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Die psychische Belastung von Migrantinnen im Vergleich zu einheimischen Frauen - der Einfluss von Ethnizität, Migrationsstatus und Akkulturationsgrad
Abstract
Fragestellung
Sind Unterschiede zwischen den deutschen und den türkischstämmigen Frauen hinsichtlich der psychischen Befindlichkeit bei Klinikaufnahme nachweisbar? Ergibt sich ein differenziertes Bild innerhalb der Gruppe der türkischen Migrantinnen in Abhängigkeit von der Migrationsgeneration oder dem Akkulturationsgrad?
Patientinnen und Methodik
Im Rahmen eines Public Health-Projekts zur Analyse der Versorgungssituation gynäkologisch erkrankter deutscher und türkischer Frauen im Krankenhaus wurden u. a. soziodemographische Faktoren, Angaben zu Migration und Akkulturation, Gesundheitswissen und -verhalten, subjektiver Krankheitstheorie und Lebenszufriedenheit erfasst. Die subjektive Beeinträchtigung der befragten Patientinnen durch körperliche und psychische Symptome wurde mit dem psychometrischen Fragebogen SCL-90-R (neun Skalen: Somatisierung, Zwanghaftigkeit, Unsicherheit, Depressivität, Ängstlichkeit, Feindseligkeit, phobische Angst, paranoides Denken, Psychotizismus) untersucht. Im Untersuchungszeitraum 3/97 bis 10/98 konnten 320 Patientinnen deutscher und 262 türkischer Herkunft mittels in deutscher und türkischer Sprache vorliegender mehrteiliger Fragebogensets am Beginn des stationären Aufenthalts auf den gynäkologischen Stationen des Virchow-Klinikums/Berlin befragt werden.
Ergebnisse und Schlussfolgerungen
In die Auswertung des SCL-90-R einbezogen werden konnten 230 türkische und 264 deutsche Frauen (Rücklaufquote 88 bzw. 83 %). Nach Bildung von sechs sozio-demographisch ähnlich zusammengesetzten Subgruppen zeigte sich im Vergleich zu den Werten im deutschen Kollektiv bei den türkischstämmigen Migrantinnen in den meisten Einzelskalen des SCL-90-R als auch global eine höhere psychische Symptombelastung am Aufnahmetag in die Klinik. Wesentliche Unterschiede in der psychischen Belastung zwischen „mehr“ oder „weniger“ akkulturierten türkischstämmigen Frauen ließen sich nicht nachweisen. Frauen der zweiten Migrationsgeneration, für die eine am wenigsten unmittelbare Migrationserfahrung anzunehmen ist, fühlten sich gegenüber Frauen der ersten Generation bzw. den nachgezogenen Ehefrauen stärker durch die mit SCL-90-R gemessenen psychischen Symptome belastet.
... Es wird angenommen, dass die Migrationserfahrung (möglicherweise auch für die zweite und dritte Generation) Einfluss auf die Gesundheit und das Inanspruchnahmeverhalten der betroffenen Personen hat. Noch ungeklärt sind die widersprüchlichen Ergebnisse verschiedener Untersuchungen, die einerseits höhere gesundheitliche Belastungen (aufgrund geringeren Einkommens, belastender Arbeitsbedingungen, ungünstiger Wohnsituation) feststellen aber gleichzeitig auch günstigere Gesundheitsaussichten -geringere Mortalitätsraten, besseren Gesundheitsstatus von türkischen Kindern im Vergleich zu gleichaltrigen deutschen Kindern und vergleichbarem Sozialstatus -nachweisen (Schenk, 2007;David et al., 2002). Hinsichtlich des Inanspruchnahmeverhaltens werden Überinanspruchnahmen ebenso berichtet wie Unterinanspruchnahmen (Walter et al., 2007;Ferber et al., 2003). ...
... Für die teilweise widersprüchlichen Erkenntnisse zum Gesundheitszustand von türkischsprachigen Migranten in Deutschland liegen bislang keine befriedigenden Erklärungen vor. So ist zwar die Sterblichkeit der ersten Migrations-generation geringer als die von deutschen Personen gleichen Alters und Geschlechts und sie nennen deutlich weniger ärztlich diagnostizierte körperliche Erkrankungen, gleichzeitig schätzen türkischsprachige Migranten ihren eigenen Gesundheitszustand schlechter ein und sie geben eine höhere Belastung durch körperliche und psychische Krankheitssymptome an (David et al., 2002;David et al., 2004;Razum et al., 2004;Rommel, 2005). Inwieweit das auf einen besseren Gesundheitszustand schließen lässt oder darauf, dass Migranten das Gesundheitssystem seltener in Anspruch nehmen -insbesondere auch für präventive und Früherkennungsmaßnahmenist nicht abschließend geklärt . ...
... Der Unterschied hatte auch unter Berücksichtigung des Bildungsniveaus Bestand. Für die deutsche Gesundheitsversorgung wird daraus ein Qualitätssicherungsbedarf und die Entwicklung angemessener Gesundheitsversorgungskonzepte abgeleitet (Borde et al., 2002;Zeeb et al., 2008). ...
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.
