Psychological distress through immigration: the two-phase temporal pattern?

Addressing Mental Health Concerns in Refugees and Displaced Populations: Is Enough Being Done?

There are over 82.4 million forcibly displaced people worldwide, about a quarter of whom are resettling as refugees. In the wake of the global refugee crisis spurred by conflict, religious and political persecution, human rights violations, and climate disasters, a mental health has crisis followed. Not only does trauma experienced in home countries and as part of forced migration affect mental health, so too do post-migration traumatic events, discrimination, lack of access to quality and affordable healthcare and housing, and acculturation. To address mental health concerns in refugees and displaced populations, collective action is needed not only from health care providers but also from mental health researchers, funders, journals, resettlement agencies, government entities, and humanitarian organizations. The present review highlights the work of numerous scholars and organizations with the goal of understanding the mental health concerns of forcibly displaced persons within and across ecological systems. The present review seeks to bring attention to the experiences of forcibly displaced persons, summarize the growing body of research understanding the acute and chronic effects of forced displacement and possible interventions, and give a call to action for all members of the global community at every level to engage in joint efforts to improve mental health in refugees and displaced persons. Notably, there is a need for more interventions at the familial and community level that serve not only as treatment but also as prevention. Smartphone-based interventions, mind-body modalities, and interventions delivered by lay and non-clinician community members hold promise. Numerous strides could be made in refugee mental health and treatment when funding agencies include these goals in their research priorities. Despite the challenges they have faced, persons who resettle as refugees are incredibly resilient and deserve to be afforded every right, opportunity, dignity, and respect.

Heart Attacks, Bloody Noses, and Other "Emotional Problems": Cultural and Conceptual Issues With the Spanish Translation of Self-Report Emotional Health Items

This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be.

Sex-dependent effect of post-migration adaptation on height and relative lower leg length in Polish youth

BACKGROUND

Growth in tibia length is considered to be particularly sensitive to environmental stress.

AIM

To estimate the effect of parental migration status on the relative length of the tibia in their school-age children.

SUBJECTS AND METHODS

Data included a nationwide random sample of 17,155 schoolchildren, 7-18 years of age, examined between 1966 and 1969 in Poland who provided information on anthropometric measurements and demographic and social characteristics. Parental migration status was based on paternal migration history. After standardisation by LMS method, z-scores of relative tibia length and z-scores of height were used for analysis. Three-way ANOVA was used to evaluate the influence of migration on tibia length-to-height ratio.

RESULTS

Sons of migrants have a significantly higher tibia length-to-height ratio compared to sons of non-migrants. Children of non-migrants were taller than children of migrants among boys in medium SES and among girls in high and low SES. Relative tibia length indicated significant effects of migration among boys in all age categories and in late adolescent girls: sons of migrants had a higher ratio and daughters of migrants had a lower tibia length-to-height ratio.

CONCLUSION

It is possible that migration experiences of the parents may have influenced the growth of their offspring. The results emphasise the potential importance of research addressing the impact of different types of migration on growth of children.

A "healthy immigrant effect" or a "sick immigrant effect"? Selection and policies matter

Previous literature on a variety of countries has documented a "healthy immigrant effect" (HIE). Accordingly, immigrants arriving in the host country are, on average, healthier than comparable natives. However, their health status dissipates with additional years in the country. HIE is explained through the positive self-selection of healthy immigrants as well as the positive selection, screening and discrimination applied by host countries. In this article we study the health trajectories of immigrants within the context of selection and migration policies. Using SHARE data we examine the HIE, comparing Israel and 16 European countries that have fundamentally different migration policies. Israel has virtually unrestricted open gates for Jewish people around the world, who in turn have ideological rather than economic considerations to move. European countries have selective policies with regards to the health, education and wealth of migrants, who also self-select themselves. Our results provide evidence that (1) immigrants who move to Israel have compromised health and are significantly less healthy than comparable natives. Their health disadvantage persists for up to 20 years of living in Israel, after which they become similar to natives; (2) immigrants who move to Europe have significantly better health than comparable natives. Their health advantage remains positive for many years. Even though during some time lapses they are not significantly different from natives, their health status never becomes worse than that of natives. Our results are important for migration policy and relevant for domestic health policy.

Kidnapping and Mental Health in Iraqi Refugees: The Role of Resilience

Although kidnapping is common in war-torn countries, there is little research examining its psychological effects. Iraqi refugees (N = 298) were assessed upon arrival to the U.S. and 1 year later. At arrival, refugees were asked about prior trauma exposure, including kidnapping. One year later refugees were assessed for posttraumatic stress disorder (PTSD) and major depression disorder (MDD) using the SCID-I. Individual resilience and narratives of the kidnapping were also assessed. Twenty-six refugees (9 %) reported being kidnapped. Compared to those not kidnapped, those who were had a higher prevalence of PTSD, but not MDD, diagnoses. Analyses examining kidnapping victims revealed that higher resilience was associated with lower rates of PTSD. Narratives of the kidnapping were also discussed. This study suggests kidnapping is associated with PTSD, but not MDD. Additionally, kidnapping victims without PTSD reported higher individual resilience. Future studies should further elucidate risk and resilience mechanisms.

