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Giesebrecht J, Reich H, Weise C, Nater UM, Mewes R. Links between ethnic discrimination, mental health, protective factors, and hair cortisol concentrations in asylum seekers living in Germany. Eur J Psychotraumatol 2024; 15:2400835. [PMID: 39297220 DOI: 10.1080/20008066.2024.2400835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/22/2024] Open
Abstract
Objective: Asylum seekers often experience ethnic discrimination on the flight or in the host country, which may be associated with chronic stress and impaired mental health. Dysregulation of the hypothalamic-pituitary-adrenal axis, a known physiological correlate of chronic stress, can be assessed using hair cortisol concentrations (HCC). The present study aimed to investigate how different forms of perceived ethnic discrimination are associated with mental health outcomes, HCC, and protective factors in asylum seekers living in Germany.Methods: Somatic symptoms (PHQ-15), symptoms of posttraumatic stress (PDS), depressive symptoms (PHQ-9), different forms of ethnic discrimination (active harm, passive harm, institutional discrimination), and protective factors (in-group identification, social support) were assessed cross-sectionally in 144 asylum seekers (average age 32 years, average duration of stay in Germany nine months; 67% men). HCC were obtained from 68 participants. Multiple regression analyses were conducted and social support and in-group identification were tested as potential moderators.Results: Active ethnic discrimination was positively associated with all assessed mental health outcomes, and all forms of ethnic discrimination positively correlated with depressive symptoms. Ethnic discrimination was not associated with HCC. When controlling for other possible influences (e.g. age, gender, traumatic events), passive harm was negatively associated with depressive symptoms (β = -0.17, p = .033) and active harm was positively associated (β = 0.28, p = .022) with somatic symptoms. After the inclusion of the protective factors, the associations were no longer significant. Lower social support was associated with higher depressive symptoms (β = -0.35, p < .001), posttraumatic stress (β = -0.77, p < .001), and somatic symptoms (β = -0.32, p < .001), but did not moderate the associations between ethnic discrimination and the mental health outcomes.Conclusions: Perceived ethnic discrimination may negatively influence asylum seekers' mental health but does not seem to be associated with HCC. Social support was associated with psychological symptom severity, but did not buffer the effects of ethnic discrimination on mental health.
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Affiliation(s)
- Julia Giesebrecht
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Hanna Reich
- Depression Research Centre of the German Depression Foundation, Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main, Germany
| | - Cornelia Weise
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Marburg, Marburg, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Ricarda Mewes
- Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
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Nykänen S, García-Velázquez R, E Castaneda A, Koponen P, Musta L, Skogberg N. Psychosocial and economic impact of COVID-19 pandemic by sex among migrant populations compared with general Finnish population: a population-based study. Scand J Public Health 2024; 52:360-369. [PMID: 38544303 PMCID: PMC11067388 DOI: 10.1177/14034948241235245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 05/04/2024]
Abstract
AIMS To study sex differences in the psychosocial and economic impact of the restrictive measures during the COVID-19 pandemic in 2020 among the migrant origin and the general population in Finland. METHODS Cross-sectional MigCOVID Survey data (10/2020-2/2021; n=3668) were used. FinHealth 2017 Follow-up Study participants constituted the general population reference group (n=3490). Sex differences in self-perceived impact of the restrictive measures during the COVID-19 pandemic in 2020 on the psychosocial and economic situation were examined with multivariate logistic regression, adjusting for sociodemographics and self-rated health. RESULTS The migrant origin population had higher odds for reporting weakened economic situation (odds ratio (OR) 5.41; 95% confidence interval (CI) 3.96-7.39), increased loneliness (OR 1.75; 95% CI 1.35-2.28), decrease in feelings of hope for the future (OR 1.70; 95% CI 1.33-2.19) and increased sleeping difficulties and nightmares (OR 1.98; 95% CI 1.34-2.92) than the general population. While the psychosocial and economic impact of COVID-19 was higher in women compared with men in the general population, findings were not fully replicated in the migrant origin population. CONCLUSIONS Individuals of migrant origin faced a higher likelihood of experiencing adverse changes in both psychosocial and economic aspects during the pandemic, suggesting increased vulnerability linked to migrant origin. Additional research is required to delve into the intricate connections among gender, migrant origin, and the impact of COVID-19, aiming to enhance comprehensive understanding of the contributing factors. Vulnerabilities of different population groups should be identified and addressed when planning measures to reduce adverse societal impact in future crises.