... Es wird angenommen, dass die Migrationserfahrung (möglicherweise auch für die zweite und dritte Generation) Einfluss auf die Gesundheit und das Inanspruchnahmeverhalten der betroffenen Personen hat. Noch ungeklärt sind die widersprüchlichen Ergebnisse verschiedener Untersuchungen, die einerseits höhere gesundheitliche Belastungen (aufgrund geringeren Einkommens, belastender Arbeitsbedingungen, ungünstiger Wohnsituation) feststellen aber gleichzeitig auch günstigere Gesundheitsaussichten -geringere Mortalitätsraten, besseren Gesundheitsstatus von türkischen Kindern im Vergleich zu gleichaltrigen deutschen Kindern und vergleichbarem Sozialstatus -nachweisen (Schenk, 2007;David et al., 2002). Hinsichtlich des Inanspruchnahmeverhaltens werden Überinanspruchnahmen ebenso berichtet wie Unterinanspruchnahmen (Walter et al., 2007;Ferber et al., 2003). ...
... Für die teilweise widersprüchlichen Erkenntnisse zum Gesundheitszustand von türkischsprachigen Migranten in Deutschland liegen bislang keine befriedigenden Erklärungen vor. So ist zwar die Sterblichkeit der ersten Migrations-generation geringer als die von deutschen Personen gleichen Alters und Geschlechts und sie nennen deutlich weniger ärztlich diagnostizierte körperliche Erkrankungen, gleichzeitig schätzen türkischsprachige Migranten ihren eigenen Gesundheitszustand schlechter ein und sie geben eine höhere Belastung durch körperliche und psychische Krankheitssymptome an (David et al., 2002;David et al., 2004;Razum et al., 2004;Rommel, 2005). Inwieweit das auf einen besseren Gesundheitszustand schließen lässt oder darauf, dass Migranten das Gesundheitssystem seltener in Anspruch nehmen -insbesondere auch für präventive und Früherkennungsmaßnahmenist nicht abschließend geklärt . ...
... Der Unterschied hatte auch unter Berücksichtigung des Bildungsniveaus Bestand. Für die deutsche Gesundheitsversorgung wird daraus ein Qualitätssicherungsbedarf und die Entwicklung angemessener Gesundheitsversorgungskonzepte abgeleitet (Borde et al., 2002;Zeeb et al., 2008). ...
... Der Zusammenhang zwischen Migration und psychischer Gesundheit wird in der Forschung kontrovers diskutiert. Vielen, meist europäischen und israelischen, Studien zufolge haben Migranten höhere Werte für psychische Belastung (Ängstlichkeit, Depression und Somatisierung) und sind häufiger von psychischen Störungen betroffen als die Mehrheitsbevölkerung im Herkunftsland und im Aufnahmeland [1][2][3][4][5][6]. ...
... Für Religiosität waren die Befunde weniger eindeutig, Jarvis et al. zeigten gerade für Juden keinen Zusammenhang [16]. Ein Effekt auf die psychische Verfassung konnte für Faktoren wie Einkommen [12], soziale Einbindung [4], Sprachkenntnisse [2] und Diskriminierungserfahrungen [4] nachgewiesen werden. ...
Background:
Research on migration provides controversial findings regarding the links between mental health and migration as well as the factors influencing the mental health of migrants. Even though there is evidence for differences between migrant groups from different countries of origin, almost no empirical studies about individual migrant groups in Austria have been undertaken so far.
Methods:
In the present population-based study we compared depression and anxiety of 96 ex-Soviet Jews to a sample of 101 Austrians matched by age and sex. Furthermore, we investigated the impact of acculturation attitude and religiosity on the psychological condition of the migrants. Depression and anxiety were measured with Beck-Depression-Inventory (BDI), State-Trait-Anxiety-Inventory (STAI) and Brief Symptom Inventory (BSI). Acculturation attitude was assessed with Vancouver Index of Acculturation (VIA) and religiosity with a self-developed scale.
Results:
Ex-Soviet Jews were significantly more depressed and more anxious than native Austrians but not more likely to be affected by clinical depression. Integration (i.e. interest in both the original and the receiving society's culture) as an acculturation strategy was associated with the lowest mental health burden. Religiosity had a protective effect against depression but not against anxiety.
Conclusion:
The present study allows initial insights into the mental health of a migrant group which has hardly been subject to research, and it indicates a need for a greater opening of the Austrian majority population to migrants.
... "In the search for the true self" -this is a central question of many second-generation Turkish people (Kılınç and King 2017). In certain circumstances, psychological and psychosomatic symptom formation are the best and most useful solution to a conflict (David et al. 2002 These findings support the case study: Dr. Mead designed the doctor-patient relationship according to the German General Practitioner's guidelines for the basic (psychosomatic) treatment of patients with depression. According to this, acceptance (problems neither condemn nor trivialize), care, attachment and the experience of a relationship which is different from the patient's previous experience, are elementary for the patient and enable self-competence (Veit 2013). ...
Background and research question: The health situation of individuals with chronic conditions is connected to missions/tasks in their family context which is rarely discussed in GP. Review Dialogues (RDs) have been evaluated in the long-term care. Methods: Video-recorded case-histories were analyzed in detail and exemplified by a case study of one patient with a migration background. Results: RDs create awareness towards the interrelationship of the patient's tasks, ill-being, health goals and opportunities of de-stigma-tising. Conclusions: RDs increase the bridging of medical world and life-world, contribute to agreeing on common health goals, strengthen the therapeutic alliance and support patient's empowerment.
