[Psychodiagnostics in Psychosocial Centers for Refugees]. / Psychodiagnostik in den psychosozialen Zentren für geflüchtete Menschen.

OBJECTIVE: Accurate psychodiagnostics is crucial for diagnosing and ensuring quality treatment for individuals with mental health disorders. However, there is limited understanding of psychodiagnostic practices within Psychosocial Centers (PSZ) when dealing with refugees, particularly in the presence of language and cultural barriers and resource constraints. This study aims to evaluate the current status and potential pathways for enhancing culturally sensitive diagnostics in this context. METHODS: We conducted an online survey using a self-developed questionnaire with representatives from 32 PSZ to examine psychodiagnostic practices, barriers, and perceived development potentials, and analyzed the data descriptively. RESULTS: Most centers prefer individual case assessments over standardized diagnostics. Key barriers to using standardized questionnaires and interviews include communication difficulties (unfamiliarity with question formats, reading and writing difficulties) and resource limitations (time, translation). When conducting diagnostics, time constraints and prioritizing complex cases are the primary challenges. Additional assessments are needed for several disorders and languages. Employees are interested in receiving training in the field of culturally sensitive diagnostics. DISCUSSION: Diagnostic practice in the PSZs is characterized by numerous challenges that differ from the challenges in standard care. In order to ensure appropriate standardized diagnostics and care for mentally distressed people with a refugee or migrant background, further expansion of the linguistic and cultural adaptation of established diagnostic instruments is essential. CONCLUSION: In the care of psychologically distressed refugees, culturally sensitive standardized diagnostics offer critical benefits for both practitioners and affected individuals. Existing resources are being referred to.

[Frequency Of Psychological Stress And Barriers To Accessing Mental Health Services For Leipzig Citizens Of Afghan And Iraqi Citizenship]. / Zugangshürden zu psychosozialen Versorgungsangeboten Leipziger Bürger*innen afghanischer und irakischer Staatsangehörigkeit.

OBJECTIVE: Aim of the study was to report evidence on mental health needs and access to mental health and psychosocial support for Leipzig citizens of Afghan and Iraqi citizenship in the presence of mental stress and, above all, to identify barriers to access to care. METHODS: All adults in Leipzig with Iraqi or Afghan citizenship, who were not born in Germany were contacted. Various instruments (PHQ-9, GAD-7, SSS-8, PCL-5/LEC-5) to screen for symptoms of depression, anxiety, somatization disorder or PTSD and one item for self-reported emotional problems were used. Questions on health care utilization and barriers to care followed. RESULTS: 51.4% screened positive in at least one of the tests and self-reported emotional problems. 38.2% of those in need of treatment did not seek help. Frequent reasons for not seeking help were, that the people wanted to solve the problem on their own or that the problem did not bother them very much. A lack of trust and understanding regarding the healthcare system and fear of discrimination and stigmatisation were also perceived as additional barriers to care. DISCUSSION: The study revealed a high percentage of mental health needs. This could be due to the high number of traumatic events and post-migration stressors. A longer period of residence in Germany and easier access to the public health system through the health insurance card could have encouraged the health care utilization. The treatment gap was caused by barriers to care such as a lack of knowledge or trust of the German health care system and fear of stigmatisation and discrimination. CONCLUSION: More information about access to care structures and more low-threshold services need to be implemented. These should be organised on an interdisciplinary basis and focus on culturally and racially sensitive care. Mental health awareness should be strengthened and under no circumstances should the access to care be restricted any further.

[The Connection between Objective and Subjective Attributions of a Migration Background with Perceived Discrimination and Racism]. / Der Zusammenhang zwischen objektiven und subjektiven Zuschreibungen eines Migrationshintergrundes mit wahrgenommener Diskriminierung und Rassismus.

