Psychiatric disorders and social characteristics among second-generation Moroccan migrants in Belgium: an age-and gender-controlled study conducted in a psychiatric emergency department

Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments

BACKGROUND AND AIMS

Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments.

STUDY DESIGN

PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review.

STUDY RESULTS

SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling.

CONCLUSIONS

Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.

Effects of country of origin and wave of immigration on prevalence of schizophrenia among first and second-generation immigrants: A 30-year retrospective study

OBJECTIVES

To compare the rates of schizophrenia among 1st and 2nd generation immigrants from two distinct backgrounds and across sequential periods of immigration.

METHODS

A 30-years retrospective cohort study (187,184 individuals) of 1st and 2nd generation East-African immigrants (EAIs) and former Soviet-Union immigrants (FSUIs) who migrated to Israel between 1980 and 2012. EAIs were further divided according to waves of immigration. Period prevalence was calculated between the years 2002-2012. Multivariate logistic regression models were used to examine the association between immigration-related factors and prevalence of schizophrenia (Native-Born Israelis serving as reference group).

RESULTS

The prevalence of schizophrenia in 1st generation EAIs and FSUIs was 1.8% and 1.2%, respectively, compared to 1.0% among NBIs (p<0.001). The prevalence of schizophrenia among 2nd generation EAIs and FSUIs was 1.3% and 0.8%, respectively, compared to 0.6% among NBIs (p<0.001). Adjusted odds ratios for developing schizophrenia compared to NBIs were 1.6 (95%CI:1.4-1.8) and 2.1 (95%CI:1.6-2.7), among 1st and 2nd generation EAIs and 1.1 (95%CI:0.9-1.2) and 1.3 (95%CI:1.0-1.8) among 1st and 2nd generation FSUIs respectively. Among EAIs, we observed the highest rate of schizophrenia in the pioneer wave of immigrants with gradual decline across subsequent waves: 2.4%, 1.9% and 1.0% for the 1st, 2nd and 3rd waves of immigration, respectively (p<0.001).

CONCLUSIONS

The increased risk for developing schizophrenia among 2nd generation immigrants and among pioneer groups of immigrants emphasizes the importance of persistent investment in acculturation. Further studies elucidating the impact of country of origin and ethnic density on the risk for developing schizophrenia are warranted.

Psychosis, migration and social environment: an age-and-gender controlled study

Purpose

Adverse social experiences are frequently invoked to explain the higher rate of psychosis among migrant groups. The aim of the present study was to establish the socio-environmental factors distinguishing migrant psychotic patients from autochthonous patients.

Subjects and method

We conducted a cross-sectional survey involving 341 migrant psychotic patients matched for age and gender with 341 autochthonous psychotic patients.

Results

Migrant patients lived more often with their parental family, were less often enrolled with a referral psychiatrist, presented a lower rate of employment, a lower percentage of alcohol misuse and of suicide attempts.

Discussion

Our findings add to the growing body of results showing that more attention needs to be focused on socio-environmental variables in psychosis research. However, several limitations have to be taken into account, particularly with regard to selection biases and age of onset of the psychotic illness.

Conclusion

Our results are compatible with the hypothesis that unemployment is a contributing factor in the risk for psychosis among migrant groups. Migrants’ families are an important keystone in the mental health care process of their sick relatives. Our service models need to be adapted with the aim to make the treatment easier for migrant patients.

Transcultural differences of psychologically traumatised children and adolescents

Background

The symptoms following a traumatic event as well as the coping strategies can be culture specific. The objective of the present study was to analyse the transcultural differences of psychologically traumatized children and adolescents with and without migration background.

Methods

The medical files of 199 psychologically traumatized children and adolescents (99 native Austrian, 100 Turkish-speaking) who were treated at the Department of Child and Adolescent Psychiatry in Vienna were retrospectively analysed.

Results

The most frequently observed causes of trauma in patients with Turkish migration background were intra-familial conflicts, forced separation from parent(s), and conforming to a new environment. In native Austrian patients, forced separation from parent(s) and divorce or separation of parents were the leading causes of trauma. Trauma-related symptoms like changed mood, cognitive and perceptual disturbance, social withdrawal, sleeping problems, somatisation and behavioural problems were similarly observed in both groups; “sleeping problems” were more often observed in Austrian patients, and “behavioural problems” were more often observed in Turkish patients. More Austrian patients (32.7%) obtained psychiatric and psychotherapeutic treatment. Turkish-speaking patients mostly obtained psychiatric treatment only. Patients with migration background were more compliant compared to indigenous patients.

