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Herold R, Morawa E, Schug C, Geiser F, Beschoner P, Jerg-Bretzke L, Albus C, Weidner K, Hiebel N, Borho A, Erim Y. The mental health of first- and second-generation migrant vs. native healthcare workers during the COVID-19 pandemic: The VOICE survey of 7,187 employees in the German healthcare sector. Transcult Psychiatry 2024:13634615241253153. [PMID: 39053896 DOI: 10.1177/13634615241253153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all βs ≤ |.030|, anxiety: all βs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.
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Affiliation(s)
- Regina Herold
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Caterina Schug
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Petra Beschoner
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Lucia Jerg-Bretzke
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Cologne, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Nina Hiebel
- Department of Psychosomatic Medicine and Psychotherapy, University Clinic of Bonn, Bonn, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Vonneilich N, Becher H, Bohn B, Brandes B, Castell S, Deckert A, Dragano N, Franzke CW, Führer A, Gastell S, Greiser H, Keil T, Klett-Tammen C, Koch-Gallenkamp L, Krist L, Leitzmann M, Meinke-Franze C, Mikolajczyk R, Moreno Velasquez I, Obi N, Peters A, Pischon T, Reuter M, Schikowski T, Schmidt B, Schulze M, Sergeev D, Stang A, Völzke H, Wiessner C, Zeeb H, Lüdecke D, von dem Knesebeck O. Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data. Int J Public Health 2023; 68:1606097. [PMID: 37533684 PMCID: PMC10391163 DOI: 10.3389/ijph.2023.1606097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
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Affiliation(s)
- Nico Vonneilich
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Barbara Bohn
- NAKO e.V., Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, University of Freiburg Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
| | - Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Deptartment of Epidemiology and Preventive Medicine, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Ilais Moreno Velasquez
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Neuherberg, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
- Berlin Institute of Health (BIH), Charité University Medicine Berlin, Berlin, Germany
| | - Marvin Reuter
- Subject Sociology, University of Bamberg, Bamberg, Bavaria, Germany
| | - Tamara Schikowski
- Leibniz-Institut für Umweltmedizinische Forschung (IUF), Dusseldorf, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Matthias Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
- Institute of Nutrition Science, Faculty of Mathematics and Natural Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Dmitry Sergeev
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Sempértegui GA, Baliatsas C, Knipscheer JW, Bekker MHJ. Depression among Turkish and Moroccan immigrant populations in Northwestern Europe: a systematic review of prevalence and correlates. BMC Psychiatry 2023; 23:402. [PMID: 37277719 DOI: 10.1186/s12888-023-04819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND This systematic review aimed to synthesize the prevalence and correlates of depressive disorders and symptoms of Turkish and Moroccan immigrant populations in Northwestern Europe, formulating evidence-informed recommendations for clinical practice. METHODS We conducted a systematic search in PsycINFO, MEDLINE, Science Direct, Web of Knowledge, and Cochrane databases for records up to March 2021. Peer-reviewed studies on adult populations that included instruments assessing prevalence and/or correlates of depression in Turkish and Moroccan immigrant populations met inclusion criteria and were assessed in terms of methodological quality. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) guideline. RESULTS We identified 51 relevant studies of observational design. Prevalence of depression was consistently higher among people who had an immigrant background, compared to those who did not. This difference seemed to be more pronounced for Turkish immigrants (especially older adults, women, and outpatients with psychosomatic complaints). Ethnicity and ethnic discrimination were identified as salient, positive, independent correlates of depressive psychopathology. Acculturation strategy (high maintenance) was related to higher depressive psychopathology in Turkish groups, while religiousness appeared protective in Moroccan groups. Current research gaps concern psychological correlates, second- and third-generation populations, and sexual and gender minorities. CONCLUSION Compared to native-born populations, Turkish immigrants consistently showed the highest prevalence of depressive disorder, while Moroccan immigrants showed similar to rather moderately elevated rates. Ethnic discrimination and acculturation were more often related to depressive symptomatology than socio-demographic correlates. Ethnicity seems to be a salient, independent correlate of depression among Turkish and Moroccan immigrant populations in Northwestern Europe.
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Affiliation(s)
- Gabriela A Sempértegui
- Tranzo, Tilburg University, Tilburg, The Netherlands
- GGz Breburg, Tilburg, The Netherlands
| | - Christos Baliatsas
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands.
| | - Jeroen W Knipscheer
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marrie H J Bekker
- Tranzo, Tilburg University, Tilburg, The Netherlands
- Department of Clinical, Neuro- and Developmental Psychology, VU University, Amsterdam, The Netherlands
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Xu L, Tang F, Chen Y, Dong X. Acculturation and depressive symptoms among older Chinese immigrants in the United States: the roles of positive and negative social interactions. Aging Ment Health 2023; 27:604-611. [PMID: 35144508 DOI: 10.1080/13607863.2022.2032592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: Immigration is a stressful experience. Social interactions with family members and friends play an important role in the health and well-being of immigrant older adults. This study examined the association between different domains of acculturation and depressive symptoms among older Chinese immigrants in the United States and investigated the roles of positive and negative interactions with family and friends in such associations.Method: We used data from the Population Study of Chinese Elderly (PINE), a population-based survey of community-dwelling Chinese older adults in the Greater Chicago area (N = 3,158). Depressive symptoms were measured by the PHQ-9. Acculturation, positive and negative social interactions with partner/family/friends were all measured by standard scales. Binary logistic regression models were used to examine the relationship between acculturation and the probability of having depressive symptoms.Results: Results showed that only social acculturation was correlated with a higher likelihood of having depressive symptoms after controlling for relevant sociodemographic variables. Results also demonstrated that 'high positive & high negative', as well as 'high positive & low negative' social interactions had significant moderating effects on the association between media acculturation and depressive symptoms.Conclusion: The study findings suggest that although older Chinese immigrants in the United States with high levels of social acculturation are vulnerable to depressive symptoms, high positive social interactions with partner/family/friends buffer the relationship between media acculturation and depressive symptoms. Community services can help with social acculturation and more positive interactions from partner/family/friends to alleviate depressive symptoms among older Chinese immigrants.
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Affiliation(s)
- Ling Xu
- School of Social Work, The University of Texas at Arlington, Arlington, TX, USA
| | - Fengyan Tang
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yiwei Chen
- College of Arts and Science, Bowling Green State University, Bowling Green, OH, USA
| | - Xinqi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers Unvieristy, New Brunswick, NJ, USA
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Entringer S, Scholaske L, Kurt M, Duman EA, Adam EK, Razum O, Spallek J. Diurnal cortisol variation during pregnancy in Turkish origin and non-migrant women in a German birth cohort study. J Psychosom Res 2022; 162:111020. [PMID: 36081181 DOI: 10.1016/j.jpsychores.2022.111020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/25/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immigrants from Turkey experience health disadvantages relative to non-immigrant populations in Germany that are manifest from the earliest stages of the lifespan onwards and are perpetuated across generations. Chronic stress and perturbations of stress-responsive physiological systems, including the hypothalamus-pituitary-adrenal (HPA)-axis, are believed to in part mediate this relationship. Cortisol plays an important role in the association between maternal stress during pregnancy and many pregnancy-, birth- and offspring-related outcomes. We therefore examined whether maternal migrant background is associated with diurnal cortisol variation during pregnancy. METHODS 109 pregnant women (incl. n = 32 Turkish origin women) that participated in a multi-site prospective cohort study in Germany collected saliva samples across the day on two consecutive days around 24 and 32 weeks gestation. Hierarchical linear models were applied to quantify associations between migrant background and diurnal cortisol variation across pregnancy. RESULTS Women of Turkish origin exhibited a significantly lower cortisol awakening response (CAR) and a flatter diurnal cortisol slope (DCS) compared to non-migrant women after adjusting for household income. These relationships between migrant status and diurnal cortisol variation were mainly driven by 2nd generation migrants. DISCUSSION A potential HPA axis dysregulation of Turkish-origin pregnant women may contribute to the intergenerational transmission of health disadvantages in this group.
