Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants and Study Design
2.2. Study Procedure
2.3. Semi-Structured Qualitative Interviews
2.4. Ethical Approval
2.5. Quantitative Data and Qualitative Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Results of the Qualitative Interviews
- (A)
- Traumatic events (18 codes)
- (B)
- Dealing with traumatic experiences and following symptoms (31 codes)
- (C)
- Changing views due to traumatic experiences (16 codes)
- (D)
- Current stress factors (83 codes)
- (E)
- Experiences with integration in Germany (29 codes)
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Symptoms Reported in the Interviews | N | % |
---|---|---|
Re-experiencing | ||
Intrusions | 6 | 42.8% |
Nightmares | 1 | 7.1% |
Avoidance | ||
Mistrust | 3 | 21.4% |
Avoidance behavior | 1 | 7.1% |
Hyperarousal | ||
Concentration difficulties/forgetfulness | 6 | 42.8% |
Sleeping difficulties | 4 | 28.6% |
Irritability | 2 | 14.3% |
Other symptoms | ||
“Stress” | 6 | 42.8% |
Somatic symptoms | 3 | 21.4% |
Ruminations | 3 | 21.4% |
Anhedonia/hopelessness | 2 | 14.3% |
Question 1: Stress Factors and Resources in Daily Life and Their Effects on Trauma Symptomatology | |
Guiding Question | Sustaining Question |
Daily life: | |
How do you currently feel about your everyday life? | |
Daily stress: | Is the current status of the asylum procedure/the uncertainty/your work situation/your health/the coronavirus 2019 (COVID-19) situation/caring for the children/(…) a burden in your everyday life? |
What are the burdens you have in your everyday life? What things in your everyday life do you find stressful? | What is particularly stressing you out? |
How much do you currently feel burdened by your trauma symptoms? | |
What effects do you currently feel from the traumatic/bad experiences you have had in your everyday life? | Which effects/symptoms of this are particularly stressful? |
What does this symptomatic burden mean for your everyday life? | |
Everyday resources: | Are there any contacts (family/friends from the temporary shelter/friends outside the temporary shelter) that support you in your everyday life? |
What things do you find comfortable/helpful/supportive in your daily life? | Are there any activities (sports/cooking/German course/visiting religious institutions) that you find helpful in your everyday life? |
Are there any activities you used to enjoy but now no longer do because of the traumatic experience and/or symptoms? | |
What helps you deal with (memory of) traumatic experiences? | Can you open up to other people? |
Whom do you turn to? | |
What activity helps you deal with (memories of) traumatic experiences? | |
How did you deal with difficulties/stresses in your home country in the past? | |
Has anything changed in this regard? | |
How have your traumatic experiences changed your view of other people? | |
How have your traumatic experiences changed your view of yourself? | |
How have your traumatic experiences changed your view of the world? | |
Question 2: Stress Factors and Resources in the Temporary Accommodation and Their Effects on Trauma Symptomatology | |
Guiding Questions | Sustaining Questions |
Temporary accommodation: | |
How do you feel about your current housing situation? | |
Stress factors in the temporary accommodation: | Do you find the number of people/different backgrounds of people/contact with people/location/sanitation/facilities/privacy/(…) a burden in your accommodation? |
What things do you find stressful and burdensome in your temporary shelter? | |
Resources in the temporary accommodation: | Do you find the number of people/different backgrounds/contact with people/contact with social workers/(…) helpful? |
What things do you find helpful in your shelter? | |
What factors in the accommodation hinder coping with memories of/consequences of traumatic experiences? | |
Question 3: Stress Factors and Resources in the Professional Environment and Their Effects on Trauma Symptomatology | |
Guiding Questions | Sustaining Questions |
Work situation: | If you work: do you find the job itself/the working hours/the language barrier/cultural barrier/contact with colleagues/discrimination a stress factor? |
Do you perceive your current work situation as a stressor? | Does your trauma symptomatology hinder you in your work? If so, in what respects (e.g., in contact with co-workers, in certain activities)? |
If you are not working: do you perceive the job search/the job search in the current COVID-19 situation/lack of support/bureaucracy/language barrier/discrimination as a stressor? | |
