S. Temur-Erman

Socio-economic status and emotional distress of female Turkish immigrants and native German women living in Berlin

BACKGROUND Many immigrants face more economic strains and hardship than non-immigrants. Income inequality and an increasing social gap between immigrants and non-immigrants in Europe warrant further studies on the impact of socioeconomic factors on health in immigrant groups. The purpose of this study was to examine the association of socioeconomic status (SES) and emotional distress in women of Turkish descent and in women of German descent. METHODS AND SUBJECTS A total of 405 women of German or Turkish descent residing in Berlin were interviewed. Emotional distress was assessed by the General Health Questionnaire-28 (GHQ-28), and SES was examined by level of education, employment status, and income. The associations of emotional distress and SES were estimated in multivariate linear regression analyses. RESULTS Unemployment was associated with increased levels of emotional distress in all women, with the highest level of distress in the group of unemployed Turkish women. The overall SES level was related to a greater level of emotional distress in Turkish women, but not in German women (-3.2, 95%CI -5.9 - -.5; p=.020 vs. -.8, 95%CI -2.7 - 1.2; p=.431). Further stratified analyses by relationship status revealed that the association of SES and emotional distress only remained significant among single women. CONCLUSION The impact of socioeconomic hardship appears to be complicated by social roles and expectations related to these. Further in-depth study of the complex nature of the interaction of social roles and socioeconomic position in female Turkish immigrants in Germany is needed to better understand differing risk patterns for emotional distress.

Suicide attempt rates and intervention effects in women of Turkish origin in Berlin

PURPOSE Ethnic minority groups show elevated suicide attempt rates across Europe. Evidence suggests a similar trend for women of Turkish origin in Germany, yet data on suicidal behaviour in minorities in Germany is scarce. The objective was to examine rates of suicidal behaviour, underlying motives, and to explore the effectiveness of an intervention program. METHODS From 05/2009-09/2011, data on all suicide attempts among women of Turkish origin who presented at a hospital-based emergency unit in Berlin, Germany, were collected. A multi-modal intervention was conducted in 2010 and the effects of age, generation and the intervention on suicide attempt rates were examined. RESULTS At the start, the highest rate was found in women aged 18-24years with 225.4 (95% CI=208.8-242.0)/100,000. Adjustment disorder was the most prevalent diagnosis with 49.7% (n=79), being more common in second-generation women (P=.004). Further analyses suggested an effect of the intervention in the youngest age group (trend change of ß=-1.25; P=.017). CONCLUSION Our findings suggest a particularly high rate of suicide attempts by 18-24-year-old, second-generation women of Turkish origin in Berlin. Furthermore, our results suggest a trend change in suicide attempts in women aged 18-24years related to a population-based intervention program.

Mental health of Turkish women in Germany: resilience and risk factors

BACKGROUND The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany. METHOD 105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations. RESULTS In all subjects, social strain (Pearsons r=.26(**), p=.008) and neuroticism (r=.34(**), p<.001) were positively associated with mental distress. In contrast, perceived self-efficacy (r=-.38(**), p<.001) and extraversion (r=-.36(**), p<.001) were negatively associated with mental distress. CONCLUSION Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.

Surveying migrant populations – methodological considerations: An example from Germany

Data available from the recruitment process for a population-based survey on psychological well-being in women of Turkish origin aged 18–75 years was subjected to post-hoc analysis to examine effects of different recruitment approaches and reasons for non-response. A random sample of 80,000 women was drawn from the Berlin population registry and 3884 women of Turkish origin identified by a name-based algorithm. The women were assigned randomly to three waves for further contact. The protocol consisted of an invitation letter, telephone contact and door-to-door visits. Door-to-door visits were only performed in one wave, to assess the effect of an intensified recruitment approach. Response rates were 11.9% (95% CI: 7.2–16.6) in the first wave, 3.9% (95% CI: 1.7–6.2) in the second wave and 1.3% (95% CI: 0.9–1.8) in the third wave. The contact rate was highest in the first wave (n=126; 68.1%), which included door-to-door visits. Participants were more often married, had more children, higher educational level, a higher net household income and more often a history of mental disorder. Participation was associated with door-to-door visits (OR=4.22; 95% CI: 1.89–9.45), age (for 35–54 years; OR=2.01; 95% CI: 1.03–3.91) and reply by telephone (OR=4.32; 95% CI: 2.18–8.60). Through the intensified recruitment approach the contact rate could be increased. Despite this we found a relatively low response rate in all recruitment waves.

Explanatory models of suicidality among women of Turkish descent in Germany: A focus group study

Women of Turkish descent in Germany show higher rates of suicidal behavior compared to their host populations and men of Turkish descent. This indicates a demand for a better understanding of suicidality in this group. Nine focus groups (N = 61) were conducted to assess explanatory models including patterns of distress, perceived causes, course/consequences of and reactions towards a suicidal crisis, help-seeking behavior, and potential intervention and prevention strategies. All participants were of Turkish descent living in Berlin, Germany. The focus groups included two with professionals such as psychiatrists or psychotherapists, two with Community Mothers, three with women from the community (ages: 18 -34, 35 -49, 50+), and of three suicide attempters (ages: 18 -33, 38 -66). Data were analyzed using the methodology of thematic analysis. Results show that suicide-related behaviors, attitudes, and help-seeking behavior have gender and culture-specific characteristics. Two central themes were identified: the impact of family and community and the impact of German society. Participants stated that they believe that family and community pressures as well as discrimination and lack of acceptance cause social isolation. Fear of stigmatization and dishonoring themselves or their family, as well as shame and self-stigma decrease the likelihood of reaching out for help. Recommended strategies are community and family interventions, promotion of integration and social inclusion, awareness campaigns to destigmatize suicidality and the use of mental health services, empowerment of women, as well as the improvement of cultural sensitivity and competency of services.