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Affiliation(s)
- Sanna Nykänen
- Department of Public Health and Welfare, Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Regina García-Velázquez
- Department of Public Health and Welfare, Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu E Castaneda
- Department of Public Health and Welfare, Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Musta
- Department of Public Health and Welfare, Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Natalia Skogberg
- Department of Public Health and Welfare, Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Ishaq B, Diaz E, Østby L. Discrimination and health: A cross-sectional study comparing Muslims with other-religious. Scand J Public Health 2024:14034948231225561. [PMID: 38517101 DOI: 10.1177/14034948231225561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
AIMS The aim of this study is to report perceived discrimination among Muslims living in Norway and to address and compare associations between perceived discrimination and health among Muslims with an immigrant background and other-religious with an immigrant background. METHOD A representative sample of individuals with an immigrant background in Norway was used in a cross-sectional study design that included 5484 respondents aged 16 to 74 years. The respondents were sub-grouped after religious affiliation, and as immigrants and Norwegian-born. This sample is from 'The Survey on living conditions among persons with an immigrant background 2016', conducted by Statistics Norway. Multivariate logistic regression analyses were conducted to investigate the relationship between perceived discrimination and self-rated health and between perceived discrimination and mental health problems. RESULTS Our findings show that Muslims with an immigrant background are more likely to report perceived discrimination than non-Muslims with an immigrant background. Perceived discrimination was associated with poor self-rated health and mental health problems among immigrant Muslims and Norwegian-born Muslims. Among other-religious with an immigrant background, perceived discrimination had an inverse relationship with mental health problems among immigrants, while an association between perceived discrimination and poor self-rated health was found among Norwegian-born. CONCLUSIONS Our findings suggest that perceived discrimination does play a role in health among minorities with an immigrant background in Norway, regardless of religion. However, the association between perceived discrimination and poor health seems to be stronger among Muslims, especially Norwegian-born Muslims.
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Affiliation(s)
- Bushra Ishaq
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
- MF Norwegian School of Theology, Religion and Society, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Lars Østby
- Statistics Norway, Oslo-Kongsvinger, Norway
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Schoenweger P, Kirschneck M, Biersack K, Di Meo AF, Reindl-Spanner P, Prommegger B, Ditzen-Janotta C, Henningsen P, Krcmar H, Gensichen J, Jung-Sievers C. Community indicators for mental health in Europe: a scoping review. Front Public Health 2023; 11:1188494. [PMID: 37538274 PMCID: PMC10396773 DOI: 10.3389/fpubh.2023.1188494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
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.
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Affiliation(s)
- Petra Schoenweger
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Kirschneck
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Katharina Biersack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Anna-Francesca Di Meo
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Philipp Reindl-Spanner
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Barbara Prommegger
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Claudia Ditzen-Janotta
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Helmut Krcmar
- TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Caroline Jung-Sievers
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Robertsson T, Kokko S, Lilja E, Castañeda AE. Prevalence and risk factors of psychological distress among foreign-born population in Finland: A population-based survey comparing nine regions of origin. Scand J Public Health 2023:14034948221144660. [PMID: 36600449 DOI: 10.1177/14034948221144660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Previous research indicates that foreign-born populations experience more psychological distress than general populations. However, it remains unclear how prevalence varies between regions of origin. The role of socio-demographic and migration-related factors also needs to be further investigated. We aimed to (a) compare the prevalence of psychological distress in foreign-born and general Finnish populations, (b) investigate differences in prevalence between nine regions of origin and (c) examine which socio-demographic and migration-related factors are associated with distress among foreign-born populations. METHODS The study used data from the Survey on Well-Being among Foreign Born Population (FinMonik), a population-based survey (n=6312) of foreign-born populations living in Finland collected between 2018 and 2019 by the Finnish Institute for Health and Welfare. Psychological distress was measured using the Mental Health Inventory-5 (MHI-5), with a cut-off point of 52. Logistic regression was used to adjust analyses by age and sex to determine the prevalence of psychological distress and the associated socio-demographic factors. RESULTS Psychological distress was more prevalent among those who were foreign born (17.4%) than among the general population (12.9%). Migrants from the Middle East and North Africa had the highest prevalence (29.7%) compared to other regions of origin. Unemployment or economic inactivity, international protection as a reason for migration and beginner-level language proficiency were the main factors increasing the odds for distress among foreign-born populations. CONCLUSIONS
Foreign-born populations experience more psychological distress than the general population, but prevalence varies between regions of origin. Future efforts should aim at a better understanding of the mental health risk factors and the development of targeted interventions for these subpopulations.
