Medical University of Vienna, Austria. Psychiatrist, Psychotherapist.Focus: Transcultural Psychiatry, Trauma, Refugees, Victims of Violence, Therapeutic Justice.
BackgroundThe genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the... more BackgroundThe genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the Sinjar area of Northern Iraq has costed many lives and has also caused a psychological long-term impact in this minority. This impact can be seen among individual survivors. Additionally, there is a large number of direct and indirect victims and for this reason, the impact can also be observed on the level of the group and society in this region at large.MethodologyThe research examines three different population groups (Yazidis members who had been exposed to violence by terrorist group actions, those not exposed to this experience as they were living in an area not directly exposed to ISIS violence, and a control group of non – Yazidi general population members). In total, 425 participants (age range 15–78) took part in the study and participated in interviews using standard scales to measure general physical and mental health.ResultsThe results demonstrate that psychological stress ...
Although nearly a century has passed since Kraepelin’s investigations in Java [Cbl Nervenheilk Ps... more Although nearly a century has passed since Kraepelin’s investigations in Java [Cbl Nervenheilk Psychiatr 1904; 27:468–469], one crucial question regarding guilt in the course of depression has still not been decided: Is there a more or less stable connection independent of culture, or is guilt confined to certain civilisations? This study investigated this issue in 100 Pakistani and 100 Austrian out-patients diagnosed with ‘major depression’ according to DSM-IV by means of standardised instruments (Schedule for Affective Disorders and Schizophrenia-Life Time Version, Hamilton Rating Scale for Depression, 21-item version). The experiences of guilt were subdivided into ethical feelings (ethical anxiety and feelings of guilt) and delusions of guilt. It turned out that ethical feelings could be found in both cultures regardless of age and sex. They seem to be primarily related to the extent of depressive retardation. However, the distribution of the two subsets of ethical feelings was c...
Terrorism, Violent Radicalisation, and Mental Health, 2021
In this chapter, we offer an interdisciplinary and group-focused model to examine how extreme vio... more In this chapter, we offer an interdisciplinary and group-focused model to examine how extreme violence develops, and discuss aspects of interventions for prevention, specifically with regard to terrorism and its many forms. We argue that an analysis of terrorism must be more open, and include research into the perpetrators of extreme violence such as genocide. In general, we see the breakdown of empathy, a group dynamic process that creates the image of ‘the other’ and the violation of basic concepts of humanitarian and human rights laws, as a precondition to terrorism when viewed as a subtype of extreme violence. In recent years, Internet-based and large multinational groups have gained importance, a factor that is insufficiently considered, meaning that more attention is needed on group dynamic processes as drivers of extreme violence. Our interpretation uses models such as that developed by the group analyst Vamik Volkan, and others, including that of chosen trauma. We discuss th...
Sport psychiatry can be seen as a new and rapidly developing global field, due not only to the gr... more Sport psychiatry can be seen as a new and rapidly developing global field, due not only to the growing popularity of sports in the general population but also to the highly challenging environments in a professional setting. Mental health problems like brain trauma, depression, suicide, doping, physical trauma and abuse, and also sport-specific problems like the female athletic triad or overtraining are risks endangering the physical and psychological benefits that can be expected from sport and exercise. Working with individual athletes or teams requires special knowledge and skills but also awareness of ethical challenges encountered especially in high-performance sports.
International Journal of Environmental Research and Public Health
The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young p... more The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey. Methods: The authors used the “Psychological General Well-being” index as part of an anonymous online survey with 3665 participants (ages 15–25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic. Results: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = −0.21, p <...
Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (... more Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (TR-PTSD). The aim of this study was to analyze the morphologic and functional brain changes in patients with TR-PTSD using magnetic resonance imaging (MRI) and positron emission tomography (PET).This study evaluated 19 subjects. Thirteen subcortical brain structures were evaluated using FSL software. On the T1-weighted images, normalized brain volumes were measured using SIENAX software. The study compared the volume of the brain and 13 subcortical structures in 9 patients suffering from TR-PTSD after torture and 10 healthy volunteers (HV). Diffusion-weighted imaging (DWI) was performed in the transverse plane. In addition, the 18F-FDG PET data were evaluated to identify the activity of the elected regions.The mean left hippocampal volume for the TR-PTSD group was significantly lower than in the HV group (post hoc test (Bonferroni) P < 0.001). There was a significant difference betwee...