How is your current trauma symptomatology related to this? | |
Work situation: | If you work: do you find the job itself/the (regular) working hours/the opportunity to learn the language/the contact with colleagues helpful? |
Do you feel that your current work situation is helpful? | What is helpful at work concerning your trauma symptomatology? |
If you are not working: do you find it helpful not to work and to have time for other things, such as language classes/taking care of children or dependents/taking care of health issues/? | |
Do you find it helpful concerning your trauma symptomatology not working? | |
Question 4: Stress Factors and Resources in Integration and Their Effects on Trauma Symptomatology | |
Guiding Questions | Sustaining Questions |
Integration: | In your opinion, what role does culture/language/asylum procedure/ |
housing/work/personal attitude play in integration? | |
In your opinion, which factors play the most important role in integration? In general, what do you feel helps and hinders integration? | |
In your opinion, what other factors are there? | |
How well/strongly do you feel integrated? | |
What factors contribute to integration in your current situation? | Does the current status of your asylum procedure/your housing situation/your work situation/contact with people from the temporary shelter/contact with people outside the temporary shelter/learning the language/(…) positively impact your integration in Germany? |
In your current situation, which factors are preventing you from settling? | Does the current status of your asylum procedure/your housing situation/your work situation/the contact with people from the temporary shelter/the contact with people outside the temporary shelter/the language course have any hindering effects on your integration in Germany? |
To what extent does your trauma symptomatology impact your integration? | Do specific symptoms prevent you from integrating? |
Or have “doors” opened due to your trauma symptomatology? |
Main Themes and Categories | Quotes |
---|---|
Psychological symptoms | |
Imposing thought | “I can’t forget them. And they outweigh me. They outweigh my thoughts. Simply it is difficult for me to stop thinking.*” (NMDOO6 + AKD005) |
“Yes, these thoughts come to me automatically, without me having any influence on them. For example, when I suddenly think of the woman’s corpse, I feel such deep pity that I have to cry.*” (0102MA) | |
“I try not to think about it. But sometimes I have no control over it. And then thoughts just come, I can do nothing about it. *” (SAD003) | |
Nightmares | “Yes. Yes. One of my nightmares is having the feeling that someone is coming in here to my room.*” (SAD003) |
Mistrust | “So I already have contact with some Turkish people there. But we don’t have such a relationship that I share everything with them. So when I have a doctor’s appointment or when I go for treatment or something, I don’t discuss such topics with them, because I have lost my trust in people. I don’t have that. I no longer trust people.*” (0101SI) |
“In fact, I am very distrustful of men. And I can no longer trust them.*” (SAD003) | |
Avoidance behavior | “Not to think about things which is giving me too much stress you know. Yes.” (AS0112) |
Concentration difficulties/forgetfulness | “The other problem is that we can not concentrate.*” (NMDOO6 +AKD005) |
“But it is, that I quickly forget everything immediately. I also told my teacher about the problem. No matter what I learn, I quickly forget it.*” (SHD007) | |
Sleep disturbance | “And at night I sleep badly.*” (SHD007) |
“And then sometimes I have to wake up terrified.*” (SAD003) | |
“(…), that I am always asleep during the day and always awake at night.*” (0101SI) | |
Irritability | “Yes, in his opinion I have become impatient and irritable. My behavior has been changed in this way. He [the participant] perceives that he becomes irritated and impatient and he can do certain things that he has to do, he said, just for example washing clothes. It takes a bit of patience and yes, you have to do it properly and for certain things he has no patience at all. And irritated.*” (FZS0021) |
“Yea so sometimes now I feel anger when I talk with my wife I see my child start to cry me. I start very angry.” (LKB0116) | |
“Stress” | “I have yes stress anyway, I have yes stress.*” (SHD007) |
Somatic symptoms | “Yes, then all the time I have a headache. And my body is cramped. So that is not normal.*” (SHD007) |
