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Angst und Depression polnischer und vietnamesischer MigrantInnen in Leipzig unter besonderer Berücksichtigung ihres Eingliederungsprozesses
Abstract
Obwohl MigrantInnen in vielen Studien einen schlechteren psychischen Gesundheitszustand als die einheimische Bevölkerung aufweisen, ist bisher kaum untersucht, welche Bedingungen der Migration einen negativen Einfluss auf den Gesundheitszustand haben. Um dies zu zeigen, beantworteten 140 polnische und 82 vietnamesische MigrantInnen die Angst- und Depressionsskala der HADS sowie Fragen zu ihrer Eingliederung (z. B. nach den Sprachkenntnissen, Kontakten, Rückkehrabsicht etc.). Beide MigrantInnengruppen zeigten höhere Angst- und Depressionswerte als eine deutsche Vergleichsstichprobe. Bezüglich der Eingliederungsvariablen konnten in den Regressionsgleichungen nur die soziale Assimilation (Eingliederung) und die wahrgenommene Diskriminierung Angst und Depression erklären, Sprachkenntnisse und strukturelle Assimilation (berufliche Eingliederung) waren keine bedeutsamen Prädiktoren für Angst und Depression, wobei es Unterschiede zwischen den MigrantInnengruppen gab. Neben Operationalisierungsproblemen sind unterschiedliche Migrationsbiografien sowie Rahmenbedingungen im Ankunftsland als Ursache für diese Ergebnisse zu sehen.
... Der Zusammenhang zwischen Migration und psychischer Gesundheit wird in der Forschung kontrovers diskutiert. Vielen, meist europäischen und israelischen, Studien zufolge haben Migranten höhere Werte für psychische Belastung (Ängstlichkeit, Depression und Somatisierung) und sind häufiger von psychischen Störungen betroffen als die Mehrheitsbevölkerung im Herkunftsland und im Aufnahmeland [1][2][3][4][5][6]. ...
... Für Religiosität waren die Befunde weniger eindeutig, Jarvis et al. zeigten gerade für Juden keinen Zusammenhang [16]. Ein Effekt auf die psychische Verfassung konnte für Faktoren wie Einkommen [12], soziale Einbindung [4], Sprachkenntnisse [2] und Diskriminierungserfahrungen [4] nachgewiesen werden. ...
... Für Religiosität waren die Befunde weniger eindeutig, Jarvis et al. zeigten gerade für Juden keinen Zusammenhang [16]. Ein Effekt auf die psychische Verfassung konnte für Faktoren wie Einkommen [12], soziale Einbindung [4], Sprachkenntnisse [2] und Diskriminierungserfahrungen [4] nachgewiesen werden. ...
Background:
Research on migration provides controversial findings regarding the links between mental health and migration as well as the factors influencing the mental health of migrants. Even though there is evidence for differences between migrant groups from different countries of origin, almost no empirical studies about individual migrant groups in Austria have been undertaken so far.
Methods:
In the present population-based study we compared depression and anxiety of 96 ex-Soviet Jews to a sample of 101 Austrians matched by age and sex. Furthermore, we investigated the impact of acculturation attitude and religiosity on the psychological condition of the migrants. Depression and anxiety were measured with Beck-Depression-Inventory (BDI), State-Trait-Anxiety-Inventory (STAI) and Brief Symptom Inventory (BSI). Acculturation attitude was assessed with Vancouver Index of Acculturation (VIA) and religiosity with a self-developed scale.
Results:
Ex-Soviet Jews were significantly more depressed and more anxious than native Austrians but not more likely to be affected by clinical depression. Integration (i.e. interest in both the original and the receiving society's culture) as an acculturation strategy was associated with the lowest mental health burden. Religiosity had a protective effect against depression but not against anxiety.
Conclusion:
The present study allows initial insights into the mental health of a migrant group which has hardly been subject to research, and it indicates a need for a greater opening of the Austrian majority population to migrants.
... Eine Vielzahl von Studien belegt den negativen Einfluss von wahrgenommener Diskriminierung auf die psychische Gesundheit, z. B. Depressivität und Angst [12,13], und die physische Gesundheit, z. B. den systolischen Blutdruck [14]. ...
... B. den systolischen Blutdruck [14]. So konnten Merbach et al. [12] in einer in Leipzig durchgeführten Untersuchung mit polnischen und vietnamesischen Migranten zeigen, dass wahrgenommene Diskriminierung im polnischen Sample einen signifikanten Prädiktor für Depression und Angst darstellt. Igel et al. [15] konstatierten in einer großen Stichprobe von 1844 Migranten unterschiedlicher Herkunft (darunter 497 türkisch-und 148 polnischstämmige Migranten), dass Personen mit Diskriminierungserfahrungen eine signifikant schlechtere subjektive Gesundheit aufweisen und dass die türkischstämmigen Migranten sich signifikant häufiger Morawa Bei den Variablen zur Erfassung der wahrgenommenen Diskriminierung handelt es sich um selbstentwickelte Fragen. ...
... B. Religion, Sprache, Kultur, Aufenthaltsstatus) heterogene Population handelt, wurden in die vorliegende Studie zwei Migrantenkollektive (ein türkisches und ein polnisches) einbezogen, die eine unterschiedlich große religiöse, kulturelle und auch äußerliche Nähe zu der einheimischen deutschen Bevölkerung aufweisen, um somit die jeweiligen Besonderheiten zu analysieren. Wie oben schon erwähnt, existieren zwar im deutschsprachigen Raum bereits Studien, die an unterschiedlichen Migrantengruppen den Zusammenhang zwischen wahrgenommener Diskriminierung und subjektiver Gesundheit[15] oder Symptombelastung[12] erforschen. Bei der vorliegenden Untersuchung handelt es sich jedoch unseres Wissens erstmals um eine Studie, die bei Personen mit türkischem und polnischem Migrationshintergrund (darunter auch [Spät-]Aussiedler, die in vielen Statistiken aufgrund ihrer deutschen Staatsangehörigkeit als Deutsche registriert und somit nicht als Migranten erfasst werden) in mehreren Bereichen subjektive Diskriminierungserlebnisse sowie deren Einfluss auf die Depressivität und die subjektive Lebensqualität untersucht. ...
Objective:
Comparative study on perceived discrimination and subjective health status in two immigrants samples.
Methods:
In a total sample consisting of 218 immigrants of Turkish and Polish origin perceived discrimination, depressiveness (BDI) and health related quality of life (SF-36) were assessed.
Results:
Turkish immigrants have shown higher levels of perceived discrimination and depressiveness as well as a lower subjective quality of life.
Conclusions:
The results indicate that Turkish immigrants have a greater mental impairment compared to persons with Polish migration background.
... A recently published Europe-wide study indicated that immigrant and ethnic minority groups do experience more depressive symptoms than natives in an essential part of the 23 participating countries (Missinne & Bracke, 2010). Merbach, Wittig, and Brähler (2008) reported that Polish and Vietnamese migrants in Germany show higher levels of anxiety and depression than a comparative sample of native-born Germans. At almost the same time, however, a study of a representative population sample showed that people with a history of migration are probably as likely to suffer from depressive disorders, somatoform disorders, and post-traumatic stress disorder (PTSD) as non-migrant Germans (Glaesmer et al., 2009). ...
... In a report from Germany, Merbach et al. (2008) indicated that migrants were more burdened by depression and anxiety, and reported a correlation with social assimilation and perceived discrimination, but not with an identification with the host country (e.g. the wish to remain in Germany or to acquire German nationality) nor with knowledge of the language (Merbach et al., 2008). Similarly, other authors have found no correlation between knowledge of the language or acculturation with depression (Haasen & Sardashti, 2000). ...
... In a report from Germany, Merbach et al. (2008) indicated that migrants were more burdened by depression and anxiety, and reported a correlation with social assimilation and perceived discrimination, but not with an identification with the host country (e.g. the wish to remain in Germany or to acquire German nationality) nor with knowledge of the language (Merbach et al., 2008). Similarly, other authors have found no correlation between knowledge of the language or acculturation with depression (Haasen & Sardashti, 2000). ...
Background
Migrants in Europe may suffer from depression more often than the native-born population of the particular host country. Reports about the prevalence of depression in migrants are, however, heterogeneous and the possible causes are the subject of controversial discussion.
Aims
The aims of this study are to determine the incidence of depressiveness in a large multi-ethnic working population with and without a history of migration, and to investigate possible connections with migration status and acculturation criteria.
Methods
The cross-sectional study asked 7062 employees of a university hospital to complete a self-rating questionnaire concerning socio-demographic data, migration status and indicators of acculturation. Depressiveness was assessed by means of the German version of the Center of Epidemiological Studies Depression Scale (CES-D).