International Journal of Environmental Research and Public Health, 2021
Background: Thus far, most researchers on genocide and transgenerational transmissions have focus... more Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping...
International Journal of Environmental Research and Public Health, 2021
Female Genital Mutilation (FGM) has been identified as one of the most serious human rights viola... more Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.
Accounts are increasing of non-voluntary deportations of Kosovar adolescents from European countr... more Accounts are increasing of non-voluntary deportations of Kosovar adolescents from European countries to Kosovo, and human rights organizations have condemned deportation practices endorsed by European governments for being violent and detrimental to adolescents' physical and psychosocial health and well-being. However, research remains scarce on the connections among migration, repatriation and reintegration realities, and adolescents' experiences of psychosocial health and well-being. This article describes how adolescent returnees living in Kosovo express their emotional distress, their struggle with negative living conditions, and their exposure to violence. Semi-structured interviews were conducted with 14 adolescents with very high-level post-traumatic stress and depression symptomatology and a General Health Questionnaire score of 40 or higher. This empirical data provided in-depth information about the adolescents' narratives of symptoms and illness, explanations ...
Violence has been shown to be a global challenge resulting in long-lasting social, medical, and m... more Violence has been shown to be a global challenge resulting in long-lasting social, medical, and mental health sequelae. In this article, we focus on massive social violence, such as war and civil war. Social suffering and mental health problems related to violence as a global public health problem can be tackled only with a holistic approach that addresses the specific region, culture and group and the limited resources available in most countries. Research that can give a reliable assessment of complex long-term outcomes is still largely missing, and can be seen as a major and complex challenge for future study.
International Journal of Environmental Research and Public Health
Little is known about the impact of the COVID-19 pandemic on the mental health and psychological ... more Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15–25 years from these two countries. We used the “Psychological General Well-being” and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher “anxiety” (ps < 0.010), lower “vitality” (ps < 0.011), and lower “general health” (ps < 0.011) than native Austrians or Austrian migrants and increased “depression” (p = 0.005) and lower “self-control” (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants...
SummaryProfessional interpretation and translation are key issues in the improvement of public he... more SummaryProfessional interpretation and translation are key issues in the improvement of public health and patient safety in an area of increased migration and multicultural healthcare system needs. Patient safety requires clear and reliable communication to avoid errors in diagnosis, treatment, and neglect of informed consent. Due to the range of languages to be covered, telephone and video interpretation (VI) can be expected to face up to the demands for trained interpreters available on short notice and in more remote healthcare sites.In a pilot project, we implemented a new up to date model video interpretation unit and used a mixed methods approach integrating quantitative and qualitative data in assessing barriers encountered prior to the use of the pilot system and satisfaction with the use of video interpretation in a number of clinical settings, including inpatient and outpatient units, in Austria. Of all respondents (n = 144) 71% reported frequently encountering language ba...
BackgroundThe genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the... more BackgroundThe genocide against the Yazidis by the Islamic State of Iraq and Al-Sham (ISIS) in the Sinjar area of Northern Iraq has costed many lives and has also caused a psychological long-term impact in this minority. This impact can be seen among individual survivors. Additionally, there is a large number of direct and indirect victims and for this reason, the impact can also be observed on the level of the group and society in this region at large.MethodologyThe research examines three different population groups (Yazidis members who had been exposed to violence by terrorist group actions, those not exposed to this experience as they were living in an area not directly exposed to ISIS violence, and a control group of non – Yazidi general population members). In total, 425 participants (age range 15–78) took part in the study and participated in interviews using standard scales to measure general physical and mental health.ResultsThe results demonstrate that psychological stress ...
Although nearly a century has passed since Kraepelin’s investigations in Java [Cbl Nervenheilk Ps... more Although nearly a century has passed since Kraepelin’s investigations in Java [Cbl Nervenheilk Psychiatr 1904; 27:468–469], one crucial question regarding guilt in the course of depression has still not been decided: Is there a more or less stable connection independent of culture, or is guilt confined to certain civilisations? This study investigated this issue in 100 Pakistani and 100 Austrian out-patients diagnosed with ‘major depression’ according to DSM-IV by means of standardised instruments (Schedule for Affective Disorders and Schizophrenia-Life Time Version, Hamilton Rating Scale for Depression, 21-item version). The experiences of guilt were subdivided into ethical feelings (ethical anxiety and feelings of guilt) and delusions of guilt. It turned out that ethical feelings could be found in both cultures regardless of age and sex. They seem to be primarily related to the extent of depressive retardation. However, the distribution of the two subsets of ethical feelings was c...
