Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Studie

Klinisch-psychologische Diagnostik in einer Flüchtlingsambulanz für Kinder und Jugendliche

Erste Ergebnisse zu psychischen Belastungen, traumatischen Lebensereignissen und Behandlungszielen

Published Online:May 17, 2019https://doi.org/10.1026/0942-5403/a000286

Abstract

Zusammenfassung. Für geflüchtete Kinder und Jugendliche wird in der Flüchtlingsambulanz des Universitätsklinikums Hamburg-Eppendorf ambulante psychiatrisch-psychotherapeutische und psychosoziale Versorgung angeboten. Seit Oktober 2016 durchlaufen die Patienten einen standardisierten klinisch-psychologischen Diagnostikprozess, welcher die Behandlungsplanung unterstützen soll. Von den N = 134 untersuchten Patienten im Alter von 8 bis 20 Jahren wurden n = 90 (69.8 %) mit einer gegenwärtig vorliegenden PTBS diagnostiziert. Weiterhin wiesen n = 67 (50.0 %) der Geflüchteten eine mittelgradige oder schwere depressive Episode auf. Nahezu alle Patienten gaben an, in ihrem Herkunftsland mehrfach interpersonelle Gewalt erlebt zu haben. Als Behandlungsziel wurde am häufigsten ein besserer Umgang mit negativen Gefühlen und Gedanken formuliert. Diese Ergebnisse demonstrieren, dass es sich bei den untersuchten geflüchteten Kindern und Jugendlichen, um eine äußerst stark belastete Gruppe mit hohem Behandlungsbedarf handelt.


The Clinical–Psychological Diagnostic Process in an Outpatient Health-Care Center for Refugee Children and Adolescents: First Results of Mental Health Problems, Traumatic Events, and Treatment Goals

Abstract. In the past years, numerous children and adolescents have fled from war zones and areas of conflict to Germany. Such experiences increase the probability of psychological distress enormously. Still, there are only scarce data about the prevalence of mental health problems in refugee children. The Outpatient Health-Care Center for Refugees of the University Medical Center Hamburg-Eppendorf offers psychiatric–psychotherapeutic and psychosocial treatment for refugee children and adolescents. A standardized clinical diagnosis process was developed in order to provide a grounded basis for treatment planning as well as a first overview of prevalence data regarding psychological disorders and accompanying mental health problems in refugee children and adolescents. This standardized clinical diagnostic process includes an anamnesis of the patient’s social background as well as a diagnostic interview. The diagnostic interview incorporates parts of a standardized clinical interview (MINI-KID) and established standardized self-reports to asses depression, posttraumatic stress disorder (PTSD), dissociative symptoms, substance consumption, and suicidal behavior. Additionally, traumatic events in their home country, during flight, and in Germany as well as the patient’s treatment goals were considered during the diagnostic process. From October 2016 to November 2017, 134 refugee children and adolescents (19.4 % female) between the age of 8 and 20 years were diagnosed in the Outpatient Health-Care Center for Refugees in Hamburg. Based on a newly developed questionnaire, it was shown that 93 (90.3 %) of the refugee children and adolescents experienced interpersonal violence multiple times in their home country and 88 (84.6 %) during their flight. Even in Germany, 18 (19.1 %) of the children and adolescents encountered interpersonal violence multiple times. Regarding psychological disorders of the refugee children, 90 (69.8 %) were diagnosed with a current PTSD. Furthermore, 67 (50 %) of the children were diagnosed with current moderate or severe depression. The most commonly reported treatment goal by patients was more adaptive dealing with negative emotions and thoughts. In sum, a standardized diagnostic process of the Outpatient Center for Refugee children is presented and high prevalence rates of psychological disorders and accompanying mental health problems are revealed. These findings clearly show that patients visiting the Outpatient Health-Care Center for Refugees in Hamburg represent a high-risk group and have, therefore, a great need for psychological treatment. As psychological health is an important factor for successful integration, specialized psychiatric–psychotherapeutic and psychosocial treatment should be made more accessible for refugee children. Moreover, such a treatment is indispensable since, should they return home, the psychological health of the refugees is essential for reconstruction and reconciliation processes in their home countries.