Results
The response rate was 41.7% (N = 2932); 14.9% of the participants (n = 419) reported a history of migration, 275 (65.8%) of whom were first-generation (M1) and 143 (34.2%) second-generation (M2) migrants. According to the CES-D scores, 8.7% of non-migrants (n = 207) suffered from clinically relevant depressive symptoms, compared to 16% (n = 44) of the M1 group (OR = 2.10, 95% CI: 1.44–3.04, p < .001) and 14% (n = 20) in M2 (OR = 1.68, 95% CI: 1.01–2.79, p = .048). Taking gender into consideration revealed that only the female migrants showed a statistically significant increased rate of depressiveness (χ ² = 16.68, p < .001).
Conclusions
Our results suggest that first- and second-generation female migrants are more likely to suffer from depressiveness than non-migrant females. In this model a history of migration is shown to be an independent risk factor for depressiveness.
... However, the psychological health of SSA migrants remains understudied. Studies on migrants' mental health have primarily focused on European migrants [21] and migrant workers [22][23][24]. These studies generally report that social assimilation and perceived discrimination are associated with anxiety and depression among migrants [21]. ...
... Studies on migrants' mental health have primarily focused on European migrants [21] and migrant workers [22][23][24]. These studies generally report that social assimilation and perceived discrimination are associated with anxiety and depression among migrants [21]. ...
African migrants living in Europe have an increased risk of adverse psychological health outcomes compared to people without a migration background. The increased vulnerability may be due to their migration experience and possible challenges in adapting and integrating into the host community. This study explores the association between community solidarity and psychological health outcome among Sub-Saharan African (SSA) migrants in Germany.
The study used data from 518 SSA migrants in Germany collected in a cross-sectional survey across the 16 German federal states. A correlation matrix was computed to evaluate the bivariate relationship between psychological health, community solidarity, and socioeconomic, and demographic features. Furthermore, regression models were calculated to predict the effect of community solidarity on psychological health outcomes and the added predictive effects of socioeconomic and demographic characteristics.
Community solidarity shows a moderately significant positive association with psychological health (r=.41; p≤.01). A linear regression model suggests that community solidarity, education and age explained 19% of the variance in psychological health scores for SSA migrants in Germany.
These results confirm community solidarity as a significant but multi-layered determinant of various factors that affect migrants’ psychological wellbeing. It supports implementing policies that promote community solidarity to facilitate SSA migrants’ wellbeing.
... One of these barely researched groups are Vietnamese migrants in Germany-with around 99,000 individuals in 2019 one of the country's largest Asian populations, and with 26,000 members the largest Southeast Asian community in the capital of Berlin (17). Among the few existing German studies on this migrant group, a survey of 82 Vietnamese living in the city of Leipzig exhibited higher anxiety and depression scores as well as a lower mental health care utilization than in the German control sample (18). Moreover, social assimilation and perceived discrimination were identified as significant influencers of both psychiatric syndromes. ...
... The BSI-18 is a frequently used self-report questionnaire that is designed to measure the current level of psychological distress in adult individuals. It consists of three subscales with each assessing a common psychiatric syndrome, namely somatization (items 1, 4, 7, 10, 13, 16), depression (items 2,5,8,11,14,17), and anxiety (items 3, 6,9,12,15,18). The 18 items are allocated equally across the three subscales, with each examining on a 5-point Likert scale (from 0 = "not at all" to 4 = "extremely") to what extent the respective symptom burdened the respondent during the previous 7 days. ...
Background: Mental health risk-factors for Asian migrants have been studied almost exclusively in the US, Canada, and Australia but not in European countries. Therefore, we aimed to identify sociodemographic, clinical, and migration-surrounding factors associated with experienced mental distress among Vietnamese migrants in Germany.
Method: 305 Vietnamese migrants utilizing Germany's first Vietnamese psychiatric outpatient clinic filled out at admission the Brief-Symptom-Inventory 18 (BSI-18) as well as a questionnaire on 22 potential mental health determinants. Using a multiple linear regression model, we identified those sociodemographic, clinical, and migration-surrounding factors that were significantly related to the Global Severity Index (GSI) of the BSI-18.
Results: The factors unemployment (B = −6.32, p = 0.014), financial problems (B = −10.71, p < 0.001), no or only little religious involvement (B = −3.23, p = 0.002), no psychiatric precontact (B = −7.35, p = 0.004), previous migration experiences (B = 8.76, p = 0.002), and perceived discrimination (B = 6.58, p = 0.011) were found to significantly increase the level of mental distress according to the BSI-GSI.
Conclusion: Based on these results, we were able to construct a mental health risk-profile for Vietnamese migrants in Germany, which aims to detect candidates for psychiatric problems earlier and supply them with customized prevention and therapy options.
... La relación entre migración, estrés y presión psicológica ha sido analizada en diversos estudios (Berry y Kim, 1988;Jerusalem, 1992;Liem et al., 2021), hallándose una relación entre migración y algunos trastornos mentales como trastornos del ánimo, estrés post-traumático y trastorno por somatización (Hovey y Magaña, 2000;Kirkcaldy et al., 2006;Merbach et al., 2008). Por ejemplo, Breslau et al. (2011) encontraron un incremento del riesgo para trastornos de ansiedad y del ánimo entre migrantes mexicanos en EEUU comparado con quienes residían en su país de origen. ...
... Despite the relatively large number of Vietnamese migrants in Germany, research on this minority group remains scarce (Kim et al., 2012;Nguyen et al., 2021;Ta et al., 2014;Wolf et al., 2020). Depression was found to be the most common diagnosis among Vietnamese migrants in Germany (Ta et al., 2014), with higher (Merbach et al., 2008) to similar (Hahn et al., 2016) levels of depressive symptoms among first-generation Vietnamese migrants compared to the native population born in Germany. Compared to other migrant groups, a lower mental health care utilization was found, making Vietnamese in Germany a relevant but underserved community (Ta et al., 2014). ...
Background
Worldwide migration represents a major challenge of the 21st century. Despite the strong association between acculturation and mental health, research findings on underlining mechanisms remain inconsistent. Prior research urges to investigate sample characteristics in a more structured manner.
Aims
The purpose of this study was to systematically investigate factors impacting acculturation and depressive symptoms in a large, not exclusively clinical, sample of Vietnamese migrants in Germany.
Method
This study investigated, with multiple regressions, factors (age at arrival, gender, education, religiousness, language skills, residence status, economic status, occupational status, migration motivation, duration of stay, and depressive symptoms) impacting the two dimensions of acculturation, dominant society immersion (DSI) and ethnic society immersion (ESI), in a not exclusively clinical sample (n = 582) of first-generation Vietnamese migrants in Germany. Further, this study examined the relationship between depressive symptoms, DSI and ESI with correlations and acculturation strategies with an ANOVA.
Results
Integration (72.5%) was the most common acculturation strategy, followed by separation (26.8%). In contrast, assimilation (0.5%) and marginalization (0.2%) were very rare acculturation strategies. As predictive factors for DSI lower depressive symptoms scores, male gender, higher education, and better German language skills were found significant. For ESI, less German language skills and older age at arrival were found to be significant. Higher ESI and DSI were correlated to lower depressive symptom scores. Compared to the three other acculturation strategies, integration was linked to the lowest depressive symptoms scores.
Conclusions
The current study identified crucial factors in the acculturation process, such as depressive symptoms, language skills, education, gender, and age at arrival. Our findings emphasize that immersion into both the dominant and the ethnic culture plays an essential supportive role in the mental health of migrants.
... Increasing age among migrants was associated with higher risk of communicable disease, including tuberculosis 33 and helicobacter pylori seroprevalence 34 ; maternal and child health conditions, 35 including risk of caesarean section, 36 near miss 37 and stillbirth 38 : cardiometabolic conditions, comprising cardiovascular risk, 39 metabolic syndrome 40 and impaired glucose metabolism 41 42 ; and mental health conditions, including psychosocial distress, 43 post-traumatic stress syndrome, 44 depression 45 46 and anxiety. 47 These associations of increasing age with other NCDs were also discernible for oral health 48 but not for cancer survival, 49 and were less clear-cut for adverse health behaviours. 49 50 Overall, women appeared to present with a more favourable health profile than men, with the exception of a female preponderance for adiposity, 51 as well as depression and perceived stress in some but not all studies. ...
Background
Germany has become an important immigration country and health services need to adopt to meet the needs of an increasingly multicultural population. For public health planning, it is essential to understand the aetiology of health problems among migrant populations. The main objective was to systematically identify, evaluate and synthesise population-based studies that investigated exposure–outcome relationships among migrant groups in Germany.
Methods
In November 2019, we searched PubMed and LIVIVO, and updated this search in November 2020, to identify peer-reviewed publications that fulfilled our eligibility criteria: English or German language; study on disease aetiology among major migrant groups in Germany, according to the latest microcensus; publication date from inception to 01 November 2020 and observational or experimental study designs. For quality appraisal, we used the Critical Appraisal Skills Programme checklists. Outcomes under investigation were categorised according to the WHO major disease groups, and their associations with risk factors were synthesised as a heat map.
