Background: The prevalence of mental disorders is high among refugees and asylum seekers due to past traumatic experiences and post-migration stressors, such as uncertain asylum status. Specialized psychosocial treatment centers aim to address this complex interplay between clinical symptoms and social stressors. Thus far, evidence for the effectiveness of such multidisciplinary treatment approaches is mixed, and the influence of post-migration stressors like asylum status changes over the course of treatment has not yet been thoroughly investigated.Objective: The present study aimed to evaluate the outcomes of a multidisciplinary trauma- and migration-focused treatment and to examine whether changes in asylum status moderate therapeutic effects.Method: As part of a standardized diagnostic procedure, self-report questionnaires assessing post-traumatic stress disorder and depression were administered to 90 patients at baseline (T1 = 90), at an intermediate assessment (T2 = 59), and at post-treatment (T3 = 90) in two psychosocial centers providing trauma-focused interventions for refugees in Germany.Results: Linear mixed models revealed significant improvements in psychopathology by the end of treatment. Changes in asylum status did not emerge as a significant moderator of treatment outcomes.Conclusions: These findings suggest that (multidisciplinary) treatment can be effective in reducing trauma-related symptoms among refugees. The results further cautiously hint towards the robustness of therapeutic gains across challenging legal circumstances. Nonetheless, asylum insecurity may still pose substantial barriers to long-term recovery and integration. Future research should therefore explore whether sustained legal stability enhances the durability of treatment effects.

Background: The PTSD Checklist for DSM-5 (PCL-5) is widely used to assess posttraumatic stress disorder (PTSD), yet validation in Arabic-speaking populations remains limited, and no guideline-based cutoff scores have been established. This study evaluated the structural validity, reliability, and diagnostic performance of the Arabic PCL-5 in a large treatment-seeking sample. Methods: As part of a broader treatment study, a total of 1140 participants from across the Southwest Asia and North Africa (SWANA) region completed the Arabic PCL-5 among other measures. PTSD diagnoses were established via the SCID-5-CV interview. Exploratory and confirmatory factor analyses assessed dimensionality. Reliability, convergent validity, and diagnostic utility were evaluated along STARD guidelines, with emphasis on ROC analyses and cutoff performance. Results: The Anhedonia model fit the data acceptably, with good to excellent internal consistencies. ROC analyses indicated moderate diagnostic utility (AUC = 0.658), with no cutoff achieving both high sensitivity and specificity. Lower cutoffs (31-33) maximized sensitivity (0.87-0.89) and positive predictive values (0.78-0.81), while a cutoff of 38 offered a more balanced compromise (sensitivity: 0.799, specificity: 0.419). The PCL-5 algorithm performed worse than optimized cutoffs. Discussion: The Arabic PCL-5 shows strong structural validity and reliability and is suitable for screening within a stepped-care approach. Its limited diagnostic accuracy likely reflects effects of the spectrum bias, sample heterogeneity and methodological differences between self-report and interviews. Based on this study, the PCL-5 is recommended for symptom monitoring and screening with clinical follow-up rather than as a stand-alone diagnostic tool in Arabic-speaking treatment-seeking individuals.

THEORETICAL BACKGROUND:The PHQ-9 is a widely used international screening instrument for depressive disorders, but optimal cut-off values vary depending on population and geographical region. RESEARCH QUESTION:This study aims to evaluate the psychometric properties and diagnostic accuracy of the Arabic PHQ-9 and identify the threshold with the best discrimination of current major depressive episode (MDE). METHOD:In this prospective diagnostic accuracy study, 2298 individuals were included as a convenience sample as part of an intake screening for an Arabic-language therapy project. Participants completed questionnaires and underwent a telephone-based SCID-5-CV interview, which served as the reference standard; the PHQ-9 served as the index test. Psychometric properties were assessed using EFA and CFA, and diagnostic accuracy was evaluated using ROC analyses. RESULTS:Of the 2298 participants included in the analyses, 1967 met SCID-5-CV criteria for a current MDE, while 331 did not. The psychometric evaluation yielded satisfactory values overall. The AUC was 0.71 (95% CI = 0.69-0.75). The highest sensitivity was observed at a cut-off of 10 (Se = 0.93, Sp = 0.34), while the Youden Index indicated that a cut-off of 14 provided the best balance between sensitivity (0.76) and specificity (0.56). CONCLUSION:Given that high sensitivity is central in clinical studies, the Arabic PHQ-9 is suitable as a first step in a stepped screening procedure, but not for diagnostic decision-making. Cut-off values from other linguistic versions cannot be automatically transferred and must instead be validated specifically for each language version. REGISTRATION:DRKS00016652.

