Ulrike Kluge

• Charité Universitätsmedizin Berlin

Zusammenfassung Trotz Bemühungen um eine gleichberechtigte Gesundheitsversorgung durch Maßnahmen der interkulturellen Öffnung bleibt die Versorgung von Menschen mit (Flucht-)Migrationsgeschichte unzulänglich. Gegenstand der Studie war die Exploration des Umgangs mit Sprachbarrieren zwischen medizinischem Personal und Patient*innen in der Krankenhau...

Background Migration is a deeply relational process that affects not only those who leave, but also those who stay behind and future generations inheriting transnational ties. While growing scholarship has explored caregiving and communication in transnational families (TFs), limited attention has been paid to how structural factors shape their emo...

Recent academic and activist critiques raise important points about the ways in which coloniality, migration and racialization are often overlooked in global health research and practice. In particular, these critiques highlight how such structural forces perpetuate inequalities and exclusions, as well as processes of epistemic violence in global h...

This text takes a chronological approach to examining the literature concerning the impact of urban living on mental health, identifying two distinct generations of knowledge production on this topic: (1) the first generation: from philosophical speculation to empirical studies, and (2) the second generation: from city-centrism to embracing the com...

Background Health and adequate access to health care are human rights. Refugees are at risk for substance abuse. Despite the known structural and personal risk factors for abuse, refugees in Germany continue to face barriers to adequate addiction prevention and care, which is a violation of the fundamental human right to health care. The question a...

Background Substance use (SU) and substance use disorders (SUDs) have been recently documented among forcibly displaced populations as a coping mechanism to migration and postmigration stressors. Although the literature exploring substance use among refugees has grown recently, little is known about SU among Arabic-speaking refugees and, more speci...

Despite the burden of mental health problems among refugees, knowledge about mental health care for this group is limited. In this context, the comprehensive discussion is important because care is more than professional care, but takes place in everyday situations and between different groups of people. In this study, we look at expert views (base...

Refugees are at high risk of mental health problems due to their pre-migration experiences, war, and post-migration challenges. Although recent studies also shed light on substance use disorders (SUDs) as another risk to refugees’ mental health, our understanding of SUDs among diverse ethnic refugee groups is still limited. This plenary aims at com...

Background Health and adequate access to health care is a human right. Despite both structural and personal risk factors towards substance abuse, refugees continue to face barriers to receive adequate addiction care in Germany, neglecting their human right of adequate health care. The question arises as to how barriers for refugees in reaching addi...

Abstract Aims: To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs and experiences. Methods: Six medical, allied health and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar and the Cochrane Library) wer...

Background Despite traumatic experiences and persistent psychosocial stressors, many refugees and migrants display resilience and strength in the midst and aftermath of hardships. ‘Value Based Counseling’ (VBC), a low-threshold, short-term and culturally sensitive psychological intervention avoids the stigmatization and pathologization of mental he...

Background In light of their experiences on the refuge and upon their arrival in the receiving society, refugees may have differentiated needs regarding health care. However, negative attitudes of the members of the receiving society and a lack of information pose as barriers for refugees when trying to access health care services. In that sense, i...

Background Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors affecting substance (mis)use embedded in the post-migration context in high-income countries. The...

Internet-based delivery of evidenced-based Value Based Counseling (VBC) fulfills the demand for a low threshold, culturally-sensitive and short-term intervention located at a level below specialized mental health care which can help those who do not require such specialized care to activate their resources and to regain their everyday functioning q...

Background: In light of their experiences on the journey and upon their arrival in the receiving society, refugees may have differentiated needs regarding health care. However, negative attitudes of the receiving society and a lack of information pose as barriers for refugees when trying to access health care services. In that sense, it is largely...

This study examines whether climate change-associated environmental stressors, including air and noise pollution, local heat levels, as well as a lack of surrounding greenspace, mediate the effects of local poverty on mental health, using the 28-item General Health Questionnaire. We recruited 478 adults who were representative of eleven of Berlin’s...

Background: Racism and structural discrimination in German healthcare have been little studied to date, although intercultural openness has been demanded for many years. At the same time, the processes of economization are progressing, especially in hospital care. This study examines current challenges of intercultural openness, including the infl...

Background Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors impacting substance (mis)use embedded in the post-migration context in high-income countries. Met...

Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the coun...

Aims: To evaluate qualitative research on substance use and substance use disorders (SUDs) among refugees in terms of practitioners' and substance users' attitudes, beliefs, and experiences. Methods: Six medical, allied health, and social sciences databases (EBSCO, PubMed, ScienceDirect, Web of Science, Scholar, and the Cochrane Library) were sy...

