Perceived ethnic discrimination, acculturation, and psychological distress in women of Turkish origin in Germany

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

Perceived stress and depressive symptoms during pregnancy and postpartum in Turkish-origin women living in Germany

OBJECTIVE

People of Turkish origin (also referred to as "with a Turkish migrant background") are one of the largest migrant groups in Germany and show disparities across different stress-related health outcomes. Specifically, women of Turkish origin in Germany have a greater risk for some mental health issues and adverse pregnancy and birth outcomes compared to women without migrant background. We tested differences between women of Turkish origin and women without migrant background in self-reported pregnancy and postpartum stress experiences and depressive symptoms.

METHODS

32 women of Turkish origin (mean age 29.7 years) and 77 women without migrant background (mean age 32 years) participated in a multi-site prospective cohort study with two study visits during pregnancy and one month postpartum. Women provided sociodemographic data and completed the Perceived Stress Scale (PSS) and the Center for Epidemiology - Depression (CESD) scale at each study visit.

RESULTS

Using hierarchical linear models, we found that women of Turkish origin (both first and second generation) reported more perceived stress (b = 0.57, CI: 0.29-0.84, p < 0.001) and depressive symptoms (b = 0.32, CI = 0.14-0.49, p < 0.001) compared to women without migrant background across gestation. A linear regression analysis showed that there was also a significant difference in depressive symptoms at one month postpartum (b = 0.35, CI = 0.03-0.66, p < 0.05).

CONCLUSION

Tailored psychosocial interventions are needed to address mental health needs of pregnant Turkish origin women and to intervene on the possible transmission of stress-related health disadvantages to their offspring.

Cross-Cultural Validation of the Barcelona Immigration Stress Scale

The concept of acculturative stress has been the subject of debate, resulting in contradictory arguments regarding its measurement. Many of the existing acculturative stress instruments have been developed for use with specific migrant groups. The objective of the current study is to revisit the psychometric properties of the Barcelona Immigration Stress Scale, an instrument aimed at measuring stress levels associated with the migration trajectory in any migrant group. Using a sample of 915 migrants who consulted in primary care, we carried out principal component and confirmatory factor analyses as well as item response theory analyses applied both to the entire sample and to different migratory groups separately. The new reduced version of the scale has very good psychometric properties both in general and applied to the Latino migratory group, the largest in the area where the study was carried out. Results were acceptable among sub-Saharan, North African, and Asian groups but not among Eastern Europeans. These results are discussed through the specificities of each migratory group and the limitations of psychometrics to capture the complexity of immigration-related and acculturative stress.

Community indicators for mental health in Europe: a scoping review

Background

Community indicators may predict and influence individuals` mental health, and support or impede mental health management. However, there is no consensus on which indicators should be included in predictions, prognostic algorithms, or management strategies for community-based mental health promotion and prevention approaches. Therefore, this scoping review provides an overview of relevant community-level indicators for mental health in the general as well as risk populations in a European context.

Methods

We conducted a scoping review in the following electronic databases: PubMed, Embase, and PsycInfo. Eligible studies focused on context factors such as either the physical or social environment, reporting at least one mental health outcome and referring to a European population. Publications between 2012 and March 8, 2022 are considered.

Results

In total, the search yielded 12,200 identified records. After the removal of duplicates, 10,059 records were screened against the eligibility criteria. In total, 169 studies were included in the final analysis. Out of these included studies, 6% focused on pan-European datasets and 94% on a specific European country. Populations were either general or high-risk populations (56 vs. 44%, respectively) with depressive disorder as the main reported outcome (49%), followed by general mental health (33%) and anxiety (23%). Study designs were cross-sectional studies (59%), longitudinal (27%), and others (14%). The final set of indicators consisted of 53 indicators, which were grouped conceptually into 13 superordinate categories of community indicators. These were divided into the domains of the physical and social environment. The most commonly measured and reported categories of community indicators associated with mental health outcomes were social networks (n = 87), attitudinal factors toward vulnerable groups (n = 76), and the characteristics of the built environment (n = 56).

Conclusion

This review provides an evidence base of existing and novel community-level indicators that are associated with mental health. Community factors related to the physical and social environment should be routinely recorded and considered as influencing factors or potentially underestimated confounders. The relevance should be analyzed and included in clinical outcomes, data, monitoring and surveillance as they may reveal new trends and targets for public mental health interventions.

Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data

Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.

Racial discrimination and its impact on mental health

There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.

The effects of perceived discrimination on immigrants' mental health: A pilot study from Germany

PURPOSE

This study aimed to reveal the effects of discrimination perceived by Turkish immigrants on their mental health.

DESIGN AND METHODS

The participants of this pilot study were 111 Turkish immigrant patients treated at the Neuro-Psychiatrisches Zentrum Riem.

FINDINGS

The preliminary findings illustrated that perceived individual discrimination was significantly correlated with three coping strategies, namely, substance use, friend support, and personal support.

PRACTICE IMPLICATIONS

This study contributes to the literature by highlighting the coping strategies and social support mechanisms of Turkish immigrants who perceived discrimination and employed strategies to combat it.

Behaviour change interventions to promote health and well-being among older migrants: A systematic review

Background

Whether behaviour change interventions are effective for the maintenance of older migrants’ health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants.

Methods

Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre–post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being).

Results

Forty-three studies (23 randomised controlled trials, 13 pre–post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters.

Conclusions

Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups.

Trial registration

PROSPERO CRD42018112859.

Acculturation and Perceived Ethnic Discrimination Predict Elevated Blood Glucose Level in Sub-Saharan African Immigrants in Australia

Sub-Saharan African migrants experience significant sociocultural challenges, including those related to acculturation and perceived ethnic discrimination (PED), in addition to increased risk of non-communicable diseases, such as type 2 diabetes mellitus (T2DM). Although acculturation and PED are each established risk factors for elevated blood glucose level (EGBL) and T2DM, they have not been studied in relation to EBGL risk in a single model. This study aimed to investigate associations between acculturation, PED and EBGL in a sub-Saharan African migrant population in Australia. Face to face survey using a purposive sampling method was used to collect data from 170 adults, aged 18-72 years. A large proportion (41.8%) of the study group was in the integration mode of acculturation, which strongly correlated positively with EBGL/T2DM, although traditional mode correlated inversely with EBGL/T2DM. PED correlated positively with EBG/LT2DM. Immigrants manifesting the integration mode were 4.2 times more likely to have EBGL/T2DM than other acculturation modes. Multiple linear regression showed that the association between integration mode and EBGL/T2DM was mediated by PED. The apparent interaction between PED and acculturation in relation to EBGL/T2DM risk suggests that interventions to lower T2DM risk in this population may benefit from incorporating strategies to address these two important health determinants.

Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: the feasibility of a randomised controlled trial of a guided online intervention

BACKGROUND

The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual.

METHODS

Turkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis.

RESULTS

Eighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups.

CONCLUSION

Although intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not.

TRIAL REGISTRATION

Netherlands Trial Register, NTR5028 . Registered on 1 March 2015.

[Racism and mental health]

Der Beitrag gibt einen Überblick zu Rassismusdiskursen in Forschung und Praxis im Gesundheitsbereich und erörtert individuelle und institutionelle Auswirkungen von Rassismus und Diskriminierung auf die psychische Gesundheit. Daran anschließend wird erörtert, welche rassismuskritischen Transformationen in den Versorgungsstrukturen für psychisch erkrankte Personen notwendig sind, um eine gleichberechtigte Teilhabe von Menschen, die von Diskriminierung und Rassismus betroffen sind, zu ermöglichen.

Perceived Stress Scale (PSS-10) psychometric properties in migrants and native Germans

BACKGROUND

With the increasing diversity of the German population, it is important to test the psychometric validity and reliability of the German version Perceived Stress Scale (PSS-10) specifically between German natives and residents with a migration background.

METHODS

Using nationally representative data (N = 2527), this study conducted an Exploratory Factor Analysis (EFA) to determine the most appropriate factor structure, a Multi-Group Confirmatory Factor Analysis (MGCFA) to compare the validity of the two-factor structure and tested the PSS-10 measurement invariance between the German native and migrant sub-samples. Lastly, reliability of the PSS-10 was examined via Cronbach's alpha, omega and individual item analyses across the two sub-samples.