BACKGROUND:Interpreters play a crucial role in the care of refugees. However, little attention has been paid to the mental health of interpreters. Despite increased levels of secondary traumatic stress (STS) and increased prevalence of post-traumatic stress disorder (PTSD) among interpreters in the refugee context, there has been little research on risk factors for STS and PTSD in this population. The aim of this study was to investigate potential risk factors for STS and PTSD symptom severity.METHODS:A Germany-wide online survey was conducted among interpreters for refugees in 2019. Only those who stated that they had experienced at least one traumatic event were included in the study. The final sample comprises N=83 interpreters. The examination of the potential risk factors (primary traumatic events, traumatic content, and personal refugee background) as well as the interaction between primary traumatic events and traumatic content was carried out using moderated multiple regression.RESULTS:There was exclusively found a positive association between the number of primary traumatic events for both STS (p=0.003) and PTSD symptom severity (p=0.042).DISCUSSION/CONCLUSION:In the present study, the number of primary traumatic events experienced was identified as a potential risk factor for STS and PTSD. The institutionalization of preventive measures such as regular supervision, follow-up talks, and interpreter-specific training could make an important contribution to protecting the mental health of interpreters. Further research is needed to gain a better understanding of risk factors for STS and PTSD in interpreters.

Women are at higher risk than men for developing posttraumatic stress disorder (PTSD), but underlying mechanisms are still unclear. Comprehensive knowledge about these mechanisms is necessary to develop tailored, sex- and gender-sensitive preventive interventions. This systematic review and meta-analysis examined sex-/gender-dependent risk factors, that is, risk factors with sex/gender differences in (a) vulnerability or (b) prevalence/severity, as well as sex-/gender-specific risk factors, that is, and (c) risk factors present in one sex/gender only. We searched PubMed, Web of Science, PsycINFO, PsycArticles, and PSYNDEX for articles published until October 16, 2022. We included prospective studies that assessed risk factors to predict subsequent PTSD symptom severity, as measured with the Clinician-Administered PTSD scale. The primary outcomes were sex/gender stratified pooled for sex-/gender-dependent vulnerability and sex-/gender-specific risk factors and pooled odds ratio (OR) or standardized mean difference (SMD) for sex-/gender-dependent risk factor prevalence/severity. We screened 17,270 records and included 117 reports from 45 studies (N = 13,752) in the systematic review. Seventeen studies (N = 4,257; 1,827 women, 2,430 men) were included in the meta-analysis. Regarding risk factor vulnerability, analyses revealed no significant sex/gender differences except for acute stress symptoms, with stronger associations for men (b = 0.11, SE = 0.06, p < .05). Regarding risk factor prevalence/severity, women reported more severe immediate psychological stress responses (range SMD = 0.23-0.56) and more commonly had a history of mental illness (OR = 1.81, 1.27-2.58). Men showed higher trauma load (SMD = -0.15, -0.29 to 0.01). Few women-specific and no men-specific factors were identified. Results suggest that women's heightened immediate psychological stress response drives sex/gender disparities in PTSD symptom severity. Preventive interventions should thus target women early after trauma. Women are at higher risk for posttraumatic stress disorder relative to men, but the underlying mechanisms are not fully understood yet. This meta-analysis suggests that women are not more vulnerable to risk factors than men (i.e., risk factors have a similar effect in women and men). Rather higher prevalence or severity of risk factors in women appears to be a driver of known sex/gender disparities in posttraumatic stress disorder risk. Sex- and gender-sensitive etiological knowledge can help to guide targeted interventions for women and men.

Zusammenfassung Ziel der Studie Dolmetschende spielen eine entscheidende Rolle bei der Versorgung von Geflüchteten. Allerdings wird der psychischen Gesundheit von Dolmetschenden bisher nur wenig Beachtung gegeben. Trotz eines erhöhten Belastungslevels von sekundärem traumatischem Stress (STS) und gesteigerten Prävalenzen Posttraumatischer Belastungsstörung (PTBS) bei Dolmetschenden im Geflüchtetenkontext, gibt es bisher nur wenig Forschung zu Risikofaktoren für STS und PTBS in dieser Population. Das Ziel dieser Studie war es, potenzielle Risikofaktoren für jeweils STS- und PTBS-Symptomschwere bei Dolmetschenden in der Geflüchtetenversorgung zu untersuchen. Methodik Eine deutschlandweite Online-Befragung wurde 2019 unter Dolmetschenden für Geflüchtete durchgeführt, in der 83 Personen eingeschlossen wurden, die angaben, mindestens ein traumatisches Erlebnis erfahren zu haben. Die Untersuchung der potenziellen Risikofaktoren (primäre traumatische Ereignisse, traumabezogne Inhalte, eigener Fluchthintergrund) und die Interaktion von primären traumatischen Ereignissen und traumabezogenen Inhalten erfolgte mittels moderierter multipler Regression. Ergebnisse Es wurde jeweils ausschließlich für STS- (p=0,003) und PTBS-Symptomschwere (p=0,042) ein positiver Zusammenhang mit der Anzahl primär erlebter traumatischen Ereignisse festgestellt. Diskussion/Schlussfolgerung In der vorliegenden Studie wurde die Anzahl der erlebten primären traumatischen Ereignisse als potenzieller Risikofaktor für STS und PTBS identifiziert. Die Institutionalisierung präventiver Maßnahmen wie Supervisionen, Nachgespräche und dolmetscher-spezifische Fortbildungen könnte einen wichtigen Beitrag zum Schutz der psychischen Gesundheit von Dolmetschenden leisten. Weitere Studien sind erforderlich, um ein besseres Verständnis von Risikofaktoren für STS und PTBS bei Dolmetschenden zu erlangen.

