Migration from Mexico to the United States and subsequent risk for depressive and anxiety disorders: a cross-national study

Ethics in Mental Health Research with Haitian Migrants: Lessons from a Community-Based Study in Santiago, Chile

Migration research poses several unique challenges and opportunities. Conducting ethical global health practice, especially when studying migrant mental health, is of particular concern. This article explores seven challenges and lessons learned in our mixed-methods study conducted to assess the impact of the migration experience on Haitian migrants' mental health in Santiago, Chile. The primary challenges were recruiting in a highly mobile population, building trust and community participation, overcoming language barriers, safety considerations during the Covid-19 pandemic, mitigating potential negative impacts of research on the community, providing psychological support, and finding meaningful ways to benefit the community. We propose moving toward a better and more ethical migrant research practice by ensuring language accessibility, hiring community members for the study team, working with local institutions and nongovernmental organizations, and maintaining sustainable connections.

Depression and anxiety symptoms among Vietnamese migrants in Japan during the COVID-19 pandemic

This study aimed to examine the mental health status and related factors among Vietnamese migrants in Japan during the COVID-19 pandemic. We conducted an online cross-sectional survey between September 21 and October 21, 2021. Along with Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scores, we collected data on demographics, changes in socioeconomic status due to the pandemic, language proficiency, social support, and health conditions. Multivariate logistic regression was performed to identify factors related to symptoms of depression and anxiety. Among 621 participants who completed the questionnaire, moderate-to-severe symptoms of depression (PHQ-9 score ≥ 10 points) and mild-to-severe symptoms of anxiety (GAD-7 score ≥ 5 points) were observed in 203 (32.7%) and 285 (45.9%) individuals, respectively. Factors related to depressive symptoms were age (95% confidence interval [CI]=0.89-0.99), pre-existing health conditions (95% [CI]=1.61-3.76), and a low subjective socioeconomic status (95% [CI]=1.64-3.71). Factors related to anxiety symptoms were being single (95% [CI]=1.01-2.93), having pre-existing health conditions (95% [CI]=1.63-3.88), subjective socioeconomic status (95% [CI]=1.87-3.97), and absence of a partner to discuss one's health with (95% [CI]=1.11-2.47). Vietnamese migrants in Japan experienced a decrease in income, worsening working conditions, and poor mental health status during the COVID-19 pandemic. Further investigations are necessary to find an effective way to increase their social support and mitigate socioeconomic adversities.

Prevalence of depressive disorder in the adult population of Latin America: a systematic review and meta-analysis

Background

Depressive disorder is one of the leading causes of disability worldwide; however its prevalence and association with inequality and crime is poorly characterised in Latin America. This study aimed to: i. systematically review population-based studies of prevalence of ICD/DSM depressive disorder in Latin America, ii. report pooled regional, country, and sex-specific prevalence estimates, and iii. test its association with four country-level development indicators: human development (HDI), income (Gini) and gender inequality (GII), and intentional homicide rate (IHR).

Methods

We conducted a systematic review and meta-analysis of population-based studies reporting primary data on the prevalence of ICD/DSM depressive disorder in Latin America from 1990 to 2023, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO (regional database), LILAC (regional database), and available grey literature. Study quality was assessed using JBI's critical appraisal tools. We generated pooled estimates using random-effects meta-analysis; heterogeneity was assessed using the I2 statistic. Meta-regression analyses were used to test associations of depression prevalence with indicators of inequality and human development. The study was registered with PROSPERO (CRD42019143054).

Findings

Using data from 40 studies in Latin America, lifetime, 12-month, and current prevalence of ICD/DSM depressive disorder were calculated at 12.58% (95% CI 11.00%-14.16%); 5.30% (4.55-6.06%), and 3.12% (2.22-4.03), respectively. Heterogeneity was high across lifetime, 12-month, and current prevalence, sex, and countries. 12-month and current prevalence was associated with higher Gini and GII, 12-month prevalence with lower HDI, and current prevalence with higher IHR.

Interpretation

We found a high prevalence of ICD/DSM depressive disorders in Latin America, and a statistically significant association with inequality and development indicators. The high heterogeneity found across prevalence periods and the major gaps in country representation underscore the need to escalate efforts to improve mental health access and research capabilities in Latin America. Systematic, comparable prevalence estimates would inform more effective decision-making in the region.

Funding

Pfizer Independent Medical Education Grant.

Barriers and facilitators to mental health promotion for Mexican immigrants in the U.S. through the Ventanillas de Salud program

Introduction

Mental health promotion and screenings are recommended as part of standard preventive care. Mexican immigrants in the U.S. are at high risk for mental health illness especially after the COVID-19 pandemic, however access to mental health prevention for this population has been limited, which results in important implementation and equity gaps. The Ventanilla de Salud (VDS) program provides preventive services through Mexican consulates in the U.S.

Objective

The objective of this study was to assess capability, opportunity, and motivation for promotores to implement mental health programming through the VDS, leveraging early experiences of ongoing mental health prevention efforts.

Methods

This was a qualitative study using the Capability, Opportunity, and Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 40 VDS promotores and 6 semi-structured interviews with program stakeholders. Data were analyzed using inductive and deductive coding.

Results

We found high levels of interest from the leadership, partners, and promotores to provide mental health services through the VDS. Early implementation of a mental health strategy that included training sessions for promotores and mental health promotion, screenings and referrals for VDS users was ongoing. We identified facilitators and barriers that could affect capability, opportunity, and motivation to provide mental health services. Facilitators included promotores' extensive knowledge about the importance of mental health, promotores service mindset and commitment to provide services to VDS users, and general support from the VDS network and partners. Barriers included promotores' turnover, need for additional economic compensation, burnout, competing priorities, and lack of mental health professionals to provide clinical services or supervision. Additional investments are recommended to support promotores' well-being.

Conclusion

The main lesson learned from this study was that investing in VDS promotores' training, resources, and well-being is key to their capability, opportunity and motivation to provide mental health services for Mexican immigrants in the US. Results from this study can be applied to improve the ongoing VDS mental health strategy and increase its impact on the mental health of Mexican immigrants.

Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark

PURPOSE

Immigrants may have increased risk of mental disorders compared with native-born persons. We aimed to expand the limited research on immigrants' posttraumatic psychopathology related to traumatic experiences in their country of resettlement.

METHODS

We obtained data from a cohort of Danish residents with ≥ 1 traumatic event recorded in health and administrative national registries during 1994-2016. We calculated risks of posttraumatic stress disorder (PTSD), depression, and substance use disorders (SUD) within 5 years post-trauma among native-born Danes and immigrants who had been in Denmark for ≥ 10 years at the time of their index trauma (including immigrants overall and immigrants from specific regions). Risks were compared via age- and sex-standardized risk ratios (SRR) with 95% confidence intervals (CI). We restricted to persons with no record of the disorder under investigation in the 10 years pre-trauma, and stratified by non-interpersonal (e.g., transport accidents) versus interpersonal trauma (e.g., assaults).

RESULTS

Following non-interpersonal trauma, immigrants were more likely than native-born Danes to be diagnosed with PTSD (SRR = 5.2, 95% CI 4.6, 5.9), about as likely to be diagnosed with depression (SRR = 0.98, 95% CI 0.92, 1.1), and less likely to be diagnosed with SUD (SRR = 0.89, 95% CI 0.82, 0.95). Results were similar following interpersonal trauma, except the SRR for PTSD was reduced in magnitude (SRR = 3.0, 95% CI 1.7, 5.4). There were differences by region of birth.