Anxiety and depression in older patients: the role of culture and acculturation

Background

Anxiety and depression are major health concerns in general among older adults and especially during hospitalization, as they lead to numerous negative outcomes. There is currently no sufficient body of research examining the role of cultural background in patients’ experience of these conditions. Better identifying patients at risk may help reduce inequity and provide patient-centered, culturally sensitive care. The current study explores the roles of culture and acculturation in anxiety and depression levels in recent and veteran Russian immigrants compared with native Israelis and veteran immigrants from Middle Eastern countries.

Methods

Secondary analysis of a prospective cohort study of cognitively intact older adults (70+) hospitalized for acute conditions in internal medical units in two hospitals in Israel during 2009–11. Depression and anxiety were assessed within 48 h of admission through personal interview using the Tucker Depression Rating and the Short Anxiety Screening Tests. Demographic and health data were collected from electronic health records. Immigration status was defined by country and emigration year. Study hypotheses were tested employing analyses of covariance, modeling anxiety and depression symptoms separately, controlling for potential confounders.

Results

Significant differences between study groups were observed in fully adjusted models for anxiety symptoms (F_{[3, 515]} = 5.24, p < .01) when both veteran (21 ± 5.83) and recent (20.2 ± 5.23) Russian immigrants expressed higher anxiety levels than native Israelis (18.35 ± 5.23) and veteran immigrants (18 ± 5.03) (from p = .05 to p < 0.01). No significant differences were found in anxiety symptoms between recent and veteran Russian immigrants. Both depression and anxiety symptoms showed an interaction effect of study immigration groups by sex: while no differences were observed among native Israelis, significantly higher depression and anxiety were observed among women than men in the other groups.

Conclusions

Culture of origin may play a central role in determining expression of anxiety symptoms and perhaps modify acculturation. During hospitalization, special attention should be given to the level of anxiety among not only recent but also veteran immigrants. Further research may explore whether elevated anxiety is a result of stress due to hospitalization or a stable trait.

The role of social capital in explaining mental health inequalities between immigrants and Swedish-born: a population-based cross-sectional study

BACKGROUND

Social capital may theoretically explain health inequalities between social groups, but empirical evidence is lacking. Some studies indicate that social capital may be particularly important for immigrant health. Nearly 16% of Sweden's population are foreign-born immigrants and research has shown them to be susceptible to psychological distress, though significant variation has been found between groups. In this study, we investigate the following hypotheses: 1) if non-refugees have better mental health than Swedish-born, and refugees experience worse mental health than Swedish-born; 2) if mental health status converges with that of Swedish-born with longer duration of residence; and 3) if social capital mediates the effect of immigrant status on psychological distress for different immigrant groups as compared to Swedish-born.

METHODS

This cross-sectional study uses baseline data from the Stockholm Public Health Cohort and includes 50,498 randomly-selected individuals from Stockholm County in 2002, 2006, and 2010. Mental health was measured as psychological distress, using the 12-item General Health Questionnaire. Social capital was measured using indicators of bonding, bridging, and linking social capital. Both cognitive and structural aspects were measured for the latter two indicators. Mediation was tested using logistic regression and the Sobel test.

RESULTS

The results show that refugees generally had greater odds of psychological distress than non-refugees compared to their respective Swedish-born counterparts. Among immigrant men, both refugees and non-refugees had significantly greater odds of psychological distress than Swedish-born men. Only refugee women in Sweden 10 years or more had significantly greater odds of psychological distress compared to Swedish-born women. The mediation analysis demonstrated that indicators of social capital mediated the association for all immigrant men (except non-refugees in Sweden 3-9 years) and for refugee women in Sweden 10 years or more. While bonding social capital showed the greatest mediatory role among the three social capital types, adding them together had the strongest explanatory effect.

CONCLUSIONS

Social capital explains differences in mental health for some immigrant groups, highlighting its role as a potentially important post-migration factor. Increased investment from policy-makers regarding how social capital can be promoted among new arrivals may be important for preventing psychological distress.

Forced migration in childhood: are there long-term health effects?

Studies on the health of migrants have increased considerably in number in recent years, but little is still known about the long-term health effects associated with forced migration, and particularly for people who were forced to migrate as children. Data shortcomings together with the methodological challenges of studying migrant populations limit the ability to disentangle the roles of various factors that influence migrant health outcomes. Finland provides an unusual opportunity to study long-term health consequences associated with forced migration. During World War II, twelve per cent of the Finnish population was forced to leave the region nowadays referred to as Ceded Karelia. After the war, these Karelians could not return home because the area was relinquished to the Soviet Union. Using high quality, linked register-based data for the period 1988–2012, we investigate whether this forced migration had long-term health consequences for those who were forced to migrate as children. Comparison groups are non-displaced persons born on the adjacent side of the new border, and people born elsewhere in Finland. Health at ages 43–65 years is measured by receipt of sickness benefit, which is an indicator of short-term illness, and receipt of disability pension, which reflects long-term illness or permanent disability. All-cause and cause-specific mortality is analysed at ages 43–84 years. We find no support for the hypothesis that the traumatic event of being forced to migrate during childhood has long-term negative health consequences. The forced child migrants have lower odds for receipt of sickness benefit, and women also have lower odds for receipt of disability pension. The mortality results are largely driven by patterns specific for eastern-born populations of Finland. A likely reason behind the absence of negative health consequences is that these migrants seem to have integrated well into post-war Finnish society.

