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Migration-related factors could be additional risk factors for the development of depression and suicidal behaviour in migrant populations. In particular, the success or failure of migration will impact on migrants’ mental well-being. The premigration experiences, the act of migration itself, the motive for migration, postmigration experiences and the structural prerequisites in the host country play a central role. On the basis of the results of a population based study on the factors associated with mental distress in female Turkish migrants in two German cities (Berlin, Hamburg) the impact of migration-specific factors on the expression of mental distress will be discussed. Factors which will be examined among others are, reasons for migration, residence status, perceived ethnic discrimination and acculturation strategies, socio-economic status and traumatic experiences (pre- and post-migration).
The process of migration can be a risk factor for suicidal behaviour. Factors such as circumstances of the migration and individual characteristics like age, education, and his offspring play an important role. The empiric evidence of today's suicide prevention therapy strategies - following a suicidal crisis or a suicide attempt - in order to prevent prospective crises are limited. There are not enough protective therapy recommendations. Psychotherapeutic interventions and antidepressants are not proven to be better than a standard treatment. An appropriate treatment of depression (antidepressant, psychotherapy, psychoeducation, self-help) seems to be preventive. In this contribution the current state of epidemiology, ethiopathogenesis, models of suicidal behaviour and suicide prevention will be discussed.
Studies demonstrate that suicidality in female Turkish immigrants in some European countries is higher compared to native-born women of the same age. This indicates a demand for a better understanding of suicide in this group of the society, and, based on such knowledge, specific concepts for prevention. Embedded in the development of a suicide prevention campaign for women of Turkish origin in Berlin, Germany, we assessed explanatory models of suicidal behavior using a qualitative approach. Specifically, we employed focus group discussions with Turkish experts as well as focus group discussions with Turkish women from the community. Groups were stratified by age (age range 18-34, 35-49, and 50+) in order to account for age effects and effects of migration generation. Results show differential conceptions of suicidal crises, the patterns of distress, the perceived causes, and the preferences for help-seeking and treatment as a function of age group and expertise. Based upon these results, we provide a framework for explanatory models of suicidal crisis behavior that are specific for women with a Turkish migratory background in Germany.
The aim of the main study is to examine the influence of risk factors and protecting factors that help elicit or alleviate mental health issues. An epidemiological cross-sectional data collection approach will be employed for this purpose, and the main outcome variable will be mental health as assessed with the General Health Questionnaire. We will recruit 340 German women and 340 Turkish migrant women. Constructs such as general self-efficacy, social support and extraversion depict protective factors and constructs such as social strain and neuroticism are considered as risk factors in this regard. Furthermore, the coherence between various acculturation patterns will be explored in order to be able to examine the presence of psychiatric symptoms more precisely.
We will present the first results of the pilot study by 50 Turkish migrant women to review the reliability and validity of the used instruments and to evaluate the hypotheses and experimental design.
The presence of at least five dimensions in mania has recently been established. This study extends previous findings by comparing the dimensions of pure vs. mixed mania.
Materials and method
One hundred and three inpatients with bipolar I disorder, manic or mixed (DSM IV), were assessed with SCID-I, YMRS and HDRS-21. The five-factor solution found after applying factorial analysis with Varimax rotation was compared between manic and mixed patients.
There were differences between pure mania and mixed states on factor 1 (depression) and factor 3 (hedonism). There was a tendency to present higher values on factor 5 (activation) in the pure manic group. No differences were found in factor 2 (dysphoria) and factor 4 (psychosis).
Hedonism and activation dimensions are present to a lesser degree in mixed states. Although the principal difference between mixed and pure bipolar disorder is the existence of depressive symptoms, the depressive dimension is strongly present in patients with pure mania.
There is need to search for core depressive symptoms in all patients suffering from mania and to evaluate their outcome in clinical trials.
Ethnic minority groups show elevated suicide attempt rates across Europe. Evidence suggests a similar trend for women of Turkish origin in Germany, yet data on suicidal behaviour in minorities in Germany is scarce. The objective was to examine rates of suicidal behaviour, underlying motives, and to explore the effectiveness of an intervention program.