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Affiliation(s)
- Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, 10117 Berlin, Germany; Department of Pediatrics and Development, Health and Disease Research Program, University of California, Irvine, USA.
| | - Laura Scholaske
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, 10117 Berlin, Germany; German Center for Integration and Migration Research (DeZIM), Berlin, Germany.
| | - Medlin Kurt
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Elif Aysimi Duman
- Department of Psychology, Bogazici University, Istanbul, Turkey; Center for Life Sciences and Technologies, Bogazici University, Istanbul, Turkey.
| | - Emma K Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, USA.
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany; Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany.
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
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Dingoyan D, Metzner F, Kongur A, Arslan Ö, Pust GEA, Weierstall-Pust R. The Impact of Perceived Discrimination on Cultural Identification, Psychological Stress, Emotion Regulation and Aggressive Tendencies in Individuals With Turkish Migration Background in Germany. FRONTIERS IN SOCIOLOGY 2022; 7:705027. [PMID: 35782709 PMCID: PMC9244781 DOI: 10.3389/fsoc.2022.705027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The following study considers correlates of the identification with the origin and host culture of German individuals with a Turkish migrant background. It examines how these two factors mediate the relationship between perceived discrimination, emotion regulation or psychological stress, and aggressive tendencies as the major dependent variable. For this purpose, the data of 229 people with Turkish migration background living in Germany was collected through an online survey. Findings depict that the identification with the Turkish (origin) and German (host) culture mediate the relationship between perceived discrimination and emotion regulation. The relationship between perceived discrimination and psychological stress is mediated by the identification with the German culture. The analysis shows that perceived discrimination is associated with a reduced identification with the German culture and with a high identification with the Turkish culture. Emotion regulation abilities are negatively related to perceived discrimination and identification with the Turkish culture. In contrary, the psychological stress level is positively related to perceived discrimination. The preparedness for aggressive behavior is also associated positively by psychological stress and negatively by emotion regulation abilities. The results are discussed against the background of the specific migration history and living conditions of Turkish immigrants in Germany.
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Affiliation(s)
- Demet Dingoyan
- Institute of Medical Sociology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Franka Metzner
- Institute of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Educational Science With a Focus on Special Education (“Emotional and Social Development”), University of Siegen, Siegen, Germany
| | - Akin Kongur
- Department of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | - Örsan Arslan
- Department of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
| | | | - Roland Weierstall-Pust
- Department of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany
- Oberberg Clinics Group, Berlin, Germany
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Kobel F, Erim Y, Morawa E. Predictors for successful psychotherapy: Does migration status matter? PLoS One 2021; 16:e0257387. [PMID: 34529716 PMCID: PMC8445403 DOI: 10.1371/journal.pone.0257387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background We investigated, if migration status, and additional sociodemographic and clinical factors, are associated with somatization and depressiveness at admission and with remission after inpatient psychotherapy. Methods Multiple linear and binary logistic regression analyses were used to identify predictors for severity of somatoform and depressive symptoms at admission of inpatient psychotherapy (T0), and for remission after inpatient psychotherapy (T1). We tested the association between symptoms concerning somatization (PHQ-15: Patient-Health-Questionnaire Somatization Module) and depression (PHQ-9: Patient-Health-Questionnaire Depression Module) and several sociodemographic and clinical factors in 263 patients at admission. For remission after treatment, we additionally included severity of symptoms at admission, number of diagnoses and duration of treatment in the regression models. Remission after treatment was defined as response plus a post value of less than 10 points in the respective questionnaire. Clinical relevance was interpreted using effect sizes (regression coefficients, Odds Ratio (OR)) and Confidence Intervals (CI). Findings Significant and clinically relevant predictors for high symptom severity at T0 were lower education (β = -0.13, p = 0.04), pretreatment(s) (β = 0.205, p = 0.002) and migration status (β = 0.139, p = 0.023) for somatization, and potential clinically relevant predictors (|β|>0.1) for depression were living alone (β = -0.116, p = 0.083), pretreatment(s) (β = 0.118, p = 0.071) and migration status (β = 0.113, p = 0.069). At T1 patients with pretreatment(s) (OR = 0.284 [95% CI: 0.144, 0.560], p<0.001) and multiple diagnoses (OR = 0.678 [95% CI: 0.472, 0.973], p = 0.035) were significantly and clinically relevant less likely to show a remission of depressive symptoms. In addition, a potentially clinically meaningful effect of migration status on remission of depressive symptoms (OR = 0.562 [95% CI: 0.264, 1.198], p = 0.136) cannot be ruled out. For somatoform symptoms pretreatment(s) (OR = 0.403, [95% CI: 0.156, 1.041], p = 0.061) and education (OR = 1.603, [95% CI: 0.670, 3.839], p = 0.289) may be regarded as clinically relevant predictors for remission. Conclusion The results of our study suggest that migration status has a clinically relevant influence on severity of somatoform and depressive symptoms at admission. Clinical relevance of migration status can also be assumed regarding the remission of depression. Migration status and further factors affecting the effectiveness of the treatment should be analyzed in future research among larger samples with sufficient power to replicate these findings.
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Affiliation(s)
- Friederike Kobel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- * E-mail:
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Urban Nature and Public Health: How Nature Exposure and Sociocultural Background Relate to Depression Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189689. [PMID: 34574611 PMCID: PMC8472783 DOI: 10.3390/ijerph18189689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/20/2022]
Abstract
As the world’s population becomes more urbanized, there is an associated decrease in nature exposure and a rise in noncommunicable diseases, including depression. Previous cross-sectional studies examining urban nature exposure and depression have reported favorable associations. However, many of these studies rely primarily on nature exposure metrics that measure the intensity of nature exposure, while other dimensions of urban nature exposure remain understudied. Therefore, in a cross-sectional, questionnaire-based case study targeting a general urban population (n = 282), we examined the relationship between two less commonly studied urban nature exposure variables (i.e., gardening behavior and greenspace visit frequency) and depression risk while also considering sociocultural background (multivariate logistic regression model). Results indicated that being a gardener was significantly associated with a reduced odds of being at risk of depression and that having a family migration history, but not a self-migration history, was associated with increased odds of being at risk of depression. In the examination of neighborhood socialization frequency and depression risk, we did not determine any significant association. The results of this study, therefore, highlight the importance of considering both people’s sociocultural backgrounds and urban nature exposure in more detail to help plan for and support healthier cities in the future.
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Spallek J, Scholaske L, Duman EA, Razum O, Entringer S. Association of maternal migrant background with inflammation during pregnancy - Results of a birth cohort study in Germany. Brain Behav Immun 2021; 96:271-278. [PMID: 34146669 PMCID: PMC8316562 DOI: 10.1016/j.bbi.2021.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Health disparities in children of immigrants are prevalent from birth and are hypothesized to - in part - emerge as a biological consequence of migration's unfavorable social and psychological sequelae. The aim of this study was to examine whether maternal migrant background is associated with inflammation during pregnancy - a key pathway by which maternal states and conditions during pregnancy may influence fetal development and subsequent pregnancy, birth, and child developmental and health outcomes. MATERIAL AND METHODS Data was available from 126 pregnant women who participated in a population based multi-site prospective birth cohort study in Bielefeld and Berlin, Germany. The study included two study visits in mid- and late pregnancy. At each visit, a composite maternal pro-inflammatory score was derived from circulating levels of plasma inflammatory markers (IL-6, CRP). Migrant background was defined by country of origin of participants and their parents' (Turkey or other) and generation status (1st or 2nd generation). We applied hierarchical linear models (HLM) in order to quantify the relationship between different migrant background variables and inflammation during pregnancy after adjustment for potential confounders (including socioeconomic status). RESULTS Migrant background was significantly associated with inflammation during pregnancy. When compared to women without migrant background, levels of inflammation were increased in 1) pregnant women with migrant background in general (B = 0.35, SE = 0.12, p < .01); 2) 1st (B = 0.28, SE = 0.15, p < .10) and 2nd generation (B = 0.40, SE = 0.15, p < .01); 3) women with a Turkish migrant background (B = 0.28, SE = 0.14, p < .10) and women with another migrant background (B = 0.42, SE = 0.15, p < .01); and 4) 2nd generation Turkish origin women (B = 0.38, SE = 0.20, p < .10), 1st generation women with other migrant background (B = 0.44, SE = 0.26, p < .10), and 2nd generation women with other migrant background (B = 0.43, SE = 0.17, p < .05). DISCUSSION Our findings support a role for maternal inflammation as a pathway of intergenerational transmission of migration-related health inequalities, suggest that the effect seems to persist in 2nd generation immigrants, and highlight the need for future research and targeted interventions in this context.
