Peer-to-Peer-Selbsthilfe-Interventionen für Geflüchtete – eine Pilotstudie

Zusammenfassung

Die Ankunft einer großen Anzahl Geflüchteter in Deutschland seit 2015 hat zu wachsenden Herausforderungen im Gesundheitssystem geführt, auch im psychosozialen Bereich. Um die Kenntnisse Geflüchteter über die Angebote im psychosozialen Bereich zu verbessern und erste Hilfestellungen anzubieten, wurden an der Klinik für Psychiatrie und Psychotherapie der Charité-Universitätsmedizin Berlin eine manualisierte Peer-to-Peer-Unterstützung (P2P) entwickelt und P2P-Trainer/innen ausgebildet. In der hier beschriebenen Pilotstudie wurden vier P2P-Gruppen mit männlichen und weiblichen farsi / dari- oder arabischsprachigen Geflüchteten ausgewertet. Die Teilnehmenden wurden in Einzelinterviews zu wahrgenommenen Vor- und Nachteilen der P2P-Gruppe sowie ihrer Präferenzen und Erwartungen befragt. Die Daten wurden mithilfe der Software MAXQDA kodiert und thematisch analysiert. Alle Teilnehmenden der Gruppen äußerten Zufriedenheit mit dem P2P-Gruppenangebot. P2P half ihnen dabei, soziale Kontakte aufzubauen und soziale Unterstützung zu finden. Eine Flexibilisierung der P2P-Interventionen, ausgerichtet an individuellen Bedürfnissen, wurde gewünscht. Die Ergebnisse unserer Studie legen nahe, dass P2P-Ansätze die Integration von Geflüchteten in die psychosoziale Versorgung verbessern können.

Abstract

The arrival of a large number of forcibly displaced people in Germany since 2015 has led to increased challenges in the mental health care system. To build up knowledge and raise awareness of refugees regarding mental health services and to provide practical support, a manual for peer-to-peer (P2P) counseling was developed at Charité-University Medical Center Berlin and refugees were trained as peer counsellors. In a pilot study, we qualitatively evaluated four P2P groups with Farsi / Dari or Arabic speaking male and female refugees. Individual interviews were conducted, which assessed perceived benefits and pitfalls of the P2P group as well as preferences and expectations of the participants. Data were coded and analyzed with the software package MAXQDA. All P2P participants expressed their satistfaction with the intervention. The P2P group helped them to find friends and to strengthen social support. Participants suggested to modify group sessions according to individual needs. The results of our study suggest that integrating P2P approaches in the mental health services for refugees may increase access to the health care system on the one hand and reduce access barriers on the other hand.

Schlüsselwörter

Flüchtlinge - psychische Gesundheit - Peer-to-Peer-Intervention (P2P) - Selbsthilfe - Abbau kulturbedingter Zugangsbarrieren

Key words

Refugees - mental health - peer support - self-help interventions - degradation of cultural barriers

