Ischemic Heart Disease in German Immigrants and Their Descendants in a Region of Southern Brazil: A Comparison of Initial Symptoms Reported between two Generations

Abstract Background Nothing is known about ischemic heart disease (IHD) in the Germans who emigrated to Brazil during the last century. Objective We sought to compare age at diagnosis and IHD manifestations between German immigrants and their first-generation descendants in the region of Blumenau, Brazil. Methods We reviewed medical records of hospitals in Blumenau. Comparison of the groups in the evaluation times was made by analysis of variance (ANOVA) with repeated measures, and comparison of two factors was made by two-way ANOVA. The level of significance was set at p <0.05. Results Study population comprised 68 patients who were born in Germany (group G) and 99 descendants (group D). Twenty-nine patients of group D had two German parents and 70 had one. Mean age at diagnosis was 66.8 ± 10.6 years, with a significant difference between the groups, four years higher in Group G than group D (69.0 ± 8.8 vs 65.4 ± 11.5 years old) (p = 0.025). There was no significant difference in risk factors or coronary angiography data between the groups. HDL cholesterol levels were significantly higher in group G than in group D (48.4 ± 11.1 mg/dL vs 43.3 ± 11.2 mg/dL, p = 0.005). Conclusion At the time of first IHD diagnosis, mean age of the group G was significantly higher than group D, with no differences between groups in sex, risk factors, LDL levels, or clinical and angiographic manifestations. An earlier manifestation of the disease could be part of lifestyle changes in descendants, in this population that mantained eating habits characterized by high saturated fat consumption.

Resilience profiles across context: A latent profile analysis in a German, Greek, and Swiss sample of adolescents.

The present study investigated resilience profiles (based on levels of symptoms of anxiety and depression and five dimensions of protective factors) of 1,160 students from Germany (n = 346, 46.0% females, Mage = 12.77, SDage = 0.78), Greece (n = 439, 54.5% females, Mage = 12.68, SDage = 0.69), and Switzerland (n = 375, 44.5% females, Mage = 12.29, SDage = 0.88) using latent profile analyses. We also checked for measurement invariance and investigated the influence of gender and migration on class membership. A three-profile-solution was found for Switzerland (nonresilient 22.1%, moderately resilient 42.9%, untroubled 34.9%), and a four-profile-solution was the best fitting model for Germany (nonresilient 15.7%, moderately resilient 44.2%, untroubled 27.3%, resilient 12.7%) and Greece (nonresilient 21.0%, moderately resilient 30.8%, untroubled 24.9%, resilient 23.3%). Measurement invariance did not hold across the three countries. Profile differences regarding class membership predictions were detected for Germany and Greece, but none for Switzerland. Results implicate that resilience profiles are highly contextually sensitive, and resilience research findings should not be generalized considering the particularity of contexts, people, and outcomes.

Influence of Turkish origin on hematology reference intervals in the German population.

Reference intervals for laboratory test results have to be appropriate for the population in which they are used to be clinically useful. While sex and age are established partitioning criteria, patients' origin also influences laboratory test results, but is not commonly considered when creating or applying reference intervals. In the German population, stratification for ethnicity is rarely performed, and no ethnicity-specific hematology reference intervals have been reported yet. In this retrospective study, we investigated whether specific reference intervals are warranted for the numerically largest group of non-German descent, individuals originating from Turkey. To this end, we analyzed 1,314,754 test results from 167,294 patients from six German centers. Using a name-based algorithm, 1.9% of patients were identified as originating from Turkey, in line with census data and the algorithm's sensitivity. Reference intervals and their confidence intervals were calculated using an indirect data mining approach, and Turkish and non-Turkish reference limits overlapped completely or partially in nearly all analytes, regardless of age and sex, and only 5/144 (3.5%) subgroups' reference limits showed no overlap. We therefore conclude that the current practice of using common reference intervals is appropriate and allows correct clinical decision-making in patients originating from Turkey.

Health determinants among refugees in Austria and Germany: A propensity-matched comparative study for Syrian, Afghan, and Iraqi refugees.

