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Globally the burden due to mental disorders is continuously increasing. Still, professional help-seeking behavior is not fully understood. To conceive cultural determinants of help-seeking is crucial to reduce personal and social costs of (untreated) mental disorders. The current study investigates mental health stigma and help-seeking attitudes in a Cuban ( n = 195) and a German ( n = 165) sample. In a questionnaire survey we asked for attitudes towards mental illness and professional help-seeking in the general Cuban and German populations. The cultural context was associated with mental health stigma and professional help-seeking attitudes. Interestingly, Cuban participants reported stronger mental health stigma and more willingness to seek help. In multiple hierarchical regression analyses, community attitudes towards the mentally ill significantly predicted help-seeking attitudes, especially in the Cuban sample. Only in the German sample, more negative individual beliefs about mental illness predicted more self-stigma on help-seeking. Beyond that, cultural context moderated the association between mental health stigma and help-seeking attitudes with a stronger association between the measures in the German sample. However, gender did not predict help-seeking attitudes and self-stigma on help-seeking and no interactions between community attitudes, cultural context, and gender were found in the prediction of help-seeking attitudes. Similarities and differences between the samples are discussed in the light of the cultural contexts and peculiarities of the current samples. Concluding, implications of the current findings are reviewed.

According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) nonclinical outcomes (e.g., feasibility, appropriateness, acceptance, and barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from 11 peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one randomized controlled trial (RCT; from two RCTs and two pilot RCTs) found a significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 to 80%. In the discussion, the heterogeneous findings are integrated into the current state of literature.

Objectives: The aim of this study was to develop and validate a questionnaire to assess interpreters’ role conflicts and the challenging aspects within the triad of practitioner, interpreter and refugee client. Methods: A questionnaire was developed based on previous literature. Its factor structure and construct validity were assessed in an online survey of 164 interpreters working with refugee clients. Psychological distress (BSI-18), work-related exhaustion (CBI), and secondary traumatic stress (ProQOL) were measured to test the questionnaire’s convergent validity. Results: Exploratory structural equation modeling for categorical variables resulted in 23 items across four subscales. The scores of all subscales had good or excellent reliability ( ω = 0.81 to ω = 0.93) and correlation analyses indicated convergent validity. Conclusion: The final questionnaire (RoCo) showed four clearly interpretable subscales and may help to identify emotional distress due to role conflicts among interpreters. Future studies should validate the questionnaire in different samples.

Several studies have demonstrated positive effects of exercise in posttraumatic stress disorder (PTSD), but it remains unclear how exercise can be optimally combined with psychotherapy. This systematic review aimed to evaluate the combinations of exercise and psychotherapy (concerning sequence, type, frequency, duration, administration, intensity) and their effect on PTSD symptom severity. After registration at PROSPERO (CRD42024502123), we conducted a systematic literature search up to 17 February 2025. Included were randomized controlled trials (RCTs) of exercise-augmented psychotherapy in adults with a PTSD diagnosis. PTSD symptoms were examined as the primary outcome. Two reviewers conducted the search and assessed the risk of bias (RoB-2) and reporting quality (CONSORT checklist). Five studies were included, encompassing a total of 677 participants. Four study samples were predominantly female, while trauma types and sample types were heterogeneous throughout the studies. The quality of studies was overall satisfactory, with one study showing a high risk of bias. Between group effect sizes on PTSD symptoms ranged from small to large and three studies reported a positive effect. Promising designs for exercise-augmented psychotherapy included 20-30-minute sessions of aerobic exercise weekly, over 9-12 weeks, both alone or combined with resistance training, at moderate to vigorous intensity, both in an individual or group format. Exercise was combined with 90-minute sessions of psychotherapy, in different sequences, in an individual or group format. The length of the sessions was not systematically varied. Various designs of psychotherapy combined with exercise hold promise for reducing PTSD symptoms. Due to the limited number and heterogeneity of studies, definitive conclusions regarding the most efficacious design are not yet possible. Further high-quality RCTs are needed.