CONCLUSION

Immigrants to Denmark have higher risk of PTSD following traumatic experiences than do native-born Danes, possibly due to the combined influence of adverse pre-, peri-, and/or post-migration experiences.

Exploring the Association Between Detention Conditions, Detention-Related Abuse, and Mental Health Among Deported Mexican Migrants

Migration, detention, and deportation are often rife with violence. This study sought to examine associations between pre-migration experiences, detention conditions, and mental health among Mexicans deported from the U.S. to Mexico between 2020 and 2021. Data from the Migrante Project (N=306, weighted N=14,841) were analyzed using descriptive statistics and unadjusted and adjusted multivariate regression models. The prevalence of a lifetime mental health diagnosis was 18.5%. Exposure to adverse conditions in detention (adjusted odds ratio [AOR]=17.56, p<.001) and having been detained in both immigration and non-immigration facilities (AOR=9.70, p=.042) were significantly associated with increased odds of experiencing abuse during migrants' most recent detention. Experiencing abuse during migrants' most recent detention was, in turn, associated with increased odds of a lifetime mental health diagnosis (AOR=4.72, p<.005). Targeted, trauma-informed mental health services are needed for deported Mexican migrants.

Common mental disorders in Peruvian immigrant in Chile: a comparison with the host population

BACKGROUND

The Inner Santiago Health Study (ISHS) aimed to (i) estimate the prevalence of common mental disorders (CMD; i.e. depressive and anxiety disorders) among immigrants of Peruvian origin in Chile; (ii) determine whether such immigrants are at higher risk of CMD when compared with the native-born geographically matched population (i.e. non-immigrants); and (iii) identify factors associated with higher risk of any CMD among this immigrant group. A secondary aim was to describe access to mental health services by Peruvian immigrants meeting criteria for any CMD.

METHODS

Findings are based on a population-based cross-sectional household mental health survey of 608 immigrant and 656 non-immigrant adults (18-64 years) residing in Santiago de Chile. Diagnoses of ICD-10 depressive and anxiety disorders and of any CMD were obtained using the Revised Clinical Interview Schedule. The relationships between demographic, economic, psychosocial, and migration-specific predictor variables, and risk of any CMD were analyzed with a series of stepwise multivariate logistic regression models.

RESULTS

The one-week prevalence of any CMD was 29.1% (95% CI: 25.2-33.1) among immigrants and 34.7% (95% CI: 30.7-38.7) among non-immigrants. Depending on the statistical model used in the pooled sample, we found the prevalence of any CMD among non-immigrants to be higher (OR=1.53; 95% CI: 1.05-2.25) or similar (OR=1.34; 95% CI: 0.94-19.2) when compared with immigrants. In the multivariate stepwise regression of any CMD in immigrants only, the prevalence was higher for females, those with primary compared to higher education, in debt and exposed to discrimination. Conversely, higher levels of functional social support, sense of comprehensibility, and manageability were associated with a lower risk of any CMD in immigrants. In addition, no differences were observed between immigrants and non-immigrants reporting any CMD in mental health service utilization.

CONCLUSION

Our results evidence high levels of current CMD in this immigrant group, particularly amongst women. However, lower adjusted prevalence of any CMD in immigrants compared to non-immigrants was limited to preliminary statistical models, thus failing to provide clear support for a "healthy immigrant effect". The study sheds new light on differences in CMD prevalence by immigrant status in Latin America by examining differential exposure to risk factors in immigrant versus non-immigrant groups.

Acculturation and depressive symptoms among older Chinese immigrants in the United States: the roles of positive and negative social interactions

Objectives: Immigration is a stressful experience. Social interactions with family members and friends play an important role in the health and well-being of immigrant older adults. This study examined the association between different domains of acculturation and depressive symptoms among older Chinese immigrants in the United States and investigated the roles of positive and negative interactions with family and friends in such associations.Method: We used data from the Population Study of Chinese Elderly (PINE), a population-based survey of community-dwelling Chinese older adults in the Greater Chicago area (N = 3,158). Depressive symptoms were measured by the PHQ-9. Acculturation, positive and negative social interactions with partner/family/friends were all measured by standard scales. Binary logistic regression models were used to examine the relationship between acculturation and the probability of having depressive symptoms.Results: Results showed that only social acculturation was correlated with a higher likelihood of having depressive symptoms after controlling for relevant sociodemographic variables. Results also demonstrated that 'high positive & high negative', as well as 'high positive & low negative' social interactions had significant moderating effects on the association between media acculturation and depressive symptoms.Conclusion: The study findings suggest that although older Chinese immigrants in the United States with high levels of social acculturation are vulnerable to depressive symptoms, high positive social interactions with partner/family/friends buffer the relationship between media acculturation and depressive symptoms. Community services can help with social acculturation and more positive interactions from partner/family/friends to alleviate depressive symptoms among older Chinese immigrants.

Examining the Independent Association Between Acculturative Stress and Psychological Distress Among Mexican Immigrants in New York City: An Exploratory Study

Objective

This study examines the association between acculturative stress and psychological distress among Mexican immigrants living in New York City. It takes account factors such as language barriers, legal status, fear of deportation, and avoidance of social health and human services, and how these factors are implicated in the mental health status of the study population.

Design

Study draws from a community-based sample of Mexican American adults from the Social Network of Mexican Americans study recruited from a church-based community center in the Bronx, New York. Eighty Mexican immigrants were included in this analysis. Descriptive statistics were used to display participants' characteristics. Pearson correlation and multiple regressions were run to determine the relationship between acculturative stress and psychological distress, and also with each of the items from the acculturative stress scale. Both scales have been validated among Spanish-speaking Latino immigrants.

Results

A significant moderate positive relationship was found between acculturative stress and psychological distress. Within the acculturative stress scale, those items related to language discrimination, evasion of health services, and feeling guilty for leaving family/friends in home country had significant associations with increased psychological distress.

Conclusion

The findings support the need for interventions that account for the major stressors associated with being a Mexican immigrant in the United States to prevent psychological distress, especially given the anti-immigration policies.

Health Correlates of Intimate Partner Violence and Help-seeking Among Unauthorized Immigrant Women

Intimate partner violence (IPV) research on immigrant women who are unauthorized is particularly scarce, despite unique vulnerabilities associated with their documentation status that may impact help-seeking and health outcomes. The purpose of this study was to document the frequency of lifetime IPV and related help-seeking behaviors, and examine the relationship between IPV, major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and health-related quality of life (HRQL) among a community health center-based sample of unauthorized, Spanish-speaking immigrant women in Philadelphia. A clinic-based sample of unauthorized Spanish-speaking women (N = 200, ages 18-65) completed an anonymous, cross-sectional survey on IPV experiences, help-seeking behaviors, and self-reported health in 2013-2014. Chi-square tests assessed associations between sociodemographic variables and IPV. Multivariable logistic regression investigated whether IPV predicted mental health outcomes. Approximately one in three (34.5%) women reported lifetime IPV experiences. Of these, half (56.6%) sought help (formal n = 22; informal n = 25) because of the violence. Women identified not knowing where to go, believing that help was not necessary, and embarrassment as barriers to help-seeking. Symptoms consistent with MDD and PTSD were reported by 40.5% and 16% of the sample, respectively. In unadjusted logistic regression models, IPV survivors were more likely to endorse MDD and PTSD, and report low mental health HRQL scores than counterparts without IPV. In fully adjusted models, only the association between IPV and PTSD remained significant (OR: 3.80, p =.01). Study findings document high frequencies of IPV, MDD, and PTSD among this clinic-based sample of unauthorized immigrant women. Women who reported IPV also had a greater likelihood of reporting symptoms consistent with PTSD. Findings highlight the need for clinic-based mental health and trauma-informed services tailored to unauthorized immigrant women as well as interventions to decrease IPV.

