Skip to main content

ORIGINAL RESEARCH article

Front. Psychol., 19 June 2023
Sec. Pediatric Psychology
This article is part of the Research Topic Mental Health in Children and Adolescents with a Refugee Background View all 11 articles

Factors affecting the acculturation strategies of unaccompanied refugee minors in Germany

  • 1Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
  • 2German Youth Institute, Munich, Germany
  • 3Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany

Background: Different acculturation strategies might be related to different mental health outcomes and social participation of unaccompanied refugee minors (URMs), but little is known about which factors influence this acculturation process. Therefore, the aim of this investigation was to examine the impact of individual, stress-related, and contextual factors on the acculturation process of URMs in Germany.

Methods: A sample of N = 132 URMs living in child and youth welfare service facilities in Germany completed questionnaires about their acculturation orientation, traumatic experiences, daily stressors, asylum stress, and perceived social support between June 2020 and October 2021. This investigation is part of the multi-center randomized control trial BETTER CARE. Data were analyzed descriptively and via multiple hierarchical regression.

Results: Integration (43.5%) and Assimilation (37.1%) were the most common acculturation strategies used by URMs. Multiple hierarchical regression models showed that daily stressors (e.g., the lack of money) were associated with a stronger orientation toward the home country, whereas traumatic events were associated with a weaker orientation toward their home country. No significant predictors were found for the orientation toward the host country.

Discussion: Overall, URMs in Germany showed favorable acculturation strategies. Nevertheless, daily stressors and traumatic experiences might influence this process. The implications for practitioners and policymakers are discussed with a view to further improving the acculturation process of URMs in Germany.

Clinical Trial Registration: German Clinical Trials Register, DRKS00017453 https://drks.de/search/de/trial/DRKS00017453. Registered on December 11, 2019.

1. Introduction

As a consequence of ongoing wars, conflicts, violence or persecution, the number of refugees worldwide continues to rise. In 2020, the UNHCR estimated that 42% of all displaced persons were minors (United Nations High Commissioner for Refugees, 2021). They are often unaccompanied and are, therefore, frequently placed in child and youth welfare service (CYWS) facilities or foster care (Karpenstein and Rohleder, 2022). At the end of 2021, 17.947 unaccompanied refugee minors (URMs) and young refugee adults under the age of 21 were living in CYWS facilities in Germany (Karpenstein and Rohleder, 2022). When resettling to a new country, they have to adapt to a new life, being confronted with acculturation tasks. This entailed learning a new language, making new friends, or becoming accustomed to different traditions (Brook and Ottemöller, 2020).

Acculturation can be understood as a multidimensional, dynamic process of simultaneously adopting aspects of the receiving country and maintaining aspects of the home country (Schwartz et al., 2010). Thus, acculturation is a relevant topic for every individual, who is in contact with more than one country, such as refugees. The most cited acculturation model by Berry (1997) distinguishes between four main acculturation strategies: assimilation, marginalization, integration, and separation. Assimilation describes a strategy in which members of a minority group do not maintain their home cultural identity and are strongly oriented toward the host country. This means, that acculturating individuals might reject traditions from their home country and want to speak the language of the host country only. They often prefer to have friends from the host country than having friends from their home country (d’Abreu et al., 2019). In contrast, the Separation strategy describes the wish of the individuals to maintain their cultural identity, whereas there is no orientation toward the host country. In this case, acculturating individuals, are avoiding the participation in the host society and focus more on their origin and traditions (El-Awad et al., 2021). When individuals are oriented toward both their home and their host country, the term used is Integration. In this case, the acculturating individual practice not only traditions and languages from their home country and aims to have contact to ethnic peers, but they also aim to learn the language of the host country, try to understand new rules and traditions, and want to have friends from both, their home country and the host country (El-Awad et al., 2021). Finally, Marginalization describes the strategy adopted by individuals who are oriented neither toward their home country nor toward the host country. Individuals are not interested neither in their home country nor in the host country. Often, they are not involved in neither activities of the host society nor of their home country.

Regarding the distribution of preferred acculturation styles among refugees, Copoc (2019) has shown that the majority of adult Syrian refugees in Germany showed either the strategy of Integration (48.4%) or Assimilation (42.4%). As the acculturation process is always influenced by the attitudes of the receiving society (Berry, 1997), a similar distribution of displayed acculturation strategies could be expected for URMs in Germany. But since URMs have to deal simultaneously with both acculturation tasks and developmental tasks (Berry et al., 2006), these results cannot be generalized. It is, therefore, even more surprising that information of the preferred acculturation strategies for the specific group of URMs has been lacking up to now.

Although the acculturation model by Berry (1997) is the most common model used in this field of research, more recently this approach has been questioned because of conceptual and statistical problems. To distinguish between the four acculturation strategies proposed by Berry (1997), continuous scores of the orientation toward home and host countries are often dichotomized using median- or mean-splits. This not only leads to a loss of variance but also to smaller sample sizes in the respective groups (Maehler and Shajek, 2016). Therefore, more recently, a continuous approach is preferred, in which the orientation toward the home country and orientation toward the host country are analyzed independently (Demes and Geeraert, 2014).

Although the importance of acculturation for the development of URMs is beyond question, there is very little evidence about factors that affect the acculturation of URMs. But knowing these factors might help to facilitate the acculturation process of URMs and thus, improve the mental health and societal participation of URMs. Some studies have discussed possible factors that influence acculturation. In terms of age, some studies have shown that a younger age might be associated with a stronger orientation toward the host country (Oppedal and Idsoe, 2012, 2015; Lutterbach and Beelmann, 2021). Other studies did not identify any differences in the acculturation strategies in terms of age (Lincoln et al., 2016). Heterogeneous results are also available for gender. Some studies have shown a stronger orientation of refugee girls toward their home country and a weaker orientation toward the host country than of refugee boys (Oppedal and Idsoe, 2012, 2015). Other studies did not identify any gender differences in the acculturation process (Lincoln et al., 2016). Furthermore, several studies have investigated the impact of the time since arrival in the host country on the acculturation process. Overall, these studies suggest that the longer refugees stay in the host country, the stronger the orientations toward the host country would be, whereas the orientation toward the home country diminishes over time (Oppedal and Idsoe, 2015; Lincoln et al., 2016; Jorgenson and Nilsson, 2021; Lutterbach and Beelmann, 2021).