RESULTS

The EFA results support a two-factor structure in the migrant sample. The MGCFA showed adequate model fit for both sub-samples and the PSS-10 is strict invariant between German natives and migrants. Cronbach's alpha and omega for Perceived Helplessness (PHS: factor 1) and Perceived Self-Efficacy (PSES: factor 2) demonstrate good internal consistency in both German and migrant sub-samples.

CONCLUSIONS

The key conclusions are: (1) the German version PSS-10 is suitable for German residents with a migration background. (2) Despite good internal consistency for the total scale, the PSS-10 measures two aspects: (a) perceived helplessness and (b) perceived self-efficacy. Future research would profit from analyzing the two subscales separately, not only using the total score.

Work and Stay: Explaining Perceived Discrimination Among Romanian Labor Migrants

Research dealing with perceptions of discrimination among migrants investigated its consequences on their daily lives. However, little systematic attention had been paid to the determinants of perceived discrimination among migrants. This article aims to explain the causes for which migrants see themselves discriminated against in their country of residence. The statistical analysis uses individual-level data from an original survey conducted in 2018 among Romanian migrants. The results indicate that poor relations with natives, a job below capabilities, and the temporary status of migration contribute to higher perceptions of discrimination.

Discrimination Among Youth of Immigrant Descent in Germany

Abstract. Ethnic discrimination has a negative impact on the socioemotional, behavioral, relational, and academic adjustment of adolescents, while belonging with classmates, teachers, heritage, and national group may promote positive socioemotional and academic adjustment. We investigate (1) whether greater discrimination by peers and a lower sense of belonging with classmates, teachers, heritage group, and national group are associated with lower socioemotional and academic adjustment of adolescents of immigrant descent in Germany; and (2) whether a sense of belonging with these different sources acts as a protective factor lowering the negative effects of discrimination on adjustment. Our sample included 439 7th-grade adolescents (51 % female, Mage = 12.4 years) of immigrant descent from 15 Berlin secondary schools. Results showed that higher discrimination was related to greater physiological stress, depressive symptoms, and disruptive school behavior. Higher heritage (but not national) identity, a higher sense of belonging with classmates and with teachers were associated with better socioemotional and academic adjustment. An examination of interaction effects between discrimination and forms of belonging on adjustment revealed that, while the association between discrimination and poorer adjustment weakened for those with higher heritage identity, the association between discrimination and physiological stress increased for those with higher teacher relatedness. We conclude that heritage identity (but not national identity or sense of belonging with classmates) can indeed be a protective factor against the negative effects of discrimination for adolescents of immigrant descent in Germany. Even though belonging with teachers may exacerbate discrimination effects, further investigation with longitudinal data is needed. The findings underline the important role of heritage ties among adolescents of immigrant descent as a source of adjustment, especially in light of discrimination experiences.

Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study

BACKGROUND AND AIMS

The associations between traumatic events, substance use and perceived discrimination have been rarely studied among migrants in host countries. We examined whether pre-migration potentially traumatic experiences (PTEs) or perceived discrimination (PD) are associated with substance use among migrants with voluntary (Russians) and forced (Kurds) migration backgrounds.

DESIGN

Cross-sectional interview and health examination data from the Finnish Migrant Health and Wellbeing Study were used. The target sample (n = 1000 for each group) was drawn from the national population register using stratified random sampling by participants' country of birth and native language.

SETTING

Population-based data were collected from six cities in Finland during 2010-12.

PARTICIPANTS

The participation rates were 68% (Russians) and 59% (Kurds). The analytical sample size varied (Russians n = 442-687, Kurds n = 459-613), as some participants completed only interview, health examination or short interview. The majority of Kurds had a refugee background (75%) while Russians had mainly migrated for other reasons (99%).

MEASUREMENTS

The three main outcomes were self-reported binge drinking, daily smoking and life-time cannabis use. PTEs and PD were self-reported in the interview. Socio-demographic background, migration-related factors and current affective symptoms were adjusted for.

FINDINGS

Among Kurds, PTEs were associated with binge drinking [adjusted odds ratio (aOR) = 2.65, 95% confidence interval (CI) = 1.30-5.42] and PD was associated with life-time cannabis use (aOR = 3.89, 95% CI = 1.38-10.97) after adjusting for contextual factors. Among Russians, PTEs were associated with life-time cannabis use adjusting for contextual factors (aOR = 2.17, 95% CI = 1.12-4.18).

