Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples - a network analysis.

BACKGROUND: Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples. METHOD: A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain. RESULTS: No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain. CONCLUSION: Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic.

The effect of a low-level psychological intervention (PM+) on post-migration living difficulties - Results from two studies in Switzerland and in the Netherlands.

AIMS OF THE STUDY: After arriving in host countries, most refugees are confronted with numerous post-migration stressors (e.g., separation from family, discrimination, and employment difficulties). Post-migration living difficulties (PMLDs) significantly contribute to the development and persistence of mental disorders. Effective treatment approaches focusing on reducing post-migration stress are urgently needed. The aim of the present study was to examine the effect of a brief psychological intervention, Problem Management Plus (PM+), on PMLDs among Syrian refugees in two European countries. METHODS: We merged data from two single-blind feasibility trials with Syrian refugees experiencing elevated levels of psychological distress and impaired functioning in Switzerland (N = 59) and the Netherlands (N = 60). Participants were randomised to receive either five sessions of PM+ or an enhanced care-as-usual control condition. PMLDs were assessed at baseline and 3 months after the intervention. To estimate treatment effect on PMLD, linear mixed model analysis was performed. RESULTS: Three months after the intervention, participants in the PM+ condition reported significantly fewer PMLDs compared to the control condition. Further analyses at item-level showed that interpersonal and family related PMLDs, such as "worries about family back home" significantly improved over time in the PM+ condition. CONCLUSIONS: This exploratory study suggests that brief psychological interventions have the potential to reduce PMLDs in refugees and asylum seekers. The reduction of post-migration stress in turn may subsequently lead to an overall reduction in psychological distress. CLINICAL TRIAL NUMBERS: BASEC Nr. 2017-0117 (Swiss trial) and NL61361.029.17, 7 September 2017 (Dutch trial).

Posttraumatic Stress Disorder in Refugees.

The number of refugees and internally displaced people in 2022 is the largest since World War II, and meta-analyses demonstrate that these people experience elevated rates of mental health problems. This review focuses on the role of posttraumatic stress disorder (PTSD) in refugee mental health and includes current knowledge of the prevalence of PTSD, risk factors, and apparent differences that exist between PTSD in refugee populations and PTSD in other populations. An emerging literature on understanding mechanisms of PTSD encompasses neural, cognitive, and social processes, which indicate that these factors may not function exactly as they have functioned previously in other PTSD populations. This review recognizes the numerous debates in the literature on PTSD in refugees, including those on such issues as the conceptualization of mental health and the applicability of the PTSD diagnosis across cultures, as well as the challenge of treating PTSD in low- and middle-income countries that lack mental health resources to offer standard PTSD treatments.

Scaling-up problem management plus for refugees in Switzerland - a qualitative study.

BACKGROUND: Refugees are at an increased risk of developing symptoms of mental disorders but face various structural and socio-cultural barriers to accessing mental health care. The SPIRIT project (Scaling-up Psychological Interventions in Refugees In SwiTzerland) seeks to promote the resilience of refugees and improve their access to mental health care. For this purpose, Problem Management Plus (PM+), an evidence-based low-intensity psychological intervention delivered by trained non-specialist "helpers", is being scaled-up in Switzerland. OBJECTIVE: To identify factors influencing the process of the large-scale implementation of PM + for refugees in Switzerland and to develop recommendations to guide the implementation process. METHODS: 22 semi-structured interviews were conducted with key informants (Syrian refugees who previously participated in PM+, PM + helpers, health professionals working with refugees and decision-makers from the migration, integration, social, and health sectors). The data were analyzed using thematic analysis, combining an inductive and deductive approach. RESULTS: The data revealed three major themes, which might have an impact for the longer-term implementation of PM + in Switzerland. First, preconditions for successful integration in the health system prior to scaling-up such as sustainable funding or the introduction of a stepped care approach. Second, the requirements for the PM + intervention supporting scale-up such as quality control during PM + delivery, PM + modality, time and setting when PM + is offered or the views on task sharing. Third, the perceived benefits of scaling-up PM + in Switzerland. CONCLUSIONS: Our results have shown that PM + must be scaled-up within a stepped care approach, including a functioning triage system and sustainable funding. Rather than selecting one modality or setting, it seemed preferable to offer a variety of formats and settings to achieve maximum reach and benefits. A successful scale-up of PM + in Switzerland might have various benefits. Communicating them to policy-makers and health providers, might enhance their acceptability of the intervention and their willingness to adopt PM + in regulatory structure and promote it.

