The relevance of social capital and sense of coherence for mental health of refugees.

Introduction: Migration puts refugees in a completely new social context when simultaneously some have to deal with previously experienced traumatic events and post-migration stressors. Social capital and sense of coherence could be key resources to improve mental health of refugees. This study aims to examine the interplay between social capital (structural and cognitive), sense of coherence and mental health of refugees in the Netherlands. Objective: The present study was conducted to i) examine if social capital (structural and cognitive) and mental health are related in a population of Dutch refugees, and ii) test if sense of coherence has a moderating and/or a mediating effect on this relation. Method: Data were collected through questionnaires (n = 154) in a cross-sectional survey at different locations throughout the Netherlands. The data were analysed with multiple regression analyses and nonparametric bootstrapping using SPSS. Results: Social capital (structural and cognitive) was positively related to mental health. In addition a positive relation between sense of coherence and mental health of refugees was found. The relationship between cognitive social capital and mental health was completely mediated by sense of coherence. No moderation effect of sense of coherence on the relation between social capital and mental health was found. Conclusions: The current study contributed to understanding the social mechanism that determines refugee mental health: participating in social groups (structural social capital) and having supportive and trusting relationships (cognitive social capital), whilst experiencing life as comprehensible, manageable, and meaningful (sense of coherence) are positively related to better mental health of refugees. Findings indicate that preventive interventions aiming to enhance refugees' mental health may be more effective when targeting and promoting both social capital and sense of coherence, from a relatively early stage after arrival in the Netherlands.

Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study.

Background: Traumatic events can be related to severe transgressions or violations of moral boundaries. Moral injury (MI) has been described as 'the lasting psychological, biological, spiritual, behavioral and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.' These events can provoke emotions such as remorse, guilt and shame, and affects someone's self-image and identity. Objective: The aim of the study is to evaluate a treatment protocol that addresses the specific characteristics of moral trauma in treatment of PTSD, next to anxiety. Method: Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT) is an adaptation of the evidence-based Brief Eclectic Psychotherapy for PTSD (BEPP). BEP-MT integrates components of cognitive-behavioural, psychodynamic, constructivist, and systemic psychotherapy. In the current study treatment progress of a refugee Dusan was monitored. Prior to and after treatment the Clinical-Administered PTSD Scale for DSM-5, the PTSD Checklist (PCL-5), the Brief Symptom Inventory (BSI) and the Moral Injury Appraisal Scale (MIAS) were administered. Every session moral emotions were assessed on a Likert scale. Results: Whereas PTSD complaints and strong feelings of guilt and shame were manifest prior to treatment, during BEP MT a gradual decline in the intensity of the moral emotions was found. After BEP-MT Dusan no longer met criteria for PTSD and his psychological complaints diminished. Conclusion: The case of Dusan has shown it is worthwhile to address moral trauma and BEP- MT is a promising treatment protocol for patients suffering from PTSD after moral trauma. Further research is needed to examine the effectiveness of BEP-MT.

Antecedentes: Los eventos traumáticos pueden estar relacionados con transgresiones graves o violaciones de los límites morales. El daño moral (DM) se ha descrito como 'el impacto duradero psicológico, biológico, espiritual, conductual y social de perpetrar, fallar en prevenir o testificar actos que transgreden creencias y expectativas morales profundamente sostenidas'. Estos eventos pueden provocar emociones como remordimiento, culpa y vergüenza, y afectan la autoimagen y la identidad de una persona.Objetivo: El objetivo del estudio es evaluar un protocolo de tratamiento que aborde las características específicas del trauma moral en el tratamiento del TEPT, junto a la ansiedad.Método: La psicoterapia ecléctica breve para el trauma moral (BEP-MT) es una adaptación de la psicoterapia ecléctica breve basada en la evidencia para el TEPT (BEPP). La BEP-MT integra componentes de psicoterapia cognitivo-conductual, psicodinámica, constructivista y sistémica. En el estudio actual, se monitoreó el progreso del tratamiento de un refugiado, Dusan. Antes y después del tratamiento, se aplicó la Escala de TEPT para el DSM-5 administrada por clínicos, la Lista de chequeo de TEPT (PCL-5, por su sigla en inglés), el Inventario breve de síntomas (BSI, por su sigla en inglés) y la Escala de evaluación de lesiones morales (MIAS, por su sigla en inglés). En cada sesión, las emociones morales se evaluaron en una escala Likert.Resultados: Mientras que las quejas de TEPT y los fuertes sentimientos de culpa y vergüenza se manifestaron antes del tratamiento, durante BEP-MT se encontró una disminución gradual en la intensidad de las emociones morales. Después de BEP-MT, Dusan dejo de cumplir los criterios para el trastorno de estrés postraumático y sus quejas psicológicas disminuyeron.Conclusiones: El Caso de Dusan ha demostrado que vale la pena abordar el trauma moral y BEP-MT es un protocolo prometedor para los pacientes que sufren de trastorno de estrés postraumático después de un trauma moral. Se necesitan más investigaciones para examinar la eficacia de BEP-MT.