From 05/2009–09/2011, data on all suicide attempts among women of Turkish origin who presented at a hospital-based emergency unit in Berlin, Germany, were collected. A multi-modal intervention was conducted in 2010 and the effects of age, generation and the intervention on suicide attempt rates were examined.
At the start, the highest rate was found in women aged 18–24 years with 225.4 (95% CI = 208.8–242.0)/100,000. Adjustment disorder was the most prevalent diagnosis with 49.7% (n = 79), being more common in second-generation women (P = .004). Further analyses suggested an effect of the intervention in the youngest age group (trend change of ß = –1.25; P = .017).
Our findings suggest a particularly high rate of suicide attempts by 18–24-year-old, second-generation women of Turkish origin in Berlin. Furthermore, our results suggest a trend change in suicide attempts in women aged 18–24 years related to a population-based intervention program.
Even though some studies suggest that in Mediterranean and non-western cultures more somatic and less psychological symptoms are reported, this so-called ‘somatization’ hypothesis has been challenged. Reviews show that somatic symptoms are a core component of depressive episodes regardless of cultural background. The expression of symptoms might be related to the psychosocial, social and cultural context surrounding the patient rather than ‘ethnicity’ or related constructs. Also, stigma associated with mental disorders can affect patients'symptom presentation.
The interrelationships of perceived stigmatization (Explanatory Model Interview Catalogue - Stigma Scale), depression (Beck Depression Index II), overall psychological distress (Symptom Checklist-90-R), and somatic symptoms (The screening for SOMATOFORM SYMPTOMS II) was assessed in a sample of female patients with Turkish descent with a diagnosis of depression (N = 63).
Depression, overall psychological distress, and somatic symptoms were positively and significantly related. Stigma was positively related to depression and overall psychological distress. There was no significant relationship between stigma and somatic symptoms, neither among the severely depressed group (N = 39), nor among the less depressed group (N = 24).
The positive relationships between stigma, depression, and overall psychological distress indicate that patients who are more depressed and who have higher levels of overall psychological distress experience their condition as more stigmatizing. Since somatic symptoms and stigma were not related (neither positively, nor negatively), it appears that depressive symptoms and other symptoms of psychological distress affect concerns about stigmatizing attitudes in a way that somatic symptoms do not. This result challenges common assumption of the ‘somatization’hypothesis, i.e. that depression is ‘somatized’because of concern about stigmatizing attitudes.
Many immigrants face more economic strains and hardship than non-immigrants. Income inequality and an increasing social gap between immigrants and non-immigrants in Europe warrant further studies on the impact of socioeconomic factors on health in immigrant groups. The purpose of this study was to examine the association of socioeconomic status (SES) and emotional distress in women of Turkish descent and in women of German descent.
Methods and Subjects
A total of 405 women of German or Turkish descent residing in Berlin were interviewed. Emotional distress was assessed by the General Health Questionnaire-28 (GHQ-28), and SES was examined by level of education, employment status, and income. The associations of emotional distress and SES were estimated in multivariate linear regression analyses.
Unemployment was associated with increased levels of emotional distress in all women, with the highest level of distress in the group of unemployed Turkish women. The overall SES level was related to a greater level of emotional distress in Turkish women, but not in German women (−3.2, 95%CI −5.9 – −.5; p = .020 vs. −.8, 95%CI −2.7 – 1.2; p = .431). Further stratified analyses by relationship status revealed that the association of SES and emotional distress only remained significant among single women.
The impact of socioeconomic hardship appears to be complicated by social roles and expectations related to these. Further in-depth study of the complex nature of the interaction of social roles and socioeconomic position in female Turkish immigrants in Germany is needed to better understand differing risk patterns for emotional distress.
The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany.
105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations.
In all subjects, social strain (Pearson's r = .26**, p = .008) and neuroticism (r = .34**, p < .001) were positively associated with mental distress. In contrast, perceived self-efficacy (r = −.38**, p < .001) and extraversion (r = −.36**, p < .001) were negatively associated with mental distress.
Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.
The integrated care in dual diagnosis units involves selecting pharmacological treatment strategies for both substance use disorder and the non-addictive psychiatric disorder. It is recommended to choose drugs with a favorable balance between efficacy/tolerability, an adequate side effects profile and the minimal drug interactions.
