Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy
Abstract
:1. Introduction
1.1. Asylum Seekers‘ Access to Health Care in Germany
1.2. Aim of the Study
2. Materials and Methods
2.1. Setting
2.2. Data Source and Collection
2.3. Inclusion and Exclusion Criteria
2.4. Variables
- When depression as such was reported as a ‘reason for consultation’, the term ‘depression’ was adopted. On the other hand, when symptoms of depression were listed (such as sadness, listlessness, anhedonia), we summarized this information as ‘depressiveness’. Since they were lay data and differentiation was not possible in hindsight, the diagnosis of post-traumatic stress disorder (PTSD) and the less specific term ‘trauma’ were summarized as ‘trauma’. The resulting categories of reasons for searching therapeutic help are later on presented as “complaints” at the time of the application.
- The documented ‘diagnoses’ were encoded according to the ICD-10. If only the information ‘depression’ was given, this was recorded as F32.9 (=Depressive episode, unspecified). If diagnoses were stated with the German prefix ‘V.a.’, indicating a suspected diagnosis, this information was listed separately.
- Since the majority of clients could not indicate a specific drug when asked about their prescribed ‘medications’, classification was carried out according to less detailed drug groups.
- During the assessment interview, there was no explicit question about ‘torture experiences’. However, if the clients reported such experiences unprompted, this was documented. In addition to the answer options yes and no, the psychologist was able to document the information about torture as ‘unclear’.
- In the course of the assessment interview, the psychologist specifically asked for ‘disorder-relevant psychopathological symptoms’. In addition to less specific items, such as sleep disorders, pain, anxiety, restlessness and appetite disorders, clear psychiatric symptoms such as suicidal- and self-injuring behavior, aggressiveness, drug use and hallucinations were also explored. During the assessment interview, these topics are explored anamnestically only, there is no standardized diagnostic at this point. We therefore report them below as “disorder-relevant psychopathological symptoms” and differentiate them from “diagnoses”, which have been assigned by physicians prior to registration with the PSZ.
- In order to assess the extent to which the ‘residence status of the clients changed’, we divided them into secure, precarious and at-risk status. When classifying, we considered legal aspects as well as the psychosocial stress associated with different statuses and their biographical implications from the asylum seeker’s point of view. We classified residence permits (in German: Aufenthaltserlaubnis) as ‘secure’. ‘Precarious statuses’ were temporary suspension of deportation (Duldung) and temporary residence permit for the time of the asylum request (Aufenthaltsgestattung). We defined a situation as ‘at-risk’ when a deportation was imminent, a title had expired or was rejected, a person was without residence status in Germany or had to live in church sanctuary. We compare these categories from the time of registration with those for the assessment interview on the level of the individual.
- From our data, two ‘waiting times’ could be determined. Firstly, the waiting period from the registration to the assessment interview. Secondly, the waiting time from the assessment interview to the beginning of psychotherapy. In order to classify the waiting times, we compared them with the average waiting time for psychotherapy of clients with regular statutory health insurance in the state of Saxony-Anhalt.
2.5. Statistical Analysis
2.6. Ethical Considerations
3. Results
3.1. Demography
3.2. Situation at the Time of Application
- Complaints
- Diagnoses
- Treatments
- Residency status
- Reason for consultation
- Electronic health insurance card
- Referring Institutions
3.3. Situation at Assessment Interview
- Torture
- Assessment of urgency
- Medications
- Disorder-relevant psychopathological symptoms
- Residence status
- Social support
- Contacts
3.4. Changes during the Time until Assessment
- Treatments
- Change in residence status
4. Discussion
- Post-migration stress and resilience
- Health insurance card
- Navigation in the health system
- Legal restrictions in conflict with the EU directive
- What does it take?
- Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | n = 437 | % | |
Gender | Female Male | 171 266 | 39.1 60.9 |
Country of origin | Afghanistan | 139 | 31.8 |
Syria | 56 | 12.8 | |
Iran | 41 | 9.4 | |
Russia | 22 | 5.0 | |
Somalia | 20 | 4.6 | |
Iraq | 18 | 4.1 | |
Chechnya | 15 | 3.4 | |
Guinea Bissau | 14 | 3.2 | |
Benin | 13 | 3.0 | |
Burkina Faso | 11 | 2.5 | |
Turkey | 9 | 2.1 | |
Mali | 8 | 1.8 | |
Kosovo | 7 | 1.6 | |
Nigeria | 7 | 1.6 | |
Unknown | 8 | 1.8 | |
Others | 49 | 11,2 | |
Age group in years | 18–19 | 43 | 9.8 |
20 ≤ 24 | 98 | 22.4 | |
25 ≤ 29 | 99 | 22.7 | |
30 ≤ 34 | 67 | 15.3 | |
35 ≤ 39 | 52 | 12 | |
40 ≤ 44 | 31 | 7.1 | |
45 ≤ 49 | 20 | 4.6 | |
50 ≤ 54 | 13 | 3.0 | |
55 ≤ 60 | 12 | 2.8 | |
>60 | 2 | 0.5 | |
mean = 30.7 years | |||
Spoken languages | Persian/Farsi/Dari | 183 | 41.9 |
English | 83 | 19.0 | |
German | 75 | 17.2 | |
Arabic | 71 | 16.3 | |
French | 42 | 9.6 | |
Russian | 42 | 9.6 | |
Pashto | 37 | 8.5 | |
Kurdish/Sorani | 37 | 8.5 | |
Somali | 21 | 4.8 | |
Turkish | 18 | 4.1 | |
Chechen | 15 | 3.4 | |
Albanian | 7 | 1.6 | |
Tigrinya | 6 | 1.4 | |
Others | 58 | 13.27 | |
Interpreter needed | Yes No | 360 77 | 82.4 17.6 |
Complaints | n = 437 | % |
Insomnia | 225 | 51.5 |
Anxiety | 143 | 32.7 |
Trauma/PTSD * | 84 | 19.2 |
Headache | 81 | 18.5 |
Depression | 69 | 15.8 |
Suicidal ideation | 67 | 15.3 |
Nightmares | 65 | 14.9 |
Depressiveness | 55 | 12.6 |
Sadness | 47 | 10.8 |
Stress | 45 | 10.3 |
Pondering | 44 | 10.1 |
Pain | 42 | 9.5 |
Others | 36 | 8.3 |
Reduced concentration | 33 | 7.6 |
Unrest | 32 | 7.3 |
No specific information | 32 | 7.3 |
Aggressiveness | 26 | 6.0 |
Social retreat | 24 | 5.5 |
Memory problems | 24 | 5.5 |
Reduced appetite | 22 | 5.0 |
Flashbacks | 21 | 4.8 |
Self-injury | 20 | 4.6 |
Exhaustion | 19 | 4.4 |
Panic | 17 | 3.9 |
No statement | 16 | 3.7 |
Dissociation | 14 | 3.2 |
Worry | 13 | 3.0 |
Affect lability | 11 | 2.5 |
Fainting attacks | 10 | 2.3 |
Stomach discomfort | 10 | 2.3 |
Consumption of drugs | 9 | 2.1 |
n = 437 | % | ||
Emergency specified? | Yes No | 207 230 | 47.4 52.6 |
n = 207 | % | ||
Specified emergencies | Suicidal ideation/Attempted suicide/Self-injury | 81 | 39.1 |
Other acute stress situations | 28 | 13.5 | |
Threatened with/Imminent deportation | 21 | 10.1 | |
Social indication | 20 | 9.7 | |
chronic condition | 16 | 7.7 | |
Exacerbation | 8 | 3.9 | |
Severe disease/poor acute condition | 6 | 2.9 | |
Follow-up therapy | 5 | 2.4 | |
Pain | 3 | 1.5 | |
Court order for treatment | 1 | 0.5 | |
No statement | 18 | 8.7 |
Registration | Assessment Interview | |||
n = 437 | % | n = 188 | % | |
Temporary residence permit (Gestattung) | 179 | 41.0 | 57 | 30.3 |
Temporary suspension of deportation (Duldung) | 123 | 28.2 | 57 | 30.3 |
Residence permit (Aufenthaltserlaubnis) | 90 | 20.6 | 25 | 13.3 |
No data | 32 | 7.3 | 49 | 26.1 |
Other | 13 | 3.0 | ||
Rejected application | 3 | 0.7 | ||
Without residential status | 3 | 0.7 | ||
Permit expired | 2 | 0.5 | ||
Dublin returnees | 2 | 0.5 | ||
Threatened with deportation/ Imminent deportation | 1 | 0.2 | ||
EU migrant | 1 | 0.2 | ||
Church sanctuary | 1 | 0.2 |
n = 188 | % | |
Improvement | 6 | 3.2 |
Constancy | 53 | 28.2 |
Deterioration | 40 | 21.3 |
No Data | 89 | 47.3 |
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Trohl, U.; Wagner, K.; Kalfa, V.; Negash, S.; Wienke, A.; Führer, A. Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy. Int. J. Environ. Res. Public Health 2021, 18, 11850. https://doi.org/10.3390/ijerph182211850
Trohl U, Wagner K, Kalfa V, Negash S, Wienke A, Führer A. Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy. International Journal of Environmental Research and Public Health. 2021; 18(22):11850. https://doi.org/10.3390/ijerph182211850
Chicago/Turabian StyleTrohl, Ulrich, Karoline Wagner, Vivian Kalfa, Sarah Negash, Andreas Wienke, and Amand Führer. 2021. "Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy" International Journal of Environmental Research and Public Health 18, no. 22: 11850. https://doi.org/10.3390/ijerph182211850
APA StyleTrohl, U., Wagner, K., Kalfa, V., Negash, S., Wienke, A., & Führer, A. (2021). Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy. International Journal of Environmental Research and Public Health, 18(22), 11850. https://doi.org/10.3390/ijerph182211850