Women and men are at different risk for posttraumatic stress disorder (PTSD). It is unclear, however, how studies on PTSD risk factors integrate this knowledge into their research. Moreover, the temporal development of women’s higher PTSD risk is unknown. In this systematic review and meta-analysis, we examine how prospective studies on PTSD development (k=47) consider sex and gender across four domains (samples, terminology, analyses, and reporting). Further, we differentially analyze sex/gender differences within five time-intervals from 1 month to 5 years post-trauma. PTSD prevalence (OR = 1.72 [1.27 – 2.34]) and severity (g = 0.31 [0.09; 0.53]) were increased for women relative to men at one month post-trauma already, i.e. at the first timepoint of a possible PTSD diagnosis. PTSD severity was elevated for women compared to men across all time intervals, but evidence for increased PTSD prevalence for women relative to men was less stable with longer follow-ups. Despite women’s higher PTSD burdens, they were clearly underrepresented in samples (68.3% male, 31.7% female participants). Only 5.0% of studies explained or described their understanding of sex and gender, and only 2.6% used sex as discovery variable, i.e. investigating sex-dependent risk mechanisms. Sex and gender aspects in design, data, and discussion were considered by only one third of studies each. Trauma research falls short of its potential to adequately consider sex and gender. Sex- and gender-sensitive practices can advance rigor, innovation and equity in psychopathology research.

Objectives: The aim of this study was to develop and validate a questionnaire to assess interpreters’ role conflicts and the challenging aspects within the triad of practitioner, interpreter and refugee client.Methods: A questionnaire was developed based on previous literature. Its factor structure and construct validity were assessed in an online survey of 164 interpreters working with refugee clients. Psychological distress (BSI-18), work-related exhaustion (CBI), and secondary traumatic stress (ProQOL) were measured to test the questionnaire’s convergent validity.Results: Exploratory structural equation modeling for categorical variables resulted in 23 items across four subscales. The scores of all subscales had good or excellent reliability (ω = 0.81 to ω = 0.93) and correlation analyses indicated convergent validity.Conclusion: The final questionnaire (RoCo) showed four clearly interpretable subscales and may help to identify emotional distress due to role conflicts among interpreters. Future studies should validate the questionnaire in different samples.

Background: Due to language barriers, interpreters are crucial for refugee care in the countries of resettlement. However, interpreters are often faced with distressing working conditions, such as precarious work circumstances, lack of supervision, or exposure to their clients' traumatic experiences. Recent studies examining interpreters' mental health focussed primarily on secondary traumatic stress. The present study aimed to gain a better understanding of psychological distress and exhaustion among interpreters in refugee care by examining these factors in the work context as well as their possible work-related correlates. Method: An online survey was carried out in Germany, which included several standardized questionnaires regarding distress, work- and client-related exhaustion, job satisfaction, and trauma exposure (BSI-18, CBI, JSS, HTQ, PCL-5). Interpreters were recruited primarily through psychosocial treatment centres and interpreter pools in Germany. Results: In total, 164 interpreters were included in the analyses. The participants showed increased psychological distress, and around 7% screened positive for posttraumatic stress disorder (PTSD). In an exploratory regression analysis, younger age (beta = -.25, p = .004) emerged as correlate of psychological distress, whereas dissatisfaction with payment (beta= -.21, p = .04) and a higher amount of traumatic content (beta =.22, p = .001) were associated with work-related exhaustion, and dissatisfaction with recognition was associated with client-related exhaustion (beta= -.35, p = .001). Conclusion: The results point to increased stress levels among interpreters for refugees. Moreover, they indicate that interpreters' distress is primarily correlated with work-related circumstances, thus suggesting the need for a greater work-related support structure for interpreters.