Objective Specialized literature has identified a need for evidence‐based, low‐threshold, short‐term, and intracultural psychological interventions that can be made available to migrants, including refugees, who suffer from psychological symptoms in host countries. The objective of the present study is to measure the efficacy of value‐based counsel...

This study takes an interdisciplinary approach to understanding the multi-dimensionality of social stress within the spatiality of initial refugee reception centers in Berlin. By focusing particularly on the experiences of women who fled from Syria and Afghanistan, it situates this humanitarian issue within an analytical framework of gender-sensiti...

Prejudices can lead to discrimination, social exclusion, and violence particularly among young male adults. Previous findings suggest that the degree of holding prejudices is linked to low levels of empathy, while low levels of empathy have been associated with alexithymia, the inability to experience one’s own feelings. We tested the hypothesis th...

Objective: To determine migration related distress pattern in refugees and feasibility of a de novo established, central low-threshold outpatient clinic serving more than 80,000 newly arrived refugees in the metropole of Berlin. Methods: In an observational cohort study the relative prevalence of major psychiatric disorders by age, place of living...

This is the first anthology in the German language that combines legal, philosophical and ethical, public health, epidemiological and psychological perspectives on current and practical insights into the link between flight, health and care. It addresses academics and practitioners who are interested in an interdisciplinary approach to care for peo...

The FOCUS project is undertaking a range of research and piloting tasks which aim to improve understanding of dynamic integration and to assist the implementation of effective practices. As part of this work a detailed programme of qualitative research has been undertaken in four countries. This report presents the country-specific findings of this...

Background: 14.9 million women (≥15 years) in Tanzania are at risk of developing cervical cancer. Limited cancer care facilities, prevention programs and sparse knowledge among community members and healthcare workers contribute to late-stage presentation leading to a high mortality rate. Objective: This study aims to scientifically accompany preve...

The article provides an overview of racism discourses in research and clinical practice in the health sector and discusses the individual and institutional effects of racism and discrimination on mental health. In addition, suggestions are provided as to which racism critical transformations in healthcare structures for mentally ill persons are nec...

Purpose of Review Losing and regaining control over alcohol intake varies as a function of individual-level predictors across the lifespan. Specifically, the interplay of protective and risk factors for losing and regaining control, particularly in real-life settings, is thus far poorly understood. Individual differences in cognition, affect, emoti...

To generate a more comprehensive understanding of mental health support for refugees, a qualitative evidence synthesis of studies examining professionals' and patients' perspectives was conducted. The aim was to identify what refugees and psycho-social professionals working with refugees perceived as positive/helpful and negative/hindering in the t...

The chapter gives a brief introduction to the mental health care situation of refugees in Germany, presenting recent developments and discourses exemplary of one research and care delivery facility in Berlin. The impact of living conditions and access barriers on the mental health situation are presented and the main challenges regarding treatment...

Zusammenfassung Die Ankunft einer großen Anzahl Geflüchteter in Deutschland seit 2015 hat zu wachsenden Herausforderungen im Gesundheitssystem geführt, auch im psychosozialen Bereich. Um die Kenntnisse Geflüchteter über die Angebote im psychosozialen Bereich zu verbessern und erste Hilfestellungen anzubieten, wurden an der Klinik für Psychiatrie un...

Zusammenfassung Mit der wachsenden Zahl von Geflüchteten, die 2015 in Deutschland ankamen, entstand ein steigender Bedarf an Unterstützung und Betreuung in psychosozialen Angelegenheiten, auf Seiten der Geflüchteten wie auch der freiwilligen Helfer/innen. Das Forschungsprojekt ReWoven untersuchte die allgemeine Beziehungsgestaltung zwischen miteina...

Due to migration and globalisation, the users of psychosocial and psychotherapeutic services are becoming more international and heterogeneous, as are the first languages of patients and users in mental health services. In consequence, besides bilingual professionals, interpreters are increasingly necessary in order to provide and deliver quality c...

Society socialises women and girls to place a high amount of value on their appearance. The role of body image culture in shaping mental health risks and quality of life amongst females has long since been a controversial topic in gender studies. Many feminist scholars believe that body dissatisfaction plays a central role in the onset and maintena...

Society socialises women and girls to place a high amount of value on their appearance. The role of body image culture in shaping mental health risks and quality of life amongst females has long since been a controversial topic in gender studies. Many feminist scholars believe that body dissatisfaction plays a central role in the onset and maintena...