... Results of clinical research showed that depression is one of the most frequently diagnosed conditions in patients with Turkish origins in Germany, occurring more frequently and with a significantly higher severity relative to patients of the host-society [32,33]. Other health care and clinical studies reported increased psychological distress among patients with Turkish migration backgrounds in Germany, particularly in female ones [34][35][36]. The probability of receiving treatment for unipolar depression was higher in Turkish migrants and their native-born descendants than in any other migrant group or the host population in the Netherlands [37]. ...
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 rates of depressive disorders and related risk factors among individuals with Turkish migration backgrounds.
Methods
A population-based sample of 662 individuals with Turkish migration backgrounds were interviewed by bilingual interviewers using a standardised diagnostic interview for DSM-IV-TR and ICD-10 diagnoses (CIDI DIA-X Version 2.8). Associations between 12-month prevalence rates of depressive disorders with potential risk factors were assessed, including gender, age, socioeconomic status, acculturation status and migration status.
Results
12-month prevalence rates of any depressive disorder were 29.0%, 14.4% of major depressive disorder (MDD) and 14.7% of dysthymia. Older age and low socioeconomic status were most consistently related to higher risks of depressive disorders. Acculturation status showed associations with subtypes of depressive disorder. Associations differed between men and women. Symptom severity of MDD was linked to gender, with females being more affected by severe symptoms.
Conclusion
The prevalence of depressive disorders is high in individuals with Turkish migration backgrounds, which can be partly explained by older age, low socioeconomic status and acculturation pressures. Only a limited number of risk factors were assessed. Acculturation in particular is a complex process which might not be sufficiently represented by the applied measures. Further risk factors have to be identified in representative samples of this migrant group.
... foreign country of birth of the individuals themselves or of at least one of the parents or the foreign first language of the individuals) [30,31] and in women with Turkish migration backgrounds, especially within the second generation (i.e. first generation: individuals who migrated in the framework of German-Turkish recruitment agreement or a family unification when older than 15 years, second generation: individuals with at least one Turkish parents who were born and/or raised in Germany) [32,33]. ...
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 using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR.
Results
The analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder.
Conclusions
Overall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.
... Innerhalb des hausärztlichen Versorgungssystems finden sich Hinweise auf soziokulturell geprägte Krankheitskonzepte, bei denen Patienten mit türkischem Migrationshintergrund stärker als die deutsche Vergleichsgruppe auf Behandlung durch Arzneimittel ausgerichtet sind und höhere Wirksamkeit erwarten [9]. In der stationär gynäkologischen Versorgung konnte für Frauen mit türkischem Migrationshintergrund im Vergleich zu deutschen Patientinnen ein signifikant höherer psychischer Gesamtbelastungsgrad unabhängig vom Akkulturationsgrad gefunden werden [10]. Im Bereich der Rehabilitation von Patienten mit psychischen/ psychosomatischen Störungen deuten die wenigen vorliegenden Studienergebnisse auf erhöhte psychosoziale Belastungen der Patienten mit türkischem Migrationshintergrund [11,12]. ...
Studienergebnisse deuten auf eine erhohte psychosoziale Belastung von in Deutschland lebenden Menschen mit turkischem Migrationshintergrund. In der vorliegenden Studie wurde untersucht, ob sich ein solcher Belastungsunterschied auch zu Beginn einer stationar rehabilitativen Behandlung bei Patienten mit psychischen/psychosomatischen Storungen finden lasst, ob sich Behandlungsverlaufe unterscheiden und welche Bedeutung insgesamt der Faktor Migrationshintergrund fur den Behandlungserfolg hat. Zum Zeitpunkt der Aufnahme zeigte sich fur die Patienten mit turkischem Migrationshintergrund (n = 99 vs. n = 753) eine signifikant hohere psychopathologische Gesamtbelastung. Der Behandlungserfolg fiel fur die Patienten mit turkischem Migrationshintergrund geringer aus und erreichte in einigen Skalen keine nachweisbaren Verbesserungen. Die regressionsanalytische Berechnung verdeutlicht die Bedeutung des Faktors Migrationshintergrund als einen unabhangigen negativen Pradiktor des Behandlungserfolgs. Study results indicate a higher psycho-social burden for people with a Turkish migration background who live in Germany. The present study researches, if such a burden difference is detectable at the beginning of an inpatient treatment program for patients with psychological/psychosomatic disorders, if different treatment progressions occur and asks which influence the factor migration background plays in terms of the treatment results. At admission patients with a Turkish migration background (N = 99 vs. N = 753) showed a higher psychopathological burden. There was less treatment success for patients with a Turkish migration background und they didn't reach verifiable improvements in some scales. The regression analysis points out the importance of the factor migration background as an independent negative predictor of a positive treatment result.
... Migrantinnen der zweiten Ge− neration hatten dabei höhere Werte auf der Symptomcheckliste (SCL−90) als Migrantinnen der ersten Generation. Akkulturation hatte dabei jedoch keinen Einfluss auf den Gesundheitszustand [19]. In letzter Zeit wird auch oft die wahrgenommene Diskriminie− rung als Migrationsstressor diskutiert. ...