CONCLUSIONS

In Finland, pre-migration traumatic experiences appear to be associated with life-time cannabis use among the Russian migrant population (voluntary migration) and binge drinking among the Kurdish migrant population (forced migration). Perceived discrimination in Finland appears to be associated with life-time cannabis use among Kurdish migrants.

Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background

BACKGROUND

Sociodemographic factors, attitude towards treatment and acculturation may be important factors influencing the decision of immigrants to seek and maintain psychiatric treatment. A better understanding of these factors may significantly improve treatment adherence and outcome in these patients. Therefore, we investigated factors associated the attitude towards psychotherapy and medication in a sample of psychiatric outpatients with and without migration background.

METHODS

N = 381 patients in a psychiatric outpatient unit offering specialized treatment for migrants were included in this study. Attitude towards psychotherapy was assessed using the Questionnaire on Attitudes Toward Psychotherapeutic Treatment, attitude towards medication with the Drug Attitude Inventory-10. Acculturation, symptom load and sociodemographic variables were assessed in a general questionnaire. Statistical analyses included analyses of covariance and hierarchical regression.

RESULTS

Patients of Turkish and Eastern European origin reported a significantly more positive attitude towards medication than patients without migration background. When controlling for sociodemographic and clinical variables, we did not observe any significant differences in attitude towards psychotherapy. Acculturation neither influenced the attitude towards psychotherapy nor towards medication.

CONCLUSION

Our study indicates that sociodemographic and clinical factors may be more relevant for patients´ attitudes towards treatment than acculturation. Considering these factors in psychiatric treatment of patients with migration background may improve treatment outcome and adherence.

[Who Benefits from the App? Internet- and Mobile-Based Interventions (IMIs) and the Tension between Autonomy and Patient Well-Being]

OBJECTIVE

The use of internet- and mobile-based interventions (IMIs) is often considered as empowerment of patients and improvement of accessibility of mental health services. Risks for specific patient groups are seldom discussed. Aim of the study is to identify patient groups that do not benefit from IMIs given the tension between autonomy and patient well-being.

METHODS

The ethical analysis is based on available empirical evidence (randomized control trials - RCTs, reviews) as well as ethical papers. Methodological background is the tension between patient autonomy and patient well-being, which is crucial to the therapeutic alliance. On this foundation, patient groups are identified that do not benefit from IMIs in terms of empowerment or accessibility.

RESULTS

The evidence-based ethical analysis shows that patients with certain disorders or high symptom severity, patients with low level of education or a lack of technical skills, and patients with a migrant background do often not benefit from IMIs. Risks of IMIs are a lack of individualization of interventions given individual treatment needs, symptom deterioration, higher dropout-rate, and insufficient identification of emergency situations.

DISCUSSION

Overemphasizing autonomy may compromize patient well-being in certain patient groups. This may lead to a situation where those patient groups whose inclusion into mental health service should be facilitated by IMIs might not be reached. These access barriers should be considered when designing IMIs, so that multimorbid marginalized groups are not forgotten in the necessary digitalization of the health market.

CONCLUSION

The application of IMIs depends on the individual resources of the patient. Should IMIs be further implemented within the German mental healthcare system, it is imperative that the patient well-being of those patient groups that do not benefit from IMIs is guaranteed. In addition, an early focus on marginalized groups may and the implementation of low-level access to counselling and treatment may provide chances for said groups.

Associations Between Acculturation, Depressive Symptoms, and Life Satisfaction Among Migrants of Turkish Origin in Germany: Gender- and Generation-Related Aspects

OBJECTIVE

The aim of the present study was to investigate the degree of depressive symptoms and life satisfaction (LS) as well as the association between acculturation and depressive symptoms among a large sample of persons with Turkish migration background in Germany, taking into account gender- and migration-related differences.

METHODS

This study was part of a pretest for a large national epidemiological cohort study in Germany. Acculturation was measured using the Frankfurt Acculturation Scale (FRACC). Based on the median split of the two subscales, four acculturative styles according to Berry (integration, assimilation, separation and marginalization) were determined. Depressive symptoms were assessed with the depression module (PHQ-9) from the Patient Health Questionnaire. LS was assessed with a single item on a scale from 1 = bad to 5 = excellent. Differences in levels of depressive symptoms and LS in relation to gender and generation of migration were tested with analysis of covariance, controlling for age. Gender-stratified multiple linear regression analyses were also conducted for depressive symptoms as criterion variable.