Migration experiences of Central American youth: Developing a new measure

In recent years, the number of children and families migrating from Central America to the United States (U.S.) has increased exponentially (Rosenblum, 2015). Likely due to this influx, research on Latinx immigrants has also increased. However, no standard assessment of youth migration experiences currently exists. The present study introduces a new measure and pilot data on the migration experiences of youth from Central America. The Migration Experiences Interview (MEI) is a 25-question semi-structured interview that encompasses youths' experiences before, during, and after migration to the U.S, covering topics such as their control over the decision to migrate, whether they witnessed frightening situations along their journey, and their experiences living in the U.S. thus far. The present study provides pilot data on a sample of 64 recently migrated Central American youths aged 15 to 25 (39.1% female). The MEI provides in-depth characterizations and narrative examples of migration experiences that add important information on a largely understudied population to the literature. The MEI's standard, publicly available format has utility for increased consistency in future research and implications for clinical practice and immigration policy.

Medical student anxiety and depression in the COVID-19 Era: Unique needs of underrepresented students

BACKGROUND

The COVID-19 pandemic has caused significant morbidity, mortality, and mental health consequences. Few studies have examined the mental toll of COVID-19 on United States (US) medical students, who experience greater rates of depression and anxiety than the general population. Students who identify as underrepresented in medicine (URM) may experience even greater mental health adversities than non-URM peers. This study examines COVID-19's impact on preclinical medical student anxiety and depression and unique challenges disproportionately affecting URM students during the initial phase of the pandemic.

METHODS

Medical students at four US institutions completed an anonymous survey including the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires for depression and anxiety. Participants provided information on demographics, past mental health difficulties, and concerns during the pandemic. Chi-square and Mann-Whitney U tests were performed using SPSS.

RESULTS

During the initial phase of the pandemic, URMs were 3.71 times more likely to be in the at-risk category on GAD-7 than non-URM peers. Before COVID-19, there was no significant difference between self-reported feelings or diagnoses of anxiety between groups. During the COVID-19 pandemic, there were significant differences in feelings of increased anxiety between URM (Mdn = 76) and non-URM (Mdn = 49) students, U = 702.5, P < 0.001, feelings of increased sadness between URM (Mdn = 49) and non-URM (Mdn = 34) students, U = 1036.5, P = 0.042, concern for new financial difficulty between URM (Mdn = 50) and non-URM students (Mdn = 7), U = 950.5, P = 0.012, and concern about lack of mental health support from their academic institution between URM (Mdn = 18) and non-URM students (Mdn = 9), U = 1083, P = 0.036 (one-tailed).

DISCUSSION

Large-scale crises such as COVID-19 may exacerbate mental health disparities between URM and non-URM students. Medical schools should consider increasing financial and mental health support for URM students in response to these significant adverse events.

Epidemiology of depression among displaced people: A systematic review and meta-analysis

INTRODUCTION

Displaced people are prone to develop mental health problems due to resettlement in new environments, traumatic events and forced migration. Depression is a mental health problem repeatedly observed among displaced people such as refugees, migrants, asylum seekers and internally displaced persons (IDPs). Therefore, estimating the global pooled prevalence of depression as well as pinpointing its determinants may support policymakers and health care workers to mitigate the disease burden and improve the psychological well-being of displaced people.

METHODS

PubMed, EMBASE, CINAHIL, Psych-INFO, and SCOPUS databases were searched for English written relevant observational studies conducted between 1984 and 2020. The methodological quality of studies was assessed using the Newcastle Ottawa Scale (NOS). Heterogeneity across studies was checked using the Q- and I² test. Publication bias was checked by observing Funnel plot symmetry and using Egger's regression test. STATA 16 was used to combine studies using a random effect model.

RESULTS

Of the 4102 studies identified, 81 studies with an overall sample size of 53,458 were included in the current systematic review and meta-analysis. The pooled prevalence estimate of depression among displaced people was 26.4% (95% CI; 22.2-31.1). Also, three in five IDPs, one in three refugees and asylum seekers and one in four migrants suffer from depression globally. Being female migrant [AOR: 2.46 95% CI: 1.79-3.13, I²=34.5%), non-partnered marital status [AOR: 2.29, 95% CI: 1.29-3.30, I²= 0.00%], and perceived low social support [AOR: 1.76, 95% CI: 1.00-2.52, I²=34.6%] were significant determinants of depression among displaced people.

CONCLUSION

Overall, around 1 in 4 displaced people suffer from depression and exceed the prevalence of depression reported by community samples in different nations and demonstrate a need for culturally fitting and targeted responses from migrant/refugee host nations and their serving clinicians.

Depression, diabetes and immigration status: a retrospective cohort study using the Canadian Longitudinal Study on Aging

BACKGROUND

A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada.

METHODS

We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin A_1c level was 7% or more; we defined participants as having depression if their Center for Epidemiological Studies Depression score was 10 or higher or if they were currently undergoing depression treatment. We excluded those with baseline depression (Cohort 1) and baseline diabetes (Cohort 2) to evaluate the associations between diabetes and depression incidence, and between depression and diabetes incidence, respectively. We constructed logistic regression models with interaction by immigrant status.

RESULTS

Cohort 1 (n = 20 723; mean age 62.7 yr, standard deviation [SD] 10.1 yr; 47.6% female) included 3766 (18.2%) immigrants. Among immigrants, 16.4% had diabetes, compared with 15.6% among nonimmigrants. Diabetes was associated with an increased risk of depression in nonimmigrants (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.08-1.49), but not in immigrants (adjusted OR 1.12, 95% CI 0.80-1.56). Younger age, female sex, weight change, poor sleep quality and pain increased depression risk. Cohort 2 (n = 22 054; mean age 62.1 yr, SD 10.1 yr; 52.2% female) included 3913 (17.7%) immigrants. Depression was associated with an increased risk of diabetes in both nonimmigrants (adjusted OR 1.39, 95% CI 1.16-1.68) and immigrants (adjusted OR 1.60, 95% CI 1.08-2.37). Younger age, male sex, waist circumference, weight change, hypertension and heart disease increased diabetes risk.

INTERPRETATION

We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.

Competence in Daily Activities and Mental Well-Being among Technical Intern Trainees in Japan: A Cross-Sectional Study

Migrant workers are at a greater risk of having low mental well-being compared to their local counterparts. The Japanese government accepts migrants through its Technical Intern Training programs, but the factors associated with their mental well-being remain unclear. This study aimed to (1) assess trainees' competence and importance in daily activities and (2) examine the association between their competence and mental well-being. We conducted a cross-sectional study using self-administered questionnaires. We recruited trainees through their supervising organizations and social media. We used the Occupational Self-Assessment tool to measure competence and importance in daily activities and the World Health Organization-5 Well-being Index to measure mental well-being. Hierarchical regression analysis was used to examine the association between competence and mental well-being. Among 383 trainees, 30.6% felt difficulty expressing themselves, and 27.4% felt difficulty accomplishing goals. Almost 50% valued self-care, working towards their goals, and managing their finances. Higher competence scores were associated with higher mental well-being scores (B = 0.76; 95% CI = 0.52, 1.00). Competence may be a key to having higher mental well-being among migrant trainees in Japan. A supportive and enabling environment, as well as mental health promotion at the community level, may improve trainees' competence in daily activities.