Development of health care workers' mental health during the SARS-CoV-2 pandemic in Switzerland: two cross-sectional studies.

BACKGROUND: Virus outbreaks such as the current SARS-CoV-2 pandemic are challenging for health care workers (HCWs), affecting their workload and their mental health. Since both, workload and HCW's well-being are related to the quality of care, continuous monitoring of working hours and indicators of mental health in HCWs is of relevance during the current pandemic. The existing investigations, however, have been limited to a single study period. We examined changes in working hours and mental health in Swiss HCWs at the height of the pandemic (T1) and again after its flattening (T2). METHODS: We conducted two cross-sectional online studies among Swiss HCWs assessing working hours, depression, anxiety, and burnout. From each study, 812 demographics-matched participants were included into the analysis. Working hours and mental health were compared between the two samples. RESULTS: Compared to prior to the pandemic, the share of participants working less hours was the same in both samples, whereas the share of those working more hours was lower in the T2 sample. The level of depression did not differ between the samples. In the T2 sample, participants reported more anxiety, however, this difference was below the minimal clinically important difference. Levels of burnout were slightly higher in the T2 sample. CONCLUSIONS: Two weeks after the health care system started to transition back to normal operations, HCWs' working hours still differed from their regular hours in non-pandemic times. Overall anxiety and depression among HCWs did not change substantially over the course of the current SARS-CoV-2 pandemic.

Resilience of people with chronic medical conditions during the COVID-19 pandemic: a 1-year longitudinal prospective survey.

BACKGROUNDS: Individuals with chronic medical conditions are considered highly exposed to COVID-19 pandemic stress, but emerging evidence is demonstrating that resilience is common even among them. We aimed at identifying sustained resilient outcomes and their predictors in chronically ill people during the first year of the pandemic. METHODS: This international 4-wave 1-year longitudinal online survey included items on socio-demographic characteristics, economic and living situation, lifestyle and habits, pandemic-related issues, and history of mental disorders. Adherence to and approval of imposed restrictions, trust in governments and in scientific community during the pandemic were also investigated. The following tools were administered: the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the PTSD Checklist DSM-5, the Oslo Social Support Scale, the Padua Inventory, and the Portrait Values Questionnaire. RESULTS: One thousand fifty-two individuals reporting a chronic condition out of 8011 total participants from 13 countries were included in the study, and 965 had data available for the final model. The estimated probability of being "sustained-resilient" was 34%. Older male individuals, participants employed before and during the pandemic or with perceived social support were more likely to belong to the sustained-resilience group. Loneliness, a previous mental disorder, high hedonism, fear of COVID-19 contamination, concern for the health of loved ones, and non-approving pandemic restrictions were predictors of not-resilient outcomes in our sample. CONCLUSIONS: We found similarities and differences from established predictors of resilience and identified some new ones specific to pandemics. Further investigation is warranted and could inform the design of resilience-building interventions in people with chronic diseases.

Problems after flight: understanding and comparing Syrians' perspectives in the Middle East and Europe.

BACKGROUND: Syrian refugees and asylum seekers (SRAs) face multiple stressors after flight, which may vary due to different geographic, economic, cultural and socio-political contexts in the host countries. Past research has recognised the importance of participants' own perspectives. The aims of this multi-country study were to identify and compare self-reported problems of SRAs between various settings. METHODS: A semi-structured client-generated outcome measurement was used to collect data among adult SRAs in Jordan (N = 61), Turkey (N = 46) and Switzerland (N = 57) between September 2018 and November 2019. Answers were analysed following thematic analysis. RESULTS: Over half of the participants reported practical problems with an emphasis on camp-related problems (Jordan), finances (Turkey), employment (Jordan and Switzerland) and government regulations (Switzerland), followed by psychological, and social issues. CONCLUSION: This study highlights the impact of local contextual factors on wellbeing. The findings emphasise that planning preventative procedures and mental health care services for SRAs need to consider local challenges affecting the population in specific countries.

Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view.

BACKGROUND: More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS: An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS: Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS: Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.

A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland.