Obwohl MigrantInnen in vielen Studien einen schlechteren psychischen Gesundheitszustand als die einheimische Bevölkerung aufweisen, ist bisher kaum untersucht, welche Bedingungen der Migration einen negativen Einfluss auf den Gesundheitszustand haben. Um dies zu zeigen, beantworteten 140 polnische und 82 vietnamesische MigrantInnen die Angst- und Depressionsskala der HADS sowie Fragen zu ihrer Eingliederung (z. B. nach den Sprachkenntnissen, Kontakten, Rückkehrabsicht etc.). Beide MigrantInnengruppen zeigten höhere Angst- und Depressionswerte als eine deutsche Vergleichsstichprobe. Bezüglich der Eingliederungsvariablen konnten in den Regressionsgleichungen nur die soziale Assimilation (Eingliederung) und die wahrgenommene Diskriminierung Angst und Depression erklären, Sprachkenntnisse und strukturelle Assimilation (berufliche Eingliederung) waren keine bedeutsamen Prädiktoren für Angst und Depression, wobei es Unterschiede zwischen den MigrantInnengruppen gab. Neben Operationalisierungsproblemen sind unterschiedliche Migrationsbiografien sowie Rahmenbedingungen im Ankunftsland als Ursache für diese Ergebnisse zu sehen.
... Innerhalb des hausärztlichen Versorgungssystems finden sich Hinweise auf soziokulturell geprägte Krankheitskonzepte, bei denen Patienten mit türkischem Migrationshintergrund stärker als die deutsche Vergleichsgruppe auf Behandlung durch Arz− neimittel ausgerichtet sind und höhere Wirksamkeit erwarten [9]. In der stationär gynäkologischen Versorgung konnte für Frauen mit türkischem Migrationshintergrund im Vergleich zu deutschen Patientinnen ein signifikant höherer psychischer Ge− samtbelastungsgrad unabhängig vom Akkulturationsgrad ge− funden werden [10]. Im Bereich der Rehabilitation von Patienten mit psychischen/ psychosomatischen Störungen deuten die wenigen vorliegenden Studienergebnisse auf erhöhte psychosoziale Belastungen der Patienten mit türkischem Migrationshintergrund [11,12]. ...
Zusammenfassung
Studienergebnisse deuten auf eine erhöhte psychosoziale Belastung von in Deutschland lebenden Menschen mit türkischem Migrationshintergrund. In der vorliegenden Studie wurde untersucht, ob sich ein solcher Belastungsunterschied auch zu Beginn einer stationär rehabilitativen Behandlung bei Patienten mit psychischen/psychosomatischen Störungen finden lässt, ob sich Behandlungsverläufe unterscheiden und welche Bedeutung insgesamt der Faktor Migrationshintergrund für den Behandlungserfolg hat. Zum Zeitpunkt der Aufnahme zeigte sich für die Patienten mit türkischem Migrationshintergrund (n = 99 vs. n = 753) eine signifikant höhere psychopathologische Gesamtbelastung. Der Behandlungserfolg fiel für die Patienten mit türkischem Migrationshintergrund geringer aus und erreichte in einigen Skalen keine nachweisbaren Verbesserungen. Die regressionsanalytische Berechnung verdeutlicht die Bedeutung des Faktors Migrationshintergrund als einen unabhängigen negativen Prädiktor des Behandlungserfolgs.
Abstract
Study results indicate a higher psycho-social burden for people with a Turkish migration background who live in Germany. The present study researches, if such a burden difference is detectable at the beginning of an inpatient treatment program for patients with psychological/psychosomatic disorders, if different treatment progressions occur and asks which influence the factor migration background plays in terms of the treatment results. At admission patients with a Turkish migration background (N = 99 vs. N = 753) showed a higher psychopathological burden. There was less treatment success for patients with a Turkish migration background und they didn't reach verifiable improvements in some scales. The regression analysis points out the importance of the factor migration background as an independent negative predictor of a positive treatment result.
... This questionnaire was used in several studies in Germany (David, B. D. Kirkcaldy et al. Copyright & Kentenich, 2002). The question 'Do you like living in Germany?' served as an indicator of satisfaction with life in the host country. ...
This is a longitudinal study exploring self-reported health status and physical symptoms of Russian-speaking migrants (n = 307) from the states formed after the break up of the Soviet Union. These health status reports were compared with Russians in Russia (n = 300) and non-immigrant native German test subjects (n = 310). Focus was on the change in subjective evaluation of physical health and adaptation to a new medical health care system as part of the acculturation process following migration.