In recent years, Germany and Austria have been among the leading European receiving countries for asylum seekers and refugees (AS&R). The two countries have cultural and economic similarities, but differ, for example, in their health care systems, with AS&R having unrestricted access to health services upon arrival in Austria, but not in Germany. This study investigates the determinants of health among refugees in Austria and Germany, and how these determinants differ between the two countries. We analyze comparable and harmonized survey data from both countries for Syrian, Afghan, and Iraqi nationals aged 18 to 59 years who had immigrated between 2013 and 2016 (Germany: n = 2,854; Austria: n = 374). The study adopts a cross-sectional design, and uses propensity score matching to examine comparable AS&R in the two receiving countries. The results reveal that the AS&R in Germany (72%) were significantly less likely to report being in (very) good health than their peers in Austria (89%). Age and education had large impacts on health, whereas the effects of length of stay and length of asylum process were smaller. Compositional differences in terms of age, sex, nationality, education, and partnership situation explained the country differences only in part. After applying propensity score matching to adjust for structural differences and to assess non-confounded country effects, the probability of reporting (very) good health was still 12 percentage points lower in Germany than in Austria. We conclude that many of the determinants of health among AS&R correspond to those in the non-migrant population, and thus call for the implementation of similar health policies. The health disadvantage found among the AS&R in Germany suggests that removing their initially restricted access to health care may improve their health.

Experiences as Actors: Labor Pains in Childbirth Care in Germany.

Taking labor pains in childbirth care in Germany as a case study, I develop a practice-based notion of experience. Labor pains are sociomaterial experiences and effected actors that are shared and "worked with." Drawing on fieldwork, I show an extensive repertoire of possible interventions used to deal with, and to co-enact, continuously shifting actorships of labor pains in childbirth care. These actorships include helpful tools, unproductive sensations, effective work, fruitless investments, products of bodily tension, and pure labor pains. Experiences such as labor pains are not only passively known, felt and done but also take active part in shaping (childbirth care) practices.

Health policy versus kava (Piper methysticum): Anxiolytic efficacy may be instrumental in restoring the reputation of a major South Pacific crop.

ETHNOPHARMACOLOGICAL RELEVANCE: Kava (Piper methysticum G. Forst. f.) is by far the most important plant used in the islands of Melanesia, Polynesia and Micronesia for its relaxing effects. Kava drinking is a pillar of South Pacific societies and is also the foundation of their economies. Preparations of kava extract as herbal medicinal drugs were banned in Germany in 2002 and again in 2019, with dramatic consequences for the South Pacific economies. In 2002, the major regulatory argument for the ban of kava was safety issues. In 2019, the assessment report of the European Medicines Agency's Herbal Medicinal Product Committee (HMPC) justified a negative benefit-to-risk ratio by a supposed lack of efficacy of ethanolic extracts for an indication of which kava extract preparations never had an approval. In this HMPC report the efficacy in the approved indications 'nervous anxiety, tension and restlessness' was attributed to the extract branded as 'WS 1490', which was assumed to have been prepared with acetone as an extraction solvent. In addition to this change of indication and the attribution of efficacy to acetone kava extract alone, the German health authorities and the HMPC still refuse to discuss quality issues as a likely factor impacting drug safety. The first case reports of liver toxicity were observed with an acetone extract in a timely relationship with the introduction of 'two-day kava' instead of 'noble kava' as used in ethanolic kava extracts. AIM OF THE STUDY: The correlation between clinical benefits and the type of extract preparation was examined. METHODS: In order to identify the types of kava material and extracts used in clinical trials, the respective publications were compared with regulatory databases and protocols of a German regulatory advisory board. RESULTS AND CONCLUSIONS: The comparison reveals inconsistencies in the regulatory decisions. In all studies with WS 1490, the evidence points to the use of an ethanolic extract. The efficacy of kava extract for the approved indication was clearly demonstrated. The HMPC report and the recent renewed German regulatory ban of kava therefore require major revision, which should include the impact of the use of "two-day kava" on drug safety. Such a revision could contribute to restoring the reputation of "noble kava" on the international markets.

The Hospital Anxiety and Depression Scale (HADS) applied to Ethiopian cancer patients.

