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

Discrimination Experiences among Asian American and Pacific Islander Adults during the COVID-19 Pandemic and Their Association with Mental Health Outcomes: Updated Findings from the COMPASS Study

BACKGROUND

Reports of escalated discrimination experiences among Asian American and Native Hawaiian Pacific Islanders (AANHPI) continue.

METHODS

Using the original and follow-up surveys of the COVID-19 Effects on the Mental and Physical Health of AAPI (Asian American and Pacific Islanders) Survey Study (COMPASS I and COMPASS II) (n = 3177), we examined changes over approximately a 1-year period in discrimination experiences attributable to being AAPI and factors associated with worse mental health outcomes.

RESULTS

Experiences of discrimination remained high in COMPASS II with 60.6% (of participants (compared to 60.2% among the same people in COMPASS I) reporting one or more discrimination experiences, and 28.6% reporting worse mental health outcomes. Experiences of discrimination were associated with modest but significant increase in the odds of worse mental health: adjusted OR 1.02 (95% CI 1.01-1.04). Being younger, being of Native Hawaiian/Pacific Islander or Hmong descent (relative to Asian Indian), and having spent 50% or less of their lifetime in the US (vs. US born), were significantly associated with worse mental health.

CONCLUSIONS

The fall-out from the pandemic continues to adversely impact AANHPI communities. These findings may help influence policy initiatives to mitigate its effects and support interventions designed to improve mental health outcomes.

US migration history and depressive symptoms among older mexican adults

OBJECTIVE

To explore the association between US migration, chronic conditions (diabetes, stroke, heart attack, cancer, and hypertension), and mental health (depressive symptoms, and depression).

MATERIALS AND METHODS

We assessed average changes in depressive symptom scores as well as depression over time and their link with migration experience controlling for health and sociodemographic factors among older Mexican adults (50+) using 2012, 2015, and 2018 waves of the Mexican Health and Aging Study (MHAS).

RESULTS

Non-migrants had higher average depressive symptom scores and prevalence of depression (5+ score) in 2012 and 2015, but there was no significant difference in either measure in 2018 or on changes over time.

CONCLUSION

Although there were no significant differences in average depressive symptoms and depression over time by migration history, this study highlights some differences in 2012 and 2015. Comparing groups across migration histories allowed the researchers to examine how life course differences impact mental health outcomes.

Identifying factors affecting willingness to participate in floating population health volunteer services by Chinese volunteers based on the theory of the planned behavior expansion model

China has the world's largest internal migrant population, called the floating population. Compared to local residents, the floating population utilizes different health services and relies heavily on health volunteer services for supplementary services. In this study, the theory of planned behavior model was used to study the willingness of volunteers to participate in floating population health volunteer services. We examined the effects of several factors on willingness to participate and found that attitude and subjective norm, but not perceived behavioral control, have significant predictive effects on willingness to participate in health volunteer services. Furthermore, altruistic values, social incentives, and personality traits not only have significant predictive effects on volunteer participation but also indirectly affect willingness through attitude and subjective norms. These findings help us understand what factors affect volunteers' willingness to provide health services to the floating population and have important implications for mobilizing volunteers for floating population health services.

Depression, diabetes and immigration status: a retrospective cohort study using the Canadian Longitudinal Study on Aging

BACKGROUND

A bidirectional association between depression and diabetes exists, but has not been evaluated in the context of immigrant status. Given that social determinants of health differ between immigrants and nonimmigrants, we evaluated the association between diabetes and depression incidence, depression and diabetes incidence, and whether immigrant status modified this association, among immigrants and nonimmigrants in Canada.

METHODS

We employed a retrospective cohort design using data from the Canadian Longitudinal Study on Aging Comprehensive cohort (baseline [2012-2015] and 3-year follow-up [2015-2018]). We defined participants as having diabetes if they self-reported it or if their glycated hemoglobin A_1c level was 7% or more; we defined participants as having depression if their Center for Epidemiological Studies Depression score was 10 or higher or if they were currently undergoing depression treatment. We excluded those with baseline depression (Cohort 1) and baseline diabetes (Cohort 2) to evaluate the associations between diabetes and depression incidence, and between depression and diabetes incidence, respectively. We constructed logistic regression models with interaction by immigrant status.

