Author
Eva Krczal
Bio: Eva Krczal is an academic researcher from Danube University Krems. The author has contributed to research in topics: Mental health & Prevalence of mental disorders. The author has an hindex of 2, co-authored 6 publications receiving 79 citations.
Papers
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TL;DR: The prevalence estimates suggest that specialized mental health care services for the most vulnerable refugee and asylum-seeking populations are needed, and the highly heterogeneous evidence base could be improved by international, methodologically comparable studies with sufficiently large sample sizes drawn randomly among specific refugee populations.
Abstract: The European Union member states received about 385,000 asylum applications from children and adolescents below 18 years in 2015, and 398,000 in 2016. The latest political crises and war have led to an upsurge in refugee movements into European countries, giving rise to a re-evaluation of the epidemiology of psychiatric disorders and mental health problems among young refugees and asylum seekers. We systematically searched five electronic databases and reference lists of pertinent review articles. We then screened the results of forward citation tracking of key articles for relevant studies in the field for the period from January 1990 to October 2017. We dually reviewed citations and assessed risk of bias. We reported the results narratively, as meta-analyses were impeded due to high heterogeneity. We included 47 studies covered in 53 articles. Overall, the point prevalence of the investigated psychiatric disorders and mental health problems varied widely among studies (presenting interquartile ranges): for posttraumatic stress disorder between 19.0 and 52.7%, for depression between 10.3 and 32.8%, for anxiety disorders between 8.7 and 31.6%, and for emotional and behavioural problems between 19.8 and 35.0%. The highly heterogeneous evidence base could be improved by international, methodologically comparable studies with sufficiently large sample sizes drawn randomly among specific refugee populations. The prevalence estimates suggest, nevertheless, that specialized mental health care services for the most vulnerable refugee and asylum-seeking populations are needed. The systematic review protocol was registered in PROSPERO on October 19th, 2017 with the number: CRD42017080039 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=80039
155 citations
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TL;DR: In this paper, the effects of ethical leadership on job satisfaction, affective commitment and burnout of health care employees, considering frustration tolerance and emotional stability as moderating variables, were examined.
Abstract: PURPOSE This study aims to examine the effects of ethical leadership on job satisfaction, affective commitment and burnout of health care employees, considering frustration tolerance and emotional stability as moderating variables. DESIGN/METHODOLOGY/APPROACH A questionnaire was used to survey health care professionals working in private and public Austrian health-care organizations (hospitals, nursing homes, rehabilitation centers and sanatoriums). The questionnaire consisted of items from well-established scales. The collected data (n = 458) was analyzed using correlation and regression analyzes. FINDINGS Findings indicated that ethical leadership is significantly positively related to job satisfaction (r = 0.485, p < 0.01) and affective commitment (r = 0.461, p < 0.01) and is significantly negatively related to burnout (r = -0.347, p < 0.01). The results also suggest that frustration tolerance (s = 0.101, p < 0.1) and emotional stability (s = 0.093, p < 0.1) moderate the relationship between ethical leadership and burnout. Furthermore, a moderation effect of emotional stability in the ethical leadership and affective commitment relation was indicated. No moderation effect was found for frustration tolerance or emotional stability for the relationship between ethical leadership and job satisfaction. PRACTICAL IMPLICATIONS Ethical leadership emphasizes the socio-emotional dimension in a leader-employee relationship, which can easily be neglected in times of staff cuts and work overload. Leadership training should include the development of skills in how to visibly act as a moral person, as well as how to set clear ethical standards and communicate them to employees. ORIGINALITY/VALUE This study adds value to the limited evidence on the beneficial role of ethical leadership in health care settings. In addition, frustration tolerance and emotional stability have not before been investigated as moderators.
13 citations
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TL;DR: System models of post-migration risk factors for mental health and their interactions were developed in the case of Austria, and fuzzy-logic cognitive mapping techniques were used to integrate the experts’ knowledge.
Abstract: Various studies have indicated that unaccompanied minor refugees (UMRs) have a higher risk of suffering from mental health problems than do accompanied minor refugees and general population norm. However, only a few studies provide data on UMRs regarding post-migration risk factors, their interrelations, and their influence on mental health. In this study, system models of post-migration risk factors for mental health and their interactions were developed in the case of Austria. In three consecutive interactive workshops with scientists and practitioners, fuzzy-logic cognitive mapping techniques were used to integrate the experts’ knowledge. The resulting final system model consists of 11 risk factors (e.g., social contacts in the host country, housing situation, or professional health care services). The model provides a deeper insight into the complexity of interrelated direct, indirect, and reciprocal relations, as well as self-reinforcing triads. This systemic approach provides a sound basis for further investigations, taking into account the inherent complex multifactorial dependencies in this topic.