URMs are not only confronted with acculturation tasks in the host country, but they have also to deal with various stress-related factors, such as previous experiences of traumatic events, the asylum process, or the experiences of daily stressors in the receiving society. Nevertheless, studies that investigate the relationship between these stress-related factors and acculturation are rare or lacking completely. Stress symptoms triggered by traumatic experiences such as concentration problems, intrusions, or hyperarousal can make it difficult to learn a new language or build new relationships. Jorgenson and Nilsson (2021) reported in a study of N = 80 Somali refugees in the United States that traumatic experiences did not significantly predict the orientation toward the United States. Similarly, for female adult refugees in Germany, Starck et al. (2020) did not identify any significant correlations between the number of traumatic events and the orientation toward the host and home country. However, an association between the asylum process and acculturation should be considered, as factors such as language acquisition or having a job in the host country are both requirements for permanent residence permits (Hornfeck et al., 2022). Furthermore, they are often used as indicators for successful acculturation (El Khoury, 2019; Brook and Ottemöller, 2020). Nevertheless, no empirical evidence on the relationship between the asylum process and acculturation has been provided up to now. Similarly, the relationship between perceived daily stressors and acculturation is still unclear. A study by Safdar et al. (2021) of Syrian refugees in Germany demonstrated a significant positive correlation between daily stressors and host cultural orientation, whereas no significant association was identified between daily stressors and the orientation toward the home country. However, URMs experience a broad spectrum of daily stressor such as social (e.g., difficulties in making friends, conflicts with adults/peers), material (e.g., lack of money, medical care, food), discrimination (e.g., feeling of being treated differently compared to others), or other stressors related to their specific situation (e.g., feeling of insecurity or worries about their documents) (Vervliet et al., 2014). These different daily stressors may have differing effects on the orientation toward the home country and the host country or vice versa.

These stress-related factors can have a severe negative impact on refugee’s mental health (Vervliet et al., 2014; Hornfeck et al., 2022; Pfeiffer et al., 2022). A large body of research has shown, that especially URMs constitute a vulnerable population for developing trauma-related mental health disorder such as posttraumatic stress disorder (PTSD), anxiety or depression (Fazel et al., 2012; Blackmore et al., 2020). To a lesser extent, research has focused on the potentially bi-directional effect of acculturation strategies and mental health state in this population. However, most of the available data are based on cross-sectional study designs, thus the present findings have to be interpreted with caution, and the association must be discussed in both directions (Green et al., 2021). For instance, in a systematic review focusing on migration populations, Choy et al. (2021) had shown that Marginalization was associated with more depression, compared to the other strategies and that those with a marginalized or separated acculturation style showed the highest anxiety-related symptoms. Several studies have shown a similar relation between acculturation and psychosocial wellbeing in URMs (Oppedal and Idsoe, 2012; El-Awad et al., 2021). In general, Assimilation or Integration seem to be stronger associated with improved psychosocial wellbeing, compared to Separation or Marginalization (Oppedal and Idsoe, 2015; Garcia and Birman, 2022). Nevertheless, there are also studies reporting no significant association between acculturation styles and mental health (Copoc, 2019; Green et al., 2021).

It is widely recognized that social support has a beneficial effect on mental health (Oppedal and Idsoe, 2015), and it seems to have a positive impact on the acculturation process, too. Generally speaking, family members may be a great source of social support for adolescents during their acculturation process (Blanc et al., 2022). For URMs, however, this situation is somewhat more complex because their family members do not live with them in their new host country and are not, therefore, in a position to provide the same social support as family members who are present. Oppedal and Idsoe (2015) highlighted the relevance of social support for URMs in Norway with regard to the acculturation process. They reported that social support from family and co-ethnic friends enhanced the orientation toward the home country, and social support from Norwegian friends enhanced the orientation toward the host country.

To summarize, much has still to be learned about the acculturation process of URMs, more precisely which individual level factors (e.g., gender, age), stress-related factors (e.g., traumatic experiences, daily stressors), or contextual factors (e.g., social support) influence the orientation toward the host country or the home country. To our knowledge, no study has examined the potential predictors of the acculturation process of URMs. Moreover, it is still unclear which acculturation strategies are preferred by this heterogeneous population. Consequently, the aim of this analysis was to gain a better understanding of the acculturation process of URMs in Germany. Our expectation was that the most prevalent acculturation strategies of URMs in Germany would be “Integration” and “Assimilation.” This expectation is based on previous acculturation research in Germany with refugees (Copoc, 2019) and the so called “integration measures” the German government is offering to all URMs (e.g., free German language classes; Hertner, 2022) and the accommodation in CWYS, with professional and specifically trained staff, aiming to help the URMs to get used to the new environment.

Furthermore, the investigation aimed to explore the impact of individual characteristics, stress-related and contextual factors on the acculturation process in order to draw conclusions about the implications for further research, and to derive recommendations for political and mental health practice on how to improve the acculturation process of URMs, which might result in improved mental health and societal participation in URMs.

2. Methods

2.1. Design and procedure

The present study represents a secondary analysis of a subsample of the randomized controlled trial BETTER CARE (bettercare.ku.de; Rosner et al., 2020). The project was approved by the ethics committees at Ulm University (No. 243/19) and at the Catholic University of Eichstätt-Ingolstadt (No. 004-19). CYWS facilities with URMs were contacted through letters of invitation, phone calls, and digital information events. Once a CYWS facility had indicated its willingness to participate in the study, the staff of the CYWS facility identified possible participants, invited and informed them about the study. Inclusion criteria for participants were (1) age 12–20 years, (2) arrived in Germany as unaccompanied minors, (3) applied for asylum or intend to do so, (4) being cared for by a CYWS facility, (5) reported at least one traumatic event in line with the DSM-5 A criterion, and (6) written informed consent given by participant. In the case of minors under the age of 16, their legal guardians were informed and asked for informed written consent.

The assessment took place between July 2020 and October 2021 in the CYWS facilities or in a digital form due to the COVID-19 restrictions. The consent forms and survey measures used in this study were translated by professional translators in cooperation with the study team using the back-translation method (Guillemin et al., 1993) into English, French, Arabic, Dari, Farsi, Pashto, Somali, and Tigrinya.

