Psychiatric morbidity among foreign housemaids in Kuwait

Psychiatric disorders in inpatient Ethiopian migrant workers in the United Arab Emirates

Migrant workers have higher rates of mental health problems than non-migrant workers, with Ethiopian migrant workers in the United Arab Emirates appearing to be overrepresented in the psychiatric inpatient population compared with their numbers in the general population. We sought to investigate the pattern of psychiatric inpatient admissions in Ethiopian migrant workers over a 10-year period (2011-2020) in order to highlight demographic and clinical characteristics, and to investigate factors predicting the length of hospital stay. We reported the mean and frequency of demographic and clinical data of Ethiopian psychiatric inpatients at one of the largest governmental hospitals in eastern Abu Dhabi between 2011 and 2020, and investigated factors predicting length of stay in hospital using linear regression. Our results show that Ethiopian expatriates made up 7.9% of all admissions over a 10-year period, had a mean length of hospital stay of almost 20 days, with 98.1% of them being female, 92.8% being domestic workers, 90.1% having a language barrier, 57.4% being single and 55.5.% having one or more recent stressors prior to admission. The most common diagnoses were acute stress reaction (31.6%), psychosis (29.3%), bipolar disorder (14.8%) and adjustment disorder (11.0%). Work-related stress, termination of employment and several clinical factors significantly predicted length of stay in hospital.

Coming Out of Employers' Homes:Migration, Domestic Work and Health Claims

Migrant domestic workers in Kuwait live amid structural inequalities, including health disparities, yet little is known about how they manage wellness alongside imperatives to work and earn. In this article, I examine Sri Lankan women's coming out of employers' homes through authorized and unauthorized channels and how they use illness and exhaustion to justify their need for more autonomous conditions. Exploring the physical, emotional, and political dimensions of these processes, I highlight the Sri Lankan vernacular notion of "heart-being" within women's actions to safeguard health and seek existential grounding, as they assert biolegitimate claims to return home or live unauthorized.

Depression, anxiety and associated factors among housemaids working in Addis Ababa Ethiopia

BACKGROUND

Housemaids are part of women with low socioeconomic status and most of them are migrant from rural to central part of Ethiopia, less educated, either with poor, separated, single or divorced family and/or dead parents. Housemaid may experience problems like depression and anxiety more than other groups of women. Therefore, the aim of this study was to assess the magnitude and determinants of those problems among housemaids.

OBJECTIVE

To assess the magnitude and determinants of depression & anxiety among housemaids in Addis Ababa; Ethiopia; 2018.

METHODS

Community based cross-sectional study was conducted from May 1 to August 30, 2018 among housemaids working in Addis Ababa, Ethiopia. Multistage sampling technique was applied with a total of 826 samples. Quantitative data was employed by using structured questionnaires. The collected data was coded, entered in to Epi-Info version 7 and analyzed by using SPSS version 20. Descriptive, analytical statistical procedures; bivariate and multivariate binary logistic regressions with odds ratios and 95% confidence interval was employed. The statistical significance was declared at p value < 0.05.

RESULTS

This study enrolled 862 participants with response rate 99.5%, 99.5% refers to the number of people who actually completed the interview. The result showed prevalence of depression and anxiety among housemaids 27.5% and 32.3% respectively. Among all participants 44.6% (95% CI= 41.0 - 47.9) have mild, 18.5% (95% CI= 15.7 - 21.2) have moderate and 6.1% (95% CI= 4.5 - 7.8) have severe form of comorbid anxiety with depression. Depression (44.9%) and anxiety (41.9%) found more prevalent among the age group 16 to 20. In this study history of parental divorce, participant's divorce, physical violence and sexual violence are positively associated. Other factors; being less educated and living with relatives; were associated negatively.

CONCLUSION

The prevalence of Depression and Anxiety is found high among housemaid; its prevalence is more among age group 16 to 20 than other age groups. Violence, participant's divorce, history of parental divorce and contraceptive use has positively associated with depression and anxiety.

Health and well-being of male international migrants and non-migrants in Bangladesh: A cross-sectional follow-up study

BACKGROUND

Temporary labor migration is an increasingly important mode of migration that generates substantial remittance flows, but raises important concerns for migrant well-being. The migration and health literature has seen a growing call for longitudinal, binational surveys that compare migrants to relevant non-migrant counterfactual groups in the sending country, in order to answer the basic question "Is migration good for health?" This study compares the health of male international migrants, internal migrants, and non-migrants using a unique representative panel survey of the Matlab subdistrict of Bangladesh.