Cultural variability regarding concepts of distress for common mental disorders (CMD) has been reported extensively in cultural clinical psychology across the globe. However, little is known about illness narratives in social communities from Southeast Europe. The purpose of this paper is to identify cultural concepts of distress (CCDs) among Albanian-speaking immigrants in Switzerland and to integrate the findings into literature from other parts of the world. Twenty semi-structured qualitative interviews were conducted using the Barts Explanatory Model Inventory (BEMI). A set of concepts was described through content analysis and semantic network analysis. The results show complex expressions of distress, which are mainly associated with post-migration living difficulties. Social problems and life-changing events mark the onset of the most common symptoms. Self-management and social support were described as the most important coping behaviors. Participants expressed trust in physical health care but little belief in psychotherapy. There is indication that mental illnesses are stigmatized in this population. It is therefore important to use non-stigmatizing terms in health communication. Moreover, individuals from this community consider suffering to be part of life, and they assume that this suffering must be endured with patience. It is vital to address these beliefs in psychological interventions.

Emotional Reactivity, Emotion Regulation Capacity, and Posttraumatic Stress Disorder in Traumatized Refugees: An Experimental Investigation.

Refugees who suffer from posttraumatic stress disorder (PTSD) often react with strong emotions when confronted with trauma reminders. In this study, we aimed to investigate the associations between low emotion regulation capacity (as indexed by low heart rate variability [HRV]), probable PTSD diagnosis, and fear and anger reaction and recovery to trauma-related stimuli. Participants were 81 trauma-exposed refugees (probable PTSD, n = 23; trauma-exposed controls, n = 58). The experiment comprised three 5-min phases: a resting phase (baseline); an exposition phase, during which participants were exposed to trauma-related images (stimulus); and another resting phase (recovery). We assessed HRV at baseline, and fear and anger were rated at the end of each phase. Linear mixed model analyses were used to investigate the associations between baseline HRV and probable DSM-5 PTSD diagnosis in influencing anger and fear responses both immediately after viewing trauma-related stimuli and at the end of the recovery phase. Compared to controls, participants with probable PTSD showed a greater increase in fear from baseline to stimulus presentation, d = 0.606. Compared to participants with low emotion regulation capacity, participants with high emotion regulation capacity showed a smaller reduction in anger from stimulus presentation to recovery, d = 0.548. Our findings indicated that following exposure to trauma-related stimuli, probable PTSD diagnosis predicted increased fear reactivity, and low emotion regulation capacity predicted decreased anger recovery. Impaired anger recovery following trauma reminders in the context of low emotion regulation capacity might contribute to the increased levels of anger found in postconflict samples.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Reactividad Emocional, Capacidad de Regulación Emocional y trastorno por Estrés Postraumático en Refugiados Traumatizados: Una Investigación Experimental REACTIVIDAD EMOCIONAL, REGULACION EMOCIONAL Y TEPT Los refugiados que sufren de trastorno de estrés postraumático (TEPT) a menudo reaccionan con emociones fuertes cuando se enfrentan a recordatorios de trauma. El objetivo de este estudio fue investigar las asociaciones entre la baja capacidad de regulación emocional (según la variabilidad de la frecuencia cardíaca [HRV en su sigla en inglés]), el diagnóstico probable de TEPT y la reacción de miedo e ira, y la recuperación ante estímulos relacionados-al-trauma. Los participantes fueron 81 refugiados expuestos a traumas (TEPT probable, n = 23; controles expuestos a traumas, n = 58). El experimento estuvo compuesto por tres fases de 5 minutos: una fase de reposo (línea base); una fase de exposición, durante la cual los participantes fueron expuestos a imágenes relacionadas-al-trauma (estímulo); y otra fase de reposo (recuperación). Se evaluó la HRV al inicio, y el miedo y la ira se evaluaron al final de cada fase. Se utilizaron análisis de modelos lineales mixtos para investigar las asociaciones entre la HRV basal y el diagnóstico probable de TEPT DSM-5 para influir en las respuestas de ira y miedo, inmediatamente después de ver los estímulos relacionados-al-trauma y al final de la fase de recuperación. En comparación con los controles, los participantes con TEPT probable mostraron un mayor incremento en miedo desde la línea base hasta la presentación del estímulo, d = 0.606. En comparación a los participantes con baja capacidad de regulación emocional, los participantes con alta capacidad de regulación emocional mostraron una menor reducción en ira desde la presentación del estímulo a la recuperación, d = 0.548. Nuestros hallazgos indican que el diagnóstico de TEPT probable predice un aumento de la reactividad al miedo y una baja capacidad de regulación emocional predice una disminución de la recuperación de ira tras la exposición a estímulos relacionados-al-trauma. Nuestros hallazgos indican que el diagnóstico de TEPT probable predice un aumento de la reactividad al miedo y una baja capacidad de regulación emocional predice una disminución de la recuperación de ira después de la exposición a estímulos relacionados-al-trauma. La recuperación de ira deteriorada seguida a los recuerdos traumáticos en el contexto de una baja capacidad de regulación emocional podría contribuir al aumento de los niveles de ira que se encuentran en las muestras posteriores al conflicto.