All variables were assessed using self-report questionnaires on tablets or on paper. Screening appointments were conducted in groups, but the participants filled out the questionnaires by themselves. Each screening appointment took approximately 2 hours for the entire group. Trained staff from the study centers assisted the participants in completing the measures. Interpreters were present when participants were not literate in the languages in which the materials were provided. The participants were given vouchers worth a total of €35 for stores of their choice as compensation for their participation. After the screening, the participants were given a confidential written evaluation of their mental health status along with an individual treatment recommendation.

2.2. Measures

2.2.1. Acculturation orientation toward the home country and the host country

Acculturation orientation was assessed using the Brief Acculturation Orientation Scale (BAOS, Demes and Geeraert, 2014). The participants rated eight items (four items each for the orientation toward the home and the host country) on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), for instance “In Germany, it is important for me to have friends from my home country.” The BAOS was specifically designed in response to the criticism on Berry’s model (Maehler and Shajek, 2016), by using continuous variables to measure acculturation instead of dichotomous variables. Previous studies showed good reliability for adult refugees (α = 0.87–0.89; Safdar et al., 2021). In the present study, both subscales showed good reliability (Cronbach’s αBAOS-Home = 0.80, Cronbach’s αBAOS-Host = 0.76).

2.2.2. Daily stressors

The experience of post-migration daily stressors was assessed using the Daily Stressors Scale for Young Refugees (DSSYR, Vervliet et al., 2014). On a 4-point Likert scale from 0 (not) to 3 (very much) the participants rated the extent to which they had experienced 19 different daily stressors, for instance “not enough food” (possible range: 0–57). The reliability of this scale was good (α = 0.86). This questionnaire is widely used in research with URMs (α = 0.79–0.91; Behrendt et al., 2022; Spaas et al., 2022). It was developed on the basis of the Columbia Impairment Scale (CIS), the Adolescents Complex Daily Stressors Scale (ACDSS), and the authors’ own experiences in the field. Nevertheless, the validation study of this measure has not yet been published.

2.2.3. Traumatic experiences

The Child and Adolescent Trauma Screen was used to assess the number of traumatic events experienced (CATS-2, Sachser et al., 2022). The event checklist with 15 possible traumatic events was presented, for instance “Threatened, hit or hurt badly in my family.” Participants could answer “yes” or “no” to indicate whether they had experienced the presented traumatic event or not. Previous studies with URMs (Müller et al., 2019; Pfeiffer et al., 2022) have shown sufficient to good reliabilities (α = 0.75–0.83). The reliability in the present study was excellent (α = 0.92).

2.2.4. Social support

Social support was assessed using an adapted version of the Social Support Questionnaire (SSQ6-G; Leppin et al., 1986). The general question “To whom can you turn confidentially, if you are in trouble or have problems, if you are in a bad mood, afraid or oppressed?” was asked and the participants could indicate the amount of support they receive from different contact persons (e.g., siblings, teacher) from 1 (most likely) to 4 (never) (13 items, α = 0.74). In the present investigation, the items of the SSQ6-G were dichotomized into yes (answers 1–3) and no (answer 4), and summed up to report the number of possible contact persons. In its original version, the SSQ6-G showed good reliability (α = 0.71 to 0.92).

Furthermore, contact with their families was assessed by means of one item “Do you have contact to your family” and a 6-point Likert scale [0 (No), 1 (Yes, once a year or less), 2 (Yes, several times a year), 3 (Yes, at least once a month), 4 (Yes, at least once per week), and 5 (Yes, daily)].

2.2.5. Group climate

The Group Climate in the CYWS was measured by the Group Climate Instrument for Children (Strijbosch et al., 2014). It contains 14 items and two subscales: open climate (9 items, α = 0.94) and closed climate (5 items, α = 0.50). Participants rated the items on a 5-point Likert-scale from 1 (I do not agree) to 5 (I totally agree). Due to the low reliability, this questionnaire was excluded in the present analysis.

2.3. Statistical analysis

Data analyses were conducted using IBM SPSS Statistics for Windows, Version 28.0. To profile the sociodemographic, the stress-related, and the contextual factors of the sample, descriptive statistics (means, standard deviation, ranges, and frequencies) and correlations were computed. To explore the frequencies of the four different acculturation strategies, the subscales of the BAOS were dichotomized at the scale center, and the participants were assigned to clusters according to how their orientation toward their home country and toward their host country Germany was described. In response to criticism of Berry’s dimensional model of acculturation (Schwartz et al., 2010), the variables of the orientation toward the home country and the host country were deemed to be continuous in all further analyses in this study. Correlation analysis and regression models were calculated separately for each variable. For the DSSYR, a sum score of all items was calculated to capture both the number and the experienced intensity of daily stressors. For the CATS-2, the number of traumatic events were included, using the sum score of the CATS-2 event checklist.

Two multiple linear hierarchical regression analyses were conducted to examine the relative contribution of individual factors, as well as stress-related and contextual factors to the orientation toward the home country and the orientation toward the host country, separately. For each hierarchical regression, the first model included individual demographic characteristics, such as age, gender, and length of stay in the host country. The second model included stress-related factors, such as the number of traumatic experiences, the daily stressors, and the stress caused by asylum status. A third model included contextual factors such as social support. The dependent variable in the regressions was either the mean score of the BAOS subscale “orientation toward the home country” or “orientation toward the host country.”

In a second step, the items of the DSSYR were entered as individual items instead of the sum score in order to consider the heterogeneity of the different types of daily stressors, and to investigate their individual impact. Consequently, the correlation between the single variables of the DSSYR and the BAOS subscales was calculated, and two additional multiple regression models were calculated. The first regression analysis targeted the orientation toward the home country and the second regression analysis the orientation toward the host country, including all 19 items of the DSSYR as independent variables.

A level of significance of p < 0.05 (two tailed) was predetermined in all analyses. Due to the exploratory character of the present analysis, no multiple test adjustments were necessary (Bender and Lange, 2001).