Migrants have more health problems than both the Russians and the native population. In addition to the stress triggered by the critical life event of migration, this finding may also reflect the poorer health status and health care in the countries of origin. In particular, immigrants suffer from headaches and symptoms of exhaustion, which are interpreted as physical correlates of the cognitive overload caused by migration. The subjective state of health of the migrants within the first 18–24 months after arrival (N = 138) showed hardly any changes. However, a high degree of satisfaction with life in the adopted country and an acculturation style distinguished by contact with the host culture correlate to a low level of health problems. The social implications of these findings are discussed. Copyright
... Controls were 119 women (104 immigrants and 15 native patients) who were hospitalized in the first trimester of pregnancy because of a disturbance in their pregnancies other than HG (imminent abortion, missed abortion, gestational diabetes, gestational-induced hypertension, preterm labor, and unspecific complaints in pregnancy) and were interviewed at an earlier time. The control group received exactly the same set of questionnaires and was admitted under the same conditions to the same ward [26]. ...
How large is the number of immigrant women being treated for hyperemesis gravidarum (HG) among the in-patients in a University hospital in Germany? Does migration have an impact on the psychosocial state of HG patients? Does acculturation have an impact on psychosocial distress in HG patients?
The following methods were used: retrospective evaluation of all in-patients with HG from 1/1997 to 11/2009, inquiry of a consecutively surveyed group (from 2007 to 2009) of HG in-patients with a questionnaire set: socio-demographic data, questionnaire on psychic distress (SCL-90-R) questionnaire on migration/acculturation, and comparison of German patients and patients with immigration backgrounds as well as among immigrant groups.
During the 13-year study period, there were 4.5 times more immigrants treated for HG than native German patients. Compared to the age standardized resident population, the number of women with immigration backgrounds is over-proportionally high. The HG patients scored high in the SCL-90-R scale "somatization" without showing a higher level of psychic distress than the native patients.
Experience of migration is an etiological cofactor for HG. The grade of acculturation does not have a significant influence on the psychic well-being of HG patients.
... According to a further Swedish study, these factors play a role particularly for men, while women with a history of migration apparently have an increased risk of hospital admission for mental disorders independent of these factors (Westman, Johansson, & Sundquist, 2006). Interestingly, a study has shown that second-generation Turkish migrants in Germany even detail higher mental burdens on the symptom checklist (SCL-90) than first-generation migrants, whereby the selected acculturation parameters apparently had no definitive influence on the emotional stress level (David, Borde, & Kentenich, 2002). ...
Background:
Migrants in Europe may suffer from depression more often than the native-born population of the particular host country. Reports about the prevalence of depression in migrants are, however, heterogeneous and the possible causes are the subject of controversial discussion.
Aims:
The aims of this study are to determine the incidence of depressiveness in a large multi-ethnic working population with and without a history of migration, and to investigate possible connections with migration status and acculturation criteria.
Methods:
The cross-sectional study asked 7062 employees of a university hospital to complete a self-rating questionnaire concerning socio-demographic data, migration status and indicators of acculturation. Depressiveness was assessed by means of the German version of the Center of Epidemiological Studies Depression Scale (CES-D).
Results:
The response rate was 41.7% (N = 2932); 14.9% of the participants (n = 419) reported a history of migration, 275 (65.8%) of whom were first-generation (M1) and 143 (34.2%) second-generation (M2) migrants. According to the CES-D scores, 8.7% of non-migrants (n = 207) suffered from clinically relevant depressive symptoms, compared to 16% (n = 44) of the M1 group (OR = 2.10, 95% CI: 1.44-3.04, p < .001) and 14% (n = 20) in M2 (OR = 1.68, 95% CI: 1.01-2.79, p = .048). Taking gender into consideration revealed that only the female migrants showed a statistically significant increased rate of depressiveness (χ (2) = 16.68, p < .001).
Conclusions:
Our results suggest that first- and second-generation female migrants are more likely to suffer from depressiveness than non-migrant females. In this model a history of migration is shown to be an independent risk factor for depressiveness.
... Innerhalb des hausärztlichen Versorgungssystems finden sich Hinweise auf soziokulturell geprägte Krankheitskonzepte, bei denen Patienten mit türkischem Migrationshintergrund stärker als die deutsche Vergleichsgruppe auf Behandlung durch Arz− neimittel ausgerichtet sind und höhere Wirksamkeit erwarten [9]. In der stationär gynäkologischen Versorgung konnte für Frauen mit türkischem Migrationshintergrund im Vergleich zu deutschen Patientinnen ein signifikant höherer psychischer Ge− samtbelastungsgrad unabhängig vom Akkulturationsgrad ge− funden werden [10]. Im Bereich der Rehabilitation von Patienten mit psychischen/ psychosomatischen Störungen deuten die wenigen vorliegenden Studienergebnisse auf erhöhte psychosoziale Belastungen der Patienten mit türkischem Migrationshintergrund [11,12]. ...
Study results indicate a higher psycho-social burden for people with a Turkish migration background who live in Germany. The present study researches, if such a burden difference is detectable at the beginning of an inpatient treatment program for patients with psychological/psychosomatic disorders, if different treatment progressions occur and asks which influence the factor migration background plays in terms of the treatment results. At admission patients with a Turkish migration background (N = 99 vs. N = 753) showed a higher psychopathological burden. There was less treatment success for patients with a Turkish migration background und they didn't reach verifiable improvements in some scales. The regression analysis points out the importance of the factor migration background as an independent negative predictor of a positive treatment result.