Literatur

  • Achenbach, T. M. & Edelbrock, C. (1991). Manual for the Child Behavior Checklist/4 – 18 and 1991 Profile. Burlington, VT: The University of Vermont. First citation in articleGoogle Scholar

  • American Academy of Pediatrics. (2010). The Children’s Impact of Event Scale (13) CRIES-13. In American Academy of Pediatrics (Ed.), Addressing Mental Health Concerns in Primary Care: A Clinician’s Toolkit [CD/DVD]. Itasca, IL: American Academic of Pediatrics. First citation in articleGoogle Scholar

  • Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, E. & Spinhoven, P. (2007). Comparing psychological distress, traumatic stress reactions, and experiences of unaccompanied refugee minors with experiences of adolescents accompanied by parents. Journal of Nervous and Mental Disease, 195, 288 – 297. First citation in articleCrossref, Google Scholar

  • Bean, T., Eurelings-Bontekoe, E., Derluyn, I. & Spinhoven, P. (2004). Stressful life events (SLE): User’s manual. Oegstgeest: Centrum’45. First citation in articleGoogle Scholar

  • Bohus, M., Kleindienst, N., Limberger, M. F., Stieglitz, R.-D., Domsalla, M., Chapman, A. L. et al. (2009). The short version of the Borderline Symptom List (BSL-23): Development and initial data on psychometric properties. Psychopathology, 42, 32 – 39. First citation in articleCrossref, Google Scholar

  • Bronstein, I. & Montgomery, P. (2011). Psychological distress in refugee children: A systematic review. Clinical Child and Family Psychology Review, 14, 44 – 56. First citation in articleCrossref, Google Scholar

  • Bundesamt für Migration und Flüchtlinge (2016). Aktuelle Zahlen zu Asyl – Ausgabe: Dezember 2016. Berlin: Bundesamt für Migration und Flüchtlinge. First citation in articleGoogle Scholar

  • Bundesamt für Migration und Flüchtlinge (2017). Aktuelle Zahlen zu Asyl – Ausgabe: August 2017. Berlin: Bundesamt für Migration und Flüchtlinge. First citation in articleGoogle Scholar

  • Canino, G. & Alegría, M. (2008). Psychiatric diagnosis – is it universal or relative to culture? Journal of Child Psychology and Psychiatry, 49, 237 – 250. First citation in articleCrossref, Google Scholar

  • Children and War Foundation. (2017). CRIES-8. Retrieved November 7, 2017, from http://www.childrenandwar.org/measures/children’s-revised-impact-of-event-scale-8---cries-8/ First citation in articleGoogle Scholar

  • D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J. & Kolk, B. A. van der (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82, 187 – 200. First citation in articleCrossref, Google Scholar

  • DeWalt, D. A., Gross, H. E., Gipson, D. S., Selewski, D. T., DeWitt, E. M., Dampier, C. D. et al. (2015). PROMIS® pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions. Quality of Life Research, 24, 2195 – 2208. First citation in articleCrossref, Google Scholar

  • Ehntholt, K. A. & Yule, W. (2006). Practitioner review: Assessment and treatment of refugee children and adolescents who have experienced war‐related trauma. Journal of Child Psychology and Psychiatry, 47, 1197 – 1210. First citation in articleCrossref, Google Scholar

  • Essau, C., Conradt, J. & Petermann, F. (1999). Häufigkeit der Posttraumatischen Belastungsstörung bei Jugendlichen. Ergebnisse der Bremer Jugendstudie. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 27, 37 – 45. First citation in articleLink, Google Scholar

  • Fazel, M., Wheeler, J. & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365, 1309 – 1314. First citation in articleCrossref, Google Scholar

  • Gavranidou, M., Niemiec, B., Magg, B. & Rosner, R. (2008). Traumatische Erfahrungen, aktuelle Lebensbedingungen im Exil und psychische Belastung junger Flüchtlinge. Kindheit und Entwicklung, 17, 224 – 231. First citation in articleLink, Google Scholar

  • Heptinstall, E., Sethna, V. & Taylor, E. (2004). PTSD and depression in refugee children. European Child & Adolescent Psychiatry, 13, 373 – 380. First citation in articleCrossref, Google Scholar

  • Hodes, M., Jagdev, D., Chandra, N. & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology and Psychiatry, 49, 723 – 732. First citation in articleCrossref, Google Scholar

  • Huemer, J., Karnik, N. S., Voelkl-Kernstock, S., Granditsch, E., Dervic, K., Friedrich, M. H. et al. (2009). Mental health issues in unaccompanied refugee minors. Child and Adolescent Psychiatry and Mental Health, 3, 13. First citation in articleGoogle Scholar

  • Irwin, D. E., Stucky, B., Langer, M. M., Thissen, D., DeWitt, E. M., Lai, J.-S. et al. (2010). An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Quality of Life Research, 19, 595 – 607. First citation in articleCrossref, Google Scholar