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Affiliation(s)
- Tessa Robertsson
- Research Center for Health Promotion, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
| | - Sami Kokko
- Research Center for Health Promotion, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
| | - Eero Lilja
- Migration and Cultural Diversity Team, Finnish Institute for Health and Welfare, Finland
| | - Anu E Castañeda
- Migration and Cultural Diversity Team, Finnish Institute for Health and Welfare, Finland
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Oyarte M, Cabieses B, Espinoza M, Valenzuela MT, Delgado I. Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes. Rev Saude Publica 2022; 56:121. [PMID: 36629712 PMCID: PMC9749657 DOI: 10.11606/s1518-8787.2022056004125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. METHODS Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. RESULTS Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). CONCLUSIONS In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.
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Affiliation(s)
- Marcela Oyarte
- Instituto de Salud Pública de ChileDepartamento Agencia Nacional de Dispositivos Médicos, Innovación y DesarrolloSantiagoChile Instituto de Salud Pública de Chile. Departamento Agencia Nacional de Dispositivos Médicos, Innovación y Desarrollo. Santiago, Chile,Universidad del DesarrolloInstituto de Ciencias e Innovación en MedicinaPrograma de Estudios Sociales en SaludSantiagoChile Universidad del Desarrollo. Instituto de Ciencias e Innovación en Medicina. Programa de Estudios Sociales en Salud. Santiago, Chile
| | - Báltica Cabieses
- Universidad del DesarrolloInstituto de Ciencias e Innovación en MedicinaPrograma de Estudios Sociales en SaludSantiagoChile Universidad del Desarrollo. Instituto de Ciencias e Innovación en Medicina. Programa de Estudios Sociales en Salud. Santiago, Chile,University of YorkFaculty of HealthDepartment of Health SciencesYorkUnited Kingdom University of York. Faculty of Health. Department of Health Sciences. York, United Kingdom
| | - Manuel Espinoza
- Pontificia Universidad Católica de ChileEscuela de MedicinaDepartamento de Salud PúblicaSantiagoChile Pontificia Universidad Católica de Chile. Escuela de Medicina. Departamento de Salud Pública. Santiago, Chile
| | - María Teresa Valenzuela
- Universidad de Los AndesFacultad de MedicinaDepartamento de Salud Pública y EpidemiologíaSantiagoChile Universidad de Los Andes. Facultad de Medicina. Departamento de Salud Pública y Epidemiología. Santiago, Chile
| | - Iris Delgado
- Universidad del DesarrolloInstituto de Ciencias e Innovación en MedicinaCentro de Epidemiología y Políticas de SaludSantiagoChile Universidad del Desarrollo. Instituto de Ciencias e Innovación en Medicina. Centro de Epidemiología y Políticas de Salud. Santiago, Chile
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Kumar BN, Diaz E, Castaneda AE, Ahrne M, NØrredam ML, Puthoopparambil SJ. Migration health research in the Nordic countries: Priorities and implications for public health. Scand J Public Health 2022; 50:1039-1046. [PMID: 36245405 DOI: 10.1177/14034948221125037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past 50 years have witnessed an increase in immigration to the Nordic countries from and beyond neighbouring countries in Europe. Diversity implies variations and differences in health status and health outcomes both within and across populations. Migrant health research has not been prioritized and health policies and practice, especially long-term national plans, often exclude migrants. In this article, we briefly trace the history, the groups, reasons for migration and the road to migrant health research in Norway, Sweden, Finland and Denmark. We discuss the case for data and research including needs, basis for data collection and the methodological challenges. We provide a brief snapshot of migrant health research, identify current gaps and discuss the implications for research. We recommend a regional Nordic strategy to promote intercountry exchange, sharing and learning. Finally, we reflect on the larger picture, implications for policy and practice that could enable societal conditions to reduce avoidable health inequalities.