Objectives and aims
To evaluate the tolerability and side effects after first administration-first dose of an extended-release injectable suspension of aripiprazole in a group of patients admitted to an acute dual diagnosis unit.
The study included a series of patients admitted in our unit from May to August 2015 that received the first dose of the aripiprazole preparation (400 mg). Evaluations included different scales for side effects (SAS, ESRS, UKU) and the clinical global impression scale (CGI).
A total of 9 patients were included and evaluated (all men, mean age: 39-years-old). Diagnoses were: bipolar disorder (5/9), schizophrenia (2/9), schizoaffective disorder (1/9) and delusional disorder (1/9) with concomitant substance use disorder (6 cannabis, 2 alcohol, 1 cocaine). All of them without outpatient control and treatment at admission. The results of the clinical scales conclude that none of them had significant side effects, including extrapyramidal, with an improvement in the ICG scale.
Tolerability of extended-release injectable suspension of aripiprazole was good in all cases. In the future, new cases should be included to extend the sample and to evaluate other aspects such as the craving for substances.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Describe the distinguishing characteristics between patients with early onset of alcohol use (EARLY, age < 15) and late onset of alcohol use (LATE, age > 16), both affected of acute non-substance use psychiatric disorders (non-SUD) and any substance use disorder admitted in a dual diagnosis unit.
Material and methods
Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit along three years, all of them meeting DSM-IV criteria of any non-substance related Axis I or II disorder and comorbid substance use disorder (SUD). Statistical analysis was performed by using SPSS program.
We show results of 748 patients (437 of EARLY group and 311 of LATE group). Predominantly male (73,53%) with a mean age of 39,60 ± 9,7 years. Most prevalent non-SUD psychiatric disorders were psychotic disorder (39,97%) and personality disorder (39,30%). In our sample, most common substances of abuse were Alcohol (45,05%) and Cocaine (30,35%). EARLY patients had an earlier first contact all substances as well as an earlier age of problematic consumption of cocaine, alcohol, opioids and nicotine; they also had major prevalence of opioid SUD, sedatives SUD and amphetamines SUD (see Tables 1, 2 and 3).
Patients who began earlier their consumptions of alcohol had major prevalence of opioid, sedatives and amphetamine use. They also had earlier consumptions of other substances and earlier problematic consumptions of cocaine, alcohol, opioids and nicotine, what probably means greater severity of drug addiction in the long run.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Physically-based avalanche propagation models must still be locally calibrated to provide robust predictions, e.g. in long-term forecasting and subsequent risk assessment. Friction parameters cannot be measured directly and need to be estimated from observations. Rich and diverse data are now increasingly available from test-sites, but for measurements made along flow propagation, potential autocorrelation should be explicitly accounted for. To this aim, this work proposes a comprehensive Bayesian calibration and statistical model selection framework. As a proof of concept, the framework was applied to an avalanche sliding block model with the standard Voellmy friction law and high rate photogrammetric images. An avalanche released at the Lautaret test-site and a synthetic data set based on the avalanche are used to test the approach and to illustrate its benefits. Results demonstrate (1) the efficiency of the proposed calibration scheme, and (2) that including autocorrelation in the statistical modelling definitely improves the accuracy of both parameter estimation and velocity predictions. Our approach could be extended without loss of generality to the calibration of any avalanche dynamics model from any type of measurement stemming from the same avalanche flow.
It is estimated that 80% of the world population trusts traditional medicine. A large number of Americans use infusions of Bocconia frutescens L. leaves to treat cough and gastrointestinal disorders. However, phytochemical studies reveal that this plant contains alkaloids and other potentially harmful substances. This study aimed to evaluate the teratogenic effects of B. frutescens L. in an experimental model. Pregnant Wistar rats were administered lyophilized B. frutescens L. extract at 300 mg/kg/day or vehicle by orogastric route during the organogenesis period (gestation days 7–13), and external and internal congenital malformations were analyzed on the progeny on gestational day 20. Bocconia frutescens L. produced a significant increase in the number of different malformations, relative to the control group. We conclude that the consumption of B. frutescens L. during pregnancy at a dose equivalent to that consumed by humans increases the risk of teratogenic effects.