Walter Renner & Marina Ortner Differential effects of lay interventions for asylum seekers, refugees, and working migrants from Afghanistan, Chechnya, and Turkey on symptoms of post-traumatic stress, anxiety, and depression: Results from three Austrian randomized controlled studies Universities of Klagenfurt and Innsbruck, UMIT (Hall in Tirol)

Background: => Asylum seekers and refugees (Chechnya and Afghanistan) vs. working migrants (Turkey) => Acculturative Stress and Post-Traumatic Stress => Psychotherapy often unavailable or not accepted => Social support by lay people can have powerful effect as a moderating variable - see forthcoming literature review by Laireiter, 2010 => ethnic (self-help, Study 1 and 3) vs. => host culture (sponsorships, Study 2)

Study 1: Self-Help Groups for Asylum Seekers and Refugees from Chechnya (Renner, 2008) => Most prominent group among refugees in Austria => 50% of them suffering from post-traumatic stress and other clinical symptoms - tedious asylum procedure => 2006 - 2008 (University of Klagenfurt, Caritas Innsbruck, Provincial Govt. Tyrol) => Four Chechens trained as group leaders (10 workshops) => Self-Help (SH) vs. Cognitive Behavior Therapy (CBT) vs. EMDR vs. Wait-List (WL) Control Group => Total N = 94 (44 Women and 50 Men)

Timetable - Interventions and Measurement Occasions

Results: => SH and CBT only worked with clients who suffered from severe post-traumatic symptoms HTQ > 1.75) => SH and CBT significantly reduced post-traumatic stress (HTQ), anxiety and depression (HSCL-25) (d = - 0.9) => No "Post-Traumatic Growth" (Tedeschi) => SH and CBT were equally effective => SH and CBT were significantly superior to WL and EMDR => EMDR was not effective => Results were stable over time

Example 1: Harvard Trauma Questionnaire Chechen Asylum Seekers and Refugees (Time p = .000; Time * Group p = 0.000, Total N = 54 with HTQ > 1.75)

Study 2: Sponsorships for Asylum Seekers and Refugees from Chechnya and Afghanistan (Renner, 2010b) => Afghans are second strongest group among displaced persons in Austria => High rate of them suffering from post- traumatic stress, similar to Chechens => Post-traumatic stress and acculturative stress are known to interact: traumatized people have more difficulties acculturating

=>. Sponsorships for adult refugees by Austrian => Sponsorships for adult refugees by Austrian population (six months duration) => 2008 - 2010 (University of Innsbruck and UMIT) => N = 35 sponsors (10 men, 25 women) and initially N = 63 refugees and asylum seekers (30 men, 38 women) participated => Initial training phase: 4 workshops - sponsors carefully selected - closely supervised => Effect of sponsorships compared with Wait-List Control Group - timetable similar to previous studies

Results: => Sponsorships only worked with clients who suffered from severe post-traumatic symptoms (cf., Study 1) => Sponsorships significantly reduced anxiety, depression, and psychological symptoms (Effect Sizes = 0.8 ... 1.0) => Positive effects were stable over time (follow- up measurement) => But had no effect on living conditions, coping meachanisms or acculturation => i.e., effects were palliative, rather than instrumental

Example 2: HSCL-25 Anxiety Sub-Scale Sponsorships for Asylum Seekers and Refugees (Time p = .030; Time * Group p = 0.004, Total N = 35)

Study 3: Self-Help Groups for Women with Recurrent Depression from Turkey (Renner, 2010a) => 180,000 people of Turkish descent living in Austria => Poor socio-economic status, often married against their will, early marriage, collectivist values, high influence of husbands' families, disappointed expectations, poorly acculturated, xenophobic attitudes of host society => 71% of Turkish women in Germany reported somatic symptoms; life time incidence of depression 81% (Cicek, 1990)

=> Conventional therapy often to no avail or not accepted => 2008 - 2010 (University of Innsbruck and UMIT) => Four female medical students of Trukish descent trained as group leaders => Self-Help (SH) vs. Cognitive Begavior Therapy (CBT) vs. Wait-List (WL) => Total N = 66 women with recurrent depression => Time-table the same as in first research

Results: => Neither SH nor CBT were effective with respect to => Depression (CES-D), => General Psychopathology (BSI), => Post-Traumatic Stress (HTQ) or => Somatic symptoms (BL) Possibly symptoms are reinforced secondarily by extremely adverse and hopeless living conditions Illness being the only perspective towards gaining a minimum of control over environment

Example 3: CES-D Depression Scale Female Turkish Migrants with Recurrent Depression (Time p = .081; Time * Group p = 0.401, Total N = 38)

Summary and Conclusions (1) Lay help has been effective for refugees and asylum seekers with post-traumatic symptoms: => Effects palliative but not instrumental => No effects for participants without post- traumatic symptoms => Effects stable over follow-up measurements => Thus: lay help can pose an alternative to professional interventions when necessary => Differential indication should be considered => Sponsorships currently considered nationally and internationally (Caritas Internationalis and International Red Cross/Red Crescent)

(2) But: No effects for Turkish migrant women with recurrent depression (as ooposed to refugees): => Extreme adverse living conditions (role of husbands and their families); Thus Illness may be the only perspective towards gaining a minimum of control over environment => Traditional expectations of Turkish women of being "healed" by an all knowing expert not compatible with typically "Western" self-help approach => Problems of confidentiality within groups => Lampe & Barbist: Individual therapy more effective => Female therapists of Turkish descent (individual setting) suggested as an alternative to self-help

We gratefully acknowledge the funding of the three studies by the Austrian Science Fund by Projects Number P18789-G14, P20423-G14 and P20523-G14.

References: Berry, J. W., Kim, U., Minde, T., & Mok, D. (1987). Comparative studies of acculturative stress. International Migration Review, 21, 491-511. Cicek., H. (1990). Psychosexuelle Probleme von ausländischen Patienten. Psychomed 2, 244-246. Laireiter, A.-R. (2010). Theoretical concepts of social support. Sponsorships for refugees and asylum aeekers. An Austrian research project on social support as a moderator of acculturative stress: Theoretical assumptions, results, and recommendations. Innsbruck: Studia. Lampe, A. & Barbist, M.-T. (2010). An unintended control group. Psycjodrama in support of Turkish migrant women. In: W. Renner (2010), Female Turkish migrants with recurrent depression. Innsbruck: Studia. ./.

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