Digital conversations about depression among Hispanics and non-Hispanics in the US: a big-data, machine learning analysis identifies specific characteristics of depression narratives in Hispanics

BACKGROUND

Digital conversations can offer unique information into the attitudes of Hispanics with depression outside of formal clinical settings and help generate useful information for medical treatment planning. Our study aimed to explore the big data from open-source digital conversations among Hispanics with regard to depression, specifically attitudes toward depression comparing Hispanics and non-Hispanics using machine learning technology.

METHODS

Advanced machine-learning empowered methodology was used to mine and structure open-source digital conversations of self-identifying Hispanics and non-Hispanics who endorsed suffering from depression and engaged in conversation about their tone, topics, and attitude towards depression. The search was limited to 12 months originating from US internet protocol (IP) addresses. In this cross-sectional study, only unique posts were included in the analysis and were primarily analyzed for their tone, topic, and attitude towards depression between the two groups using descriptive statistical tools.

RESULTS

A total of 441,000 unique conversations about depression, including 43,000 (9.8%) for Hispanics, were posted. Source analysis revealed that 48% of conversations originated from topical sites compared to 16% on social media. Several critical differences were noted between Hispanics and non-Hispanics. In a higher percentage of Hispanics, their conversations portray "negative tone" due to depression (66% vs 39% non-Hispanics), show a resigned/hopeless attitude (44% vs. 30%) and were about 'living with' depression (44% vs. 25%). There were important differences in the author's determined sentiments behind the conversations among Hispanics and non-Hispanics.

CONCLUSION

In this first of its kind big data analysis of nearly a half-million digital conversations about depression using machine learning, we found that Hispanics engage in an online conversation about negative, resigned, and hopeless attitude towards depression more often than non-Hispanic.

Estimating the effects of Mexico to U.S. migration on elevated depressive symptoms: evidence from pooled cross-national cohorts

PURPOSE

Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health.

METHODS

We pooled data from the Mexican Health and Aging Study (N = 17,771) and Mexican-born U.S. Health and Retirement Study (N = 898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration.

RESULTS

Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count = 1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood.

CONCLUSIONS

In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms.

Symptoms of PTSD and Depression among Central American Immigrant Youth

The aim of this paper is to explore the mental health challenges that Central American immigrant youth face before and after arriving in the United States. This population is hard to reach, marginalized, and disproportionately exposed to trauma from a young age. This paper investigates the mental health stressors experienced by Central American immigrant youth and asylum seekers, including unaccompanied minors, surveyed in the U.S. in 2017. This mixed methods study uses qualitative data from interviews along with close-ended questions and the validated PHQ-8 Questionnaire and the Child PTSD Symptom Scale (CPSS). These new migrants face numerous challenges to mental health, increased psychopathological risk exacerbated by high levels of violence and low state-capacity in their countries of origin, restrictive immigration policies, the fear of deportation for themselves and their family members, and the pressure to integrate once in the U.S. We find that Central American youth have seen improvements in their self-reported mental health after migrating to the U.S., but remain at risk of further trauma exposure, depression, and PTSD. We find that they exhibit a disproportionate likelihood of having lived through traumatizing experiences that put them at higher risk for psychological distress and disorders that may create obstacles to integration. These can, in turn, create new stressors that exacerbate PTSD, depression, and anxiety. These conditions can be minimized through programs that aid immigrant integration and mental health.

Mental Health Needs of an Emerging Latino Community

Over the last decade, Baltimore has become a non-traditional sanctuary city, receiving an unprecedented influx of Latino immigrants, mostly from Central America’s Northern Triangle, who are often fleeing violence in their home countries. This study explored the nature and frequency of healthcare utilization for mental health problems among uninsured/uninsurable Latinos who received outpatient care between 2012 and 2015 through an academic hospital-affiliated program that covers primary and specialty services to uninsured patients without regard to documentation status. Encounters for mental health disorders were the most common category, accounting for 14.88% of all visits. Mood (78%) and anxiety disorders (16%) were the most prevalent mental health diagnoses. The most frequent reason to seek care was symptom, signs, and ill-defined conditions (37.47%), and within this subgroup, pain was the leading cause of seeking care (88%), which may indicate high rates of somatization of mental health distress. This study presents a unique opportunity to explore the burden and nature of mental health needs among a population for which healthcare information is rarely attainable and highlights the need for culturally competent screening mechanisms and interventions to address the stressors faced by emergent communities.

Intercepted journeys: Associations between migration and mobility experiences and depressive symptoms among substance using migrants at the Mexico-Guatemala border

Substance use and depressive psychiatric symptoms have been associated with migration and mobility. The Mexico-Guatemala border is a key transit point for internal, regional, and international migration flows. However, there is limited knowledge of the role of substance use, migration, and mobility on mental health among migrants at this border. Our paper explores the association of migration and mobility patterns with possible major depressive symptoms among migrants at this key geographic region. We recruited 392 substance-using migrants using modified time-location sampling. Crude and adjusted logistic regression models were developed. We found that 12% of the sample had possible major depressive symptoms. After adjusting for relevant covariates, including gender, income, and perceived homelessness, we found that recent rural-urban and short-term migrants had higher odds of possible major depressive symptoms, whereas international migrants had lower odds. Findings of this paper suggest that although migrants experience hardship and uncertainty, they may respond with complex and nuanced forms of coping and planning.

A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants

BACKGROUND

Female Mexican Immigrants (FMIs) experience high rates of depression compared with other populations. For this population, depression is often exacerbated by social isolation associated with the experience of immigration. Aim 1. To measure whether a culturally situated peer group intervention will reduce depression and stress associated with the experience of immigration. Aim 2. To test whether an intervention using a "women's funds of knowledge" approach results in improved resilience, knowledge and empowerment. Aim 3. To investigate whether a culturally situated peer group intervention using a women's funds of knowledge approach can give participants a sense and experience of social and physical connection ("emplacement") that is lost in the process of immigration.

METHODS

This mixed-methods study will implement "Tertulias" ("conversational gatherings" in Spanish), a peer support group intervention designed to improve health outcomes for FMI participants in Albuquerque, New Mexico. We will document results of the intervention on our primary hypotheses of a decrease in depression, and increases in resilience and social support, as well as on our secondary hypotheses of decreased stress (including testing of hair cortisol as a biomarker for chronic stress), and an increase in social connectedness and positive assessment of knowledge and empowerment.

DISCUSSION

This project will address mental health disparities in an underserved population that experiences high rates of social isolation. Successful completion of this project will demonstrate that health challenges that may appear too complex and too hard to address can be using a multi-level, holistic approach. Our use of hair samples to test for the 3-month average levels of systemic cortisol will contribute to the literature on an emerging biomarker for analyzing chronic stress.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198 .

Cumulative Lifetime Adversity and Depression among a National Sample of U.S. Latinx Immigrants: Within-group Differences in Risk and Protective Factors Using Data from the HCHS/SOL Sociocultural Ancillary Study

Background

Latinx immigrants are exposed to multiple stressors before, during, and after migration. However, most past research has assumed the effects of these stressors are uniform across Latinx groups despite considerable within-group variation. The purpose of this study was to (a) assess the moderating effects of several risk and protective factors on the association between cumulative lifetime adversity and depression among U.S. Latinx immigrants and (b) examine the extent to which risk and protective processes differed between Latinx subgroups.

Method

Data came from a cross-sectional secondary dataset, called the HCHS/SOL Sociocultural Ancillary Study. The sample (N = 2893) was identified using stratified random probability sampling in four of the largest Latinx metropolitan areas: the Bronx, NY, San Diego, CA, Chicago, IL, and Miami, FL. We included four Latinx subgroups in our study: Puerto Ricans, Cubans, Mexicans, and Dominicans.

