{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:02:00Z","timestamp":1790161320046,"version":"4.1.0"},"reference-count":54,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2017,6,7]],"date-time":"2017-06-07T00:00:00Z","timestamp":1496793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire\u2014depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and\/or witnessed traumatic events was 80.4% (n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0\u201327). Moderate to severe depression (PHQ-9 score \u2265 15) was found in 35.7% (n = 20) of our sample and severe depression (PHQ-9 score \u2265 20) was found in 23.2% (n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0\u201321), with 26.8% (n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score \u2265 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of culturally sensitive psychological interventions. However, more studies are required to improve the understanding of mental health among this particularly vulnerable population.<\/jats:p>","DOI":"10.3390\/ijerph14060612","type":"journal-article","created":{"date-parts":[[2017,6,7]],"date-time":"2017-06-07T10:01:20Z","timestamp":1496829680000},"page":"612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany"],"prefix":"10.3390","volume":"14","author":[{"given":"Ekaterini","family":"Georgiadou","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Morawa","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesim","family":"Erim","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), Schwabachanlage 6, 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,6,7]]},"reference":[{"key":"ref_1","unstructured":"United Nations (2017, May 30). High Commissioner for Refugees. Global Trends in Forced Displacement 2016. Available online: http:\/\/www.unhcr.org\/576408cd7."},{"key":"ref_2","unstructured":"Bundesamt f\u00fcr Migration und Fl\u00fcchtlinge (2017, March 29). Das Bundesamt in Zahlen 2015\u2014Asyl, Available online: https:\/\/www.bamf.de\/SharedDocs\/Anlagen\/DE\/Publikationen\/Broschueren\/bundesamt-in-zahlen-2015.html2016."},{"key":"ref_3","unstructured":"Bundesamt f\u00fcr Migration und Fl\u00fcchtlinge (2017, March 29). Aktuelle Zahlen zu Asyl. Ausgabe Dezember 2016, Available online: http:\/\/www.bamf.de\/SharedDocs\/Anlagen\/DE\/Downloads\/Infothek\/Statistik\/Asyl\/aktuelle-zahlen-zu-asyl-dezember-2016.html?nn=7952222."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-2008-1067358","article-title":"Depression, anxiety and posttraumatic stress disorders in labor migrants, asylum seekers and refugees. A systematic overview","volume":"58","author":"Lindert","year":"2008","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1055\/s-0029-1223513","article-title":"Mental disorders in people with migration background compared with German general population","volume":"37","author":"Bermejo","year":"2010","journal-title":"Psychiatr. Prax."},{"key":"ref_6","first-page":"472","article-title":"Prevalence, comorbidity and severity of psychosomatic disorders in outpatients with Turkish migration background","volume":"61","author":"Erim","year":"2011","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_7","first-page":"209","article-title":"Mental health of Polish immigrants compared to that of the Polish and German populations","volume":"59","author":"Morawa","year":"2013","journal-title":"Z. Psychosom. Med. Psychother."},{"key":"ref_8","first-page":"324","article-title":"Iranian and German Patients in an Urban Psychiatric Practice: Are they Different Concerning Frequency and Severity of Mental Illness?","volume":"43","author":"Leidinger","year":"2016","journal-title":"Psychiatr. Prax."},{"key":"ref_9","first-page":"12","article-title":"Prevalence of posttraumatic stress disorder among asylum seekers in Germany and its detection in the application process for asylum","volume":"35","author":"Ruf","year":"2006","journal-title":"Z. Klein. Psychol. Psychother."},{"key":"ref_10","unstructured":"Baloch-Kaloianov, E., and Mikus Kos, A. (2009). Anxiety and trauma symptoms in refugees after displacement from Kosovo. Activating Psychosocial Local Resources in Territories Affected by War and Terrorism, IOS Press."},{"key":"ref_11","unstructured":"Jung, F. (2017, March 29). Das Bremer Modell\u2014Gesundheitsversorgung Asylsuchender. Available online: http:\/\/www.gesundheitsamt.bremen.de\/detail.php?template=20_search_d&search%5Bsend%5D=true&lang=de&search%5Bvt%5D=jung+2011+bremer+modell."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.comppsych.2016.04.002","article-title":"Prevalence of depression in Syrian refugees and the influence of religiosity","volume":"68","author":"Naja","year":"2016","journal-title":"Compr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"45","DOI":"10.3109\/13651501.2014.961930","article-title":"Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional study","volume":"19","author":"Alpak","year":"2015","journal-title":"Int. J. Psychiatry Clin. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.comppsych.2016.09.007","article-title":"Post-traumatic stress disorder in a sample of Syrian refugees in Lebanon","volume":"72","author":"Kazour","year":"2017","journal-title":"Compr. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1007\/s10903-013-9893-6","article-title":"Physical and mental health status of Iraqi refugees resettled in the United States","volume":"16","author":"Taylor","year":"2014","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Slewa-Younan, S., Mond, J.M., Bussion, E., Melkonian, M., Mohammad, Y., Dover, H., Smith, M., Milosevic, D., and Jorm, A.F. (2015). Psychological trauma and help seeking behaviour amongst resettled Iraqi refugees in attending English tuition classes in Australia. Int. J. Ment. Health Syst.","DOI":"10.1186\/1752-4458-9-5"},{"key":"ref_17","first-page":"834","article-title":"Waiting for Asylum: Psychiatric Diagnosis in Bavarian Admission Center","volume":"77","author":"Richter","year":"2015","journal-title":"Gesundheitswesen"},{"key":"ref_18","first-page":"385","article-title":"Psychometric Evaluation of an Arabic Version of the PHQ-4 Based on a Representative Survey of Syrian Refugees","volume":"66","author":"Kliem","year":"2016","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1055\/s-0042-114045","article-title":"Posttraumatic Stress and Depressive Symptoms amongst Asylum Seekers","volume":"66","author":"Frantz","year":"2016","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_20","first-page":"A130","article-title":"Health care for refugees. Secure data","volume":"113","author":"Razum","year":"2016","journal-title":"Dtsch. Arztebl."},{"key":"ref_21","unstructured":"Lindert, J., von Ehrenstein, O.S., Wehrwein, A., Brahler, E., and Schafer, I. (2017). Anxiety, Depression and Posttraumatic Stress Disorder in Refugees\u2014A Systematic Review. Psychother. Psychosom. Med. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E959","DOI":"10.1503\/cmaj.090292","article-title":"Canadian Collaboration for Immigrant and Refugee Health (CCIRH) Common mental health problems in immigrants and refugees: General approach in primary care","volume":"183","author":"Kirmayer","year":"2011","journal-title":"CMAJ"},{"key":"ref_23","first-page":"75","article-title":"The Essen Trauma-Inventory (ETI)\u2014A screening instrument of identification of traumatic events and posttraumatic disorders","volume":"1","author":"Tagay","year":"2007","journal-title":"Z. Psychotraumatologie Psychother. Psychol. Med."},{"key":"ref_24","first-page":"459","article-title":"Reliability and validity of a brief instrument for assessing post-traumatic stress disorder","volume":"6","author":"Foa","year":"1993","journal-title":"J. Trauma. Stress"},{"key":"ref_25","first-page":"130","article-title":"Revised version of the Impact of Event Scale (IES-R)","volume":"44","author":"Maercker","year":"1998","journal-title":"Diagnostica"},{"key":"ref_26","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR, American Psychiatric Association. [4th ed.]."},{"key":"ref_27","first-page":"369","article-title":"Traumatic Events, Posttraumatic Stress Disorder and Utilization of Psychotherapy in Immigrants of Polish Origin in Germany","volume":"66","author":"Morawa","year":"2016","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_30","unstructured":"(2017, May 04). Multicultural Mental Health Resource Centre. Available online: http:\/\/www.multiculturalmentalhealth.ca\/clinical-tools\/assessment\/screening-for-common-mental-disorders\/phq-in-different-languages\/."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/MLR.0b013e318160d093","article-title":"Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population","volume":"46","author":"Decker","year":"2008","journal-title":"Med. Care"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s00115-013-3961-y","article-title":"Mental disorders in the general population: Study on the health of adults in Germany and the additional module mental health (DEGS1-MH)","volume":"85","author":"Jacobi","year":"2014","journal-title":"Nervenarzt"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/NMD.0b013e3182392c0d","article-title":"Lifetime traumatic experiences and posttraumatic stress disorder in the German population: Results of a representative population survey","volume":"199","author":"Hauffa","year":"2011","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s00103-013-1688-3","article-title":"Prevalence of depressive symptoms and diagnosed depression among adults in Germany: Results of the German Health Interview and Examination Survey for Adults (DEGS1)","volume":"56","author":"Busch","year":"2013","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jad.2016.12.012","article-title":"Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample","volume":"210","author":"Hinz","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.janxdis.2008.10.009","article-title":"The epidemiology of anxiety disorders in the Arab world: A review","volume":"23","author":"Tanios","year":"2009","journal-title":"J. Anxiety Disord."