METHODS AND FINDINGS

A cohort of 5,072 respondents born 1958-1992 were interviewed in 1996-1997, and reinterviewed in 2012-2014. Extensive migrant follow-up yielded a 92% reinterview rate. We explored health and income outcomes for respondents who at the time of the follow-up interview were current international migrants (n = 790), returned international migrants (n = 209), internal migrants (n = 1,260), and non-migrants (n = 2,037). Compared to non-migrants, current international migrants were younger (mean 32.9 years versus 35.8 years), had more schooling (7.6 years versus 5.8 years), and were more likely to have an international migrant father (9.7% versus 4.0%) or brother (49.1% versus 30.3%). We estimated multivariate ordinary least squares and logistic regression models controlling for a wide range of control variables measured as far back as 1982. Results show that current international migrants had substantially better health status on factors that likely relate to self-selection such as grip strength and self-rated health. Current international migrants had no excess risk of injury in the past 12 months compared to non-migrants (adjusted mean risk = 6.0% versus 9.3%, p = 0.084). Compared to non-migrants, current international migrants had roughly twice the risk of overweight/obesity (adjusted mean risk = 51.7% versus 23.3%, p < 0.001), obesity (6.9% versus 3.4%, p = 0.012), and stage 1 or higher hypertension (13.0% versus 7.0%, p = 0.014). Compared to internal migrants, current international migrants had significantly higher levels of overweight/obesity (adjusted mean risk = 51.7% versus 37.7%, p < 0.001). Current international migrants showed above average levels of depressive symptoms on a 12-item standardized short-form Center for Epidemiologic Studies Depression Scale (+0.220 SD, 95% CI 0.098-0.342), significantly higher than internal migrants (-0.028 SD, 95% CI -0.111, 0.055; p < 0.001). Depressive symptoms differed significantly from those reported by non-migrants when restricting to items on negative emotions (international migrant score = 0.254 SD, non-migrant score = 0.056 SD, p = 0.004). Key limitations include the descriptive nature of the analysis, the use of both in-person and phone survey data for international migrants, the long recall period for occupational and mental health risk measures, and the coverage of a single out-migration area of origin.

CONCLUSIONS

In this study, we observed that international migrants had comparable or lower injury and mortality risks compared to respondents remaining in Bangladesh, due in part to the high risks present in Bangladesh. International migrants also showed higher levels of self-rated health and physical strength, reflective of positive self-selection into migration. They had substantially higher risks of overweight/obesity, hypertension, and depression. Negative health impacts may reflect the effects of both harsh migration conditions and assimilation into host population conditions. Our results suggest the need for bilateral cooperation to improve the health of guest workers.

The effect of discrimination on depression and anxiety symptoms and the buffering role of social capital among female domestic workers in Macao, China

Foreign migrant domestic workers experience an increased burden of mental disorders. Discrimination contributes to this burden. Social resources may buffer migrants from the effects of this discrimination. The present study explored the relationship between discrimination and common mental disorder (CMD) symptoms, anxiety and depression, and examined whether social capital (cognitive and structural) modified this association. A total of 131 female migrant Filipina domestic workers in Macao, China (M_age = 39.7) were sampled using snowball methods. Self-report data were obtained using tablet devices. Correlation analyses demonstrated that discrimination was significantly associated with depression (r_s = 0.43) and anxiety (r_s = 0.42). Mulitvariable regressions showed that cognitive, but not structural, social capital was significantly negatively associated with depression (β = -0.30) and anxiety (β = -0.32). Cognitive social capital modified the association between discrimination and depression (β = 0.39) and anxiety (β = 0.53). Contrary to predictions, as discrimination increased, compared to those with no cognitive social capital, those with moderate or high levels of cognitive social capital experienced worsening CMD symptoms. This finding provides greater nuance to our understanding of how and under what circumstances social resources are protective for mental health for migrant workers.

Prevalence and associated factors of common mental disorders among Ethiopian migrant returnees from the Middle East and South Africa

BACKGROUND

Ethiopian migrants to the Middle East and South Africa experience a range of problems at various stages of their migration including overwork, sleep deprivation, denial of food, emotional abuse, difficulty adapting to the host culture, salary denial, sexual abuse, labor exploitation, confiscation of their travel documents, confinement, denial of medication, lack of access to legal service and degrading attitude by employers, traffickers and smugglers. These experiences can be associated with different types of mental disorders. This study sought to determine the prevalence of common mental disorders (CMD) and socio-demographic and other migration related associated factors among Ethiopian migrant returnees from the Middle East and South Africa.