3. Results

Altogether N = 132 URMs who lived in 22 different CYWS facilities in Germany were included in the present investigation. Eight participants were excluded because of missing data (more than 30% of the items in one questionnaire were unanswered). Of the participants, n = 101 (82.5%) identified themselves as male, n = 22 (17.7%) as female, and n = 1 (0.8%) as diverse. Hence, the final sample for this investigation consisted of N = 124 URMs. They ranged in age between 13 and 20 (M = 16.94; SD = 1.47). They were born in 28 different countries, mainly in the Middle East (e.g., Afghanistan n = 38; Syria n = 12) and in African countries (e.g., Somalia n = 15; see Supplementary Material for a detailed list). The length of stay in Germany ranged from 1 to 90 months (M = 25.20, SD = 20.40). Table 1 contains the descriptive characteristics of the full study sample (N = 124) and intercorrelations for each study variable. The participants reported between 1 and 14 traumatic events (M = 6.57, SD = 3.07). Furthermore, n = 43 (34.7%) had no contact with their family, n = 31 (25.0%) reported having contact with their family at least once a week, and n = 19 (15.3%) had contact with their family on a daily basis.

TABLE 1
www.frontiersin.org

Table 1. Descriptive statistics and correlations for study variables.

3.1. Current acculturation patterns of participating URMs

The participants scored higher than the mid-point on the scales of the orientation toward the home country (M = 4.09, SD = 1.60) and the orientation toward the host country Germany (M = 5.36, SD = 1.26). Of the participants, n = 10 (8.1%) displayed a marginalized, n = 5 (4.0%) a separated, n = 46 (37.1%) an assimilated, and n = 54 (43.5%) an integrated acculturation style. The values of n = 9 (7.3%) participants were positioned between two acculturation styles. For more details, see Figure 1.

FIGURE 1
www.frontiersin.org

Figure 1. Acculturation styles.

3.2. Contribution of individual, stress-related, and contextual factors to the acculturation process

The results indicated that the orientation toward the host country Germany correlated positively with the reported stress regarding asylum status (r = 0.261, p = 0.003, 95% CI [0.089; 0.418]), and correlated positively with the orientation toward the home country (r = 0.190, p = 0.035, 95% CI [0.014; 0.354]). Furthermore, the orientation toward the home country correlated positively to a significant degree with the experience of daily stressors (r = 0.201, p = 0.025, 95% CI [0.026; 0.364]). None of the other variables correlated significantly with the acculturation scales.

For the dependent variable orientation toward the home country, only the second model was significant [R2 = 0.121, F(6, 115) = 2.648; p = 0.019]. The results of the hierarchical regressions are presented in Table 2. The number of traumatic events was associated negatively with the orientation toward the home country (β = −0.264, p = 0.009), while the experience of daily stressors was associated positively with the orientation toward the home country (β = 0.310, p = 0.001). Model 3 was not significant. No regression model for the dependent variable of orientation toward the host country was significant (see Table 3).

TABLE 2
www.frontiersin.org

Table 2. Hierarchical regression with orientation toward the home country as dependent variable.

TABLE 3
www.frontiersin.org

Table 3. Hierarchical regression with orientation toward the host country as dependent variable.

3.3. Contribution of daily stressors to the acculturation process

Table 4 shows the correlations between the items of the DSSYR and the orientation toward the host and the home countries. Difficulties in obtaining official documents were related positively to a significant degree with the orientation toward Germany (r = 0.184, p = 0.050; 95% CI [0.000; 0.355]). Not having enough food (r = 0.268, p = 0.003; 95% CI [0.092; 0.427]), clothes (r = 0.269, p = 0.003; 95% CI [0.096; 0.427]), and/or money (r = 0.376, p < 0.001; 95% CI [0.211; 0.520]) as well as involuntarily changes to the CYWS facility (r = 0.199, p = 0.029, 95% CI [0.021; 0.365]) correlated positively with the orientation toward the home country. Difficulties in finding new friends in Germany correlated negatively with the orientation toward the home country (r = −0.215, p = 0.017; 95% CI [−0.377; −0.039]). Further multiple linear regression analyses were conducted to examine the relative contribution of the items of the DSSYR. The regression model for the dependent variable of orientation toward the host country Germany was not significant [R2 = 0.22, F(19, 70) = 1.01, p = 0.457], but the regression model for the dependent variable of orientation toward the home country was significant [R2 = 0.34, F(19, 70) = 1.88, p = 0.03; see Table 5]. The lack of money (β = 0.377, p = 0.019, 95% CI [0.096; 1.034]) and difficulties in making new friends (β = −0.284, p = 0.014; 95% CI [−0.914; −0.104]) was associated with the orientation toward the home country.

TABLE 4
www.frontiersin.org

Table 4. Pearson correlation of items of DSSYR and BAOS Subscales.

TABLE 5
www.frontiersin.org

Table 5. Multiple linear regressions for orientation toward the home country.

4. Discussion

The current study investigated the prevalence of acculturation strategies of URMs in Germany and possible predictors for orientation toward the host country and the home country. As expected, Integration (43.5%) and Assimilation (37.1%) were the most frequent acculturation styles reported by the participants. This is in line with previous studies with adult refugees in Germany (Copoc, 2019). It may back the assumption that the attitudes of the host society play a major role in the acculturation process of refugees (Berry, 1997). In the case of Germany, previous research has shown that the majority population expected refugees to assimilate into German society (Hertner, 2022). URMs in Germany might be confronted with these expectations through overt or subtle comments, behaviors, or policies (Katbeh, 2020), and react consciously or unconsciously with a stronger orientation toward the host country. This assumption is also supported by our finding that none of the studied factors were associated with the orientation toward the host country. This suggest that the attitudes of the receiving society might play an important part in the acculturation process of URMs. Nevertheless, other factors, such as the language proficiency of the URMs (Beißert et al., 2020) or the cultural distance between the home country and the host country (Sam and Berry, 2006) were not included in the present investigation, but might impact the acculturation process of URMs.