“Well, I used to be, 93, I weighed 93 kilos, but now I’m 59. I have so little appetite.*” (SHD007) | |
Rumination | “Apart from the fact that, when I have the opportunity, I think about it a lot.*” (FZS0021) |
“And after that, the usual thoughts come back to me. So this is only temporary. Sure, two hours with my daughter. An hour or so I read. But the rest then I make myself thoughts.*” (0102MA) | |
Anhedonia/Hopelessness | “[‥] that contributes to life becoming meaningless for me. My future is uncertain. And not hopeful.*” (FZS0021) |
Traumatic experiences | |
Physical violence | “I told him, the wounds in my hand I have too much wounds. Because this one also you see my hand. You see this one here. This one is like yea. It’s big you know. It’s left from here you know. So this one they put like hot matches, they put it in the fire until this one get hot hot hot hot. Till you can see red after [‥] you understand.” (AS0112) |
Sexual violence | “Then so I did not want to have a sexual relationship with him. But he always forced me. [Interpreter: And then that comes across to me as a rape] That was so terrible for me. I had such a bad feeling about it. I can’t even put it into words, but did he force me to just.*” (1006IE) |
Witness of violence | “… how my daughter was arrested by the police in Iran and they beat her.*” (NMDOO6 +AKD005) |
“I saw someone being hanged. Although I was a bit older, was in my 30th year, but I can’t get that off my head either.*” 0102MA | |
Trauma not due to human agency | “My major trauma in Iran is because of an explosion that caused my eyes, or rather my back, to lose my eyes and injure my back.*” (0102MA) |
Emotional violence | “In Iran my husband treated me like a prisoner. For example, she covered the windows with the newspaper or with such a curtain, so that I do not have an overview of the outside and the other way around.*” (1006IE) |
Discrimination | “And again, when they call or when they write “Why? Why like this? Why like that?” And again about thinking why, what should I answer. I can’t just say “I love and that’s it.” That’s not. That you can’t just tell without, understand and after telling too. This is hard mentality.*” (NMS0009) |
Dealing with traumatic experiences and symptoms | |
Distraction strategies | “Yes, I was recently in a German course, I have finished. That was an occupation for me. A daily occupation. And yes, I talk on the phone with my family, with friends, and I try to overcome the time that way.*” (AA0115) |
“Yeah, sure. I try to distract myself by talking to my daughter or I occupy myself with my cell phone or I occupy myself with the internet. But yes, sometimes I can’t escape from it right away, escape from it, because it’s not possible for me. Then yes, it takes time.*” (0102MA) | |
“I try to distract myself from the bad thoughts by learning German and shopping and being on the internet.*” (FZS0021) | |
Psychotherapeutic help | “So that’s, that’s been the case now. And we were there at the first appointment. And they had said at that time that we [they] would organize an interpreter. But the interpreter was not there. That’s why they only asked us a few questions and then they said that we would be invited to the second appointment because there was no interpreter at the first appointment.*” (0102SI) |
“So the word you mentioned is the English [word], but presumably that’s psychotherapist or psychiatrist. So he talks to him in English and he can tell him quite a lot.*” (FZS0021) | |
Social support | “No, I don’t tell them. No no no. I just don’t tell them, but some people, they know. They ask me why you lose weight or something I say yea it’s normal. I just it’s work.” (LKB0116) |
“In total I have two friends. One is in Frankfurt and lives with her boyfriend. And well, of course she is still far away from me. And this friend in Mannheim is a bit, we have a better relationship. And the children of her calm me down, for example, I get a good feeling in any case.*” (SHD007) | |
“She has always been helpful, even with learning languages or helping me with different topics.*” (0102SI) | |
“Yes, I have Turkish acquaintances, friends who have lived here for a long time. Who came here from Turkey. From them I get support.*” (AA0115) | |
Changing views due to traumatic experiences | |
“So all in all, I feel safe here. But every now and then, for example on the street, I meet people who immediately make me think “Okay, they could also be susceptible to punishment if there was no law”.*” (0102MA) | |