The impact of enhancing perceived self-efficacy in torture survivors.

BACKGROUND: Perceived self-efficacy (SE) is an important factor underlying psychological well-being. Refugees suffer many experiences that can compromise SE. This study tested the impact of enhancing perceived SE on coping with trauma reminders and distress tolerance in tortured refugees. METHODS: Torture survivors (N = 40) were administered a positive SE induction in which they retrieved mastery-related autobiographical memories, or a non-SE (NSE) induction, and then viewed trauma-related images. Participants rated their distress following presentation of each image. Participants then completed a frustration-inducing mirror-tracing task to index distress tolerance. RESULTS: Participants in the SE condition reported less distress and negative affect, and improved coping in relation to viewing the trauma-related images than those in the NSE condition. The SE induction also led to greater persistence with the mirror-tracing task than the NSE induction. CONCLUSIONS: These findings provide initial evidence that promoting SE in tortured refugees can assist with managing distress from trauma reminders, and promoting greater distress tolerance. Enhancing perceived SE in tortured refugees may increase their capacity to tolerate distress during therapy, and may be a useful means to improve treatment response.

The Association of Post-traumatic and Postmigration Stress with Pain and Other Somatic Symptoms: An Explorative Analysis in Traumatized Refugees and Asylum Seekers.

Objective: Post-traumatic stress disorder (PTSD) and somatic symptoms, such as pain, are frequently seen in refugees. Their relationship is poorly understood, and the treatment of these comorbid conditions can be very challenging. The current cross-sectional study examined pain and other somatic symptoms and their relationship with trauma history, PTSD symptom clusters, and current living difficulties among treatment-seeking refugees. Methods: One hundred thirty-four treatment-seeking traumatized refugees (78% male, mean age = 42 years) were assessed regarding lifetime traumatic experiences, symptoms of post-traumatic stress, overall pain and somatic symptoms, and postmigration living difficulties. Results: An exploratory factor analysis of the 12 somatic symptoms revealed two distinct factors: somatic symptoms related to bodily dysfunction ("weakness") and somatic symptoms related to increased sympathetic activity ("arousal"). DSM-5 PTSD Criteria D "alterations in cognitions and mood" and E "alterations in arousal and reactivity" were primarily related to "weakness," while PTSD Criterion E "alterations in arousal and reactivity" and postmigration living difficulties were associated with "arousal." Overall pain was associated primarily with living difficulties and PTSD Criterion D and Criterion E. Conclusions: Results indicate that somatic symptoms are of considerable concern among traumatized refugees and that different patterns of somatic symptoms are associated with different clusters of PTSD symptoms. The findings contribute to the better understanding of the symptom presentation of traumatized people who are experiencing somatization and potentially inform treatment directions and highlight the importance of screening for PTSD in refugees presenting with pain and somatic symptoms.

Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims.

BACKGROUND: It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms. METHODS: Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998). RESULTS: Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD. CONCLUSION: Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.

Comorbidity of Posttraumatic Stress Disorder and Depression in Tortured, Treatment-Seeking Refugees.