METHOD

A cross-sectional study was conducted using non-probability (i.e. purposive, availability and snowball) sampling techniques. Migrant returnees (n = 1036) were contacted individually at their homes in eight high prevalent immigrant returnee locations in Ethiopia. Common mental disorders were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect data on socio-demographic and migration related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression.

RESULTS

The prevalence of CMD among migrant returnees was found to be 27.6%. Highly prevalent specific CMD symptoms included headaches, poor appetite, being tired, sleeping problems, and feeling unhappy or nervous. Being originally from Amhara and Oromia regions, being Christian, being divorced, not receiving salary on time, not being able to contact family, unable to prepare for domestic labor abroad, lack of cross- cultural awareness, and lack of knowledge and skills for work were all important risk factors for CMD. Migrants experienced adversities at different stages of their migration which are associated with psychological distress and even to long term mental illnesses.

CONCLUSIONS

CMD symptoms were found to be prevalent among Ethiopian migrant returnees. As pre-migration factors are associated with CMD symptoms, pre-departure training could be useful to mitigate the risk factors. Creating and routinely arranging mental health interventions and rehabilitation services are advisable for returnees who are screened for, or diagnosed with, mental health problems.

Foreign Domestic Workers in Kuwait: Who Employs How Many

The percentage of Kuwaiti households with at least one foreign domestic worker increased from 13 percent in 1977/79 to 87 percent in 1999. This paper describes the workers' characteristics, their workload and attributes of the households they live in. Predictors of the number of domestic workers employed by households are examined by using multinomial logistic regression. Households that employ at least one domestic worker have a larger number of children than those who employ none. Households that employ two (or three) domestic workers have more children and older people and are significantly richer (i.e., have higher income, larger homes etc.) than those who do not employ any.

Toward healthy migration: an exploratory study on the resilience of migrant domestic workers from the Philippines

Domestic workers face many migration-related stressors that affect their mental health. Currently there is an emphasis in the literature on these workers' problems and vulnerability, while there is little insight into factors that positively affect their mental health. In this study, we describe a range of factors that potentially contribute to the resilience of female domestic workers from the Philippines, and explore their relation to stress and well-being. The study used an explorative, mixed-methods design. First, data were collected using questionnaires (n = 500) to assess self-perceived stress levels, well-being, personal resources, and social resources. Then, findings from the questionnaires were validated and elaborated on in a workshop (n = 23) and two focus groups (n = 13; n = 8). Results show that participants perceived their well-being abroad as relatively good, while they also experienced high levels of stress. Workers used a variety of resources in dealing with stress. Socially oriented coping strategies and spirituality seemed to play an important role as personal resources, while the influence of reasons for migration was less clear. Employers and (access to) social networks appeared important in determining social resources. Social resources were more often related to stress and well-being than were personal resources. Findings from this study can help to design strengths-based interventions aimed at improving the well-being of female domestic workers and preventing mental health problems. The environmental factors and structural constraints that provide the context for resilience should be further explored as they influence the ability to mobilize resources.

Mental health issues among migrant workers in Gulf Cooperation Council countries: literature review and case illustrations

More than 15 million non-nationals are currently living and working in Gulf Cooperation Council (GCC) states. The majority are blue-collar or domestic workers coming from the Indian Subcontinent or South East Asia. They often work under very harsh conditions. There are reports of a high rate of psychosis and suicide among these people but no reliable data are available. To address this issue we conducted a literature search both in English and in Arabic to review the available articles on the psychological well-being of this population. Very few articles were found. We hereby review the available literature and contribute by presenting several brief vignettes to illustrate the various clinical aspects of this at risk population. We also discuss possible reasons for underreporting and underscore the need for more research in this area.