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Analyse long-term health effects associated with forced migration in childhood.

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A unique event that forced 12 percent of Finnish population to relocate during WWII.

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Circumvent common methodological challenges of studying migrant populations.

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Register-based data to analyse health and mortality from main causes in 1988–2012.

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Absence of health malicious effect likely due to successful integration.

Trends in dual diagnosis of severe mental illness and substance use disorders, 1996-2010, Israel

OBJECTIVES

(1) To examine the trends in the incidence of dual diagnosis (DD) of severe mental illness and substance-related disorders among inpatients in Israel, and (2) the demographic and clinical correlates of DD patients.

METHOD

Using data from the National Psychiatric Case Register, we identified 56,774 inpatients aged 15-64 whose first psychiatric hospitalization occurred between 1996 and 2010. We compared the characteristics of inpatients having DD with drugs, alcohol or drug/alcohol abuse with those with mental disorder only.

RESULTS

Over the period, DD with drugs decreased from 8.2% in 1996 to 6% in 2010; DD with alcohol increased from 3% to 4% and DD with drugs/alcohol from 2% to 4%. DD with drugs was highest, whereas DD with alcohol was lowest for the youngest age- group in 1996 but increased to the same as other age-groups in 2006-2010. Male gender, a previous suicide attempt, compulsory hospitalizations and marital status were positive predictors for all DD. Immigrant status was a positive predictor of DD with alcohol, but the opposite for DD with drugs; being Jewish and psychotic diagnosis was a positive predictor of DD with drugs, but negative for DD with alcohol.

CONCLUSIONS

Over the study period, DD with drugs has decreased among young patients, although it is still higher than among older groups. However, DD with alcohol or drugs/alcohol has increased in the younger group. The clinical-demographic profile of DD patients was similar to that from the relevant literature, except for immigrant status that was negatively associated with DD with drugs.

Migration and common mental disorder: an improvement in mental health over time?

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.

Characteristics of immigrant suicide completers in a sample of suicide victims from Greece

BACKGROUND

Immigrants have higher rates of suicidal behaviour in comparison to the indigenous population.

AIMS

To describe the characteristics of foreign nationality suicide completers and search for differences between them and native Greeks. This is the first study focused on immigrant suicide victims in Greece.

METHODS

Data were collected for all recorded cases of completed suicide for the two-year period November 2007 to October 2009 at the Athens Department of Forensic Medicine, the largest, by far, of its kind in Greece covering approximately 35% of the country's population. The material was collected using the method of psychological autopsy as well as from the victims' forensic records.

RESULTS

Nearly 10% of Greece's 11 million population are of foreign nationality. Approximately half of them live in Athens and its suburbs, an area where 35% of Greece's population lives. In our sample, 15.8% of the suicide victims were of foreign nationality (53 cases): 41 men (77.4%) and 12 women (22.6%). Higher suicide rates were found for citizens of Kuwaiti (9.1%), Somali (6.7%) and Afghan (0.9%) nationality (immigrant communities with very few members); the lower suicide rates were for individuals of Egyptian (0.01%), Ukrainian (0.01%) and Albanian (0.006%) nationality (the Albanian immigrant community is the largest in Greece). In comparison to their Greek counterparts, immigrant victims were younger (mean age 38.7 vs 54.9 years, p < .001) more often unemployed (p = .007) and with a history of alcohol abuse (p < .001). The main suicide method used by immigrants was hanging (p < .001) while for Greeks it was jumping from a height.

CONCLUSIONS

Individuals who belong to small national communities seem to have the highest risk of dying by suicide. Immigrant suicide victims differ from the indigenous population in several parameters. Our data could help define the most vulnerable of them and apply more effective suicide prevention strategies.

Acculturation Expectations and Experiences as Predictors of Ethnic Migrants’ Psychological Well-Being

There is a need for a better acknowledgement of the pre- and postmigration factors that influence postmigration psychological adaptation of ethnic migrants. In the present study, first, we examined the effects of pre-acculturative stress, anticipated sociocultural difficulties, and anticipated discrimination on ethnic migrants’ ( N = 153) psychological well-being in the postmigration stage. These pre-migration factors were expected to influence postmigration acculturation experiences (i.e., perceived acculturative stress, sociocultural difficulties, and discrimination), which, in turn, were expected to be decisive for postmigration well-being. Second, we examined how the concordance between these premigration and postmigration factors affects postmigration well-being. According to the first set of results, (1) the effect of anticipated sociocultural difficulties on psychological adaptation is mediated by perceived sociocultural difficulties and acculturative stress in the postmigration stage, and (2) the effects of pre-acculturative stress and anticipated discrimination are present in terms of their impact on subsequent postmigration experiences (stress and discrimination, respectively), which are further associated with postmigration well-being. The second set of results, in turn, shows that ethnic migrants’ psychological adaptation is highest (1) when both anticipated and perceived sociocultural difficulties are low and correspond with each other (but not when they anticipated more sociocultural difficulties than they experienced after migration), (2) when they both anticipate and perceive low levels of ethnic discrimination, and (3) when their perceived acculturative stress after migration is lower than pre-acculturative stress. The implications of the results for premigration interventions are discussed.