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Affiliation(s)
| | | | | | - Malin Ahrne
- Public Health Agency of Sweden, Solna, Sweden
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8
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Salama E, Castaneda AE, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Substance use, affective symptoms, and suicidal ideation among Russian, Somali, and Kurdish migrants in Finland. Transcult Psychiatry 2022; 59:37-51. [PMID: 32164497 PMCID: PMC8859688 DOI: 10.1177/1363461520906028] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Comorbidity of substance use with affective symptoms and suicidality has been well documented in the general population. However, population-based migrant studies about this association are scarce. We examined the association of affective symptoms and suicidal ideation with binge drinking, daily smoking, and lifetime cannabis use among Russian, Somali, and Kurdish migrants in comparison with the Finnish general population. Cross-sectional data from the Finnish Migrant Health and Wellbeing Study (Maamu, n = 1307) and comparison group data of the general Finnish population (n = 860) from the Health 2011 Survey were used. Substance use included self-reported current binge drinking, daily smoking, and lifetime cannabis use. Affective symptoms and suicidal ideation were measured using the Hopkins Symptom Checklist-25 (HSCL-25). We performed multivariate logistic regression analyses, including age, gender, and additional socio-demographic and migration-related factors. Suicidal ideation (OR 2.4 95% CI 1.3-4.3) was associated with binge drinking among Kurds and lifetime cannabis use among Russians (OR 5.6, 95% CI 1.9-17.0) and Kurds (OR 5.5, 95% CI 1.9-15.6). Affective symptoms were associated with daily smoking (OR 1.6, 95% CI 1.02-2.6) and lifetime cannabis use (OR 6.1, 95% CI 2.6-14.5) among Kurdish migrants. Our results draw attention to the co-occurrence of suicidal ideation, affective symptoms, and substance use, especially among Kurdish migrants. These results highlight the variation of comorbidity of substance use and affective symptoms between the different populations. This implies that screening for substance use in mental healthcare cannot be neglected based on presumed habits of substance use.
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Affiliation(s)
- Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, Finland.,Child Psychiatry, Turku University Hospital, Finland
| | - Anu E Castaneda
- National Institute for Health and Welfare (THL), Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Shadia Rask
- National Institute for Health and Welfare (THL), Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.,Joint municipal authority for North Karelia social and health services (Siun sote), Finland
| | - Solja Niemelä
- Department of Psychiatry, University of Turku, Finland.,Addiction Psychiatry Unit, Turku University Hospital, Finland
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9
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Delgado-Flores C, Cutire OS, Cvetkovic-Vega A, Nieto-Gutierrez W. Perceived discrimination as a barrier for the adequate treatment of chronic diseases in Venezuelan migrants from Peru. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210029. [PMID: 34076091 DOI: 10.1590/1980-549720210029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/11/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the association between perceived discrimination and receiving adequate treatment for chronic diseases in Venezuelan migrants. METHODOLOGY A cross-sectional study was performed. This is a secondary analysis of the ENPOVE national survey from Peru. The association between the perceived discrimination and receiving adequate treatment for chronic diseases was evaluated using a Poisson regression model, considering the adjusted effect of the multistage sampling. RESULTS A total of 865 migrants were evaluated (age: 36.6 ± 0.7 years and 58.2% women). Of these, 54.8% perceived discrimination, and 89.2% did not receive adequate treatment for chronic diseases. Perceived discrimination was significantly associated with a lower prevalence of receiving adequate treatment for chronic diseases (PRa = 0.49; 95%CI 0.25 - 0.97). CONCLUSION This study evidenced that perceived discrimination decreases the prevalence of receiving adequate treatment for chronic diseases by approximately 50% compared with those who did not perceive discrimination.
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Affiliation(s)
| | | | | | - Wendy Nieto-Gutierrez
- Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud - Lima, Peru
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Casillas-Clot J, Pereyra-Zamora P, Nolasco A. Determinants of Disability in Minority Populations in Spain: A Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3537. [PMID: 33805538 PMCID: PMC8037545 DOI: 10.3390/ijerph18073537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022]
Abstract
Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to estimate the prevalence of disability using the GALI and to analyse its determinants in immigrant and Roma populations. Data from the Spanish National Health Survey 2017 and the National Health Survey of the Roma Population 2014 were used, including adults aged 50 and above. Prevalence of disability was estimated, and odds ratios were calculated using logistic regression models to assess the association between disability and demographic, socioeconomic, and health variables. The prevalence of disability was estimated at 39.4%, 30.6%, and 58.7% in the native, immigrant, and Roma populations, respectively. Gender was a common determinant for the native and Roma populations. On the other hand, among immigrants, the risk of disability increased over the time residing in Spain. There were significant interactions with age and gender in the native population. Disability has different determinants in the three population groups. Public health measures to protect the Roma population and immigrants' health should be considered.
