Psychological Burden in Female, Iraqi Refugees Who Suffered Extreme Violence by the “Islamic State”: The Perspective of Care Providers

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Abstract

Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers.

Material and methods: Care providers with various professional backgrounds ( N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany. We controlled for potential confounders, namely the care providers' personal experiences of trauma and flight, by using chi-square tests.

Results: The mean psychological burden for the whole period in Germany as perceived by care providers was M = 5.51 ( SD = 0.94). As the main factors of distress the care providers reported: worries about family members in Iraq ( M = 6.69; SD = 0.69), worries about relatives' possibilities to be granted asylum in Germany ( M = 6.62; SD = 0.68), and uncertainties regarding their future ( M = 5.89; SD = 1.02). The most prominent trauma-related psychological symptoms were nightmares ( M = 6.43; SD = 0.54). The care providers reported that somatic complaints have been present among the refugees in the following manifestation: pain ( M = 6.24; SD = 1.08), gastrointestinal complaints ( M = 4.62; SD = 1.62), and dizziness ( M = 4.40; SD = 1.59). The care providers' personal experiences of trauma and flight had no significant influence on their response behavior.

Discussion: Care providers working with IS-traumatized female refugees evaluate the psychological burden and trauma-related somatic and psychological symptom loads of their clients as very high. The results of this study provide important information about the perceptions of care providers working in a refugee-services context and may provide insights for the progression of specialized treatment programs and interventions for highly traumatized refugees and culture-sensitive training programs for their care providers.

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Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian-Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n=24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.

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Review of somatic symptoms in post-traumatic stress disorder.

Ravindra K. Gupta (2013)

Post-traumatic stress disorder (PTSD) is associated with both (1) 'ill-defined' or 'medically unexplained' somatic syndromes, e.g. unexplained dizziness, tinnitus and blurry vision, and syndromes that can be classified as somatoform disorders (DSM-IV-TR); and (2) a range of medical conditions, with a preponderance of cardiovascular, respiratory, musculoskeletal, neurological, and gastrointestinal disorders, diabetes, chronic pain, sleep disorders and other immune-mediated disorders in various studies. Frequently reported medical co-morbidities with PTSD across various studies include cardiovascular disease, especially hypertension, and immune-mediated disorders. PTSD is associated with limbic instability and alterations in both the hypothalamic- pituitary-adrenal and sympatho-adrenal medullary axes, which affect neuroendocrine and immune functions, have central nervous system effects resulting in pseudo-neurological symptoms and disorders of sleep-wake regulation, and result in autonomic nervous system dysregulation. Hypervigilance, a central feature of PTSD, can lead to 'local sleep' or regional arousal states, when the patient is partially asleep and partially awake, and manifests as complex motor and/or verbal behaviours in a partially conscious state. The few studies of the effects of standard PTSD treatments (medications, CBT) on PTSD-associated somatic syndromes report a reduction in the severity of ill-defined and autonomically mediated somatic symptoms, self-reported physical health problems, and some chronic pain syndromes.

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Author and article information

Contributors

Caroline Rometsch-Ogioun El Sount: URI : http://loop.frontiersin.org/people/527625/overview

Jana Katharina Denkinger: URI : http://loop.frontiersin.org/people/525947/overview

Christoph Nikendei: URI : http://loop.frontiersin.org/people/565389/overview

Viola Renner: URI : http://loop.frontiersin.org/people/612483/overview

Sara Brucker: URI : http://loop.frontiersin.org/people/219230/overview

Stephan Zipfel: URI : http://loop.frontiersin.org/people/181432/overview

Florian Junne: URI : http://loop.frontiersin.org/people/449286/overview

Journal

Journal ID (nlm-ta): Front Psychiatry

Journal ID (iso-abbrev): Front Psychiatry

Journal ID (publisher-id): Front. Psychiatry

Title: Frontiers in Psychiatry

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-0640

Publication date (Electronic): 08 November 2018

Publication date Collection: 2018

Volume: 9

Electronic Location Identifier: 562

Affiliations

[1] ¹Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen , Tübingen, Germany

[2] ²Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg , Heidelberg, Germany

[3] ³Department of Psychiatry, Psychosomatic Medicine and Psychotherapy for children and Youth, University Hospital Tübingen , Tübingen, Germany

[4] ⁴Department of Gynecology, University Hospital Tübingen , Tubingen, Germany

[5] ⁵Harvard Humanitarian Initiative, Harvard University , Cambridge, MA, United States

[6] ⁶Harvard Medical School, Harvard University , Boston, MA, United States

Author notes

Edited by: Michael Noll-Hussong, Universitätsklinikum des Saarlandes, Germany

Reviewed by: Yesim Erim, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany; Sverre Varvin, OsloMet - Oslo Metropolitan University, Norway

*Correspondence: Caroline Rometsch-Ogioun El Sount caroline.rometsch@ 123456med.uni-tuebingen.de

This article was submitted to Psychosomatic Medicine, a section of the journal Frontiers in Psychiatry

Article

DOI: 10.3389/fpsyt.2018.00562

PMC ID: 6236063

PubMed ID: 29410632

SO-VID: f9cc071f-08e8-45cd-a3f6-f2df340d5a1d

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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 06 April 2018

Date accepted : 17 October 2018

Page count

Figures: 2, Tables: 5, Equations: 0, References: 56, Pages: 10, Words: 7159

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Most cited references 28

Depression and anxiety in labor migrants and refugees--a systematic review and meta-analysis.

Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India.

Review of somatic symptoms in post-traumatic stress disorder.

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