Is acculturation associated with physical activity among female immigrants in Sweden?

BACKGROUND

Immigrant women in Sweden have lower levels of leisure time physical activity (LTPA) than Swedish-born women. The reasons are unclear, although acculturation has been suggested to play a role.

METHODS

We used a cross-sectional study design to investigate the association between LTPA and two indicators of acculturation: (i) language proficiency (ability to understand news reports on the radio and television) and (ii) age at the time of migration, and if there existed a modifying effect on these hypothesized associations. The study sample consisted of 1651 women, aged 18-65, living in Sweden and born in Finland, Chile or Iraq. A postal questionnaire (translated into the women's native language) was used to collect the variables. The International Physical Activity Questionnaire was used to assess LTPA. Data were collected in 2002-05 and analyzed in 2009-10. A partial-proportional odds model was used for the analysis.

RESULTS

Increased language proficiency was associated with increased LTPA [odds ratio (OR) = 2.31, 95% confidence interval (CI) = 1.57-3.41]. Country of birth modified the association. Furthermore, younger age at migration was associated with increased LTPA (OR = 1.44, 95% CI = 1.01-2.03).

CONCLUSIONS

Increased language proficiency has the potential to be an important health-promoting factor among immigrant women.

Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality

Background

There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration.

Methods

This study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately.

Results

Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results.

Conclusions

Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.

Vulnerability to stress in migratory contexts: a study with Eastern European immigrants residing in Portugal

The assessment of individual vulnerability to stress emerges as a predictive factor of a higher risk of developing stress-related disorders. In the last decade, the geography of immigration in Portugal experienced intense transformations in terms of recruitment and patterns of geographic settlement, with an increasing and exponential inflow of new and diversified migratory groups. The immigrant populations coming from Eastern European countries are a recent migratory flow, with linguistic, cultural and socio-demographic specificities which are very different from the general Portuguese population. This makes them a paradigmatic group in potential transcultural studies on mental health issues. The primary aim of the study was to describe the characteristics of vulnerability to stress and determine their impact on the mental health status of Russian-speaking immigrants residing in Portugal. The relationship between vulnerability to stress, sociodemographic variables, mental health status and social support were analyzed, using the SSQ6, GHQ28, 23QVS and a socio-demographic questionnaire. A comparative analysis was carried out, using a control group of 110 Portuguese subjects without previous migratory experiences, matched by sex, age group and academic qualifications. The eastern European immigrants reported high levels of vulnerability to stress assessed by the cut-off point of the 23QVS. Immigrants also reported higher percentage of vulnerability to stress and lower social support levels of social support versus the control group. Several factors inherent to the dynamics of the migratory process were related to the presence of vulnerability to stress. The findings suggest that vulnerability to stress is positively correlated with worse mental health outcomes and negatively correlated with the social support perceived as available--number of supporters and satisfaction with social support.

Psychological Adaptation of Adolescent Immigrants From the Former Soviet Union in Germany

Stress-and-coping frameworks predict increasing psychological adaptation of immigrants over time, but although previous studies found evidence for this assumption in adult samples, this temporal pattern was hardly found among adolescent immigrants. The authors argue that in adolescent immigrants an acculturation-related increase in psychological adaptation over time might be counterbalanced by an age-typical decrease in indicators of psychological adaptation. This longitudinal study, covering a 3-year period in mid-adolescence, compared change in depressed mood as an indicator of psychological adaptation in three matched samples of 101 newcomer adolescent immigrants, 101 more experienced adolescent immigrants, and 101 native adolescents. Results showed that native adolescents and experienced adolescent immigrants increased in depressed mood, as is typical for this age group, over the 3-year period. Newcomer adolescent immigrants, however, remained stable, reporting more depressed mood initially than the more experienced immigrants. Moreover, the extent of depressed mood reported by newcomer and more experienced adolescent immigrants converged over time. This pattern of results indicates that both age-typical development and acculturation need to be considered when drawing conclusions on change in psychological adaptation over time in immigrant populations.

Stress and depression in Latin American immigrants: the mediating role of religiosity

OBJECTIVE

Migrating implies a high level of stress that may destabilise immigrants' mental health. The sense of spiritual fulfilment (feelings of faith, religiosity, and transcendence beyond ordinary material life) can mitigate the stress and benefit mental health. The objective of the present study was to analyze the relationship between migratory stress, religiosity and depression symptoms, as well as the mediating role of religiosity between migratory stress and depression symptoms.

METHOD

Participants were 295 Latin American immigrants living in Barcelona (Spain), 186 of whom (63.1%) were women and 109 (36.9%) were men. They were recruited from a Spanish NGO by means of a consecutive-case method.