Similar to previous studies (Müller et al., 2019), the participants reported having experienced a high number of traumatic events in the present study, too. Higher numbers of traumatic events experienced by the URMs were linked to weaker orientation reported toward their home country or vice versa. It is common knowledge that URMs frequently experienced traumatic events in their home country (Pfeiffer et al., 2022). The weaker orientation toward the home country in relation to experiences of traumatic events might, therefore, constitute a coping strategy of the URMs to avoid being reminded of these traumatic experiences. Nevertheless, our findings contrasted with those of Jorgenson and Nilsson (2021). They did not report any significant association between traumatic experiences and acculturation. Jorgenson and Nilsson (2021) focused on adult Somali refugees in the United States whereas the participants in the present study were URMs in Germany. These two samples differ significantly regarding age and country of origin, and also regarding their migration journey, their current accommodation situation, and their current societal circumstances. Since individual, familial, and contextual factors should be considered when discussing the psychosocial well-being and the acculturation process of refugees (Demes and Geeraert, 2014; Arakelyan and Ager, 2021), generalizations between different refugee populations should be avoided. Instead, our investigation highlights the importance of taking a differentiated look at URMs. It suggests that the traumatic experiences of URMs in Germany might have a relation to the acculturation process that might be different from that of adult refugees.

Furthermore, the URMs reported a high number of daily stressors. This is in line with previous research with URMs after resettlement (Pfeiffer et al., 2022), and highlights the challenging living situation of URMs. In the present investigation, the experience of daily stressors was associated with a stronger orientation toward the home country. This means, that URMs who experienced more daily stressors might show a stronger orientation toward their home country or vice versa. This outcome contrasted with Safdar et al. (2021) who did not report any association between daily stressors and the orientation toward the home country but suggested an association between daily stressors and the orientation toward the host country. There are several possible explanations for this result. The study by Safdar et al. (2021) was conducted with adult Syrian refugees and not with URMs. Moreover, to measure the perceived daily stressors, they used a checklist developed for Vietnamese immigrants in Canada (Lay and Nguyen, 1998) and not a dedicated instrument to measure the daily stressors young refugees may perceive in the host country like the one used in the present study. Nevertheless, it has to be acknowledged that URMs do experience specific daily stressors (Vervliet et al., 2014). It is, therefore, necessary to use special instruments to accommodate this situation. Hence, the present investigation suggests that, for URMs, the experience of daily stressors might lead to a stronger orientation toward their home country, potentially as a way of coping with negative experiences in the host country.

When considering the effects of different stressors independently, our results suggest that, more particularly, the perceived lack of money and fewer difficulties in making new friends might be related with the orientation toward the home country. Vervliet et al. (2015) investigated the aspirations of Afghan refugee minors in Belgium. In this host country, 67% of the participants had the aspiration of earning money for themselves and 56% had the aspiration of earning money for their family. In Germany, while living in CYWS facilities, the URMs only receive a small amount of pocket money according to German law (§34 SBG VIII). Therefore, these aspirations often cannot be fulfilled (Thomas et al., 2018). This might be linked to homesickness (Rosner et al., 2022). The feeling of homesickness might subsequently be related to URMs thinking more about their home country and might be correlated to the orientation toward the home country—as demonstrated in this investigation.

In the present investigation, difficulties in making new friends were negatively associated with the orientation toward the home country. Participants who faced more difficulties in making new friends reported a weaker orientation toward their home country, or vice versa. No significant association with the orientation toward the host country was shown. At first glance, this finding may seem counterintuitive as social support by peers has been identified as an important factor in the acculturation process (Oppedal and Idsoe, 2015). Nevertheless, previous research differentiated between the effect of having friends in the host country and having co-ethnic friends. On the one hand, having friends from the host country might lead to an increase of the orientation toward the host country—by learning the new language or coming into contact with traditions of the host country. On the other hand, having co-ethnic friends might lead to an increase of the orientation toward the home country by offering the possibility of integrating traditions or habits from their home country into their new living environment (Oppedal and Idsoe, 2015; Behrendt et al., 2021). Consequently, the reported difficulties in making new friends might be linked to the wish of having more co-ethnic friends in the host country. This might, in turn, lead to an increased orientation toward the host country.

4.1. Limitations

Several limitations to this investigation have to be borne in mind. First, acculturation must be understood as a lifelong process of negotiation between the home culture and the host culture (Sam and Berry, 2006). Moreover, the participants in the present study came from very different countries of origin and therefore, might have encountered very different acculturation challenges, depending on the customs in their home country. The results can, therefore, only give a first overview about the acculturation of URMs but cannot be generalized for all URMs. Moreover, given the high proportion of male participants (82.5%), the results cannot be easily transferred to merely female groups. Future studies should attempt to work with a larger sample size in order to provide more differentiated views of the acculturation process of URMs.

Second, acculturation is a complex process and might take place differently in various spheres of life (e.g., private vs. public, school vs. home; Safak-Ayvazoglu and Kunuroglu, 2021). This factor also needs to be discussed against the backdrop of the attitudes of the host country (Sam and Berry, 2006). The results of this investigation give a first impression of the overall acculturation orientations of URMs in Germany. Further studies should differentiate between various spheres, and also examine the attitudes of the members of the host country. Qualitative measures could provide further insights, and should be used in future studies.

Third, the results are only based on cross-sectional data, not allowing any causal one-directional conclusions. Future studies should investigate these potentially bi-directional effects in longitudinal study designs to gain further insights into the acculturation process of URMs. Nevertheless, URMs are a very mobile sample (Keles et al., 2018), and longitudinal studies with this population are, therefore, quite challenging, leading to a lack of follow-up data.

Fourth, in respect to the used questionnaires, the CATS-2 is only using a standardized checklist of potentially traumatic events, thus we cannot draw any conclusions about subjective experience behind the reported events. Furthermore, due to the unreliability of the Group Climate Instrument for Children (Strijbosch et al., 2014), this instrument could not be included in the analysis. Consequently, a limited number of contextual factors were considered in the present study. However, the acculturation process is also significantly influenced by societal and contextual factors, and should not be seen as the responsibility of the refugees alone. Further acculturation studies with URMs should take this aspect into account, especially as, in the present investigation, many individual factors did not play a significant role in the acculturation process of URMs.

Sixth, the present investigation was a secondary analysis of the randomized controlled trial “BETTER CARE” (Rosner et al., 2020). Therefore, there was no a priori power calculation made for this specific analysis. Moreover, due to the exploratory character of the present investigation, no alpha correction was made (Bender and Lange, 2001). Nevertheless, there is a potential risk of alpha error inflation, thus generalizations of the present findings should be avoided and previous studies are needed to replicate our findings.