Results

Results from multi-group regression analyses suggested that social support moderated the association between cumulative lifetime adversity and depression. However, further subgroup analyses showed the moderation effect was only present for Cuban and Dominican immigrants. We also found that perceived discrimination moderated the association between lifetime adversity and depression for Cuban immigrants and ethnic identity moderated the relationship between lifetime adversity and depression for Dominican immigrants.

Conclusions

Our results provide preliminary evidence for the presence of within-group differences in responses to adverse events among Latinx immigrant groups. Results can be used to inform the development of mental health interventions tailored to the specific needs of various Latinx immigrant populations.

Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review

Migration is a complex phenomenon and mental illness among immigrants remains a major matter of concern in Italy and worldwide. 243 medical and pharmacy records of patients admitted to University of Foggia hospital between 2004 and 2018 were retrospectively screened and included in the study. Socio-demographic data and clinical characteristics of inpatients were compared in those with and without first-episode of mental illness (FEMI). Subjects (140 men, 103 women; aged 34.4 ± 10.2 years) represented 6.66 ± 3.73% of all hospitalizations in 15 years. Nearly half of them (48.5%) had emigrated from other European countries. 30.8% were diagnosed with a DSM-IV TR unspecified psychosis. 103 patients (42.3%) were in first-lifetime episodes of mental illness. Factors significantly associated with FEMI were: younger age, sex (men), immigrating from Africa, poor language proficiency, lower amount of prescribed psychotropics. Mental health among immigrants is of major concern in Italy. Our findings report on factors possibly associated to the onset of mental illness among immigrant psychiatric inpatients.

Depression risk and body mass index among immigrants and non-immigrants in Canada: results from the Canadian Community Health Surveys, 2010-2014

PURPOSE

Obesity has been associated with an increased risk of the depression in the general population, but it is unknown whether this relationship applies equally to immigrants as well as non-immigrants. Furthermore, the nature of the relationship is uncertain, is it direct or curvilinear? The aim of this study is to examine the relationship between body mass index and major depressive episode among immigrants and non-immigrants.

METHODS

To provide more statistically robust data, a series of cross-sectional health surveys of the Canadian population for the 5 years 2010-2014 were pooled to increase the number of immigrants in the study. Restricted cubic splines analysis was used to examine the nature of the association.

RESULTS

Immigrants had lower 12-month depression and obesity prevalence rates than non-immigrants. In addition, it was found that non-immigrants were more likely to develop depression than immigrants, OR = 1.40 (95% CI, 1.16-1.67). Obese respondents were more likely to develop depression than normal weight respondents in both immigrant (OR = 1.55; 95% CI, 1.03-2.32) and non-immigrant groups (OR = 1.23; 95% CI, 1.15-1.32). A significant nonlinear elongated J-shaped association between obesity and depression was found for both immigrants and non-immigrants with increased risk of depression in obese individuals.

CONCLUSION

Culture-specific, clinical-based interventions should be developed to improve the early identification, treatment and recovery of individuals with a high BMI particularly among those with BMIs in the obese range.

Stress and depression in the context of migration among Haitians in the United States

Our global communities are becoming increasingly more diverse and interwoven; thus, research that enhances our understanding of the multidimensional relationship between depression and migration among distinct ethnic groups is imperative. This study examined the relationship between migration-related stress and depression and the extent to which that relationship is modified by other factors, through the lens of the stress process model. This cross-sectional pilot study used purposive sampling methods to recruit 76 first-generation Haitian immigrants living in South and West Florida from February 2018-May 2018. Descriptive statistics, bivariate and multiple regressions were utilized to assess associations among migration-related stress (Demands of Immigration Scale), depression (Center for Epidemiological Studies Depression (CESD), Zanmi Lasante Depression Symptom Inventory (ZLDSI)), and key demographic variables. Findings showed a strong positive correlation between migration-related stress and depression (CESD (β =.606, 95% CI [.296, .556]) and ZLDSI (β = .624, 95% CI [.242, .440]). Relative to the standardized coefficient, migration-related stress was the strongest predictor of depression after controlling for other predictors. Presence at the 2010 earthquake was the only significant moderator, showing an amplifying effect between migration-related stress and depression (ZLDSI) for those in Haiti during the 2010 earthquake. Consideration of pre-migration factors and the degree of migration-related stress encountered while adapting to life post-migration is critical because they play a significant role in shaping immigrants' depression realities. Community-based services that incorporate or partner with established immigrants to strengthen support for the most vulnerable immigrants early on after migration could serve to mitigate migration-related stressors and facilitate mental health promotion and prevention.

Health Profile and Health Care Access of Mexican Migration Flows Traversing the Northern Border of Mexico

BACKGROUND

The health of Latino migrants is most often studied with samples of immigrants settled in the United States or returned migrants in Mexico. We examine health outcomes and health care access of Mexican migrants traversing the Mexican border region to gain a better understanding of migrant health needs as they transition between migration phases.

METHODS

We used data from a 2013 probability survey of migrants from Northbound and Southbound migration flows in Tijuana, Mexico (N=2412). Respondents included Northbound migrants with and without US migration experience, Southbound migrants returning home from the United States or the Mexican border region, and migrants returning to Mexico via deportation. Descriptive statistics and regression models were estimated to characterize and compare their health status, behavioral health, and health care access across migration phases.

RESULTS

Northbound migrants with US migration experience, Southbound migrants from the United States, and deported migrants had worse levels of health insurance, health care utilization, and diabetes than Northbound migrants without US migration experience. Southbound migrants returning from the border reported worse self-rated health and deportees had higher odds of reported substance use compared with Northbound migrants without US migration experience.

CONCLUSIONS

Mexican migrants' health profile and health care access vary significantly across migration flows and generally are worse for migrants with US migration experience. The results add to our understanding of Mexican migrant health along the migration continuum and can inform services in sending, receiving, and intermediate communities.

How involuntary subordination and social support influence the association between self-esteem and depression: a moderated mediation model

BACKGROUND

In China, young migrants are at elevated risk of mental health problems, such as depression. The influence of self-esteem on depression is well acknowledged. We examined correlates of depression and their mediating and moderating role in the association between self-esteem and depression to promote a better understanding of depression prevention among young migrants.

METHODS

We conducted a cross-sectional study among young Chinese migrants. A moderated mediation model was used to test the combined effect of involuntary subordination and social support on the association between self-esteem and depression. The Johnson-Neyman method was used to identify the range of scores for which social support acted as a moderator.

RESULTS

A total of 572 participants completed questionnaires. The median depression score was 19 (interquartile range: 14). Self-esteem had a negative effect on involuntary subordination (β = - 2.1440, p < 0.001). Involuntary subordination (β = 0.2406, p < 0.001), self-esteem (β = - 0.3870, p < 0.01), and social support (β = - 0.1221, p < 0.01) all had significant effects on depression. The effect of involuntary subordination on depression was moderated by social support (β = - 0.0041, p < 0.05), and the effect decreased as social support scores increased.

CONCLUSIONS

Our results indicated a mediating role of involuntary subordination and a moderating role of social support in the association between self-esteem and depression among young Chinese migrants. Future intervention strategies should focus on these factors to reduce depressive symptoms.