BACKGROUND: The criteria-oriented assessment of the population with a migration background that is common in Germany is currently being criticized from a social science and methodological perspective, among others. In particular, its usefulness as an indicator of perceived discrimination against the population with a migration background can be critically questioned based on the current state of research METHOD: Based on a population-representative data set (N=1,989) for the city of Berlin, the subjective perception of a migration background based on self-attribution and anticipated external attribution of a migration background was recorded in addition to the objective assessment of a migration background. Furthermore, socio-demographic and migration-specific characteristics as well as perceived discrimination were assessed. Using descriptive and inferential statistical methods, differences between the objective and subjective assessment of a migration background and their relationship with perceived discrimination were analyzed. RESULTS: Less than half (38%, 154/400) of the respondents identified as having a migrant background using the criterion-oriented approach reported describing themselves as migrants. 36% (144/405) reported that they believed that others in Germany described them as a person with a migrantion background. Respondents with a migration background are significantly more likely to experience discrimination on grounds of skin color, religion or country of origin compared to respondents without a migration background. Furthermore, it was found that both the self-attribution and the anticipated attribution by others as a migrant are positively associated with experiences of discrimination and racism. DISCUSSION: The results suggest that migration-sensitive research should not simply differentiate between people with and without a migration background according to official criteria. Rather, the subjective perceptions of one's own attribution as a migrant seem more suitable as indicators of discrimination and should be taken into account in future research or surveys on experiences of discrimination.

[Assessment of the Individual Experience of Sexual Violence in War and Forced Displacement and its Consequences Among Male Victims: A Narrative Literature Review]. / Dimensionale Erfassung des individuellen Erlebens kriegs- und vertreibungsbezogener sexualisierter Gewalt und ihrer Folgen bei männlichen Betroffenen: Eine narrative Literaturübersicht.

From a psychological perspective, male survivors of sexual violence in the context of war and forced displacement represent a highly burdened population. An adequate assessment of traumatic events and trauma related disorders is often hampered by both disclosure barriers from the patient side as well as by lack of awareness on the part of healthcare professionals regarding male victimization. Based on a narrative literature review, relevant characteristics of violence and their relation to the diagnostic process are elaborated on eight dimensions of individual experience of violence (form of violence, frequency and severity, perpetrator-victim context, societal discrimination, subjective evaluation, concept of masculinity, culture-specific norms, and trauma sequelae). The dimensions are delineated in a case study. In order to thoroughly assess sexualized experiences of violence, there is a need for sensitivity on the part of practitioners to the signs of male victimization and regular assessment of sexualized violence in male patients. In this context, certainty about the confidentiality of the information disclosed and recognition of the injustice are of central importance for those affected. In the long term, the development of specialized support services for male victims is needed.

Mental health of recently arrived male refugees in Germany reporting sexual violence.

Conflict-related sexual violence (CRSV) is one of the most severe and stigmatizing human rights violations. The recognition of men and boys as targets of sexual violence is a rather recent development. In the present study data on experiences of sexual violence as well as mental health outcomes were analysed in recently arrived male refugees (N = 392) in Germany. More than one third of the men interviewed (n = 128; 36.6%) reported having experienced sexual violence. Compared to male refugees without experiences of sexual violence, male refugee survivors showed higher prevalence rates of PTSD. Moreover, some differences were found between the subgroups on the single symptoms level, indicating higher severity in those affected by sexual violence, including negative alterations in cognition/mood, suicidal ideation, and nervousness or shakiness inside. The findings provide initial data on prevalence of sexual violence and related mental health outcomes in male refugees newly arrived in Germany and emphasize the significance of sexual violence as a risk factor for different mental health outcomes. This provides clear implications for health care professionals that could aid them in better identifying those affected. Finally, further research is urgently needed that takes a closer, more differentiated look at sexual violence in male refugee populations.

Suicidal ideation among recently arrived refugees in Germany.