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Affiliation(s)
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.C.-C.); (A.N.)
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11
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Çilenti K, Rask S, Elovainio M, Lilja E, Kuusio H, Koskinen S, Koponen P, Castaneda AE. Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2229. [PMID: 33668241 PMCID: PMC7956472 DOI: 10.3390/ijerph18052229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/03/2023]
Abstract
Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.
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Affiliation(s)
- Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
| | - Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (S.R.); (M.E.); (E.L.); (H.K.); (S.K.); (P.K.); (A.E.C.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
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12
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Castaneda AE, Çilenti K, Rask S, Lilja E, Skogberg N, Kuusio H, Salama E, Lahti J, Elovainio M, Suvisaari J, Koskinen S, Koponen P. Migrants Are Underrepresented in Mental Health and Rehabilitation Services-Survey and Register-Based Findings of Russian, Somali, and Kurdish Origin Adults in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176223. [PMID: 32867157 PMCID: PMC7504052 DOI: 10.3390/ijerph17176223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
Mounting evidence suggests that migration background increases the risk of mental ill health, but that problems exist in accessing healthcare services in people of migrant origin. The present study uses a combination of register- and survey-based data to examine mental health-related health service use in three migrant origin populations as well as the correspondence between the need and use of services. The data are from the Finnish Migrant Health and Wellbeing Study (Maamu), a comprehensive cross-sectional interview and a health examination survey. A random sample consisted of 5909 working-aged adults of Russian, Somali, and Kurdish origin of which 3000 were invited to participate in the survey and the rest were drawn for a register-based approach. Some of the mental health services, based on registers, were more prevalent in the Kurdish origin group in comparison with the general population and less prevalent in the Russian and Somali origin groups. All the migrant origin groups were underrepresented in rehabilitation services. When affective symptoms were taken into account, all the migrant origin groups were underrepresented in all of the services. This calls for actions to promote mental health, diminish the barriers to access services, and improve the service paths for migrants.
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Affiliation(s)
- Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
- Correspondence: ; Tel.: +358-29-524-7848
| | - Katja Çilenti
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Shadia Rask
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Eero Lilja
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Natalia Skogberg
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Essi Salama
- Doctoral Programme in Clinical Research, Faculty of Medicine, University of Turku, FI-20014 Turku, Finland & Child Psychiatry, Turku University Hospital, 20521 Turku, Finland;
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland;
| | - Jaana Suvisaari
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (K.Ç.); (S.R.); (E.L.); (N.S.); (H.K.); (M.E.); (J.S.); (S.K.); (P.K.)
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13
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Lämsä R, Castaneda AE, Weiste A, Laalo M, Koponen P, Kuusio H. The Role of Perceived Unjust Treatment in Unmet Needs for Primary Care Among Finnish Roma Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165825. [PMID: 32806508 PMCID: PMC7460452 DOI: 10.3390/ijerph17165825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022]
Abstract
The main goal in developing services is to guarantee equal access to healthcare services that are suited to the patients’ needs. Previous studies have shown that the Roma are more likely to experience unjust treatment in health services than the general population. This study examines the association between perceived unjust treatment in healthcare and self-assessed unmet need for primary care provided by general practitioners (GPs) and nurses among the Finnish Roma. The data from the Finnish Roma Wellbeing Study (Roosa), conducted in 2017–2018, were used. Snowball sampling was used in recruiting study participants (n = 365, 61% women). Logistic regression was used to test the association between perceived unjust treatment and unmet need for primary care. Confounders used were gender, age, marital status, education, employment, and self-rated health. Those who had experienced unjust treatment in healthcare were more likely to report unmet need for care provided by GPs (odds ratios (OR) = 6.44; p < 0.001) and nurses (OR = 11.18; p < 0.001) than those who felt that they had been treated justly. This association remained after adjustments for the confounders. Bidirectional guidance between the Roma and service providers should be improved and the Roma communities involved in service development using participatory methods.
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Affiliation(s)
- Riikka Lämsä
- Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Correspondence:
| | - Anu E. Castaneda
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Anneli Weiste
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Marianne Laalo
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Päivikki Koponen
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
| | - Hannamaria Kuusio
- Finnish Institute for Health and Welfare, 00271 Helsinki, Finland; (A.E.C.); (A.W.); (M.L.); (P.K.); (H.K.)