Comorbid posttraumatic stress disorder (PTSD) and depression is common in refugee groups; however, little is known about the predictors and correlates of comorbidity in treatment-seeking refugees. Participants in this study were 134 refugees resettled in Switzerland. Most participants were from Turkey, Iran, and Sri Lanka, and 92.7% had been exposed to torture. Self-report measures were implemented to assess PTSD, depression, mental and physical health-related quality of life (QoL), as well as pre- and postmigration experiences. Findings indicated that approximately half the sample met criteria for PTSD and depression, 33.6% met criteria for depression only, and only 2.2% met criteria for PTSD only. Several variables emerged as predictors of comorbidity in contrast to no diagnosis: female gender, odds ratio (OR) = 0.17; age, OR = 0.93; time in Switzerland, OR = 1.16; and trauma exposure, OR = 1.19. Postmigration stress was also associated with greater likelihood of comorbidity compared with no diagnosis, OR = 1.32, and a single diagnosis, OR = 1.14. Further, dual diagnosis was associated with significantly poorer mental health-related and physical health-related QoL (mental health-related QoL: dual diagnosis vs. single diagnosis, d = -0.52 and dual diagnosis vs. no diagnosis, d = -1.30; physical health-related QoL: dual diagnosis vs. single diagnosis, d = -0.73 and dual diagnosis vs. no diagnosis: d = -1.04). Findings indicated that comorbidity was highly prevalent in this sample of treatment-seeking refugees and was associated with a substantial impairment burden. Psychological interventions for refugees should consider the dual impact of PTSD and depression symptoms to optimally decrease distress and improve QoL in this vulnerable group.

Obsessive-compulsive and posttraumatic stress symptoms among civilian survivors of war.

BACKGROUND: Several psychological sequelae have been identified in civilian war survivors. However, little is known about the prevalence of obsessive-compulsive symptoms and their relationship to trauma in this population. METHOD: Fifty-one adult civilian survivors of the Kosovo War (28 males) who had immigrated to Switzerland completed the Revised Obsessive-Compulsive Inventory Scale, the Posttraumatic Stress Diagnostic Scale and the Hopkins Symptom Checklist. Data were analysed using multiple regression analyses. RESULTS: Overall, 35 and 39% of the sample scored above the cut-offs for likely obsessive-compulsive disorder and posttraumatic stress disorder, respectively. Participants with high levels of posttraumatic stress symptoms were significantly more likely to have obsessive-compulsive symptoms, and vice versa. In multiple regression analysis, gender and severity of posttraumatic stress symptoms were predictors of obsessive-compulsive symptoms, whereas number of traumatic life event types and depressive symptoms were not. CONCLUSION: Given the small sample size, the results of this study need to be interpreted cautiously. Nevertheless, a surprisingly high number of participants in our study suffered from both obsessive-compulsive and posttraumatic stress symptoms, with obsessive-compulsive symptoms tending to be more pronounced in women. It remains, therefore, critical to specifically assess both obsessive-compulsive and posttraumatic stress symptoms in civilian war survivors, and to provide persons afflicted with appropriate mental health care.

Attachment style and interpersonal trauma in refugees.

BACKGROUND: Refugees can suffer many experiences that threaten their trust in others. Although models of refugee mental health have postulated that attachment securities may be damaged by refugee experiences, this has yet to be empirically tested. This study aimed to understand the relationship between the nature of traumatic experiences sustained by refugees and attachment styles. METHOD: In a cross-sectional study, treatment-seeking refugees (N = 134) were assessed for traumatic exposure using the Harvard Trauma Questionnaire and Posttraumatic Diagnostic Scale. Attachment style was assessed using the Experiences in Close Relationship Scale. RESULTS: Whereas gender and severity of interpersonal traumatic events predicted avoidant attachment style (accounting for 11% of the variance), neither these factors nor non-interpersonal trauma predicted anxious attachment. CONCLUSIONS: Exposure to interpersonal traumatic events, including torture, is associated with enduring avoidant attachment tendencies in refugees. This finding accords with attachment theories that prior adverse interpersonal experiences can undermine secure attachment systems, and may promote avoidance of attachment seeking. This finding may point to an important process maintaining poor psychological health in refugees affected by interpersonal trauma.

A Comparison of DSM-5 and DSM-IV Diagnostic Criteria for Posttraumatic Stress Disorder in Traumatized Refugees.