Results
Out of 2407 articles retrieved, we included 68 publications with a total number of 864 518 participants. These publications reported on cross-sectional data (n=56), cohort studies (n=11) and one intervention study. The population groups most frequently studied were from the Middle East (n=28), Turkey (n=24), sub-Saharan Africa (n=24), Eastern Europe (n=15) and the former Soviet Union (n=11). The outcomes under study were population group specific. There were consistent associations of demographic and socioeconomic factors with ill health among migrants in Germany.
Discussion
In this systematic review, we observed low risk of bias in two-thirds of the studies. There is an increasing body of evidence for aetiological research on migrants’ health in Germany. Still, the directions of associations between a wide range of risk factors and major disease groups seem only partially understood.
PROSPERO registration number
CRD42018085074.
... Highest degree of perceived discrimination has been found in separated (second generation) and marginalized (both generations) women of Turkish origin (46). Perceived discrimination has been shown to be related with depressive symptoms in Turkish migrants (5) as well as other migrants groups (45,(47)(48)(49)(50). The European Social Surveys from 2006/2007 (51) and 2014 (37) confirm the association between perceived discrimination and depressive symptoms in migrants and also non-migrants. ...
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.
... Merbach, Wittig and Brähler found not only a higher symptom load for anxiety and depression in migrants but also showed an association of the symptoms with the extent of assimilation and sensed discrimination [24]. ...
Abstract Background Data on the prevalence of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background are scarce. There are hints that this population is at risk. The aim of the study is to investigate the epidemiology of suicidal ideation, suicide attempts, and direct self-injurious behavior in adolescents with a migration background in Germany while taking gender-specific differences into consideration. Methods A representative study with N = 10,638 students (mean age 14.91 years, SD = .73).) in the state of Lower Saxony in Germany was conducted. In the 2014–2015 school year, 672 classes were selected by randomly sampling different school types. The participation rate was 84.1%, excluding any classes for which the director refused to provide consent. A total of 49.8% were female adolescents, and 23.3% of the participants had a migration background. Target variables were assessed with items from the Ottawa Self-Injury Inventory, the Self-Harm Behavior Questionnaire and the Self-Harm Inventory, partly adapted. Results Of all students, 7.6% had a lifetime history of suicide attempts, and 36.6% answered with a rating of at least “rarely” when asked to rate the lifetime prevalence of suicidal ideation. The 12-month prevalence of direct self-injurious behavior was 17.8%. Adolescents with a migration background showed a significantly higher prevalence of all three constructs (p = .006; p
... Diese konnte in mehreren empirischen Untersuchungen bestätigt werden [30]. Anhand der Prävalenzraten für psychi- sche Erkrankungen, insbesondere der depressiven Störung, lässt sich nachweisen, dass Migranten häu- figer als die österreichische Gastpopulationen unter diesen leiden [31][32][33]. ...
Background:
Attachment is a psychological parameter across cultures and is influenced by childhood experiences. Though the construct of attachment tends to certain stability, different influences, like culture, can change the quality of attachment during lifetime. As can be seen from the example of depression in adulthood the clinical symptoms of this disorder may be different due to the cultural background.
Methods:
The present study focuses on inter- and intracultural differences concerning the attachment qualities of Turkish people in the homeland, Turkish migrants in Austria and Austrians (N = 297) by using the self-assessment questionnaire RSQ. Each ethnic group consisted of a healthy control group (N = 153) as well as a patient group currently suffering from a depressive episode (N = 144) and were getting an in or outpatient treatment.
Objective:
The hypothesis tested was whether culture moderates a correlation between depressive disorders and attachment abilities.
Results:
There were significant differences in attachment ability between cultures whereby controls presented significantly more secure attachment ability in all parameters compared to patients. While the Austrian control group showed the most secure attachment orientation, the Austrian patients had the highest level of insecurity, followed by the migrant group. However, the comparison of healthy and depressive Turks revealed no significant differences.
Conclusion:
Thus, culture shows significant effects concerning depressive disorders and attachment dimensions.
... So belegen Daten des Deutschen Sozio-ökonomischen Panels (SO-EP), dass wahrgenommene Diskriminierung, die zwischen unterschiedlichen Migrantengruppen variiert, diese negativ beeinflusst [7]. Merbach et al. [8] stellten in einer (nicht repräsentativen) Studie in Leipzig fest, dass polnische und vietnamesische Staatsangehörigkeit ein Prädiktor für Depression und Angst ist. Auch bei Personen mit türkischem und polnischem Migrationshintergrund der ersten und zweiten Generation konnte ein derartiger Zusammenhang bestätigt werden [9]. ...
Currently the majority of data regarding indicators of psychiatric morbidity of migrant and minority groups in Germany is derived from studies on help-seeking behavior, mental health service use, or data from population studies, which were not specifically aimed at including migrants. Such data are only available for certain groups, for example, population-based studies on psychiatric disorders and suicidal behavior among Turkish migrants have been conducted, while, comprehensive data on the psychiatric morbidity among major migrant groups in Germany are still rather limited. Barriers to recruiting migrants for health studies, difficulties in assessing psychiatric morbidity in multi-cultural samples, observed as feasibility problems, are among the factors that interfere with population-based studies.
... So belegen Daten des Deutschen Sozio-ökonomischen Panels (SO-EP), dass wahrgenommene Diskriminierung, die zwischen unterschiedlichen Migrantengruppen variiert, diese negativ beeinflusst [7]. Merbach et al. [8] stellten in einer (nicht repräsentativen) Studie in Leipzig fest, dass polnische und vietnamesische Staatsangehörigkeit ein Prädiktor für Depression und Angst ist. Auch bei Personen mit türkischem und polnischem Migrationshintergrund der ersten und zweiten Generation konnte ein derartiger Zusammenhang bestätigt werden [9]. ...
Currently the majority of data regarding indicators of psychiatric morbidity of migrant and minority groups in Germany is derived from studies on help-seeking behavior, mental health service use, or data from population studies, which were not specifically aimed at including migrants. Such data are only available for certain groups, for example, population-based studies on psychiatric disorders and suicidal behavior among Turkish migrants have been conducted, while, comprehensive data on the psychiatric morbidity among major migrant groups in Germany are still rather limited. Barriers to recruiting migrants for health studies, difficulties in assessing psychiatric morbidity in multi-cultural samples, observed as feasibility problems, are among the factors that interfere with population-based studies.
... Viele von ihnen leiden an Traumatisierungen, die oftmals ein Leben lang den Gesundheitszustand beeinträchtigen können. Der Zusammenhang zwischen Traumatisierung und Gesundheitszustand wurde schon oft beschrieben (Joksimovic, 2002;Krämer & Prüfer-Krämer, 2004;Silove et al., 2002;Weine et al., 1995). ...
Zusammenfassung Migrant(inn)en und Flüchtlinge unterscheiden sich von der einheimischen Bevölkerung in ihrem Verständnis von Gesundheit und Krankheit, ihrem Gesundheitsverhalten und im Zugang zur gesundheitlichen Versorgung. Da-her ermöglichen Konzepte und Ansätze, welche die Bedürfnisse der Mi-grant(inn)en berücksichtigen, erst die Integration von Migrant(inn)en in die Versorgung. Im Artikel wird eines dieser Konzepte vorgestellt. Das Projekt "Gesundheit braucht Kommunikation" ist ein Beispiel einer "best practice" in diesem Bereich aus den Neuen Bundesländern, in denen sich die Ge-schichte und Lage der Migrant(inn)en und Flüchtlinge deutlich von denen im früheren Bundesgebiet unterscheidet. Die Projektergebnisse zeigen, dass durch die Weiterbildung und den Einsatz von Multiplikator(inn)en, Sprach-Kulturmittler(innen) sowie die Arbeit einer Clearingstelle die psychosoziale Versorgung der Flüchtlinge verbessert werden konnte. Abstract Immigrants and refugees differ from native-born Germans in their under-standing of health and illness, in their health-related behaviours and in their access to the health care system. Thus, concepts and approaches that in-clude the needs of immigrants allow the integration of immigrants into the health care system. In this article, one of these concepts will be presented. The project "Health needs Communication" is an example of best practice in this field within the former East German territory, where the history and the circumstances of immigrants and refugees are different from those of the former West German territory. The results of the project show that the training and employment of information multipliers, community translators and the work of a consultation centre increase the immigrants' and refugees' use of/access to health care services.
... 15 (15,5) 24 (24,7) 19 (19,6) 32 ( Objective: Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany. ...
Objective:
Vietnamese migrants underutilize and are a "hard to reach group" within the existing mental health care system in Germany.
Methods:
We analyzed migration related and clinical data for all first-time Vietnamese migrants seeking psychiatric help, within the first 30 months of a newly established outpatient clinic, offering culture-sensitive psychiatric treatment in native Vietnamese language.
Results:
Most first time patients were female, first generation Vietnamese migrants with poor German language skills. Only 1 /3 of all patients had a psychiatric history, while this number was higher in patients with schizophrenia. Over time, more first time patients with depression were seeking psychiatric care, accompanied with an increase of non-professional referrals within the Vietnamese communities.