BACKGROUND: Refugees are considered a high-risk population for developing mental health disorders. Yet little research has been conducted on suicidal ideation among refugees resettled in Western high-income countries. In the present hstudy, suicidal ideation and its association with different socio-demographic, flight-related, and mental health-related factors were analyzed in recently arrived refugees in Germany. METHODS: The study was conducted in a reception facility for asylum-seekers in Leipzig, where 564 newly arrived adult residents participated. The questionnaire included socio-demographic and flight-related questions as well as standardized instruments for assessing suicidal ideation (item 9 from PHQ-9), a variety of traumatic experiences (LEC-5), posttraumatic stress disorder (PCL-5), depression (PHQ-8), and somatic symptoms (SSS-8). Multiple logistic regression models were run to predict suicidal ideation in relation to different socio-demographic, flight, and mental health-related factors. RESULTS: In total, 171 (30.3%) participants who had just or very recently arrived in Germany reported having experienced suicidal ideation within the two weeks prior to being assessed. Those who reported suicidal ideation also reported higher prevalence of somatic symptoms, posttraumatic stress disorder, depression, and experiences of sexual violence, as well as worse self-rated mental and physical health. In addition, there were significant independent associations between suicidal ideation and (1) younger age, (2) longer flight duration, (3) experiences of sexual violence, (4) symptoms of posttraumatic stress disorder, and (5) symptoms of depression. CONCLUSIONS: The results emphasize the association between suicidal ideation and different clinically relevant mental health symptoms among newly arrived refugees in Germany. Special attention should not only be given to refugees suffering from symptoms of poor mental health, but also to those of younger age as well as refugees who have experienced sexual violence, as they might be affected by suicidal ideation whether or not they suffer from other mental health problems.

Prevalence of suicidal ideation and suicide attempts among refugees: a meta-analysis.

BACKGROUND: Suicidal ideation and attempts are one of the most serious mental health problems affecting refugees. Risk factors such as mental disorders, low socio-economic status, and stressful life events all contribute to making refugees a high-risk group. For this reason, this meta-analysis aims to investigate the prevalence of suicidal ideation and attempts among refugees in non-clinical populations. METHOD: We searched PubMed, Web of Science, PubPsych, and PsycInfo for articles reporting (period) prevalence rates of suicidal ideation and attempts. Inclusion criteria were the population of refugees or asylum seekers (aged 16 years and older), assessment of the prevalence of suicidal ideation and attempts in empirical studies in cross-sectional or longitudinal settings, written in English, and published by August 2020. Exclusion criteria were defined as a population of immigrants who have lived in the host country for a long time, studies that examined children and adolescents younger than 16 years, and research in clinical samples. Overall prevalence rates were calculated using Rstudio. RESULTS: Of 294 matches, 11 publications met the inclusion criteria. The overall period prevalence of suicidal ideation was 20.5% (CI: 0.11-0.32, I2 = 98%, n = 8), 22.3% (CI: 0.10-0.38, I2 = 97%, n = 5) for women, and 27.7% for men (CI: 0.14-0.45, I2 = 93%, n = 3). Suicide attempts had an overall prevalence of 0.57% (CI: 0.00-0.02, I2 = 81%, n = 4). CONCLUSION: There is a great lack of epidemiological studies on suicidal ideation and attempts among refugees. The high prevalence of suicidal ideation indicates the existence of heavy psychological burden among this population. The prevalence of suicide attempts is similar to that in non-refugee populations. Because of the large heterogeneity between studies, the pooled prevalence estimates must be interpreted with caution. The results underline the need for systematic and standardized assessment and treatment of suicidal ideation and attempts.

Challenges faced by university students during the COVID-19: An international study in five countries during the early phase of the pandemic.

This study focused on the specific challenges of university students in the face of the COVID-19 pandemic and examined similarities and differences in COVID-related concerns and difficulties in functioning in samples of undergraduate students in five countries. A sample of 4306 undergraduate university students (43.8% males, 56.2% females) from Israel, Kosovo, Ukraine, Cyprus and Germany participated in an anonymous online survey during the first wave of the pandemic, between March and June 2020. Study variables included the assessment of the exposure to COVID-19, perceived health status, specific COVID-related concerns and functional difficulties, social support, and the perceived level of coping. Similar concerns about the uncertainty regarding the termination of the health crisis and worry for the health of family members were identified as the most common concerns in the five countries. Challenges in online learning and financial difficulties were rated as the most central difficulties. Both COVID-related concerns and COVID-related difficulties predicted lower levels of perceived coping. Greater social support was associated with better perceived coping. Policymakers should be informed by the accumulating research showing the substantive relationships between academic difficulties and perceived COVID-related distress and coping.

