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Psychische Auffälligkeiten von Flüchtlingskindern

Eine Blickverengung durch die Posttraumatische Belastungsstörung?

Published Online:August 25, 2016https://doi.org/10.1026/0942-5403/a000207

Abstract

Zusammenfassung. Die gestiegenen Flüchtlingszahlen in den letzten Jahren werden von einer erhöhten Forschungstätigkeit begleitet. Viele dieser Studien in der Klinischen Kinderpsychologie und Kinder-/Jugendpsychiatrie beschäftigen sich dabei mit psychischen Auffälligkeiten bei Flüchtlingskindern, insbesondere der Posttraumatischen Belastungsstörung und depressiven Symptomen. Als Ursache dieser Auffälligkeiten werden dabei vor allem traumatisierende Erlebnisse vor oder während der Flucht angenommen. Diese traumafokussierte Sichtweise greift jedoch zu kurz, da sie (a) Prozesse von Resilienz (b) den Einfluss von Akkulturation auf das psychische Befinden und (c) die unmittelbare Erfüllung von primären Grundbedürfnissen nach einer Flucht vernachlässigt.


Refugee Children’s Mental Health Problems: Beyond Posttraumatic Stress Disorder

Abstract. During the past few years there has been a worldwide increase in the number of refugees. In Germany, the number of asylum seekers reached about 500,000 in 2015 – about one-third being children and adolescents. To date, several studies assessing the mental health of refugees relied on the implicit assumption that mental health problems in refugee minors are primarily due to traumatic experiences prior to or during their flight. However, this narrow view of traumatic stressors and refugees’ mental health falls short as it ignores processes of (a) resilience and (b) acculturation as well as (c) the importance of fulfilling the refugees’ basic needs before the start of psychotherapy. Epidemiological studies of the prevalence rates of mental health problems in refugee minors have yielded mixed results. For instance, the prevalence rates of general mental health problems varied between 20 and 82 % depending on the diagnostic method (self-report, informant report, clinical interview) and on the refugee’s gender, with female minors reporting the highest prevalence rates. Similar variations were observed for specific clinical diagnoses, for example, for posttraumatic stress disorder or depression it was revealed that a high number of refugee minors – possibly the majority – do not develop any mental health problems and, thus, can be considered resilient. In addition, mental health problems cannot solely be attributed to traumatic events prior to or during the flight as there are several stressors refugees experience during their residence in the host country, for example, a new language, different food, and different values and norms. Living between cultures results in cultural and psychological changes termed acculturation. How refugee minors approach acculturation not only impacts on their belonging to the host society but also explains mental health problems beyond the experience of traumatic events. Refugee minors who highly value both their home culture and their host culture display the best mental health. Furthermore, consistent with Maslow’s hierarchy of needs, psychological distress in refugee minors might be due to unmet basic needs such as, for instance, a lack of food, suboptimal housing conditions, or an uncertain asylum status. Future research needs to address the interplay of traumatic events and acculturative stress with a special focus on possible moderator effects and shared or contradictory risk and protective factors. On the other hand, before beginning psychotherapy with refugee minors, clinicians should first assess whether the minor’s basic needs are truly met and whether psychotherapy is indicated. Second, they should be aware of cultural differences in the minor’s responses to clinical interventions and incorporate elements to support acculturation in their therapy sessions.

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