Guided Self-Help Groups for Female Turkish Migrants

Turks are among the most prominent groups of migrants in Austria. Most of these families came to Austria during the sixties of the 20th century, following labor recruitment agreements and initially planned to stay as sojourners only for a limited period of time. Following continuing economic necessity, however, they decided to stay permanently. Most people of Turkish descent, also in the second and third generation, still affiliate with Turkish more than with Austrian culture and still Turkish parents transmit to their children collectivist rather than individualistic values. Traditional Turkish gender roles are adhered to strictly and women have experienced little change with respect to self-determination and personal freedom. Recurrent depressive symptoms, often accompanied by somatic complaints, are frequent among Turkish migrant women. These symptoms are often triggered or intensified both by the cultural strain exerted by their society of origin and by xenophobia encountered from Austrians. Fearing stigmatization and discrimination, many Turkish women are reluctant to utilize psychiatric, psychological, or psychotherapeutic care, even if offered free of charge and the Austrian medical and psychotherapeutic system often is unable to attend sufficiently to the specific needs of Turkish patients. Alternatively, encouraging anecdotal evidence exists towards the effectiveness of culturally sensitive self-help activities for indigenous people. Such community based activities have been frequently reported but rarely examined on a sound empirical basis with respect to their effectiveness. The proposed study intends to install two guided self-help groups (N = 10 each) for Turkish migrant women in Austria with a diagnosis of Recurrent Depressive Disorder (ICD-10 F33) comprising 15 weekly sessions and two booster sessions at a one and a six months follow-up. Administering measures of depressive and somatic symptoms as well as of general psychopathology, in a randomized design, the effectiveness of this intervention will be compared with two group interventions on the basis of interpreter-assisted Cognitive Behavior Therapy (CBT) (N = 10 each) and with two Waiting List Control Groups (N = 10 each). Thus a total of N = 60 women will participate. Measures will be administered at pre-, post-, and at one- and six-months follow up occasions. Each self-help group will be facilitated by a woman of Turkish descent who will receive a para-professional training during a preparatory phase of six months. We hypothesize that, with respect to symptom reduction, the self-help groups (1) will be significantly superior to the Waiting-List Control condition and (2) will be equally effective as the CBT-groups, (3) yielding effect sizes > 1.00 when compared to the Waiting-List Control condition. The self-help groups examined in this study will serve as an example of culturally sensitive, community based interventions for an ethnic group and thus, new insights about the effectiveness and the working mechanisms of such interventions in general are expected. The results shall also highlight promising ways of intervention for other indigenous groups worldwide.

We installed guided self-help groups for N = 66 female Turkish migrants with recurrent depression (mean age 42.7 years) which met 15 times on a weekly basis and compared their effectiveness with 15 sessions of Cognitive Behavior Therapy (CBT) in a group setting and Wait-List Control Groups in a randomized design. People of Turkish descent are among the most frequent groups of migrants in Austria. Most of them, also in the second and third generation, still affiliate with Turkish more than with Austrian culture and many parents transmit to their children rather the values of collectivist Turkish than individualist Austrian culture. Similarly, traditional gender roles are adhered to frequently and women are allowed only limited self-determination and personal freedom. As a consequence, frequently recurrent depressive and somatic symptoms are triggered or intensified by cultural strain from their extended families as well as from xenophobia encountered by Austrians. Fearing stigmatization and discrimination, many Turkish women are reluctant to utilize psychiatric, psychological, or psychotherapeutic care, even if offered free of charge and the Austrian medical and psychotherapeutic system often is unable to attend sufficiently to the specific needs of Turkish patients. Alternatively, encouraging anecdotal evidence exists towards the effectiveness of culturally sensitive self-help activities for indigenous people. Such community based activities have been frequently reported but rarely examined on a sound empirical basis with respect to their effectiveness. Group leaders were female students of Turkish descent, carefully selected, trained and supervised. We administered questionnaires measuring depression, general clinical symptomatology and post-traumatic stress before and after the interventions as well as at two follow-up occasions. In addition, we analyzed session protocols, supervision protocols and interviews with the participants. Contrary to our expectations, neither self-help groups nor CBT were effective in reducing depression, post-traumatic stress or general clinical symptoms as compared to the Wait List Control Group. On an individual basis, however, N = 12 participants reported improvement of depressive symptoms. Younger women and those who reported higher numbers of traumatic events and longer periods of stay in Austria reported a higher amount of symptom reduction. In contrast, in the interviews almost all of the participants agreed that they experienced self-help groups as supportive, as increasing mutual trust and personal strength. Possibly as a consequence of uncontrollable living conditions, short term self-help and CBT were subjectively supportive, but not effective for most of the participants. Both are typically "western" interventions previously unknown to our participants, which may have put too high demands on their autonomy and self- management abilities. As an alternative, we recommend long term psychotherapy in a single setting by female psychotherapists of Turkish descent who are knowledgeable of the patients` cultural background and specific needs.