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14
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Salama ES, Castaneda AE, Lilja E, Suvisaari J, Rask S, Laatikainen T, Niemelä S. Pre-migration traumatic experiences, post-migration perceived discrimination and substance use among Russian and Kurdish migrants-a population-based study. Addiction 2020; 115:1160-1171. [PMID: 31797477 PMCID: PMC7317749 DOI: 10.1111/add.14904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/01/2019] [Accepted: 11/08/2019] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Essi S. Salama
- Faculty of MedicineUniversity of TurkuTurkuFinland
- Child PsychiatryTurku University HospitalTurkuFinland
| | - Anu E. Castaneda
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Faculty of Medicine, Department of Psychology and LogopedicsUniversity of HelsinkiHelsinkiFinland
| | - Eero Lilja
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Jaana Suvisaari
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Shadia Rask
- National Institute for Health and Welfare (THL)HelsinkiFinland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL)HelsinkiFinland
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote)JoensuuFinland
| | - Solja Niemelä
- Department of PsychiatryUniversity of TurkuTurkuFinland
- Addiction Psychiatry UnitTurku University HospitalTurkuFinland
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15
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Nystedt TA, Rosvall M, Lindström M. The association of self-reported discrimination to all-cause mortality: A population-based prospective cohort study. SSM Popul Health 2019; 7:100360. [PMID: 30766909 PMCID: PMC6360602 DOI: 10.1016/j.ssmph.2019.100360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/13/2019] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
Discrimination has is an important social determinant of health and though some research has been carried out on this it is mostly from the United States, which may not be generalisable to Europe and Sweden. This study investigated the association between self-reported experiences of repeated discrimination and all-cause mortality in Scania, Sweden. The Scania Public Health survey was sent out in 2008 with a follow-up in 2013 through the Swedish national cause of death register (N=28,062). The exposure variable under investigation was self-reported discrimination and the outcome variable was all-cause mortality. Additional variables included demographics (age, sex, marital status, immigrant status), health behaviours (smoking, alcohol consumption, physical exercise), BMI, social participation, economic stress, and mental health. Time was measured as total number of days. Statistical analysis included association of the different variables to discrimination (ORs) and to all-cause mortality (HRs) adjusting for different covariates. Effect modification was tested for social participation, economic stress and mental health. The odds of discrimination was higher among the most vulnerable groups in society. All-cause mortality was strongly associated to age and sex, with a much higher risk among men than women. The association of repeated discrimination to all-cause mortality remained significant after adjusting for demographic variables, health behaviours and either social participation or economic stress, but not both. The association was non-significant after adjusting for demographic variables and mental health. Social participation was found to be an effect modifier with low participation strengthening the effect of the association of repeated discrimination to all-cause mortality. Repeated discrimination clearly has a strong impact on mental health but also on economic stress and social participation which in turn have a strong impact on mortality.
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Affiliation(s)
- Tanya Andersson Nystedt
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
- Department of Community Medicine and Public Health, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
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Benbassat J. Obtaining a second opinion is a neglected source of health care inequalities. Isr J Health Policy Res 2019; 8:12. [PMID: 30651143 PMCID: PMC6335699 DOI: 10.1186/s13584-019-0289-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/25/2022] Open
Abstract
Observational studies have detected discrepancies between two expert interpreters of imaging and histopathological studies. Furthermore, in a substantial proportion of patients, an independent second opinion disagreed with the first one. Therefore, it is widely accepted that patients have a right to obtain a second opinion and, in case of divergent opinions, to deliberate and choose the option that they believe is most consistent with their individual circumstances. However, doctors are less likely to inform old and poorly educated patients about the possibility of seeking a second opinion, and this may contribute to healthcare inequalities. Hence the importance of (a) promoting doctors’ self-awareness of a possible tendency to discriminate against old and poorly educated patients, and (b) creating programs within the healthcare system that would help patients in seeking a second opinion, suggest specialists for the specific problem of the patient, and provide tools to reconcile between discrepant opinions.
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Affiliation(s)
- Jochanan Benbassat
- Myers-JDC-Brookdale Institute, Department of Health Policy Research, PO Box 3886, 91037, Jerusalem, Israel.
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