4.2. Implications

Based on the research findings, several implications and recommendations could be derived that could help to improve the successful acculturation process of URMs in Germany. The beneficial acculturation patterns displayed by the URMs highlighted the positive effects of the German so-called “integration measures” (language courses, integration classes, accommodation in CYWS) for URMs. Nevertheless, there is a need to focus more on those who have not yet benefited from these offers, and who potentially displayed less favorable acculturation patterns such as Separation and Marginalization. Having identified specific factors that might have an influence on the acculturation process of URMs, the mental health of this vulnerable population can be improved by clinical, pedagogical and policy interventions that target the individual acculturation process more thoroughly. One way of doing this would be for policymakers and practitioners to focus not only on the orientation toward the host country, but also to consider the orientation toward the home country in their interventions and measures. Up to now, so-called “integration measures” in Germany have mainly sought to strengthen the orientation toward the host country, for example, by offering language courses (Katbeh, 2020; Hertner, 2022). Nevertheless, the present investigation highlights the relevance of the orientation toward the home country when dealing with negative experiences in the host society. Moreover, the association between difficulties in making new friends and poorer orientation toward the home country highlights the importance of creating opportunities for interaction and making friends with both co-ethnic peers and peers from the host society. Therefore, it is crucial to offer acculturation-based programs that strengthen both the orientation toward the home and the host country. This would give URMs an opportunity to develop their own bi- or multicultural identity and to acculturate according to their needs and at their own pace. In the long term, such changes, on the practical and political level, could impact the societal discourse in Germany leading to a shift from the expectation of assimilation (Katbeh, 2020) toward the “real” integration of minority groups such as URMs into the majority society. Moreover, as acculturation always depends on the host society, interventions should not refer solely to URMs, but also consider the perspective, expectations, and participation of the majority society in order to generate a holistic view of the “integration discourse.”

4.3. Conclusion

In sum, URMs in Germany mainly showed favorable acculturation patterns. Stress-related factors such as traumatic experiences and daily stressors may impact the acculturation process of URMs. The investigation highlights possible improvements in policy and practice, which could have lasting positive effects not only on the psychosocial health and social participation of URMs, but also on society as a whole. Future research should investigate the acculturation process in a longitudinal design, possibly over several years and across different developmental phases of the young refugees.

Data availability statement

The datasets generated for this study are available from the corresponding author on request.

Ethics statement

The studies involving human participants were reviewed and approved by ethics committees at Ulm University (No. 243/19) and at the Catholic University of Eichstätt-Ingolstadt (No. 004-19). Written informed consent to participate in this study was provided by the participants and their legal guardians if necessary.

Author contributions

HK, RR, CS, and EP designed the study and were responsible for securing the funding. MG, JE, CS, and EP collected the data. MG performed the statistical analysis and drafted the paper under the supervision of EP and CS. All authors contributed to the article and approved the submitted version.

Funding

This work is part of the BETTER CARE project supported by the German Ministry of Education and Research (01EF1802A, 01EF1802B, and 01EF1802C).

Acknowledgments

We thank all refugees and cooperating CYWS facilities for their participation in our study.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1149437/full#supplementary-material

References

Arakelyan, S., and Ager, A. (2021). Annual research review: a multilevel bioecological analysis of factors influencing the mental health and psychosocial well-being of refugee children. J. Child Psychol. Psychiatry 62, 484–509. doi: 10.1111/jcpp.13355

PubMed Abstract | CrossRef Full Text | Google Scholar

Behrendt, M., Lietaert, I., and Derluyn, I. (2021). Continuity and social support: a longitudinal study of unaccompanied refugee minors’ care networks. J. Immigr. Refug. Stud. 20, 398–412. doi: 10.1080/15562948.2021.1930322

CrossRef Full Text | Google Scholar

Behrendt, M., Pfeiffer, E., Devlieger, I., Adeyinka, S., Rota, M., Uzureau, O., et al. (2022). The impact of daily stressors on unaccompanied young refugees' mental health: a longitudinal study. Am. J. Orthop. 92, 681–691. doi: 10.1037/ort0000644

CrossRef Full Text | Google Scholar

Beißert, H., Gönültaş, S., and Mulvey, K. L. (2020). Social inclusion of refugee and native peers among adolescents: it is the language that matters! J. Res. Adolesc. 30, 219–233. doi: 10.1111/jora.12518

CrossRef Full Text | Google Scholar

Bender, R., and Lange, S. (2001). Adjusting for multiple testing—when and how? J. Clin. Epidemiol. 54, 343–349. doi: 10.1016/S0895-4356(00)00314-0

PubMed Abstract | CrossRef Full Text | Google Scholar

Berry, J. W. (1997). Immigration, acculturation, and adaptation. Appl. Psychol. Int. Rev. 46, 5–34. doi: 10.1111/j.1464-0597.1997.tb01087.x

CrossRef Full Text | Google Scholar

Berry, J. W., Phinney, J., Sam, D. L., and Vedder, P. (2006). Immigrant youth: acculturation, identity, and adaptation. Appl. Psychol. 55, 303–332. doi: 10.1111/j.1464-0597.2006.00256.x

CrossRef Full Text | Google Scholar

Blackmore, R., Gray, K. M., Boyle, J. A., Fazel, M., Ranasinha, S., Fitzgerald, G., et al. (2020). Systematic review and Meta-analysis: the prevalence of mental illness in child and adolescent refugees and asylum seekers. J. Am. Acad. Child Adolesc. Psychiatry 59, 705–714. doi: 10.1016/j.jaac.2019.11.011

PubMed Abstract | CrossRef Full Text | Google Scholar

Blanc, A., Navas, M., Calderón, S., and Sánchez-Castelló, M. (2022). The importance of family in acculturation process of adolescents of Moroccan origin in Spain. Int. J. Psychol. 57, 240–250. doi: 10.1002/ijop.12804

PubMed Abstract | CrossRef Full Text | Google Scholar

Brook, M. I., and Ottemöller, F. G. (2020). A new life in Norway: the adaptation experiences of unaccompanied refugee minor girls. Child Youth Serv. Rev. 117:105287. doi: 10.1016/j.childyouth.2020.105287

CrossRef Full Text | Google Scholar

Choy, B., Arunachalam, K., S, G., Taylor, M., and Lee, A. (2021). Systematic review: acculturation strategies and their impact on the mental health of migrant populations. Public Health Pract. 2:100069. doi: 10.1016/j.puhip.2020.100069