Differential HPA axis function has been proposed to underlie sex-differences in mental disorders; however, the impact of fluctuating sex hormones across the menstrual cycle on HPA axis activity is still unclear. This meta-analysis investigated basal cortisol concentrations as a marker for HPA axis activity across the menstrual cycle. Through a systematic literature search of five databases, 121 longitudinal studies were included, summarizing data of 2641 healthy, cycling participants between the ages of 18 and 45. The meta-analysis showed higher cortisol concentrations in the follicular vs. luteal phase (dSMC = 0.12, p =.004, [0.04 – 0.20]). Comparisons between more precise cycle phases were mostly insignificant, aside from higher concentrations in the menstrual vs. premenstrual phase (dSMC = 0.17, [0.02 – 0.33], p =.03). In all included studies, nine samples used established cortisol parameters to indicate HPA axis function, specifically diurnal profiles (k = 4) and the cortisol awakening response (CAR) (k = 5). Therefore, the meta-analysis highlights the need for more rigorous investigation of HPA axis activity and menstrual cycle phase.

Dolmetschende sind ein elementarer Bestandteil der Psychotherapie beim Vorliegen von Sprachbarrieren. Häufig werden sie wenig auf diese Tätigkeit vorbereitet. Viele Psychotherapeut/-innen empfinden die Therapie zu dritt als ungewohnt und zeitintensiv. Daher sind Richtlinien hilfreich, um ein qualifiziertes Therapieangebot zu ermöglichen und eine angenehme Atmosphäre in der Triade von Klient/-in, Dolmetschenden und Psychotherapeut/-in herzustellen.

Background Interpreters in the care of refugees work in various different settings. Qualitative studies suggest that interpreters are confronted with a variety of demands depending on the context in which they work, which may in turn influence their wellbeing. To date, no larger-scale study has investigated differences between work settings regarding interpreters’ work-related characteristics or wellbeing. Objective The aim of this study was to compare the work-related characteristics and possible changes in the wellbeing of interpreters between four main work settings (psychotherapy, counselling, medical setting, and authorities) in the care of refugees. Method Interpreters in refugee care were recruited for a nationwide online survey in Germany with two measurement time points. Participants provided socio-demographic data and answered questions about the working conditions in their respective main work setting. In addition, psychological distress (Brief Symptom Inventory, BSI-18), work-related exhaustion (Copenhagen Burnout Inventory, CBI), and compassion satisfaction (Professional Quality of Life, ProQOL) were assessed. Results Overall, 158 interpreters were included at t1, of whom 63 were also included at t2. Significantly more traumatic content was interpreted in counselling settings and psychotherapy than in medical and authorities settings ( H (3) = 26.09, p < .001). The highest proportion of interpreters with an interpreting degree worked in the authorities setting (Fisher’s exact test, p = .002). Significant differences between the four settings were found for psychological distress (Kruskal–Wallis-test, H (3) = 12.02, p = .01) and work-related exhaustion (Kruskal–Wallis-test, H (3) = 8.10, p = .04) but not for compassion satisfaction. Conclusion The presented results indicate differences regarding working conditions, psychological distress, and work-related exhaustion between different work settings of interpreters. Future studies may explore each setting in greater detail and include a larger sample size to reach a better understanding of the relationship between setting-specific challenges and interpreters’ wellbeing.

Background: Interpreters often play a crucial role in the health care of refugees. Although interpreters working with refugees are regularly confronted with emotionally stressful content, little is known about their work-related stress and psychological well-being. Primarily qualitative studies indicate increased emotional stress in interpreters, and difficulties in handling the traumatic content from their clients. Additionally, the working conditions of interpreters appear to be demanding, due to low payment and a lack of supervision or adequate preparation. Objective: The presented systematic review aimed to identify and summarise quantitative and qualitative research on the mental health of interpreters in the mental health care of refugees. Method: A systematic search was performed in five databases, and specific interpreting journals were searched. After removal of duplicates, 6,920 hits remained. Eligible studies included quantitative, qualitative, and mixed-methods studies as well as case studies and grey literature. The studies aimed to examine mental health aspects or work experiences of spoken language interpreters in mental health care settings for adult refugees. Results: Altogether, 25 studies were identified, including six quantitative and 19 qualitative studies. Studies were analysed and presented narratively. In the analysis of the qualitative studies, three themes emerged: “Emotions, behaviour, and coping strategies,” “Working in a triad,” and “Working environment.” In the quantitative studies, interpreters showed heightened levels of emotional stress and anxiety, and secondary traumatic stress reactions. In several qualitative studies, interpreters described a devaluing health care system and stressful working conditions with a lack of support structures. Conclusion: Overall, the results indicate a high level of stress among interpreters working with refugees. Quantitative data are sparse, and studies employ heterogeneous assessments in diverse study settings. Therefore, future quantitative research is necessary to consistently investigate interpreters' mental health in different mental health care settings. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42019117948.