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Affiliation(s)
- Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
| | - Laura Scholaske
- German Center for Integration and Migration Research (DeZIM), Berlin, Germany
| | - Elif Aysimi Duman
- Department of Psychology, Bogazici University, Istanbul, Turkey,,Center for Life Sciences and Technologies, Bogazici University, Istanbul, Turkey
| | - Oliver Razum
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sonja Entringer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, 10117 Berlin, Germany;,Department of Pediatrics, University of California, Irvine, California 92617, USA.,Development, Health and Disease Research Program University of California, Irvine, California 92617, USA
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10
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Weber J, Angerer P, Brenner L, Brezinski J, Chrysanthou S, Erim Y, Feißt M, Hansmann M, Hondong S, Kessemeier FM, Kilian R, Klose C, Köllner V, Kohl F, Krisam R, Kröger C, Sander A, Schröder UB, Stegmann R, Wegewitz U, Gündel H, Rothermund E, Herrmann K. Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project). BMC Public Health 2021; 21:1187. [PMID: 34158017 PMCID: PMC8218449 DOI: 10.1186/s12889-021-11195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. METHODS This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. DISCUSSION Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. TRIAL REGISTRATION The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049 .
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Affiliation(s)
- Jeannette Weber
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lorena Brenner
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Jolanda Brezinski
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sophia Chrysanthou
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Marieke Hansmann
- Institute of Psychology, University of Hildesheim Foundation, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Sinja Hondong
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Franziska Maria Kessemeier
- Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Reinhold Kilian
- Department Psychiatry II, Section of Health Economics and Psychiatric Services Research, Ulm University, Lindenallee 2, 89312, Günzburg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Volker Köllner
- Research Group Psychosomatic Rehabilitation, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Fiona Kohl
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christoph Kröger
- Institute of Psychology, University of Hildesheim Foundation, Universitätsplatz 1, 31141, Hildesheim, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Ute Beate Schröder
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Ralf Stegmann
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Uta Wegewitz
- Federal Institute for Occupational Safety and Health (BAuA) Division 3 Work and Health Unit 3.5 Evidence-based Occupational Health, Workplace Health Management, Nöldnerstr, 40-42 10317, Berlin, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Kristin Herrmann
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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11
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Krist L, Dornquast C, Reinhold T, Becher H, Jöckel KH, Schmidt B, Schramm S, Icke K, Danquah I, Willich SN, Keil T, Brand T. Association of Acculturation Status with Longitudinal Changes in Health-Related Quality of Life-Results from a Cohort Study of Adults with Turkish Origin in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062827. [PMID: 33802126 PMCID: PMC7999343 DOI: 10.3390/ijerph18062827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
Health-related quality of life (HRQL) among migrant populations can be associated with acculturation (i.e., the process of adopting, acquiring and adjusting to a new cultural environment). Since there is a lack of longitudinal studies, we aimed to describe HRQL changes among adults of Turkish descent living in Berlin and Essen, Germany, and their association with acculturation. Participants of a population-based study were recruited in 2012–2013 and reinvited six years later to complete a questionnaire. Acculturation was assessed at baseline using the Frankfurt acculturation scale (integration, assimilation, separation and marginalization). HRQL was assessed at baseline (SF-8) and at follow-up (SF-12) resulting in a physical (PCS) and mental (MCS) sum score. Associations with acculturation and HRQL were analyzed with linear regression models using a time-by-acculturation status interaction term. In the study 330 persons were included (65% women, mean age ± standard deviation 43.3 ± 11.8 years). Over the 6 years, MCS decreased, while PCS remained stable. While cross-sectional analyses showed associations of acculturation status with both MCS and PCS, temporal changes including the time interaction term did not reveal associations of baseline acculturation status with HRQL. When investigating HRQL in acculturation, more longitudinal studies are needed to take changes in both HRQL and acculturation status into account.
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Affiliation(s)
- Lilian Krist
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Correspondence:
| | - Christina Dornquast
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- German Center for Neurodegenerative Diseases (DZNE), 17489 Greifswald, Germany
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Sara Schramm
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Katja Icke
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Ina Danquah
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Institute of Global Health (HIGH), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan N. Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, 97688 Bad Kissingen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany;
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12
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Seven ÜS, Stoll M, Dubbert D, Kohls C, Werner P, Kalbe E. Perception, Attitudes, and Experiences Regarding Mental Health Problems and Web Based Mental Health Information Amongst Young People with and without Migration Background in Germany. A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E81. [PMID: 33374310 PMCID: PMC7796242 DOI: 10.3390/ijerph18010081] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
Mental illnesses in adolescence and young adulthood are steadily increasing. Thus, mental disorders represent an individual and societal challenge and an enormous health economic burden, creating an urgent need for research and action. Mental health problems are omnipresent in the life of young people and the internet is the first resource, which helps them to understand their situation. Young people with migration background often have more difficulties accessing health care services. Digital technologies offer an ideal opportunity for a low-threshold platform that addresses the needs of young people. The current project "GeKo:mental" aims to design a multilingual website for Cologne-based adolescents and young adults that will enable them to obtain comprehensive information about mental illness and health, treatment options and first contact points. To design this website, this study aims to find out what kind of health information is needed and how it should best be presented. Nine focus group discussions with adolescents and young adults with and without migration background (N = 68) were conducted; the focus group discussions took place at schools, in an association for social youth work and in an cultural association, which is linked to a mosque in Cologne, Germany. A qualitative content analysis was conducted on the gathered material. The participants reported concrete challenges and needs. The results will form the basis for the development and design of a website.
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Affiliation(s)
- Ümran Sema Seven
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
| | - Mendy Stoll
- Faculty of Information Science and Communication Studies, TH Köln/University of Applied Sciences, 50678 Cologne, Germany; (M.S.); (P.W.)
| | - Dennis Dubbert
- Faculty of Computer Science and Engineering Science, TH Köln/University of Applied Sciences, 50678 Cologne, Germany; (D.D.); (C.K.)
| | - Christian Kohls
- Faculty of Computer Science and Engineering Science, TH Köln/University of Applied Sciences, 50678 Cologne, Germany; (D.D.); (C.K.)
| | - Petra Werner
- Faculty of Information Science and Communication Studies, TH Köln/University of Applied Sciences, 50678 Cologne, Germany; (M.S.); (P.W.)
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany;
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Thein K, Erim Y, Morawa E. Comparison of Illness Concepts and Coping Strategies among Cancer Patients of Turkish and German Origin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5580. [PMID: 32748869 PMCID: PMC7432793 DOI: 10.3390/ijerph17155580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to compare illness concepts and coping strategies among native German cancer patients and those with a Turkish migration background. METHODS Guideline-based, semi-structured interviews were conducted with 11 German (♂: 8, ♀: 3) and 11 Turkish (♂: 2, ♀: 9) cancer patients. The transcripts were evaluated using a qualitative content analysis in accordance with Mayring. RESULTS We identified eight categories of illness concepts: stressful life events, environmental influences, the will of God, medical factors, fate, trauma, health behaviour, and psychological causes. German patients frequently attributed their illness to environmental influences, persistent stress, or medical factors, whereas Turkish patients blamed persistent stress, the will of God, or trauma. The last two categories are not found among German patients. We classified the coping strategies into 11 main categories: social support, activity, patient competence, fighting spirit/positive thinking, use of health services/alternative healing methods, lifestyle, emotional coping, cognitive coping, religious coping, spiritual coping, and culture-specific methods for patients of Turkish origin. For German patients, activities as well as social support played primary roles in coping. Turkish patients also often used social support. However, in contrast to the German patients, they are less active and use much more religious coping and culture-specific means. In addition, negative emotions occur more often when processing the illness than in the German patients. CONCLUSION Common illness representations and coping strategies could be found for Turkish and German patients, but also specific ones for the respective group. It is particularly noticeable that German patients attach more importance to medical factors and try more actively to cope with the illness. For Turkish patients, cultural and religious factors play an important role, which should also be considered in treatment.
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Affiliation(s)
| | | | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (K.T.); (Y.E.)