RESULTS

328 Turkish migrants participated (61.3% women). The cut-off-value of ≥10 for the PHQ-9 was achieved by 33.2% of the women and 26.4% of the men (p=0.209, φ=0.071). In female migrants, the age-adjusted mean score for depressive symptoms was 7.81 (SD=6.42), in males 6.70 (SD=6.41) (p=0.137, η²=0.007). After controlling for unemployment status, women showed a trend for being more frequently depressed than men (p=0.055, φ=0.117) and also demonstrated a trend for higher levels of depressive symptoms (p=0.072, η²=0.012). No significant gender-specific difference was found concerning age-adjusted mean score for LS (p=0.547, η²=0.001), also when controlled for unemployment status (p=0.322, η²=0.004). In both sexes, the second generation demonstrated a significantly higher age-adjusted mean score for LS of small/medium effect size than the first generation. In women, separation as acculturation style (linear regression coefficient (B=4.42, 95% CI=1.68, 7.17, p=0.002; reference: integration), having no partnership (B=2.56, 95% CI=0.26, 4.86, p=0.03) and lower education (B=-2.28, 95% CI=-4.54, -0.02, p=0.048) were associated with higher severity of depressive symptoms; in men, separation as acculturation style (B=4.01, 95% CI=0.70, 7.31, p=0.018; reference: integration) and employment status (B=-3.32, 95% CI=-5.71, -0.92, p=0.007) were related to depression levels.

CONCLUSIONS

Separation as acculturation style is associated with higher levels of depressive symptoms (for both genders). Gender-sensitive health promotion programs should target separated migrants to improve their integration into the German society.

[Poverty, migration and mental health]

Poverty and social exclusion are closely related to an increased risk for the deterioration of mental health. In 2018 approximately 19% of the German population were threatened by poverty and the associated social ostracization. Migrant groups in particular often show an increased risk for poverty and are often exposed to multiple socioeconomic stress factors depending on the context of migration, pre-migration and post-migration social factors. Numerous studies have shown that societal exclusion, precarious living conditions and the residential environment negatively affect mental health beyond the effects of pre-migration risk factors. This article provides a review and discussion on the relationship between mental health, poverty and related constructs, such as social cohesion, social capital and social exclusion in general as well as in specific risk groups, such as migrant and refugee populations.

[Depressive and somatoform disorders in persons with a Turkish migration background in Germany]

BACKGROUND

Migration is a risk factor for the onset of mental disorders. Epidemiologic studies indicate that there is an increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany.

OBJECTIVES

The aim of this review article is to determine the impact of sociocultural factors on depressive and somatoform disorders in individuals with a Turkish migration background in Germany.

MATERIALS AND METHODS

The systematic review is based on 23 studies identified in PubMed and PsycINFO.

RESULTS

Acculturation, perceived discrimination and the socioeconomic status affect the severity of mental disorders, and impair the access to the health care system as well as to psychotherapy. Women with a Turkish migration background represent a particularly vulnerable group in this context.

CONCLUSION

Multiple factors influence the increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. Most of the identified studies suffer from significant methodological restrictions and as such do not allow generalization to the whole population of individuals with a Turkish migration background in Germany. There is a lack of national surveys and a need for longitudinal studies in representative population samples.

Acculturation and suicidal ideation among Turkish migrants in the Netherlands✰

More suicidal ideation and higher rates of attempted suicide are found in Turkish people when compared with the general population in Europe. Acculturation processes and related distress may explain an elevated risk of suicide. The current study investigates the association between acculturation and suicidal ideation among Turkish migrants in the Netherlands. The mediating effect of hopelessness and moderating effect of secure attachment are also examined. A total of 185 Turkish migrants living in the Netherlands were recruited through social media and through liaison with community groups. They completed an online survey including validated measures of suicidal ideation, hopelessness, acculturation and attachment style. Mediation and moderation analyses were tested using bootstrapping. Higher participation was associated with less hopelessness and less suicidal ideation. Greater maintenance of one's ethnic culture was associated with higher hopelessness and higher suicidal ideation. Greater participation was associated with less suicidal ideation particularly amongst those with less secure attachment styles. Turkish migrants who participate in the host culture may have a lower risk of developing suicidal thinking. Participation may protect against suicidal thinking, particularly among those with less secure attachment styles.