  • Keilson, H. (1979). Sequentielle Traumatisierung bei Kindern: deskriptiv-klinische u. quantifizierend-statistische follow-up Untersuchung zum Schicksal der jüdischen Kriegswaisen in den Niederlanden. Stuttgart: Enke. First citation in articleGoogle Scholar

  • Keles, S., Friborg, O., Idsøe, T., Sirin, S. & Oppedal, B. (2016). Depression among unaccompanied minor refugees: The relative contribution of general and acculturation-specific daily hassles. Ethnicity & Health, 21, 300 – 317. First citation in articleCrossref, Google Scholar

  • Klasen, F., Petermann, F., Meyrose, A.-K., Barkmann, C., Otto, C., Haller, A.-C. et al. (2016). Verlauf psychischer Auffälligkeiten von Kindern und Jugendlichen. Kindheit und Entwicklung, 25, 10 – 20. First citation in articleLink, Google Scholar

  • Kolk, B. A. van der, Pynoos, R. S., Cicchetti, D., Cloitre, M., D’Andrea, W., Ford, J. D. et al. (2009). Proposal to include a developmental trauma disorder diagnosis for children and adolescents in DSM-V. Retrieved May 23, 2018 from http://cismai.it/wp-content/uploads/2013/11/DTD_papers_Oct_095eb2.pdf First citation in articleGoogle Scholar

  • Landolt, M. A. (2012). Psychotraumatologie des Kindesalters: Grundlagen, Diagnostik und Interventionen. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Lincoln, A. K., Lazarevic, V., White, M. T. & Ellis, B. H. (2016). The impact of acculturation style and acculturative hassles on the mental health of Somali adolescent refugees. Journal of Immigrant and Minority Health, 18, 771 – 778. First citation in articleCrossref, Google Scholar

  • Lynch, M. A. (2001). Providing health care for refugee children and unaccompanied minors. Medicine, Conflict and Survival, 17, 125 – 130. First citation in articleCrossref, Google Scholar

  • Mannhart, A. & Freisleder, F. J. (2017). Traumatisierung bei minderjährigen unbegleiteten Flüchtlingen. Monatsschrift für Kinderheilkunde, 165, 38 – 47. First citation in articleCrossref, Google Scholar

  • Martínez-Taboas, A., Shrout, P. E., Canino, G., Chavez, L. M., Ramírez, R., Bravo, M. et al. (2004). The psychometric properties of a shortened version of the Spanish Adolescent Dissociative Experiences Scale. Journal of Trauma & Dissociation, 5, 33 – 54. First citation in articleCrossref, Google Scholar

  • Mayring, P. (2010). Qualitative Inhaltsanalyse. Grundlagen und Techniken (11., akt. u. überarb. Aufl.). Weinheim: Beltz. First citation in articleGoogle Scholar

  • Metzner, F., Reher, C., Kindler, H. & Pawils, S. (2016). Psychotherapeutische Versorgung von begleiteten und unbegleiteten minderjährigen Flüchtlingen und Asylbewerbern mit Traumafolgestörungen in Deutschland. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 59, 642 – 651. First citation in articleCrossref, Google Scholar

  • Möhler, E., Simons, M., Kölch, M., Herpertz-Dahlmann, B., Schulte-Markwort, M. & Fegert, J. M. (2015). Diagnosen und Behandlung (unbegleiteter) minderjähriger Flüchtlinge. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 43, 381 – 383. First citation in articleLink, Google Scholar

  • Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K. & Brouwer, K. C. (2009). Healthcare barriers of refugees post-resettlement. Journal of Community Health, 34, 529 – 538. First citation in articleCrossref, Google Scholar

  • Plener, P. L., Groschwitz, R. C., Brähler, E., Sukale, T. & Fegert, J. M. (2017). Unaccompanied refugee minors in Germany: attitudes of the general population towards a vulnerable group. European Child & Adolescent Psychiatry, 26, 733 – 742. First citation in articleCrossref, Google Scholar

  • Putnam, F. W., Helmers, K. & Trickett, P. K. (1993). Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect, 17, 731 – 741. First citation in articleCrossref, Google Scholar

  • Pynoos, R. S., Steinberg, A. M., Layne, C. M., Briggs, E. C., Ostrowski, S. A. & Fairbank, J. A. (2009). DSM‐V PTSD diagnostic criteria for children and adolescents: A developmental perspective and recommendations. Journal of Traumatic Stress, 22, 391 – 398. First citation in articleCrossref, Google Scholar

