Z. Bromand

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.

Teaching psychiatry and establishing psychosocial services--lessons from Afghanistan.

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 later serve in various medical disciplines in regional and district hospitals) and to medical staff including nurses and psychosocial counsellors working in health posts and district hospitals. We describe such a brief but clinically relevant list of symptoms and classifications based on experiences with medical student and practitioner training.

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.

Suizidraten und Suizidprävention bei Berliner Frauen mit türkischem Migrationshintergrund

Suicidality in female Turkish immigrants is higher as compared to that of native-born women of the same age. The analysis of the national mortality registry in Germany reported a 2-fold suicide risk in the target group compared to German women of the same age. A population-based multi-modal intervention project was conducted. Suicidal crisis were analysed in focus groups and guided the development of the intervention module. The intervention consisted of a public awareness campaign, a telephone hotline, and the training of key persons. All parts of the intervention were subsequently evaluated. Suicide attempts of the target group that were presented at all emergency units in Berlin were registered. In a population-based interview survey the aim was to elicit central sociodemographic and psychosocial variables that may influence distress and help-seeking behaviour in women of Turkish origin.

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.

Neue Ansätze zur Erkennung und Differenzierung von Depression bei Migranten@@@New procedures for recognition and differentiation of depression in immigrants: Fallbeispiel einer Patientin mit türkischem Migrationshintergrund@@@Case report of a patient with Turkish immigrant background

Depression is a cross-cultural disorder, which displays cultural differences in symptom presentation and prevalence. The guidelines for the assessment of cultural influencing factors for the medical history and therapy and the consideration of stressors associated with the immigration process can help to better understand the socio-cultural background of patients with an immigration background and facilitate the differential diagnosis. Using these strategies, psychiatry and psychotherapy are better prepared to deal with this large heterogeneous population given the fact that one fifth of Germanys population has an immigration background. The transcultural aspects of depression are illustrated with a case report.

Neue Ansätze zur Erkennung und Differenzierung von Depression bei Migranten

Depression is a cross-cultural disorder, which displays cultural differences in symptom presentation and prevalence. The guidelines for the assessment of cultural influencing factors for the medical history and therapy and the consideration of stressors associated with the immigration process can help to better understand the socio-cultural background of patients with an immigration background and facilitate the differential diagnosis. Using these strategies, psychiatry and psychotherapy are better prepared to deal with this large heterogeneous population given the fact that one fifth of Germanys population has an immigration background. The transcultural aspects of depression are illustrated with a case report.

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.