RESULTS

The results showed an inverse relationship between religiosity and depression symptoms, but only in women. Likewise, in women, the sense of spiritual fulfilment had mediating value in buffering the relationship between stress and depression symptoms. This mediating value of spiritual fulfilment was not observed in men. For both genders religiosity was inversely related with stress. In addition, it was observed that the sense of religiosity decreases as the time since immigration passes.

CONCLUSIONS

These results may be of importance in clinical practice for prevention and therapeutic intervention with Latin American immigrants. As sense of transcendence and social support from the religious community are intertwined, it is difficult to specifically attribute the observed benefit of religiosity to the former versus the later.

The impact of duration of residence on cause-specific mortality: a cohort study of migrants from the Former Soviet Union residing in Israel and Germany

A cohort study of migrants from the Former Soviet Union in Israel (N=528,848) and in Germany (N=34,393) was conducted. The impact of length of residence on cause-specific mortality was investigated using Poisson regression and differences between the migrant groups were assessed. In both migrant cohorts, all cause mortality in males but not in females significantly decreased with increasing duration of residence (RR=0.76, 95% CI: 0.73-0.79 for 9+years of residence compared to 0-3 years), specifically in Israel for infectious diseases, cancer and CVD. For male and female migrants in Israel there was a large reduction in external cause mortality. The cancer risk in male migrants declined from 1 to 0.76 (95% CI: 0.69-0.83) and in female migrants to 0.85 (95% CI: 0.78-0.93) after nine and more years of stay. Adjusting for several covariables, there were differences between migrants in the cause of death patterns in the two host countries, which may be associated with differences in their initial conditions or with effects of the destination country. The study highlights the need for migrant-specific prevention approaches.

Mood and anxiety disorders and the use of services and psychotropic medication in an immigrant population: findings from the Israel National Health Survey

OBJECTIVE

Using the Israel National Health Survey (INHS), we compared immigrants' 12-month prevalence of mental disorders and the use of services and psychotropic drugs with that of the general population.

METHODS

A representative sample of noninstitutionalized residents, aged 21 years and older, was drawn from the National Population Register. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders were assessed using a revised version of the Composite International Diagnostic Interview. Respondents were asked to report any health service and psychotropic drug use in the past 12 months.

RESULTS

During the 12 months preceding the INHS, immigrants and Israelis (that is, those born in Israel or those who emigrated to Israel before 1989) were equally likely to have a common mental disorder (OR 0.9; 95% CI 0.7 to 1.1) and to use health services (OR 0.9; 95% CI 0.7 to 1.2). However, among respondents who did not meet the DSM-IV criteria for a specific mental disorder, the immigrants reported markedly more use of psychotropic drugs than the Israelis, in particular more anxiolytics, mood stabilizers, and hypnotics.

CONCLUSION

The results suggest that the common mental disorders and mental health service use among the immigrants are no higher than that among their Israeli counterparts. The higher use of psychotropic drugs by immigrants may be an indirect indicator of a higher level of psychological distress symptoms, such as anxiety, depression, and sleep disorders.

Mental health implications of migration: a review of mental health community studies on Russian-speaking immigrants in Israel

INTRODUCTION

Since late 1980s, 1,001,726 immigrants arrived in Israel from the former Soviet Union (FSU). A review of community studies on the mental health of these immigrants is presented.

METHOD

Israeli studies from the past two decades were reviewed. Presented are findings on the prevalence of psychological distress and psychiatric disorders as well as on a number of risk factors among FSU immigrants.

RESULTS

Higher psychological distress and psychiatric morbidity were consistently found among FSU immigrants compared to the Israel-born. Social support was identified as a major stress-mitigating factor in migration. Most studies reveal the persistence of psychological distress among FSU immigrants during the first 5 years following migration, with a risk period around the second and third years following migration.

DISCUSSION

Findings from Israel corroborate some findings on immigrants in other countries but as they are limited to a single immigrant population, replication of these studies is necessary.

Psychological distress and its demographic associations in an immigrant population: findings from the Israeli National Health Survey

OBJECTIVE

This study compared psychological distress and its sociodemographic correlates in immigrant and veteran Israeli populations using data from the Israel National Mental Health Survey, the first nationwide study designed to estimate the prevalence rates of psychological distress and mental disorders in the Israeli adult population, which was carried out in 2003-2004, in conjunction with the World Mental Health survey initiative.

METHOD

Personal interviews were held with 3906 veteran Israelis, 845 immigrants from the former Soviet Union (FSU) and 107 immigrants from other countries (all the immigrants immigrated after 1989). Psychological distress was measured on the General Health Questionnaire-12.

RESULTS

Psychological distress among FSU immigrants was significantly higher than among veteran Israelis and immigrants from elsewhere. FSU immigrants were almost twice as likely to report severe psychological distress. Factors associated with psychological distress were female gender, age above 50, being divorced/widowed, being secular, having higher education and being either unemployed or 'not in workforce'.

CONCLUSION

The results support the acculturation stress hypothesis as an explanation for psychological distress in immigrants only in immigrants from the FSU, indicating that policymakers should plan services and prevention programmes differentially for different immigrant populations.