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Karam, E.G., Mneimneh, Z.N., Dimassi, H., Fayyad, J.A., Karam, A.N., Nasser, S.C., Chatterji, S., and Kessler, R.C. (2008). Lifetime prevalence of mental disorders in Lebanon: First onset, treatment, and exposure to war. PLoS Med., 5.","DOI":"10.1371\/journal.pmed.0050061"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1001\/jama.286.5.555","article-title":"Lifetime events and posttraumatic stress disorder in 4 postconflict settings","volume":"286","author":"Komproe","year":"2001","journal-title":"JAMA"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1001\/archpsyc.1995.03950240066012","article-title":"Posttraumatic stress disorder in the National Comorbidity Survey","volume":"52","author":"Kessler","year":"1995","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00038-007-6002-4","article-title":"Migration and health-developing an explanatory and analytical model for epidemiological studies","volume":"52","author":"Schenk","year":"2007","journal-title":"Int. J. Public Health"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Machleidt, W., and Heinz, A. (2011). Acculturation. Praxis der Interkulturellen Psychiatrie und Psychotherapie. Migration und Psychische Gesundheit, Elsevier, Urban & Fischer.","DOI":"10.1016\/B978-3-437-24570-1.10042-X"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1192\/bjp.bp.110.084764","article-title":"Factors associated with mental disorders in long-settled war refugees: Refugees from the former Yugoslavia in Germany, Italy and the UK","volume":"200","author":"Bogic","year":"2012","journal-title":"Br. J. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jpsychires.2009.08.006","article-title":"The impact of fear for family on mental health in a resettled Iraqi refugee community","volume":"44","author":"Nickerson","year":"2010","journal-title":"J. Psychiatr. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.cpr.2014.03.002","article-title":"Remission from post-traumatic stress disorder in adults: A systematic review and meta-analysis of long term outcome studies","volume":"34","author":"Morina","year":"2014","journal-title":"Clin. Psychol. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1097\/01.nmd.0000146739.26187.15","article-title":"Impact of a long asylum procedure on the prevalence of psychiatric disorders in Iraqi asylum seekers in The Netherlands","volume":"192","author":"Laban","year":"2004","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/hsw\/25.1.23","article-title":"Risk factors associated with PTSD and major depression among Cambodian refugees in Utah","volume":"25","author":"Blair","year":"2000","journal-title":"Health Soc. Work"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1002\/nur.20125","article-title":"Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union","volume":"29","author":"Miller","year":"2006","journal-title":"Res. Nurs. Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s00038-011-0317-x","article-title":"Measuring population mental health and social well-being","volume":"57","author":"Barry","year":"2012","journal-title":"Int. J. Public Health"},{"key":"ref_50","first-page":"1","article-title":"Trauma and PTSD among Civilians in the Middle East","volume":"21","author":"Neria","year":"2010","journal-title":"PTSD Res. Q."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.wpsyc.2012.01.008","article-title":"Mental health services in the Arab world","volume":"11","author":"Okasha","year":"2012","journal-title":"World Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/nur.20364","article-title":"Cultural adaptation and translation of measures: An integrated method","volume":"33","author":"Sidani","year":"2010","journal-title":"Res. Nurs. Health"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Vindbjerg, E., Carlsson, J., Mortensen, E.L., Elklit, A., and Makransky, G. (2016). The latent structure of post-traumatic stress disorder among Arabic-speaking refugees receiving psychiatric treatment in Denmark. BMC Psychiatry, 16.","DOI":"10.1186\/s12888-016-0936-0"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/00005053-199202000-00008","article-title":"The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees","volume":"180","author":"Mollica","year":"1992","journal-title":"J. Nerv. Ment. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:38:16Z","timestamp":1760207896000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/6\/612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6,7]]},"references-count":54,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,6]]}},"alternative-id":["ijerph14060612"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14060612","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,6,7]]}}}