Abstract: There is a considerable lack of research concerning the mental health of immigrants in Germany. Studies related to this topic have usually been based exclusively on questionnaire data and have not used standardized instruments for the categorical assessment of disorders according to ICD-10 or DSM-IV. A convenience sample of 100 patients of Turkish origin was taken in two general physicians' practices. The patient assessment included psychometric instruments (SCL-14, CES-D, F-SozU, FAKKS-T) and the IDCL…("International Checklist for Diagnoses according to ICD-10") for the standardized assessment of ICD-10 diagnoses. Compared to German samples, the assessed immigrant population showed an increased number of psychological symptoms and a higher rate (45%) of mental disorders. Most prevalent were anxiety and depressive disorders. The study also indicates a higher rate of mental disorders among women (55%) than among men (35%) as well as a higher subjective psychological distress among the female participants.
Keywords: Immigrants, mental health, mental disorders, categorical assessment, social support
Abstract: The experience of traumatic events and posttraumatic stress disorder were examined among n = 77 patients of a Turkish-language outpatient unit at a University Department of Psychosomatics in Essen, Germany, using the Essen Trauma Inventory (ETI) and the Sense of Coherence Scale (SOC-29). At least one traumatic event was reported for 92.2% of the patients. Severe disease, the death or loss of an important person, as well as the experience of a severe accident, were reported…most frequently, followed by marital problems. In the psychometric assessment, indices for a positive PTSD diagnosis were found among nearly half of the patients (48.1%). PTSD was most often caused by marital problems (13.5%), severe disease (13.5%) and the loss of an important individual (10.8%). Turkish immigrant patients scored significantly lower on sense of coherence (SOC-29) in comparison to the normal Turkish and German populations as well as to Germans with psychiatric symptoms (all comparisons p < 0.001). This study demonstrates the high prevalence of posttraumatic stress disorder in a clinical population of Turkish immigrants and the pathogenic potential of marital problems.
Keywords: Immigrants, trauma, PTSD, sense of coherence, Essen Trauma Inventory
Abstract: Background: In 2005, the German Microcensus began gathering data on the history of migration among the general population in addition to citizenship. It was found that 18.6% of the population had a history of migration. 14.2% of all immigrants were of Turkish origin and a further 9.4% were of Russian origin. The present study compares Turkish and Eastern European subgroups of immigrants in a psychiatric inpatient population. Methods: TheMigration Working Group of the German Federal Conference…of Psychiatric Hospital Directors surveyed newly admitted inpatients on one index day (July 19th, 2006) regarding history of migration, diagnosis, main language, and communication difficulties in 131 hospitals. Results: 20.8% of the patients were of Eastern European and 6.2% of Turkish descent. Eastern European patients were overrepresented as compared to Turkish patients in the inpatient sample. Turkish immigrants reported Non-German as their main language more often than Eastern Europeans did. There was a trend towards more diagnostic categories of schizophrenia, schizotypal and delusional disorders (F2) as well as of mood disorders (F3) within the Turkish group. Eastern European patients had significantly more diagnoses of mental and behavioural disorders due to psychoactive substance use (F1). Eastern Europeans were more likely to have immigrated as adults, whereas Turkish patients were more often the children of immigrants. Conclusions: Overall, an overrepresentation of Eastern European patients was found, whereas Turkish patients were underrepresented. Eastern European patients may have better access to psychiatric inpatient treatments than Turkish patients do. Moreover, Eastern European patients are more often found to be treated for addiction disorders in an inpatient setting.
Keywords: Use of inpatient psychiatric care, migratory background, Turkey, Eastern Europe
Abstract: Background: The issue of migration has been gaining importance in the health care system due to the growing rate of immigrants among the German population. Immigrants with a Turkish background represent the largest group of migrants. Due to the low return rate, the proportion of elderly persons with a Turkish background is expected to rise in accordance with the demographic development. Furthermore, an increase in the use of health care services by Turkish immigrants is expected…– a process that is characterized by a complex structure of different influencing factors. Methods: In the following paper, possible factors influencing the use of health care services by immigrants are structured on the basis of available research findings. The aim of this paper is to identify and assign starting points for the improvement of health care for Turkish migrants living in Germany. Results and conclusions: The intricacy of factors influencing the use of health care services among immigrants is illustrated. The factors may be classified according to their malleability as follows: factors that are influenced by the individual himself, particularly concerning perceptions about health and disease, the related health behaviours, as well as the burdens caused by the migration process. Various approaches to improving the skills and capacities of immigrants exist within the German health care system (e. g. migrant-specific choices within the respective cultural community, improvement of health literacy). Approaches that should be implemented by the host country are related to ethnicity, socioeconomic status, insurance laws and aspects of access and communication in the context of medical care. In this regard, measures to reduce exclusion and discrimination should be developed. These aim at target-group-oriented health information and improved communication on the part of the physician. Further approaches include the support of migrant-specific resources, such as social networks and healthy habits (healthy diet, abstention from alcohol, etc.). So far, very little detailed information about the health care of migrants is available. Specific research into groups of migrants that addresses the heterogeneity of influencing factors has rarely been done. The need for further migrant-specific research becomes apparent.