5 citations
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3 citations
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28 Dec 2017
TL;DR: Findings suggest that health care professionals are highly motivated by intrinsic motivators and support the importance of health workforce engagement and participation in planning health care integration.
Abstract: Fostering integration between caregivers in the ambulatory sector involves transforming the institutional, organizational and technical framework but also redesigning the work performed by health care professionals. Empirical research on the implementation of integrated care highlights professional engagement and commitment as a key success factor during the change process. Although a mismatch of motives during the integration process is often reported only a few studies have explored motivational aspects of health care integration. The aim of this study is to explore motivational factors for health care professionals in order to identify the determinants of attractiveness of integrated forms of care. An online-questionnaire was developed to identify the most important motivational factors for health care professionals and to reflect their perceptions on the attractiveness of interdisciplinary forms of care. The sample includes practicing physicians (general practitioners and specialists), practicing nurses and non-physician professions (physiotherapists, midwives, speech therapists, occupational therapists). Findings suggest that health care professionals are highly motivated by intrinsic motivators. Physicians turned out to be the most reluctant group towards integrated care models. Participating in integrated forms of care would challenge working independently which represents a strong motivator. The responses of nurses suggest that they are the most favorable group. Integrated care forms would be attractive offering more possibilities for social relationships, expanding responsibilities and challenging work. Results support the importance of health workforce engagement and participation in planning health care integration.
2 citations
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01 Jan 2010
TL;DR: In this article, the authors explore the many definitions, concepts, logics and methods found in health system and service integration, and summarize the main elements or building blocks of integrated care and suggest a way to address its various complexities and unknowns in a real world sense.
Abstract: Integrated care is a key strategy in reforming health systems around the world. Despite its importance, the concept's polymorphous nature and lack of specificity and clarity significantly hamper systematic understanding, successful application and meaningful evaluation. This article explores the many definitions, concepts, logics and methods found in health system and service integration. In addition to framing this evolving, albeit imprecise field, the article summarizes the main elements or building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.
310 citations
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TL;DR: Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest a high proportion of refugee children are at risk of educational disadvantage and poor social integration in host communities, potentially affecting their life course.
Abstract: Objective Over half of the world’s refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations. Method Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349). Results Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79−32.64), depression 13.81% (95% CI 5.96−21.67), and anxiety disorders 15.77% (95% CI 8.04−23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08−16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI −0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted. Conclusion Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.
108 citations
27 Aug 2013
TL;DR: Results indicate that many unaccompanied asylum-seeking children have experienced not only war-related traumas but several other severe life adversities as well and it may thus be helpful to conduct early assessments on this group of children to assess their need for treatment or other psychosocial interventions.
Abstract: Severe life events and psychological symptoms were measured by self-report in unaccompanied asylum-seeking children 6 months after arrival in Norway.
88 citations
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TL;DR: Routine assessment and intervention to reduce daily stressors can prevent and reduce psychiatric morbidity in these populations of conflict-affected forced migrants.
82 citations
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TL;DR: Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor of posttraumatic stress, but mean levels of anxiety, PTS, and externalizing symptoms did not.
Abstract: Unaccompanied refugee minors are a particularly vulnerable group. The aim of this study is to increase our knowledge about possible pathways to well-being and integration for unaccompanied refugee minors as they strive to establish new lives in a host county. The present study followed a group of youth who fled to Norway without their caregivers at three time points; 6 months (n = 95; M age = 13.8, 80% boys), 2 years (n = 78; M age = 16.5, 83% boys), and 5 years (n = 47; M age 20.0, 83% boys) after arrival. Linear mixed effects models were used to assess whether age, gender, and trauma exposure prior to arrival were associated with levels and changes in symptoms of posttraumatic stress (PTS), depression, anxiety, and externalizing symptoms over time. Regression analyses were conducted to examine whether daily hassles, perceived social support, and new trauma experiences predict PTS, internalization, externalization, and somatization. The mean levels of depression had decreased significantly at 5 years, but mean levels of anxiety, PTS, and externalizing symptoms did not. Females and severely trauma exposed had higher levels of symptoms. Higher age was associated with less change in symptoms of depression and posttraumatic stress over time. Five years after arrival, many still experienced clinical levels of mental health problems, and level of daily hassles was an important predictor. Support may be needed not only at arrival to handle mental health problems in general and posttraumatic stress in particular, but also after resettlement. Help to manage daily hassles may be especially important to ensure well-being and integration.
62 citations