Mental health treatment for refugees in Germany: need and barriers (TREAT)

德国难民的心理健康治疗：需求和障碍（TREAT）

• 批准号: 427276142
• 负责人: Professor Dr. Frank Neuner
• 金额: --
• 依托单位: Arbeitseinheit 11 - Klinische Psychologie und Psychotherapie
• 依托单位国家: 德国
• 项目类别: Research Units
• 财政年份: 2019
• 资助国家: 德国
• 起止时间: 2018-12-31 至 2023-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/427276142?language=en
• 关键词: Mental; health; treatment; refugees; Germany

The high number of refugees who have arrived in Germany since 2015 has posed a challenge to the German Mental Health care system. While, in general, refugees do not present with higher rates of diseases than the host population, rates of specific psychological disorders, in particular posttraumatic stress disorder (PTSD), are substantially increased. According to current guidelines, the first-line treatment for PTSD is trauma-focused psychotherapy. However, since access to psychotherapy for ethnic minorities has ever been difficult in Germany, it is likely that only a small minority of the refugees have received adequate evidence-based treatment. The aim of the TREAT project is to identify barriers to mental health care for refugees, with a specific focus on psychotherapy. Based on the current literature on health care utilization among refugees, we expect that access to mental health care is limited by both, subjective as well as objective factors. In close collaboration with the PH-LENS NEXUS project, TREAT will carry out in-depth interviews with sub-sample of N = 200 participants of the second wave of the NEXUS survey who screen positive for a psychological disorder. Using validated instruments, we aim to determine a tentative diagnosis of PTSD or depression. Within a process model of mental health care access, we will determine rates and predictors of mental health care utilization on different steps, ranging from the perceived need for treatment to help seeking and, finally, the utilization of adequate evidence-based treatment. As factors that may be associated with utilization we will assess mental health beliefs, knowledge about the health care system, the expected efficacy of various types of treatment as well as attitudes to help seeking including perceived stigmatization. In regression and mediator analyses the process of mental health care utilization will be explored, using both, subjective as well as objective parameters as predictors of utilization. In a preceding preparatory phase of this survey we will adapt and evaluate the study instruments, in particular a questionnaire to assess scientific and traditional mental health beliefs among refugees, in close collaboration with the ENSURE project. Furthermore, we will inform the LARGE project about the key parameters of this study in their panel study to allow the assessment of mental health care utilization in a representative sample of refugees in Germany. TREAT will not only allow to specify the barriers to mental health care access for refugees, but, using the situation of refugees as a magnifying lens of processes in the general population, reveal limitations of the existing mental health care system. In the context of the PH-LENS research unit, TREAT will contribute to the understanding of health system resilience, by determining how subjective individual-level factors interact with health system factors in affecting access to care.

自2015年以来抵达德国的难民人数居高不下，对德国的精神卫生保健系统构成了挑战。一般而言，难民的发病率并不比收容人口高，但具体的心理障碍，特别是创伤后应激障碍的发病率却大大增加。根据目前的指导方针，创伤后应激障碍的一线治疗是以创伤为重点的心理治疗。然而，由于少数族裔在德国一直难以获得心理治疗，很可能只有一小部分难民得到了充分的循证治疗。治疗项目的目的是找出难民心理健康护理方面的障碍，重点是心理治疗。根据目前关于难民卫生保健利用情况的文献，我们预计获得精神卫生保健的机会受到主观和客观因素的限制。在与PH-LENS Nexus项目的密切合作下，Treat将对Nexus调查第二波中N=200名筛查阳性心理障碍的参与者进行深入访谈。使用经过验证的工具，我们的目标是确定创伤后应激障碍或抑郁症的初步诊断。在精神卫生保健获取的过程模型中，我们将确定不同步骤的精神卫生保健利用率和预测因素，从感知的治疗需求到寻求帮助，最后是充分的循证治疗的利用。作为可能与使用相关的因素，我们将评估精神健康信念、对医疗保健系统的了解、各种治疗的预期效果以及寻求帮助的态度，包括感觉到的污名化。在回归和中介分析中，将使用主观和客观参数作为心理卫生保健利用的预测因素，探索精神卫生保健利用的过程。在本次调查的前一筹备阶段，我们将与确保项目密切合作，调整和评估研究工具，特别是评估难民的科学和传统心理健康信念的问卷。此外，我们将在小组研究中告知大型项目这项研究的关键参数，以便评估在德国的有代表性的难民样本中的精神卫生保健利用情况。Treat不仅允许明确难民获得精神卫生保健的障碍，而且将难民的情况作为普通人口过程的放大镜头，揭示现有精神卫生保健系统的局限性。在卫生保健透镜研究单位的背景下，治疗将通过确定主观的个人因素如何与影响获得护理的卫生系统因素相互作用，来促进对卫生系统复原力的了解。