RESULTS

Cohort 1 (n = 20 723; mean age 62.7 yr, standard deviation [SD] 10.1 yr; 47.6% female) included 3766 (18.2%) immigrants. Among immigrants, 16.4% had diabetes, compared with 15.6% among nonimmigrants. Diabetes was associated with an increased risk of depression in nonimmigrants (adjusted odds ratio [OR] 1.27, 95% confidence interval [CI] 1.08-1.49), but not in immigrants (adjusted OR 1.12, 95% CI 0.80-1.56). Younger age, female sex, weight change, poor sleep quality and pain increased depression risk. Cohort 2 (n = 22 054; mean age 62.1 yr, SD 10.1 yr; 52.2% female) included 3913 (17.7%) immigrants. Depression was associated with an increased risk of diabetes in both nonimmigrants (adjusted OR 1.39, 95% CI 1.16-1.68) and immigrants (adjusted OR 1.60, 95% CI 1.08-2.37). Younger age, male sex, waist circumference, weight change, hypertension and heart disease increased diabetes risk.

INTERPRETATION

We found an overall bidirectional association between diabetes and depression that was not significantly modified by immigrant status. Screening for diabetes for people with depression and screening for depression for those with diabetes should be considered.

Differences between Chinese Adolescent Immigrants and Adolescent Non-Immigrants in Hong Kong: Perceived Psychosocial Attributes, School Environment and Characteristics of Hong Kong Adolescents

Although the impact of immigration on adolescent developmental outcomes has received extensive scholarly attention, the impact of internal migration, particularly in the Chinese context, on adolescents’ psychosocial development has not been scientifically investigated. This study examined whether mainland Chinese adolescent immigrants (N = 590) and adolescent non-immigrants (n = 1798) differed on: (a) psychosocial attributes indexed by character traits, well-being, social behavior, and views on child development, (b) perceived school environment, and (c) perceptions of characteristics of Hong Kong adolescents. Consistent with the healthy migration hypothesis, Hong Kong adolescents and mainland Chinese adolescent immigrants did not differ on most of the outcomes; Chinese adolescent immigrants showed higher perceived moral character, empathy, and social trust than did Hong Kong adolescent non-immigrants. Chinese adolescent immigrants also showed more favorable perceptions of the school environment and moral character, social trust and social responsibility of adolescents in Hong Kong. This pioneer Chinese study provides support for the healthy immigration hypothesis (immigration paradox hypothesis) but not the immigration morbidity hypothesis within the specific sociocultural context of Hong Kong in China.

Immigration stress among refugees resettled in the United States

BACKGROUND

Immigration stress includes acculturation stress and the stress related to language barriers, discrimination, occupational challenges, and feelings of isolation from society and a sense of newness or loss.

AIMS

The purpose of this study was to examine immigration stress among refugees resettled in the United States.

METHODS

A self-administered or interviewer-administered survey was collected from individuals with a refugee background in Utah from summer through fall in 2017 (N = 190).

RESULTS

Older age was associated with higher levels of financial stress and homesickness. Poorer levels of self-rated health and fewer somatic symptoms were related to higher levels of homesickness and language barriers. Higher educational attainment was associated with higher levels of financial stress.

CONCLUSION

Refugees are a vulnerable population due to being displaced to a foreign country and having to quickly learn a new language and different culture. It is imperative to gain more knowledge on diverse refugee groups and ways in which they can maintain optimum quality of life through and after the resettlement process.

