Autor:innen:
Maren Wiechers, München (Germany)
Michael Strupf, München (Germany)
Stephan Goerigk, München (Germany)
Malek Bajbouj, Berlin (Germany)
Kerem Böge, Berlin (Germany)
Carine Karnouk, (Germany)
Andreas Heinz, Berlin (Germany)
Ute Habel, Aachen (Germany)
Tilmann Bunse, München (Germany)
Max Burger, München (Germany)
Andrea Jobst-Heel, München (Germany)
Oliver Pogarell, München (Germany)
Peter Falkai, München (Germany)
Alkomiet Hasan, München (Germany)
Frank Padberg, München (Germany)
Aline Übleis, (Germany)
The process of forced migration has been associated with a higher vulnerability for mental health problems in the diverse population of refugees and asylum seekers (Fazel, Wheeler & Danesh, 2005). Pre-migration stressors (living conditions in country of origin, exposure to war, violence and torture), the process of forced migration itself and post-migration stressors experienced in the country of arrival (uncertainties about asylum procedure and residence status, living conditions, social status) play a vital role in the development of mental disorders. Meta-analytic findings suggest prevalence rates of 31% for both post-traumatic stress disorders and affective disorders in refugees (Steel et al., 2009). The demand for culturally sensitive, accessible and effective psychological treatments for this population is imposing new challenges on the mental health care system in Germany.
Here we describe the implementation and evaluation of an interpreter-based, culturally sensitive group therapy (“Empowerment”) for the treatment of affective disorders in refugees and asylum seekers (Wiechers, Übleis & Padberg, in press). The Empowerment-manual consists of sixteen modules, imparting cognitive and behavioural strategies such as behavioural activation, stress management and emotion regulation. The aim of the study is to evaluate the efficacy of the Empowerment-manual compared to a treatment-as-usual in a multicentre-trial. The study is implemented within the project “Mental Health in Refugees and Asylum Seekers” (MEHIRA), a multicentre-trial investigating the effect of a Stepped and Collaborative Care Model for refugees and asylum seekers.
Method:
In a randomized multi-center study, patients with moderate depressive symptoms (PHQ-9 sum score between 15 and 19) are randomly assigned to a treatment condition or treatment-as-usual. The treatment comprises an interpreter-based group intervention with 16 modules for a duration of 12 weeks. Primary endpoints are a reduction in depressive symptoms from baseline to post-intervention, measured by the PHQ-9 and the MADRS, for the treatment group compared to the TAU group. Secondary endpoints are a reduction on distressing physical and emotional symptoms, such as PTSD, measured by the RHS-15 for the treatment group, compared to the TAU group.
Results:
Data analysis will be conducted using a mixed effect model, compromising 4 hierarchical levels: Time of measurement (Baseline vs. Post-Intervention vs. Follow-up after 24 weeks vs. Follow-up after 48 weeks) will be included as level 1 predictor, condition (SCCM vs. TAU) will be included as level 2 predictor. Therapist will be included as level 3 predictor and study center as level 4 predictor. Thus far 63 patients have been recruited in four study sites. Data collection will close in September 2019. Results will be presented in the final poster.
Discussion:
The aim of the presented study is to contribute to a differentiated understanding of the effectiveness for culturally sensitive and resource-effective psychotherapeutic interventions in refugee populations with affective disorders. Through an economic allocation and use of available resources, group therapy may provide an effective way to treat refugees and asylum seekers. The intervention presented may furthermore be applied to other vulnerable populations with impeded access to the German health care services.
This work is supported by the Innovationsfond program of Gemeinsamer Bundesausschuss (G-BA)
References: Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309-1314. Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & Van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. Jama, 302(5), 537-549.
Wiechers, M., Übleis, A., & Padberg, F. (in press). Empowerment für Menschen mit affektiven Erkrankungen und Migrationserfahrungen. Therapiemanual für Einzel- und Gruppensettings. Stuttgart: Schattauer.