Somatic distress among Syrian refugees with residence permission in Germany: analysis of a cross-sectional register-based study

Abstract

Background Previous studies have already proven high rates of common mental disorders in Syrian refugees. Nevertheless, little is known about the patterns of somatic distress among this refugee population. For this reason, we aimed to examine the prevalence, co-occurrence, and risk factors of somatic distress among Syrian refugees in Germany. Methods This study analyzes the second measurement point (N = 116) of a prospective register-based survey among 200 adult Syrian refugees with residence permission in Germany. The survey consisted of information on sociodemographic and migration-specific characteristics, health care utilization, traumatic life events, acculturative stress (Barcelona Immigration Stress Scale (BISS); subscales: perceived discrimination, intercultural contact stress, homesickness, and general psychosocial stress), and self-reported outcomes of somatic distress (Patient Health Questionnaire (PHQ-15)), depression (PHQ-9), generalized anxiety disorder (GAD-7), and post-traumatic symptoms (Essen Trauma Inventory (ETI)). Results Almost half of the respondents (49.1%) were identified as being at risk of somatic distress (PHQ-15 score ≥ 6), and even 24.1% being bothered by moderate-to-severe levels of somatic distress (PHQ-15 score ≥ 10). The most robust associations with somatic distress were found for female gender, the amount of health care utilization, multiple trauma exposures, general psychosocial stress, and self-reported depression and anxiety symptoms. High comorbidities with somatic distress were shown for all of the common mental disorders studied. Conclusions The presented study reveals a significant risk of somatic distress among this displaced population and highlights implications for policy and health care providers.

Assessing Somatic Symptoms With the Patient Health Questionnaire (PHQ-15) in Syrian Refugees

“…The models may have been too complex for our data given sample size restrictions. However, this may be a problem that researchers face in refugee studies because of typically small sample sizes due to practical constraints ( Borho et al, 2021 ). It, thus, remains open whether a general somatization factor in a model that additionally accounts for the variance by specifying specific orthogonal factors reduces biases in total scores meaningfully.…”

“…However, clinical presentations and epidemiological research also highlight the role of somatic symptoms that remain medically unexplained among refugees ( Hassan et al, 2015 ; Nesterko et al, 2020 ). In fact, somatic symptoms are common among Syrian refugees ( Borho et al, 2021 ) and play a central role in their mental health symptom constellations ( Schlechter, Wilkinson, et al, 2021 ).…”

Improving Attitudes Toward Psychotherapy in Residents and Syrian Refugees in Germany: An Interview Vignette Intervention Study

“…Recently, he also experienced potentially traumatic events. In all vignettes, the described person visited a general practitioner because of somatic complaints (e.g., headache, stomach pain), matching the fact that many Syrian refugees in Germany report somatic symptoms that are medically unexplained (Borho et al, 2021). When no organic causes for the complaints could be identified, the general practitioner referred them to a psychotherapist for a mental health examination.…”

“…Patients' expectations of mental health treatment, including therapeutic content, may critically influence APPH. Refugees often report symptoms related to anxiety, depression, sleep problems, somatization, and traumatic stress (Borho et al, 2021;Henkelmann et al, 2020;Lies et al, 2021). Especially two forms of mental health treatment appear effective for such symptoms, namely (1) trauma-focused therapy to deal with emotional consequences of traumatic events (Bisson et al, 2007) and ( 2) skill training that provides practical coping strategies for stressful situations or sleep problems (Van Heemstra et al, 2019).…”

Perceived post-migration discrimination: the perspective of adolescents with migration background

“…Among these post-migration stress factors, discrimination is one of the most burdening, significantly worsening the health and well-being of young people with migration background [5]. Research with adult as well as immigrant and refugee youth underscores the negative impact of discrimination on both physical (e.g., self-rated, hypertension, cardiovascular, respiratory) and mental health (affective disorders, e.g., anxiety, depression) [6][7][8]. A recent study among 1366 refugee and non-refugee migrant young people in five European countries revealed that perceived discrimination was associated with increased levels of mental health problems and lower overall well-being for refugees and nonrefugee migrants.…”