Mental health among immigrants in Germany - the impact of self-attribution and attribution by others as an immigrant.

BACKGROUND: In Germany, the term 'migration background' has been established to differentiate between immigrants and natives. In the present study post-traumatic stress disorder (PTSD), anxiety, and depression were analysed in immigrant populations in Germany by considering self-attribution as well as attribution by others on one's own 'migration background'. METHODS: In a population-based survey (N = 2317), socio-demographic characteristics, migration background (official statistics definition vs. self-attribution as well as the anticipated attribution by others), PTSD (PCL-5), and symptoms of anxiety and depression (PHQ-4) were assessed. Logistic regression models were applied to predict mental health outcomes by considering socio-demographic and immigration-related factors. RESULTS: A total of 10.7% of respondents (N = 248) had a 'migration background'. Immigrants of the 2nd generation compared to 1st generation immigrants are less likely to see themselves as immigrants. Attribution as an immigrant (self and/or by others) was found as significant predictor for PTSD and depression, but not anxiety. CONCLUSIONS: It seems useful to focus on immigration-related factors considering subjective perspectives and not only comparing immigrants and natives using a federal statistics definition. Our findings suggest that research on the association between immigration-related factors such as attribution as an immigrant and mental health outcomes might be a promising approach to better identify subgroups at higher risk of mental distress.

Alone, but protected? Effects of social support on mental health of unaccompanied refugee minors.

Unaccompanied refugee minors (URM) are the most vulnerable group of refugees suffering from higher levels of mental health problems. Yet, there is also a group of URM with little or no symptoms or disorders. A major predictor for positive mental health outcomes is the social support network in the post-flight period which has rarely been investigated for the group of URM. The present study analyzes differences between perceived social support from family, peers, and adult mentors in URM, with subgroup analyses of peer and mentor support in URM with and without family contact. Furthermore, we investigate whether social support from each of the three sectors moderates the relationship between stressful life events (SLE) and mental health of URM with family contact. Questionnaire data were collected from 105 male URM from Syria and Afghanistan aged 14-19 years who were living in group homes of the Child Protection Services in Leipzig, Germany, in summer 2017. URM receive most social support from their families, followed by peers and adult mentors. URM without family contact received less peer and mentor support compared to URM with family contact. Lower social support from mentors increased the risk for PTSD, depression and anxiety symptoms after SLE, whereas lower social support from peers increased the association between SLE and anxiety symptoms. Mentor and peer support in the host country is relevant for the processing of SLE. URM without family contact represent a "double burden" group, as they might feel less supported by other social networks.

[The Impact of Immigrant Status on the Mode of Hospital Referral, Impression of Disease Severity and Length of Stay in Inpatient General Pediatric Care]. / Die Bedeutung des Migrationshintergrundes für Einweisungsmodus, Krankheitseindruck und Verweildauer in der stationären pädiatrischen Versorgung.

BACKGROUND: National as well as international research often shows differences in health and health behavior between children and youth with and without migration background. It is also noted that there are differences in the use of health services depending on the migration background. PATIENTS AND METHODS: Data from 266 pediatric patients, regarding their hospitalization, general impression of health status and length of stay in a hospital, were analyzed depending on the migration background. Information on migration background and treatment-related data were obtained from the parents of the patient or from the hospital information system (SAP). 20.7% of patients (n=55) had a migration background. RESULTS: Migrants were hospitalized more often under a participation of the emergency room than non-migrants; also migrants showed a more severe illness picture. Regarding the number of diagnoses and length of stay as well as the distribution of the main diagnoses, no differences were found. DISCUSSION: Language barriers, culture-specific ideas about illness and insufficient knowledge of the German health care system were discussed as possible reasons to for the differences between migrants and non-migrants. CONCLUSION: This study confirms already known differences in the use of health services by people with and without migration background. The results indicate worse health status in migrant patients compared to non-migrants by hospitalization. Future research with greater numbers of participants should specifically investigate on this point.