The Process of Immigrant Adjustment

This study examines the role played by length of residence in determining the psychological adjustment of 382 new immigrants from the former Soviet Union during their first 2 years in Israel. Psychological adjustment was evaluated using longitudinal ( n = 133) and cross-sectional ( n = 382) designs. The findings partially support the U-curve 3-stage social adjustment model (Lysgaard, 1955). The first stage, occurring from the first days up to 5 months in the new country, is the deterioration stage. The second stage, occurring between 5 and 11 months, is the low well-being stage. The third stage, occurring after more than 11 months, is the recovery stage. Significant differences in psychological adjustment exist between the first and second stages.

[Diagnosis of depression in Sub-Saharan immigrants]

OBJECTIVE

The migratory process, its social-demographic characteristics, and the lack of integration into the social and health networks of Sub-Saharan immigrants could favour an increase in mental health-related pathology. The objective is to find the prevalence of depression among this population and its risk factors.

DESIGN

Cross-sectional, descriptive survey.

SETTING

Community of Madrid, Spain.

PARTICIPANTS

Sub-Saharan immigrants over 18 years old who attended 2 "Health Care Programmes for immigrants in the Community of Madrid" between August 2003 and February 2004.

MEASUREMENTS

Semi-structured interviews (DSM-IV criteria) conducted by trained staff and the Beck Depression Inventory were used to diagnose depression.

RESULTS

Of 606 Sub-Saharan immigrants, 55.45% were men. Average age was 27 +/- 6.61. Depression diagnosis was 5.4% (95% CI, 3.78-7.56). There was greater risk of depression among those immigrants who had lived in Spain for over 2 years (13.1%), among those who had children (10.7%), and among those with certain health problems, such as muscle and skeletal trouble (18.9%), gastro-intestinal problems (18.8%), neurology problems (17.4%), dermatology problems (20.5%) and fatigue (70.6%). Six percent of immigrants with depression took pharmacological treatment.

CONCLUSIONS

The prevalence of depression among Sub-Saharan immigrants is similar to that of the native population. There is an increase as they stay longer in our country, probably due to their social and economic situation, which over time can act as a chronic stress factor. The other main fact is the lack of treatment of immigrants diagnosed with depression.

Self-reported anxiety, sleeping problems and pain among Turkish-born immigrants in Sweden

OBJECTIVES

To study whether symptoms of self-reported anxiety, sleeping problems and severe pain are more common among Turkish-born immigrants in Sweden than among Swedes, and whether age and socio-economic status can explain this hypothesised difference.

DESIGN

Two random samples were studied -- the Swedish National Board of Health and Welfare Immigrant Survey, and the Swedish Annual Level-of-Living Survey, both from 1996. A total of 526 Turkish-born immigrants in Sweden were compared with 2,854 Swedish controls, all aged between 27 and 60 years. Data were analysed by sex, in an age-adjusted model; and a full model also included age, education, marital status, employment and country of origin (logistic regression).

RESULTS

In the full model, odds ratios were 2.12 (1.43-3.15) for anxiety, 2.60 (1.82-3.72) for sleeping problems, and 2.14 (1.50-3.05) for severe pain among Turkish-born men, and 2.44 (1.69-3.53) for anxiety, 3.01 (2.09-4.33) for sleeping problems, and 2.59 (1.80-3.71) for severe pain among Turkish-born women, using the Swedish controls as references.

CONCLUSIONS

Being a Turkish-born immigrant in Sweden significantly increases the risks for self-reported anxiety, sleeping problems and severe pain, even after adjusting for age and socio-economic status (education, marital status and employment).

Use of health care services for psychological distress by immigrants in an urban multicultural milieu

OBJECTIVE

Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system.

METHODS

A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events.

RESULTS

Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help.

CONCLUSION

Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.

Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study

BACKGROUND

Enlargement of the European Union has caused worries about the possibility of increased migration from its new members, the former Soviet countries, and consequently increased demands on the health care systems of the host countries. This study investigated whether or not earlier immigrants from the former Soviet Bloc have poorer self-reported mental health, measured as self-reported psychiatric illness and psychosomatic complaints, than the host population in Sweden. It also examined the particular factors which might determine the self-reported mental health of these immigrants.

METHODS

The cross-sectional national sample included 25-84-year-old Swedish-born persons (n = 35,459) and immigrants from Poland (n = 161), other East European countries (n = 164), and the former Soviet Union (n = 60) who arrived in Sweden after 1944 and were interviewed during 1994-2001. Unconditional multivariate logistic regression was used in the analyses.

RESULTS

The findings indicated that the country of birth had a profound influence on self-reported mental health. Polish and other East European immigrants in general had a twofold higher odds ratio of reporting psychiatric illness and psychosomatic complaints, which fact could not be explained by adjustments for the demographic and socioeconomic variables. However, immigrants from the former Soviet Union had odds similar to those of the Swedish-born reference group. Adjustments for migration-related variables (language spoken at home and years in Sweden) changed the association between the country of birth and the outcomes only to a limited extent.

CONCLUSION

Since poor mental health may hinder acculturation, the mental health of immigrants from Poland and other East European countries should be acknowledged, particularly with the expansion of the European Union and inclusion of nine former Soviet Bloc countries by 2007.