Conclusions

Both study groups differed in type, causes and symptoms of trauma, and in preferred therapy. Turkish-speaking patients were more compliant with therapy, as they received culture and language-sensitive medical advice and treatment in their mother tongue. Considering the cultural background of patients can optimize service delivery and therapy outcomes among children and adolescents with stressful and traumatic experiences.

Psychosocial stressors contributing to emergency psychiatric service utilization in a sample of ethno-culturally diverse clients with psychosis in Toronto

BACKGROUND

Understanding the psychosocial stressors of people with psychoses from minority ethnic groups may help in the development of culturally appropriate services. This study aimed to compare psychosocial factors associated with attendance at an emergency department (ED) for six ethnic groups. Preventing crises or supporting people better in the community may decrease hospitalization and improve outcomes.

METHOD

A cohort was created by retrospective case note analysis of people of East-Asian, South-Asian, Black-African, Black-Caribbean, White-North American and White-European origin groups attending a specialized psychiatric ED in Toronto with a diagnosis of psychosis between 2009 and 2011. The psychological or social stressors which were linked to the presentation at the ED that were documented by the attending physicians were collected for this study. Logistic regression models were constructed to analyze the odds of presenting with specific stressors.

RESULTS

Seven hundred sixty-five clients were included in this study. Forty-four percent of the sample did not have a psychiatrist, and 53% did not have a primary care provider. Social environmental stressors were the most frequent psychosocial stressor across all six groups, followed by issues in the primary support group, occupational and housing stressors. When compared to White-North American clients, East-Asian and White-European origin clients were less likely to present with a housing stressor, while Black-African clients had decreased odds of presenting with primary support group stressor. Having a primary care provider or psychiatrist were predominantly protective factors.

CONCLUSION

In Toronto, moving people with chronic mental health conditions out of poverty, increasing the social safety net and improving access to primary care and community based mental health services may decrease many of the stressors which contribute to ED attendance.

Evidence of an excessive gender gap in the risk of psychotic disorder among North African immigrants in Europe: a systematic review and meta-analysis

PURPOSE

Epidemiological studies in the Netherlands have reported an excessive gender gap in the risk for non-affective psychotic disorder (NAPD) among immigrants from Morocco with a higher risk elevation in males compared to females. We examined the consistency of these findings and their generalizability to immigrants from the Maghreb (Mauritania, Morocco, Algeria, Tunisia and Libya) in other European countries.

METHODS

Systematic review and meta-analysis. Medline, PsychINFO and EMBASE databases were searched for publications in the period from January 1970 to April 2014. We included incidence and prevalence studies of non-affective psychotic disorder (NAPD) among migrants from the Maghreb in Europe and studies of subclinical psychotic symptoms (SPS) in representative samples. A meta-analysis was performed on the subgroup of incidence studies.

RESULTS

Five incidence and three prevalence studies of NAPD, and two prevalence studies of SPS, conducted in the Netherlands (n=7), Belgium (n=1), France (n=1) and Italy (n=1) met our inclusion criteria. Across all research designs, the risks of NAPD and SPS were consistently increased among male, not female immigrants from the Maghreb. The meta-analysis of incidence studies of NAPD yielded male-to-female risk ratios of 5.1 [95 % confidence interval (CI) 3.1-8.4] for migrants from the Maghreb, 2.0 (95 % CI 1.6-2.5) for other migrant groups, and 1.8 (95 % CI 1.3-2.5) for non-migrant Europeans.

CONCLUSIONS

The marked gender gap in psychosis risk among migrants from the Maghreb appears a consistent finding, foremost among the Moroccan-Dutch. The small number of studies limits the strength of conclusions that can be drawn about countries other than the Netherlands. Achievement-expectation mismatch, social marginalization and an increased prevalence of illicit drug use are possible explanations.

Prevalence of mental disorders in migrants compared with original residents and local residents in Ningxia, China

BACKGROUND

Ecological migrants has a special background compared with other types of migrant. However, the mental health status of ecological migrants who were expected to benefit from a massive "ecological migration project" initiated by the Chinese government is unknown. This study aims to explore the influence of environmental change on individuals' mental health and to improve current understanding of the mechanisms that mental disorders occurred.