Explanatory models of suicidality among women of Turkish descent in Germany: A focus group study

Women of Turkish descent in Germany show higher rates of suicidal behavior compared to their host populations and men of Turkish descent. This indicates a demand for a better understanding of suicidality in this group. Nine focus groups ( N = 61) were conducted to assess explanatory models including patterns of distress, perceived causes, course/consequences of and reactions towards a suicidal crisis, help-seeking behavior, and potential intervention and prevention strategies. All participants were of Turkish descent living in Berlin, Germany. The focus groups included two with professionals such as psychiatrists or psychotherapists, two with Community Mothers, three with women from the community (ages: 18 -34, 35 -49, 50+), and of three suicide attempters (ages: 18 -33, 38 -66). Data were analyzed using the methodology of thematic analysis. Results show that suicide-related behaviors, attitudes, and help-seeking behavior have gender and culture-specific characteristics. Two central themes were identified: the impact of family and community and the impact of German society. Participants stated that they believe that family and community pressures as well as discrimination and lack of acceptance cause social isolation. Fear of stigmatization and dishonoring themselves or their family, as well as shame and self-stigma decrease the likelihood of reaching out for help. Recommended strategies are community and family interventions, promotion of integration and social inclusion, awareness campaigns to destigmatize suicidality and the use of mental health services, empowerment of women, as well as the improvement of cultural sensitivity and competency of services.

Bidimensional Acculturation and Psychological Distress in Pakistani Immigrant Women in Norway: A Cross-Sectional Study

Immigrants from South Asia have higher risks of mental health problems . Low levels of acculturation and self-efficacy may be risk factors for depression and psychological distress in immigrants. 355 Pakistani immigrant women in Oslo, filled out a questionnaire concerning demographic variables, self-efficacy, and psychological distress. A bidimensional acculturation variable was constructed. A stepwise logistic regression model was used to investigate the importance of the level of acculturation and self-efficacy on psychological distress. Low levels of acculturation were reported. Integrated participants reported significantly less psychological distress on the depression score and total score than separated and marginalized participants. The model showed that assimilated or marginalized participants had a fourth and three times higher risk of high levels of distress compared with integrated participants. The possibility to be bicultural seems important in order to ensure mental health and national policies should promote an integrative and multiculturalism approach.

Gender Differences in Stressors Related to Migration and Acculturation in Patients with Psychiatric Disorders and Turkish Migration Background

Migration, acculturation, and psychiatric disorders may cause stress and adaptation processes differently in men and women, but empirical research is scarce. In a retrospective study n = 62 Turkish migrants and n = 62 native German inpatients with depressive or anxiety disorders, matched for age, gender, and diagnoses, were compared using a 10-item instrument for the assessment of migration- and acculturation related stressors (MIGSTR10). Gender differences in the prevalence of stressors and in the total sum of stressors were calculated and compared between migrants and indigenous patients. Results showed a higher global stress level in migrants and in women than in men with migration background. Regarding single stressors, the perceived loss of status was significantly more prevalent and more pronounced in men than in women (P < 0.05) whereas guilt feelings were more severe in women with Turkish migration background compared to men (P < 0.05). Gender differences of perceived stress should be taken into account in migration and acculturation research.

Parenting and globalization in western countries: explaining differences in parent-child interactions

We review research on intra-cultural differences in parenting, and the sources of those differences. Ethnic-minority parents differ from majority parents in parenting values, childrearing goals and resources-differences that affect parenting practices and children's development. Within-country comparisons indicate less sensitivity, more authoritarian discipline, less child-focused communications, and less engagement in learning activities in ethnic-minority compared to ethnic-majority parents, which help account for disparities in children. Despite group differences in parenting, associations between parenting and child development generalize across cultures, with rare exceptions. However, a focus on intra-cultural differences is based on comparisons of group 'averages', which masks the enormous variation within ethnic-minority samples. Within-group variation can be partly explained by stressors associated with low socioeconomic status (SES), acculturation and discrimination.

