Many refugees experience a wide range of mental health problems, but typically use mental health services less often than settled residents. Practical constraints like limited access to mental health care and language barriers largely account for this discrepancy. However, little is known about the psychological aspects explaining this difference in mental health service usage, like attitudes toward psychological help-seeking and the disclosure of distress. The present study compares German residents’ and Syrian refugees’ attitudes toward seeking professional psychological help ( N = 384). Refugees reported more depressive symptoms and functional impairment than residents. Crucially, refugees also held more negative attitudes toward professional psychological help-seeking than residents. These group differences in attitudes were to a large part mediated by distress disclosure. We conclude that it is important to achieve a thorough understanding of how to address help-seeking attitudes and to encourage distress disclosure to promote treatment of mental health issues among many refugees.

Screening tools developed for Western populations have produced heterogeneous prevalence estimates for depression and anxiety disorders among refugees. The use of these instruments assumes that psychopathological symptoms are manifested similarly across different cultural groups. Here, we scrutinized whether depressive and anxiety symptoms are manifested similarly between German residents and refugees in Germany. We tested measurement invariance, test information and specifics of symptom interrelations in 200 refugees and 202 German residents with classical test theory (CTT), item response theory (IRT) and network analysis. Participants completed the Patient Health Questionnaire regarding depressive and anxiety symptoms in either Arabic or German. Measurement invariance was only present to a certain extent. Questionnaires were most informative on different spectrums of the latent traits for the two groups. Network analysis demonstrated that symptom interrelations of depressive and anxiety symptoms differed across residents and refugees. This was especially true for core symptoms of common nosological systems, such as losing interest or feeling depressed. Surprisingly, traumatic events in the past were not central in refugees' anxiety networks. Core symptoms of nosological systems seem to be differently pronounced in refugees and residents, which has important implications for our understanding of mental health symptoms in refugees.

Syrian refugees underutilize mental health services in Western receiving countries, which is partly attributable to negative attitudes toward seeking professional psychological help (APPH) and denial of the need for psychological help (DNPH). Interventions tailored to culture-specific characteristics of Syrian refugees are needed. We tested an intervention that disseminated information about the benefits of psychotherapy via ostensible interview vignettes to 205 German residents and 187 Syrian refugees residing in Germany. We used a 2 (group: residents vs. refugees) × 2 (source of information: ingroup vs. outgroup member) × 2 (therapy content: skill training vs. emotion regulation) × 2 (gender: women vs. men) between-participants design with the dependent variables APPH and DNPH. We measured adherence to masculine norms, support by religious faith, and distress disclosure as additional predictors. Refugees reported more negative APPH and higher DNPH than residents. Source of information and therapy content had no detectable effect. Men reported more negative APPH and higher DNPH than women. Adherence to masculine norms emerged as the strongest predictor of APPH. Masculine norms and support by religious faith partly explained differences between refugees and residents in APPH and DNPH. Exploratory post hoc analyses with nonintervention samples of 182 Syrian refugees and 202 residents from a similar study indicated that Syrian refugees who received an intervention (vs. no intervention) reported more positive APPH. No such difference was found for residents. Disseminating information about psychotherapy could positively impact APPH/DNPH in refugees but needs to be tailored to their sociocultural context. We outline recommendations for further research.