title: Mental health of refugees following state-sponsored repatriation from Germany.
abstract: BACKGROUND
  In recent years, Voluntary Assisted Return Programmes (VARPs) have received increasing funding as a potential way of reducing the number of refugees in EU member states. A number of factors may affect the mental well-being of returnees. These include adjustment to the home country following return, difficult living conditions, and long-term effects resulting from the severe traumatic stress that had originally driven the affected out of their homes. Little is known about the extent to which these and other factors may promote or inhibit the willingness of refugees to return to their country of origin. The present pilot study investigated refugees who returned to their country of origin after having lived in exile in Germany for some 13 years.
  
  
  METHODS
  Forty-seven VARP participants were interviewed concerning their present living conditions, their views of their native country, and their attitudes towards a potential return prior to actually returning. 33 participants were interviewed nine months after returning to their country of origin. Mental health and well-being were assessed using the questionnaires Posttraumatic Stress Diagnostic Scale (PDS) and EUROHIS and the structured Mini International Neuropsychiatric Interview (M.I.N.I.).Our objectives were to examine the mental health status of refugees returning to their home country following an extended period of exile. We also aimed to assess the circumstances under which people decided to return, the current living conditions in their home country, and retrospective returnee evaluations of their decision to accept assisted return.
  
  
  RESULTS
  Prior to returning to their home country, participants showed a prevalence rate of 53% for psychiatric disorders. After returning, this rate increased to a sizeable 88%. Substantial correlations were found between the living situation in Germany, the disposition to return, and mental health. For two thirds of the participants, the decision to return was not voluntary.
  
  
  CONCLUSIONS
  Psychological strain among study participants was of a considerable magnitude. As a result of traumatic stress experienced during war and refuge, victims were vulnerable and not well equipped to cope with either post-migration stressors in exile or with a return to their country of origin. It is noteworthy that the majority returned under pressure from immigration authorities. Living conditions after return (such as housing, work, and health care) were poor and unstable. Participants also had great difficulty readapting to the cultural environment after having lived abroad for an average of 13 years. Current VARPs do not take these factors into account and are therefore not able to assist in a humanitarian reintegration of voluntary returnees.
authors.affiliation: Psychotrauma Research- and Outpatient Clinic for Refugees, University of Konstanz, Germany. ulrike.von.lersner@psychologie.hu-berlin.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: von Lersner
authors.forename: Thomas
authors.initials: T
authors.lastname: Elbert
authors.forename: Frank
authors.initials: F
authors.lastname: Neuner
mesh_terms: D003710:Demography; D004522:Educational Status; D004641:Emigration and Immigration; D004651:Employment; D005062:European Union; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D001523:Mental Disorders / Q000453:epidemiology*; D008603:Mental Health; D009042:Motivation; D009483:Neuropsychological Tests; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D014857:Warfare