Utilization of Mental Health Services Among Older Chinese Immigrants in New York City

Older immigrants are at risk of developing mental illness. This study aims to examine mental health service utilization among older Chinese immigrants, using a mixed-method design. Andersen's Behavioral Model of Health Services Use informed an examination of predictors of mental health services utilization, and semi-structured individual interviews were conducted to illuminate these findings. Participants who were younger, had less than a high school education, and had a higher level of depressive symptoms were more likely to use mental health services. Stressors of psychological distress included breakdown of support system, language barriers, and financial hardships. Factors influencing mental health services use included information from family/friends, referrals from primary care physicians, perceived needs for help, mental health stigma, and culturally competent mental health professionals. Understanding the factors associated with seeking mental health services for older Chinese immigrants could help health care providers to develop early screening programs and culturally sensitive interventions.

Injury among the immigrant population in Canada: exploring the research landscape through a systematic scoping review

BACKGROUND

Injuries are the leading cause of death among younger Canadians and represent a large economic burden on the Canadian population. Although immigrants comprise more than 20% of the Canadian population, the research landscape on injury in this group is unclear. We conducted a scoping review to summarize existing research regarding injuries among Canadian immigrants to identify research gaps and future research opportunities.

METHODS

Relevant electronic databases of peer-reviewed articles and grey literature were systematically searched. Original articles were selected based on predefined criteria. Relevant information from the articles was extracted and reported in the review.

RESULTS

After a comprehensive search, screening and full-text evaluation, 28 articles were selected for the synthesis. Of the injuries that have been studied among Canadian immigrants, the majority focused on occupational injuries, followed by road traffic accidents. Of the 28 studies, 16 were quantitative and 12 were qualitative. The research themes among occupational injury papers centred on factors leading to injury, factors leading to delayed reporting and compensation of injury and post-occupational injury experiences. Language barriers, informal training and the mismatch between education and occupation among immigrants were found to be the most frequent determinants of injury risk.

CONCLUSIONS

The synthesized knowledge in this scoping review offers an understanding of the current research landscape on injury among immigrants that can be used to assist policymakers, service providers, employers and researchers regarding injuries in this population.

Is childhood migration a mental health risk? Exploring health behaviors and psychosocial resources as pathways using the cross-sectional Canadian Community Health Survey

Drawing on the Stress Process Model, this study investigates the effect of early migration on health behaviors and psychosocial resources. Further, I consider whether health behaviors and psychosocial processes lead to higher psychological distress for childhood immigrants in adulthood. Cross-sectional data from the Canadian Community Health Survey-Mental Health 2012 (N = 4282) reveal that compared to adult immigrants, childhood immigrants are not only four times more likely to use drugs, but also experience greater interpersonal strain. However, health behaviors such as these contribute less to psychological distress than do psychosocial resources. Additionally, longer duration of migration is found to reduce psychological distress when controlling for age at migration, thus suggesting the migrant health literature should examine age-salient life challenges at the time of migration, instead of continuing to use duration of migration as a proxy for negative acculturation.

Usage of healthcare services and preference for mental healthcare among older Somali immigrants in Finland

Objectives: The aims of the study were, first, to describe and analyze healthcare services utilization patterns of older immigrants in Finland, and particularly to compare the availability and accessibility of health services between older Somalis and Finns. The second aim was to examine the preferences for mental healthcare within the group of Somalis. The third aim was to test the existence of a service usage gap expected to be characteristic of the Somali group, in which high levels of mental health problems occur alongside simultaneous low levels of mental health service usage. Design: The participants were 256 men and women between the ages of 50-85; half were Somali migrants and the other half Finnish matched pairs. The participants were surveyed regarding their usage of somatic, mental, and preventive health services, as well as symptoms of depression, general distress, and somatization. The Somali participants were also surveyed regarding their usage of traditional healing methods and preferences for mental healthcare. Results: The Somali group had significantly lower access to personal/family doctors at healthcare centers as well as a lower availability of private doctors and occupational health services than the Finns. Instead, they used more nursing services than Finnish patients. The Somali participants attended fewer age-salient preventive check-ups than the Finns. The majority of the Somalis preferred traditional care, most commonly religious healing, for mental health problems. The hypothesized service gap was not substantiated, as a high level of depressive symptoms was not associated with a low usage of health services among the Somalis, but it was found unexpectedly among the Finns. Conclusion: Our findings call for culturally appropriate general and mental health services for older immigrants, which requires awareness of clients' preferences, needs, and alternative healing practices. Somali participants encountered institutional barriers in accessing healthcare, and they preferred informal mental healthcare, especially religious healing instead of Western practices.