The socio-cultural context of family caregiving and psychological distress: a comparison of immigrant and non-immigrant caregivers in Israel

The study aimed to examine the differences in caregiving context and psychological distress outcome between non-immigrant and immigrant caregivers; to investigate these differences by relationship type; and to examine the factors related to psychological distress. Spouse or adult child caregivers (213 non-immigrants and 206 immigrants from the Former Soviet Union) were interviewed. Based on stress and appraisal conceptual framework, caregiving stressors, primary appraisal, psychosocial resources, secondary appraisal and psychological distress were measured. A series of two-way MANOVA, followed by ANOVA, was used to examine the differences by immigration status, by relationship type and their interaction. Hierarchical multiple linear regression was conducted to examine variables associated with psychological distress. Negligible differences in caregiving stressors, but significant differences in caregiving primary and secondary appraisal, psychosocial resources and psychological distress were found by immigration status and by relationship type, and significant interactions only in caregiving primary appraisal. The regression models showed that the differences in psychological distress by immigration status and by relationship type were fully explained by caregiving stressors (care recipient's problem behavior), psychosocial resources (mastery) and caregiving secondary appraisal (role overload, captivity, economic difficulties). The results suggest that socio-cultural background and role relationship shape caregiving appraisal and psychosocial resources, and that these factors explain psychological distress outcomes.

Self-Reported Integration as a Proxy for Acculturation

BACKGROUND

It is essential to account for acculturation in any research conducted in multicultural populations. Both unidimensional and bidimensional approaches are used to measure the extent of acculturation; however, neither one of them is optimal.

OBJECTIVE

To explore the immigrants' rating of the extent of their acculturation (self-reported integration) in contrast to an external (researchers') measurement.

METHODS

Fifteen in-depth interviews with strategically sampled Russian-speaking men and women aged 25-70 years, with varying marital and employment status and living permanently in Stockholm, Sweden, were analyzed using a content analysis technique. The results were validated by means of a series of additional mini-interviews by telephone.

RESULTS

The immigrants' self-reported integration corresponded with the researchers' bidimensional measurement of the extent of acculturation of these immigrants. Self-reported integration accounted for the mastering of the formal criteria of integration, resolving of grief concerning the homeland, and fulfilling the internal criteria of integration.

DISCUSSION

Self-reported integration may be used as a proxy for acculturation but its application should be tested primarily in other settings and in a quantitative analysis.

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM

Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that.

METHODS

This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts.

RESULTS

Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden.

CONCLUSIONS

Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.

Psychological and mental illness among elder immigrants from the former Soviet Union

The study examined the cultural context of psychological illness among elder immigrants from the former Soviet Union (FSU). Kleinman's (1980) explanatory model of illness and Leininger's theory of culture care (1997) provided the conceptual framework for the study. Participant Observations were conducted in an Adult Day Care Center and Senior Housing. Twenty-three key informants and 10 general informants participated. The social and historical context of the FSU influenced the meaning, attitudes, expressions, and coping strategies toward psychological and mental illness. Cultural stigma influenced the attribution of cause, somatic expression of symptoms, and attitudes toward seeking professional help. Psychological illness was unrecognized, whereas mental illness was viewed as lack of dusha (inner strength and moral character). Group differences were evident with ethnicity as a significant influence in symptom recognition, expression, and attitude toward seeking professional help.

Psychological distress among recent Russian immigrants in the United States

BACKGROUND

The purpose of this study was to examine the psychological status of Russian immigrants who have recently come to the United States.

AIMS

The project included creation of a Russian version of the Hopkins Symptom Checklist-25 (HSCL-25) in order to identify anxiety and depression in members of the Russian-speaking immigrant population.

METHODS

Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability and internal consistency. Seventeen Russian-speaking patients at a Russian psychiatric clinic were recruited for the study and were compared with a sample of 42 Russian-speaking members of the community.

RESULTS

The instrument showed internal consistency when evaluated with coefficient alpha. Clinic patients had significantly higher anxiety and depression symptom scores than community subjects. Russian immigrants' scores on the anxiety and depression scales were less than comparative data for the United States and notably less than similar measures for Russian immigrants to Israel.

CONCLUSIONS

Recent Russian immigrants to the United States appear to have low prevalences of anxiety and depression.

Caregiving stressors and psychological distress among veteran resident and immigrant family caregivers in Israel

The study compared caregiving stressors and psychological distress between Israeli veteran resident and immigrant family caregivers. It examined whether psychosocial variables (appraisal of caregiving, mastery, social support and coping) mediate the differences in psychological distress between these two groups. A total of 213 veteran resident and 206 immigrant (from the former Soviet Union) caregivers of chronically ill elderly were recruited from health services. The comparisons between the two groups were examined separately for spouse and adult child caregivers. The immigrant spouse and adult child caregivers reported significantly higher levels of caregiving stressors than veteran resident caregivers, but psychological distress was significantly higher only among the immigrant adult child caregivers. In multivariate analyses, the difference in psychological distress disappeared when caregiving stressors and mediating psychosocial variables were included in the regression models. Different caregiving stressors and psychosocial variables were associated with psychological distress among the spouses and among the adult child caregivers. The findings suggest that the caregiving stressors and psychosocial variables explain differences in psychological health outcomes between veteran resident and immigrant caregivers. Social work interventions should address these factors among caregivers, take into account the relationship to the care recipient, be culturally adapted to the immigrant caregivers, and target immigrant adult child caregivers in particular.