Adverse social and economic conditions negatively impact mental health and well-being. To the best of the authors’ knowledge, the present systematic review is the first to investigate the association between housing insecurity and mental health outcomes among renters, with a focus on housing affordability and instability. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in December 2022 across four databases (MEDLINE, PsycINFO, Web of Science, and ASSIA). Quantitative studies from OECD (Organisation for Economic Co-operation and Development) member countries were eligible for inclusion if they investigated housing insecurity by examining at least one independent variable related to housing affordability and/or instability, and included at least one mental health-related outcome among adult renters. Studies needed to specifically distinguish effects for renters, not simply adjust for tenure or include an interaction. Studies were excluded if they analyzed other forms of housing insecurity, examining residential satisfaction and general health outcomes, or populations other than adult renters (< 15 years of age). The methodological quality of the included studies was rated with the JBI Critical Appraisal Tools, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Due to heterogeneity of the identified studies, we performed a narrative synthesis. Twenty-two studies with sample sizes ranging from n = 89 to n = 179,037 met the inclusion criteria (resulting in a total sample size of at least N = 336,775), of which 14 applied a longitudinal design, five a cross-sectional design, and three a quasi-experimental design. Based on the JBI ratings, the overall methodological quality of the included studies was good. The overall ratings of certainty of evidence, based on the GRADE ratings, were between low and very low – mainly due to the non-controlled study designs of included studies. Among the nine studies examining housing affordability, six reported significant associations between unaffordable rent and poor mental health in low-income renters. Regarding housing instability, 12 out of 14 studies reported significant associations between unstable housing and renters’ mental health issues. Measures of housing insecurity varied, with rent-to-income ratio and forced moves being most commonly employed. Mental health outcomes focused primarily on overall mental health, well-being, and depressive symptoms, while few studies explored other mental health outcomes. Despite methodological limitations due to the non-controlled studies included in the review, the findings suggest overall that experiencing unaffordable or unstable housing has a negative impact on renters’ overall mental health and depressive symptoms. Housing insecurity poses a significant challenge for renters in OECD countries, highlighting the need for policymakers to implement supportive housing policies and tenure protection measures in order to improve renters’ housing security and ultimately public health. Nevertheless, more research with robust study designs is needed to draw further conclusions. The systematic review has been conducted without external funding. It has not been pre-registered and no study protocol has been published.

Background Refugees are at high risk for developing mental illnesses. Due to language and cultural barriers, there is need for specifically adapted therapeutic procedures for refugees in inpatient mental health care settings. Internet-based applications in refugee mother tongues have the potential to improve the outcomes of mental health care for this vulnerable population. The key research question of the present implementation study is whether the newly developed “blended ALMAMAR” app for Arabic and Farsi speaking refugees in Germany is used and accepted by patients and professionals in routine inpatient mental health care (blended care). Methods We present the design of an observational, prospective multicenter implementation study in eight psychiatric hospitals. We plan to recruit 100 Farsi or Arabic speaking refugees receiving in-patient treatment due to depression, anxiety disorder, posttraumatic stress disorder or substance use disorders. These patients will get access to the “blended ALMAMAR” app during their inpatient stay in a blended-care approach. We will assess the usage (e.g., duration and frequency of use of the app) as well as subjective acceptability and usability of the intervention. To identify sociodemographic and clinical factors associated with “blended ALMAMAR” usage, we will also perform clinical and questionnaire assessments. Discussion The newly developed “blended ALMAMAR” app may help to close communication gaps for the hard-to reach and vulnerable group of refugees in inpatient mental health care. It is the first blended-care intervention that addresses severely mentally ill refugees in an inpatient psychiatric setting in Germany. Trial registration The trial was registered in the German Clinical Trials Register on November 11, 2021 (DRKS00025972) and adapted on November 14, 2023.