Psychological distress is a common problem associated with cancer. The main objective of the present study was to test the Hospital Anxiety and Depression Scale (HADS) in a sample of Ethiopian cancer patients and to compare the results with those obtained from a sample in Germany. Data were collected from 256 cancer patients who visited the University of Gondar Hospital between January 2019 and June 2019 using the HADS, the European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC QLQ-C30), and the Multidimensional Fatigue Inventory MFI-20. The reliability of the HADS was good, with Cronbach's α coefficients of 0.86 (anxiety), 0.85 (depression), and 0.91 (total scale). The Ethiopian cancer patients were more anxious (M = 7.9) and more depressed (M = 9.3) than the German patients (M = 6.8 for anxiety and M = 5.5 for depression). Only a weak level of measurement invariance was detected between the Ethiopian and the German sample. In the Ethiopian sample, anxiety and depression were associated with tumor stage (high levels in stage 4) and treatment (high levels for patients not receiving surgery and chemotherapy). Both anxiety and depression were significantly associated with all of the EORTC QLQ-C30 and MFI-20 scales. The HADS proved to be applicable for use with Ethiopian cancer patients. The high level of anxiety and depression present in that group indicates a need for psychosocial care.

Effect of Covid-19 pandemic on mental health among Albanian people residing in the country and abroad - Implications for mental care.

BACKGROUND: Coronavirus disease caused by the novel coronavirus Covid-19 is a current worldwide outbreak. The use of quarantine and isolation proved effective in containing the spread of infection. OBJECTIVES: The purpose of this cross-sectional study was to assess the mental health of Albanian people residing in the country and abroad during the quarantine period for the Covid-19 pandemic. DESIGN: This study was carried out from 25th March - 20th April 2020 through a web survey shared on social networks. The goal was to reach at least the minimum sample size for cross-sectional studies. The Patient Health Questionnaire (PHQ-9) was used to assess mental health. Chi-square (χ2) and Fisher -Exact test were used to assess the statistical significance among variables. P values ≤0.05 were considered statistically significant. RESULTS: 715 participants were included in the final analyses (78.41% females and 21.53% males). Most were residents in Albania (80.41%) and the others resided mainly in Italy (6.89%), Greece (3.51%), Germany (2.43%), Kosovo (1.62%) and the UK (1.69%). Statistical association was found between gender, country of residency and measures taken. Summary score of PHQ-9 items was 6.4662. The total score of depression classification shows that 31.82% and 12.90% of participants have respectively mild and moderate depression. Female participants showed the highest score for some items of PHQ-9, p≤0.05. CONCLUSIONS: Findings suggest that health care professionals should recognize and address mental health problems associated with Covid-19 especially in vulnerable groups. Acting in a timely and proper manner is essential in preventing these problems from becoming chronic.

Dementia in People with a Turkish Migration Background: Experiences and Utilization of Healthcare Services.

BACKGROUND: As the proportion of older people with migration background (PwM) increases, the proportion of older PwM with dementia might also increase. Dementia is underdiagnosed in this group and a large proportion of PwM with dementia and family caregivers are not properly supported. Healthcare utilization is lower among older migrant populations. Thus, a better understanding of how PwM and family caregivers perceive their situation and how they experience healthcare services is needed to improve utilization of the healthcare system. OBJECTIVE: Analyze how family caregivers of PwM with dementia experience their situation, why healthcare services are utilized less often, and what can be done to reverse this. METHODS: Eight semi-structured interviews were conducted with people with Turkish migration background caring for PwM with dementia. Qualitative content analysis was used for data analysis. RESULTS: Daily care was performed by one family member with the support of others. Healthcare services were used by most participants. Participants identified a need for better access to relevant information and incorporation of Turkish culture into healthcare services. CONCLUSION: PwM face similar challenges in taking care of persons with dementia as those without migration background. There is a willingness to use services, and services embracing Turkish culture would help to reduce hesitance and make affected people feel more comfortable, thereby increasing utilization and satisfaction. A limitation of this study is that participants were already connected to health services, which may not reflect the help-seeking behavior of those in the Turkish community who are not involved in healthcare.

Systemic lupus erythematosus and neutropaenia: a hallmark of haematological manifestations.