S19-04 - Current findings of suicidality and migration

The process of migration can be a risk factor for suicidal behaviour. Factors such as circumstances of the migration and individual characteristics like age, education, and his offspring play an important role. The empiric evidence of todays suicide prevention therapy strategies - following a suicidal crisis or a suicide attempt - in order to prevent prospective crises are limited. There are not enough protective therapy recommendations. Psychotherapeutic interventions and antidepressants are not proven to be better than a standard treatment. An appropriate treatment of depression (antidepressant, psychotherapy, psychoeducation, self-help) seems to be preventive. In this contribution the current state of epidemiology, ethiopathogenesis, models of suicidal behaviour and suicide prevention will be discussed.

P01-323 - Mental health resilience and vulnerability factors in Turkish female migrants and German controls

The aim of the main study is to examine the influence of risk factors and protecting factors that help elicit or alleviate mental health issues. An epidemiological cross-sectional data collection approach will be employed for this purpose, and the main outcome variable will be mental health as assessed with the General Health Questionnaire. We will recruit 340 German women and 340 Turkish migrant women. Constructs such as general self-efficacy, social support and extraversion depict protective factors and constructs such as social strain and neuroticism are considered as risk factors in this regard. Furthermore, the coherence between various acculturation patterns will be explored in order to be able to examine the presence of psychiatric symptoms more precisely. We will present the first results of the pilot study by 50 Turkish migrant women to review the reliability and validity of the used instruments and to evaluate the hypotheses and experimental design.

P01-328 - Explanatory models of suicidal crisis behavior in women with Turkish migratory background

Studies demonstrate that suicidality in female Turkish immigrants in some European countries is higher compared to native-born women of the same age. This indicates a demand for a better understanding of suicide in this group of the society, and, based on such knowledge, specific concepts for prevention. Embedded in the development of a suicide prevention campaign for women of Turkish origin in Berlin, Germany, we assessed explanatory models of suicidal behavior using a qualitative approach. Specifically, we employed focus group discussions with Turkish experts as well as focus group discussions with Turkish women from the community. Groups were stratified by age (age range 18-34, 35-49, and 50+) in order to account for age effects and effects of migration generation. Results show differential conceptions of suicidal crises, the patterns of distress, the perceived causes, and the preferences for help-seeking and treatment as a function of age group and expertise. Based upon these results, we provide a framework for explanatory models of suicidal crisis behavior that are specific for women with a Turkish migratory background in Germany.

S19-02 - Effects of social determinants on depression and suicidality

Migration-related factors could be additional risk factors for the development of depression and suicidal behaviour in migrant populations. In particular, the success or failure of migration will impact on migrants’ mental well-being. The premigration experiences, the act of migration itself, the motive for migration, postmigration experiences and the structural prerequisites in the host country play a central role. On the basis of the results of a population based study on the factors associated with mental distress in female Turkish migrants in two German cities (Berlin, Hamburg) the impact of migration-specific factors on the expression of mental distress will be discussed. Factors which will be examined among others are, reasons for migration, residence status, perceived ethnic discrimination and acculturation strategies, socio-economic status and traumatic experiences (pre- and post-migration).

Inanspruchnahme psychosozialer Hilfsangebote durch Frauen mit türkischem Migrationshintergrund in psychischen Krisen: Bestehen generationsübergreifende Unterschiede?

Hintergrund: Bisher ist wenig uber den Einfluss der Migrationsgeneration auf die tatsachliche und potenzielle Inanspruchnahme in psychischen Krisen durch Migrantinnen mit turkischer Herkunft bekannt. Methode: Es wurden 101 Frauen mit turkischem Migrationshintergrund Interviewer gestutzt und mit Hilfe verschiedener Fragebogen befragt. Ergebnisse: Frauen mit turkischem Migrationshintergrund der ersten und der zweiten Generation unterschieden sich nicht bezuglich der potenziellen Inanspruchnahme in psychischen Krisensituationen. Migrantinnen der ersten Generation und Migrantinnen mit einem segregierten Akkulturationsstil berichteten, sich weniger uber bestehende psychologische Angebote informiert zu fuhlen. Sie gaben an Informationen uber psychosoziale Hilfsdienste in der Muttersprache hilfreich zu finden. Schlussfolgerungen: Fur eine Verbesserung der Inanspruchnahme psychosozialer Versorgungseinrichtungen scheint es wesentlich, gezielte Subgruppen anzusprechen, um insbesondere Frauen mit geringen Deutschkenntnissen den Zugang zu erleichtern.