METHODS

The data were extracted from a cross-sectional study. Anxiety disorders, mood disorders and substance use disorders were assessed using the Chinese version WHO-CIDI. The prevalence of mental disorders was stratified by migration status into ecological migrant, local resident and original resident groups. Unconditional logistic regression models were used to calculate the risk of prevalence among these three groups.

RESULTS

After controlling for gender, ethnicity, age, marriage, and education, the migrants had lower risk of mental disorders than original residents [OR = 0.70 (95 % CI: 0.57-0.86)], p < 0.001), but had a higher risk of mental disorders than local residents [OR = 1.29 (95 % CI: 1.06-1.55)], p = 0.007).

CONCLUSION

The ecological migration project may be beneficial to people's mental health by improving their living environment and social economy.

Leadership and cultural competence of healthcare professionals: a social network analysis

BACKGROUND

International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care.

OBJECTIVES

The purpose of this study was to investigate the influence of leaders on the cultural competence of healthcare professionals.

METHODS

A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff.

RESULTS

Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence-mediation and paradigm-after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders.

DISCUSSION

Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders.

Mental health of aging immigrants and native-born men across 11 European countries

OBJECTIVES

Though working-age immigrants exhibit lower mortality compared with those domestic-born immigrants, consequences of immigration for mental health remain unclear. We examine whether older immigrants exhibit a mental advantage and whether factors believed to underlie immigrant vulnerability explain disparities.

METHOD

The sample includes 12,247 noninstitutionalized men more than 50 years in 11 European countries. Multivariate logistic regression models estimated the impact of physical health, health behaviors, availability of social support, social participation, citizenship, time since immigration, socioeconomic status (SES), and employment on the mental health of immigrants.

RESULTS

Immigrants face 1.60 increased odds of depression despite a physical health advantage, evidenced by 0.74 lower odds of chronic illness. SES and availability of social support were predictive, though acculturation measures were not. Decomposition analysis revealed that only approximately 20% of the variation in depression rates between immigrants and native-born peers were explained by commonly cited risk factors.

CONCLUSIONS

Despite physical health advantages, older immigrants suffer substantially higher depression rates. Time since immigration does not appear to mitigate depressive symptoms.

Towards fair health policies for migrants and ethnic minorities: the case-study of ETHEALTH in Belgium

BACKGROUND

In Europe, progress in the development of health policies that address the needs of migrants and ethnic minorities has been slow. This is partly due to the absence of a strategic commitment by the health authorities. The Ministry of Public Health commissioned the ETHEALTH (EThnicity &HEALTH) group to formulate relevant recommendations to the public authorities with a view to reducing health inequalities among ethnic minorities. This paper describes the political process and the outcomes of the ETHEALTH expert group.

RESULTS

After ten meetings, the ETHEALTH group came up with 46 recommendations, which were presented at a national press conference in December 2011. Target groups concerned by these recommendations covered both irregular migrants and migrants entitled to the national insurance coverage. Recommendations were supported by the need of combining universal approaches to health care with more specific approaches. The scope of the recommendations concerned health care as well as prevention, health promotion and access to health care. When analysing the content of the recommendations, some ETHEALTH recommendations were not fully measurable, and time-related; they were, however, quite specific and realistic within the Belgian context. The weak political commitment of an executive agency was identified as a major obstacle to the implementation of the recommendations.

CONCLUSIONS

The ETHEALTH group was an example of scientific advice on a global health issue. It also demonstrated the feasibility of coming up with a comprehensive strategy to decrease ethnic health inequalities, even in a political context where migration issues are sensitive. Two final lessons may be highlighted at the end of the first phase of the ETHEALTH project: firstly, the combination of scientific knowledge and practical expertise makes recommendations SMART; and, secondly, the low level of commitment on the part of policymakers might jeopardise the effective implementation of the recommendations.

Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996-2005

PURPOSE

Several European studies have shown that migrants from non-western countries are at increased risk of psychotic disorders. This study examines how this is reflected in the risk of acute compulsory admission (ACA).

METHODS

Information on all patients with an ACA in Amsterdam from 1996 to 2005 was linked to the Amsterdam municipal register.

