von Lersner Ulrike, Wiens Ulrike, Elbert Thomas, Neuner Frank
Psychotrauma Research- and Outpatient Clinic for Refugees, University of Konstanz, Germany.
BMC Int Health Hum Rights. 2008 Jun 12;8:8. doi: 10.1186/1472-698X-8-8.
Many refugees live for years in exile. The combination of stress in the host country, together with long-term effects resulting from traumatic stress usually experienced in the home country may affect mental health. Little is known, to what extent these and other factors promote or stall the willingness to return to the country of origin. Here, we investigate, as an example, refugees who will return to their country of origin after having lived in exile in Germany for some 11 years.
What is the mental health status of returnees before the actual return who have been living in exile for an extended period? We also asked, what are the current living conditions in Germany and what are the motives for and reasons against a voluntary return to the country of origin?
Forty-seven participants of programs for assisted voluntarreturn were interviewed about their present living situation, their view regarding their home country and voluntary return. These findings were compared to a group of 53 refugees who had decided to remain in Germany (stayers). Participants were recruited by means of advertisements posted in refugee centres, language schools, at doctors' offices and in organisations involved in the management of voluntary return in Germany. The prevalence of psychiatric disorders among respondents was tested using the structured interview M.I.N.I. The Posttraumatic Stress Diagnostic Scale (PDS) was used to assess PTSD in more detail and EUROHIS was applied to measure the subjective quality of life of participants.
We found a prevalence rate of 44% psychiatric disorders in the group of returnees and a rate of 78% in the group of stayers. We also recorded substantial correlations between the living situation in Germany, disposition to return and mental health. In almost two thirds of the participants the decision to return was not voluntary but strongly influenced by immigration authorities. The most important reason for participants to opt for a stay in Germany were their children, who have been born and raised in Germany.
Psychological strains among the study participants were very high. Traumatic stress, experienced during war and refuge, has left the victims vulnerable and not well equipped to cope with post-migration stressors in exile. It is noteworthy that the majority returned under pressure of the immigration authorities. The fear of an uncertain future after the return was substantial. These factors should be taken into account in programs designed to assist returnees, including those that offer support after return to the country of origin.
许多难民长期流亡在外。东道国的压力，再加上通常在祖国经历的创伤性应激的长期影响，可能会影响心理健康。对于这些因素以及其他因素在多大程度上促进或阻碍返回原籍国的意愿，人们了解甚少。在此，我们以在德国流亡约11年后将返回原籍国的难民为例进行调查。
长期流亡后实际回国前的归国者心理健康状况如何？我们还询问了他们目前在德国的生活状况，以及自愿返回原籍国的动机和反对理由。
对47名参与协助自愿回国项目的参与者就其目前的生活状况、对祖国的看法以及自愿返回的情况进行了访谈。将这些结果与53名决定留在德国的难民（留居者）群体进行比较。参与者是通过在难民中心、语言学校、医生办公室以及德国参与自愿回国管理的组织张贴广告招募的。使用结构化访谈M.I.N.I.测试受访者中精神障碍的患病率。创伤后应激诊断量表（PDS）用于更详细地评估创伤后应激障碍，EUROHIS用于测量参与者的主观生活质量。
我们发现归国者群体中精神障碍的患病率为44%，留居者群体中为78%。我们还记录了德国的生活状况、回国倾向和心理健康之间的显著相关性。近三分之二的参与者返回的决定并非出于自愿，而是受到移民当局的强烈影响。参与者选择留在德国的最重要原因是他们在德国出生和长大的孩子。
研究参与者的心理压力非常大。战争和避难期间经历的创伤性应激使受害者变得脆弱，无法很好地应对流亡中的移民后应激源。值得注意的是，大多数人是在移民当局的压力下返回的。对回国后不确定未来的恐惧很大。在旨在协助归国者的项目中，包括那些在返回原籍国后提供支持的项目，应考虑到这些因素。