The aim of this study was to compare the prevalence rate and factor structure of posttraumatic stress disorder (PTSD) based on the diagnostic criteria of the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; DSM-5; American Psychiatric Association, , ) in traumatized refugees. There were 134 adult treatment-seeking, severely and multiply traumatized patients from various refugee backgrounds were assessed in their mother tongue using a computerized set of questionnaires consisting of a trauma list, the Posttraumatic Diagnostic Scale, and the new PTSD items that had been suggested by the DSM-5 Task Force of the American Psychiatric Association. Using DSM-IV, 60.4% of participants met diagnostic criteria for PTSD; using DSM-5, only 49.3% fulfilled all criteria (p < .001). Confirmatory factor analysis of DSM-IV and DSM-5 items showed good and comparable model fits. Furthermore, classification functions in the DSM-5 were satisfactory. The new Cluster D symptoms showed relatively high sensitivity, specificity, positive predictive power, and negative predictive power. The DSM-5 symptom structure appears to be applicable to traumatized refugees. Negative alterations in cognitions and mood may be especially useful for clinicians, not only to determine the extent to which an individual refugee is likely to meet criteria for PTSD, but also in providing targets for clinical intervention.

[What do Interpreters Understand as their Role in a Medical Consultation and How do they Carry it out in Reality?]. / Wie verstehen Dolmetscher ihre Rolle in medizinischen Konsultationen und wie verhalten sie sich konkret in der Praxis?

OBJECTIVES: In the literature the role of an interpreter in the clinical setting is not yet clearly defined. The aim of the study is to explore, which role the interpreters assign to themselves and which role they actually take in the clinical setting. METHODS: In the quantitative part of the study, the interpreters evaluated their role in the clinical encounter through a questionnaire, whereas in the qualitative part the interpreters' role was assessed by analysing videotapes of the clinical encounters. RESULTS: 373 questionnaires and 19 videotapes were collated and analysed. According to the results of the questionnaire interpreters seem to prefer a neutral role in the clinical encounter. This was in contrast to what was observed in practice, as seen in the videotapes. In reality, they take in an active role while interpreting. CONCLUSIONS: It is important that medical professionals and interpreters discuss their roles and expectations before every clinical consultation.

The role of the health care interpreter in a clinical setting--a narrative review.

OBJECTIVE: To examine published models of health care interpretation and associated roles, expectations, and outcomes. METHODS: A literature search was conducted using the key words interpreter/translator, communication, and role and their combinations in PubMed, CINAHL, PsycINFO, and PSYNDEXPlus. References mentioned in articles identified with these search terms were then checked by hand in corresponding publications and books. We excluded articles if they were dealing with concepts of interpretation, role definitions, etc., without presenting any empirical evidence to support their recommendations. Thirty-four of 1,121 references that investigated the role of professional interpreters in health care were found to meet inclusion criteria. RESULTS: Out of 34 articles, only 2 recommend strict adherence to the conduit model in which interpreters are faithfully and exclusively transmitting information; the interpreter's role is in 32 studies defined in broader terms as the role of a cultural broker (n = 18), a manager or clarifier (n = 22), a patient advocate (n = 13), or a mediator (n = 6). CONCLUSION: There are no commonly accepted understandings of the interpreters' role; empirical data are lacking. PRACTICE IMPLICATIONS: The interpreter's function must be explicitly clarified before a health care encounter is conducted. There should be an agreement of some basic rules.

Cultural concepts of distress among Albanian young adults living in Switzerland - a qualitative study.

Objectives: Existing research recognizes the critical role that social, sociodemographic, and acculturative processes play in increasing vulnerability for experiencing psychological distress among second-generation migrants. However, to date, far too little attention has been given to the study of psychological distress in this social group. The main objective of this study is to examine cultural identities, as well as expressions and causes of psychological distress among second-generation Albanian-speaking migrants in Switzerland. Methods: Semi-structured qualitative interviews were conducted with 13 Albanian-speaking participants between 19 and 35 years of age using the interview of the Barts Explanatory Model Inventory. Data were analyzed by qualitative content analysis using MAXQDA-2018 software. Findings: Study participants showed bicultural identities, which caused value conflicts and a feeling of being "caught" between Swiss and Albanian culture. Some participants experienced the fear of disappointing their parents. Others find it difficult to deal with conflicting norms and values. Parentification was another important cause within their cultural concept of distress. At the same time, (implicit) social support, i.e., spending time with the family and the community, was an important coping mechanism. Conclusion: Second-generation immigrants are exposed to specific risk factors for psychological distress. A better understanding of these risk factors and their coping mechanisms is essential for providing them with meaningful support services, both in prevention and psychotherapy.