Differences in Subjective Well-being Between Older Migrants and Natives in Europe

This study examines disparities in subjective well-being (SWB) among older migrants and natives across several European countries using data from the Survey of Health, Aging and Retirement in Europe (SHARE). Our results show a significant SWB gap between migrants and non-migrants that diminishes with increasing age. While migrants from Northern and Central Europe have similar SWB levels as natives, Southern European, Eastern European, and Non-European migrants have significantly lower levels of SWB than the native population. The immigrant-native gap becomes smaller but remains significant after controlling for sociodemographic characteristics and health, the financial situation, citizenship, age at migration, and length of residence. Additionally, we find that the size of the SWB gap varies largely across countries. Current family reunion policies as measured by the Migrant Integration Policy Index (MIPEX) correlate with these country differences. The immigrant-native gap is bigger in countries with restrictive and smaller in countries with open policies.

The UCL-Lancet Commission on Migration and Health: the health of a world on the move

With one billion people on the move or having moved in 2018, migration is a global reality, which has also become a political lightning rod. Although estimates indicate that the majority of global migration occurs within low-income and middle-income countries (LMICs), the most prominent dialogue focuses almost exclusively on migration from LMICs to high-income countries (HICs). Nowadays, populist discourse demonises the very same individuals who uphold economies, bolster social services, and contribute to health services in both origin and destination locations. Those in positions of political and economic power continue to restrict or publicly condemn migration to promote their own interests. Meanwhile nationalist movements assert so-called cultural sovereignty by delineating an us versus them rhetoric, creating a moral emergency.

In response to these issues, the UCL-Lancet Commission on Migration and Health was convened to articulate evidence-based approaches to inform public discourse and policy. The Commission undertook analyses and consulted widely, with diverse international evidence and expertise spanning sociology, politics, public health science, law, humanitarianism, and anthropology. The result of this work is a report that aims to be a call to action for civil society, health leaders, academics, and policy makers to maximise the benefits and reduce the costs of migration on health locally and globally. The outputs of our work relate to five overarching goals that we thread throughout the report.

First, we provide the latest evidence on migration and health outcomes. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health. Migrants generally contribute more to the wealth of host societies than they cost. Our Article shows that international migrants in HICs have, on average, lower mortality than the host country population. However, increased morbidity was found for some conditions and among certain subgroups of migrants, (eg, increased rates of mental illness in victims of trafficking and people fleeing conflict) and in populations left behind in the location of origin. Currently, in 2018, the full range of migrants’ health needs are difficult to assess because of poor quality data. We know very little, for example, about the health of undocumented migrants, people with disabilities, or lesbian, gay, bisexual, transsexual, or intersex (LGBTI) individuals who migrate or who are unable to move.

Second, we examine multisector determinants of health and consider the implication of the current sector-siloed approaches. The health of people who migrate depends greatly on structural and political factors that determine the impetus for migration, the conditions of their journey, and their destination. Discrimination, gender inequalities, and exclusion from health and social services repeatedly emerge as negative health influences for migrants that require cross-sector responses.

Third, we critically review key challenges to healthy migration. Population mobility provides economic, social, and cultural dividends for those who migrate and their host communities. Furthermore, the right to the highest attainable standard of health, regardless of location or migration status, is enshrined in numerous human rights instruments. However, national sovereignty concerns overshadow these benefits and legal norms. Attention to migration focuses largely on security concerns. When there is conjoining of the words health and migration, it is either focused on small subsets of society and policy, or negatively construed. International agreements, such as the UN Global Compact for Migration and the UN Global Compact on Refugees, represent an opportunity to ensure that international solidarity, unity of intent, and our shared humanity triumphs over nationalist and exclusionary policies, leading to concrete actions to protect the health of migrants.

