The mental health status of Filipinas in Queensland

How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis

BACKGROUND

Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years).

METHODS

For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379.

FINDINGS

Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I²=79-87%). GRADE certainty was low or very low.

INTERPRETATION

Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged.

FUNDING

Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.

Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review

PURPOSE

This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking.

METHODS

Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis.

RESULTS

Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help.

CONCLUSION

We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.

A qualitative study on the stigma experienced by people with mental health problems and epilepsy in the Philippines

BACKGROUND

Stigma towards people with mental health problems (PMHP) is known to have substantial negative impacts on their lives. More in-depth exploration of the stigma and discrimination experienced by PMHP in low- and middle-income countries is needed. Previous research suggests that negative attitudes towards PMHP are widespread among the Filipino general public. However, no study has investigated PMHP's own experiences of being stigmatised in the Philippines.

METHODS

A qualitative study was conducted on the stigma experienced by PMHP (including people with epilepsy) and its related factors in the Philippines, employing the constructivist grounded theory approach. We analysed data on 39 PMHP collected through interviews with PMHP, their carers, and community health volunteers who know them well.

RESULTS

The findings highlight the culturally and socio-economically specific contexts, consequences, and impact modifiers of experiences of stigma. Participants emphasised that PMHP face stigma because of the cultural traits such as the perception of mental health problem as a disease of the family and the tendency to be overly optimistic about the severity of the mental health problem and its impact on their life. Further, stigma was experienced under conditions where mental health care was not readily available and people in the local community could not resolve the PMHP's mental health crisis. Stigma experiences reduced social networks and opportunities for PMHP, threatened the economic survival of their entire family, and exacerbated their mental health problems. An individual's reaction to negative experiences can be fatalistic in nature (e.g. believing in it is God's will). This fatalism can help PMHP to remain hopeful. In addition, traditional communal unity alleviated some of the social exclusion associated with stigma.

CONCLUSIONS

The study indicates that existing stigma-reduction strategies might have limitations in their effectiveness across cultural settings. Therefore, we propose context-specific practical implications (e.g. emphasis on environmental factors as a cause of mental health problems, messages to increase understanding not only of the possibility of recovery but also of challenges PMHP face) for the Philippines.

Migrant Live-in Caregivers Mental Health in Canada

Empirical evidence suggests rapid health decline among temporary migrant workers but there is limited knowledge about their mental health. This study explored live-in care givers' (LCs) mental health and its determinants. Using a mixed methods design, a purposeful sample of 30 LCs was recruited. Data were collected through a selfcompleted questionnaire. A third of participants reported their mental health as poor or fair. Almost half experienced major depression. The poor mental health was associated with the average working hours and living accommodation. The average resiliency scores was moderately high and appeared to function as a protective factor against mental illness. Our findings suggest LCs are at risk of compromised mental health associated to their substandard working and living conditions. These conditions originates from violation of employment contracts, unfair employment practices, and the lack of enforcement of LCs' legal and human rights.

"It has not occurred to me to see a doctor for that kind of feeling": a qualitative study of Filipina immigrants' perceptions of help seeking for mental health problems

BACKGROUND

Immigrant women face greater barriers to health care, especially mental health care, than non-immigrant women. However, immigrants are a heterogeneous group and bring with them a range of different personal, social, cultural and economic factors, which impact both mental health and access to care. In this study, we explored factors that influence Filipina immigrants' perceptions of help seeking from a general practitioner for mental health problems in Norway.

METHOD

Using data from semi-structured interviews, we applied a post-colonial feminist perspective to identify factors that affect perceptions of help seeking.

RESULTS

Findings indicated that a combination of the women's beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influence perceptions of help seeking. Some factors represented structural barriers to healthcare seeking in general, while others related to mental healthcare seeking in particular. The significance of each factor varied depending on the women's backgrounds.

CONCLUSIONS

Socioeconomic status, educational background, familiarity with health services and experience of mental health can influence immigrant women's perceptions of, and barriers for, help seeking for mental health problems. There are a number of barriers to address at a structural level to improve both the propensity to seek healthcare in general, as well as mental healthcare in particular. Efforts to increase awareness of primary mental healthcare services may also help change the perception that professional help is only appropriate for serious mental health disorders.