  • Reinelt, T., Vasileva, M. & Petermann, F. (2016). Psychische Auffälligkeiten von Flüchtlingskindern. Eine Blickverengung durch die Posttraumatische Belastungsstörung? Kindheit und Entwicklung, 25, 231 – 237. First citation in articleLink, Google Scholar

  • Resch, F., Parzer, P. & Brunner, R., BELLA Study Group (2008). Self-mutilation and suicidal behaviour in children and adolescents: Prevalence and psychosocial correlates: Results of the BELLA study. European Child & Adolescent Psychiatry, 17, 92 – 98. First citation in articleCrossref, Google Scholar

  • Ruf, M., Schauer, M. & Elbert, T. (2010). Prävalenz von traumatischen Stresserfahrungen und seelischen Erkrankungen bei in Deutschland lebenden Kindern von Asylbewerbern. Zeitschrift für Klinische Psychologie und Psychotherapie, 39, 151 – 160. First citation in articleLink, Google Scholar

  • Ruf, M., Schauer, M., Neuner, F., Catani, C., Schauer, E. & Elbert, T. (2010). Narrative exposure therapy for 7‐to 16‐year‐olds: A randomized controlled trial with traumatized refugee children. Journal of Traumatic Stress, 23, 437 – 445. First citation in articleCrossref, Google Scholar

  • Schmid, M., Fegert, J. M. & Petermann, F. (2010). Traumaentwicklungsstörung: Pro und Contra. Kindheit und Entwicklung, 19, 47 – 63. First citation in articleLink, Google Scholar

  • Sheehan, D. V., Lecubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E. et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22 – 33. First citation in articleGoogle Scholar

  • Sheehan, D. V., Sheehan, K. H., Shytle, R. D., Janavs, J., Bannon, Y., Rogers, J. E. et al. (2010). Reliability and validity of the Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID). The Journal of Clinical Psychiatry, 71, 313 – 326. First citation in articleCrossref, Google Scholar

  • Sheehan, D., Shytle, D. & Milo, K. (2003). Internationales Neuropsychiatrisches Interview für Kinder und Jugendliche (M.I.N.I. KID). [Deutsche Version 1.0, B. Plattner, J. Kindler, S. Bauer & H. Steiner, Trans.]. Wien: Medizinische Universität Wien. First citation in articleGoogle Scholar

  • Smith, P., Perrin, S., Dyregrov, A. & Yule, W. (2003). Principal components analysis of the impact of event scale with children in war. Personality and Individual Differences, 34, 315 – 322. First citation in articleCrossref, Google Scholar

  • Steinberg, A. M., Brymer, M. J., Decker, K. B. & Pynoos, R. S. (2004). The University of California at Los Angeles post-traumatic stress disorder reaction index. Current Psychiatry Reports, 6, 96 – 100. First citation in articleCrossref, Google Scholar

  • Sukale, T., Hertel, C., Möhler, E., Joas, J., Müller, M., Banaschewski, T. et al. (2017). Diagnostik und Ersteinschätzung bei minderjährigen Flüchtlingen. Der Nervenarzt, 88, 3 – 9. First citation in articleCrossref, Google Scholar

  • United Nations Children’s Fund. (2016). UNICEF-Lagebericht – Zur Situation der Flüchtlingskinder in Deutschland. Retrieved from https://www.unicef.de/blob/115186/de54a5d3a8b6ea03337b489816eeaa08/zur-situation-derfluechtlingskinder-in-deutschland-data.pdf First citation in articleGoogle Scholar

  • United Nations High Commissioner for Refugees. (2016). Global trends – Forced displacement in 2016. New York, NY: UN. First citation in articleGoogle Scholar

  • Varni, J. W., Magnus, B., Stucky, B. D., Liu, Y., Quinn, H., Thissen, D. et al. (2014). Psychometric properties of the PROMIS® pediatric scales: Precision, stability, and comparison of different scoring and administration options. Quality of Life Research, 23, 1233 – 1243. First citation in articleCrossref, Google Scholar

  • Verlinden, E., Meijel, E. P., Opmeer, B. C., Beer, R., Roos, C., Bicanic, I. A. et al. (2014). Characteristics of the children’s revised impact of event scale in a clinically referred Dutch sample. Journal of Traumatic Stress, 27, 338 – 344. First citation in articleCrossref, Google Scholar

  • Zurhold, H. (2017). Problematischer Substanzkonsum von unbegleiteten minderjährigen Flüchtlingen – Eine Befragung von Fachkräften. Suchttherapie, 18, 1 – 72. First citation in articleGoogle Scholar