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Higher prevalence of depressed mood in immigrants' offspring reflects their social conditions in the host country: The HELIUS study. PLoS One 2020; 15:e0234006. [PMID: 32497057 PMCID: PMC7272005 DOI: 10.1371/journal.pone.0234006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/15/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Immigrants from low- and middle-income countries who have settled in high-income countries show higher risks of depression in comparison with host populations. The risks are associated with adverse social conditions. Indecisive results have been reported on the depression risks of the offspring of immigrant populations. OBJECTIVE To assess the prevalence of depressed mood in immigrant offspring relative to the host population and to analyse whether that risk is explained by social conditions. METHODS Cross-sectional data from the Dutch HELIUS study were analysed, involving 19,904 men and women of Dutch, South-Asian Surinamese, African Surinamese, Turkish or Moroccan ethnic descent aged 18 to 70. Depressive symptomatology was assessed using the Patient Health Questionnaire-9 (PHQ-9). Indicators of social conditions were socioeconomic position (educational level, occupational level, employment status), perceived ethnic discrimination and sociocultural integration (ethnic identity, cultural orientation, social network). We used logistic regression to assess the risk of depressed mood (PHQ-9 sum score ≥10) in immigrants' offspring, as well as in first generation immigrants, relative to the risk in the host population. Social indicators were stepwise added to the model. RESULTS The prevalence of depressed mood was 13% to 20% among immigrant offspring, with the lowest level for those of African Surinamese descent; prevalence in the Dutch origin population was 7%. Relative risk of depressed mood, expressed as average marginal effects (AMEs), decreased substantially in all offspring groups after adjustment for socioeconomic indicators and discrimination. E.g. the AME of Turkish vs. Dutch decreased from 0.11 (0.08-0.13) to 0.05 (0.03-0.08). Patterns resembled those in first generation immigrants. CONCLUSIONS Results suggest that the observed higher prevalence of depressed mood in immigrants' offspring will decline to the level of the host population as the various populations grow closer in terms of socioeconomic position and as immigrant offspring cease to experience discrimination.
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15
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Starck A, Gutermann J, Schouler-Ocak M, Jesuthasan J, Bongard S, Stangier U. The Relationship of Acculturation, Traumatic Events and Depression in Female Refugees. Front Psychol 2020; 11:906. [PMID: 32528358 PMCID: PMC7247808 DOI: 10.3389/fpsyg.2020.00906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/14/2020] [Indexed: 12/31/2022] Open
Abstract
Recent research has identified significant correlations between traumatic events and depression in refugees. However, few studies have addressed the role of acculturation strategies in this relationship. This study explored the relationship between cultural orientation, traumatic events and depression in female refugees from Syria, Afghanistan, Eritrea, Iran, Iraq, and Somalia living in Germany. We expected acculturation strategies to moderate the effect of traumatic experiences on depression. The sample included 98 female refugees in Germany. The depression scale of the Hopkins Symptom Checklist (HSCL) represented the dependent measure. The trauma checklists derived from the Post-traumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ) as well as the Frankfurt Acculturation Scale (FRACC) were used as independent measures for traumatic events and orientation toward the host culture as well as orientation toward the culture of origin, respectively. A moderation analysis was conducted to examine whether the relationship between the number of traumatic events and depression was influenced by the women's orientation toward the culture of origin and the host culture. We identified a significant model explaining 26.85% of the variance in depressive symptoms (Cohen's f2 = 0.37). The number of traumatic events and the orientation toward the host culture exerted significant effects on depressive symptoms. The moderating effect was not significant, indicating that the effect of the number of traumatic events was not influenced by cultural orientation. Based on our results, orientation toward the host culture as well as traumatic experiences exert independent effects on depressive symptoms in refugees.
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Affiliation(s)
- Annabelle Starck
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Jana Gutermann
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Jenny Jesuthasan
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Stephan Bongard
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Ulrich Stangier
- Clinical Psychology and Psychotherapy, Department of Psychology, Goethe-University Frankfurt, Frankfurt, Germany
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16
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Schumann M, Bug M, Kajikhina K, Koschollek C, Bartig S, Lampert T, Santos-Hövener C. The concept of acculturation in epidemiological research among migrant populations: A systematic review. SSM Popul Health 2020; 10:100539. [PMID: 32042888 PMCID: PMC6997899 DOI: 10.1016/j.ssmph.2020.100539] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 01/10/2023] Open
Abstract
•Acculturation is a widely used concept in epidemiological research.•There are various ways to measure acculturation using proxies or scales; often an acculturation score is calculated.•Studies often show inconsistencies in operationalization and measurement of the concept of acculturation.•The exact outcome is often unclear; this creates a lack of comparability, generalizability and transferability of the results.•Health relevant proxies such as language skills or feeling of belonging should be measured without calculating a score.
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Affiliation(s)
| | | | - Katja Kajikhina
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, FG28: Social Determinants of Health, General-Pape-Str. 62-66, 12101, Berlin, Germany
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Spallek J, Scholaske L, Kurt M, Lindner-Matthes D, Entringer S. Intergenerational transmission of health disparities among Turkish-origin immigrants in Germany: study protocol of a multi-centric cohort study (BaBi-stress and BaBeK study). BMC Pregnancy Childbirth 2020; 20:158. [PMID: 32164606 PMCID: PMC7069210 DOI: 10.1186/s12884-020-2853-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immigrants in Germany exhibit higher levels of social disadvantage when compared to the non-immigrated population. Turkish-origin immigrants constitute an important immigrant group in Germany and show disparities in some health domains that are evident from birth onwards. Several studies have shown the mechanisms by which social disadvantage is biologically embedded to affect health over the lifespan. Relatively little, however, is still known about if and how the maternal social situation is transmitted to the next generation. This study therefore aims to analyse the effects of maternal socioeconomic status and migration status on stress-related maternal-placental-fetal (MPF) biological processes during pregnancy on infant birth and health outcomes. METHODS This longitudinal cohort study of N = 144 child-mother dyads is located at two study sites in Germany and includes pregnant women of Turkish origin living in Germany as well as pregnant German women. During pregnancy, MPF stress biology markers from maternal blood and saliva samples, maternal socio-economic and migration-related information, medical risk variables and psychological well-being are assessed. After birth, infant anthropometric measures and developmental outcomes are assessed. The same measures will be assessed in and compared to Turkish pregnant women based on a collaboration with BABIP study in Istanbul. DISCUSSION This is the first study on intergenerational transmission of health disparities in Germany with a focus on women of Turkish-origin. The study faces similar risks of bias as other birth cohorts do. The study has implemented various measures, e.g. culturally sensitive recruitment strategies, attempt to recruit and follow-up as many pregnant women as possible independent of their social or cultural background. Nevertheless, the response rate among lower-educated families is lower. The possibility to compare results with a cohort from Turkey is a strength of this study. However, starting at different times and with slightly different recruitment strategies and designs may result in cohort effects and may affect comparability of the sub-cohorts. TRIAL REGISTRATION N.A. (Observational study, no clinical trial, no interventions on human participants).