Psychiatric morbidity, phenomenology and management in hospitalized female foreign domestic workers in Lebanon

40 million female domestic workers worldwide experience the inhumane conditions associated with this unregulated occupation, a situation that induces psychiatric morbidities in many. The case in Lebanon is not any better where it is estimated that one foreign domestic worker (FDW) commits suicide weekly. 33 female FDW and 14 female Lebanese (control group, CG) were enrolled. Brief Psychotic Rating Scale (BPRS) and Clinical Global Impression (CGI) scales were administered on admission and discharge and socio-demographic, living conditions, mental health care data and phenomenological observations were collected. Sexual, physical, and verbal abuses were detected in FDW (12.5, 37.5, and 50.0 %. respectively). 66.7 % of them were diagnosed with brief psychotic episode. The mean duration of hospital stay (13.1 days) was significantly lower in the FDW group. The mean cumulative antipsychotic dose of the FDW was 337.1 mg of chlorpromazine equivalent and the mean BPRS total pre-score of FDW was 66.4 with a much improved state on the CGI global improvement scale, all of which were nonsignificantly different from the CG. Striking phenomenological findings among FDW were acute anorexia (39.4 %), nudity (30.3 %), catatonic features (21.2 %), and delusion of pregnancy (12.1 %). Inpatient FDW are more diagnosed with psychotic than affective disorders and receive approximately similar treatment as controls in spite of the trend to rapidly discharge and deport the worker to limit the costs. Both groups presented with similar severity, although the FDW had peculiar phenomenological observations.

Gender disadvantage and common mental disorders in women

Research in the area of gender and mental health indicates that women are disproportionately affected by common mental disorders (CMDs) as well as co-morbid mental disorders. However, the concept of gender disadvantage, its correlates, and mental health outcomes has received relatively less research attention. In addition, there are no known systematic reviews in the area of gender disadvantage and common mental disorders in recent years. In this review we have therefore attempted to deconstruct the concept of gender disadvantage, identify important correlates of gender disadvantage and illustrate their influence on common mental disorders. Since gender is a social construct and is greatly influenced by one's culture and ethnicity, we have made an attempt to integrate international literature on the subject and highlight cultural and ethnic relevance of topics as they emerge. Finally, we have provided take home messages from existing literature, identified gaps in literature, and formulated directions for future research in this area.

Acute psychiatric disorders in foreign domestic workers in Hong Kong: a pilot study

AIM

To explore the psychopathology of foreign domestic workers (FDWs) who had an acute psychiatric disorder in Hong Kong.

METHOD

This was a retrospective chart review. Demographic and clinical data were extracted from case records of FDWs who were admitted for the first time as inpatients for psychiatric treatment to three regional hospitals of the same catchment area in Hong Kong between 2000 and 2004. Relevant socio-demographic data on local FDWs and the general population of Hong Kong were obtained from local government departments.

RESULTS

Twenty-seven Filipino and 14 Indonesian FDWs presenting with their first and so far only psychiatric admission were identified. There were significantly more FDWs who were single or never married in the sample. Filipino FDWs tended to fall ill after 4 years of service in Hong Kong while the corresponding figure for Indonesian FDWs was 2 years. Indonesian FDWs were older and had less access to social and medical services than their Filipino counterparts. Home sickness and marital problems were more commonly identified as stressors rather than work-related difficulties. Acute and Transient Psychotic Disorder (ICD-10) was diagnosed in over 60% of the subjects, making FDWs two times more vulnerable than local women of similar age for this illness.

CONCLUSIONS

FDWs constitute a vulnerable group in terms of psychiatric morbidity. Concerted political, social and psychological efforts would be require to alleviate the distress faced by this particularly disadvantaged subset of female expatriates.

Migration and mental health: a study of low-income Ethiopian women working in Middle Eastern countries

BACKGROUND

Few studies have explored influences on mental health of migrants moving between non-Western countries.

METHODS

Focus group discussions were used to explore the experiences of Ethiopian female domestic migrants to Middle Eastern countries, comparing those who developed severe mental illness with those remaining mentally well.

DISCUSSION

Prominent self-identified threats to mental health included exploitative treatment, enforced cultural isolation, undermining of cultural identity and disappointment in not achieving expectations. Participants countered these risks by affirming their cultural identity and establishing socio-cultural supports.

CONCLUSIONS

Mental health of migrant domestic workers may be jeopardized by stressors, leading to experience of social defeat.