Conclusion:
This first study on mental health care utilization in Vietnamese migrants in Germany points towards the fact that "migrants" cannot be considered as a homogeneous group. Mental health care utilization must be evaluated for specific migrant groups, and can be initially improved if offered in native language and when it is referred to by members of migrant communities.
... Es konnte mehrfach gezeigt werden, dass die erlebte Benachteiligung negative Auswirkungen auf das psychische und körperliche Wohlbefinden [10][11][12], psychische Symptome wie z. B. Angst und Depression [13,14], ein geringeres Selbstwertgefühl [10,[15][16][17] und körperliche Gesundheit [10,15,18,19] hat. Die Wirkung von Diskriminierungserfahrungen als Stressor wurde vielfach diskutiert [10,12,15,17,20,21]. ...
OBJECTIVE The aim of the study was to investigate the influence of racial discrimination on subjective health in migrants. METHODS The sample included 1.844 migrants from the SOEP. Discrimination was assessed by two items. Socioeconomic status, country of origin, and health behavior were included in multivariate regression models to control for effects on health. Differential models with regard to gender and origin were analysed. RESULTS Migrants who experienced discrimination report a worse health status. Discrimination determines mental and physical health of migrants. There are differences in models due to gender and origin. CONCLUSIONS In addition to socioeconomic factors experienced discrimination should be taken into account as a psycho-social stressor of migrants.
... The relationship between migration, stress and psychological strain has been investigated in several studies [6,25]. Several psychiatric disorders consisting of depressive disorders, posttraumatic stress disorder, and somatization disorder appear to be related to migration [11,24,29,37]. For example, Breslau et al. found increased risk for mood and anxiety disorders among Mexican immigrants to the United States compared with Mexicans who remained in their home country [9]. ...
The aim of the main study is to examine the influence of risk factors and protecting factors that help elicit or alleviate mental health issues. An epidemiological cross-sectional data collection approach will be employed for this purpose, and the main outcome variable will be mental health as assessed with the General Health Questionnaire. We will recruit 340 German women and 340 Turkish migrant women. Constructs such as general self-efficacy, social support and extraversion depict protective factors and constructs such as social strain and neuroticism are considered as risk factors in this regard. Furthermore, the coherence between various acculturation patterns will be explored in order to be able to examine the presence of psychiatric symptoms more precisely.
We will present the first results of the pilot study by 50 Turkish migrant women to review the reliability and validity of the used instruments and to evaluate the hypotheses and experimental design.
... The relationship between migration, stress and psychological strain has been investigated in several studies [6,25]. Several psychiatric disorders consisting of depressive disorders, posttraumatic stress disorder, and somatization disorder appear to be related to migration [11,24,29,37]. For example, Breslau et al. found increased risk for mood and anxiety disorders among Mexican immigrants to the United States compared with Mexicans who remained in their home country [9]. ...
The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany.
105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations.
In all subjects, social strain (Pearson's r=.26(**), p=.008) and neuroticism (r=.34(**), p<.001) were positively associated with mental distress. In contrast, perceived self-efficacy (r=-.38(**), p<.001) and extraversion (r=-.36(**), p<.001) were negatively associated with mental distress.
Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.
... The situation-related factors prior to and during immigration as well as in the accommodating community may vary extremely and infl uence the mental state of those involved (Bhugra, 2004). Although in a large number of studies the migration status has been shown to be a risk factor for health problems (Bayard-Burfi eld et al., 2001;Bermejo et al., 2010;Merbach et al., 2008), there are many immigrants who stay healthy despite immigration-associated encumbrances. Due to the fact that immigration has become an integral phenomenon of extending scale in the globalized world it is worth exploring which factors may play a protective role for mental health of immigrants and, in this context, the protective function of SOC. ...
The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.
The destructive effects of racist discrimination can be observed on various levels. Chapter 3 deals, among other things, with the psychological and physical effects of racism and also goes into more detail on the effects in the school education structure. In numerous scientific articles, emotional stress and the resulting traumatic stress have already been reported. In addition to psychological consequences such as anxiety disorders, phobias and depression, physical complaints such as blood pressure changes and sleep problems can also occur. Through the phenomenon of migration, racist discrimination is increasingly occurring in schools, which not only has an impact on the psychosocial school results, but also the long-term school and professional career.
Die destruktiven Auswirkungen von rassistischer Diskriminierung können auf verschiedenen Ebenen beobachtet werden. Kapitel 3 beschäftigt sich unter anderem mit den psychischen und physischen Auswirkungen von Rassismus und geht ebenfalls näher auf die Auswirkungen in der Bildungsstruktur Schule ein. In zahlreichen wissenschaftlichen Artikeln wurde bereits über die emotionale Belastung und den einhergehenden traumatischen Stress berichtet. Neben psychologischen Konsequenzen wie Angststörungen, Phobien und Depressionen, können auch körperliche Beschwerden wie Blutdruckveränderungen und Schlafprobleme auftreten. Durch das Phänomen der Migration kommt es an Schulen vermehrt zu rassistischer Diskriminierung, die nicht nur Auswirkungen auf die psychosozialen schulischen Ergebnisse hat, sondern auch die langfristige Schul- und Berufslaufbahn beeinflusst.
Unter Akkulturation werden allgemein Anpassungsvorgänge von Personen mit Migrationshintergrund an eine neue Kultur und der Mehrheitskultur an kulturelle Vielfalt verstanden. Während klassische und weitverbreitete unidimensionale Ansätze (die Anpassung auf einem Kontinuum von dem Aufgeben der Herkunftskultur hin zur Anerkennung der Aufnahmekultur) den vielfältigen Modalitäten der heutigen globalisierten Welt nicht mehr gerecht werden, beziehen neuere bidimensionale Ansätze (Aufgabe und Anerkennung als voneinander unabhängige Variablen, Bikulturalität) Perspektiven der Theorie sozialer Identität zur funktionalen Betrachtung von identitätsstiftenden Intergruppenbeziehungen mit ein. Die Integration von sozialen Repräsentationen von Multikulturalismus in der Dynamik von kulturellen Anpassungsprozessen erweitern das Verständnis identitätsrelevanter Elemente innerhalb von Akkulturationsvorgängen um eine sinngestaltende inhaltsleitende psychologische Dimension. Eine Komplexität und Reflexivität gestattende Akkulturationsforschung wird der modernen Lebensrealität nicht nur gerechter, sondern antwortet auch auf den kritischen Appell sowohl von Seiten akkulturationstheoretischer als auch klinischer Akteure in Bezug auf eine alltagsrelevante gesundheitsbezogene Akkulturationsforschung, was am Beispiel von akkulturativen Stress aufgezeigt wird.
Objectives
Vietnamese in Germany represent a scarcely researched and vulnerable group for mental health problems, especially under exposure to migration-related stressors (MRS). This study analyzes the effect of those MRS on the severity level and symptom pattern of depression.
Design
We analyzed the data of 137 depressed Vietnamese patients utilizing Germany's first Vietnamese psychiatric outpatient clinic. Hierarchical linear regression models were applied to investigate how the quantity of MRS influenced (1) the overall severity of self-reported depression symptoms; (2) the cognitive, affective, and somatic BDI-II subscale; and (3) the single BDI-II items of these subscales.
Results
A greater number of MRS were related to a higher severity level of depression in general, as well as to a higher level on the cognitive depression subscale in particular. The BDI-II single items pessimism, past failure, guilt feelings, punishment feelings, and suicidal thoughts were particularly associated with a higher quantity of perceived MRS.
Conclusion
Among depressed Vietnamese migrants in Germany, a higher number of reported MRS were associated with higher overall depression severity. Within the domains of depression, particularly the cognitive domain was linked to perceived MRS. The association between MRS and suicidal thoughts is clinically highly relevant.
