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Evangelidou S, Cruz A, Osorio Y, Sequeira-Aymar E, Gonçalves AQ, Camps-Vila L, Monclús-González MM, Cuxart-Graell A, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Dalmau Llorca MR, Aguilar Martín C, Requena-Mendez A. Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study. J Migr Health 2023; 8:100205. [PMID: 38047139 PMCID: PMC10692454 DOI: 10.1016/j.jmh.2023.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 11/04/2023] [Indexed: 12/05/2023] Open
Abstract
Background Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2-1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8-6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5-3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services.
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Affiliation(s)
- Stella Evangelidou
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Yolanda Osorio
- Parc Sanitari Sant Joan de Deu, Programa Atenció a la Salut Mental de les persones Immigrades i Programa per Persones Sense Llar, Carrer Dr. Antoni Pujadas, 42, 08830 Barcelona, Spain
| | - Ethel Sequeira-Aymar
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Carrer Rosselló 161, 08036 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Carrer Rosselló, 149, Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Laura Camps-Vila
- Unitat Docent Multiprofessional d'Atenció Familiar i Comunitària Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, 08272 Sant Fruitós de Bages, Barcelona, Spain
| | - Marta M. Monclús-González
- Centre d'Atencio Primaria Sagrada Família, Consorci Sanitari Integral (CSI), Carrer Còrsega 643, 08025 Barcelona, Spain
| | - Alba Cuxart-Graell
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - Elisa M. Revuelta-Muñoz
- Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Carrer Rambla Ferran 44, 25007, Lleida, Spain
| | - Núria Busquet-Solé
- Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Carrer St. Cristòfol, 34, 08243 Manresa, Barcelona, Spain
| | - Susana Sarriegui-Domínguez
- Centre d'Atencio Primaria 1 Maig, Institut Català de la Salut (ICS), Carrer De la Mercè, 5, 25003, Lleida, Spain
| | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
| | - M. Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Equip d'Atenció Primària Tortosa Oest, Institut Català de la Salut, 43500, Tortosa, Tarragona, Spain
| | - Carina Aguilar Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
- Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona). Carrer Roselló 132, 40, 08036 Barcelona, Spain
- Department of Medicine Solna, Karolinska Institutet, Solnavägen 17177, Solna, Stockholm, Sweden
- CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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Sequeira-Aymar E, Cruz A, Serra-Burriel M, di Lollo X, Gonçalves AQ, Camps-Vilà L, Monclus-Gonzalez MM, Revuelta-Muñoz EM, Busquet-Solé N, Sarriegui-Domínguez S, Casellas A, Llorca MRD, Aguilar-Martín C, Jacques-Aviñó C, Hargreaves S, Requena-Mendez A. Improving the detection of infectious diseases in at-risk migrants with an innovative integrated multi-infection screening digital decision support tool (IS-MiHealth) in primary care: a pilot cluster-randomized-controlled trial. J Travel Med 2022; 29:6316245. [PMID: 34230959 PMCID: PMC9635062 DOI: 10.1093/jtm/taab100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are major shortfalls in the identification and screening of at-risk migrant groups. This study aims to evaluate the effectiveness of a new digital tool (IS-MiHealth) integrated into the electronic patient record system of primary care centres in detecting prevalent migrant infections. IS-MiHealth provides targeted recommendations to health professionals for screening multiple infections, including human immunodeficiency virus (HIV), hepatitis B and C, active tuberculosis (TB), Chagas disease, strongyloidiasis and schistosomiasis, based on patient characteristics (including variables of country of origin, age and sex). METHODS A pragmatic pilot cluster-randomized-controlled trial was deployed from March to December 2018. Eight primary care centres in Catalonia, Spain, were randomly allocated 1:1 to use of the digital tool for screening, or to routine care. The primary outcome was the monthly diagnostic yield of all aggregated infections. Intervention and control sites were compared before and after implementation with respect to their monthly diagnostic yield using regression models. This study is registered on international standard randomised controlled trial number (ISRCTN) (ISRCTN14795012). RESULTS A total of 15 780 migrants registered across the eight centres had at least one visit during the intervention period (March-December 2018), of which 14 598 (92.51%) fulfilled the criteria to be screened for at least one infection. There were 210 (2.57%) individuals from the intervention group with new diagnoses compared with 113 (1.49%) from the control group [odds ratio: 2.08, 95% confidence interval (CI) 1.63-2.64, P < 0.001]. The intervention centres raised their overall monthly diagnosis rate to 5.80 (95% CI 1.23-10.38, P = 0.013) extra diagnoses compared with the control centres. This monthly increase in diagnosis in intervention centres was also observed if we consider all cases together of HIV, hepatitis B and C, and active TB cases [2.72 (95% CI 0.43-5.00); P = 0.02] and was observed as well for the parasitic infections' group (Chagas disease, strongyloidiasis and schistosomiasis) 2.58 (95% CI 1.60-3.57; P < 0.001). CONCLUSIONS The IS-MiHealth increased screening rate and diagnostic yield for key infections in migrants in a population-based primary care setting. Further testing and development of this new tool is warranted in larger trials and in other countries.
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Affiliation(s)
- Ethel Sequeira-Aymar
- Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Casanova, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Angeline Cruz
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zürich, Switzerland
| | - Ximena di Lollo
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain.,Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Laura Camps-Vilà
- Centre d'Atencio Primaria Plaça Catalunya, Institut Català de la Salut (ICS), Manresa, Spain
| | | | - Elisa M Revuelta-Muñoz
- Centre d'Atencio Primaria Rambla Ferran, Institut Català de la Salut (ICS), Lleida, Spain
| | - Nuria Busquet-Solé
- Centre d'Atencio Primaria Sagrada Família, Institut Català de la Salut, Manresa, Barcelona, Spain
| | | | - Aina Casellas
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Maria Rosa Dalmau Llorca
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain.,Equip d'Atenció Primària Tortosa Est, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Carina Aguilar-Martín
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tarragona, Spain.,Unitat d'Avaluació, Direcció d'Atenció Primària Terres de l'Ebre, Institut Català de la Salut, Tortosa, Tarragona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Sally Hargreaves
- Migrant Health Research Group, Institute for Infection and Immunity, St. George's University of London, London, UK
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.,Department of Medicine-Solna, Karolinska Institutet, Solna, Stockholm, Sweden
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