[Immigrated Physicians: Chances and Challenges]. / Zugewanderte Ärzte: Chancen und Herausforderungen im deutschen Klinikalltag.

BACKGROUND AND OBJECTIVE: In the health care infrastructure of Germany a demand for physicians with immigrant background exists. The situation of immigrated physicians is largely unexplored so far. In the framework of a pilot study stressors and resources of physicians with immigrant background have been explored concerning their migration-related experiences at German hospitals, and within the medical team. METHODS: As part of a qualitative analysis 8 physicians with immigrant background have been interviewed (problem-centered interview) from July to September 2014. The respondents stemmed from countries of the European Union and of non-EU countries. They have worked for 1-4,5 years in different German hospitals. RESULTS: Stressors and challenges derived from a lack in German language skills, different medical skills, cooperation in the team, and from dealing with a new health care system. Perceived discrimination by colleagues and patients represented a particular burden. In the meantime physicians with immigrant background disposed resources on different levels as on communicational, medical, social and organizational levels. DISCUSSION: The results highlight the particular demands that physicians with immigrant background face. Future research should explore potentials of stressors and resources for physicians with immigrant background by using quantitative methods; in terms of a multi-perspective approach German colleagues and patients should be included.

[Culture-Sensitive Aspects in Diagnostics of Mental Distress in Refugees - Two Commented Case Reports]. / Kultursensible Aspekte während der Diagnostik von psychischen Belastungen bei Flüchtlingen ­ Zwei kommentierte Fallberichte.

High levels of mental disorders, especially PTSD, are commonly known among groups of people forced to leave their homeland as a consequence of war-related experiences (e. g. armed conflict, torture or persecution). Depending on the cultural background the perceptions of illnesses vary, different symptom presentation and thereupon different coping strategies respectively expectations towards health care services exist. To minimize the danger of misdiagnosis by different experts working with refugees in the host countries, a culture-sensitive diagnostic approach is needed from the beginning. This article describes important aspects of culture-sensitive diagnostics by means of 2 commented case reports. Special focus is set on the aspect of linguistic and in a broader sense cultural comprehension between therapist, client and if necessary language mediator.

The German PCL-5: evaluating structural validity in a large-scale sample of the general German population.

Background: In attempts to elucidate PTSD, recent factor analytic studies resulted in complex models with a proliferating number of factors that lack psychometrical and clinical utility. Recently, suggestions have been made to optimize factor analytic practices to meet a refined set of statistical and psychometric criteria.Objective: This study aims to assess the factorial structure of the German version of the PCL-5, implementing recent methodological advancements to address the risk of overfitting models. In doing so we diverge from traditional factor analytical research on PTSD.Method: On a large-scale sample of the German general population (n = 1625), exploratory factor analyses were run to investigate the dimensionality found within the data. Subsequently, we validated and compared all model suggestions from our preliminary analyses plus all standard and common alternative PTSD factor models (including the ICD-11 model) from previous literature with confirmatory factor analyses. We not only consider model fit indices based on WLSMV estimation but also deploy criteria such as favouring less complex models with a parsimonious number of factors, sufficient items per factor, low inter-factor correlations and number of model misspecifications.Results: All tested models showed adequate to excellent fit in respect to traditional model fit indices; however, models with two or more factors increasingly failed to meet other statistical and psychometric criteria.Conclusion: Based on the results we favour a two-factor bifactor model with a strong general PTSD factor and two less dominant specific factors - one factor with trauma-related symptoms (re-experiencing and avoidance) and one factor with global psychological symptoms (describing the trauma's higher-order impact on mood, cognition, behaviour and arousal).From the perspective of clinical utility, we recommend the cut-off scoring method for the German version of the PCL-5. Basic psychometric properties and scale characteristics are provided.