Transkulturelle Psychiatrie ist definiert als eine Richtung der Psychiatrie, die sich mit den kulturellen Aspekten der Ätiologie, der Epidemiologie und dem Erscheinungsbild sowie der Therapie und Nachbehandlung psychischer Krankheiten befasst. Ihre beiden hauptsächlichen Aufgabenfelder liegen auf dem Gebiet der kulturvergleichenden Analyse psychischer Störungen und in der Entwicklung von Therapieverfahren mit kulturspezifischer oder auch mit kulturübergreifender Wirksamkeit. In dieser Hinsicht ist ihr praktisches Anliegen, eine kulturkompetente psychiatrische-psychotherapeutische Versorgung von ethnischen Minoritäten und Migranten sicherzustellen. Für die Diagnostik psychischer Störungen aus kultureller Sicht sind Leitlinien und Standards entwickelt worden, anhand derer die Betroffenen angemessener beurteilt werden können. Schizophrenie, akute vorübergehende Psychosen und affektive Erkrankungen sind z. T. erheblichen Unterschieden in Prävalenz und Erscheinungsbild in verschiedenen Kulturen der Welt unterworfen und bedürfen kulturell adaptierter Behandlungskonzepte. Gleiches gilt für Angstsyndrome, Anpassungs- und Persönlichkeitsstörungen. Eine Ausnahme bilden die kulturabhängigen Syndrome (CBS), deren Verbreitung sich auf bestimmte Regionen und Kulturkreise beschränkt, die aber vereinzelt auch bei Migranten beobachtet werden können. Migranten entwickeln im Zusammenhang mit dem Migrationsprozess und der „kulturellen Adoleszenz“ als Integrationsleistung in der Aufnahmegesellschaft eine erhöhte Vulnerabilität, in deren Folge es bei erheblichen Stressoren zur Manifestation psychischer Störungen kommen kann. Nur für einzelne diagnostische Bereiche sind bei bestimmten Migrantengruppen erhöhte Prävalenzen wahrscheinlich, wie z. B. für psychotische, affektive, Angst und psychosomatische Störungen. Die psychiatrisch-psychotherapeutische Versorgung verfolgt das Konzept der Integration der Patienten mit Migrationshintergrund in die stationäre und ambulante Regelversorgung. In diesem Bemühen sind im zurückliegenden Jahrzehnt unter Berücksichtigung der „Sonnenberger Leitlinien“ bedeutsame Fortschritte erzielt worden.
Menschen mit Migrationshintergrund werden in der gesundheitlichen Versorgung sichtbarer. Das liegt zum einen daran, dass ihr Anteil an der Gesamtbevölkerung steigt. So hatten von den knapp 81 Mio. Einwohnern Deutschlands 16,4 Mio. einen Migrationshintergrund (darunter 10,9 Mio. mit eigener Migrationserfahrung und 9,2 Mio. mit deutscher Staatsbürgerschaft). Dazu kommen 1,1 Mio. Geflüchtete (428.456 Syrer, 154.046 Afghanistani und 121.662 Iraki), die sich im Jahr 2015 registrieren ließen, knapp 500.000 konnten einen Asylantrag stellen, darunter 162.510 Syrer, 54.762 Albaner und 37.095 Kosovaren. Auch diese Personen erkranken und müssen entsprechend versorgt werden; teilweise sind Erkrankungen auch die Fluchtursache, beispielsweise wenn die medizinische Behandlung im Herkunftsland nicht gewährleistet ist.
Zum anderen ändert sich auch die Altersstruktur der Menschen mit Migrationshintergrund, die bereits seit vielen Jahren in Deutschland leben: Die in der 1970er-Jahren eingereisten Gastarbeiter kommen nun ins Rentenalter. Dies stellt auch die gesundheitliche Versorgung vor neue Herausforderungen. Wir müssen uns deshalb verstärkt mit der Frage auseinandersetzen, wie eine kultur-, flucht- und migrationssensible gesundheitliche Versorgung aussehen kann.
Background:
Immigration, both voluntary and forced, is driven by social, political and economic factors. Accordingly, some discussions and debates have emerged in recent years about the impact of migration on the health status of migrants. The aim of this review was to identify the impact of migration on the health status of Iranian immigrants and present a conceptual framework to facilitate the design and delivery of services and supports for this particular immigrant group.
Methods:
Data for this integrative review were collected from Medline, PsycINFO, Scopus, ProQuest, Academic Search Complete, CINAHL, and Google Scholar search engine. The database search was limited to peer-reviewed literature, published in English, between 1980 and 2013.
Results:
Twenty six articles were included in the review. Analysis revealed several factors influencing the mental health of immigrants, including language insufficiency; unemployment; sense of discrimination; cultural shock; lack of social support; lack of information about health care services; and intimate partner violence.
Conclusion:
Findings of this review have contributed to development of a conceptual framework that delineates the impact of migration on Iranian immigrants' health. This conceptualization may also help in addressing the needs of other vulnerable groups during the transition phase of migration.
Intercultural psychotherapeutic treatment must involve the psychological integration of different cultures within an individual as an additional developmental dimension. The literature concerning acculturation and mental health yields heterogeneous results concerning strategies of adaptive acculturation. In intercultural psychotherapy the integration strategy is usually the strategy with the highest adaptability. It is still uncertain which theoretical assumptions might be applicable to a healthy acculturation process. However, it is assumed that increased acculturative stress may lead to higher risk and susceptibility for emotional distress and depression.
Individual change during the course of migration towards a bicultural identity that includes aspects of both the culture of origin and of the host culture has often been viewed as a desirable adaptation, although the theoretical foundation of the concept of bicultural identity remains inadequate. The cultural-dynamic model presented here distinguishes between personal and social identity on the basis of the identity concept proposed by Mead (1988). We discuss implications for the intercultural psychotherapeutic process, for identity configuration in second-generation migrants, for different phases of the lifespan, and in acquiring the language of the host culture.
We examined psychosocial and informational services used by long-term survivors of breast, colon and prostate cancer in immigrants versus non-immigrants.
Patients were sampled from population-based cancer registries in Germany. They completed a questionnaire assessing immigration biography, service use and socio-demographic characteristics.
Data of 6143 cancer survivors were collected of whom 383 (6%) were immigrants. There was no evidence of an association between immigration status and service use. However, immigration biography played a role when patients' and their parents' birthplace were taken into account. When parents were born outside Europe, survivors less frequently used information from the Internet (ORadj 0.4, 95% CI 0.2; 0.8). Web-based information (ORadj 0.7, 95% CI 0.5; 0.9) was less frequently used when the participant was born outside Germany.
The differences in the use of psychosocial and informational services between immigrants and non-immigrants seem to be generally small. Acculturation may play a role in service uptake. In survey-based health services research, investigators should not stratify by census-defined immigration status, but rather by cultural background. Copyright © 2014 John Wiley & Sons, Ltd.
Copyright © 2014 John Wiley & Sons, Ltd.
In low- and middle-income countries, migration to urban settings has reshaped the sprawl and socio demographic profiles of major cities. Depressive episodes make up a large portion of the burden of disease worldwide and are related to socio-demographic disruptions. As a result of terrorism, political upheaval, followed by economic development, Peru has undergone major demographic transitions over the previous three decades including large migrations within the country. We aimed to determine the prevalence of current depressive mood and its relationship with parameters of internal migration, i.e. region of origin, age at migration, and years since migration. A community-wide census was carried out between January and June 2010 within a shantytown immigrant receiving community in Lima, Peru. One male or female adult per household completed a survey. Depressive mood was assessed with a 2-item Center for Epidemiologic Studies Depression (CESD) scale. Migration-related variables included place of birth, duration of residence in Lima, and age at migration. Prevalence ratios (PR) and 95 % confidence intervals (95 % CI) were calculated. A total of 8,551 out of 9,561 participants, response rate 89 %, participated in the census. Of these, 8,091 records were analyzed: 71.8 % were women [average age 39.4 (SD 13.9 years)] and 59.3 % were immigrants. The overall prevalence of individuals with current depressive mood was 17.1 % (95 % CI 16.2–17.9 %) and varied significantly by all socio-demographic and migration variables assessed. On unadjusted analyses, immigrants to Lima had higher prevalence of depressive mood if they originated in other costal or Andean areas, had lived in Lima for more than 20 years, or were
Anliegen: Bei älteren jüdischen Menschen wurde der Einfluss von Diskriminierung und Religiosität auf psychische Gesundheit untersucht. Methodik: Angst- und Depressionswerte (PHQ-4) wurden erhoben (n = 110) und Regressionsmodelle als statistische Analysen berechnet.
Ergebnisse: Ältere jüdische Einwanderer mit Dis- kriminierungserfahrungen zeigen höhere PHQ-4- Werte. Die Aufenthaltsdauer ist mit Angst und Religiosität mit Depression positiv assoziiert. Schlussfolgerung: Der negative Einfluss von Diskriminierung wurde belegt und die Bedeutung der Integration jüdischer Einwanderer verdeutlicht.
The present study explores the impact of acculturation on depressive symptoms among Turkish immigrants in Germany, taking into account different dimensions of cultural orientation. A total of 471 patients from two selected samples (254 primary care patients and 217 outpatients of a psychosomatic department) participated. Levels of acculturation were measured as orientation towards culture of origin (CO), and orientation towards the host culture (HC). Acculturation strategies (integration, assimilation, separation, and marginalization) were also assessed as well as their association with depressive symptoms (BDI). Furthermore, gender- and migration-related differences in terms of acculturation and levels of depressive symptomatology were analyzed. Integration was the acculturation strategy associated with the lowest level of depressive symptoms (M = 14.6, SD = 11.9), while marginalization was associated with the highest (M = 23.5, SD = 14.7). Gender was not found to have a significant impact on acculturation but influenced depressive symptoms, with women (M = 21.8, SD = 13.3) reporting higher levels of depressive symptomatology than men (M = 15.1, SD = 14.0; p < 0.001). In first generation immigrants, significantly higher CO (M = 46.6, SD = 8.3; p < 0.001), lower HC (M = 31.0, SD = 9.6; p < 0.001), and higher levels of depressive symptoms (M = 20.2, SD = 14.1; p < 0.001) were found in comparison to second generation immigrants (CO: M = 41.3, SD = 7.4; HC: M = 36.2, SD = 8.8; depressive symptoms: M = 14.0, SD = 12.9). Our results suggest that orientation towards both the heritage and the host culture has a positive effect on the mental health status of immigrants. Future research needs to include representative samples of migrants from different cultures to further explore the association between acculturation and mental health.