PubMed Abstract | CrossRef Full Text | Google Scholar

Copoc, P. (2019). Acculturation of Syrian refugees in Germany: using a variation of the multidimensional individual difference acculturation (MIDA) model in a new context. Stud. Undergrad. Res. Guelph 11, 1–12. doi: 10.21083/surg.v11i0.5219

CrossRef Full Text | Google Scholar

d’Abreu, A., Castro-Olivo, S., and Ura, S. K. (2019). Understanding the role of acculturative stress on refugee youth mental health: a systematic review and ecological approach to assessment and intervention. Sch. Psychol. Int. 40, 107–127. doi: 10.1177/0143034318822688

CrossRef Full Text | Google Scholar

Demes, K. A., and Geeraert, N. (2014). Measures matter: scales for adaptation, cultural distance, and acculturation orientation revisited. J. Cross-Cult. Psychol. 45, 91–109. doi: 10.1177/0022022113487590

CrossRef Full Text | Google Scholar

El Khoury, S. J. (2019). Factors that impact the sociocultural adjustment and well-being of Syrian refugees in Stuttgart—Germany. Br. J. Guid. Couns. 47, 65–80. doi: 10.1080/03069885.2018.1520196

CrossRef Full Text | Google Scholar

El-Awad, U., Fathi, A., Vasileva, M., Petermann, F., and Reinelt, T. (2021). Acculturation orientations and mental health when facing post-migration stress: differences between unaccompanied and accompanied male middle eastern refugee adolescents, first- and second-generation immigrant and native peers in Germany. Int. J. Intercult. Relat. 82, 232–246. doi: 10.1016/j.ijintrel.2021.04.002

CrossRef Full Text | Google Scholar

Fazel, M., Reed, R. V., Panter-Brick, C., and Stein, A. (2012). Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 379, 266–282. doi: 10.1016/S0140-6736(11)60051-2

PubMed Abstract | CrossRef Full Text | Google Scholar

Garcia, M. F., and Birman, D. (2022). Understanding the migration experience of unaccompanied youth: a review of the literature. Am. J. Orthop. 92, 79–102. doi: 10.1037/ort0000588

PubMed Abstract | CrossRef Full Text | Google Scholar

Green, M., King, E., and Fischer, F. (2021). Acculturation, social support and mental health outcomes among Syrian refugees in Germany. J. Refug. Stud. 34, 2421–2433. doi: 10.1093/jrs/fez095

CrossRef Full Text | Google Scholar

Guillemin, F., Bombardier, C., and Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J. Clin. Epidemiol. 46, 1417–1432. doi: 10.1016/0895-4356(93)90142-N

CrossRef Full Text | Google Scholar

Hertner, I. (2022). Germany as ‘a country of integration’? The CDU/CSU’s policies and discourses on immigration during Angela Merkel’s chancellorship. J. Ethn. Migr. Stud. 48, 461–481. doi: 10.1080/1369183X.2020.1853908

CrossRef Full Text | Google Scholar

Hornfeck, F., Sowade, C., and Bovenschen, I. (2022). Effects of the asylum process on the mental health of unaccompanied young refugees—a scoping review. Child Youth Serv. Rev. 137:106490. doi: 10.1016/j.childyouth.2022.106490

CrossRef Full Text | Google Scholar

Jorgenson, K. C., and Nilsson, J. E. (2021). The relationship among trauma, acculturation, and mental health symptoms in Somali refugees. Couns. Psychol. 49, 196–232. doi: 10.1177/0011000020968548

CrossRef Full Text | Google Scholar

Karpenstein, J., and Rohleder, D. (2022). Die Situation geflüchteter junger Menschen in Deutschland. Bundesfachverband unbegleitete minderjährige Flüchtlinge.

Google Scholar

Katbeh, A. (2020). Social integration of Syrian refugees in Germany: challenges and approaches. Harmoon center for contemporary studies. Available at: https://www.harmoon.org/wp-content/uploads/2020/10/Social-Integration-of-Syrian-Refugees-in-Germany_Katbeh_24.10.2020.pdf

Google Scholar

Keles, S., Friborg, O., Idsøe, T., Sirin, S., and Oppedal, B. (2018). Resilience and acculturation among unaccompanied refugee minors. Int. J. Behav. Dev. 42, 52–63. doi: 10.1177/0165025416658136

CrossRef Full Text | Google Scholar

Lay, C., and Nguyen, T. (1998). The role of acculturation-related and acculturation non-specific daily hassles: Vietnamese-Canadian students and psychological distress. Can. J. Behav. Sci. 30, 172–181. doi: 10.1037/h0087060

CrossRef Full Text | Google Scholar

Leppin, A., Quast, H. H., and Sarason, I. G. (1986). Fragebogen zur Sozialen Unterstützung (Kurzform) SSQ6-G. Skal. Zur Befindlichk. Persönlichkeit Forschungsbericht 5, 195–202.

Google Scholar

Lincoln, A. K., Lazarevic, V., White, M. T., and Ellis, B. H. (2016). The impact of acculturation style and acculturative hassles on the mental health of Somali adolescent refugees. J. Immigr. Minor. Health 18, 771–778. doi: 10.1007/s10903-015-0232-y

PubMed Abstract | CrossRef Full Text | Google Scholar

Lutterbach, S., and Beelmann, A. (2021). How refugees’ stereotypes toward host society members predict acculturation orientations: the role of perceived discrimination. Front. Psychol. 12:612427. doi: 10.3389/fpsyg.2021.612427

PubMed Abstract | CrossRef Full Text | Google Scholar

Maehler, D., and Shajek, A. (2016). “Psychologische Akkulturationsforschung,” in Methoden der Migrationsforschung. eds. D. Maehler and H. Brinkmann (Wiesbaden: Springer).

