus of control are transdiagnostically associated with symptoms of depression, anxiety, somatisation, psychological distress, and a higher-order psychopathology factor ('p') in Middle Eastern refugees residing in Germany.Method: In total, 200 Middle Eastern refugees took part in this cross-sectional study, comprising 160 male and 40 female refugees. Participants were, on average, 25.56 years old (SD = 9.19), and 182 (91%) originally came from Syria, while remaining refugees were from Iraq or Afghanistan. They completed measures of depression, anxiety, somatisation, self-efficacy, and locus of control.Results: In multiple regression models adjusting for demographic factors (gender and age), self-efficacy and external locus of control were transdiagnostically related to depression, anxiety, somatic symptoms, psychological distress, and a higher-order psychopathology factor. Internal locus of control had no detectable effect in these models.Conclusions: Self-efficacy and external locus of control appear critical in the mental health of refugees and may be important mechanisms in overcoming posttraumatic stress and resettlement stressors. Our findings support the need to target self-efficacy and external locus of control as transdiagnostic factors of general psychopathology in Middle Eastern refugees.

Middle Eastern refugees report high levels of psychopathology.Transdiagnostic interventions are often applied, yet knowledge about relevant transdiagnostic factors is scarce.Self-efficacy and external locus of control emerged as relevant transdiagnostic factors.

Psychotherapy motivation in refugees: The role of alexithymia, stigmatization, self-esteem, and psychotherapy expectations.

OBJECTIVE: Despite elevated mental health problems, refugees tend to hold more negative attitudes toward psychological help seeking than residents of receiving countries. Therefore, we examined variables expected to be related to different aspects of psychotherapy motivation (psychological distress, knowledge about therapy, and denial of psychological helplessness) in 202 German residents and 200 refugees in Germany. METHOD: Participants completed measures of psychotherapy motivation, together with alexithymia, stigmatization toward help seeking, self-esteem, and expectations of therapy as variables with an expected relationship with psychotherapy motivation. RESULTS: Refugees reported higher scores of psychological distress, more denial of psychological helplessness, and less knowledge about psychotherapy than residents. Refugees further reported higher levels of alexithymia and lower expectations for interpersonal and intrapersonal change in therapy compared to residents. In a pathway model, alexithymia, perceived stigmatization, self-esteem, and expectations for interpersonal changes emerged as critical variables associated with psychotherapy motivation. Alexithymia and expectations for interpersonal change partly accounted for group differences of reduced psychotherapy motivation in refugees. CONCLUSIONS: We discuss implications for practice and future research with respect to reducing treatment barriers and providing culturally-sensitive treatments for refugees suffering from psychological distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing Somatic Symptoms With the Patient Health Questionnaire (PHQ-15) in Syrian Refugees.

Somatic symptoms are common among Syrian refugees. To quantify somatic symptom load, sum score models derived from the Patient Health Questionnaire (PHQ-15) have been frequently applied without psychometric justification. Across two studies (total N = 776), we (a) tested different PHQ-15 factor solutions in Syrian refugees, (b) investigated measurement invariance (MI) of the factor solutions compared with German residents, and (c) scrutinized whether sum score models adequately represent the data and differ in associations with external validators compared with factor scores. One-factor, three-factor, four-factor, and a reduced one-factor solution all displayed acceptable to good model fit. The four-factor solution showed the best fit, enabling differential symptom analyses. Sum score models often had poor model fit, necessitating independent investigations before applying them. For all factor solutions, (partial) strict MI between residents and refugees could be established. All scoring methods displayed high and comparable associations with functional impairment, depressive, and anxiety symptoms.

Helping in the context of refugee immigration.

We review psychological approaches of helping behavior in the context of refugee immigration. Refugee migration, compared with nonrefugee migration, is characterized by greater forcedness and related perils. Taking into account perceptions of forcedness and perils, we examine potential helpers' responses at each of four successive stages toward helping people in perilous, distressing, or emergency situations: (1) noticing and recognizing distressing, help-demanding conditions; (2) taking responsibility; (3) knowing how to help; and (4) transfer of one's knowledge into action. In so doing, we discuss the role of different motives and functions of providing help (e.g. preserving refugees' dependency or facilitating their autonomy) and implications of unequal power relations between help providers and refugees.

Unraveling specifics of mental health symptoms in war survivors who fled versus stayed in the area of conflict using network analysis.

BACKGROUND: War survivors often report symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and somatization. Hence, understanding symptom constellations among different populations of war survivors is critical. METHODS: Using the network approach to psychopathology, we examined symptom centrality for these conditions in war survivors from Balkan countries who had stayed in the area of former conflict compared to those individuals from Balkan countries who had fled to Western European countries (N = 4,167) with the Impact of Events Scale-Revised and the Brief Symptom Inventory. We further compared networks for war survivors who met criteria for PTSD-diagnosis (assessed with the MINI-International Neuropsychiatric Interview) to those without PTSD-diagnosis. RESULTS: Globally, networks were similar across the groups, whereas specific differences emerged in symptom centrality. More consistencies were found between PTSD and Western country networks, which may be partially explained by a higher prevalence of PTSD in those who had fled to Western European than in those who had stayed in the Balkan countries. LIMITATIONS: Given the cross-sectional nature of our data, the directionality of edges in our networks remains unclear. Further, higher levels of trauma exposure and symptom severity in Western country participants may have confounded results. CONCLUSIONS: The PTSD findings are in line with previous research on PTSD symptoms. They further provide novel insights into depressive, anxiety, and somatization symptoms in survivors of war. These findings need to be substantiated and call for future intervention studies that test the effects of targeting central symptoms we identified in our study.