Cross-border healthcare and prognosis of HIV infection in the triple border Brazil-Paraguay-Argentina

The act of crossing an international border for healthcare is a reality in border areas and the flow is in the direction of the city with more human and healthcare resources. Although several prognostic factors related to HIV+ patients are known, the prognostic value of this type of mobility for long term care is still neglected. This study compares the prognosis of HIV patients from three groups, one involved in regional mobility, another in cross-border mobility in search for healthcare and the reference group which is composed by patients living in the same city of the health facility. This is a retrospective cohort study using medical records from a healthcare service in Brazil. Following survival analysis with log-rank test and Cox proportional hazard models, overall survival had no significant difference between patients who were involved in regional (HR = 1.03; 95%CI: 0.69-1.54; p = 0.89) or international (HR = 1.07; 95%CI: 0.58-1.97; p = 0.83) mobility and those who were not. This lack of difference was kept when adjusted for known prognostic factors. In this retrospective cohort study, exposure to both regional and international migration did not have a significant association with the risk of death by any cause in crude or adjusted analyses for already known prognostic factors. This is the first study to consider the prognostic role of cross-border healthcare for HIV patients. Despite these findings, the need of monitoring the extent and the clinical and demographic characteristics of healthcare demand originated in the other side of the border and the use of these data for decision making in health management is emphasized.

The Disparity in Mental Health Between Two Generations of Internal Migrants (IMs) in China: Evidence from A Nationwide Cross-Sectional Study

Background: Internal migrants (IMs) are a large, vulnerable population in China and are mostly driven by national economic reform. IMs who were born before and after 1980, when the general social and economic reform began to appear in China, are considered to be two separate generations. The generational differences in mental health across IMs remain undocumented. In this study, the intergenerational disparity in IMs’ mental health, using data from a national cross-sectional study, was assessed. Methods: Cross-sectional data from the “National Internal Migrant Dynamic Monitoring Survey 2014” were used. IMs were divided into the “old” or “new” generation, based on their date of birth (before 1980 vs. from 1980 onwards). Mental health includes psychological distress, which was measured using the Kessler Screening Scale for Psychological Distress (K6), and perceived stress, which was measured with the Perceived Stress Scales (PSS-4). Two-level Generalized Linear Mixed Models were performed so as to assess the generation gap and associated factors of each group’s mental health. IM demographics, migration characteristics, and social integration indicators were controlled for when assessing the intergenerational disparity in mental health. Results: A total of 15,999 IMs from eight different cities participated in the survey. New generation migrants accounted for 61.5% (9838/15,999) of the total sample. After controlling for participants’ characteristics, new generation migrants had higher psychological distress scores (β_ad = 0.084, 95% CI: (0.026,0.193) and higher perceived stress scores (β_ad = 0.118, 95% CI: 0.029, 0.207) than the older generation. For both generations, factors associated with good mental health included high levels of social integration, personal autonomy, and life satisfaction, as well as self-rated good physical health. For the new generation, the mental health of urban-to-urban IMs (β_ad = 0.201, 95%CI: 0.009, 0.410) for the K6, β_ad = 0.241, 95% CI: 0.073, 0.409 for the PSS-4), IMs with a longer migration duration (β_ad = 0.002, 95% CI: (0.000, 0.003) for the PSS-4) and IMs with a higher annual income (β_ad = 0.124, 95% CI: (0.029, 0.218) for the K6) was significantly poorer than their counterparts. Conclusions: New-generation migrants’ mental health is worse compared to older IMs. An array of services for addressing these generation-specific needs may facilitate the promotion of mental health among IMs in China.

Longitudinal associations between having an adult child migrant and depressive symptoms among older adults in the Mexican Health and Aging Study

Background

Migration may impact the mental health of family members who remain in places of origin. We examined longitudinal associations between having an adult child migrant and mental health, for middle-aged and older Mexican adults accounting for complex time-varying confounding.

Methods

Mexican Health and Aging Study cohort (N = 11 806) respondents ≥50 years completed a 9-item past-week depressive symptoms scale; scores of ≥5 reflected elevated depressive symptoms. Expected risk differences (RD) for elevated depressive symptoms at each wave due to having at least one (versus no) adult child migrant in the US or in another Mexican city were estimated with longitudinal targeted maximum likelihood estimation.

Results

Women with at least one adult child in the US had a higher adjusted baseline prevalence of elevated depressive symptoms (RD: 0.063, 95% CI: 0.035, 0.091) compared to women with no adult children in the US. Men with at least one child in another Mexican city at all three study waves had a lower adjusted prevalence of elevated depressive symptoms at 11-year follow-up (RD: -0.042, 95% CI: -0.082, -0.003) compared to those with no internal migrant children over those waves. For men and women with ≤3 total children, adverse associations between having an adult child in the US and depressive symptoms persisted beyond baseline.

Conclusions

Associations between having an adult child migrant and depressive symptoms varied by respondent gender, family size, and the location of the child migrant. Trends in population aging and migration bring new urgency to examining associations with other outcomes and in other settings.

Migration and Mental Health in Mexico: Domestic Migrants, Return U.S. Migrants, and Non-Migrants

In this paper, we use survey data from the Mexican Retrospective Demographic Survey (Encuesta Demográfica Retrospectiva) and National Survey of Households (Encuesta Nacional de Hogares) collected in 2017 to examine self-reports of depression, anxiety, chronic fatigue, and pain among domestic migrants, returned U.S. migrants, and non-migrants. Although self-reports do not always correspond to clinical diagnoses, they offer some insight into mental health, especially for those without a diagnosis because of limited access to services or stigma. Regression results reveal that domestic migrants, e.g., those who moved within Mexico, reported more anxiety, chronic fatigue, and pain, but risks for U.S. migrants were comparable to non-migrants, controlling for other characteristics. Findings from the decomposition analysis helps explain these findings. While domestic migrant vs. non-migrant differences result both from different migrant demographic attributes, such as age and gender, and differences in the effects of these characteristics between the groups, U.S. migrant vs. non-migrant differences in anxiety and pain emerge only after allowing for the relationship between each observed characteristic and the mental health outcome to vary. Thus, compared to domestic migrants, U.S. migrants are selected on characteristics associated with good mental health-they are positively selected-but those characteristics are not protective for them.

Migration and depression: A cross-national comparison of Mexicans in sending communities and Durham, NC

RATIONALE

Latino immigrants have been shown to average better health and longevity than native whites, in spite of their relative socioeconomic disadvantage. However, mental health outcomes stand in stark contrast to this epidemiological "paradox," as factors such as depression are significantly higher for Latino immigrants than other groups.

OBJECTIVE

We explore the link between migration and depressive feelings using a binational random survey of Mexicans in Durham, NC and sending communities in Mexico.

METHOD

Explanations for the link between migration and depression, such as acculturative stress, lack of social support, and powerlessness and isolation, are analyzed by comparing results for protective vs. risk factors between residents of Mexico and Durham, and among immigrants themselves. Besides, selection hypothesis is explored using propensity matching scores.

RESULTS

Results show little support for selection as an important source of migrant depression, and instead provide strong evidence that migration itself, and the disruption of social networks that it entails, is primarily responsible for the association. Family separation, in particular, is the strongest predictor of depressive feelings and accounts for a sizeable portion of the heightened depression among migrants.

CONCLUSIONS

Understanding the subjective experiences of migration is necessary to better integrate newcomers into host societies.

Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis

As the number of migrants worldwide increases, it is worthwhile to examine the extent to which depression has affected this group of often vulnerable individuals. The purpose of this systematic review and meta-analysis is to examine the aggregate prevalence of depression among international migrants and to explore the variations in prevalence with demographic and educational factors. A search was conducted on the online databases PubMed and ScienceDirect whole using the terms "depression", "depressive disorder", "immigration", "immigrant", "migration", and "migrant". A total of 25 studies met our inclusion criteria. A random-effects model meta-analysis calculated an aggregate prevalence of 15.6% among migrants. Heterogeneity was identified by meta-regression and subgroup analyses, and the level of educational attainment, employment status, and length of residency spent in country of migration were found to be significant moderators contributing to depression prevalence. In conclusion, newly arrived migrants appear to be susceptible to developing depression and it is imperative that more in the form of preventive strategies and increased assistance be incorporated to ensure their psychological wellbeing and improve their mental health outcomes. Further research should be conducted to better understand the risk of psychiatric disorders among members of this subpopulation.