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Affiliation(s)
- Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Universitätsplatz 1, 01968, Senftenberg, Germany.
| | - Laura Scholaske
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute for Medical Psychology, Luisenstr. 57, Berlin, 10117, Germany
| | - Medlin Kurt
- Department of Public Health, Brandenburg University of Technology, Universitätsplatz 1, 01968, Senftenberg, Germany
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Denise Lindner-Matthes
- Department of Public Health, Brandenburg University of Technology, Universitätsplatz 1, 01968, Senftenberg, Germany
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute for Medical Psychology, Luisenstr. 57, Berlin, 10117, Germany
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
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18
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Depressive complaints and utilization of mental health services: Comparison of adult cancer survivors of different ethnic origin. J Psychosom Res 2020; 130:109915. [PMID: 31918358 DOI: 10.1016/j.jpsychores.2019.109915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/04/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate depressive symptoms and mental health care utilization in adult cancer survivors (CS) of different ethnic origin. METHODS Mental health care utilization in dependence of depression (Patient Health Questionnaire, PHQ-9 ≥ 10) was analyzed in native German CS (GE) and in CS with Turkish (TR) or Polish (PL) migration background, recruited by a cancer registry. Frequencies and odds ratios (OR) were calculated. RESULTS 135 native German and 50 CS belonging to the first migration generation (TR: n = 25 and PL: n = 25) participated. TR showed the highest rate of depression (36.0%), followed by PL (32.0%), while GE revealed the lowest frequency (20.9%). The frequency of the utilization of mental health services was 17.4% (TR), 4.5% (PL) and 8.1% (GE). After adjusting for sociodemographic and clinical variables, no significant differences between the migrants and German CS were detected for the risk of being depressed, however a tendency for an increased risk in the migrant group was observed (OR = 2.53, CI = 0.96-6.65, p = .061). Female gender (OR = 3.88, CI = 1.29-11.68, p = .016) and prior psychological/psychiatric treatment (OR = 4.35, CI = 1.86-10.18, p = .001) were significantly associated with a higher risk of being depressed. CONCLUSION Contrastingly to numerous surveys, our results indicate no substantial differences between migrants and native CS, when adjusted for important confounders. High levels of migrants´ acculturation (good language proficiency, German citizenship/unlimited residence permit, long duration of stay in Germany) may contribute to eliminate inequalities caused by migration status in depressive symptomatology and mental health care utilization in CS.
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Current status of the intercultural opening at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2020; 66:20-31. [PMID: 32066348 DOI: 10.13109/zptm.2020.66.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.
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Morawa E, Brand T, Dragano N, Jöckel KH, Moebus S, Erim Y. Associations Between Acculturation, Depressive Symptoms, and Life Satisfaction Among Migrants of Turkish Origin in Germany: Gender- and Generation-Related Aspects. Front Psychiatry 2020; 11:715. [PMID: 32848908 PMCID: PMC7406783 DOI: 10.3389/fpsyt.2020.00715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the degree of depressive symptoms and life satisfaction (LS) as well as the association between acculturation and depressive symptoms among a large sample of persons with Turkish migration background in Germany, taking into account gender- and migration-related differences. METHODS This study was part of a pretest for a large national epidemiological cohort study in Germany. Acculturation was measured using the Frankfurt Acculturation Scale (FRACC). Based on the median split of the two subscales, four acculturative styles according to Berry (integration, assimilation, separation and marginalization) were determined. Depressive symptoms were assessed with the depression module (PHQ-9) from the Patient Health Questionnaire. LS was assessed with a single item on a scale from 1 = bad to 5 = excellent. Differences in levels of depressive symptoms and LS in relation to gender and generation of migration were tested with analysis of covariance, controlling for age. Gender-stratified multiple linear regression analyses were also conducted for depressive symptoms as criterion variable. RESULTS 328 Turkish migrants participated (61.3% women). The cut-off-value of ≥10 for the PHQ-9 was achieved by 33.2% of the women and 26.4% of the men (p=0.209, φ=0.071). In female migrants, the age-adjusted mean score for depressive symptoms was 7.81 (SD=6.42), in males 6.70 (SD=6.41) (p=0.137, η2=0.007). After controlling for unemployment status, women showed a trend for being more frequently depressed than men (p=0.055, φ=0.117) and also demonstrated a trend for higher levels of depressive symptoms (p=0.072, η2=0.012). No significant gender-specific difference was found concerning age-adjusted mean score for LS (p=0.547, η2=0.001), also when controlled for unemployment status (p=0.322, η2=0.004). In both sexes, the second generation demonstrated a significantly higher age-adjusted mean score for LS of small/medium effect size than the first generation. In women, separation as acculturation style (linear regression coefficient (B=4.42, 95% CI=1.68, 7.17, p=0.002; reference: integration), having no partnership (B=2.56, 95% CI=0.26, 4.86, p=0.03) and lower education (B=-2.28, 95% CI=-4.54, -0.02, p=0.048) were associated with higher severity of depressive symptoms; in men, separation as acculturation style (B=4.01, 95% CI=0.70, 7.31, p=0.018; reference: integration) and employment status (B=-3.32, 95% CI=-5.71, -0.92, p=0.007) were related to depression levels. CONCLUSIONS Separation as acculturation style is associated with higher levels of depressive symptoms (for both genders). Gender-sensitive health promotion programs should target separated migrants to improve their integration into the German society.
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Affiliation(s)
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Tilman Brand
- Department for Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Urban Public Health, University Hospital Essen, Essen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Kim CJ, Park HR, Schlenk EA, Kang SW, Seo EJ. The moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life among international students in Korea. Arch Psychiatr Nurs 2019; 33:192-197. [PMID: 31753227 DOI: 10.1016/j.apnu.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/28/2019] [Accepted: 08/18/2019] [Indexed: 11/18/2022]
Abstract
We examined the moderating role of acculturation mode on the relationship between depressive symptoms and health-related quality of life (HRQoL) in international students. This cross-sectional study enrolled a convenience sample of 147 international students at a university in Korea. Participants' overall HRQoL was moderate (mean = 57.2 of 80). The main and interaction effects of depressive symptoms and selected acculturation modes explained 39.9% of the variance in HRQoL. For all acculturation modes except the integration mode, as depressive symptom scores increased, HRQoL decreased. Specifically, at high depressive symptoms levels, participants with the marginalization, separation, and assimilation modes had worse HRQoL than did the integration mode, while HRQoL was similar for all acculturation modes at low depressive symptom levels. These findings suggest that future prospective intervention strategies should be considered for not only depressive symptoms levels, but also for different acculturation modes to enhance HRQoL in this population.
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Affiliation(s)
- Chun-Ja Kim
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, South Korea.
| | - Hyung-Ran Park
- Department of Nursing Science, Chungbuk National University, Cheongju, South Korea.
| | | | - Se-Won Kang
- Department of Nursing Science, Dongseo University, Busan, South Korea.
| | - Eun Ji Seo
- Ajou University College of Nursing and Research Institute of Nursing Science, Suwon, South Korea.
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Schumann M, Kajikhina K, Polizzi A, Sarma N, Hoebel J, Bug M, Bartig S, Lampert T, Santos-Hövener C. Concepts for migration-sensitive health monitoring. JOURNAL OF HEALTH MONITORING 2019; 4:49-65. [PMID: 35146253 PMCID: PMC8734173 DOI: 10.25646/6075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/16/2019] [Indexed: 12/01/2022]
Abstract
According to microcensus data, nearly one quarter of the German population has a migration background. This means that either themselves or at least one parent was born without German citizenship. Based on the currently available data and due to the underrepresentation of specific population groups, representative findings on the health of the total population residing in Germany are only possible to a limited degree. Against this backdrop, the Robert Koch Institute initiated the Improving Health Monitoring in Migrant Populations (IMIRA) project. The project aims to establish a migration-sensitive health monitoring system and to better represent people with a migration background in health surveys conducted by the Robert Koch Institute. In this context it is crucial to review and further develop relevant migration-sensitive concepts and appropriate surveying instruments. To achieve this, the concepts of acculturation, discrimination, religion and subjective social status were selected. This article theoretically embeds these concepts. Furthermore, we describe their application in epidemiology as well as provide a proposal on how to measure and operationalise these concepts. Moreover, recommendations for action are provided regarding the potential application of these concepts in health monitoring at the Robert Koch Institute.
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Affiliation(s)
- Maria Schumann
- Corresponding author Maria Schumann, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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Igde E, Heinz A, Schouler-Ocak M, Rössler W. [Depressive and somatoform disorders in persons with a Turkish migration background in Germany]. DER NERVENARZT 2019; 90:25-34. [PMID: 30187080 DOI: 10.1007/s00115-018-0602-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migration is a risk factor for the onset of mental disorders. Epidemiologic studies indicate that there is an increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. OBJECTIVES The aim of this review article is to determine the impact of sociocultural factors on depressive and somatoform disorders in individuals with a Turkish migration background in Germany. MATERIALS AND METHODS The systematic review is based on 23 studies identified in PubMed and PsycINFO. RESULTS Acculturation, perceived discrimination and the socioeconomic status affect the severity of mental disorders, and impair the access to the health care system as well as to psychotherapy. Women with a Turkish migration background represent a particularly vulnerable group in this context. CONCLUSION Multiple factors influence the increased prevalence of depressive and somatoform disorders in individuals with a Turkish migration background in Germany. Most of the identified studies suffer from significant methodological restrictions and as such do not allow generalization to the whole population of individuals with a Turkish migration background in Germany. There is a lack of national surveys and a need for longitudinal studies in representative population samples.
