Hertner Laura, Stylianopoulos Panagiotis, Heinz Andreas, Kluge Ulrike, Schäfer Ingo, Penka Simone
Department of Psychiatry and Neurosciences at the Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Berlin Institute for Empirical Integration and Migration Research at the Humboldt Universität zu Berlin, Berlin, Germany.
Confl Health. 2023 Jan 19;17(1):1. doi: 10.1186/s13031-023-00499-9.
Previous research concluded that substance (mis)use is increasing among forcibly displaced populations. Nevertheless, little research has been conducted within a social ecological framework aimed at identifying and understanding the factors affecting substance (mis)use embedded in the post-migration context in high-income countries. The present study aims to develop an understanding of the links and underlying mechanisms between refugees' social ecological determinants and substance (mis)using behavior.
Rapid assessments (RAs), including 108 semi-structured interviews and 10 focus group discussions with key persons from various professional, and personal backgrounds, were carried out in German urban and rural areas. The RA approach of interviewing key persons and not solely refugees that (mis)use substances allowed us to gather multi-perspective knowledge on this sensitive topic. Qualitative content analysis was applied, aiming at identifying determinants of substance (mis)use embedded in the post-migration context of refugees and understanding the underlying mechanisms.
One main result of the data suggests that the link between refugees' countries of origin and their post-migration substance (mis)use is not as direct as often assumed. It is observed that refugees' prospects and opportunities in receiving countries (e.g., work permits) undermine this commonly reproduced link. Further determinants are related to living conditions in German refugee shelters and social relations with peers and families. The influence of refugees' living conditions can be summarized as potentially increasing substance availability and distress, whereas family separation produces a loss of control and responsibility, increasing the risk for substance (mis)use. Peers' influence on substance (mis)use was reported to reflect a search for a sense of belonging.
Given that refugees who (mis)use substances have limited to no control over the factors identified in our study to be associated with substance (mis)use, common treatment and prevention approaches are challenged. Furthermore, we recommend aiming for a holistic comprehension of refugees' substance (mis)use by expanding the focus beyond individuals to the social ecological context in any attempt, including prevention, treatment, research, and policy.
先前的研究得出结论，在被迫流离失所人群中，物质（滥用）使用情况呈上升趋势。然而，在社会生态框架内针对高收入国家移民后背景下影响物质（滥用）使用的因素进行识别和理解的研究却很少。本研究旨在了解难民社会生态决定因素与物质（滥用）使用行为之间的联系及潜在机制。
在德国城乡地区开展了快速评估（RA），包括与来自不同专业和个人背景的关键人物进行108次半结构化访谈和10次焦点小组讨论。通过访谈关键人物而非仅针对物质（滥用）使用者难民的RA方法，使我们能够就这一敏感话题收集多视角知识。应用了定性内容分析，旨在识别难民移民后背景下物质（滥用）使用的决定因素，并理解其潜在机制。
数据的一个主要结果表明，难民原籍国与其移民后物质（滥用）使用之间的联系并不像通常认为的那样直接。据观察，难民在接收国的前景和机会（如工作许可）削弱了这种普遍存在的联系。其他决定因素与德国难民收容所的生活条件以及与同龄人和家庭的社会关系有关。难民生活条件的影响可概括为可能增加物质可得性和痛苦，而家庭分离会导致失去控制和责任感，增加物质（滥用）使用风险。据报告，同龄人对物质（滥用）使用的影响反映了对归属感的寻求。
鉴于物质（滥用）使用者难民对我们研究中确定的与物质（滥用）使用相关的因素几乎没有控制权，常见的治疗和预防方法受到了挑战。此外，我们建议在包括预防、治疗、研究和政策在内的任何尝试中，通过将重点从个人扩展到社会生态背景，以全面理解难民的物质（滥用）使用情况。
