Mental symptoms, psychotropic drug use and alcohol consumption in immigrated middle-aged women. The Women's Health in Lund Area (WHILA) Study

Variations in psychiatric morbidity between traumatized Norwegian, refugees and other immigrant patients in Oslo

Background: There is a lack of clinical studies that focus on different psychiatric disorders after trauma and the relationship with migration status.Purpose: To examine differences in psychiatric morbidity in traumatized patients referred to psychiatric treatment in Southern Oslo.Materials and methods: Hundred and ten patients with trauma background attending an outpatient clinic in Southern Oslo were studied. Forty-four of the participants (40%) were ethnic Norwegians, 25 (22.7%) had refugee background and 41 (37.3%) were first- or second-generation immigrants without refugee background. Thorough diagnostic assessment was done by experienced psychiatrists through several structured clinical interviews and self-report questionnaires.Results: Ninety-eight patients (89%) were diagnosed with at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) disorder. There was a clear difference in the presentation of certain psychiatric disorders between the groups. Ethnic Norwegian patients were more likely to have anxiety disorders: agoraphobia, social phobia and panic disorder than non-refugee immigrant patients. They also had higher rates of alcohol abuse/dependence. Somatoform pain disorder was more common in both the refugee and other-immigrant groups than among the ethnic Norwegian patients. The refugee patients had significantly more major depressive disorder, post-traumatic stress disorder (PTSD) and both co-occurring.Conclusion: Trauma is frequently associated with depression, anxiety disorders, somatoform pain disorder and PTSD in a clinical population. The clinical presentation and comorbidity of these disorders seem to vary significantly between traumatized patients with Norwegian, refugee and non-refugee immigrant backgrounds. After a major trauma, refugees may be at greater risk for both PTSD and depression than other immigrants and the native population.

Alcohol use disorders and perceived drinking norms: ethnic differences in Israeli adults

OBJECTIVE

Individuals' perceptions of drinking acceptability in their society (perceived injunctive drinking norms) are widely assumed to explain ethnic group differences in drinking and alcohol use disorders (AUDs), but this has never been formally tested. Immigrants to Israel from the former Soviet Union (FSU) are more likely to drink and report AUD symptoms than other Israelis. We tested perceived drinking norms as a mediator of differences between FSU immigrants and other Israelis in drinking and AUDs.

METHOD

Adult household residents (N = 1,349) selected from the Israeli population register were assessed with a structured interview measuring drinking, AUD symptoms, and perceived drinking norms. Regression analyses were used to produce odds ratios (OR) and risk ratios (RR) and 95% confidence intervals (CI) to test differences between FSU immigrants and other Israelis on binary and graded outcomes. Mediation of FSU effects by perceived drinking norms was tested with bootstrapping procedures.

RESULTS

FSU immigrants were more likely than other Israelis to be current drinkers (OR = 2.39, CI [1.61, 3.55]), have higher maximum number of drinks per day (RR = 1.88, CI [1.64, 2.16]), have any AUD (OR = 1.75, CI [1.16, 2.64]), score higher on a continuous measure of AUD (RR = 1.44, CI [1.12, 1.84]), and perceive more permissive drinking norms (p < .0001). For all four drinking variables, the FSU group effect was at least partially mediated by perceived drinking norms.

CONCLUSIONS

This is the first demonstration that drinking norms mediate ethnic differences in AUDs. This work contributes to understanding ethnic group differences in drinking and AUDs, potentially informing etiologic research and public policy aimed at reducing alcohol-related harm.

The women's health in the Lund area (WHILA) study--an overview

The Women's Health in the Lund Area (WHILA) study invited all women (n=10,766) living in the Lund area of Southern Sweden by 1995, who were born between 1935 and 1945. The health screening program included a postal validated questionnaire concerning medical history, drug treatment, family history of diabetes and hypertension, menopausal status, smoking and alcohol habits, education, household, and working status, physical activity, quality of life as well as subjective physical and mental symptoms. The screening consisted of a routine physical examination with standardized blood pressure measurements, bone densitometry and an extended laboratory examination. A link with the mammography registry was established. Based on menopausal status, the population was divided in three subgroups; premenopausal (PM), postmenopausal with hormone replacement therapy (PMT), and postmenopausal without hormone replacement therapy (PM0). Menopause was defined as a bleed-free interval of at least 12 months. Of 10,766 women, 6917 (64.2%) had complete data sets. A number of observational analyses were carried out based on the screening data at baseline, to be followed by long-term follow-up analyses based on national register linkages that are currently being started.