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Affiliation(s)
- E Igde
- Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - A Heinz
- Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Schouler-Ocak
- St. Hedwig-Krankenhaus, Tagesklinik Wedding, Psychiatrische Universitätsklinik, Charité, Berlin, Deutschland
| | - W Rössler
- Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Psychiatrische Universitätsklinik Zürich, Zürich, Schweiz
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24
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Orhan C, Lenoir D, Favoreel A, Van Looveren E, Yildiz Kabak V, Mukhtar NB, Cagnie B, Meeus M. Culture-sensitive and standard pain neuroscience education improves pain, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain: a pilot randomized controlled trial. Physiother Theory Pract 2019; 37:633-645. [PMID: 31280694 DOI: 10.1080/09593985.2019.1639231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the effectiveness of culture-sensitive and standard pain neuroscience education (PNE) on pain knowledge, pain intensity, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain (CLBP).Methods: Twenty-nine Turkish first-generation migrants with CLBP were randomly assigned to the culture-sensitive (n = 15) or standard PNE (n = 14) groups. Primary (pain knowledge, pain intensity, and disability) and secondary outcomes (pain beliefs, catastrophization, and fear of movement) were evaluated at baseline, immediately after the second session of PNE (week 1), and after 4 weeks.Results: There was a significant main effect of time in pain knowledge (p < .001), pain intensity (p = .03), disability (p = .002), organic and psychological pain beliefs (p = .002, p = .01), catastrophization (p = .002), and fear of movement (p = .02). However, no significant difference was found between groups in terms of all outcome measures (p > .05).Conclusions: Both PNE programs resulted in improvements in knowledge of pain, pain intensity, perceived disability, and pain cognitions. Nevertheless, the superiority of the culture-sensitive PNE approach could not be proved. Therefore, maybe migrants who are living in the host country for longer length of time do not need culturally adapted therapies due to cultural integration, while these adaptations might be essential for the recent migrants or the autochthonous population in Turkey. Further research is required to investigate the effects of culture-sensitive PNE alone or in combination with physiotherapy interventions in recent migrants or Turkish natives with CLBP.
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Affiliation(s)
- Ceren Orhan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - An Favoreel
- Department of Physiotherapy, De Sleep Health Center, Ghent, Belgium
| | - Eveline Van Looveren
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Belgium
| | - Vesile Yildiz Kabak
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Naziru Bashir Mukhtar
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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Aldin A, Chakraverty D, Baumeister A, Monsef I, Noyes J, Jakob T, Seven ÜS, Anapa G, Woopen C, Kalbe E, Skoetz N. Gender differences in health literacy of migrants: a synthesis of qualitative evidence. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Angela Aldin
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Digo Chakraverty
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Annika Baumeister
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Research Unit Ethics, Institute for the History of Medicine and Medical Ethics; Kerpener Str. 62 Cologne NRW Germany 50937
- University of Cologne; Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES); Cologne Germany
| | - Ina Monsef
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Jane Noyes
- Bangor University; Centre for Health-Related Research, Fron Heulog; Bangor Wales UK LL57 2EF
| | - Tina Jakob
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematological Malignancies; University of Cologne; Kerpener Str. 62 Cologne Germany
| | - Ümran Sema Seven
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Görkem Anapa
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Christiane Woopen
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Research Unit Ethics, Institute for the History of Medicine and Medical Ethics; Kerpener Str. 62 Cologne NRW Germany 50937
- University of Cologne; Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES); Cologne Germany
| | - Elke Kalbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne; Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI); Kerpenerstr. 62 Cologne NRW Germany 50937
| | - Nicole Skoetz
- Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Cancer; University of Cologne; Kerpener Str. 62 Cologne Germany 50937
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Sempértegui GA, Knipscheer JW, Baliatsas C, Bekker MHJ. Symptom manifestation and treatment effectiveness, -obstacles and -facilitators in Turkish and Moroccan groups with depression in European countries: A systematic review. J Affect Disord 2019; 247:134-155. [PMID: 30665076 DOI: 10.1016/j.jad.2018.12.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/02/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study examined the state of the art relevant for clinical practice on symptom manifestation of depression or depression-related idioms of distress, the treatment effectiveness and obstacles and facilitators for therapeutic success in Turkish and Moroccan immigrant populations with depression in Europe. METHODS We conducted a systematic search in PsycINFO, MEDLINE, Science Direct, Web of Knowledge, and Cochrane databases (1970- 31 July 2017). Peer-reviewed studies, with adult populations, and an instrument assessing depressive symptoms met inclusion criteria and were evaluated following quality guidelines. RESULTS We included 13 studies on symptom manifestation, 6 on treatment effectiveness, and 17 on obstacles and facilitators, published between 2000 and 2017, from Germany, the Netherlands, Austria and Sweden (n Turkish individuals = 11,533; n Moroccan individuals = 5278; n native individuals = 303,212). Both ethnic groups more often reported combined mood and somatic symptoms (and anxiety in the case of Turkish groups) than natives, and had higher levels of symptoms. There was no report on effectiveness of pharmacotherapy and there was weak evidence of the effectiveness of examined psychological treatments for depression in Turkish groups. No treatment has been examined in Moroccan groups. Salient obstacles to therapeutic success were socioeconomic problems, higher level of psychological symptoms at baseline, and negative attitudes towards psychotherapy. Possible facilitators were interventions attuned to social, cultural and individual needs. Results were most representative of first generation, low SES Turkish immigrant patients, and Moroccan-Dutch members of the general populations. CONCLUSION Turkish and Moroccan immigrants with depression presented a comorbid symptom profile with more intertwined depressive and somatic complaints. There were indications that the available therapies are insufficient for Turkish groups, but the current evidence is scarce and heterogeneous, and RCTs suffer from methodological limitations.
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Affiliation(s)
- Gabriela A Sempértegui
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Jeroen W Knipscheer
- Arq Psychotrauma Expert Group, Diemen, the Netherlands; Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Christos Baliatsas
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Marrie H J Bekker
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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Abstract
Among migrants who arrived in the USA and Europe, communicable diseases such as dermatologic, gastrointestinal, and respiratory infections are frequent; non-communicable diseases including chronic diseases such as hypertension and diabetes, and vaccine-preventable diseases are also prevalent. Refugees are often not up to date on routine immunizations and screenings for chronic diseases and cancer. In addition, many immigrants have trauma-related mental health problems, which are often not addressed by the healthcare systems where they reside. Determining the healthcare needs of specific immigration groups should lead to the establishment of evidence-based guidelines for providing screening and healthcare services to immigrant populations, for the benefit of the individuals concerned, as well as the host countries.
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Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Carlson E, Güler A. Cultural Involvement and Preference in Immigrant Acculturation. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2018. [DOI: 10.1007/s12134-018-0554-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Müller MJ, Koch E. Gender Differences in Stressors Related to Migration and Acculturation in Patients with Psychiatric Disorders and Turkish Migration Background. J Immigr Minor Health 2018; 19:623-630. [PMID: 27026345 DOI: 10.1007/s10903-016-0408-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Migration, acculturation, and psychiatric disorders may cause stress and adaptation processes differently in men and women, but empirical research is scarce. In a retrospective study n = 62 Turkish migrants and n = 62 native German inpatients with depressive or anxiety disorders, matched for age, gender, and diagnoses, were compared using a 10-item instrument for the assessment of migration- and acculturation related stressors (MIGSTR10). Gender differences in the prevalence of stressors and in the total sum of stressors were calculated and compared between migrants and indigenous patients. Results showed a higher global stress level in migrants and in women than in men with migration background. Regarding single stressors, the perceived loss of status was significantly more prevalent and more pronounced in men than in women (P < 0.05) whereas guilt feelings were more severe in women with Turkish migration background compared to men (P < 0.05). Gender differences of perceived stress should be taken into account in migration and acculturation research.
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Affiliation(s)
- Matthias Johannes Müller
- Faculty of Medicine, University of Giessen, Giessen, Germany.