Association of blood levels of C-reactive protein with clinical phenotypes in Arab schizophrenic patients

Schizophrenia may be associated with inflammatory reactions and C-reactive protein (CRP) is a nonspecific serum protein marker for persisting inflammatory states. This study aimed to assess concentrations of high sensitivity CRP (hsCRP) in schizophrenic Arab patients and evaluate the relationships of hsCRP levels with aspects of clinical phenotypes of the disease. Two age-matched groups of subjects were studied: (1) healthy controls, HC, n=165; (2) patients with schizophrenia, SZ: n=207. Each subject was evaluated with a standard questionnaire for age at disease onset, family history, disease severity and outcome. Serum hsCRP levels were measured by immunoassay. The two groups of subjects were similar in age, ethnic composition and socioeconomic status. Those with SZ had significantly greater serum concentrations of hsCRP. There were significant associations between hsCRP and (i) age in both groups; (ii) body mass index (BMI) in HC but not in SZ. In the latter, hsCRP levels were: (a) marginally higher in women with later age of disease onset; (ii) highest with remission and with catatonic features; and (iii) lower with family history of psychosis. The study concludes that serum levels of hsCRP are increased in clinically stable Arab patients with schizophrenia and appear related to the disorder's clinical expression. It is suggested that there may be an inflammatory component to schizophrenia which is associated with aspects of its clinical phenotype.

Associations of blood homocysteine concentrations in Arab schizophrenic patients

BACKGROUND

This study aimed to evaluate the blood homocysteine concentration in Arab patients with schizophrenia and assess its associations with clinical phenotypes of the disease.

SUBJECTS AND METHODS

Two age-matched groups of subjects were studied: (1) Healthy Controls, HC, n=165; (2) patients with schizophrenia, SZ: n=207. Each subject was evaluated with a standard questionnaire for age at disease onset, family history, disease severity and outcome. Plasma homocysteine levels (Hcys) were measured by immunoassay and serum levels of other biochemical parameters were measured by routine Autoanalyzer techniques.

RESULTS AND DISCUSSION

Group HC was heavier (body mass index, BMI) while SZ had greater waist-hip ratio (WHR) and plasma Hcys levels. In SZ, there were significant correlations between Hcys and BMI, triglycerides and HDL. Hcys levels in SZ were highest in the younger male patients.

CONCLUSION

Schizophrenic patients have increased blood Hcys levels which correlate with components of the metabolic syndrome. Hcys levels were highest in the younger male patients and were not influenced by prognostic features of the disease.

Stigma towards people with mental illness in developing countries in Asia

BACKGROUND

There is a wide range of literature on stigmatization and discrimination of people with mental illness. Most studies, however, derive from Western countries. This review aims at summarizing results from developing countries in Asia published between 1996-2006.

METHOD

Medline search focusing on English-speaking literature.

RESULTS

Comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. People with mental illness are considered as dangerous and aggressive which in turn increases the social distance. The role of supernatural, religious and magical approaches to mental illness is prevailing. The pathway to care is often shaped by scepticism towards mental health services and the treatments offered. Stigma experienced from family members is pervasive. Moreover, social disapproval and devaluation of families with mentally ill individuals are an important concern. This holds true particularly with regards to marriage, marital separation and divorce. Psychic symptoms, unlike somatic symptoms, are construed as socially disadvantageous. Thus, somatisation of psychiatric disorders is widespread in Asia. The most urgent problem of mental health care in Asia is the lack of personal and financial resources. Thus, mental health professionals are mostly located in urban areas. This increases the barriers to seek help and contributes to the stigmatization of the mentally ill. The attitude of mental health professionals towards people with mental illness is often stigmatizing.

CONCLUSION

This review revealed that the stigmatization of people with mental illness is widespread in Asia. The features of stigmatization-beliefs about causes of and attitudes towards mental illness, consequences for help-seeking-have more commonalities than differences to Western countries.

Psychiatric morbidity among housemaids in Kuwait. III: Vulnerability factors

BACKGROUND

Housemaids are a relatively homogenous immigrant subgroup in terms of their gender; ethnic origin; and socio-cultural, educational and occupational background. Psychiatric morbidity among housemaids is two to five times higher than the native female population.

AIMS

To determine the possible pre-immigration risk factors for prospective psychiatric breakdown among the housemaids.

METHODS

The sample consisted of all the housemaids (N = 197) hospitalised during the two-year study period. The controls comprised all the newly arrived housemaids (N = 502). The measures obtained included demographic characteristics and previous history of physical illness, psychiatric illness, hospitalisation and family history of psychiatric disorder.

RESULTS

More than a quarter of the hospitalised group broke down within one month of their arrival. The hospitalised group had a significant excess of Sri Lankan housemaids; non-Muslims; those with less than four years of education and those with a previous history of physical illness, psychiatric illness or hospitalisation.

CONCLUSIONS

A number of potential risk factors results in premature repatriation of housemaids on mental health grounds. Preventive measures involving recruitment procedures and pre-departure orientation courses are needed to minimise the expatriate failure among the housemaids.