Fourth, we examine equity in access to health and health services and offer evidence-based solutions to improve the health of migrants. Migrants should be explicitly included in universal health coverage commitments. Ultimately, the cost of failing to be health-inclusive could be more expensive to national economies, health security, and global health than the modest investments required.

Finally, we look ahead to outline how our evidence can contribute to synergistic and equitable health, social, and economic policies, and feasible strategies to inform and inspire action by migrants, policy makers, and civil society. We conclude that migration should be treated as a central feature of 21st century health and development. Commitments to the health of migrating populations should be considered across all Sustainable Development Goals (SDGs) and in the implementation of the Global Compact for Migration and Global Compact on Refugees. This Commission offers recommendations that view population mobility as an asset to global health by showing the meaning and reality of good health for all. We present four key messages that provide a focus for future action.

On the move in search of health and care: Circular migration and family conflict amongst older Turkish immigrants in Germany

This study focuses on circular migration amongst older Turkish immigrants to investigate two main questions: (1) How do perceived health and available healthcare systems in Turkey and Germany determine the structure of circular migration? (2) How is eldercare shaped by intergenerational conflict and exchange relations amongst older immigrants, their adult children in Germany, and their extended families in Turkey? Through the analysis of 40 in-depth interviews, this study finds that while Turkey offers healthier physical, psychological, and religious options, older circular migrants are more drawn to Germany because they perceive its healthcare system to be superior. Furthermore, contrary to conventional accounts, eldercare has mostly been navigated through intergenerational conflict and exchange relations, instead of family solidarity or traditional filial roles, and these conflicts and exchange principles around eldercare regulate family living arrangements across the two countries. In short, older Turkish immigrants encounter unique challenges in both their home and host countries, which promulgates their circular migration.

Emotional Stress and the Integration of Muslim Minorities in France and Canada

This study examines theories of Muslim minority integration as these apply to republican France and multicultural Canada, using data on psychological distress as a key measure. Based on the 2001–2002 Canadian Community Health Survey and the 2008 French Enquête sur la Santé et la Protection Sociale, we find Muslim minorities experience higher levels of psychological distress than non-Muslims, not only in France but also in Canada. The Muslim difference is unrelated to religious attachment and rather is partly explained by high rates of unemployment or labor market inactivity.

Marital Status and Trajectories of Depressive Symptoms Among Older Adults of Mexican Descent

Little is known about the implications of marital status for the age patterning of depressive symptoms in later life. Drawing on seven waves of data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, this research uses growth curve models to examine age trajectories of depressive symptoms among continuously married and recently and continuously widowed older adults of Mexican descent (aged 65 years and older; N = 1,452). The findings demonstrate that despite having a higher mean level of depressive symptoms, the recently widowed experienced a similar rate of increase in distress with age to that of their married counterparts. Compared with the married, the continuously widowed had a steeper rise in depressive symptoms with age, although they had fewer symptoms at younger ages in later life. Physical health, financial strain, social support, and church attendance might account to a certain extent for marital status differences in depressive symptoms across later life.

Investigating the Dynamics of Migration and Health in Australia: A Longitudinal Study