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Licher Strasse 106, 35394, Giessen, Germany.
| | - Eckhardt Koch
- Vitos Clinical Centre for Psychiatry and Psychotherapy Giessen-Marburg, Licher Strasse 106, 35394, Giessen, Germany
- Institute of European Ethnology and Cultural Studies, University of Marburg, Marburg, Germany
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Brunnet AE, Bolaséll LT, Weber JLA, Kristensen CH. Prevalence and factors associated with PTSD, anxiety and depression symptoms in Haitian migrants in southern Brazil. Int J Soc Psychiatry 2018; 64:17-25. [PMID: 29082817 DOI: 10.1177/0020764017737802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prevalence rates of mental health disorders in migrants are controversial. The socio-historical and economic background of the host country may play an important role in the mental health status of migrants. As studies are mostly conducted in developed countries, researching migration in developing countries may add important information to scientific literature. AIMS This study aims to investigate the prevalence and factors associated with posttraumatic stress disorder (PTSD), anxiety and depression symptoms in Haitian migrants in southern Brazil. METHODS The sample comprises 66 participants selected from four different sites in three cities of a Brazilian southern state. Participants fulfilled a sociodemographic questionnaire, as well as instruments investigate traumatic events; post-migration difficulties and symptoms of PTSD, anxiety and depression. Linear regression models were utilized to investigate factors associated with PTSD, anxiety and depression symptoms. RESULTS PTSD prevalence in the sample was 9.1%. Depression and anxiety symptoms were in the clinical range of 10.6%-13.6% of participants, respectively. A number of traumatic events, acculturation difficulties, discrimination and low social support were associated with the investigated mental health disorders. CONCLUSION The results point to the importance of public policies in promoting better social and mental health support for migrants. Providing information to the Brazilian population about migration may improve receptiveness in the host society.
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Affiliation(s)
- Alice E Brunnet
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Laura T Bolaséll
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - João LA Weber
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Christian H Kristensen
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Ruiz-Castell M, Kandala NB, Perquin M, Bocquet V, Kuemmerle A, Vögele C, Stranges S. Depression burden in luxembourg: Individual risk factors, geographic variations and the role of migration, 2013-2015 European Health Examination Survey. J Affect Disord 2017; 222:41-48. [PMID: 28668715 DOI: 10.1016/j.jad.2017.06.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is a complex mental disorder that affects an increasing proportion of the worldwide population. This study aims to estimate the prevalence of depressive symptoms in Luxembourg, associated risk factors and geographic variations. Additionally, it aims to assess whether first and second generation immigrants are at higher risk for depressive symptoms compared to non-immigrants. METHODS Representative cross-sectional data from 1499 residents of Luxembourg, aged 25-64 years, were collected from the Luxembourg European Health Survey (EHES-LUX). Depressive symptoms were defined as a score of ≥5 on the Patient Health Questionnaire for depression (PHQ-9) (i.e. mild, moderate or severe). Standard and Bayesian regression models were used to examine associations between depressive symptoms, immigration status and geographic distribution across Luxembourg. RESULTS The prevalence of depressive symptoms was 21.55% (15.54% mild, 3.54% moderate, and 2.49% moderately severe to severe). The odds of having depressive symptoms was higher among second generation immigrants compared to non-immigrants (OR: 1.58, 95% CI: 1.04, 2.41), independent of socioeconomic and behavioral characteristics. Healthier diet, higher social support and good health perception were protective towards experiencing depressive symptoms. One of the highest likelihoods of reporting depressive symptoms was observed in the South-West of the country with a positive effect at 80% credible region [CR] (1.42 [0.92, 2.73]). LIMITATIONS The participation rate was low (26.7%). The cross-sectional nature of the study does not allow us to establish causality. CONCLUSIONS Depression constitutes an important public health challenge in Luxembourg due to the impact on the overall health of the population. Social programs of health promotion should be developed to improve mental wellbeing in immigrants, especially those of second generation.
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Affiliation(s)
- Maria Ruiz-Castell
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.
| | - Ngianga-Bakwin Kandala
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Mathematics, Physics and Electrical Engineering, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, UK
| | - Magali Perquin
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Valéry Bocquet
- Competence Center in Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Andrea Kuemmerle
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg
| | - Claus Vögele
- Institute for Health and Behaviour, Research Unit INSIDE, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Saverio Stranges
- Epidemiology and Public Health Research Unit, Department of Population Health, Luxembourg Institute of Health (LIH), Strassen, Luxembourg; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Acculturation and other risk factors of depressive disorders in individuals with Turkish migration backgrounds. BMC Psychiatry 2017; 17:264. [PMID: 28724369 PMCID: PMC5517803 DOI: 10.1186/s12888-017-1430-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 07/13/2017] [Indexed: 12/03/2022] Open
Abstract
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.
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Dingoyan D, Schulz H, Kluge U, Penka S, Vardar A, von Wolff A, Strehle J, Wittchen HU, Koch U, Heinz A, Mösko M. Lifetime prevalence of mental disorders among first and second generation individuals with Turkish migration backgrounds in Germany. BMC Psychiatry 2017; 17:177. [PMID: 28490323 PMCID: PMC5425978 DOI: 10.1186/s12888-017-1333-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject. METHODS In total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR. RESULTS The analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder. CONCLUSIONS Overall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.
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Affiliation(s)
- Demet Dingoyan
- Department of Medical Psychology, Study group on Psychosocial Migration Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building W(est)26, 20246, Hamburg, Germany.
| | - Holger Schulz
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Study group on Psychosocial Migration Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building W(est)26, 20246 Hamburg, Germany
| | - Ulrike Kluge
- 0000 0001 2218 4662grid.6363.0Clinic for Psychiatry and Psychotherapy, Charité – University Medicine Berlin, Campus Mitte, Berlin, Germany ,0000 0001 2248 7639grid.7468.dBerlin Institute for Integration and Migration Research, Department Migration, Mental and Physical Health and Health Promotion, Faculty of Humanities and Social Sciences, Humboldt University Berlin, Berlin, Germany
| | - Simone Penka
- 0000 0001 2218 4662grid.6363.0Clinic for Psychiatry and Psychotherapy, Charité – University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Azra Vardar
- 0000 0001 2218 4662grid.6363.0Clinic for Psychiatry and Psychotherapy, Charité – University Medicine Berlin, Campus Mitte, Berlin, Germany
| | - Alessa von Wolff
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Study group on Psychosocial Migration Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building W(est)26, 20246 Hamburg, Germany
| | - Jens Strehle
- 0000 0001 2111 7257grid.4488.0Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hans-Ulrich Wittchen
- 0000 0001 2111 7257grid.4488.0Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Uwe Koch
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Study group on Psychosocial Migration Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building W(est)26, 20246 Hamburg, Germany
| | - Andreas Heinz
- 0000 0001 2218 4662grid.6363.0Clinic for Psychiatry and Psychotherapy, Charité – University Medicine Berlin, Campus Mitte, Berlin, Germany ,0000 0001 2248 7639grid.7468.dBerlin Institute for Integration and Migration Research, Department Migration, Mental and Physical Health and Health Promotion, Faculty of Humanities and Social Sciences, Humboldt University Berlin, Berlin, Germany
| | - Mike Mösko
- 0000 0001 2180 3484grid.13648.38Department of Medical Psychology, Study group on Psychosocial Migration Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Building W(est)26, 20246 Hamburg, Germany
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Morawa E, Dragano N, Jöckel KH, Moebus S, Brand T, Erim Y. Somatization among persons with Turkish origin: Results of the pretest of the German National Cohort Study. J Psychosom Res 2017; 96:1-9. [PMID: 28545785 DOI: 10.1016/j.jpsychores.2017.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Despite the emerging need to examine mental health of immigrants, there are no investigations designed to analyze representative samples in Germany. The aim of the present study was to explore the severity of somatic symptoms/somatization among a sample of considerable size consisting of persons with Turkish origin. We studied whether somatization was associated with sociodemographic and migration-related characteristics. METHODS This examination was part of a pretest for a large national epidemiological cohort study in Germany. We applied the somatization (PHQ-15) and the depression module (PHQ-9) from the Patient Health Questionnaire in a subsample of 335 Turkish immigrants. We analyzed the distribution of the sum score. Differences in degree of somatization in relation to relevant socio-demographic (gender) and migrant-related characteristics (generation of immigration) were tested with analysis of covariance (ANCOVA), controlling for age. A multiple linear regression analysis was also conducted. RESULTS Women had significantly higher age-adjusted mean scores than men (M=10.4, SD=6.3 vs. M=8.1, SD=6.3; F=10.467, p=0.001), a significant effect of age was also found (F=4.853, p=0.028). First generation immigrants had a higher age-adjusted mean number of symptoms in relation to the second generation immigrants (M=10.0, SD=6.5 vs. M=7.4, SD=7.0; F=6.042, p=0.014), the effect of age was not significant (F=0.466, p=0.495). Multiple regression analysis revealed that lower severity of somatization was associated with lower numbers of diagnosed physical illnesses (β=0.271, p<0.001) and better language proficiency (β=0.197, p=0.003, explained variance: 15.6%). CONCLUSIONS The degree of somatization among Turkish immigrants in Germany is associated with gender and generation of immigration.