Association between induced abortion and suicidal ideation among unmarried female migrant workers in three metropolitan cities in China: a cross-sectional study

Background

Despite reports of mental health issues, suicidality has not been closely examined among the migrant population. The association between induced abortion and suicidal ideation is unknown among unmarried female migrant workers of reproductive age in China. This study aims to examine induced abortion and suicidality among the Chinese migrant population.

Methods

We recruited 5115 unmarried female migrant workers during 2015 to 2016 from Shanghai, Beijing and Guangzhou, and collected demographic, psychosocial, reproductive and mental health information using structured questionnaires. We used logistic regression models to examine the association between lifetime induced abortion and suicidal ideation during the past year among the subjects.

Results

Overall, 8.2% of the subjects had suicidal ideation during the past year, and 15.5% of the subjects experienced induced abortion. Induced abortion was associated with nearly twice the odds of having past-year suicidal ideation (Odds ratio, OR = 1.89; 95% confidence interval, CI: 1.46, 2.44) after adjusting for age, education, years in the working place, tobacco use, alcohol consumption, daily internet use, attitude towards premarital pregnancy, multiple induced abortion, self-esteem, loneliness, depression, and anxiety disorders. The association was stronger in those aged > 25 (OR = 3.37, 95% CI = 2.16, 5.28), with > 5 years of stay in the working place (OR = 2.98, 95% CI = 2.02, 4.39), the non-anxiety group (OR = 2.28, 95% CI = 1.74, 3.00), and the non-depression group (OR = 2.94, 95% CI = 2.08, 4.15).

Conclusions

Induced abortion was associated with increased odds for suicidal ideation among the unmarried female migrant workers in urban cities in China. More attention should be paid to the mental health of the population.

Prevalence and factors associated with PTSD, anxiety and depression symptoms in Haitian migrants in southern Brazil

BACKGROUND

Prevalence rates of mental health disorders in migrants are controversial. The socio-historical and economic background of the host country may play an important role in the mental health status of migrants. As studies are mostly conducted in developed countries, researching migration in developing countries may add important information to scientific literature.

AIMS

This study aims to investigate the prevalence and factors associated with posttraumatic stress disorder (PTSD), anxiety and depression symptoms in Haitian migrants in southern Brazil.

METHODS

The sample comprises 66 participants selected from four different sites in three cities of a Brazilian southern state. Participants fulfilled a sociodemographic questionnaire, as well as instruments investigate traumatic events; post-migration difficulties and symptoms of PTSD, anxiety and depression. Linear regression models were utilized to investigate factors associated with PTSD, anxiety and depression symptoms.

RESULTS

PTSD prevalence in the sample was 9.1%. Depression and anxiety symptoms were in the clinical range of 10.6%-13.6% of participants, respectively. A number of traumatic events, acculturation difficulties, discrimination and low social support were associated with the investigated mental health disorders.

CONCLUSION

The results point to the importance of public policies in promoting better social and mental health support for migrants. Providing information to the Brazilian population about migration may improve receptiveness in the host society.

Depression burden in luxembourg: Individual risk factors, geographic variations and the role of migration, 2013-2015 European Health Examination Survey

BACKGROUND

Depression is a complex mental disorder that affects an increasing proportion of the worldwide population. This study aims to estimate the prevalence of depressive symptoms in Luxembourg, associated risk factors and geographic variations. Additionally, it aims to assess whether first and second generation immigrants are at higher risk for depressive symptoms compared to non-immigrants.

METHODS

Representative cross-sectional data from 1499 residents of Luxembourg, aged 25-64 years, were collected from the Luxembourg European Health Survey (EHES-LUX). Depressive symptoms were defined as a score of ≥5 on the Patient Health Questionnaire for depression (PHQ-9) (i.e. mild, moderate or severe). Standard and Bayesian regression models were used to examine associations between depressive symptoms, immigration status and geographic distribution across Luxembourg.

RESULTS

The prevalence of depressive symptoms was 21.55% (15.54% mild, 3.54% moderate, and 2.49% moderately severe to severe). The odds of having depressive symptoms was higher among second generation immigrants compared to non-immigrants (OR: 1.58, 95% CI: 1.04, 2.41), independent of socioeconomic and behavioral characteristics. Healthier diet, higher social support and good health perception were protective towards experiencing depressive symptoms. One of the highest likelihoods of reporting depressive symptoms was observed in the South-West of the country with a positive effect at 80% credible region [CR] (1.42 [0.92, 2.73]).

LIMITATIONS

The participation rate was low (26.7%). The cross-sectional nature of the study does not allow us to establish causality.

CONCLUSIONS

Depression constitutes an important public health challenge in Luxembourg due to the impact on the overall health of the population. Social programs of health promotion should be developed to improve mental wellbeing in immigrants, especially those of second generation.

Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants

BACKGROUND

Early detection and intervention in primary care is integral to behavioral health. Valid, practical screening assessments are scarce, particularly for non-English speaking populations. We address this need by evaluating the psychometric properties of the Spanish version of the AC-OK Screen for Co-occurring Disorders for first and second generation immigrant Latinos in Massachusetts, USA, and Madrid and Barcelona, Spain.

METHODS

567 Latino participants were recruited in waiting areas of clinics or by referral from Primary Care, Mental Health, Substance Use, and HIV Treatment Clinics, as well as Community Agencies. We use confirmatory factor analyses to evaluate the factor structure, correlation analysis to examine concurrent and discriminant validity, and receiver operating curves (ROC) to determine the ability of the AC-OK to approximate a composite of established instruments designed to measure depression, generalized anxiety, post-traumatic stress disorder symptoms, alcohol, and drugs (including benzodiazepines) as external criteria.

RESULTS

The original two factor structure was replicated in samples of Latino respondents in the US and Spain. Correlations with other measures followed the expected pattern. In both the US and Spain, ROC analyses suggested that the AC-OK scale was an adequate approximation to other specific measures of mental health (ROC=0.90) and substance abuse problems (ROC=0.83).

CONCLUSIONS

The Spanish version of the AC-OK Screen has good to excellent psychometric properties in both its subscales. These findings are robust across sites, gender, and type of clinic. We recommend its use for clinical research and for routine screening at treatment centers.

Internationally Educated Nurses in Transition in the United States: Challenges and Mediators

International migration has doubled worldwide since 1970, and nurses are increasingly becoming a part of this trend. In 2008, approximately 5.6% of RN positions were filled by nurses educated in other countries. One of the critical issues is the transition of these immigrated nurses to the U.S. health care system and acculturation in a new society. Continuing education is necessary to promote adjustment and provide for a successful transition while ensuring quality patient care. The life patterns model provides a framework to describe the challenges and potential mediators in the transition process. J Contin Educ Nurs. 2017;48(3):139-144.

Mental health of the old- and new-generation migrant workers in China: who are at greater risk for psychological distress?