Background: Migration is a global phenomenon. Nevertheless, there are still data lacking about physicians and other health care provider perceptions and expectations concerning the management of patients with migration background. This national survey was therefore conducted. Method: Physicians and psychotherapists working at Charite Universitatsmedizin Berlin and Vivantes Hospital Group clinics, as well as resident doctors and psychotherapists, were invited to participate in this quantitative online-survey. The statistical analysis was anonymous and descriptive. Results: Overall, 355 questionnaires could be analyzed. The quality of care for migrants and non-migrants was rated as “good” or “very good” by at least 88% of the participants. The respondents estimated that 1% of the migrants were “not at all satisfied”. Of the respondents, 58% were dissatisfied at least once a week due to a language barrier. A specific training program on dealing with migrants and migrant care was desired by 61%. Conclusions: The topic of migrant care in the German health care system is relevant. Structured and systematic training on intercultural competence should be offered to improve migrant patient care quality and medical staff satisfaction. Institutionalized professional language translation could possibly improve the satisfaction of migrant patients and medical staff.
Im Zuge vorhandener Migrationsbewegungen in Europa ist eine Zunahme an Migranten und Migrantinnen im Gesundheitssystem festzustellen. Das Versorgungssystem ist auf die Herausforderungen, insbesondere im Hinblick auf psychische Probleme, ungenügend vorbereitet. Die Datenlage und somit das Wissen um psychische Belastungen und Erkrankungen sind nach wie vor unzureichend, genderspezifische Differenzierungen sind selten. Migration stellt per se kein gesundheitliches Risiko dar, bedeutet aber eine Phase erhöhter Vulnerabilität – insbesondere für Frauen. Grundlagen und Strategien interkultureller Kompetenz bei Gesundheitsberufen sowie interkultureller Öffnung von Gesundheitsinstitutionen werden vorgestellt. Als Beispiel guter Praxis wird die Arbeit des Frauengesundheitszentrums FEM Süd in Wien dargestellt, in dem interkulturelle Kompetenz bereits gelebt wird.
Objective:
Despite the emerging need to examine mental health of immigrants, there are no investigations designed to analyze representative samples in Germany. The aim of the present study was to explore the severity of somatic symptoms/somatization among a sample of considerable size consisting of persons with Turkish origin. We studied whether somatization was associated with sociodemographic and migration-related characteristics.
Methods:
This examination was part of a pretest for a large national epidemiological cohort study in Germany. We applied the somatization (PHQ-15) and the depression module (PHQ-9) from the Patient Health Questionnaire in a subsample of 335 Turkish immigrants. We analyzed the distribution of the sum score. Differences in degree of somatization in relation to relevant socio-demographic (gender) and migrant-related characteristics (generation of immigration) were tested with analysis of covariance (ANCOVA), controlling for age. A multiple linear regression analysis was also conducted.
Results:
Women had significantly higher age-adjusted mean scores than men (M=10.4, SD=6.3 vs. M=8.1, SD=6.3; F=10.467, p=0.001), a significant effect of age was also found (F=4.853, p=0.028). First generation immigrants had a higher age-adjusted mean number of symptoms in relation to the second generation immigrants (M=10.0, SD=6.5 vs. M=7.4, SD=7.0; F=6.042, p=0.014), the effect of age was not significant (F=0.466, p=0.495). Multiple regression analysis revealed that lower severity of somatization was associated with lower numbers of diagnosed physical illnesses (β=0.271, p<0.001) and better language proficiency (β=0.197, p=0.003, explained variance: 15.6%).
Conclusions:
The degree of somatization among Turkish immigrants in Germany is associated with gender and generation of immigration.
Intercultural psychotherapeutic treatment must involve the psychological integration of different cultures within an individual as an additional developmental dimension. The literature concerning acculturation and mental health yields heterogeneous results concerning strategies of adaptive acculturation. In intercultural psychotherapy the integration strategy is usually the strategy with the highest adaptability. It is still uncertain which theoretical assumptions might be applicable to a healthy acculturation process. However, it is assumed that increased acculturative stress may lead to higher risk and susceptibility for emotional distress and depression.
Individual change during the course of migration towards a bicultural identity that includes aspects of both the culture of origin and of the host culture has often been viewed as a desirable adaptation, although the theoretical foundation of the concept of bicultural identity remains inadequate. The cultural-dynamic model presented here distinguishes between personal and social identity on the basis of the identity concept proposed by Mead (1988). We discuss implications for the intercultural psychotherapeutic process, for identity configuration in second-generation migrants, for different phases of the lifespan, and in acquiring the language of the host culture.
