Item List

Item Text	Antwort Format	Ergebnis
Demokratien sind entscheidungsschwach und es gibt zu viel Zank und Streit. (2)	Nein
Die Demokratie mag Probleme mit sich bringen, aber sie ist besser als jede andere Regierungsform. (4)	Nein
1. ... felt rushed or under time pressure?[... sich gehetzt oder unter Zeitdruck fühlten?]	Nein
2. ... had severe physical pain?[... starke körperliche Schmerzen hatten?]	Nein	What do test persons mean by "severe physical pain"? The question posed no difficulties for the test persons, who had a homogeneous understanding of severe physical pain. Moreover, no differences by language or country of origin were apparent. Five test persons explained that severe pain was often caused by injuries, especially accidents or sports (IR05, IR06, DA01, DA03, DA06). Four test persons defined severe pain as a physical impairment (DA04) experienced by not being able to walk (SY01, SY04), stand (SY01), or stand up (IR02). Likewise, four test persons explained when pain, in their understanding, should be considered "severe". This was the case when one could not sleep (SY02, IR02), one fainted from it (IR03) or one could not stand the pain without medication (DA05). Most of the test persons mentioned typical site-specific pain in their explanations. These included headaches or migraines (SY03, IR01, DA02, DA03), back pain or problems with the intervertebral disc (IR01, IR02, IR03), pain in the hip, legs, joints, bones (e.g., due to a fracture) or chest (SY04, IR01, IR05, IR06, DA01), pain in internal organs, abdomen, or muscles (SY02, SY03, DA03), and dental pain (SY03) and pain after surgery (SY06). Two test persons also mentioned emotional pain. One of the Iranian test persons even referred exclusively to psychological pain, which was an important topic for the test person for personal reasons at the time of the interview (IR04). A Dari-speaking test person, on the other hand, seemed to have over-read the word "physical" and first explained that there was external, internal, and psychological pain, all of which needed to be considered (DA03). When asked if all forms were meant, she noticed this mistake and focused exclusively on physical pain.
3. … felt down and gloomy?[... sich niedergeschlagen und trübsinnig fühlten?]	Nein	What do the test persons mean by feeling "down" or "gloomy"? Of the Arabic-speaking test persons, six stated that the feelings of dejection and gloom were pressures that were felt (SY04, SY05, SY06, IR01, IR03, IR05). They explained in more detail that this pressure was internal (SY04, IR03) or general (IR01) or a pressure in everyday life (SY06). Four Arabic-speaking test persons equated the words with depression or feeling depressed (SY03, SY04, SY05, IR04). Other explanations included mental stress (IR02), psychological or emotional problems (IR01, IR04), feeling stressed (SY03), or not having peace of mind (IR05). There were no differences in understanding between Arabic-speaking test persons from Syria and Iraq. The Dari-speaking test persons did not name any synonyms for these emotional states, with the exception of DA01, who also spoke German and spoke of depressive. Instead, the Dari-speaking test persons increasingly mentioned (as did a few Arabic-speaking test persons) effects of dejection and gloom. These effects were characterized by either withdrawal or inner turmoil. One test person stated that when she felt this way, she had no desire to exercise or work (SY01). Another said that one did not feel pleasure or was even deprived of pleasure (DA05). Another test person tried to withdraw in such cases and was then not very talkative (DA02). Another explained that she sometimes had so much to do that she no longer knew what to do first. In the end, when she didn't accomplish anything because she had so much on her mind, she felt down. In the case of gloom, it felt like someone was sitting next to her and holding her down in such a way that she couldn't do anything (IR02). Lastly, one test person stated that for her, feeling down or gloomy was feeling angry and that this mood did not go away throughout the day (DA01). The most frequently cited triggers for these problems were homesickness for the country of origin, longing for and concern about the well-being of the family, and fear of whether they would see them again (SY03, SY06, IR03, DA02, DA05). Also frequently mentioned was frustration at not making progress, not achieving goals, or experiencing other obstacles (SY02, SY03, DA01, DA04). In addition, the test persons mentioned work-related problems or the problem of not having a job or having lost their job (SY01, IR04, DA02). Two test persons mentioned physical pain as the only trigger for feeling down and depressed (IR06, DA06). Possibly this is due to the directly preceding item on the topic of pain.