OBJECTIVE: Systemic lupus is a chronic autoimmune disease characterised by its phenotypic heterogeneity. Neutropaenia is a frequent event in SLE occurring in 20%-40% of patients depending on the threshold value of neutrophil count. On a daily basis, the management of neutropaenia in SLE is difficult with several possible causes. Moreover, the infectious consequences of neutropaenia in SLE remain not well defined. METHODS: 998 patients from the Lupus BioBank of the upper Rhein (LBBR), a large German and French cohort of patients with SLE, mostly of Caucasian origin (83%), were included in this study. Neutropaenia was considered when neutrophil count was below 1800×106/L. An additional analysis of detailed medical records was done for 65 LBBR patients with neutropaenia. RESULTS: 208 patients with neutropaenia (21%) were compared with 779 SLE patients without neutropaenia. Neutropaenia in SLE was significantly associated with thrombocytopaenia (OR 4.11 (2.57-10.3)), lymphopaenia (OR 4.41 (2.51-11.5)) and low C3 (OR 1.91 (1.03-4.37)) in multivariate analysis. 65 representative patients with neutropaenia were analysed. Neutropaenia was moderate to severe in 38%, chronic in 31%, and both severe and chronic in 23% of cases. Moderate to severe and chronic neutropaenia were both associated with lymphopaenia and thrombopaenia. Chronic neutropaenia was also associated anti-Ro/SSA antibodies and moderate to severe neutropaenia with oral ulcers. CONCLUSION: This study is to date the largest cohort to describe neutropaenia in SLE. Neutropaenia displays a strong association with other cytopaenias, suggesting a common mechanism. Chronic neutropaenia is associated with anti-Ro/SSA antibodies with or without identified Sjögren's disease.

Bullying Experience among Adolescents with a Turkish Migration Background in Germany: Ethnic Class Composition, Integration, and Religiosity as Protective Factors?

Bullying is a worldwide problem that has serious effects on the mental health of both victims and perpetrators. Although bullying seems related to increasing globalization and migration, it has seldom been researched in this context. This exploratory study examined bullying experiences and related depressive symptoms among a sample of adolescents with a Turkish migration background in a German school context (N = 103, 56.7% female, MAge = 16.17, SDAge = 1.36). The study focuses on three migration-related variables as potentially salutogenic factors: Ethnic class composition, acculturation, and religiosity. While the ethnic class composition did not show any effect, an integration acculturation strategy and religiosity proved to be protective factors against bullying experience. The negative prediction of integration on depressive symptoms was not consistent throughout the multivariate analyses. The results are discussed against the background of new impulses for bullying intervention programs for this vulnerable group of adolescents from a Turkish migration background.

Conceiving one's national group as transgenerational: Effects on attitudes towards 'foreign' and diaspora migrants.

The current paper presents three studies, which suggest that perceiving one's nation as transgenerational (TG) is related to a differentiation in the evaluation of ethnically German diaspora migrants and ethnically non-German ('foreign') migrants. First, we find that unlike 'classical' concepts such as right-wing authoritarianism (RWA), social dominance orientation (SDO), and hierarchic self-interest (HSI), TG explains differences in derogatory sentiments expressed towards diaspora and 'foreign' migrants. Second, TG is differentially related to positive emotions and behavioral intentions expressed towards these two groups of migrants. Lastly, results indicate that people who perceive the ingroup as TG require 'foreign' migrants to fulfill more criteria that make them eligible for citizenship and are thereby more exclusionist than people who include only the current generation into their concept of national identity. The social implications of these findings in face of the so-called refugee crisis in Germany and the wider European Union are discussed.

Evaluation of the Metabotype Concept Identified in an Irish Population in the German KORA Cohort Study.

SCOPE: Previous work identified three metabolically homogeneous subgroups of individuals ("metabotypes") using k-means cluster analysis based on fasting serum levels of triacylglycerol, total cholesterol, HDL cholesterol, and glucose. The aim is to reproduce these findings and describe metabotype groups by dietary habits and by incident disease occurrence. METHODS AND RESULTS: 1744 participants from the KORA F4 study and 2221 participants from the KORA FF4 study are assigned to the three metabotype clusters previously identified by minimizing the Euclidean distances. In both KORA studies, the assignment of participants results in three metabolically distinct clusters, with cluster 3 representing the group of participants with the most unfavorable metabolic characteristics. Individuals of cluster 3 are further characterized by the highest incident disease occurrence during follow-up; they also reveal the most unfavorable diet with significantly lowest intakes of vegetables, dairy products, and fibers, and highest intakes of total, red, and processed meat. CONCLUSION: The three metabotypes originally identified in an Irish population are successfully reproduced. In addition to this validation approach, the observed differences in disease incidence across metabotypes represent an important new finding that strongly supports the metabotyping approach as a tool for risk stratification.