Armut und soziale Ausgrenzung stehen in engem Zusammenhang mit psychischer Belastung und einem erhöhten Erkrankungsrisiko. Im Jahr 2018 waren rund 19 % der deutschen Bevölkerung von Armut und damit verbundener sozialer Ausgrenzung bedroht. Insbesondere Migrantengruppen zeigen häufig eine besondere Mehrfachbelastung durch sozioökonomische Belastungs...

Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic str...

Die Ausstellung „erfasst, verfolgt, vernichtet. Kranke und behinderte Menschen im Nationalsozialismus“ stellt die Frage nach den Entstehungsbedingungen der tausendfachen Zwangssterilisierungen und Patientenmorde und nach den heutigen Anforderungen an eine Versorgung psychisch kranker Menschen, die sich der Vergangenheit bewusst und an den Menschenr...

Background Acculturation is a long-term, multi-dimensional process occurring when subjects of different cultures stay in continuous contact. Previous studies have suggested that elevated rates of depression among different migrant groups might be due to patterns of acculturation and migration related risk factors. This paper focused on prevalence r...

Zusammenfassung. Angesichts gestiegener Geflüchtetenzahlen und sich ändernder Regelungen zur gesundheitlichen Versorgung von Asylsuchenden ist anzunehmen, dass perspektivisch mehr niedergelassene Psychotherapeuten Geflüchtete behandeln werden. Bisher gibt es in Deutschland kaum Studien, die sich mit den Schwierigkeiten in der psychotherapeutischen...

People with a migration background are a risk group for psychiatric disorders. Innovative, transnational and sustainable projects are necessary to ensure adequate care for refugees and asylum seekers. Selected projects of the University of Munich, the Charité Berlin and the University of Konstanz show promising approaches in addition to other initi...

Conflicts and precarious living conditions resulted in the arrival of large numbers of refugees in Europe and especially in Germany. Evidence suggests that immigrant populations are at elevated risk of psychotic disorders. Considering the traumatic pre- and post-migratory adversities refugees may have encountered, people granted refugee status may...

Background This paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject. Methods In total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers usi...

Objective Aim of the study was to examine how discourses of refugees in the media influence the perspective of independent psychotherapists working with refugees. Methods 20 problem-centered interviews were carried out across Germany with independent psychotherapists, and were analyzed using the principles of Grounded Theory. Results 4 portrayals o...

Background: More than half of the global population currently lives in cities, with an increasing trend for further urbanization. Living in cities is associated with increased population density, traffic noise and pollution, but also with better access to health care and other commodities. Methods: This review is based on a selective literature sea...

Universitätsmedizin Berlin university hospital, we briefly discuss in this paper the pertinence of a differentiated understanding of culture, interculturality, and transculturality in the context of clinical practice. We then cast light on a few challenges posed by the clinical care of refugees. The paper is primarily focused on the psychotherapeut...

The Composite International Diagnostic Interview (CIDI), which has been widely applied in epidemiological research, is a standardized, clinically structured interview that enables the diagnosis of mental disorders based on DSM and ICD criteria. The computerized DIA-X CIDI Version 2.8 investigated in this study is an adaptation of the German DIA-X/M...

The article gives an overview of facts and figures, background information on health legislation and the current psychosocial situation of refugees and asylum seekers in Germany. It portrays the challenges for psychiatric, psychotherapeutic and psychosocial care. Using an extended concept of traumatization, which takes not only medical, but also ps...

Zusammenfassung Der Beitrag gibt eine einführende Übersicht über Zahlen und Fakten, gesundheitsrechtliche Hintergründe und die aktuelle psychosoziale Situation von Geflüchteten und Asylsuchenden in Deutschland. Dargestellt werden die Herausforderungen für die psychiatrische, psychotherapeutische und psychosoziale Versorgung. Anhand eines erweiterte...

About half of all murders are committed in Western industrialized countries by subjects under the influence of alcohol. Chronic alcohol use also increases the rate of violent attacks. These findings appear to be due to an interaction between acute and chronic environmental effects (acute alcohol consumption and chronic social isolation stress) on t...

Background: There is a lack of reliable epidemiological data on prevalence and comorbidity rates of mental disorders in the migrant population in Germany. Despite existing national and international data on the extent of psychosocial burdens in migrant populations the prevalence among the study population remains unclear. The aim of this study was...