Die psychosomatische, rehabilitative Behandlung von Patienten mit Migrationshintergrund gewinnt zunehmend an Bedeutung. Hauptursache für die bei ihnen beobachteten schlechteren Behandlungsergebnisse in der psychosomatischen Rehabilitation und für erhöhte Berentungszahlen im Vergleich zu deutschen Rehabilitanten sind neben kulturellen Unterschieden vermehrt vorliegende Hemmfaktoren. Im vorliegenden Beitrag werden Perspektiven für die psychosomatische Rehabilitation erarbeitet, die sich nicht mehr allein auf den Migrationshintergrund als Ursache schlechterer Behandlungsergebnisse konzentrieren, sondern auch die bei Versichertengruppe vorhandenen Hemmfaktoren berücksichtigen. Damit wird die Notwendigkeit integrativer und flexibilisierter Formen psychosomatischer Rehabilitation deutlich, die zusätzliche Komponenten wie psychosomatisches Fallmanagement, ambulante psychosomatische Nachsorge und prästationäre Vorbereitungsgruppen beinhalten.
The psychosomatic rehabilitation of migrants is often unsuccessful. This is partly due to the language barrier, the social medical situation, the trend to somatization and last but not least in many cases the continual late start of the treatment. The migrants at the time of admission are already in an advanced disintegration process. Questions and methods: It is being investigated which prediction validity the migration background has for subjective prediction of future employment taking into consideration the personal and environmental factors. 640 rehabilitants were interviewed at the beginning of their inpatient rehabilitation with regard to their complaint load, their working motivation, their mobbing experience and their subjective future prospects of gaining employment. Results: 28.5% of the rehabilitants came from a migration background. The subjective prediction of gaining employment was dependent on the extent of their complaint load and their incentive to come to grips with the work-related problems. Simultaneously the lower class affinity increased the risk of a negative prognosis. In contrast to this, the influence of a migration background was of secondary importance. Discussion: In order to improve the rehabilitation prognosis all personal and environmental factors, irrespective of migration status, should be taken into consideration. A culturally sensible and work related case management could improve the care of the migrants and produce the desired results.
Objective: There is a lack of empirical studies focusing on mental health in Jews from former Soviet Union in Germany. The influence of discrimination and religiosity on symptoms of depression and anxiety was investigated. Methods: 110 elderly Jews living in Leipzig and Halle/Saale were asked to fill out a questionnaire including information about their immigration background (length of stay, age at migration, and country of origin), perceived discrimination, religiosity and level of integration. Depression and anxiety were assessed with PHQ-4. Linear regressions were applied as statistical tests. Results: Participants who live alone and report higher level of perceived discrimination indicate higher anxiety and depression scores. Length of stay is positively associated with anxiety, as well as religiosity with symptoms of depression. Conclusions: Some results are similar to the findings of others international studies, some other findings underline the specificity of the target group. The influence of discrimination has been demonstrated, implications for further investigation, especially with attention to the integration of older Jews from former Soviet Union in Germany are given.
The roots of transcultural psychiatry in Germany can be traced back to Emil Kraepelin, who made the first culturally comparative observations on mental disorders in Southeast Asia at the start of the 20th century. Since the beginning of the 1970s, contributors to the literature of transcultural psychiatry in Germany have been predominantly concerned with the mental health of migrant workers from Mediterranean countries, particularly the practical difficulties and therapeutic implications of inpatient psychiatric treatment of these migrant groups. The inauguration of the Section on Transcultural Psychiatry of the German Association for Psychiatry and Psychotherapy 20 years ago reflected an increasing scientific interest in this topic. In addition to the psychic impact of migration, research into transcultural care is currently focused on disparities in the utilization of health care and conjectured barriers to access to health and mental health care among migrants. Furthermore, studies based on epidemiological approaches have been carried out in order to resolve the question of whether migrants are as affected by mental disorders as the ethnic German population, and which issues contribute to the so-called "healthy migrant" effect. Other topics that have been explored in the last 10 years are the particular psychosocial situation of asylum seekers and refugees in Germany, and the effects of inadequate integration and discrimination on their mental health. In summary, after a short historical and theoretical overview, this article reviews the current major themes in transcultural research in German contemporary psychiatry, and concludes with an overview of future developments in this field.
Die psychosomatische Rehabilitation von Migranten ist in vielen Fallen nicht erfolgreich. Neben der sprachlichen Barriere wird die sozialmedizinische Situation, die Somatisierungstendenz, aber auch der haufig zu spate Zeitpunkt der Behandlung zur Erklarung herangezogen, dass Migranten sich bei Aufnahme in eine psychosomatische Rehabilitationsklinik bereits in einem fortgeschrittenen Desintegrationsprozess befinden. Fragestellung und Methodik: Es wird untersucht, welche Vorhersagevaliditat der Migrationshintergrund fur die subjektive Prognose der Erwerbstatigkeit unter Berucksichtigung personlicher und umweltbezogener Faktoren hat. 640 Rehabilitanden wurden zu Beginn der stationaren Rehabilitation hinsichtlich ihrer Beschwerdebelastung, ihrer Arbeitsmotivation, zum Mobbingerleben und zur subjektiven Prognose der Erwerbstatigkeit befragt. Ergebnisse: 28.5 % der Rehabilitanden hatten einen Migrationshintergrund. Die subjektive Prognose der Erwerbstatigkeit war vom Ausmas der Beschwerdebelastung und der Motiv...
Objectives:
This survey examines the mental health of immigrants of Polish origin compared to samples from the Polish and German populations.
Methods:
In a sample of 513 subjects (261 persons with Polish migration background and 252 autochthone Poles) depression (BDI), anxiety (BAI), and somatic complaints (GBB-24) were measured.
Results:
Immigrants of Polish origin showed a significantly higher level of anxiety as well as somatic complaints but only a tendency toward higher depressiveness than the German normvalue, but not than that of the native Poles. Female immigrants showed an overall higher number of symptoms in the three domains in question compared to German women and - except for depressiveness - also compared to male immigrants.
Conclusions:
Persons with a Polish migration background present levels of mental distress higher than the general German population, but similar to the population of their country of origin. Further research is needed to clarify the special structure of the mental morbidity in Polish immigrants.
The mental health status of persons with Jewish background living in Germany is discussed with special regard to social exclusion like anti-Semitism and overprotective parental rearing behavior, as a transmissional factor of the KZ-Syndrome. These stressors are considered in the context of a higher risk for depression/fear and psychosomatic disorders and also abnormal cortisol levels. The present sample (N=89) is derived from the Jewish population currently living in the German region of Saxony aged between 17-36 years that emigrated from the post-Soviet-Union areas. The mean age was 22.9 years. Two questionnaires to detect psychosomatic symptoms (Giessen complaint list (GBB)-24, hospital anxiety and depression scale) and one questionnaire addressing parental rearing behavior (FEE) were employed. Comparisons were drawn with normative data from the literature about the German residential population. In addition, questions were asked concerning the experience of anti-Semitism in Germany and in the post-Soviet-Union areas. A higher prevalence of depression/fear (10.3% versus 18.2%) and psychosomatic symptoms (M=14.03 versus 17.8; t=2.42; P<0.05) was observed in Jewish migrants to Germany as compared with non-Jewish German residents. Furthermore, anti-Semitic experiences in Germany correlated positively with depression (r=0.293; P<0.01) and fear (r=0.254; P<0.05). The anti-Semitic experiences in the post-Soviet-Union areas also correlated positively with limb pain (r=0.41, P<0.01), fatigue symptoms (r=0.296, P<0.01) and psychocardial symptoms (r=0.219, P<0.05). It was also confirmed that the male respondents recalled a controlling and overprotecting maternal rearing behavior more frequently than the German standard random sample (M=15.39 versus 18.6; t=2.68; P<0.01). The latter also correlated significantly positive with epigastric pain (r=0.349; P<0.01). The present results show that depression, fear and psychosomatic problems are common in Jewish residents with a background of migration from the post-Soviet-Union areas to Germany. Apart from the transgenerational passing of psychological traumata and the Holocaust experiences, other stressors like anti-Semitism, control and overprotection as parental rearing measures appear to be important factors specifically contributing to the pathogenesis of the attributed symptoms.
Many immigrants face more economic strains and hardship than non-immigrants. Income inequality and an increasing social gap between immigrants and non-immigrants in Europe warrant further studies on the impact of socioeconomic factors on health in immigrant groups. The purpose of this study was to examine the association of socioeconomic status (SES) and emotional distress in women of Turkish descent and in women of German descent.