RESULTS

The incidence of first ACA in Amsterdam was 4.5 per 10,000 person years. The incidence risk of ACA for any psychiatric disorders and for psychotic disorders in particular showed a 2- to 3-fold increase in almost all migrant groups from non-western countries, and especially for second-generation migrants. In addition, all non-western migrant groups were at increased risk of being assessed as posing a danger to others.

CONCLUSIONS

The relative risk of ACA for psychotic disorders was similar to that for the incidence of psychotic disorders in most ethnic groups from other studies, suggesting that the increased risk of ACA in non-western migrants can mainly be explained by the increased incidence of psychotic disorders in these groups. However, the relative risk of ACA for psychotic disorders among Moroccan migrants was lower than expected on the basis of incidence studies, which suggests that additional factors are relevant, such as illness-related expression and access to and quality of care.

Access to social capital and social support among South East Asian women with severe mental health problems: a cross-sectional survey

BACKGROUND

Migrant groups in the UK are at an increased risk of experiencing psychosis. In particular, South East Asian women are substantially more at risk of mental illness than men. Perceived social support and access to social capital are two important psychosocial factors, which may explain this differential risk.

AIMS

This study aimed to explore if migrant status was associated with the perception of social support and access to social capital of Punjabi women suffering from enduring mental illness.

METHOD

We conducted a cross-sectional survey of a homogeneous group of Punjabi women (n = 54). Outcome measures included the Multidimensional Scale of Perceived Social Support (MSPSS) and Resource Generator-UK (RG-UK).

RESULTS

No significant differences were found between the two generations on our outcome measures. However, univariate analysis revealed an association of socio-economic and demographic variables with the MSPSS and RG-UK. Linear regression confirmed that being employed, living with others and human capital predicted increased access to social capital.

CONCLUSIONS

Intervening to help this vulnerable group to enhance their social skills and to develop their social networks may improve their access to social capital and promote their recovery from mental illness.

Differences in psychotropic drug prescriptions among ethnic groups in the Netherlands

BACKGROUND

Psychotropic drug use in Europe and the USA has increased in the past 20 years. The rise in mental health-care use instigated a debate about possible differences in prevalence rates between different ethnic groups in the Netherlands, although the exact differences were unknown. The aim of this study was to determine whether these minority groups were more or less likely than the native population to receive psychotropic drugs.

METHODS

A descriptive population study was conducted using the Agis Health Database, containing demographic and health-care consumption data of approximately 1.5 million inhabitants of the Netherlands. Rates of prescriptions of psychotropic drugs from 2001 to 2006 and adjusted odds ratios for psychotropic drug prescriptions among native Dutch, Turkish and Moroccan ethnic groups were calculated. These data were analysed using logistic regression, after being adjusted for age, gender and socioeconomic status.

RESULTS

The mean year prevalence of psychotropic drug prescriptions from 2001 to 2006 was 14.0%. Except for a decrease in anxiolytic drugs, the prescriptions of psychotropic drugs increased from 2001 to 2006. These trends were the same for all of the ethnic groups considered. Among both the Moroccan and Turkish populations, there was a higher risk of antidepressant and antipsychotic drug prescriptions, and a pronounced lower risk of ADHD medication and lithium prescriptions compared to the native population. Among the Turkish population, the risk of anxiolytic drug prescriptions was greater than in the native population.

CONCLUSIONS

Compared to the native population in the Netherlands, first- and second-generation Turkish and Moroccan immigrants had an increased risk of antidepressant and antipsychotic drug prescriptions and a decreased risk of ADHD medication and Lithium prescriptions. Further research is needed to clarify whether patients of different ethnic backgrounds with the same symptoms receive similar diagnosis and adequate treatment.

Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna

BACKGROUND AND AIMS

Social exclusion and reduced access to community health services can lead to urgent health problems among immigrants; this may explain their increasing rate of admittance to psychiatric inpatient units. This cross-sectional study aims to evaluate the prevalence of psychotic symptoms among Romanian immigrants living in very poor conditions at an abandoned hotel in Bologna and to highlight the possible correlation with general health status, distress and socio-demographic characteristics.

METHODS

The Psychosis Screening Questionnaire (PSQ) and General Health Questionnaire-12 (GHQ-12) were administered to all immigrants residing at the hotel during two index days with the help of a cultural mediator. Socio-demographic, migration and health characteristics were also collected.

