{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:49:49Z","timestamp":1784015389892,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T00:00:00Z","timestamp":1579564800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"ELAN Fund of the Medical Faculty of the Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU)","award":["16-12-21-1Georgiadou"],"award-info":[{"award-number":["16-12-21-1Georgiadou"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: A high prevalence of mental distress, especially posttraumatic stress disorder, has been widely confirmed among refugees. In order to establish adequate interventions in psychotherapy, however, it must first be examined whether refugees have similar ideas and concepts of stress, trauma, and healing. This study, therefore, aimed to analyze the representations of trauma, self-reported complaints, indications of somatization, and coping strategies among a refugee population. Methods: Semi-structured interviews based on the Cultural Formulation Interview (CFI) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were conducted with Syrian refugees who have residence permission in Germany. The interviews were audio-recorded, transcribed, and analyzed according to the qualitative content analysis of Mayring. The foci of interest were determined on the basis of the predefined interview guideline, and inductive subcategories were extracted from the transcripts. Results: Sixteen refugees participated (50% women; mean age: 35.5 years, SD = 11.2; the mean duration of stay in Germany: 23.3 months, SD = 6.6). War experiences were the most frequently reported subjective perceptions of trauma. Frequently reported complaints included sleeping disturbance, cardiovascular symptoms, rumination, and pain. Among half of the participants, we found indications of somatization. We identified the following coping strategies: Activity, cognitive coping, social coping, religious coping, avoidance, and emotional coping. Conclusions: War-related traumatic events are the most common trauma perceptions among Syrian refugees. The self-reported complaints demonstrate somatoform, depressive, and posttraumatic symptoms. Syrian refugees should be screened for somatization, depression, and posttraumatic stress disorder and should receive targeted interventions that consider and support individual coping resources.<\/jats:p>","DOI":"10.3390\/ijerph17030693","type":"journal-article","created":{"date-parts":[[2020,1,21]],"date-time":"2020-01-21T11:25:59Z","timestamp":1579605959000},"page":"693","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["The Perceptions of Trauma, Complaints, Somatization, and Coping Strategies among Syrian Refugees in Germany\u2014A Qualitative Study of an At-Risk Population"],"prefix":"10.3390","volume":"17","author":[{"given":"Ali","family":"Zbidat","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterini","family":"Georgiadou","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Paracelsus Medical University, 90419 N\u00fcrnberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-6158","authenticated-orcid":false,"given":"Andrea","family":"Borho","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesim","family":"Erim","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Morawa","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-N\u00fcrnberg (FAU), 91054 Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,21]]},"reference":[{"key":"ref_1","unstructured":"(2019, December 10). The Refugees Operational Data Portal by UNHCR. Available online: https:\/\/data2.unhcr.org\/en\/situations\/syria."},{"key":"ref_2","unstructured":"Federal Office for Migration and Refugees (2019, December 10). The Federal Office in Figures 2015. Asylum, Migration and Integration. Available online: https:\/\/www.bamf.de\/SharedDocs\/Anlagen\/DE\/Statistik\/BundesamtinZahlen\/bundesamt-in-zahlen-2015.pdf?__blob=publicationFile&v=16."},{"key":"ref_3","unstructured":"(2020, January 14). UN General Assembly: Convention Relating to the Status of Refugees. Available online: https:\/\/www.refworld.org\/docid\/3be01b964.html."},{"key":"ref_4","first-page":"397","article-title":"Psychotherapy with Immigrants and Traumatized Refugees","volume":"66","author":"Erim","year":"2016","journal-title":"Psychother. Psychosom. Med. Psychol."},{"key":"ref_5","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_6","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_7","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_8","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jama.2009.1132","article-title":"Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis","volume":"302","author":"Steel","year":"2009","journal-title":"JAMA"},{"key":"ref_9","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_10","first-page":"12","article-title":"Prevalence of Posttraumatic Stress Disorder (PTSD) and ways to identify asylum procedures","volume":"35","author":"Ruf","year":"2006","journal-title":"Z. f\u00fcr Klin. Psychol. Psychother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1177\/1363461517745473","article-title":"Posttraumatic stress disorder and comorbid depression among refugees: Assessment of a sample from a German refugee reception center","volume":"54","author":"Belz","year":"2017","journal-title":"Transcult. Psychiatry"},{"key":"ref_12","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_13","doi-asserted-by":"crossref","unstructured":"Georgiadou, E., Morawa, E., and Erim, Y. (2017). High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14060612"},{"key":"ref_14","unstructured":"Lazarus, R., and Folkman, S. (1984). Stress, Appraisal, and Coping, Springer Publishing Company."