Cross-cultural variation in how much, but not whether, children overimitate.

Children from Western industrialized populations tend to copy actions modeled by an adult with high fidelity even if these actions are functionally irrelevant. This so-called overimitation has been argued to be an important driver of cumulative cultural learning. However, cross-cultural and developmental evidence on overimitation is controversial, likely due to diverging task demands regarding children's attention and memory capabilities. Here, children from a recent hunter-gatherer population (Hai||om in Namibia) were compared with urban Western children (Germany) using an overimitation procedure with minimal cognitive task demands. Although the proportion of children engaging in any overimitation was similar across the two populations, German overimitators copied irrelevant actions more persistently across tasks. These results suggest that the influence of culture on children's overimitation may be one of degree, not kind.

Differential Influence of Same- and Cross-Ethnic Friends on Ethnic-Racial Identity Development in Early Adolescence.

Recent research has shown that peers influence ethnic-racial identity (ERI) development during early adolescence. Arguments based on social identity theory, however, suggest that only same-ethnic but not cross-ethnic friends are important for ERI development. Using longitudinal social network analysis, we examined peer influence of both same- and cross-ethnic friends on ERI attachment and private regard. Data were drawn from six ethnically diverse schools in Western Germany (N = 1,349; Mage  = 13.3). Our results provide empirical evidence for early adolescents' ERI being influenced by same- but less by cross-ethnic friends. Considering peers' ethnicity therefore is crucial for understanding peer influence on ERI development.

Positive Effects of Practical Nutrition Lessons in a Primary School Setting with a High Proportion of Migrant School Children.

BACKGROUND: Children with migration background are at increased risk for overweight, partly due to less favorable dietary habits compared to their German counterparts. We examined the effects of practical nutrition lessons among children with a high proportion of migration background in a primary school setting. METHODS: Ten 3rd and 4th grade classes (n=166 children, 73% with migration background) received the intervention and nine school classes (n=139 children, 76% with migration background) served as control. Before, shortly after (only among the intervention group) and three months after the three-day practical nutrition lessons, the nutrition-related skills, behavior, attitudes, and knowledge of the children were assessed using a questionnaire. Changes between baseline and 1st follow-up among children of the intervention group were calculated using linear mixed models. Differences between the two groups for changes between baseline and 2nd follow-up were tested using linear regression analyses. Models were adjusted for potential confounders. RESULTS: Shortly after the practical nutrition lessons, the children of the intervention group had improved their knowledge (ß=1.7; 95% CI: 1.0; 2.4, P<0.001) and skills (ß=1.8; 95% CI: 1.4; 2.2, P<0.001). These changes were sustainable and larger in the intervention compared to the control group (knowledge: ß=1.6; 95% CI: 0.7; 2.5, P<0.001; skills: ß=1.3; 95% CI: 0.7; 1.9, P<0.001). Changes in nutrition-related behavior and attitudes did not differ between the groups. CONCLUSIONS: Providing practical nutrition lessons in a primary school setting with a high proportion of children with immigrational background improved the children's nutrition-related knowledge and skills.

Emotion regulation as a transdiagnostic factor in Afghan refugees.

OBJECTIVE: In response to the high rates of comorbidity as well as the severe social impairment among refugees, the examination of transdiagnostic factors such as emotion regulation appears particularly promising in this group. This study investigates the contribution of difficulties in emotion regulation to the self-reported symptom levels of posttraumatic stress disorder (PTSD), depression, and anxiety/insomnia, which are highly prevalent symptoms among refugees. In addition, the link between emotion regulation and social impairment is examined. METHOD: Participants were 74 male Afghan refugees exposed to trauma. They completed measures of trauma exposure, difficulties in emotion regulation (Difficulties in Emotion Regulation Scale), PTSD (PTSD Checklist for DSM-5), depression, anxiety/insomnia, and social impairment (General Health Questionnaire-28). RESULTS: Higher symptom severities of PTSD, depression, and anxiety/insomnia were related to the Difficulties in Emotion Regulation Scale subscales nonacceptance, goals, impulse, strategies, and clarity, but none of our outcomes was related to lack of emotional awareness. Difficulties in emotion regulation accounted for significant variance in PTSD, depression, and anxiety/insomnia beyond demographics and trauma exposure. When predicting social impairment, difficulties in emotion regulation accounted for significant variance beyond PTSD and anxiety/insomnia but not beyond depression. CONCLUSION: The findings indicate that emotion regulation may be a transdiagnostic key factor contributing to symptoms of different mental disorders as well as social impairment in trauma-exposed refugees. It highlights the need and potential directions for transdiagnostic interventions that target these difficulties. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Cultural determinants of food attitudes in anosmic patients.