Google Scholar

Müller, L. R. F., Büter, K. P., Rosner, R., and Unterhitzenberger, J. (2019). Mental health and associated stress factors in accompanied and unaccompanied refugee minors resettled in Germany: a cross-sectional study. Child Adolesc. Psychiatry Ment. Health 13:8. doi: 10.1186/s13034-019-0268-1

PubMed Abstract | CrossRef Full Text | Google Scholar

Oppedal, B., and Idsoe, T. (2012). Problemas de Conducta y Depresión entre Refugiados no Acompañados: La asociación entre el impacto del trauma pre-migratorio y la aculturación. Anal. Psicol. 28, 683–694. doi: 10.6018/analesps.28.3.155981

CrossRef Full Text | Google Scholar

Oppedal, B., and Idsoe, T. (2015). The role of social support in the acculturation and mental health of unaccompanied minor asylum seekers. Scand. J. Psychol. 56, 203–211. doi: 10.1111/sjop.12194

PubMed Abstract | CrossRef Full Text | Google Scholar

Pfeiffer, E., Behrendt, M., Adeyinka, S., Devlieger, I., Rota, M., Uzureau, O., et al. (2022). Traumatic events, daily stressors and posttraumatic stress in unaccompanied young refugees during their flight: a longitudinal cross-country study. Child Adolesc. Psychiatry Ment. Health 16:26. doi: 10.1186/s13034-022-00461-2

PubMed Abstract | CrossRef Full Text | Google Scholar

Rosner, R., Hagl, M., Bücheler, L., and Comtesse, H. (2022). Homesickness in asylum seekers: the role of mental health and migration-related factors. Front. Psychol. 13:1034370. doi: 10.3389/fpsyt.2022.1034370

PubMed Abstract | CrossRef Full Text | Google Scholar

Rosner, R., Sachser, C., Hornfeck, F., Kilian, R., Kindler, H., Muche, R., et al. (2020). Improving mental health care for unaccompanied young refugees through a stepped-care approach versus usual care+: study protocol of a cluster randomized controlled hybrid effectiveness implementation trial. Trials 21:1013. doi: 10.1186/s13063-020-04922-x

PubMed Abstract | CrossRef Full Text | Google Scholar

Sachser, C., Berliner, L., Risch, E., Rosner, R., Birkeland, M. S., Eilers, R., et al. (2022). The child and adolescent trauma screen 2 (CATS-2)—validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. Eur. J. Psychotraumatol. 13:2105580. doi: 10.1080/20008066.2022.2105580

PubMed Abstract | CrossRef Full Text | Google Scholar

Safak-Ayvazoglu, A., and Kunuroglu, F. (2021). Acculturation experiences and psychological well-being of Syrian refugees attending universities in Turkey: a qualitative study. J. Divers. High. Educ. 14, 96–109. doi: 10.1037/dhe0000148

CrossRef Full Text | Google Scholar

Safdar, S., Ray-Yol, E., Reif, J. A., and Berger, R. (2021). Multidimensional individual difference acculturation (MIDA) model: Syrian refugees’ adaptation into Germany. Int. J. Intercult. Relat. 85, 156–169. doi: 10.1016/j.ijintrel.2021.09.012

CrossRef Full Text | Google Scholar

Sam, D. L., and Berry, J. W. (2006). The Cambridge Handbook of Acculturation Psychology. 1st Edn. Cambridge University Press.

Google Scholar

Schwartz, S. J., Unger, J. B., Zamboanga, B. L., and Szapocznik, J. (2010). Rethinking the concept of acculturation: implications for theory and research. Am. Psychol. 65, 237–251. doi: 10.1037/a0019330

PubMed Abstract | CrossRef Full Text | Google Scholar

Spaas, C., Verelst, A., Devlieger, I., Aalto, S., Andersen, A. J., Durbeej, N., et al. (2022). Mental health of refugee and non-refugee migrant young people in European secondary education: the role of family separation, daily material stress and perceived discrimination in resettlement. J. Youth Adolesc. 51, 848–870. doi: 10.1007/s10964-021-01515-y

PubMed Abstract | CrossRef Full Text | Google Scholar

Starck, A., Gutermann, J., Schouler-Ocak, M., Jesuthasan, J., Bongard, S., and Stangier, U. (2020). The relationship of acculturation, traumatic events and depression in female refugees. Front. Psychol. 11:906. doi: 10.3389/fpsyg.2020.00906

PubMed Abstract | CrossRef Full Text | Google Scholar

Strijbosch, E. L. L., van der Helm, G. H. P., van Brandenburg, M. E. T., Mecking, M., Wissink, I. B., and Stams, G. J. J. M. (2014). Children in residential care. Res. Soc. Work. Pract. 24, 462–469. doi: 10.1177/1049731513510045

CrossRef Full Text | Google Scholar

Thomas, S., Sauer, M., and Zalewski, I. (2018). Unbegleitete minderjährige Geflüchtete: Ihre Lebenssituationen und Perspektiven in Deutschland. Transcript-Verlag.

Google Scholar

United Nations High Commissioner for Refugees (ed.). (2021). Global trends: Forced displacement in 2020.

Google Scholar

Vervliet, M., Lammertyn, J., Broekaert, E., and Derluyn, I. (2014). Longitudinal follow-up of the mental health of unaccompanied refugee minors. Eur. Child Adolesc. Psychiatry 23, 337–346. doi: 10.1007/s00787-013-0463-1

PubMed Abstract | CrossRef Full Text | Google Scholar

Vervliet, M., Vanobbergen, B., Broekaert, E., and Derluyn, I. (2015). The aspirations of afghan unaccompanied refugee minors before departure and on arrival in the host country. Childhood 22, 330–345. doi: 10.1177/0907568214533976

CrossRef Full Text | Google Scholar

Keywords: unaccompanied refugee minors, acculturation, daily stressors, integration, trauma

Citation: Garbade M, Eglinsky J, Kindler H, Rosner R, Sachser C and Pfeiffer E (2023) Factors affecting the acculturation strategies of unaccompanied refugee minors in Germany. Front. Psychol. 14:1149437. doi: 10.3389/fpsyg.2023.1149437

Received: 21 January 2023; Accepted: 22 May 2023;
Published: 19 June 2023.

Edited by:

Serena Grumi, Neurological Institute Foundation Casimiro Mondino (IRCCS), Italy

Reviewed by:

Caterina Mamprin, Universitéde Moncton, Canada
Kerstin Spanhel, University of Freiburg, Germany

Copyright © 2023 Garbade, Eglinsky, Kindler, Rosner, Sachser and Pfeiffer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Maike Garbade, TWFpa2UuR2FyYmFkZUB1bmlrbGluaWstdWxtLmRl

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.