“So the whole thing that is being done there, that people are being killed, mistreated, treated badly and that nobody or no one can help them, always makes me think that there really will be an end of the world soon.*” (LVP001) | |
Current stress factors | |
Uncertain residency status and insecure living conditions | “They say still now we don’t believe you, you understand. So this is what they reply me. Okay. So after I sit there like long time like five months again they send me another letter they tell me you have to come for the second interview again, you understand, in Karlsruhe. So I go. With my lawyer. This is the first interview, see, they reject me, they say they don’t trust me.” (AS0112) |
“I had a career, of course. And here, of course, I have to start from 0. And now to go from to from 0 to 1, that’s difficult. So every beginning is difficult. And that is stressful for me.*” (AA0115) | |
Worry for loved ones | “I don’t understand the meaning of BAMF (Federal office for Migrants and Refugees). How do they decide? All of us, except my daughter, we are recognized. So only except my daughter, I do not understand. We are a family. And for what reason, why do they do that? I don’t know. That is don’t understand that either. And right now, we have a lot of Iranians being deported to Iran, that scares me even more.*” (NMDOO6 +AKD005) |
Lack of influence | “Yea I think, you know, later if you have child here, I think you request for the family reunion. They have to give it to you. I requested but they don’t give nothing they don’t act and do nothing.” (LKB0116) |
“Yes, most of the time I’m in the shelter, the asylum seekers’ home. And then I spend my time learning German and things like that. So most of the time I am actually in the shelter.*” (SAD003) | |
Experiences of integrating in Germany | |
Language | “Yes, the key is of course the language. If I can speak the language well, then I can do almost anything with it. I can make contact with my environment.*” (SAD003) |
Work | “Before, I didn’t speak too much. But at work, you get to know things, you speak with the people. How to say, you have more and more integration.*” (FKS0011) |
Cultural differences | “So according to his perception, there are more people who are cold from his point of view than the people who want to warm up to him. However, you always have to distinguish it culturally. So to warm up with each other in German is maybe different than in […] Asian countries. So there is a certain distance, which may be cold to one.*” (FZS0021) |
“The tradition too. The mentality too. Because if you tell me the mentality of the Spanish is not the mentality of the Germans either, it’s not the mentality of the French it’s not the Germans either.*”(FKS0011) |
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Sociodemographic Data | ||
---|---|---|
Age | ||
Mean | 36.1 | |
SD | 10.2 | |
Min./Max. | 22/53 | |
Gender | n | % |
Male | 8 | 54.1% |
Female | 6 | 42.9% |
Country of origin | n | % |
Iran | 7 | 50.0% |
Turkey | 2 | 14.3% |
The Gambia | 2 | 14.3% |
China | 1 | 7.1% |
Morocco | 1 | 7.1% |
Armenia | 1 | 7.1% |
Years in Germany | n | % |
2015 | 2 | 14.3% |
2017 | 2 | 14.3% |
2018 | 5 | 35.7% |
2019 | 4 | 28.6% |
Not specified | 1 | 7.1% |
Asylum status | n | % |
Asylum received | 1 | 7.1% |
Awaiting asylum decision | 6 | 42.9% |
Received tolerance (German: ‘Duldung’) | 5 | 35.7% |
Not specified | 2 | 14.3% |
Screening data | M (SD); Range | |
PC-PTSD-5 | 4.14 (0.86); 3–5 | |
PHQ-2 | 4.25 (1.71); 1–6 | |
GAD-2 | 4.25 (1.71); 1–6 |
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Rzepka, I.; Zehetmair, C.; Roether, E.; Kindermann, D.; Cranz, A.; Junne, F.; Friederich, H.-C.; Nikendei, C. Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis. Int. J. Environ. Res. Public Health 2022, 19, 10893. https://doi.org/10.3390/ijerph191710893
Rzepka I, Zehetmair C, Roether E, Kindermann D, Cranz A, Junne F, Friederich H-C, Nikendei C. Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis. International Journal of Environmental Research and Public Health. 2022; 19(17):10893. https://doi.org/10.3390/ijerph191710893
Chicago/Turabian StyleRzepka, Irja, Catharina Zehetmair, Emma Roether, David Kindermann, Anna Cranz, Florian Junne, Hans-Christoph Friederich, and Christoph Nikendei. 2022. "Impact of and Coping with Post-Traumatic Symptoms of Refugees in Temporary Accommodations in Germany: A Qualitative Analysis" International Journal of Environmental Research and Public Health 19, no. 17: 10893. https://doi.org/10.3390/ijerph191710893