*2.3. Setting—Psychosocial Walk-In Clinic in the PHV*

The psychosocial walk-in clinic is a psychosocial support offer for mentally burdened refugees. Its team consists of six professionals with psychiatric, psychosomatic, and psychotherapeutic expertise working in the Heidelberg University Hospital's Department of General Psychiatry, Department of Internal Medicine and Psychosomatics, and the Institute of Medical Psychology [28]. Since June 2019, the psychosocial walk-in clinic offers consultation hours three times a week; previously, the service was offered twice a week. Each week, the clinic can provide counseling sessions to fifteen to twenty refugees. Each consultation session is staffed with two members of the psychosocial walk-in clinic and includes clinical diagnostics, documentation, supportive and stabilizing counseling, psychopharmacological medication, and further treatment recommendations [28,29].


**Table 1.** Sociodemographic sample characteristics.

**Sample Characteristics (***n* **= 22)**

Note: <sup>a</sup> information provided by the semi-structured interviews. PTSD: post-traumatic stress disorder. M: mean, SD: standard deviation.

#### *2.4. Semi-Structured Qualitative Interviews*

We used semi-structured, qualitative interviews to collect data on the interviewees' experiences of their mental health problems and the counseling services provided at the PHV psychosocial walk-in clinic. The respective interviews were designed based on the methodological approach by Helfferich [30]. The semi-structured interviews comprised key questions which were followed by probing and more detailed clarifying questions. Table A1 shows the interview guideline used for this study.

#### *2.5. Quantitative and Qualitative Data Analysis*

Demographic variables and baseline characteristics were analyzed using descriptive statistics (frequencies, means, and standard deviations (SD)) and managed with the Statistical Package for the Social Sciences (SPSS) program version 24 [31]. Statements regarding the access routes to the psychosocial walk-in clinic and satisfaction with counseling session were analyzed descriptively (see Table 1).

The qualitative interviews were digitally recorded and transcribed verbatim by one of the first authors (V.Z.) using predefined transcription rules. The qualitative data were analyzed with the software MAXQDA [32] following the principles of qualitative content analysis, as described by Mayring [33]. To do this, we first defined each statement (single or multiple sentences) related to our key questions as a content analytic unit of analysis. Double statements were eradicated, and one statement referred to only one category, so no double coding was possible. We went through each transcribed interview and identified single or multiple content-bearing sentences as quotes, representing the most elemental unit of meaning [34]. Accordingly, these quotes were coded and hereby paraphrased with a term or a short sentence (coding) to summarize them into a relevant category. Thereafter, the categories were grouped into main themes until we could define a number of relevant main themes for all participants. Finally, we discussed the categories and main themes to reach consensus and adjusted them, if necessary [33]. Statements which did not refer to any of our key questions were not analyzed.

#### **3. Results of the Qualitative Interviews**

We identified 315 statements that were coded and summarized into categories. Finally, eleven categories and four main themes were derived. In the following paragraphs, we will present the main themes and categories. Table A2 shows examples of statements for each individual category within the main themes.

#### *3.1. Mental Burden from the Patients' Perspective*

The interviewees described their mental health problems symptomatically, with regard to their illness attributions, and in terms of their perceived future mental well-being.


notably, interviewees often highlighted their current living conditions as a major exacerbating contributor to their psychological burden. For example, one participant stated that he no longer felt like a normal human being and that the accommodations were demeaning.