The decrease in food enjoyment is a major factor why patients suffer from depression when having anosmia, or total loss of smell. While we have some knowledge about how food preferences and attitudes change with dysosmia, these findings are limited because other factors such as culture are not factored in. It is likely that the culture in which an anosmic patient identifies with will influence how their smell loss impacts their relationship with food. This study examined the current attitudes within the United States and Germany towards foods, focusing on the comparison between anosmic patients (N = 53) and those with a healthy sense of smell (N = 121). A survey was used to collect free responses for liking on a variety of foods (N = 15) that were also rated for their overall liking. Additionally, individuals rated and ranked their liking for sensory attributes in relation to their enjoyment of food. Free responses were classified into categories and subcategories, the frequency of those responses were then compared across groups. The patient population of each culture gave lower importance to aroma and flavor; however, the U.S.A. patient population showed a larger decrease from their healthy counterparts. Furthermore, anosmic patients from the U.S.A. showed less overall liking towards the food stimuli compared to their healthy counterparts, while no such effect observed among the German population. Reasons to enjoy a food were largely explained by the culture, and patients within a culture took on different compensation strategies which we use to explain their effectiveness.

The relation between emotion regulation and migraine: A cross-cultural study on the moderating effect of culture.

BACKGROUND: Effects of emotion suppression on physical health might be contingent on culture. Existing research on emotion regulation has mainly included western participants. Herewith the question arises, whether this gained expertise is transferable to an Asian culture. OBJECTIVES: This cross-sectional study evaluated to what extent the regulation of emotions is related to migraine and if the relation between emotion regulation and migraine complaints differs between a Western and an Asian population. Therefore, the main characteristics and symptoms of patients with migraine from both Germany and Japan are compared. METHODS: 261 Japanese and 347 German headache patients participated in this online study and completed self-report measures of emotion regulation (suppression and reappraisal) and headache complaints. RESULTS: Cultural groups did not differ regarding their demographic data, intake of medication and number of days with headache. German participants showed significantly higher levels of anxiety and lower levels of emotion suppression compared to Japanese patients. Emotion regulation is not correlated with headache complaints either in the Japanese or in the German patient group. CONCLUSION: Although group differences were found with respect to anxiety and emotion suppression, subsequent regression analysis revealed these differences were unrelated to headache complaints. As our baseline analysis focused on group means, approaches that examine individual reaction patterns to stress and accompanying sensory stimulus processing may prove to be more fruitful and illuminating.

Is depression comparable between asylum seekers and native Germans? An investigation of measurement invariance of the PHQ-9.

BACKGROUND: Asylum seekers show high prevalence of depressive disorders compared to native populations. For the assessment of depression, the Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument that has shown high validity and reliability. However, it is largely unknown whether PHQ-9 scores are comparable between asylum seekers living in Western countries and native populations, and whether results can be interpreted without reservation. METHOD: Data from asylum seekers living in Germany (n = 243) and Germans without a migration background (n = 171) were used to analyze measurement invariance of the PHQ-9. Configural, scalar, and metric invariance was investigated, and test functioning was determined. RESULTS: The PHQ-9 was not measurement invariant across Germans without a migration background and asylum seekers living in Germany. Differences were found regarding metric invariance and scalar invariance. The items anhedonia, depressed mood, appetite changes, psychomotor changes, and suicidal ideation had lower loadings and lower thresholds in asylum seekers compared to Germans without a migration background. That led to an overestimation translated into approximately one point on the sum-score. LIMITATIONS: The study limitations include a heterogeneous sample of asylum seekers regarding countries of origin, and the utilization of the different language versions of the PHQ-9. CONCLUSION: Our results may have implications for studies comparing levels of depression between asylum seekers and native Western samples. Even with the same latent level of depression, asylum seekers may have higher scores on several items and consequently a higher sum score. Therefore, the present results suggest a new determination or differentiation of the cut-off scores that were derived from Western samples.