Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people

BACKGROUND: Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film ‘Coping with Flight and Trauma’ was developed as a brief online intervention. OBJECTIVE: The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. METHOD: The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. RESULTS: A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. CONCLUSIONS: Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. HIGHLIGHTS: Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people. Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services

Addressing barriers to mental health services: evaluation of a psychoeducational short film for forcibly displaced people

Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film ‘Coping with Flight and Trauma’ was developed as a brief online intervention. The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people.Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services. Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people. Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services.</p

Secondary Traumatization in Caregivers Working With Women and Children Who Suffered Extreme Violence by the “Islamic State”

Introduction: Refugees fleeing persecution, torture, or sexual violence are at high risk of developing both acute and chronic psychological disorders. Systematic violence, as committed against the Yazidi minority in Northern Iraq by the terror organization known as the Islamic State (IS), can be seen as a particularly traumatic burden to the victims, but also to caregivers providing treatments and assistance to them. The intense exposure to traumatic content may cause secondary traumatization in respective caregivers. This study aims (1) to identify the prevalence of secondary traumatization in caregivers working with traumatized women and children from Northern Iraq; (2) to determine the specific distressing factors and resources of the caregivers; as well as (3) to analyze whether caregivers' personal history of trauma or flight, attachment styles, working arrangements as well as support offers qualify as risk or resilience factors for secondary traumatization.Materials and Methods: In this cross-sectional study, N = 84 caregivers (social workers, psychotherapists/physicians, and interpreters) in the context of a Humanitarian Admission Program (HAP) for women and children traumatized by the so called IS were investigated about their work-related burdens and resources. Secondary traumatization was assessed with the Questionnaire for Secondary Traumatization (FST). To identify relevant determinants for secondary traumatization multiple linear regression analyses were performed.Results: Secondary traumatization was present in 22.9% of the participating caregivers, with 8.6% showing a severe symptom load. A personal history of traumatic experiences, a personal history of flight, a higher number of hours per week working in direct contact with refugees as well as a preoccupied attachment style were detected as risk factors for secondary traumatization. A secure attachment style could be identified as a resilience factor for secondary traumatization.Discussion: Caregivers working with traumatized refugees are at high risk of developing secondary traumatization. Based on the findings of this study and theoretical considerations, a framework of classification for different types of trauma-associated psychological burdens of caregivers working with traumatized refugees is proposed. Implications for the training and supervision of professionals in refugee- and trauma-care are discussed

Self-harming and aggressive behavior in females with posttraumatic stress disorder and substance use disorder : the role of emotion regulation strategies

Die vorliegende Arbeit beschäftigt sich mit dem Zusammenhang von Suizidalität und selbstverletzendem Verhalten sowie Gewalt gegen andere Personen bei Frauen, die sowohl an einer Posttraumatischen Belastungsstörung (PTBS) als auch an substanzbezogenen Störungen (SUD) leiden. Hinsichtlich potenzieller Risikofaktoren wurde ein besonderes Augenmerk auf Emotionsregulationsstrategien gelegt. Die Ergebnisse der Studie zeigen, dass ein Großteil der untersuchten 343 Frauen mindestens eine traumatische Kindheitserfahrung erlebt hat und die berichtete Gewalt dabei häufiger gegen sich selbst als gegen andere gerichtet ist. Ferner wird deutlich, dass der Einsatz funktionaler Emotionsregulationsstrategien wie beispielsweise Neubewertung oder sozialer Unterstützung mit einer geringeren Tendenz zu Gewaltanwendung einhergeht als der Einsatz dysfunktionaler Strategien wie beispielsweise Vermeidung unangenehmer Gefühle oder Grübeln. Funktionale Emotionsregulationsstrategien könnten in der Therapie dieser Patientinnen gezielt gefördert werden, um das Risiko für suizidales Erleben und Verhalten, Selbstverletzungen sowie Gewaltanwendung zu reduzieren