Kobel Friederike, Morawa Eva, Erim Yesim
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Front Psychiatry. 2020 Jun 11;11:542. doi: 10.3389/fpsyt.2020.00542. eCollection 2020.
Research on the effectiveness of inpatient psychotherapy for migrant patients predominantly concludes that they have greater symptom severity at admission and benefit less from psychotherapy. This study aims to compare symptom severity and effects of psychotherapy regarding depression, somatoform disorders, anxiety disorders, and posttraumatic stress disorder (PTSD) in a sample of patients with and without migratory background (MB).
Symptom severity of 263 patients (T0, pretreatment) and 256 patients (T1, posttreatment) was assessed using the Patient Health Questionnaire somatization module (PHQ-15), depression module (PHQ-9), and general anxiety disorder module (GAD-7), and the PTSD Checklist (PCL-5). Calculations were made for a completer sample and an intention-to-treat (ITT) sample. To investigate the effectiveness of psychotherapy, we calculated effect sizes (Cohen's d) and clinically significant changes using the reliable change index (RCI).
Patients with MB showed significantly higher symptom burden at admission for somatization (p = 0.025, d = 0.345) and posttraumatic symptoms (p = 0.008, d = 0.424) than patients without MB. At discharge, patients with MB reported significantly higher severity regarding all assessed symptoms (somatization: p = 0.001, d = 0.507; depression: p = 0.045, d = 0.313; anxiety: p = 0.012, d = 0.428; traumatization: p = 0.040, d = 0.329) compared with non-migrant patients. Patients without MB improved significantly regarding all assessed symptoms (somatization: p < 0.001, d = -0.304; depression: p < 0.001, d = -0.692; anxiety: p < 0.001, d = -0.605; posttraumatic symptoms: p < 0.001, d = -0.204). Patients with MB improved significantly concerning depression (p < 0.001, d = -0.649) and anxiety (p = 0.002, d = -0.441). Occurrence of comorbidity was high (87.1% had more than one psychiatric diagnosis). Neurotic, stress-related, and somatoform disorders (F4) and personality disorders (F6) were more frequent among patients with MB.
Patients with MB showed higher symptom severity at admission. Our study demonstrated a significant reduction of depressive and anxiety symptoms among patients with MB receiving psychotherapy. Further research is needed to identify interventions that effectively improve somatization and posttraumatic stress for patients with MB, since these symptoms were not significantly reduced.
关于住院心理治疗对移民患者有效性的研究主要得出结论，即他们入院时症状严重程度更高，且从心理治疗中获益较少。本研究旨在比较有和没有移民背景（MB）的患者样本在抑郁症、躯体形式障碍、焦虑症和创伤后应激障碍（PTSD）方面的症状严重程度及心理治疗效果。
使用患者健康问卷躯体化模块（PHQ - 15）、抑郁模块（PHQ - 9）、广泛性焦虑障碍模块（GAD - 7）以及创伤后应激障碍检查表（PCL - 5）对263例患者（T0，治疗前）和256例患者（T1，治疗后）的症状严重程度进行评估。对完整样本和意向性治疗（ITT）样本进行了计算。为研究心理治疗的有效性，我们使用可靠变化指数（RCI）计算效应量（科恩d值）和临床显著变化。
有MB的患者在入院时躯体化症状（p = 0.025，d = 0.345）和创伤后症状（p = 0.008，d = 0.424）的负担显著高于没有MB的患者。出院时，与非移民患者相比，有MB的患者在所有评估症状方面的严重程度均显著更高（躯体化：p = 0.001，d = 0.507；抑郁：p = 0.045，d = 0.313；焦虑：p = 0.012，d = 0.428；创伤：p = 0.040，d = 0.329）。没有MB的患者在所有评估症状方面均有显著改善（躯体化：p < 0.001，d = -0.304；抑郁：p < 0.001，d = -0.692；焦虑：p < 0.001，d = -0.605；创伤后症状：p < 0.001，d = -0.204）。有MB的患者在抑郁（p < 0.001，d = -0.649）和焦虑（p = 0.002，d = -0.441）方面有显著改善。共病发生率很高（87.1%有不止一种精神科诊断）。在有MB的患者中，神经症性、与应激相关的和躯体形式障碍（F4）以及人格障碍（F6）更为常见。
有MB的患者入院时症状严重程度更高。我们的研究表明，接受心理治疗的有MB的患者抑郁和焦虑症状有显著减轻。由于这些症状没有显著减轻，需要进一步研究以确定能有效改善有MB患者躯体化和创伤后应激的干预措施。