Prevalence of mild cognitive impairment and dementia in older non-western immigrants in the Netherlands: a cross-sectional study

OBJECTIVE

In the Netherlands, persons of Turkish, Moroccan and Surinamese descent form the largest groups of non-western immigrants. A high prevalence of mild cognitive impairment (MCI) and dementia has been described in immigrant populations in the United States of America and the United Kingdom. We determined the prevalence of MCI and dementia in older community-dwelling adults from the largest non-western immigrant groups in the Netherlands.

METHODS

Participants, aged 55 years and older, of Turkish, Moroccan (Arabic or Berber), Surinamese (Creole or Hindustani) or Dutch descent were recruited via their general practitioners. Cognitive deficits were assessed using the Cross-Cultural Dementia screening instrument, which was validated in poorly educated people from different cultures. Differences in prevalence rates of MCI and dementia between the immigrant groups and a native Dutch group were analysed using chi-square tests.

RESULTS

We included 2254 participants. Their mean age was 65.0 years (standard deviation, 7.5), and 44.4% were male. The prevalence of MCI was 13.0% in Turkish, 10.1% in Moroccan-Arabic, 9.4% in Moroccan-Berber and 11.9% in Surinamese-Hindustani participants, compared to 5.9% in Surinamese-Creoles and 3.3% in native Dutch. The prevalence of dementia was 14.8% in Turkish, 12.2% in Moroccan Arabic, 11.3% in Moroccan Berber and 12.6% in Surinamese-Hindustani participants, compared to 4.0% in Surinamese-Creoles and 3.5% in native Dutch.

CONCLUSIONS

MCI and dementia were three to four times more prevalent in the majority of non-western immigrant groups when compared to the native Dutch population. These differences are important for planning and improving healthcare facilities. Copyright © 2016 John Wiley & Sons, Ltd.

Depression, anxiety and suicidal ideation among 1(st) and 2(nd) generation migrants - results from the Gutenberg health study

BACKGROUND

Even though migrants constitute a large proportion of the German population, there is a lack of representative studies on their mental health. Hence, the present study explored mental health characteristics and suicidal ideation comparing 1(st) and 2(nd) generation migrants to non-migrants and subgroups within 1(st) generation migrants.

METHODS

We investigated cross-sectional data of 14,943 participants of the Gutenberg Health Study (GHS), a population-based, prospective, single-center cohort study in Mid-Germany (age 35 to 74 years). Migration status was assessed according to the German microcensus criteria. Depression and anxiety were measured by the PHQ (PHQ-8, GAD-2, Panic module), social anxiety by the Mini SPIN and Distressed Personality (Type D) by the DS-14. Suicidal ideation was assessed by the single item of the PHQ-9.

RESULTS

A total of n = 3,525 participants had a migration background; the proportion of 1(st) generation (immigrated after 1949) migrants was 10.6 % (2(nd) generation 13 %). Among the 1(st) generation migrants those with Polish (N = 295) and Turkish (N = 141) origins were the largest groups from single countries. Controlling for sex, age and socioeconomic status, 1(st) generation migrants reported significantly more depression (OR 1.24; CI 1.01-1.52), generalized anxiety (OR 1.38; CI 1.13-1.68), panic attacks in the past 4 weeks (OR 1.43; CI 1.16-1.77); Type D (OR 1.28; CI 1.13-1.45) and suicidal ideation (1.44; CI 1.19-1.74) compared to non-migrants. The mental health of 2(nd) generation migrants did not differ from native Germans; they had the highest socioeconomic status of the three groups. Compared to native Germans, Turkish migrants of both sexes reported more depression and panic, particularly a strongly increased suicidal ideation (OR 3.02; CI 1.80-5.04) after taking sex, age, and socioeconomic status into account. Polish migrants only reported an increased rate of suicidal ideation and Type D. Turkish migrants exceeded Polish migrants regarding depression (OR = 2.61; 95 % CI 1.21-5.67), and panic attacks (OR=3.38; 95 % CI 1.45-7.85). In the subgroup analyses years lived in Germany was not significant.

CONCLUSIONS

One of few representative community studies shows that compared to native Germans depression, anxiety and suicidal ideation were more frequently reported by 1(st) generation migrants, particularly of Turkish origin. Overall, 2(nd) generation migrants appear to have adjusted successfully. Limitations refer to a lack of data for persons without German language skills and missing mental health data in the Turkish sample. Further analyses need to address causes of mental strains and health care needs and provision.