The present study explores the impact of acculturation on depressive symptoms among Turkish immigrants in Germany, taking into account different dimensions of cultural orientation. A total of 471 patients from two selected samples (254 primary care patients and 217 outpatients of a psychosomatic department) participated. Levels of acculturation were measured as orientation towards culture of origin (CO), and orientation towards the host culture (HC). Acculturation strategies (integration, assimilation, separation, and marginalization) were also assessed as well as their association with depressive symptoms (BDI). Furthermore, gender- and migration-related differences in terms of acculturation and levels of depressive symptomatology were analyzed. Integration was the acculturation strategy associated with the lowest level of depressive symptoms (M = 14.6, SD = 11.9), while marginalization was associated with the highest (M = 23.5, SD = 14.7). Gender was not found to have a significant impact on acculturation but influenced depressive symptoms, with women (M = 21.8, SD = 13.3) reporting higher levels of depressive symptomatology than men (M = 15.1, SD = 14.0; p < 0.001). In first generation immigrants, significantly higher CO (M = 46.6, SD = 8.3; p < 0.001), lower HC (M = 31.0, SD = 9.6; p < 0.001), and higher levels of depressive symptoms (M = 20.2, SD = 14.1; p < 0.001) were found in comparison to second generation immigrants (CO: M = 41.3, SD = 7.4; HC: M = 36.2, SD = 8.8; depressive symptoms: M = 14.0, SD = 12.9). Our results suggest that orientation towards both the heritage and the host culture has a positive effect on the mental health status of immigrants. Future research needs to include representative samples of migrants from different cultures to further explore the association between acculturation and mental health.
The objective of the present study was to differentiate specific migration-related factors that can account for an increased vulnerability to pathological gambling (PG) among migrants in Germany. One hundred and six gamblers (61 migrants, 45 Germans) with varying degrees of gambling problems participated in the study. We analysed (1) differences between migrants and Germans regarding gambling patterns, severity of gambling problems, motivation and craving; influence of (2) acculturative stress; (3) acceptance and popularity of gambling in the culture of origin on gambling problems; (4) differences between migrants and Germans regarding family gambling and peer gambling; and (5) differences in religiosity and its influence on gambling problems. Results suggest no differences between migrants and Germans regarding gambling patterns and the severity of gambling problems. However, findings indicate that migrants have higher motivation and craving to gamble. Findings further suggest that acculturative stress is associated with more severe gambling problems. In contrast, acceptance and popularity of gambling in the country of origin was not a significant predictor of gambling problems. At the same time, family gambling and peer gambling was significantly more prevalent among migrants, constituting an additional risk factor in the present sample. On the other hand, migrants in the sample benefit more often from a protective influence of religiosity.
Objective:
To identify differences and similarities between immigrants of Turkish origin and native German patients in therapeutically relevant dimensions such as subjective illness perceptions and personality traits.
Method:
Turkish and native German mentally disordered in-patients were interviewed in three psychiatric clinics in Hessen, Germany. The Revised Illness Perception Questionnaire (IPQ-Revised) and the Neuroticism-Extraversion-Openness Five-Factor Inventory (NEO-FFI) were used. Differences of scales and similarities by k-means cluster analyses were estimated.
Results:
Of the 362 total patients, 227 (123 immigrants and 104 native Germans) were included. Neither demographic nor clinical differences were detected. Socioeconomic gradients and differences on IPQ-R scales were identified. For each ethnicity, the cluster analysis identified four different patient types based on NEO-FFI and IPQ-R scales. The patient types of each ethnicity appeared to be very similar in their structure, but they differed solely in the magnitude of the cluster means on included subscales according to ethnicity.
Conclusion:
When subjective illness perceptions and personality traits are considered together, basic patient types emerge independent of the ethnicity. Thus, the ethnical impact on patient types diminishes and a convergence was detected.
Dieser Artikel gibt eine Übersicht über die aktuelle Literatur zu sozialen und psychologischen Faktoren der Migration. Aus gehend von einer Begriffsbestimmung „Migration“ und methodischen Besonderheiten in der Migrationsforschung wird ein Stressmodell der Migration vorgestellt, und anschließend werden mögliche Stress auslösende Migrationsfolgen wie berufliche Belastungen, soziale Isolation oder familiäre Probleme analysiert und ihre Auswirkungen auf den psychischen Gesundheitszustand der Migranten untersucht. Zur psychischen Gesundheit von Migranten gibt es jedoch widersprüchliche Befunde, die mit dem healthy migrant effect, der Aufenthaltsdauer oder der Kulturspezifität erklärt werden können. Danach wird der Frage nachgegangen, wie sich diese teilweise belasteten Migranten im Gesundheitswesen wiederfinden. Schließlich wird diskutiert, welche Konsequenzen die dargestellten Ergebnisse für die weitere Forschung und für oziale und gesundheitspolitische Entscheidungen haben können.
In this study the prevalence and comorbidity of mental disorders were examined for the first time with the Structured Clinical Interview for DSM-IV (SCID-I) in a consecutive sample of Turkish speaking patients (n=51). The symptom severity of the depressiveness was measured with the Beck Depression Inventory (BDI), of the somatoform complaints with the Screening for Somatoform Symptoms (SOMS) and of the posttraumatic stress disorder (PTSD) with the Essen Trauma Inventory (ETI). The most common current diagnoses were the somatization disorder (41.2%; n=21), a single episode of major depression (37.3%; n=19) and the PTSD (31.4%; n=16). In 80.4% (n=41) of the patients at least one comorbid mental disorder was documented. In comparison with German reference values the Turkish patients showed a significant higher severity of the depressive and posttraumatic, however not of the somatoform symptomatology.
© Georg Thieme Verlag KG Stuttgart · New York.
