Mental Health Self-Stigma of Syrian Refugees With Posttraumatic Stress Symptoms: Investigating Sociodemographic and Psychopathological Correlates

Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization of mental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization.Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self , Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales.Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t = 2.65, p = 0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma (β = 0.18, p = 0.044), controlling for sociodemographic covariates.Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.

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Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany

PLoS ONE ◽

10.1371/journal.pone.0254406 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0254406

Author(s):

Anna Renner ◽

David Jäckle ◽

Michaela Nagl ◽

Rahel Hoffmann ◽

Susanne Röhr ◽

...

Keyword(s):

Mental Health ◽

Social Support ◽

Health Outcomes ◽

Posttraumatic Stress ◽

Traumatic Events ◽

Posttraumatic Stress Symptoms ◽

Mental Health Stigma ◽

Syrian Refugees ◽

Stress Symptoms ◽

Migration Factors

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the “Sanadak” randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

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Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients

Iranian Journal of Psychiatry ◽

10.18502/ijps.v15i4.4303 ◽

2020 ◽

Author(s):

Atefeh Zandifar ◽

Rahim Badrfam ◽

Nami Mohammadian Khonsari ◽

Mohammad Reza Mohammadi ◽

Hamid Asayesh ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Logistic Regression ◽

Posttraumatic Stress ◽

Health Care Workers ◽

Associated Factors ◽

Posttraumatic Stress Symptoms ◽

Multivariate Logistic Regression ◽

Stress Symptoms ◽

Care Workers

Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic. Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis. Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91). Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.

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Supplemental Material for Posttraumatic Stress Symptom Change After Family Involvement in Veterans’ Mental Health Care

Psychological Services ◽

10.1037/ser0000200.supp ◽

2017 ◽

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Posttraumatic Stress ◽

Family Involvement ◽

Symptom Change ◽

Posttraumatic Stress Symptom ◽

Stress Symptom

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Syrian Refugees in Canada: Clinical Experience in Mental Health Care

10.26226/morressier.588f064fd462b8028d892631 ◽

2017 ◽

Author(s):

Khalid Bazaid

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Clinical Experience ◽

Syrian Refugees

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Posttraumatic Growth, Posttraumatic Stress Symptoms and Mental Health Among Coronary Heart Disease Survivors

Journal of Clinical Psychology in Medical Settings ◽

10.1007/s10880-012-9318-z ◽

2012 ◽

Vol 20 (2) ◽

pp. 164-172 ◽

Cited By ~ 34

Author(s):

Irit Bluvstein ◽

Liat Moravchick ◽

David Sheps ◽

Shaul Schreiber ◽

Miki Bloch

Keyword(s):

Mental Health ◽

Coronary Heart Disease ◽

Heart Disease ◽

Posttraumatic Growth ◽

Posttraumatic Stress ◽

Posttraumatic Stress Symptoms ◽

Stress Symptoms

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Posttraumatic Stress Symptoms in Victims of the Tokyo Subway Sarin Attack: Twenty Years Later

Journal of Social and Clinical Psychology ◽

10.1521/jscp.2018.37.10.794 ◽

2018 ◽

Vol 37 (10) ◽

pp. 794-811 ◽

Cited By ~ 1

Author(s):

Shin Nakamine ◽

Maiko Kobayashi ◽

Hiroyuki Fujita ◽

Sachiko Takahashi ◽

Yutaka Matsui

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Posttraumatic Stress ◽

Comparison Group ◽

Terrorist Attack ◽

Physical Symptoms ◽

Posttraumatic Stress Symptoms ◽

Stressful Event ◽

Secondary Victimization ◽

Stress Symptoms

Introduction: Previous studies found that about 10–30% of terrorist attack survivors suffer mental disorders such as posttraumatic stress disorder (PTSD) which persist up to 10 years. However, little is known about whether the effects of terrorism on mental health could last for a longer period or whether physical symptoms and secondary victimization are associated with the persistence of mental disorders. Method: A questionnaire survey was conducted with the victims of the Tokyo subway sarin attack in March 1995 (N = 299). Victims’ physical and ophthalmic symptoms, secondary victimization, and posttraumatic stress symptoms were surveyed. For comparison, those who have experienced a stressful event were surveyed with the same instruments as of victims’ survey except secondary victimization. Results: Results indicated that 21.3% of the male and 36.1% of the female victims were in the high-risk group for posttraumatic stress symptoms (PTSS), which did not differ from those of the comparison group. However, victims had physical and ophthalmic symptoms of greater severity than the comparison group. Moreover, we found that PTSS was strongly associated with physical symptoms and secondary victimization. Discussion: There is a need to develop a support system that would be helpful in reducing mental health suffering of terrorist victims. Providing regular physical checkups and building support for those who experience life changes caused by victimization are suggested.

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Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China

Psychological Medicine ◽

10.1017/s0033291720000999 ◽

2020 ◽

pp. 1-2 ◽

Cited By ~ 96

Author(s):

Hai-Xin Bo ◽

Wen Li ◽

Yuan Yang ◽

Yu Wang ◽

Qinge Zhang ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Posttraumatic Stress ◽

Posttraumatic Stress Symptoms ◽

Stress Symptoms

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Treatment gap and mental health service use among Syrian refugees in Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckz185.579 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Cited By ~ 1

Author(s):

D C Fuhr ◽

C Ataturk ◽

M McGrath ◽

Z Ilkkursun ◽

A Woodward ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Service Use ◽

Mental Health Problems ◽

Mental Health Service Use ◽

Continuing Care ◽

Syrian Refugees ◽

Depression And Anxiety ◽

Treatment Gap

Abstract Introduction Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey. Methods A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used. Results The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported. Conclusions To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness. Key messages This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.

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