Keywords: Turkish migrants, health care usage, factors of influence, starting points
Abstract: This study investigated the degree to which Turkish migrants in Germany, Turks in Turkey and Germans suffer from somatoform complaints and how these groups differ in reference to causal attributions. 94 Turkish migrants, 183 Turks and 91 Germans were investigated using the Screening for Somatoform Disorders (SOMS-2) and a modified scale for causal illness attributions stemming from the Illness-Perception Questionnaire-revised (IPQ-R). Turkish migrants and Turks suffered from significantly more somatoform complaints than…Germans, but they did not differ from each other. The level of education and the employment status also contributed to the number of reported somatoform complaints. The causal attributions did not differ between the three groups. The reported higher number of somatoform complaints among Turkish migrants seems to be mainly associated with their cultural background and their education and employment-status, rather than the migration itself.
Keywords: Somatoform complaints, causal attributions, Turkish migrants, cultural background, education and employment status
Abstract: Euroamerican diagnostic categories as stated in the manuals of ICD-10 and DSM-IV comprise the attempt to integrate psychiatric phenomena and symptoms as objective entities. They are purported to be universal and assumed to be free of culture. Former theoretical approaches on diversification ofmental disorders have been superseded bymeans of objectification, as, for example, the differentiation between the pathology of conflicts (neurosis) and the pathology of development (psychosis). Within our increasingly globalized and migratory world,…Western experts are ever more confronted with patients of Non-Western origins. In this paper, we will discuss how cultural biases that inevitably appear when patients and caregivers are of diverse backgrounds might decrease in intercultural settings. In paragraph one, we will reflect on the cultural reference system of Western/Euroamerican psychiatry and its context. In paragraph two, the history and approaches of comparative psychiatry and transcultural psychiatry will be introduced. In paragraph three, still relevant historical texts of African psychiatrists will show what difficulties evolve when Western reference systems are transferred into Non-Western contexts. Finally, an ethnopsychiatric approach will be introduced, combined with casuistics of African patients.
Keywords: Ethnopsychiatric differential diagnosis, cultural specific experience and recontextualization, transcultural psychiatry
Abstract: Immigrants, as compared to the native German population, differ in their health behavior and health care usage. Aside from social factors, culture and religion play an important role. They influence the perceived meaning and the appraisal of a disease as well as the choice of coping strategies. This can be related to a reduced access to health care. Taking Turkish-Muslim and Kurdish-Yezidi patients as an example, we show the need for health care that is sensitive…to religion and culture. A huge heterogeneity as regards culture and religion is evident even within single nationality groups. Thus, health care needs can also differ between people originating from the same country. Current models for coping strategies among patients do not sufficiently consider culture and religion in the context of migration. We describe how illness perceptions and health behaviors are influenced by these constructs and derive implications for the health care of immigrants and cultural minorities. If cultural and religious characteristics are considered in clinical practice as part of a diversity management, health care can be provided according to the patients' needs.
Keywords: Coping with illness, culture, religion, migrants
Abstract: Immigrants and refugees differ from native-born Germans in their understanding of health and illness, in their health-related behaviours and in their access to the health care system. Thus, concepts and approaches that include the needs of immigrants allow the integration of immigrants into the health care system. In this article, one of these concepts will be presented. The project "Health needs Communication" is an example of best practice in this field within the former East German…territory, where the history and the circumstances of immigrants and refugees are different from those of the former West German territory. The results of the project show that the training and employment of information multipliers, community translators and the work of a consultation centre increase the immigrants' and refugees' use of/access to health care services.
Keywords: Migration, health, culture, communication, best practice