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1177\/1054773817749724","article-title":"Coping Strategies Used by Syrian Refugees in Jordan","volume":"28","author":"Alzoubi","year":"2019","journal-title":"Clin. Nurs. Res."},{"key":"ref_16","unstructured":"El-Masri, R., Harvey, C., and Garwood, R. (2013). Shifting Sands: Changing Gender Roles among Refugees in Lebanon, ABAAD\u2014Resource Centre for Gender Equality and Oxfam GB."},{"key":"ref_17","first-page":"23","article-title":"Coping strategies among self-settled Syrians in Lebanon","volume":"47","author":"Thorleifsson","year":"2014","journal-title":"Forced Migr. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"393","DOI":"10.3389\/fpsyt.2018.00393","article-title":"Prevalence of Mental Distress Among Syrian Refugees with Residence Permission in Germany: A Registry-Based Study","volume":"9","author":"Georgiadou","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u00ae), American Psychiatric Publishing.","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_20","first-page":"134","article-title":"Exploration of the illness beliefs of refugees regarding their posttraumatic stress disorder","volume":"14","author":"Mika","year":"2015","journal-title":"Psychotherapeutenjournal"},{"key":"ref_21","unstructured":"Mayring, P. (2015). Qualitative Content Analysis: Basics and Techniques, Beltz."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fritzsche, K., and Wirsching, M. (2006). Somatization. Psychosomatische Medizin und Psychotherapie, Springer Medizin Verlag.","DOI":"10.1007\/3-540-29972-6"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1017\/S0033291710001406","article-title":"A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants","volume":"41","author":"Bourque","year":"2011","journal-title":"Psychol. Med."},{"key":"ref_24","unstructured":"Maercker, A. (2013). Posttraumatic Stress Disorder, Springer."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/pac0000247","article-title":"The health effect of the Syrian conflict on IDPs and refugees","volume":"23","author":"Kira","year":"2017","journal-title":"Peace Confli. J. Peace Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1002\/jts.22244","article-title":"Posttraumatic Stress, Somatization, and Quality of Life Among Ivorian Refugees","volume":"30","author":"Kounou","year":"2017","journal-title":"J. Trauma. Stress"},{"key":"ref_27","unstructured":"Morschitzky, H. (2007). Somatoform Disorders: Diagnostics, Concepts and Therapy in Somatic Symptoms without Organ Findings, Springer."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1093\/rsq\/hdt017","article-title":"Coping Strategies of Sudanese Refugee Women in Kakuma Refugee Camp, Kenya","volume":"32","author":"Gladden","year":"2013","journal-title":"Refug. Surv. Q."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1177\/0886109915572845","article-title":"Understanding community resilience through the accounts of women living in West Bank Refugee Camps","volume":"30","author":"Darychuk","year":"2015","journal-title":"Affilia"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1080\/00048670601172780","article-title":"Coping and resilience in refugees from the Sudan: A narrative account","volume":"41","author":"Schweitzer","year":"2007","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1177\/0020764018765237","article-title":"Coping, resilience and posttraumatic growth among Eritrean female refugees living in Norwegian asylum reception centres: A qualitative study","volume":"64","author":"Abraham","year":"2018","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1177\/1363461517705570","article-title":"At zero and turning in circles: Refugee experiences and coping in Durban, South Africa","volume":"54","author":"Labys","year":"2017","journal-title":"Transcult. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Morawa, E., and Erim, Y. (2018). Health-Related Lifestyle Behavior and Religiosity among First-Generation Immigrants of Polish Origin in Germany. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15112545"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/3\/693\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:05:33Z","timestamp":1760364333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/3\/693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,21]]},"references-count":33,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,2]]}},"alternative-id":["ijerph17030693"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17030693","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,21]]}}}