Gerhard Hapfelmeier’s research while affiliated with Sana Klinikum Remscheid GmbH and other places

The recommended selection criteria for interpreters in the psychotherapy of refugees are mostly based on practical experience from the perspective of therapists. This study aimed to use a participatory approach to investigate the preferences of the refugees themselves and to compare them with existing recommendations. In the anonymous survey 70 refugees took part. In addition to the participants’ demographic data, their preferences for characteristics of interpreters were recorded using a questionnaire. Exploratory data analyses were performed using SPSS. The majority of participants had no preferences regarding denomination (90%), wearing religious symbols (99%), country of origin (86%) and interpreters’ current place of residence (81%). Of the participants 20% indicated a preference for the biological gender, with no significant preference for the same gender. Approximately 26% of the refugees rejected the family affiliation of interpreters. Refugees with and without psychotherapy experience did not differ significantly in the frequency of the named preferences. The majority of the refugees did not state any specific preferences regarding interpreter characteristics. Nevertheless, interpreter characteristics should not be considered as trivial. The need for same-sex interpreters appears to be overestimated, which is why corresponding recommendations may be individually checked for suitability with patients. The recommendation to reject family members as interpreters is based not only on previous study results but also often corresponded to the wishes of the refugees surveyed.

Assessing the general intelligence of refugees poses a great challenge. Common intelligence tests developed according to Western concepts are not culture-fair, even when presented nonverbally. Thus, refugees often perform below average on such tests, which does not correspond to the clinical impression. This case report shows that the uncritical interpretation of such test results can lead to significant consequences regarding schooling and housing. Intelligence tests should, therefore, only be carried out for refugees if indicated. When interpreting the results, one must consider the lack of cultural sensitivity and view the determined IQ values as minimum values. Instead of establishing a status diagnosis, one should conduct a process diagnosis that includes an intelligence test, case history, and coping skills. In the future, performance tests should be developed that, with technical support, can be presented in a culturally sensitive way and have norm samples for different ethnic groups and cultures.

This study examines the impact of post‐migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post‐traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.

Unaccompanied refugees are a high-risk group for trauma-induced psychiatric disorders. Besides traumatic experiences pre- and during migration, post-migration stressors such as insecure residency status affect refugees’ mental health and foster aggressive emotions. High levels of psychological distress and psychopathology distort time perspectives. Consequently, an insecure residency status linked to distress may influence a refugee’s time perspective. This study investigated psychological distress, PTSD symptoms, aggressive emotions, and time perspectives in 33 unaccompanied adolescent refugees with and without secure residency status in Germany. Refugees with precarious residency status showed higher levels of overall distress and aggression than individuals with secure residency status. Both groups revealed a distorted time perspective profile, but individuals with a residence permit showed a stronger orientation toward the present hedonistic perspective than those without a permit. Higher aggressive emotions were related to insecure status, higher levels of psychological distress, more pronounced PTSD symptoms, and lower orientation to future time perspective. Distorted time perspectives among refugees may be caused by traumatic experiences and having been uprooted, independently of their residency status in the host country. A higher future orientation may buffer the association between distorted time perspectives and aggressive emotions in the highly stressed group of unaccompanied adolescent refugees.

The aim of this study is to assess adolescent refugees’ psychological distress and examine how reliably caseworkers can assess distress through a proxy-report instrument. The distress of 102 unaccompanied refugees between 16 and 21 years of age housed in youth welfare accommodations in Germany was assessed by self-report using the Brief Symptom Checklist and by proxy-report through the Child Behavior Checklist. Independent of residence status, the self and proxy ratings reveal that more than half of the refugees suffer from increased levels of psychological distress, particularly from anxiety and somatisation. There was a moderate positive correlation between the total scales of the two instruments. The high number of clinically meaningful distress poses a great challenge to caseworkers in facilities for unaccompanied refugees. The Child Behavior Checklist can be a suitable measure to detect clinically meaningful problems, but its validity seems to depend on a good relationship between caseworker and refugee.

Background Unaccompanied minor refugees (UMR) are a particularly vulnerable group with respect to mental illness. In addition to potentially traumatizing experiences before and during the flight, stressors in the host country affect their mental health. In particular, an uncertain residency status perspective can have an aggravating effect on the symptoms. In order to make the illness valid in asylum legal proceedings, patients can request appropriate attestations from the treatment provider.Methods By retrospective data analysis of the utilization population of a child and adolescent psychiatric outpatient department, data from 402 UMR were evaluated to collect information about demographic characteristics, the diagnostic spectrum, the course of treatment and the need for attestations in this group.ResultsThe majority of patients (70%) suffered from posttraumatic stress disorder. In addition, depressive disorders (24%) and adjustment disorders (31%) were diagnosed relatively frequently. Less than one third of the UMR requested an attestation. Patients from countries of origin with a high protection rate requested an attestation comparatively rarely. Attestations were mainly issued for patients with severe mental illnesses and thus increased need for treatment.Conclusion The results show that UMR do not generally require attestations and argue against a regular instrumentalization of trauma sequelae in asylum legal procedures.

Effectiveness of stabilization training for adolescent refugees with trauma-induced disorders: A randomized controlled trial Abstract. Unaccompanied minor refugees (UMR) are a group particularly vulnerable to mental illness. They pose a great challenge not only for child and youth psychiatric and psychotherapeutic care, but also for youth-welfare institutions. The study examines the effectiveness of Stabilization Training for Adolescent Refugees with Trauma Induced Disorders in inpatient youth-welfare facilities. Methods: We conducted a randomized controlled trial with pre-post design in a naturalistic setting, randomly assigning 9 housing groups for UMRs to the intervention or waiting control condition. The mental stress of 46 UMRs was assessed by both self-report and educational staff-report. Two educational staff members conducted the Stabilization Training for Adolescent Refugees with Trauma Induced Disorders as an intervention in each of the respective residential groups. Results: Participation in training led to a reduction in subjective general psychological stress. At the end of the training, psychological stress in self-judgment was significantly lower in the intervention group than in the waiting control condition. The effectiveness of the training is apparently not reflected by educational staff assessments. Conclusions: Stabilization training is a suitable instrument for the preclinical care of UMR and thus an essential basis for further psychotherapy.

Young refugees are a high-risk group for mental disorders, particularly for posttraumatic stress disorder (PTSD). Individuals with PTSD suffer from an altered time perspective with a focus on negative experiences in the past and a disregard for positive life events and the future. This study investigates time perspectives and psychological distress in 30 adolescent refugees from Syria and Afghanistan in Germany. Time perspective was assessed using the Zimbardo Time Perspective Inventory. The refugees exhibited a distorted time perspective that is common for individuals with PTSD: a high orientation toward the negative past and a low orientation toward the positive past and future. A high orientation toward the negative past was associated with high levels of general psychological distress, PTSD symptoms, and depression. A low orientation toward the future was related to high levels of anxiety. Taking time perspective and corresponding beliefs into consideration may be advantageous when treating refugees with trauma-related disorders.