The findings highlight the effects of ethnic discrimination beyond the influence of known risk factor for psychological distress in migrants, such as unemployment, being single, having a limited residence permit or the presence of personality structures that may increase vulnerability for stress responses and mental disorders.

Women of Turkish descent in Germany show higher rates of suicidal behavior compared to their host populations and men of Turkish descent. This indicates a demand for a better understanding of suicidality in this group. Nine focus groups ( N = 61) were conducted to assess explanatory models including patterns of distress, perceived causes, course/consequences of and reactions towards a suicidal crisis, help-seeking behavior, and potential intervention and prevention strategies. All participants were of Turkish descent living in Berlin, Germany. The focus groups included two with professionals such as psychiatrists or psychotherapists, two with Community Mothers, three with women from the community (ages: 18 -34, 35 -49, 50+), and of three suicide attempters (ages: 18 -33, 38 -66). Data were analyzed using the methodology of thematic analysis. Results show that suicide-related behaviors, attitudes, and help-seeking behavior have gender and culture-specific characteristics. Two central themes were identified: the impact of family and community and the impact of German society. Participants stated that they believe that family and community pressures as well as discrimination and lack of acceptance cause social isolation. Fear of stigmatization and dishonoring themselves or their family, as well as shame and self-stigma decrease the likelihood of reaching out for help. Recommended strategies are community and family interventions, promotion of integration and social inclusion, awareness campaigns to destigmatize suicidality and the use of mental health services, empowerment of women, as well as the improvement of cultural sensitivity and competency of services.

The positive relationships between stigma, depression, and overall psychological distress indicate that patients who are more depressed and who have higher levels of overall psychological distress experience their condition as more stigmatizing. Since somatic symptoms and stigma were not related (neither positively, nor negatively), it appears that depressive symptoms and other symptoms of psychological distress affect concerns about stigmatizing attitudes in a way that somatic symptoms do not. This result challenges common assumption of the 'somatization'hypothesis, i.e. that depression is 'somatized'because of concern about stigmatizing attitudes.