The need for intercultural opening of supply facilities for improving access and treatment of people with migration background is acknowledged in Germany. The purpose of the survey was to determine the current state of intercultural opening of psychosocial services in one Berlin district. 127 representatives of institutions were interviewed using a...

Currently the majority of data regarding indicators of psychiatric morbidity of migrant and minority groups in Germany is derived from studies on help-seeking behavior, mental health service use, or data from population studies, which were not specifically aimed at including migrants. Such data are only available for certain groups, for example, po...

Currently the majority of data regarding indicators of psychiatric morbidity of migrant and minority groups in Germany is derived from studies on help-seeking behavior, mental health service use, or data from population studies, which were not specifically aimed at including migrants. Such data are only available for certain groups, for example, po...

Rates of severe mental disorders such as schizophrenia substantially increased among migrants to Western European countries, particularly when living in a neighbourhood in which they can receive little social support. We assessed rates of self-rated mental health problems as well as individual and neighbourhood factors such as income and joblessnes...

The aim of this Hypothesis and Theory is to question the recently increasing use of the “race” concept in contemporary genetic, psychiatric, neuroscience as well as social studies. We discuss “race” and related terms used to assign individuals to distinct groups and caution that also concepts such as “ethnicity” or “culture” unduly neglect diversit...

Background: Different service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups. The objectives of this work were to assess the organisational characteristics of services prov...

Aim: This study examines the accessibility of addiction treatment within services providing mental health care and support for people from socially marginalized groups in deprived urban areas across EU countries. Methods: Services providing mental health care and support in deprived areas of 14 EU capital cities were assessed with a questionnaire....

Detailed knowledge about the mental health of immigrants in Europe is limited due to a lack of representative data. Part of the problem is the difficult accessibility to and the participation of immigrants.AimsThe international research project “Mental Health and Immigration” (see: www.segemi.de) funded by the VW-foundation, is aiming to provide th...

Einwanderung als Bedrohung? Thilo Sarrazin hat mit seinen Thesen zur erblichen Intelligenz ethnischer Gruppen alte Weltbilder in die gesellschaftliche Diskussion zurückgeholt, so auch die Angst vor dem Fremden. Die Debatte darüber nehmen die Autorinnen und Autoren zum Anlass, neben der Frage der Genetik auch die Mythen zu Kriminalität, Integrations...

Mental health care for migrants is often impaired by a lack of policies and provisions in the respective institutions. This article focuses on "communication barriers" in psychosocial and psychotherapeutic settings, where personal communication is of great importance. Barriers that prevent migrants from using health care institutions include transl...

Interkulturelle Behandlungssituationen stellen besondere Anforderungen an die Behandelnden und Patienten/Patientinnen. Die Gesundheitsversorgung von Menschen mit Migrationshintergrund kann deshalb unzureichend sein. Im vorliegenden Beitrag stehen „kommunikative Hindernisse“ im Vordergrund, die für den psychiatrisch/psychotherapeutischen Bereich bes...

Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care...

Purpose: While there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals' experiences of deliv...

The number of immigrants using health services has increased across Europe. For assessing and improving the quality of care provided for immigrants, information is required on how many immigrants use services, what interpreting services are provided and whether staff members are from immigrant groups. Structured interviews were conducted with 15 he...

The paper explores expressions used by Turkish immigrants in Berlin to delineate psychiatric illnesses and psychological problems. These are compared to expressions used by native Germans in Berlin and Turks in Istanbul to assess possible cultural differences in articulating mental disorders. For this purpose, results of a Free Listing carried out...

The German concept of "intercultural opening" is an approach to facilitating migrants' access to the health care system and improving the care they receive. No data exist concerning the current status of the implementation of this approach in Germany, and the concept has never been analysed in practice. To assess the status of "intercultural openin...

We describe the extremely limited psychiatric resources of war-torn countries like Afghanistan. In such countries, we suggest to apply experience from training medical students in industrialized countries to teach a very basic and simplified understanding of psychiatric classifications and core diagnostic symptoms to medical students (who will late...

Background Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these ba...

Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European coun...

European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe.

Background: Providing mental health care to socially marginalized groups is a challenge. There is limited evidence on what form of mental health-care generic (i.e. not targeting a specific social group) and group-specific services provide to socially marginalized groups in Europe. Aim: To describe the characteristics of services providing mental...

Health services in Europe face the challenge of delivering care to a heterogeneous group of irregular migrants (IM). There is little empirical evidence on how health professionals cope with this challenge. This study explores the experiences of health professionals providing care to IM in three types of health care service across 16 European countr...