Psychological distress in refugees: The role of traumatic events, resilience, social support, and support by religious faith.

Many refugees have been exposed to potentially traumatic events and report elevated levels of psychological distress. However, refugees vary greatly in the severity of mental health problems. Intra- and interpersonal factors help some refugees to cope effectively. To shed light on these factors, we scrutinized how potentially traumatic events, resilience, social support, and support by religious faith are associated with psychological distress in refugees in Germany and German residents. We assessed data from 205 German residents and 205 refugees (total N = 410). Questionnaires assessing psychological distress, potentially traumatic events, resilience, social support, and perceived support by religious faith were disseminated online in Arabic and German. Refugees reported higher levels of psychological distress, more exposure to potentially traumatic events, less social support, less resilience, and more perceived support from their faith than German residents. Using a pathway model, lower social support and resilience partially accounted for group differences of higher psychological distress in refugees. This study points to the importance of social support and individual resilience in explaining mental health discrepancies between refugees and residents. This, in turn, may inform future intervention studies to reduce elevated levels of psychological distress experienced by refugees.

Psychological Antecedents of Refugee Integration (PARI).

The successful management of refugee immigration, including refugee integration in host societies, requires a sound understanding of underlying psychological processes. We propose the psychological antecedents of refugee integration (PARI) model, highlighting perceived forcedness (i.e., coercion and loss of control from "push" factors) and ensuing perils (risks and potential suffering during migration) as distinctive factors of refugee (vs. voluntary) migration. According to our model, perceptions and subjective representations of forcedness and associated perils activate specific psychological processes relevant to refugee integration and thus moderate responses to the demands and stressors of the immigration situation. We conceptualize these distinctive influences for integration-relevant processes in both refugees and in residents. By pinpointing the unique features of refugee migration, PARI generates novel and specific hypotheses about psychological processes predicting refugee integration. For instance, refugees' memories of forcedness and associated perils should lead to a high level of preoccupation with the restoration of basic needs after arrival in a receiving country that interferes with integration-related activities. Conversely, residents' perceptions of forcedness and related perils may enhance empathy with refugees but may also magnify feelings of anxiety and threat. Implications for refugee integration are discussed for the domains of occupational work, education, and mental health.

Climate of Hate: Similar Correlates of Far Right Electoral Support and Right-Wing Hate Crimes in Germany.

Since 2015, far right parties drawing heavily on radical anti-refugee rhetoric gained electoral support in Germany while the number of political hate crimes targeting refugees rose. Both phenomena - far right electoral support and prevalence of right-wing hate crimes - have theoretically and empirically been linked with socio-structural and contextual variables. However, systematic empirical research on these links is scattered and scarce at best. We combine official statistics on political hate crimes targeting refugees in Germany and far right electoral support of the far right party "Alternative für Deutschland" (AfD) in the German national elections 2017 with socio-structural variables (proportion of foreigners and unemployment rate) and survey data collected in a representative survey (N = 1,506) in 2016. We aggregate and combine data for all German municipalities except Berlin which were the level of analysis for the current study. In path analyses, we find socio-structural variables to be unrelated with each other but significantly correlated with both criterion variables in a systematic fashion: proportion of foreigners was negatively while unemployment rate was positively linked with far right electoral support. Right-wing crime was linked positively with unemployment rate across Germany and positively with proportion of foreigners only in East Germany while proportion of foreigners was unrelated to right-wing crime in West Germany. When including survey measures into the model, they were linked with socio-structural variables in the predicted fashion - intergroup contact correlated positively with proportion of foreigners, collective deprivation correlated positively with unemployment rates, and both predicted extreme right-wing attitudes. However, their contribution to the explained variance in outcome variables above and beyond socio-structural variables was neglectable. We argue that both far right-wing electoral support and right-wing hate crime can be conceptualized as behavioral forms of political extremism shaped through socio-structural and contextual factors and discuss implications for preventing political extremism.

"A letter for Dr. Outgroup": on the effects of an indicator of competence and chances for altruism toward a member of a stigmatized out-group.

The lost letter technique is an unobtrusive method to investigate attitudes in a particular population. Ostensibly lost letters from senders who apparently belong to different groups or addressed to recipients from apparently different groups are dispersed in public places, and return rates represent a measure of altruistic or discriminatory behavior toward one group or another. In two field experiments using the lost letter technique, we investigated the influence of group membership and the presence or absence of a doctorate degree as an indicator of competence on the likelihood of receiving helping behavior. Experiment 1 showed that a generic member of a low-status ethnic out-group (Turks living in Germany) was the target of discrimination, while a generic member of a non-stigmatized out-group (French in Germany) was not. Moreover, when the name of the member from the stigmatized out-group was (vs. was not) preceded by a doctorate degree, more of the allegedly lost letters were returned. There were no such differential effects for recipients who were members of the in-group (Germans) or the non-stigmatized out-group (French). Experiment 2 showed that a recipient from the stigmatized out-group (Turk) with a doctorate degree received more letters when the sender was German versus Turkish (i.e., from the recipient's own group). Overall, the sender's ethnic group membership was an important factor for the likelihood of receiving an ostensibly lost letter, in that fewer letters arrived from a sender with a Turkish (vs. German) name. We conclude that the likelihood of altruistic behavior toward out-group members can increase when in-group members intend to communicate with competent out-group members. Therefore, under certain conditions, the presentation of a highly competent member of an otherwise stigmatized out-group may serve as a discrimination buffer.