Publication History

Received: 24 April 2019

Accepted: 09 September 2019

Article published online:
26 February 2020

• Literatur

• 1 Katz B, Noring L, Garrelts N. Cities and refugees: The German experience. Brooklyns. 2016 [Online]. Available at:. https://www.brookings.edu/research/cities-and-refugees-the-german-experience/ . [Zugriff am 01.04.2019]
• 2 Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 2005 365.
• 3 Dapunt J, Kluge U, Heinz A. Risk of psychosis in refugees: a literature review. Transl Psychiatry 2017; 7: e1149
• 4 Böge K, Karnouk C, Hahn E. et al. Mental health in refugees and asylum seekers (MEHIRA): study design and methodology of a prospective multicentre randomized controlled trail investigating the effects of a stepped and collaborative care model. Eur Arch Psychiatry Clin Neurosci 2019; 2019: 1-12
• 5 Penka S, Schouler-Ocak M, Heinz A. et al. Interkulturelle Aspekte der Interaktion und Kommunikation im psychiatrisch / psychotherapeutischen Behandlungssetting. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 2012; 55: 1168-1175
• 6 WHO Regional Office for Europe. What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services?. World Health Organization; 2004
• 7 Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud 2003; 40: 321-322
• 8 Schneider F, Bajbouj M, Heinz A. Mental treatment of refugees in Germany: Model for a stepped approach. Nervenarzt 2017; 88: 10-17
• 9 Flegg M, Gordon-Walker M, Maguire S. Peer-to-peer mental health: a community evaluation case study. J Mental Health Training Educ Pract 2015; 10: 282-293
• 10 Missmahl I, Kluge U, Bromand Z. et al. Teaching psychiatry and establishing psychosocial services–lessons from Afghanistan. Eur Psychiatry 2012; (Suppl. 2): S76-80
• 11 Im H, Rosenberg R. Building social capital through a peer-led community health workshop: A pilot with the bhutanese refugee community. J Community Health 2016; 41: 509-517
• 12 Deitrick L, Paxton H, Rivera A. et al. Understanding the role of the promotora in a Latino diabetes eductaion program. Qual Health Res 2010; 20: 386-399
• 13 Burnett A. Health needs of asylum seekers and refugees. BMJ 2001; 322: 544-547
• 14 Heinz A, Schneider F. Psychiatric and psychotherapeutic care of refugees: Challenges and perspectives. Nervenarzt 2017; 88: 1-2
• 15 Weine SM. Developing preventive mental health interventionsfor refugee families in resettlement. Fam Process 2011; 50: 410-430
• 16 WHO: World Health Organisation. Refugee and migrant health. World Health Organization. 2019 [Online]. Available at:. https://www.who.int/migrants/en/ . [Zugriff am 01.04.2019]
• 17 Leh Hoon Chuah F, Teng Tan S, Jason Y. et al. The health needs and access barriers among refugees and asylum-seekers in Malaysia: A qualitative study. Int J Equity Health 2018; 17: 120
• 18 Webel AR, Okonsky J, Trompeta J. et al. A systematic review of the effectiveness of peer-based interventions on health-related behaviors in adults. Am J Public Health 2010; 100: 247-253
• 19 Masalehdan A, Aizenman L, Saad A. et al. Peer support groups: Evaluating a culturally grounded, strengths-based approach for work with refugees. Adv Social Work Spec Issue Immigrants Refugees 2018 18.
• 20 Behnia B. Refugees’ Convoy of Social Support Community Peer Groups and Mental Health Services. Int J Ment Health 2004; 32: 6-19
• 21 Wollersheim D, Koh L, Walker R. et al. “Happy, just talking, talking, talking”: Community strengthening through mobile phone-based peer support among refugee women. J Community Inf. 2017 13.
• 22 Stewart M, Simich L, Shizha E. et al. Supporting African refugees in Canada: Insights from a support intervention. Health social care community 2012; 20: 516-527
• 23 Stewart M, Simich L, Beiser M. et al. Impacts of a social support intervention for Somali and Sudanese refugees in Canada. Ethnicity Inequalities Health Social Care 2011 4.
• 24 Liamputtong P, Koh L, Wollersheim D. et al. Peer support groups, mobile phones and refugee women in Melbourne. Health Promot Int 2015; 31: 715-724
• 25 Dennis CL. Peer support for postpartum depression: Volunteers’ perceptions, recruitment strategies and training from a randomized controlled trial. Health Promot Int 2013 28. 187-196
• 26 Wöller W. Trauma-informed peer counselling in the care of refugees with trauma-related disorders. Psychother Psych Med 2016; 66: 349-355
• 27 Berger R, Benatov J, Abu-Raiya H. et al. Reducing prejudice and promoting positive intergroup attitudes among elementary-school children in the context of the Israeli-Palestinian conflict. J Sch Psychol 2016; 57: 53-72
• 28 Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005; 15: 1277-1288
• 29 Zubovic S, Mental health through a healing activity. In: Barnes D. ed. Asylum seekers and refugees in Australia, issues of mental health. Sydney: Trans-cultural Mental Health Center; 2003
• 30 McMahon L. The handbook of play therapy and therapeutic play. New York: Routledge; 2009
• 31 Kira IA, Ahmed A, Wasim F. et al. Group therapy for refugees and torture survivors: Treatment model innovations. Int J Group Psychother 2012; 62: 69-88