Post-migration living difficulties, discrimination, and mental health of traumatized refugees in Germany: data from the refuKey project for timely and need-adapted treatment in a stepped-care setting.

Asylum seekers and refugees (ASR) experience many short-term and long-term post-migration stressors, e.g. discrimination after resettlement, leading to increased psychiatric morbidity in this population. Using data from the state-funded stepped-care project refuKey based in Lower Saxony, Germany, that aims to provide better mental health care access for ASR, we investigated the relationship between post-migration stressors and mental health in treatment-seeking ASR. In our naturalistic multi-centric study we assessed mental health (e.g. symptoms of depression, anxiety, traumatization, etc.), post-migration living difficulties, and perceived discrimination in ASR before and after treatment using questionnaires in eight languages consisting of internationally validated scales. Participants displayed poor mental health before, and significantly improved mental health parameters after treatment (p < 0.001). Post-migration living difficulties and perceived discrimination significantly predicted all mental health outcomes before treatment (p < 0.001) but not the treatment effects. However, perceived discrimination only contributed significantly to the prediction of quality-of-life and traumatization. Our findings suggest that refuKey-treatment helps despite the presence of post-migration living difficulties. Asylum policies should aim at reducing and overcoming post-migration living difficulties due to the strong association to mental health levels in treatment-seeking ASR.

Implementing a Need-Adapted Stepped-Care Model for Mental Health of Refugees: Preliminary Data of the State-Funded Project "RefuKey".

Introduction: Refugees have been shown to be a rather vulnerable population with increased psychiatric morbidity and lack of access to adequate mental health care. By expanding regional psychosocial and psychiatric-psychotherapeutic care structures and adapting psychiatric routine care to refugees' needs, the state-funded project "refuKey" based in Lower Saxony, Germany, pursues to ease access to mental health care and increase service quality for refugees. A stepped-care treatment model along with intercultural opening of mental health care services is proposed. Methods: The project is subject to a four-part evaluation study. The first part investigates the state of psychiatric routine care for refugees in Lower Saxony by requesting data from all psychiatric clinics, participating and non-participating ones, regarding the numbers of refugee patients, their diagnoses, settings of treatment, etc. The second part explores experiences and work satisfaction of mental health care professionals treating refugees in refuKey cooperation clinics. The third part consists of interviews and focus group discussions with experts regarding challenges in mental health care of refugees and expectations for improvement through refuKey. The fourth part compares mental health parameters like depression, anxiety, traumatization, somatization, psychoticism, quality of life, as well as "pathways-to-care" of refuKey-treated refugees before and after treatment and, in a follow-up, to a non-refuKey-treated refugee control group. Results: RefuKey-treated refugees reported many mental health problems and estimated their mental health burden as high. The symptoms decreased significantly over the course of treatment. Mental health in the refuKey sample was strongly linked to post-migration stressors. Discussion: The state of mental health care for refugees is discussed. Implications for the improvement and the need for adaptation of routine mental health care services are drawn.