A qualitative study of Filipina immigrants' stress, distress and coping: the impact of their multiple, transnational roles as women

Background

Migration is associated with a number of stress factors which can affect mental health. Ethnicity, gender and socioeconomic status can intertwine with and influence the process of migration and mental health. Philippine migration to Europe has increased in recent years and has become more feminised. Knowing more about the factors that influence immigrants’ mental health and coping can help aid health care delivery and policy planning. The purpose of this qualitative study was to explore the contextual factors that influence the mental health of Filipinas living in Norway and their coping strategies.

Method

Individual in-depth interviews were conducted with fourteen Filipinas 24–49 years, living in Norway. The analysis was informed by the post-colonial feminist perspective in order to examine the process by which gender, ethnicity and socioeconomic status interact with contextual factors in these women’s lives and influence their wellbeing.

Results

Data analysis revealed that all informants experienced some level of stress or distress. Two main factors: Sense of belonging and Securing a future contributed to the women’s level of distress associated with living abroad as an immigrant woman. Distress was heighted by the women’s multiple, transnational roles they occupied; roles as workers, breadwinners, daughters, wives and mothers. None of the women had sought professional help for their distress. Religion and informal support from friends and family appear to help these women cope with many of the challenges they face as immigrant women living and working abroad.

Conclusions

Filipinas face a number of challenges related to their status as immigrant women and the juggling of their transnational lives. Understanding the context of these women’s lives may aid the identification of mental health problems. Although the women show resilience and appear to cope successfully, some may benefit from professional help.

Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada

Background

Canada depends on Temporary Foreign Workers (TFWs), also known as migrant workers, to fill labour shortage in agriculture, hospitality, construction, child/senior care, and other low-skilled occupations. Evidence shows that TFWs, especially women live-in caregivers (LC), constitute a vulnerable population. Their health is compromised by the precarious and harsh working and living conditions they encounter. There is a paucity of research on the mental health of LCs, their support systems and access to mental health services.

Method

In this community-based exploratory study, we used mixed methods of survey and focus groups to explore the work related experiences and mental health of migrant live-in caregivers in the Greater Toronto Area in Ontario, Canada. Convenience and snowball sampling were used to recruit participants. The inclusion criteria were: being 18 years or older, initially migrated to Canada as TFWs under LC program, resided in the Greater Toronto Area, and able to understand and converse in English based on self-report. This paper reports on the focus group results derived from inductive thematic analysis.

Results

A total of 30 women LCs participated in the study. Most of them were from the Philippines. A number of key themes emerged from the participants’ narratives: (1) precarious migration-employment status (re)produces exploitation; (2) deskilling and downward social mobility reinforce alienation; (3) endurance of hardship for family back home; (4) double lives of public cheerfulness and private anguish; and (4) unrecognized mental health needs. The study results reflected gross injustices experienced by these women.

Conclusion

A multi-faceted approach is required to improve the working and living conditions of this vulnerable group and ultimately their health outcomes. We recommend the following: government inspection to ensure employer compliance with the labour standards and provision of safe working and living conditions; change immigration policy to allow migrant caregivers to apply for permanent residence upon arrival; the TFWs Program to establish fair wages and subsidized housing so that caregivers can truly access the live-out option; and local ethno-specific, settlement and faith organizations be leveraged to provide TFWs with social support as well as information about their rights and how to access health and social care.

Psychological Wellbeing in Three Groups of Skilled Immigrants to New Zealand

The present study sought to investigate the current levels of psychological wellbeing in three immigrant groups to New Zealand. In addition, we sought to determine whether aspects of the acculturation process were related to mental health outcomes. This is a cross–sectional study from the fifth wave of annual in-depth interviews with three groups of recently arrived skilled immigrants from India, the People's Republic of China and South Africa. Interviews focused on international contacts and the migration of relatives and friends, housing, language, qualifications and employment, and social participation. Participants were also asked about health difficulties, homesickness, and whether they felt settled in New Zealand. The SF-36 Health Status Questionnaire (Ware, 1997), assessed the respondent's functional status and wellbeing in relation to four health concepts: vitality, social functioning, role limitations due to emotional health, and general mental wellbeing. The immigrant group differed significantly from the New Zealand population on only one of the four mental health scales, Vitality, with immigrants reporting higher levels. Different acculturation factors were found to predict different mental health subscales in regression analyses. Gender, home contact and health difficulty explained 22% of the unique variance in Vitality; employment status and health difficulty explained 18% of the variance in Social Functioning; health difficulty significantly contributed to the explained variance (14%) in the Role limitations due to emotional health subscale; gender, home contact and health difficulty explained 27% of the variance in the Mental Health subscale. There was little evidence for lower levels of psychological wellbeing for the three immigrant groups compared to the general New Zealand population, nor for differences between the three groups. However, results highlight the importance of differential predictors in the understanding of psychological health in migrant groups.