Perceived Discrimination in Patients With Psychiatric Disorder and Turkish Migration Background in Germany

Perceived discrimination (PD) has a negative impact on the course of psychiatric disorders. We have investigated PD in inpatients with affective or anxiety disorder and Turkish migration background (TP) or native Germans (GP). Migration-related, clinical, and sociodemographic data of n = 62 TP and n = 62 GP, matched for age, sex, and psychiatric diagnoses, were retrospectively analyzed. PD was assessed as one of 10 questions related to migration and acculturation (yes/no, severity 0-10). PD prevalence rates were compared between TP and GP; relationships of PD with other variables were analyzed using bivariate correlations and multiple regression analyses. A PD prevalence of 26% in TP and 1% in GP was found (odds ratio, 21.2 [2.7-165.8]). Migration background was the strongest predictor of PD in the total group. Within the TP sample, asylum-seeking status and migration-related distress were significantly predictive of PD. In patients with psychiatric disorder in Germany, PD seems to be strongly related to migration-related distress.

Attempted suicide and violent criminality among Danish second-generation immigrants according to parental place of origin

BACKGROUND

Immigrant populations in Western European countries have grown in their size and diversity, but little is known about risks of self-directed and externalised violence among second-generation immigrants.

AIMS

To compare risks for attempted suicides and violent offending among second-generation immigrants to Denmark according to parental region of origin versus the native Danish population.

METHODS

Data from interlinked national Danish registers were used (N = 1,973,614). Parental origin outside Denmark was categorised thus: Asia, Africa, Middle East, Greenland, other Scandinavian countries, elsewhere in Europe and all other regions. We estimated gender-specific cumulative incidence and incidence rate ratios (IRRs) versus native Danes.

RESULTS

In virtually all subgroups of second-generation immigrants, risk was elevated for the two adverse outcomes in both genders. Females generally had greater elevations in attempted suicide risk, and males had greater elevations in violent offending risk. For attempted suicide, especially large IRRs were observed for males and females whose parents emigrated from Greenland; for violent offending, risks were particularly raised for males and females of Middle Eastern, Greenlandic and African origin. Adjustment for socioeconomic status partially explained these associations.

CONCLUSION

Western European nations should develop preventive programmes tailored towards specific second-generation immigrant populations, with integrated approaches jointly tackling suicidality and violence.

Effects of acculturative stress on PTSD, depressive, and anxiety symptoms among refugees resettled in Australia and Austria

BACKGROUND

Research indicates that exposure to war-related traumatic events impacts on the mental health of refugees and leads to higher rates of posttraumatic stress disorder (PTSD), depression, and anxiety symptoms. Furthermore, stress associated with the migration process has also been shown to impact negatively on refugees' mental health, but the extent of these experiences is highly debatable as the relationships between traumatic events, migration, and mental health outcomes are complex and poorly understood.

OBJECTIVE

This study aimed to examine the influence of trauma-related and post-migratory factors on symptoms of PTSD, depression, and anxiety in two samples of Bosnian refugees that have resettled in two different host nations-Austria and Australia.

METHOD

Using multiple recruitment methods, 138 participants were recruited to complete self-report measures assessing acculturative stress, PTSD, depressive, and anxiety symptoms.

RESULTS

Hierarchical regressions indicated that after controlling for age, sex, and exposure to traumatic events, acculturative stress associated with post-migratory experiences predicted severity of PTSD and anxiety symptoms, while depressive symptoms were only predicted by exposure to traumatic events. This model, however, was only significant for Bosnian refugees resettled in Austria, as PTSD, depressive, and anxiety symptoms were only predicted by traumatic exposure in the Bosnian refugees resettled in Australia.

CONCLUSION

These findings point toward the importance of assessing both psychological and social stressors when assessing mental health of refugees. Furthermore, these results draw attention to the influence of the host society on post-migratory adaptation and mental health of refugees. Further research is needed to replicate these findings among other refugee samples in other host nations.

Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies

Background: Discrimination harms immigrants’ health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Methods: Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. Results: We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16–2.07) and 1.47 (95% CI: 1.15–1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Conclusion: Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.