RESULTS

Sixty eight subjects were evaluated. More than 80% had left Romania for economic reasons. Of immigrants, 57% exceeded the four-point GHQ-12 threshold of potential mental disorder and 19% scored positively at the PSQ. Immigrants with positive PSQ showed higher mean GHQ-12 scores (5.9 +/- 3.5 vs. 3.8 +/- 2.75; p = 0.02). The development of post-migration health problems significantly predicts positive PSQ cases even after adjusting for age, sex and GHQ-12 dichotomized score (OR = 21.2, CI = 1.1-169.4).

CONCLUSION

This community of immigrants living in deprived conditions showed a high prevalence of distress and psychotic symptoms, related to health problems. Preventing excess of psychosis among immigrants and ethnic minorities in critical socio-economic conditions should mean, first and foremost, facilitating social integration and access to primary care.

Arranging appropriate activities immigrant women's ideas of enabling exercise

OBJECTIVE

Several studies have reported low levels of physical activity among immigrant women. However, few studies have attempted to explore possible causes underlying this phenomenon. This study intended to explore immigrant women's attitudes and experiences of physical activity and exercise. The ultimate goal was to find methods that can increase levels of physical activity among immigrant women.

METHODS

A qualitative exploratory study was undertaken in Stockholm County, Sweden, involving 63 immigrant women from Chile, Iraq, and Turkey. Data were collected through interviews in 10 focus groups. The analysis was based on grounded theory approaches. Constant comparative analysis and theoretical sampling were employed to construct categories.

MAIN FINDINGS

The model that emerged illustrated the core process, that is, enabling exercise. The model also described the women's attitudes and experiences and their ideas of how exercise can be made possible. The women agreed that the local community should recognize the problem and arrange exercise in familiar places. In addition, they called for activities that felt appropriate. If appropriate exercise was arranged, the women sometimes decided to participate. Otherwise, they hesitated or waited.

CONCLUSION

If appropriate activities are arranged, levels of physical activity and exercise might increase among immigrant women. Future studies could explore specific activities that can facilitate immigrant women's opportunities to exercise.

Mental hospital admission rates of immigrants in Switzerland

PURPOSE

This epidemiological study aims to assess the utilisation of inpatient psychiatric services by immigrants. Specifically, we address the question of gender-specific differences in immigrants and compare the population-based rates of males and females from different countries of origin.

METHODS

We analysed inpatient admission rates from a defined catchment area over a 6-year period by means of psychiatric register data. Poisson regression analysis was used to model effects of gender, age and country group (immigrants grouped into six categories according to their country of origin).

RESULTS

Of the total of 28,511 subjects consecutively referred to psychiatric inpatient treatment, 4,814 were foreign nationals (16.9%). Among immigrants the proportion of female inpatients (38.7%) was far lower than in the general population (45.6%; equal proportion of female-to-total among Swiss inpatients). Immigrants were 37.4 years old on average at index admission (Swiss people: 46.3 years), but there were considerable differences across country groups. We found three groups with particularly high admission rates: male immigrants originating from Turkey, Eastern European and 'Other' countries (rates >6 per 1,000 population/year). These were admitted as inpatients at far higher rates than females from the same countries. In women, there was no immigrant group utilising inpatient treatment at a higher level than Swiss females. The rates of inpatient admission in males and females was almost equal among the Swiss (4.3 per 1,000), as was the case for immigrants from Southern, Western/Northern Europe and former Yugoslavia, although on a lower level (2.26-3.15 per 1,000). Regression analysis further suggests that country effects and age effects are different for males and females, and age effects are specific to the country of origin.

DISCUSSION

These gender- and interaction effects point to inequalities in psychiatric service use in people with different migration background. Further research is needed, particularly to understand the reasons for the markedly different gender-specific utilisation of psychiatric services by some immigrant groups.

A gender-oriented comparison between the mental health profiles of Bulgarian immigrants forcibly migrated to Turkey and the native population 15 years after migration

Background. The considerable problem of the migration of people, mainly from developing or undeveloped countries to developed countries, is a worldwide issue. The aims of this study were to compare, according to gender, scores obtained pertaining to mental symptom distributions of Bulgarian immigrants arriving in one city of west Turkey in 1989 with those of native-born citizens, as well as to the scores obtained from the scales of anxiety, hopelessness, job and life satisfaction. Methods. During the period of study between 1 February and 31 April 2003, short symptom inventory, state and trait anxiety scales, and hopelessness, job, and life satisfaction scales were collected from 85 immigrants living in a district where immigrants are prevalent. The results of 98 of the native population living in the same district were also collected during the same period. Data were analyzed using chi-square, t, Mann-Whitney U-tests, and percent ratios.