4. …felt lots of energy?[... jede Menge Energie verspürten?]	Nein
5. …because of mental or emotional problems in your work or your daily activities you have achieved less than you wanted?[... wegen seelischer oder emotionaler Probleme in Ihrer Arbeit oder Ihren alltäglichen Beschäftigungen weniger geschafft haben, als Sie wollten?]	Nein	What do the test persons understand by "mental and emotional problems"? Four test persons (across both languages and all three countries of origin) explicitly distinguished between mental or psychological problems on the one hand and emotional problems on the other (SY03, SY06, IR03, DA06). They related emotional problems to family ties, family life, or personal relationships. Two of these test persons explained that they were happily married and therefore had no emotional problems (SY03, SY06). Another explained that she was currently suffering from emotional problems because her spouse was ill (IR03). They defined emotional or psychological problems somewhat more heterogeneously. One respondent spoke of psychological problems due to experiences in the home country that led to flight (SY03). Another remained vague but seemed to refer to mental illnesses (IR03). One test person each mentioned homesickness (SY06) and discrimination or lack of attention (DA06) as psychological problems. The explanations indicate that the question was perceived as a double stimulus at least by individual test persons; however, none of the test persons mentioned having had problems with the question. A total of four other test persons mentioned physical problems that impaired their work or everyday activities. Of these, one test person, even when asked, defined mental problems exclusively as physical problems (SY05). It should be noted that this test person generally showed reading difficulties and comprehension problems throughout the interview. Another test person, when filling out the question, stated that she had health problems that affected her work and that she therefore answered "always" (IR03). However, when asked, she explained what she meant by mental and emotional problems, suggesting that she had rather skimmed over the orientation of the item when first reading and answering. The third test person stated that she understood emotional problems to mean both physical and psychological stress, although in her case the psychological stress also had physical effects such as abdominal pain due to her family situation (IR02). The fourth test person first mentioned psychological problems and then wanted to talk about physical problems (SY03). The interpreter intervened, however, and pointed out to the test person that it was about psychological problems. One test person did not answer the question because she did not currently have a job and felt that the question therefore did not apply to her (DA03). Even the interviewer's inquiry as to whether she had seen the addition of "everyday occupations" did not convince the test person that she could complete this question. For her, work was clearly related to occupation. In addition, she had not experienced any impairment due to mental or emotional problems in the last four weeks, although she attested to suffering from such problems. Another test person, on the other hand, explained that she was currently a housewife and that her daily occupation was therefore her children, even though this did not constitute work (DA05). She had no problems understanding the question or applying it to her circumstances. None of the test persons understood the word "psychic" in a religious context.
Feeling unhappy, sad or depressed most of the time (2) [Sich die meiste Zeit unglücklich, traurig oder deprimiert fühlen (2)]	Nein	What do the test persons understand by feeling "unhappy, sad, or depressed"? While all of the Iraqi test persons stated that they felt "moderately" or even "quite" unhappy, sad or depressed, the Syrian test persons stated that this was "not at all," "not very much" or "moderately. The test persons from Afghanistan used the entire range of answers, with "little" being the most frequently selected answer category and thus more similar to the Syrian test persons. Another difference between the test persons from Iraq on the one hand and from Syria and Afghanistan on the other hand was that only test persons from Syria and Afghanistan (SY01, SY02, SY04, DA05, DA06) made a clear distinction between "unhappy/sad" on the one hand and "depressed" on the other. Sadness was described as something caused by an external event (SY01), such as losing one's house or home due to war (SY01, SY02) or losing an important person (SY03, SY04). Sadness is a negative feeling when one does not feel joy (DA05), but a rather short-term feeling (DA06). Depressiveness, on the other hand, is a stronger negative feeling than sadness (DA05), which is more equivalent to depression (DA06), and especially more persistent than sadness (SY02, DA06). Moreover, depressiveness is not caused by external events, but one carries it within oneself (SY01). One test person explained that sadness is felt when one loses someone, whereas depressiveness is felt when one basically has no one (SY04). For a test person from Afghanistan, the item even contained a double stimulus. She herself was often sad, but not at all depressed, and therefore did not know how to answer (DA06, answer: not specified). None of the test persons from Iraq explicitly made this distinction between sadness/unhappiness and depressed, and all used all three terms synonymously in their explanations. Despite these differences, the test persons from all three countries named similar triggers and also effects of the feelings, so that the item as a whole was understood in the same way across all three countries of origin. States in which one feels "unhappy, sad or depressed" were often described in connection with the social environment. Some test persons were concerned with the loss of family members (SY03, SY04), while others were concerned with the state of being alone (SY04, IR01) and loneliness (SY02, DA02). One test person mentioned the distance to the family, which was in the country of origin (IR06). Not being able to integrate in Germany (currently due to the Corona pandemic; SY06) and general uncertainty about the future (IR02, IR04) were also mentioned as reasons. The effects mentioned included feelings of restlessness (DA02), but also the need to withdraw into oneself (DA05).