Background Mental health care faces significant challenges, particularly in Arabic-speaking countries, where only a fraction of individuals with depression receive treatment. While internet-based interventions (IBIs) have shown promising results, how clients experience IBIs is not well known, highlighting the need for a deeper understanding of client experiences. Objective To better understand the impact of IBIs, qualitative interviews were conducted with participants from Arabic-speaking countries regarding perceived changes, causes of changes, and hindering and helpful aspects of IBIs. Method In total, 93 participants (68% female; M_age = 27.45) from various Arabic-speaking countries who completed either an internet-based cognitive ( n  = 49) or an internet-based interpersonal ( n  = 44) treatment for depression were interviewed via structured change interviews to understand perceived positive and negative changes after treatment as well as perceived causes of changes, as well as helpful and hindering aspects. The interviews were analyzed using qualitative content analysis. Results Most of the participants reported positive changes after treatment, which were categorized into the five following domains: Coping strategies, Personal Growth, Interpersonal Changes, Symptomatic Changes and Increase in Activity and Energy. Causes of changes were attributed mainly to the Program Structure, Personal Factors, Working Alliance, and External Reasons. However, negative changes were also reported and categorized into Short-term and Persistent Negative Changes. Hindering aspects were related to the Program Structure and Technical Difficulties, Standardization and External Reasons. Helpful aspects were related to the Program Structure. Conclusion Despite some hindering aspects and negative changes, the IBIs predominantly induced positive changes across multiple life domains, with the Program Structure being identified as both the main cause of positive effects and an obstacle, which indicates individual-dependent differences.

Background Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transdiagnostic Internet-based treatment. The trial aims at establishing its efficacy and cost-effectiveness compared with no treatment. Methods N  = 131 treatment-seeking Arabic- or Farsi-speaking patients, meeting diagnostic criteria for a depressive, anxiety, and/or posttraumatic stress disorder will be randomized to either the intervention or the waitlist control group. The intervention group receives an Internet-based treatment with weekly written guidance provided by Arabic- or Farsi-speaking professionals. The treatment is based on the Common Elements Treatment Approach (CETA), is tailored to the individual patient, and takes 6–16 weeks. The control group will wait for 3 months and then receive the Internet-based treatment. Discussion The planned trial will result in an estimate of the efficacy of a low-threshold and scalable treatment option for the most common mental disorders in refugees. Trial registration German Registry for Clinical Trials DRKS00024154. Registered on February 1, 2021.

Numerous randomized controlled trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT), metacognitive therapy (MCT), and methods to reduce intolerance of uncertainty (IU-CBT) in the treatment of generalized anxiety disorder (GAD). However, few studies have investigated these treatments under conditions of routine clinical care. The main objective of this study was to investigate the effectiveness of psychotherapy for GAD in an outpatient setting and to identify factors influencing treatment outcome. Fifty-nine GAD patients received naturalistic CBT (including MCT and IU-CBT) in an outpatient clinic and postgraduate training center for psychotherapy. Patients completed self-report questionnaires at the beginning and end of therapy regarding the main outcome worry as well as metacognitions, intolerance of uncertainty, depression, and general psychopathology. Worry, negative metacognitions, intolerance of uncertainty, depression, and general psychopathology decreased significantly (p's < .001) with large effect sizes for all symptoms (d = 0.83-1.49). A reliable change in the main outcome worry was observed in 80% of patients, and recovery occurred in 23%. Higher worry scores at posttreatment were predicted by higher pretreatment scores, female sex, and less change in negative metacognitive beliefs during treatment. Naturalistic CBT for GAD appears to be effective in routine clinical care for worry as well as depressive symptoms, with particular benefits associated with altering negative metacognitions. However, a recovery rate of only 23% is lower than the rates reported in RCTs. Treatment needs to be improved, especially for patients with more severe GAD and for women.