RESULTS

Upon comparison of the scores of both immigrant women and native women, and immigrant men and native men, no differences were found between scores obtained from the subscales of short symptom inventory, state and trait anxiety scales, and hopelessness and job satisfaction scales (p>0.05). The only observable difference was between scores obtained from the life satisfaction scale (p<0.01 and p<0.05, respectively). The depression subscale of the short symptom inventory revealed a difference in the scores of immigrant women compared to immigrant men, as did the somatization subscale for native-born women when compared to native men (p<0.05 and p<0.05, respectively).

CONCLUSIONS

That both male and female immigrants had low scores for life satisfaction forces us to draw the conclusion that their expectations, necessities, desires and wishes were not entirely fulfilled. The reason for their being no observable differences between the other scale scores may be attributed to the fact that the immigrant women and men share not only the same ethnic origin, but also historical and cultural ties with those in Turkey. An alternative view could be that those entering the country may have adapted to the environment after the passage of 15 years. Furthermore, the significant difference seen between immigrant women and men, and native women and men in terms of symptoms of depression and somatization, respectively, may be explained through the notion that women perceived migration to be more different, and that native women more readily accepted the thought of physical illness according to mental disorders. Further studies are needed to better explain some of these results.

Coronary heart disease risks in first- and second-generation immigrants in Sweden: a follow-up study

OBJECTIVES

To analyse whether there is an association between country of birth in first-generation immigrants and first hospitalization for or death from coronary heart disease (CHD) and to analyse whether this association remains in second-generation immigrants.

DESIGN

In this follow-up study, the MigMed database at the Karolinska Institute, Stockholm, was used to identify all hospital diagnoses of and deaths from incident CHD in first- and second-generation immigrants in Sweden between 1 January 1987 and 31 December 2001. Incidence ratios standardized by age, geographical region and socio-economic status were estimated by sex in first- and second-generation immigrants; the reference group was Swedish-born people whose parents were both born in Sweden.

SUBJECTS

The total Swedish population aged 25-69 years.

RESULTS

First-generation immigrants from Finland, central European countries, other eastern European countries and Turkey had higher rates of CHD than men or women in the reference group. First-generation immigrant women born in southern Europe, other western European countries and Baltic countries had lower CHD risks than the reference group. Sons of both male and female first-generation immigrants showed CHD risks similar to or slightly higher than those of their parents. Amongst second-generation women, only subjects with Finnish fathers or mothers had higher risks of developing CHD than the reference.

CONCLUSIONS

Increased risks of CHD found in some first-generation immigrant groups often persist in second-generation immigrant men. Healthcare professionals and policy makers should take this into account when designing and undertaking measures to prevent CHD.

Emergency psychiatry, compulsory admissions and clinical presentation among immigrants to the Netherlands

BACKGROUND

Black individuals in the UK have higher rates of contact with psychiatric emergency services than their White counterparts. It is unknown whether this is also the case in other European countries.

AIMS

To compare the risk of contact with psychiatric emergency services and of compulsory admission between immigrant groups to The Netherlands and Dutch natives, and to determine the unique contribution of ethnicity to compulsory admission.

METHOD

Study of 720 people referred to emergency psychiatric services in Greater Rotterdam, The Netherlands.

RESULTS

The relative risks (RRs) for contacts with psychiatric emergency services, for having a psychotic disorder and for compulsory admission were significantly higher in most immigrant groups. Moroccans, Surinamese and Dutch Antilleans had the highest risks of compulsory admission. After controlling for symptom severity, danger, motivation for treatment and level of social functioning, non-Western origin was no longer associated with compulsory admission.

CONCLUSIONS

Non-Western immigrant groups were overrepresented in psychiatric emergency care and were admitted compulsorily more frequently, possibly owing to a different clinical presentation.

Patterns of inpatient care for immigrants in Switzerland: a case control study

BACKGROUND

Migration has become a major political and social concern in West European societies.

METHODS

A case-control method was used to analyse the utilisation of inpatient mental health services by immigrants from a catchment area in Switzerland over a 7-year period.