Acculturation, social alienation, and depressed mood in midlife women from the former Soviet Union

Level of acculturation has been linked to depressed mood in studies across culturally diverse immigrant groups. The purpose of this study was to determine the effects of acculturation, social alienation, personal and family stress, and demographic characteristics on depressed mood in midlife immigrant women from the former Soviet Union. Structural equation modeling showed that higher acculturation scores, measured by English language and American behavior, were indirectly related to lower scores for depressed mood. Higher acculturation levels promoted mental health indirectly by reducing social alienation and, subsequently, lowering family and personal stress, both of which had direct relationships to symptoms of depression. These findings support the ecological framework that guided our research and point to the importance of focusing on contextual factors in developing interventions for new immigrants.

Implications of Ethnic Group Origin for Israeli Women’s Mental Health

Israel is an immigrant society comprised of diverse ethnic groups differentiated by variables such as emigration history, health status, educational level, and economic status. The major question addressed in this study is whether differences in women's mental health status are related to ethnic group origin, per se, or rather can be explained by the associated social-demographic strata. The impact of ethnic group origin, social support, health status, education, and economic difficulties was assessed on a set of mental health outcomes. The analysis was carried out in a random sample of 522 women residing in the Negev region of Israel-a culturally diverse area. The findings indicate that social support, economic status, health status, and ethnic group origin all contribute to shaping women's mental health status.

Demographic characteristics, menopausal status, and depression in midlife immigrant women

The purpose of this cross-sectional analysis is to examine symptoms of depressed mood in relation to age, menopausal status, and length of residence in the United States in midlife women who are recent immigrants from the former Soviet Union. Data for this analysis are from a longitudinal study of the impact of acculturation on postimmigration health status and psychological well-being. The mean score for the Center for Epidemiological Studies-Depression (CES-D) scale was 23.56, with 77.3% of the women obtaining a score greater than the usual screening cutoff score for referral. Women taking antidepressant medications had a mean score of 30.52. CES-D scores varied significantly by age group. The lowest CES-D scores were reported by women aged 40-50, and women aged 55-60 had significantly higher scores than younger women and those over 65 years old. Total CES-D scores did not vary significantly by length of residence in United States or use of hormone therapy. Regression analysis indicated that even when use of antidepressant medication was held constant, age and residence in the United States were significant independent contributors to CES-D score: women who were older, had lived fewer years in the United States, and those who took antidepressants had higher CES-D scores. Cultural and immigration-related explanations for high scores on the depression scale are suggested.

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.

Age differences in stress process of recent immigrants

In the present study we sought to examine whether age affects the relationship between stress/social support and psychological distress in community residents in Israel who recently emigrated from the former Soviet Union (FSU). A cross-sectional and partly longitudinal design was used to compare emotional distress, stressor, and social support measures in three age groups (18 to 29, 30 to 59, and 60 to 86 years) of adult immigrants (N = 563). Age-related differences in the parameters of interest and their changes over time were examined with analysis of variance (ANOVA), t tests, and multiple regression analyses. We found that older immigrants reported higher levels of health-related stressors, but did not differ on total social support from younger immigrants. Specific predictors of elevated distress differed by age. For the youngest cohort, these included climate changes and anxiety for the future. For the middle-aged immigrants, these included female gender, lower education, unemployment, and longer time in Israel. For the oldest immigrants, predictors of distress included being divorced, separated, or widowed, and perceiving long-time residents of Israel as hostile. Only the middle-aged cohort showed a significant decline in levels of perceived stressors and distress during a 1-year follow-up. Thus, age differences in the stress process of recent immigrants are associated with age-specific perceived adjustment difficulties and demographic characteristics.

Quality of life and coping with schizophrenia symptoms

The question addressed in this paper is whether different coping styles mediate the relationship between psychopathology and related distress and the quality of life (QOL) among patients with schizophrenia. In a cross-sectional design, 161 schizophrenia inpatients were comprehensively evaluated with standardized measures of QOL, psychopathology, psychological distress and coping styles. Correlations and regression analyses were performed to examine the relationship among parameters and to estimate the mediating effect of coping styles on QOL in the framework of a distress/protection model. Life quality correlated positively with task- and avoidance-oriented coping styles and slightly negatively with emotion-oriented coping. Emotion-oriented coping mediated the relationship between the severity of activation, anxiety/depression symptoms, and QOL, while avoidance-oriented (distraction) coping was mediated between QOL and paranoid symptoms. Coping styles accounted for 25% of the variance in subjective QOL scores compared with 15% for psychological distress, and only 3% for clinical variables. The ability to cope with symptoms and associated distress substantially contributes to QOL appraisal in schizophrenia. Thus, different coping strategies may reduce the negative influence of specific symptoms and related distress on the subjective QOL of schizophrenia patients.