There have been few longitudinal studies investigating the immigrant health and changes in their health with longer residency in the host country. Additionally, the pathways and mechanisms by which transition of health over time occurs are poorly understood, limiting the ability to implement policies that will result in improved health for all, including immigrants. We assessed differences in health outcomes among foreign-born people from English speaking countries and non-English speaking countries relative to native-born Australians over a 10-year period using a large representative longitudinal dataset. We also explored English language proficiency, socio-economic factors and health behaviour factors as possible mechanisms through which health outcomes change over time post-migration. Conventional multilevel mixed and hybrid regression models were used to evaluate health outcomes in 9558 native-born and 3067 foreign-born people from the Household, Income and Labour Dynamics in Australia survey. There were clear differences in physical health, mental health and self-assessed health between foreign-born subgroups in comparison with native-born Australians. Foreign-born people from English speaking countries typically had a health advantage relative to native-born people, and foreign-born people from non-English speaking countries had a health disadvantage with respect to native-born people for all health outcomes. There was no evidence that these differences changed by duration of residence except for self-assessed health amongst foreign-born people from non-English speaking countries when duration of residence exceeded 20 years. English language proficiency mediated the relationship between duration of residence and health for foreign-born people from non-English speaking countries.

Acculturation and other risk factors of depressive disorders in individuals with Turkish migration backgrounds

BACKGROUND

Acculturation is a long-term, multi-dimensional process occurring when subjects of different cultures stay in continuous contact. Previous studies have suggested that elevated rates of depression among different migrant groups might be due to patterns of acculturation and migration related risk factors. This paper focused on prevalence rates of depressive disorders and related risk factors among individuals with Turkish migration backgrounds.

METHODS

A population-based sample of 662 individuals with Turkish migration backgrounds were interviewed by bilingual interviewers using a standardised diagnostic interview for DSM-IV-TR and ICD-10 diagnoses (CIDI DIA-X Version 2.8). Associations between 12-month prevalence rates of depressive disorders with potential risk factors were assessed, including gender, age, socioeconomic status, acculturation status and migration status.

RESULTS

12-month prevalence rates of any depressive disorder were 29.0%, 14.4% of major depressive disorder (MDD) and 14.7% of dysthymia. Older age and low socioeconomic status were most consistently related to higher risks of depressive disorders. Acculturation status showed associations with subtypes of depressive disorder. Associations differed between men and women. Symptom severity of MDD was linked to gender, with females being more affected by severe symptoms.

CONCLUSION

The prevalence of depressive disorders is high in individuals with Turkish migration backgrounds, which can be partly explained by older age, low socioeconomic status and acculturation pressures. Only a limited number of risk factors were assessed. Acculturation in particular is a complex process which might not be sufficiently represented by the applied measures. Further risk factors have to be identified in representative samples of this migrant group.

Factors associated with psychological distress or common mental disorders in migrant populations across the world

We systematically review factors associated with the presence of psychological distress or common mental disorders in migrant populations. Articles published between January 2000 and December 2014 were reviewed and 85 applying multivariate statistical analysis were selected. Common mental disorders were significantly associated with socio-demographic and psychological characteristics, as observed in large epidemiological studies on general populations. The probability of common mental disorders occurrence differs significantly among migrant groups according to their region of origin. Moreover, traumatic events prior to migration, forced, unplanned, poorly planned or illegal migration, low level of acculturation, living alone or separated from family in the host country, lack of social support, perceived discrimination, and the length of migrants' residence in the host country all increase the likelihood of CMD. In contrast, language proficiency, family reunification, and perceived social support reduce such probability. Factors related with the risk of psychiatric morbidity among migrants should be taken into account to design preventive strategies.

The Role of Children’s Education for the Mental Health of Aging Migrants in Europe

Abstract. In this study, using SHARE data we examined whether the education of adult children is associated with depressive symptoms (EURO-D caseness) for older immigrants and nonimmigrants in Europe. After controlling for possible confounders, we found that the education of adult children has independent effects on the mental health of their parents, and that having children with upper secondary or tertiary levels of education significantly lessen the odds of immigrants experiencing depressive symptoms. Furthermore, regular contact between parents and their adult children exerts a positive influence as well as amplifying the relationship between children’s education and mental health. Taken together, the results demonstrate that, were it not for family social capital, older immigrants might experience much worse mental health outcomes.

Receiving Instrumental Support in Late Parent-Child Relationships and Parental Depression

OBJECTIVES

This study investigates the role of gender, functional limitations, and social interaction in the association between instrumental support from adult children and parental depression. We apply self-determination theory to hypothesize about the role of physical needs and social resources on parental depression in a European context.