Die Symptom-Checkliste SCL-90-R ist ein weltweit sehr häufig eingesetztes Selbstbeurteilungsinstrument zur Erfassung der psychischen Symptombelastung. In der vorliegenden Arbeit wird über die testtheoretische Überprüfung des Verfahrens und die bisher noch fehlende Normierung an einer für die deutsche Bevölkerung repräsentativen Stichprobe von 2179 Personen im Altersbereich von 16 bis 96 Jahren berichtet. Es konnte gezeigt werden, dass die SCL-90-R als Gesamtskala ein reliables Instrument zur Messung der globalen psychischen Symptombelastung darstellt. Die von den Autoren des Verfahrens postulierte dimensionale Struktur mit neun Skalen zur Erfassung unterschiedlicher Symptombereiche lässt sich faktorenanalytisch jedoch nicht bestätigen. Sowohl die hohen Interkorrelationen der Skalen als auch der Eigenwerteverlauf der Faktorenanalyse legt die Existenz eines varianzstarken Generalfaktors (global distress factor) nahe, der die allgemeine Symptombelastung einer Person abbildet. Eine valide Erfassung voneinander abgrenzbarer Symptombereiche mittels verschiedener Subskalen ist mit der SCL-90-R somit nicht möglich. Die mitgeteilten Normwerte beziehen sich deshalb lediglich auf die globalen Skalenkennwerte. Schlüsselwörter: SCL-90-R, testtheoretische Überprüfung, Normierung, repräsentative Bevölkerungsstichprobe Abstract.The Symptom-Checklist SCL-90-R by Derogatis (1977) is a frequently used inventory to assess psychological distress. This study presents results of the validation and standardization of the SCL-90-R based on a representative sample of the German population (2179 subjects aged 16 to 96 years). It could be demonstrated that the SCL-90-R is a reliable instrument to measure the global intensity of psychological distress. Factor analysis of the items of the questionnaire yielded a strong unrotated first factor, suggesting that a general factor (global distress factor) may be present. This, together with the fact that high intercorrelations were found between the nine original subscales, suggests that the instrument is not multidimensional. Therefore a classification of different groups of symptoms by different subscales is not possible, and the representative norms reported in this paper are limited to the global scores GSI, PST, and GSDI.
Little is known about cultural differences in psychological adjustment and perception of illness (PI) during medical procedures in general and radiotherapy in particular. This study compares a Turkish (TP) and a French speaking Belgian (BP) population. A group of 296 consecutive patients attending the radiotherapy clinic of Institut Jules Bordet, Brussels, (n = 172) and Oncology Institute, Capa-Istanbul, (n = 124) were interviewed and assessed by a symptom checklist, the SCL-90-R, at the beginning and at the end of the radiotherapy. PI, derived from a semi-structured interview, was assessed at the beginning of radiotherapy by a five-point observer-rating scale derived from the Omega Vulnerability Rating Scale. Differences in SCL-90-R scores, taking into account country, age, gender, level of education and PI as potential explanatory variables, have been tested by a multivariate analysis of variance with a design of repeated measures using the SCL-90-R scores as dependent variables. Mainly a time effect and a country effect have been found. Some interactions between both effects have also been found. Globally, all the SCL-90-R scores decrease between the beginning and the end of the radiotherapy. The effect of country is noticeable for most of the SCL-90-R components, with higher scores in the BP, except for the positive symptom total score where the TP showed higher scores. The interaction between country and time is not significant, the scores of both the BP and TP decreasing over time, except for somatization scores (P < 0.001) where the scores of the BP were stable over time while the scores of the TP decreased considerably, and for paranoid ideation scores (P = 0.001) where the scores of the BP decreased while the scores of the TP increased. Results showed a higher rate of correct perception in the BP compared to the TP (P = 0.0001). A PI effect has been found for somatization (P = 0.02), anxiety (P = 0.01) and Global Severity Index scores (P = 0.05), with higher mean scores for the "correct perception" category. No interaction with time was found. A significant interaction effect between country and PI has been found for anxiety scores with higher scores in the correct perception category in the BP and in the "denial of implications" category in the TP (P < 0.001). Results highlight cultural differences in psychological adjustment and/or in the responses to self-report questionnaires: greater weight was given to items by the BP, more numerous items were scored by the TP, and greater weight was given to the somatization subscale compared to the psychological subscales by the TP. This study suggests that psychosocial distress is expressed differently in Belgium and Turkey, where patients express mostly somatic complaints. Finally PI, a culture-dependent factor, appears to influence psychological adjustment very differently, a correct perception of illness leading to more anxiety in the BP compared to the TP.
This study was designed to examine the functional loss in ankylosing spondylitis and explore the relationship between disability and various factors such as age, disease duration, disease activity, spinal mobility, chest expansion, peripheral joint involvement, radiological changes, and psychosocial well-being.
Forty-two patients were included in this cross-sectional study.
The results showed that 37 patients had mild to moderate disability, two patients had severe disability, and three patients did not report any functional loss. Spearman correlation analyses showed that disability was strongly correlated with spinal mobility measures, disease activity measures, and disease duration. Also, patients with peripheral joint involvement had greater disability. When the predictive effect of five independent variables was studied by multiple regression analysis, it was found that the most powerful predictors of functional loss in AS patients were cervical rotation, modified Schober's test, and pain.
These data suggest that functional consequences of AS are constituted by multiple impairments and each needs to be managed by an integrated physiatric approach.