A total of 405 women of German or Turkish descent residing in Berlin were interviewed. Emotional distress was assessed by the General Health Questionnaire-28 (GHQ-28), and SES was examined by level of education, employment status, and income. The associations of emotional distress and SES were estimated in multivariate linear regression analyses.
Unemployment was associated with increased levels of emotional distress in all women, with the highest level of distress in the group of unemployed Turkish women. The overall SES level was related to a greater level of emotional distress in Turkish women, but not in German women (-3.2, 95%CI -5.9 - -.5; p=.020 vs. -.8, 95%CI -2.7 - 1.2; p=.431). Further stratified analyses by relationship status revealed that the association of SES and emotional distress only remained significant among single women.
The impact of socioeconomic hardship appears to be complicated by social roles and expectations related to these. Further in-depth study of the complex nature of the interaction of social roles and socioeconomic position in female Turkish immigrants in Germany is needed to better understand differing risk patterns for emotional distress.
Transkulturelle Psychiatrie ist definiert als eine Richtung der Psychiatrie, die sich mit den kulturellen Aspekten der Ätiologie,
der Epidemiologie und dem Erscheinungsbild sowie der Therapie und Nachbehandlung psychischer Krankheiten befasst. Ihre beiden
hauptsächlichen Aufgabenfelder liegen auf dem Gebiet der kulturvergleichenden Analyse psychischer Störungen und in der Entwicklung
von Therapieverfahren mit kulturspezifischer oder auch kulturübergreifender Wirksamkeit. In dieser Hinsicht ist ihr praktisches
Anliegen, eine möglichst gute psychiatrische Versorgung von ethnischen Minoritäten und Migranten zu erreichen. Für die Diagnostik
und Therapie psychischer Störungen aus kultureller Sicht sind Leitlinien entwickelt worden, anhand derer Betroffene angemessener
beurteilt und behandelt werden können.
This paper analyses the psychopathology and differential diagnosis of anxiety disorders and their worldwide prevalence. It focuses particularly on migrant-specific aetiopathogenetic factors and approaches prevalence and important cultural aspects of anxiety disorders in migrants as a narrative empirical review.
Transcultural research demonstrates the universal existence of anxiety disorders. However, the cross-cultural comparison of the epidemiological data is complicated and often leads to systematic bias. The described psychopathology varies significantly across cultures, indicating different ways of expressing and experiencing the basic emotion of anxiety. As a result, anxiety disorders manifest themselves differently across cultures, which may affect the diagnostic and therapeutic procedure. Migration is an additional extraordinary stressor playing a substantial role in the development of anxiety disorders. However, despite the high prevalence of anxiety disorders among migrants, a high threshold due to several barriers leads to an underrepresentation of migrants in the utilization of the mental health system.
In the transcultural differential diagnosis of anxiety disorders, as among migrants, understanding and openness to other cultures and their standards is essential. Thereby, a migrant-specific treatment approach with a long-term binding of patients in a multimodal and culture-sensitive and -permissive treatment option is of vital importance.
In this study the prevalence and comorbidity of mental disorders were examined for the first time with the Structured Clinical Interview for DSM-IV (SCID-I) in a consecutive sample of Turkish speaking patients (n=51). The symptom severity of the depressiveness was measured with the Beck Depression Inventory (BDI), of the somatoform complaints with the Screening for Somatoform Symptoms (SOMS) and of the posttraumatic stress disorder (PTSD) with the Essen Trauma Inventory (ETI). The most common current diagnoses were the somatization disorder (41.2%; n=21), a single episode of major depression (37.3%; n=19) and the PTSD (31.4%; n=16). In 80.4% (n=41) of the patients at least one comorbid mental disorder was documented. In comparison with German reference values the Turkish patients showed a significant higher severity of the depressive and posttraumatic, however not of the somatoform symptomatology.
© Georg Thieme Verlag KG Stuttgart · New York.
This study aims to investigate whether there are differences in the prevalence of common mental disorders and social capital between migrant and non-migrant groups in Peru.
The PERU MIGRANT study is a cross-sectional study comprising three groups: an urban group from a shanty town in Lima; a rural group from a community in Ayacucho-Peru; and a migrant group originally from Ayacucho currently living in the same urban shanty town. Common mental disorders were assessed using the General Health Questionnaire (GHQ-12), and social capital was assessed using the Short Social Capital Assessment Tool (SASCAT). Poisson regression with robust standard errors was used to estimate prevalence ratios.
The overall prevalence of common mental disorders was 39.4%; the highest prevalence was observed in the rural group. Similar patterns were observed for cognitive social capital and structural social capital. However after adjustment for sex, age, family income and education, all but one of the significant relationships was attenuated, suggesting that in this population migration per se does not impact on common mental health disorders or social capital.
In the PERU MIGRANT study, we did not observe a difference in the prevalence of common mental disorders, cognitive and structural social capital between migrant and urban groups. This pattern of associations was also similar in rural and urban groups, except that a higher prevalence ratio of structural social capital was observed in the rural group.
Two paradigms that have shaped our understanding of refugee health are identified: the objectification of refugees as a political class of excess people, and the reduction of refugee health to disease or pathology. Alternative paradigms are recommended: one to take the polyvocality of refugees into account, and one to construe refugees as prototypes of resilience despite major losses and stressors. The article is organized into three sections, mirroring the life history of refugees from internal displacement in the country of origin to asylum in a second (usually neighboring) country, and for some, to permanent resettlement in a third country. In each of the three sections, the primary topics that are treated in the literature are identified, and key problems identified for discussion.
Illinois vital records for 1982/1983 and US census income data for 1980 were analyzed to ascertain the relationship of income incongruity, race, and very low birthweight.
Positive income incongruity was considered present when study infants resided in wealthier neighborhoods than non-Latino Whites at the same level of parental education attainment and marital status.
The odds ratios of very low birthweight for African Americans (n = 44,266) and Whites (n = 27,139) who experienced positive income incongruity were 0.7 (95% confidence interval [CI] = 0.5, 0.9) and 0.6 (95% CI = 0.5, 0.9), respectively.
Positive income incongruity is associated with lower race-specific rates of very low birthweight.
Knowledge about the frequency, severity, and risk factors of somatization (somatic manifestations of psychological distress) among immigrants is limited. The authors examined somatic distress in an immigrant population in Israel, explored its relationship with psychological distress symptoms and health-care-seeking behavior, and determined its correlation with the length of residence in Israel.
Two reliable and validated self-report questionnaires, the Brief Symptom Inventory and the Demographic Psychosocial Inventory, were administered in a cross-sectional community survey of 966 Jewish immigrants from the former Soviet Union who had arrived in Israel within the previous 30 months.
The 6-month prevalence rate for somatization was 21.9% and for psychological distress, 55.3%. The current rate of co-occurrence of somatization and psychological distress was 20.4%. The most common physical complaints were heart or chest pain, feelings of weakness in different parts of the body, and nausea. Somatization was positively correlated with the intensity of psychological distress and with help-seeking behavior during the 6 months preceding the survey. Women reported significantly more somatic and other distress symptoms than men. Older and divorced or widowed individuals were more likely to meet the criteria for somatization. Within the first 30 months after resettlement, longer length of residence was associated with higher levels of somatization symptoms.
Somatization is a prevalent problem among individuals in cross-cultural transition and is associated with psychological distress; demographic characteristics such as gender, age, marital status, and duration of immigration; self-reported health problems; and immigrants' help-seeking behavior.
This study examined the relationship among acculturative stress, depression, and suicidal ideation in a sample of Mexican immigrants. Also examined were variables that predict depression and suicidal ideation. Multiple regression analyses revealed that acculturative stress significantly predicted depression and suicidal ideation and that family support, social support, religiosity, agreement with the decision to migrate, and expectations for the future were significant predictors of depression and suicidal ideation. The overall findings suggest that adult Mexican immigrants who experience elevated levels of acculturative stress may be at risk for experiencing critical levels of depression and suicidal ideation. The findings highlight the importance of using culturally relevant clinical methods when assessing and treating the depressed and potentially suicidal acculturating individual.
The reasons for a greater prevalence of psychological distress among women than men remain unknown. We sought to test two hypotheses that gender operates either as (1) a moderator or (2) a mediator between psychosocial risk factors and experienced distress. A cross-sectional community survey of 1,062 adult Russian-born Jewish immigrants to Israel was conducted. The Demographic Psychosocial Inventory (DPSI) and the Talbieh Brief Distress Inventory (TBDI) were used to measure the parameters of interest. Univariate and multivariate analyses were used to test the moderation versus mediational hypotheses of gender in the stress-distress relationship. The aggregate levels of psychological distress and depression, anxiety, and obsessive symptoms were significantly higher for women than for men. Five sources of distress were more likely to be reported by women: family problems, inappropriate climatic conditions, anxiety about the future, poor health status, and uncertainty in the present life situation. Men scored higher on three stress-protective factors: the number of reasons for immigration, commitment to the host country, and job adequacy. Results of multiple regression and multivariate analysis of variance (MANOVA) supported the mediation hypothesis that gender differences in psychological distress stem from women's greater exposure to specific psychosocial stressors. Our findings demonstrate the validity of gender as an important mediating mechanism underlying the differential perception of risk factors for the development of psychological distress.