Terrorism, Violent Radicalisation, and Mental Health, 2021
In this chapter, we offer an interdisciplinary and group-focused model to examine how extreme vio... more In this chapter, we offer an interdisciplinary and group-focused model to examine how extreme violence develops, and discuss aspects of interventions for prevention, specifically with regard to terrorism and its many forms. We argue that an analysis of terrorism must be more open, and include research into the perpetrators of extreme violence such as genocide. In general, we see the breakdown of empathy, a group dynamic process that creates the image of ‘the other’ and the violation of basic concepts of humanitarian and human rights laws, as a precondition to terrorism when viewed as a subtype of extreme violence. In recent years, Internet-based and large multinational groups have gained importance, a factor that is insufficiently considered, meaning that more attention is needed on group dynamic processes as drivers of extreme violence. Our interpretation uses models such as that developed by the group analyst Vamik Volkan, and others, including that of chosen trauma. We discuss th...
Sport psychiatry can be seen as a new and rapidly developing global field, due not only to the gr... more Sport psychiatry can be seen as a new and rapidly developing global field, due not only to the growing popularity of sports in the general population but also to the highly challenging environments in a professional setting. Mental health problems like brain trauma, depression, suicide, doping, physical trauma and abuse, and also sport-specific problems like the female athletic triad or overtraining are risks endangering the physical and psychological benefits that can be expected from sport and exercise. Working with individual athletes or teams requires special knowledge and skills but also awareness of ethical challenges encountered especially in high-performance sports.
International Journal of Environmental Research and Public Health
The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young p... more The COVID-19 pandemic has been shown to have impaired the mental health and well-being of young people. This study, for the first time, explores these aspects in young people with and without a migratory background during the extended course of the pandemic and restrictive measures, comparing two countries with a high COVID-19 prevalence: Austria and Turkey. Methods: The authors used the “Psychological General Well-being” index as part of an anonymous online survey with 3665 participants (ages 15–25), recruited from both countries during the first and the second waves of the pandemic, collecting data on individual experiences and problems encountered during the pandemic. Results: Mental health (b = 0.06, p < 0.023) and general psychological well-being worsened with the progression of the pandemic. Participants with financial problems had the most severe negative effect on mental health (b = 0.12, p < 0.001). Furthermore, females living in Turkey, both natives (b = −0.21, p <...
Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (... more Many people exposed to torture later suffer from torture-related post-traumatic stress disorder (TR-PTSD). The aim of this study was to analyze the morphologic and functional brain changes in patients with TR-PTSD using magnetic resonance imaging (MRI) and positron emission tomography (PET).This study evaluated 19 subjects. Thirteen subcortical brain structures were evaluated using FSL software. On the T1-weighted images, normalized brain volumes were measured using SIENAX software. The study compared the volume of the brain and 13 subcortical structures in 9 patients suffering from TR-PTSD after torture and 10 healthy volunteers (HV). Diffusion-weighted imaging (DWI) was performed in the transverse plane. In addition, the 18F-FDG PET data were evaluated to identify the activity of the elected regions.The mean left hippocampal volume for the TR-PTSD group was significantly lower than in the HV group (post hoc test (Bonferroni) P < 0.001). There was a significant difference betwee...
International Journal of Environmental Research and Public Health, 2021
Background: Thus far, most researchers on genocide and transgenerational transmissions have focus... more Background: Thus far, most researchers on genocide and transgenerational transmissions have focused on the National Socialist Holocaust as the most abhorrent example of this severe human rights violation. Few data have been published on other ethnic or religious groups affected by genocidal actions in this context. Methodology: Using a mixed-method approach integrating qualitative interviews with standardized instruments (SCID and PDS), this study examines how individual and collective trauma have been handed down across three generations in an Alevi Kurd community whose members (have) suffered genocidal perpetrations over a longer time period (a “genocidal environment”). Qualitative, open-ended interviews with members of three generations answering questions yielded information on (a) how their lives are shaped by the genocidal experiences from the previous generation and related victim experiences, (b) how the genocidal events were communicated in family narratives, and (c) coping...