RESULTS

Compared to natives, immigrants had fewer psychiatric hospitalisations, but more emergency and compulsory admissions. During inpatient treatment, they received less psycho-, ergo- and physiotherapy. Other therapies as well as compulsory measures were at comparable rates, as was the frequency of irregular discharge. They spent shorter periods as inpatients and the rate of psychiatric readmissions was significantly lower. Comparison of different countries of origin revealed that only patients from West and North Europe were comparable to natives regarding type of referral, inpatient treatment, and longitudinal measures of service utilisation. Even after accounting for effects of social class, immigrants from South Europe, former Yugoslavia, Turkey, East Europe and more distant countries spent significantly shorter time in inpatient treatment, compared to Swiss control patients.

CONCLUSIONS

Results of this study clearly point to an underutilisation of inpatient facilities among immigrants with mental disorders, and to disadvantages in psychiatric inpatient care. This, however, does not pertain to all foreign patients to the same extent: inequalities of mental health service use are particularly pronounced in immigrants from more distant countries.

Incidence of schizophrenia or other psychoses in first- and second-generation immigrants: a national cohort study

The main aims of this study were to investigate whether the increased risk of psychotic disorders among certain immigrant groups is present in the next generation and whether having one parent born in Sweden has a protective effect on the risk of psychotic disorders among second-generation immigrants. In total, 2,243,546 individuals were followed from January 1, 1992, until December 31, 1999, for first hospital admission for schizophrenia or other psychoses. Cox regression was used to estimate hazard ratios. The highest risks of psychotic disorders were found among first-generation and second-generation Finns, after adjustment for socioeconomic status. Having one parent born in Sweden had no protective effect on the risk of being hospitalized for psychotic disorders among second-generation immigrants. The disabling symptoms of psychotic disorders call for increased awareness among clinicians and public health planners involved in the treatment and prevention of psychotic disorders, especially among certain immigrant groups.

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

BACKGROUND

This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

METHODS

The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.

RESULTS

Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Incidence of mental disorders in second-generation immigrants in sweden: a four-year cohort study

BACKGROUND

Few studies have investigated mental health among second-generation immigrants who have reached adulthood. The aim of this study was to examine whether second-generation adult immigrants have a higher risk of being hospitalised for mental disorders than the Swedish majority population after adjustment for socio-economic status.

METHODS

In total 1.9 million Swedish-born women and men aged 16-34 were followed from 1 January 1995 to 31 December 1998 for first hospital admissions for mental disorders, categorised in four main diagnosis groups. Second-generation immigrants comprised four groups and the Swedish majority population was used as reference group. Cox proportional hazard models were used to analyse the data.

RESULTS

Second-generation immigrants with one parent born in Sweden and second-generation Finns had higher risks of being hospitalised for psychotic disorders, affective disorders, neurotic disorders, and personality disorders than the Swedish majority population. For second-generation Finns the age- and sex-adjusted hazard ratio for psychotic disorders was 2.42 (CI = 2.09-2.80). No significant hazard ratios were found for second-generation labour immigrants. For second-generation refugees the risk of being hospitalised was higher than for the Swedish majority population but only for psychotic disorders. All results remained significant and decreased only slightly after adjustment for income and education.

CONCLUSIONS

Many groups of second-generation immigrants have a higher risk of being hospitalised for mental disorder than the majority population. With increasing global migration it is crucial for all industrialised countries to take measures to improve mental health among second-generation immigrants.

Are immigrants at a disadvantage in psychiatric in-patient care?

OBJECTIVE

To assess the utilization of psychiatric in-patient care among immigrants, and to compare immigrants and natives with respect to sociodemographic and clinical characteristics.

METHOD

Analysing a sample of 23 377 consecutive referrals to psychiatric hospitals of a catchment area in 1995-2001.

RESULTS

Within this sample, 20% were foreign nationals. Rates of psychotic disorders were similar in immigrants and natives. Regarding other diagnoses, sociodemographic and clinical measures, there were significant differences. Most immigrant groups had higher rates of compulsory admission, were more likely to be admitted with lower illness severity and not to be readmitted, and spent significantly shorter time in hospital, compared with Swiss in-patients. Some of these differences were clearly gender-specific.

CONCLUSION

Service utilization and psychiatric treatment decisions are not explained merely by illness-related aspects in immigrants. Social and cultural factors have to be recognized in order to prevent disadvantages in psychiatric care.