METHOD

A sample of 6,268 parents older than 65 who have nonresident children from the first wave of Survey of Health, Ageing and Retirement in Europe (2004) is analyzed. We estimate logistic regression models to test for the association between instrumental support and depression. Physical needs, gender, and social interaction are used as moderators.

RESULTS

Net of core factors that contribute to depression, including previous history of depression, there is a U-shaped pattern between receiving instrumental support and depression that persists across country regimes. For respondents with medium physical limitations, too little or too frequent support from children is associated with higher depression. For respondents with severe limitations, receiving at least some support is better than receiving none at all. The receipt of too frequent support from children increases the level of depression more for women than men. All interaction effects are comparable across country regimes.

DISCUSSION

Heterogeneity in physical needs and resources of older individuals must be taken into account when assessing the effects of instrumental support on mental health.

The 'healthy immigrant effect': breastfeeding behaviour in Ireland

BACKGROUND

The benefits of breastfeeding for babies, mothers and society have been demonstrated in a large scientific literature. Irish rates of breastfeeding are amongst the lowest in Europe (in 2010, Ireland had the lowest breastfeeding initiation rate of 14 European countries). One of the most distinctive features of breastfeeding behaviour in Ireland is the large difference in breastfeeding rates between immigrants to Ireland and the Irish-born. Data from the 2010 Irish National Perinatal Reporting System show that just 46.1% of Irish-born mothers were breastfeeding at hospital discharge, in comparison with 84.2% of immigrant mothers. Descriptive patterns suggest that breastfeeding behaviour in Ireland may exhibit a 'healthy immigrant' effect, whereby the health status and behaviours of immigrants are better than the native-born on arrival, but converge to native levels as length of time since migration increases.

METHODS

Using nationally representative data from two cohorts of children in Ireland, the purpose of this article is to examine the evidence for a 'healthy immigrant' effect with respect to breastfeeding behaviour.

RESULTS

The results indicate that immigrants are significantly more likely to breastfeed than Irish-born mothers, but that immigrant breastfeeding rates converge towards Irish-born rates of breastfeeding as length of time since migration increases.

CONCLUSION

The decline in breastfeeding behaviour among immigrants to Ireland with length of time since migration highlights the need for appropriate interventions aimed at countering the particular negative attitudes to breastfeeding that are observed in Irish society.

Acculturation and depressive symptoms among Turkish immigrants in Germany

The present study explores the impact of acculturation on depressive symptoms among Turkish immigrants in Germany, taking into account different dimensions of cultural orientation. A total of 471 patients from two selected samples (254 primary care patients and 217 outpatients of a psychosomatic department) participated. Levels of acculturation were measured as orientation towards culture of origin (CO), and orientation towards the host culture (HC). Acculturation strategies (integration, assimilation, separation, and marginalization) were also assessed as well as their association with depressive symptoms (BDI). Furthermore, gender- and migration-related differences in terms of acculturation and levels of depressive symptomatology were analyzed. Integration was the acculturation strategy associated with the lowest level of depressive symptoms (M = 14.6, SD = 11.9), while marginalization was associated with the highest (M = 23.5, SD = 14.7). Gender was not found to have a significant impact on acculturation but influenced depressive symptoms, with women (M = 21.8, SD = 13.3) reporting higher levels of depressive symptomatology than men (M = 15.1, SD = 14.0; p < 0.001). In first generation immigrants, significantly higher CO (M = 46.6, SD = 8.3; p < 0.001), lower HC (M = 31.0, SD = 9.6; p < 0.001), and higher levels of depressive symptoms (M = 20.2, SD = 14.1; p < 0.001) were found in comparison to second generation immigrants (CO: M = 41.3, SD = 7.4; HC: M = 36.2, SD = 8.8; depressive symptoms: M = 14.0, SD = 12.9). Our results suggest that orientation towards both the heritage and the host culture has a positive effect on the mental health status of immigrants. Future research needs to include representative samples of migrants from different cultures to further explore the association between acculturation and mental health.