Faculties' and nurses' perspectives regarding knowledge of high-alert medications

The incorrect administration of high-alert medications can have serious consequences. A previous study by the authors of this study developed and validated 20 true-false questions concerning high-alert medications and suggested that the topic be taught to nurses. The perspectives of faculty and nurses, however, needed to be assessed before such teaching could be implemented. The aim of this study was to understand the views of faculty and nurses about training in high-alert medications: its importance, the frequency with which it is provided, and the ideal stage at which it should be provided. A cross-sectional study was conducted in 2008 in Taiwan. A questionnaire was used to determine whether the 20 questions are important, whether its content was being taught, and the ideal time for teaching it. Snowball sampling and descriptive statistics were used. A total of 136 faculty and 199 nurses participated. From the perspectives of faculty and nurses, all 20 questions regarding high-alert medications were important (faculty vs. nurses: 4.65±0.35 vs. 4.45±0.67) but the issues to which they related were insufficiently taught (faculty vs. nurses: 3.88±0.87 vs. 3.06±0.94). Faculty believed that the ideal stage at which to provide training on high-alert medications was during formal, in-school nursing education (94.3%) while nurses believed that the ideal stage was during in-hospital continuing education (48.9%). For training in high-alert medications, the researchers recommended the inclusion of classes on the subject as part of formal, in-school nursing education, as well as of hospital-based continuing education. The instrument's questions highlight the important concepts concerning high-alert medications which should be taught to nurses and nursing students.

A comparison of female migrant workers' mental health in four cities in China

BACKGROUND

There are approximately 47.5 million female migrant workers living in major cities in China. Numerous studies have documented the marginalized living conditions confronting migrant workers in cities, such as employment difficulties, unjustifiably demanding working conditions, lack of medical insurance and social provision, poor housing conditions, unfavourable educational arrangements for migrant children, and discrimination by urban residents. In addition, female migrant workers may suffer from discrimination, exploitation and oppression.

AIM

This study aimed to explore the difficulties and perceived meaningfulness of migration and their effect on the mental health status of female migrant workers in Shanghai, Kunshan, Dongguan and Shenzhen.

METHODS

A total of 959 female migrant workers from 12 factories completed the questionnaires, which included the Brief Symptom Inventory, the Migration Stress Scale and the Meaning in Migration Scale.

RESULTS

The findings indicate that 24% of female migrant workers could be classified as having poor mental health and the percentage in Shenzhen (35%) was far greater than in the three other cities in China. 'Financial and employment-related difficulties', 'cultural differences', gender-specific stressors and 'better future for self and children' significantly accounted for the mental health outcomes of female migrant workers.

CONCLUSION

Recommendations for policy change and service initiatives targeted at improving the mental health of female migrant workers are discussed.

The health status of migrants in Australia: a review

This review summarizes the findings of studies conducted in Australia between 1980 and 2008 that focused on the health status of migrants in one or more of Australia's National Health Priority Areas (NHPAs), identifies gaps in knowledge, and suggests further research directions. Systematic literature searches were performed on CINAHL, MediText, PsycINFO, and MEDLINE. It was found that the majority of migrants enjoy better health than the Australian-born population in the conditions that are part of the NHPAs, with the exception of diabetes. Mediterranean migrants have particularly favorable health outcomes. The migrant health advantage appears to deteriorate with increasing duration of residence. Many of the analyzed studies were conducted more than 10 years ago or had a narrow focus. Little is known about the health status of migrants with respect to a number of NHPAs, including musculoskeletal conditions and asthma.The health status of recently arrived migrant groups from the Middle East and Africa has not been explored in detail.

Mental health of migrant workers in China: prevalence and correlates

BACKGROUND

This study aimed to examine the prevalence and the socio-demographic correlates of mental health of migrant workers in Shanghai China.

METHODS

A total of 475 migrant workers from four major districts in Shanghai were recruited through a survey design with a multistage cluster [corrected] sampling. Male and female migrant workers were identified as mentally healthy or unhealthy using the brief symptom inventory. Socio-demographic characteristics and migration stress were explored as correlates of the mental health of the migrant workers.