Rural-to-urban migrant workers (MWs) are a large vulnerable population in China and, recently, the new-generation MWs (those born in 1980 or later) have become the majority of this population. Examining difference in the epidemiology of poor mental health between the new- and old-generation (those born before 1980) MWs would facilitate mental health promotion efforts. However, very few related studies are available and they produced conflicting findings. This study investigated intergenerational difference in prevalence and correlates of psychological distress (PD) in MWs. A total of 3031 MWs (691 old- and 2340 new-generation MWs) completed a standardized questionnaire containing socio-demographic, migration-related, and work-related variables and the Chinese 12-item General Health Questionnaire (GHQ-12). A GHQ-12 score of 3 or higher was used to denote PD. PD was more prevalent in the new- than old-generation MWs (36.2% versus 28.2%, P < 0.001). The elevated risk of PD in the new- versus old-generation remained significant after controlling for potential confounders (OR=1.51, P < 0.001). For the new-generation, correlates for PD included low monthly income, recent two-week physical morbidity, migrating alone, poor Mandarin proficiency and long working hours; while for the old-generation, correlates for PD included low education, recent two-week physical morbidity, and having worked in many cities. The new-generation MWs are at higher risk for PD than the old-generation MWs. Mental health services for addressing the generation-specific needs may be an effective way to prevent or reduce PD of MWs.

The centrality of social ties to climate migration and mental health

Climate change-related hazards and disasters, known to adversely impact physical and mental health outcomes, are also expected to result in human migration above current levels. Environmentally-motivated migration and displacement may lead to the disruption of existing social ties, with potentially adverse consequences for mobile populations as well as their family members who remain in places of origin. We propose that the disruption of social ties is a key mechanism by which climate-related migration may negatively impact mental health, in particular. Existing social ties may provide social and material resources that buffer mental health stressors related to both prolonged and acute climate events. Preparation for such events may also strengthen these same ties and protect mental health. Communities may leverage social ties, first to mitigate climate change, and second, to adapt and rebuild post-disaster in communities of origin. Additionally, social ties can inform migration decisions and destinations. For example, scholars have found that the drought-motivated adaptive migration of West African Fulbe herders only occurred because of the long-term development of social networks between migrants and non-migrants through trade and seasonal grazing. On the other hand, social ties do not always benefit mental health. Some migrants, including those from poor regions or communities with no formal safety net, may face considerable burden to provide financial and emotional resources to family members who remain in countries of origin. In destination communities, migrants often face significant social marginalization. Therefore, policies and programs that aim to maintain ongoing social ties among migrants and their family and community members may be critically important in efforts to enhance population resilience and adaptation to climate change and to improve mental health outcomes. Several online platforms, like Refugee Start Force, serve to integrate refugees by connecting migrants directly to people and services in destination communities. These efforts may increasingly draw upon novel technologies to support and maintain social networks in the context of population mobility due to climatic and other factors.

Immigration and Mental Health

Purpose of review

While the experience of migration and resettlement in a new country is associated with mental health risks, immigrants generally demonstrate better mental health than expected. This review describes patterns in mental health outcomes among immigrants. We discuss a conceptual model of the potential underlying mechanisms that could buffer the stress and disadvantage experienced by this substantial and growing population.

Recent findings

While epidemiological studies have established a general pattern of lower risk for mental health disorders among first-generation (foreign-born) immigrants in the U.S., recent studies highlight how this pattern varies substantially by the intersection of race, ethnicity, national origin, gender, and socioeconomic status. Contextual factors including the family and neighborhood context; an immigrant's social position; experiences of social support and social exclusion; language competency and ability; and exposure to discrimination and acculturative stress further influence the relationship between immigration and mental health.

Summary

We conclude with an emphasis on social resilience processes, with a focus on how immigrants develop social relations, social capital and social networks. We recommend future directions for research that prioritize identifying and understanding social adaptation strategies adopted by immigrant groups to cope with immigration stressors.

Psychosocial Indicators in North African Immigrant Women in Italy

The present research evaluated the psychosocial health and quality of life of North African (NA) immigrant women living in Italy. A survey of 205 NA-born and Italian-born women was carried out. Psychosocial, sociodemographic and migration data were collected. Anthropometric indices were computed by direct measurements of height, weight, waist and hip circumferences. Multivariate analysis showed that the main explanatory variable for all dimensions of psychosocial status was the migrant status. Other explanatory variables were educational level and number of children for psychological discomfort, and weight status for well-being, quality of life and stress. Anthropometric indices were explanatory variables for quality of life. In conclusion, this study provides further evidence of higher psychological stress and discomfort and lower well-being and quality of life in immigrant women. Public social support is necessary to control, maintain and improve the mental health outcomes of immigrant communities in the host country.

Prevalence and clinical severity of mood disorders among first-, second- and third-generation migrants

BACKGROUND

The role of migration as a risk factor remains unknown for mood disorders because of poor data. We sought to examine the prevalence and severity of mood disorders (bipolar disorder (BD), unipolar depressive disorder (UDD) and dysthymia) in first, second, and third generation migrants in France.

METHODS

The Mental Health in the General Population survey interviewed 38,694 individuals. The prevalence of lifetime mood disorders, comorbidities, and clinical features was compared between migrants and non-migrants and by generation. All analyses were adjusted for age, sex and level of education.

RESULTS

The prevalence of any lifetime mood disorder was higher in migrants compared with non-migrants (OR = 1.36, 95% CI [1.27 - 1.45]). This increased prevalence was significant for UDD (OR = 1.44, 95% CI [1.34 - 1.54]), but not for BD (OR = 1.15, 95% CI [0.96 - 1.36]) or dysthymia (OR = 1.09, 95% CI [0.94 - 1.27]), although the prevalence of BD was increased in the third generation (OR = 1.27, 95% CI [1.01 - 1.60]). Migrants with BD or UDD were more likely to display a comorbid psychotic disorder compared to non-migrants with BD or UDD. Cannabis-use disorders were more common in migrant groups for the 3 mood disorders, whereas alcohol-use disorders were higher in migrants with UDD. Posttraumatic stress disorder was more frequent among migrants with UDD.

LIMITATIONS

The study used cross-sectional prevalence data and could be biased by differences in the course of disease according to migrant status. Moreover, this design does not allow causality conclusion or generalization of the main findings.

CONCLUSION

Mood disorders are more common among migrants, especially UDD. Moreover, migrants with mood disorders presented with a more severe profile, with increased rates of psychotic and substance-use disorders.

Common Mental Disorders at the Time of Deportation: A Survey at the Mexico-United States Border

Deportations from the Unites States (US) to Mexico increased substantially during the last decade. Considering deportation as a stressful event with potential consequences on mental health, we aimed to (1) estimate the prevalence of common mental disorders (CMD) among deported migrants; and (2) explore the association between migratory experience, social support and psychological variables, and CMD in this group. In repatriation points along the border, a probability sample of deportees responded to the Self Reporting Questionnaire (SRQ). The prevalence of CMD was 16.0% (95% CI 12.3, 20.6). There was a U-shaped association between time in the US and SRQ score. Times returned to Mexico, having a spouse in the US, number of persons in household, less social support, anxiety as a personality trait, and avoidant coping style were directly associated with SRQ score. Public health policies should address the need for mental health care among deported migrants.

I Didn't Ask to Come to this Country…I was a Child: The Mental Health Implications of Growing Up Undocumented

Growing up as an undocumented immigrant and transitioning to "illegal" adulthood can expose the person to adverse social determinants, which can detrimentally affect mental health by acting as chronic stressors. Although there have been several attempts to reform immigration, none have been entirely successful. Recently, the Dream Act and the path toward citizenship may be important steps for reducing mental health disparities among the undocumented, immigrant population. This case report will describe the experiences of one Latino "dreamer", reveal the effects of an undocumented status on mental health, and posit future directions for mental health promotion in this vulnerable population.