International Journal of Environmental Research and Public Health, 2021
Female Genital Mutilation (FGM) has been identified as one of the most serious human rights viola... more Female Genital Mutilation (FGM) has been identified as one of the most serious human rights violations women are exposed to in many countries, in spite of national and international efforts. The actual implementation of preventive strategies and support of victims faces a number of challenges that can only be addressed by an interdisciplinary approach integrating public health and legal considerations. FGM in the context of women as refugees who left their country to escape FGM has rarely been covered in this context. This article summarizes the most important international standards and initiatives against FGM, highlights the medical, legal, and psychological factors identified so far, and explores the interdisciplinary considerations in changing a country and society to permit safe return of those escaping FGM to third countries and support public health in the country.
Accounts are increasing of non-voluntary deportations of Kosovar adolescents from European countr... more Accounts are increasing of non-voluntary deportations of Kosovar adolescents from European countries to Kosovo, and human rights organizations have condemned deportation practices endorsed by European governments for being violent and detrimental to adolescents' physical and psychosocial health and well-being. However, research remains scarce on the connections among migration, repatriation and reintegration realities, and adolescents' experiences of psychosocial health and well-being. This article describes how adolescent returnees living in Kosovo express their emotional distress, their struggle with negative living conditions, and their exposure to violence. Semi-structured interviews were conducted with 14 adolescents with very high-level post-traumatic stress and depression symptomatology and a General Health Questionnaire score of 40 or higher. This empirical data provided in-depth information about the adolescents' narratives of symptoms and illness, explanations ...
Violence has been shown to be a global challenge resulting in long-lasting social, medical, and m... more Violence has been shown to be a global challenge resulting in long-lasting social, medical, and mental health sequelae. In this article, we focus on massive social violence, such as war and civil war. Social suffering and mental health problems related to violence as a global public health problem can be tackled only with a holistic approach that addresses the specific region, culture and group and the limited resources available in most countries. Research that can give a reliable assessment of complex long-term outcomes is still largely missing, and can be seen as a major and complex challenge for future study.
International Journal of Environmental Research and Public Health
Little is known about the impact of the COVID-19 pandemic on the mental health and psychological ... more Little is known about the impact of the COVID-19 pandemic on the mental health and psychological well-being of young people. The aim of this study is to investigate the psychological well-being and changes in the mental-health state of young people living in Austria and Turkey. By using an anonymous online survey, we recruited 1240 people aged 15–25 years from these two countries. We used the “Psychological General Well-being” and a self-created questionnaire to capture individual experiences during the COVID-19 pandemic and quarantine period. The native Turks indicated higher “anxiety” (ps < 0.010), lower “vitality” (ps < 0.011), and lower “general health” (ps < 0.011) than native Austrians or Austrian migrants and increased “depression” (p = 0.005) and lower “self-control” (p = 0.022), than Austrian migrants. Moreover, 50.9% of native Turks reported a decrease in their mental health status, compared to 31.1% of native Austrians and 23.7% of Austrian migrants. Participants...
SummaryProfessional interpretation and translation are key issues in the improvement of public he... more SummaryProfessional interpretation and translation are key issues in the improvement of public health and patient safety in an area of increased migration and multicultural healthcare system needs. Patient safety requires clear and reliable communication to avoid errors in diagnosis, treatment, and neglect of informed consent. Due to the range of languages to be covered, telephone and video interpretation (VI) can be expected to face up to the demands for trained interpreters available on short notice and in more remote healthcare sites.In a pilot project, we implemented a new up to date model video interpretation unit and used a mixed methods approach integrating quantitative and qualitative data in assessing barriers encountered prior to the use of the pilot system and satisfaction with the use of video interpretation in a number of clinical settings, including inpatient and outpatient units, in Austria. Of all respondents (n = 144) 71% reported frequently encountering language ba...
International Journal of Environmental Research and Public Health
Minors with and without migration background can have different risk factors and triggering reaso... more Minors with and without migration background can have different risk factors and triggering reasons for self-harming and suicidal behaviour. We retrospectively analysed the data of 192 children and adolescents to investigate the transcultural differences in self-harming, as well as suicidal behaviour in Austrian, Turkish, and Bosnian/Croatian/Serbian (BCS)-speaking patients, who were treated in an emergency out-patient clinic in Vienna. Our results showed transcultural differences in both behaviours. In all groups, females had higher rates of suicide attempts and self-harming behaviour than males. While Turkish-speaking patients received treatment more often, after attempted suicide, Austrians and BCS-speaking patients needed treatment more often for acute stress disorder. Suicide attempts and self-harming behaviours were triggered most frequently by intrafamilial problems, but more frequently in migrant patients. Turkish-speaking patients were at a more than 2 times (OR = 2.21, 95%...
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