RESULTS

A total of 73 migrant workers could be classified as mentally unhealthy (25% for men and 6% for women). Male migrant workers who were married (OR 6.16, 95% CI 1.83-20.70), manual laborers (OR 1.56, 95% CI 0.97-2.51), and experienced more stress in "financial and employment-related difficulties" (OR 2.75, 95% CI 1.47-5.14) and "interpersonal tensions and conflicts" (OR 4.18, 95% CI 1.55-11.25) were more likely to be mentally unhealthy, whereas the female migrant workers who experienced more stress in "interpersonal tensions and conflicts" (OR 6.52, 95% CI 0.83-51.14) were more likely to have poor mental health.

CONCLUSION

The findings provide information for the prevention of mental illness among migrant workers in China. The implications and limitations are also discussed.

The resilience of migrant workers in Shanghai China: the roles of migration stress and meaning of migration

BACKGROUND

In China, more than 10 million rural migrants move to cities every year. Because of the Household Registration System, migrant workers are not entitled to subsidised housing, education, social security or medical benefits.

AIMS

Using a resilience perspective, this study attempted to explore not only the migration stress that is experienced by migrant workers, but also the protective function of meaning of migration in helping migrant workers withstand the stress of migration.

METHOD

A survey design with multistage cluster sampling was used and 475 migrant workers were recruited. The questionnaire contained demographic data, the Brief Symptom Inventory, a migration stress scale and meaning of migration scale.

RESULTS

Financial and employment difficulties stood out as the most stressful issues for migrant workers. More financial and material gains and personal aspirations and achievement were the most common reasons for living in Shanghai. Regression analyses revealed that financial and employment difficulties and interpersonal tensions and conflicts significantly predicted the mental health of both male and female migrant workers. In addition, while marital status significantly predicted the mental health of male migrant workers, the subscale 'more financial and material gains' in the meaning of migration scale predicted the mental health of female migrant workers. Finally, there was a moderating effect of meaning of migration on the mental health of female migrant workers.

CONCLUSION

There is a need to consolidate and develop policies to protect the rights of migrant workers in China. Mental health counselling for migrant workers who are experiencing difficulties living in Shanghai should be introduced.

Acculturation and mental health among ghanaians in The Netherlands

BACKGROUND

The current literature on the relationship between cultural adaptation and mental health is premature to offer a comprehensive explanation about the ways acculturation exerts either positive or adverse effects on the mental health of migrants.

AIM

This study is an empirical approach towards understanding the magnitude of the relationship between consequences of cultural adaptation and psychological distress.

METHODS

Two samples of Ghanaian migrants in The Netherlands were included: a clinical group (n = 36) and a non-clinical community group (n = 97). Data were acquired by administering a semi-structured interview. Quantified data were analysed using multivariate techniques.

RESULTS

Contradictory to our hypotheses, the reported level of mental health symptoms in both groups was relatively low, suggesting a substantial resilience among the Ghanaian group. Confirming our hypotheses, specific dimensions of the acculturation process were associated with health status, particularly affiliation with cultural traditions and feelings of loss concerning the country of birth.

CONCLUSIONS

Acculturation demands capture critical elements of migrants' experiences that warrant professional interventions tailored to their specific needs. A subtle balance between holding on to the supportive cultural traditions together with moderate involvement in ruminating about pre-migration life, in conjunction with acquiring instrumental skills of the host culture, is a starting position for better health.

The social and cultural context of the mental health of Filipinas in Queensland

OBJECTIVE

To describe the social and cultural context of risk surrounding the mental health of Filipino women living in Queensland, Australia and elicit the meaning and experience of mental health and illness for these women.

METHODS

One hundred and thirty-nine in-depth interviews and 7 focus group discussions (FGDs) were nested within the baseline survey of the Filipina cohort of the Australian Longitudinal Study on Women's Health. Seventy-four in-depth interviews and 8 FGDs were conducted at follow-up. A semi-structured interview guide that included sections on emotional health, social support and changes guided these. A subset of responses was fully transcribed and analysed for ethnographic content and themes.

RESULTS

"Mental" problems are highly stigmatized, in comparison to "emotional" problems that are believed to result largely from the absence of close family ties. The loss of these ties and the transition from a collectivist to individualist society are key themes related to emotional distress in Filipinas.

CONCLUSIONS

This understanding of meaning and context of mental health and its risk factors in migrants is important for informing public health and clinical practice and for the improvement of quantitative research instruments.