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Affiliation(s)
- Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Susanne Moebus
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Essen, Germany
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Acculturation and health-related quality of life: results from the German National Cohort migrant feasibility study. Int J Public Health 2017; 62:521-529. [PMID: 28255647 DOI: 10.1007/s00038-017-0957-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES We assessed the association between acculturation and health-related quality of life (HRQoL) among persons with a Turkish migrant background in Germany. METHODS 1226 adults of Turkish origin were recruited in four German cities. Acculturation was assessed using the Frankfurt Acculturation Scale resulting in four groups (integration, assimilation, separation and marginalization). Short Form-8 physical and mental components were used to assess the HRQoL. Associations were analysed with linear regression models. RESULTS Of the respondents, 20% were classified as integrated, 29% assimilated, 29% separated and 19% as marginalized. Separation was associated with poorer physical and mental health (linear regression coefficient (RC) = -2.3, 95% CI -3.9 to -0.8 and RC = -2.4, 95% CI -4.4 to -0.5, respectively; reference: integration). Marginalization was associated with poorer mental health in descendants of migrants (RC = -6.4, 95% CI -12.0 to -0.8; reference: integration). CONCLUSIONS Separation and marginalization are associated with a poorer HRQoL. Policies should support the integration of migrants, and health promotion interventions should target separated and marginalized migrants to improve their HRQoL.
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Jurado D, Alarcón RD, Martínez-Ortega JM, Mendieta-Marichal Y, Gutiérrez-Rojas L, Gurpegui M. Factors associated with psychological distress or common mental disorders in migrant populations across the world. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.rpsmen.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Factors associated with psychological distress or common mental disorders in migrant populations across the world. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 10:45-58. [PMID: 27291831 DOI: 10.1016/j.rpsm.2016.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/07/2016] [Accepted: 04/21/2016] [Indexed: 11/21/2022]
Abstract
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.
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Esmeyer EM, Magallón-Botaya R, Lagro-Janssen ALM. Gender Differences in the Incidence of Depression Among Immigrants and Natives in Aragón, Spain. J Immigr Minor Health 2016; 19:1-5. [PMID: 26880029 PMCID: PMC5285428 DOI: 10.1007/s10903-016-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Knowledge of depression among immigrants within Spanish primary care is limited. This database study investigates the incidence of depressive disorders among immigrants and natives within primary care in Aragón (Spain). Participants were patients registered in an electronic record register, aged above 20 years diagnosed with depression. Incidence of depression was calculated and compared per continent of origin, gender and age with the Mann-Whitney U test and the Kruskal–Wallis test. The population consisted of 11,088 patients with depression of whom 93.0 % natives and 7.0 % immigrants. Incidence of depression amongst male immigrants was lower than amongst male natives (OR 0.80). Eastern European males showed the lowest incidence 4.1 (3.5–5.3). The gender difference in incidence was larger in immigrants than in natives (OR 3.4 vs. 2.7). Due to male immigrants the incidence of depression within primary care is lower among immigrants. Equal care should be provided to patients of both genders and all origin.
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Affiliation(s)
- E M Esmeyer
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Center, Internal Post 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - A L M Lagro-Janssen
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Center, Internal Post 117, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Haverkamp GLG, Loosman WL, van den Beukel TO, Hoekstra T, Dekker FW, Chandie Shaw PK, Smets YFC, Vleming LJ, Ter Wee PM, Honig A, Siegert CEH. The association of acculturation and depressive and anxiety symptoms in immigrant chronic dialysis patients. Gen Hosp Psychiatry 2016; 38:26-30. [PMID: 26724601 DOI: 10.1016/j.genhosppsych.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Among immigrant chronic dialysis patients, depressive and anxiety symptoms are common. We aimed to examine the association of acculturation, i.e. the adaptation of immigrants to a new cultural context, and depressive and anxiety symptoms in immigrant chronic dialysis patients. METHODS The DIVERS study is a prospective cohort study in five urban dialysis centers in the Netherlands. The association of five aspects of acculturation ("Skills", "Social integration", "Traditions", "Values and norms" and "Loss") and the presence of depressive and anxiety symptoms was determined using linear regression analyses, both univariate and multivariate. RESULTS A total of 249 immigrant chronic dialysis patients were included in the study. The overall prevalence of depressive and anxiety symptoms was 51% and 47%, respectively. "Skills" and "Loss" were significantly associated with the presence of depressive and anxiety symptoms, respectively ("Skills" β=0.34, CI: 0.11-0.58, and "Loss" β=0.19, CI: 0.01-0.37; "Skills" β=0.49, CI: 0.25-0.73, and "Loss" β=0.33, CI: 0.13-0.53). The associations were comparable after adjustment. No significant associations were found between the other subscales and depressive and anxiety symptoms. CONCLUSION This study demonstrates that less skills for living in the Dutch society and more feelings of loss are associated with the presence of both depressive and anxiety symptoms in immigrant chronic dialysis patients.
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Affiliation(s)
- Gertrud L G Haverkamp
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands; Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands.
| | - Wim L Loosman
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands; Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | | | - Tiny Hoekstra
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Yves F C Smets
- Department of Nephrology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | - Pieter M Ter Wee
- Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
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Haverkamp GLG, Torensma B, Vergouwen ACM, Honig A. Psychological Distress in the Hospital Setting: A Comparison between Native Dutch and Immigrant Patients. PLoS One 2015; 10:e0130961. [PMID: 26110275 PMCID: PMC4482519 DOI: 10.1371/journal.pone.0130961] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/27/2015] [Indexed: 12/01/2022] Open
Abstract
Background Prevalence of psychological distress (i.e. depressive and anxiety symptoms) in medically ill patients is high. Research in the general population shows a higher prevalence of psychological distress among immigrants compared to natives. Our aim was to examine the prevalence of psychological distress in the hospital setting comparing immigrant and native Dutch patients and first and second generation immigrant patients. Methods Prevalence of psychological distress was assessed using the extended Kessler-10 (EK-10) in 904 patients in a Dutch general teaching hospital. Logistic regression was used to calculate odds ratios to determine differences between native and immigrant patients and first and second generation immigrants in the prevalence of psychological distress. We adjusted for demographic and social variables, socio-economic status, physical quality of life, history of psychiatric disease and health care use. Results Of 904 patients, 585 were native Dutch patients and 319 were immigrant patients. The prevalence of psychological distress in native compared to immigrant patients was 54% and 66% respectively, with especially high prevalences among Turkish and Moroccan immigrant patients. The crude OR for prevalence of psychological distress for immigrant patients versus native patients was 1.7 (95% CI 1.2–2.2) and for first versus second generation immigrant patients 2.1 (95% CI 1.2–3.5). After full adjustment ORs were 1.7 (95% CI 1.2–2.3) and 2.2 (95% CI 1.2–4.1) respectively. Conclusion Immigrant patients and first generation immigrant patients were more likely to have psychological distress compared to native patients and second generation immigrant patients respectively. We found a particularly high prevalence of psychological distress in Turkish and Moroccan immigrants.
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Affiliation(s)
- Gertrud L. G. Haverkamp
- Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
- Research department, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
- * E-mail:
| | - Bart Torensma
- Research department, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | | | - Adriaan Honig
- Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
- Department of psychiatry, VU Medical Centre, Amsterdam, The Netherlands
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