Physical inactivity is strongly associated with anxiety and depression in Iraqi immigrants to Sweden: a cross-sectional study

Background

Increasing evidence on associations between mental health and chronic diseases like cardio-vascular disease and diabetes together with the fact that little is known about the prevalence of anxiety/depression and associated risk factors among Iraqi immigrants to Sweden, warrants a study in this group. The aim was to study the prevalence of anxiety and depression in immigrants from Iraq compared to native Swedes and compare socioeconomic and lifestyle-related factors associated with these conditions.

Method

A population-based, cross-sectional study of residents of Malmö, Sweden, aged 30–75 years, born in Iraq or Sweden. The overall response rate was 49% for Iraqis and 32% for Swedes. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations were studied using multivariate logistic regression models. The outcome was odds of depression and/or anxiety.

Results

Compared to Swedes (n = 634), anxiety was three times as prevalent (52.6 vs. 16.3%, p < 0.001) and depression five times as prevalent (16.3 vs. 3.1%, p < 0.001) in Iraqi immigrants (n = 1255). Iraqis were three times more likely to be anxious and/or depressed compared to Swedes (odds ratio (OR) 3.02, 95% confidence interval (CI) 2.06-4.41). Among Iraqis, physical inactivity (<150 min/week) (OR 2.00, 95% CI 1.49-2.69), economic insecurity (OR 2.16, 95% CI 1.56-3.01), inability to trust people (OR 1.75, 95% CI 1.28-2.39) and smoking (OR 1.43, 95% CI 1.02-2.01), were strongly associated with anxiety/depression. Among Swedes, living alone (OR 2.10, 95% CI 1.36-3.25) and economic insecurity (OR 2.38, 95% CI 1.38-4.12) showed the strongest associations with anxiety/depression. Country of birth modified the effect of physical inactivity (P_interaction =0.058) as well as of marital status (P_interaction =0.001).

Conclusion

Our study indicates that economic insecurity has a major impact on poor mental health irrespective of ethnic background but that physical inactivity may be more strongly associated with anxiety/depression in immigrants from the Middle East compared to native Swedes. Preventive actions emphasizing increased physical activity may reduce the risk of poor mental health in immigrants from the Middle East, however intervention studies are warranted to test this hypothesis.

Frailty and migration in middle-aged and older Europeans

We evaluated life course influences on health by investigating potential differences in levels of frailty between middle-aged and older European immigrants born in low- and middle-income countries (LMICs), immigrants born in high income countries (HICs), and their native-born European peers. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE), we constructed a frailty index from 70 age-related health measures for 33,745 participants aged 50+ (mean=64.9 ± 10.2 years; 54% women) in 14 European countries. Participants were grouped as native-born or as immigrants born in LMICs or in HICs, and further by current residence in Northern/Western or Southern/Eastern Europe. Seven percent of participants (n=2369) were immigrants (mean=64.4 ± 10.2 years; 56% women; LMIC-born=3.4%, HIC-born=3.6%). In Northern/Western Europe, after adjustment for age, gender, and education, LMIC-born immigrants demonstrated higher frailty index scores (mean=0.18, 95% confidence interval=0.17-0.19) than both HIC-born immigrants (0.16, 0.16-0.17) and native-born participants (0.15, 0.14-0.15 both p<0.001). In Southern/Eastern Europe, frailty index scores did not differ between groups (p=0.2). Time since migration explained significant variance in frailty index scores only in HIC-born immigrants to Southern/Eastern Europe (4.3%, p=0.03). Despite differences in frailty, survival did not differ between groups (p=0.2). LMIC-born immigrants demonstrated higher levels of frailty in Northern/Western Europe, but not Southern/Eastern Europe. Country of birth and current country of residence were each associated with frailty. Life course influences are demonstrable, but complex.