Feeling restless, unable to sit still (8) [Sich ruhelos fühlen, nicht stillsitzen können (8)]	Nein	How do the test persons understand "not being able to sit still"? Across both languages and all three countries of origin, the test persons showed a good and very homogeneous understanding of the item. The only exception was a test person from Syria (SY05), who did not understand the first part of the item, "feeling restless". Moreover, she could only imagine physical causes for "not being able to sit still". This test person showed comprehension problems several times during the interview. All other test persons understood the item in the intended sense, that inner restlessness could be expressed physically, so that one could no longer sit still. There were hardly any differences between the countries of origin with regard to the triggers and effects of this feeling. The test persons described the emotional state mainly as restlessness (SY02, SY05, DA02, DA03), excitement (DA01) or nervousness (SY03, IR04, IR05). The Arabic-speaking test persons from Syria and Iraq saw the reasons for restlessness or "not being able to sit still" more in psychological aspects, such as grief (SY06) or internal pressure (IR01, IR02). The test persons from Afghanistan also described aspects related to work, such as unemployment (DA02) or unsuccessful applications (DA03), as well as family problems (DA02) and living conditions (DA04, DA05). Only one test person stated that feelings of restlessness, at least in her case, were mainly due to personal predisposition (SY02).
Cry easily (9) [Leicht weinen zu müssen(9)]	Nein	Is the question about having to "cry easily" perceived as uncomfortable? When translating the item into Arabic and Dari, the translators expressed fears that the translation could be interpreted as "tearful" or even "pretending to cry" and that the question could make the test persons uncomfortable. The cognitive interviews contained evidence that the Arabic-speaking test persons in particular found the item uncomfortable or at least wanted to make sure when answering that they did not portray themselves as tearful. These instances are explained below. Two test persons left the item unanswered (SY05, IR05). Both spontaneously stated that they did not understand the question. SY05 wanted to know whether it was about herself or about other people in general. Although she was supposed to answer in general, she answered that she did not know such situations. When asked if she could imagine why someone else might indicate that they cry easily, she replied that it probably has to do with that person's psyche. The test person seemed to want to avoid any discussion of crying. IR05 explained that she would have to cry quickly if something bothered her that involved a friend or family member, but most of all it was because some people would cry quickly as a matter of principle. She chose to leave the question unanswered. Two other test persons who answered the question with "not at all" also spontaneously indicated comprehension problems (SY01, SY03). For example, one test person remarked that she did not understand the question and asked what was supposed to make her cry (SY03). Pictures and videos showing her home under fire would naturally make her cry, but otherwise this did not happen. Finally, a fourth person made sure whether it was tears of joy or sadness (SY01). She decided herself that it was about tears from sadness. Furthermore, one test person stated that showing tears was a sign of weakness (SY02, answer: little). The remaining seven Arabic-speaking and all Dari-speaking test persons did not seem to find the question unpleasant. The Arabic-speaking test persons focused more on their personality and predisposition to cry in their answers. For example, four Arabic-speaking persons stated that they described themselves as very emotional and empathetic and would therefore cry more easily (SY04, SY06, IR01, IR03). Occasions for this were when they saw other people crying (SY04), when they noticed that others were unwell because they could not manage their daily tasks (IR01), during films or series (SY04, SY06) or also to express their emotional state (IR03). Another test person said that it was basically very difficult for her to cry, especially in front of other people (IR02). The test persons from Afghanistan, on the other hand, included more concrete situations in their explanations that made them cry easily. Two test persons explained that this was triggered primarily by memories and news from their homeland (DA02, DA03, DA05) or interpersonal conflicts (DA03, DA05). Across both languages, only one test person (DA02) explicitly referred to the period of the last four weeks in her answer. In summary, the item was perceived as unpleasant by several test persons; moreover, several test persons understood the item to be about their general disposition to cry. If the health screener is to record whether the respondents have had to cry quickly more often than usual in the last four weeks, this should be emphasized in the item wording.

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