We contribute new insights to the debate on the factor structure of the PTSD Checklist (PCL-5) based on a large German general population sample deploying the newest methodological developments in a revised factor-analytical approach.Combining theoretical, statistical and practical considerations, we favour a two-factor bifactor model with a strong general PTSD factor and two less dominant specific factors ­ one factor with trauma-related symptoms and one factor with global psychological symptoms.For clinical practitioners, we recommend using the cut-off scoring method.

Efficacy of internet-based cognitive behavioral and interpersonal treatment for depression in Arabic speaking countries: A randomized controlled trial.

BACKGROUND: Politically and economically unstable contexts have been associated with increased prevalence rates of depression. Despite high demand, the availability of mental health experts and care systems is limited in Arabic-speaking countries. Internet-based interventions might provide an opportunity to treat patients independently of location. Therefore, we investigated the efficacy of internet-based cognitive behavioral treatment (iCBT) and interpersonal treatment (iIPT) for depression in Arabic-speaking countries. METHODS: In total, 743 Arabic-speaking adults with depression were randomly allocated to iCBT (n = 243), iIPT (n = 247), or waitlist (n = 253). Depressive, anxiety, and somatoform symptoms, perceived social support and quality of life (QoL) were assessed at pre-, and post-treatment and at three months follow-up. Multiple imputation was performed for missing data. Changes associated with treatment were analyzed using regression in the completer and intention-to-treat sample. RESULTS: Participants in both treatment groups showed lower depressive and anxiety symptom severity, higher QoL, and perceived social support compared to the waitlist group (p < .001). Somatoform symptom severity was significantly lower in participants receiving iIPT compared to waitlist (p < .001). Differences between the two treatments in all outcomes were non-significant (p > .05). Three-month follow-up treatment effects regarding depressive symptoms were indicated. LIMITATIONS: The sample mainly consists of educated, single, female adults. Three-month follow-up results rely on a small subsample and must be interpreted with caution. CONCLUSIONS: This is the first randomized controlled trial to demonstrate the efficacy of iCBT and iIPT for depression in Arabic-speaking countries. It provides first indications that internet-based interventions might help specific individuals in this region.

Temporal stability of optimism and pessimism (LOT-R) over 6 years in the general population.

Objective: The aims of this study were to examine changes in habitual optimism over a six-year period and to analyze the relationship between changes in optimism and changes in other quality of life-related variables. Method: A randomly selected community sample of the German adult general population (N = 4,965) was surveyed twice, with a time interval of 6.04 years. Results: During the course of the 6 years, the mean score of the LOT-R total scale improved (effect size d = 0.11). The temporal stability in terms of the test-retest correlation was r = 0.61 for the total sample. There were only marginal gender differences in this temporal stability, however, the stability in the oldest age group ≥70 years (r = 0.50) was lower than the stability of the other age groups. The cross-sectional correlations showed clear relationships between optimism on the one hand and quality of life, life satisfaction, social support, and low levels of anxiety and physical complaints on the other. The corresponding longitudinal correlations between changes in optimism and changes in the other variables were less pronounced, but in the same direction. Conclusion: The study confirmed the applicability of the LOT-R in longitudinal studies. In samples with participants of 70 years and above, the limited stability in the optimism assessments needs to be considered in clinical practice and epidemiologic research.

An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial.

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = -4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment.

Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD.

Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.

Exposure and cognitive restructuring treatment in Arabic-speaking individuals with PTSD yield significant changes in shame, self-blame, fear, anger, and alienation.Changes in PTSD symptoms are positively associated with changes in specific trauma appraisals.There is no evidence of differences between both treatments for any specific trauma appraisal.

Mental healthcare access among resettled Syrian refugees in Leipzig, Germany.

Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02-2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.