This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage).
The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals.
The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation.
These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity.
Examined the relationship among acculturative stress, depression, and suicidal ideation in a sample of 114 17–77 yr old Mexican immigrants. Also examined were variables that predict depression and suicidal ideation. Multiple regression analyses revealed that acculturative stress significantly predicted depression and suicidal ideation and that family support, social support, religiosity, agreement with the decision to migrate, and expectations for the future were significant predictors of depression and suicidal ideation. The overall findings suggest that adult Mexican immigrants who experience elevated levels of acculturative stress may be at risk for experiencing critical levels of depression and suicidal ideation. The findings highlight the importance of using culturally relevant clinical methods when assessing and treating the depressed and potentially suicidal acculturating individual.
The aim of this study was to compare experiences of discrimination and their influence on trust in authorities and psychological distress among immigrants in Finland. A sample of 1146 immigrants, aged between 20 and 36 and representing seven immigrant groups (Russians, Ingrian/Finnish returnees, Estonians, Somalis, Arabs, Vietnamese and Turks), answered a mailed questionnaire based on traditional acculturation research as well as victim research. In accordance with our expectations, discrimination experiences in various realms of life were highly predictive of the psychological well-being of all immigrants, as well as of lack of trust in the Finnish authorities. However, contrary to our hypotheses regarding the effects of visibility and cultural proximity, group differences in psychological distress did not correspond to the group differences observed in perceived discrimination. These results are discussed in the light of the opposing predictions concerning self-damage effects of discrimination, made by social identity theory on the one hand and the theory on self-protecting functions of external attributions (Crocker and Major, 1989) on the other. It is concluded that the low level of stress observed in the most visible and most culturally distant group, despite high levels of perceived discrimination, is better explained by the latter than the former.
Ethnic gaps in mortality persist in the United States but the specific causes remain elusive. We propose a broader mortality framework that includes neighborhood characteristics that we test using data from a file that links the National Health Interview Survey (NHIS) from 1986 through 1990 with information from death certificates from the National Death Index (NDI), and additional census tract-level data from the 1990 Census STF-3A files. Cox proportional hazards models, which include measures of minority concentration and median income at the neighborhood level, for all-cause mortality during the follow-up, are estimated for men and women separately. The concentration of African Americans in the neighborhood of residence, in addition to individual socioeconomic status, fully account for differential mortality between African American and non-Hispanic white men and women. For Mexican Americans, the concentration of Hispanics in the neighborhood slightly enhances their significant mortality advantage. From additional analyses, it appears that the pathway between residential segregation and mortality is routed through poorer neighborhood economic conditions for men and high levels of female headship in segregated neighborhoods for women. The final analysis conducted for men by age at death shows that both young and middle-aged African American men are affected by the concentration of African Americans in the community.
This article examines ethnic differences in total and cause-specific mortality. We employ the linked National Health Interview
Survey-National Death Index (NHIS-NDI) to examine ethnic differences in mortality from a combination of demographic, socioeconomic,
and health characteristic perspectives. We find that Asian American mortality is low in part because of healthy behaviors
and socioeconomic advantages; that Caucasian American mortality is higher partly because of high prevalence and quantity of
cigarette smoking; and that Mexican, Native, and African American mortality is higher partly from socioeconomic disadvantages.
These results give us added insight into the demographic, social, and health mechanisms that lead us to persevere or to perish.
Fragestellung
Sind Unterschiede zwischen den deutschen und den türkischstämmigen Frauen hinsichtlich der psychischen Befindlichkeit bei Klinikaufnahme nachweisbar? Ergibt sich ein differenziertes Bild innerhalb der Gruppe der türkischen Migrantinnen in Abhängigkeit von der Migrationsgeneration oder dem Akkulturationsgrad?
Patientinnen und Methodik
Im Rahmen eines Public Health-Projekts zur Analyse der Versorgungssituation gynäkologisch erkrankter deutscher und türkischer Frauen im Krankenhaus wurden u. a. soziodemographische Faktoren, Angaben zu Migration und Akkulturation, Gesundheitswissen und -verhalten, subjektiver Krankheitstheorie und Lebenszufriedenheit erfasst. Die subjektive Beeinträchtigung der befragten Patientinnen durch körperliche und psychische Symptome wurde mit dem psychometrischen Fragebogen SCL-90-R (neun Skalen: Somatisierung, Zwanghaftigkeit, Unsicherheit, Depressivität, Ängstlichkeit, Feindseligkeit, phobische Angst, paranoides Denken, Psychotizismus) untersucht. Im Untersuchungszeitraum 3/97 bis 10/98 konnten 320 Patientinnen deutscher und 262 türkischer Herkunft mittels in deutscher und türkischer Sprache vorliegender mehrteiliger Fragebogensets am Beginn des stationären Aufenthalts auf den gynäkologischen Stationen des Virchow-Klinikums/Berlin befragt werden.
Ergebnisse und Schlussfolgerungen
In die Auswertung des SCL-90-R einbezogen werden konnten 230 türkische und 264 deutsche Frauen (Rücklaufquote 88 bzw. 83 %). Nach Bildung von sechs sozio-demographisch ähnlich zusammengesetzten Subgruppen zeigte sich im Vergleich zu den Werten im deutschen Kollektiv bei den türkischstämmigen Migrantinnen in den meisten Einzelskalen des SCL-90-R als auch global eine höhere psychische Symptombelastung am Aufnahmetag in die Klinik. Wesentliche Unterschiede in der psychischen Belastung zwischen „mehr“ oder „weniger“ akkulturierten türkischstämmigen Frauen ließen sich nicht nachweisen. Frauen der zweiten Migrationsgeneration, für die eine am wenigsten unmittelbare Migrationserfahrung anzunehmen ist, fühlten sich gegenüber Frauen der ersten Generation bzw. den nachgezogenen Ehefrauen stärker durch die mit SCL-90-R gemessenen psychischen Symptome belastet.
This chapter reviews recent studies of socioeconomic status (SES) and racial differences in health. It traces patterns of the social distribution of disease over time and describes the evidence for both a widening SES differential in health status and an increasing racial gap in health between blacks and whites due, in part, to the worsening health status of the African American population. We also describe variations in health status within and between other racial populations. The interactions between SES and race are examined, and we explore the link between health inequalities and socioeconomic inequality both by examining the nature of the SES gradient and by identifying the determinants of the magnitude of SES disparities over time. We consider the ways in which major social structures and processes such as racism, acculturation, work, migration, and childhood SES produce inequalities in health. We also attend to the ways in which other intervening factors and resources are constrained by social str...
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Differences between Eastern European immigrants of German origin and the rest of the German population in health status, health care use and health behaviour: a comparative study using data from the KORA-Survey 2000
Objectives: To identify differences in health status, health care use and health behaviour between Eastern European immigrants of German origin and the rest of the German population in order to develop new concepts for preventive programs.
Methods: Using data from the KORA-Survey 2000 (Cooperative Health Research in the Region of Augsburg), immigrants of German origin were compared to the rest of the German population with multiple regression models controlling for sex, age, living with partner, years of education and occupation. Tests of trend were performed for the groups classified according to the year of immigration.
Results: Compared to other Germans, immigrants of German origin consider their health status more often as poor. They were more likely to be obese (OR = 1.95) and have hyperlipidemia (total-cholesterol/HDL-C > 4: OR = 1.71). They were less likely to use cancer screening (OR = 0.41) or to perform sport activities (OR = 0.47). All these differences decrease with the length of residence in Germany.
Conclusions: Concerning their health status, Eastern European immigrants of German origin were identified as a high risk group. They should be considered for specific preventive programs and health care interventions, especially during the first years of immigration.
In this paper we examine the hypothesis that health differences between Blacks and Whites in later life are related to socioeconomic status. Using the 1984 panel of the Survey of Income and Program Participation, we construct four measures of health and two measures of health care service utilization. Multivariate analyses show that the racial differences are eliminated in some measures of health and health care service utilization after holding constant individual-level socioeconomic characteristics and resources. However, even after accounting for differences in socioeconomic status, Black self-rated health is poorer than that of Whites. Further, Blacks report more visits to medical personnel but do not report higher rates of hospitalization when levels of health and economic resources are controlled. Additional analyses suggest that the impact of socioeconomic status on health is different for Blacks than for Whites.
Acculturation, the process whereby immigrants change their behavior and attitudes toward those of the host society, is a fundamental part of migration-induced adaptations to new sociocultural environments. A rapidly expanding research literature on acculturation has accompanied the growth of international migrations. In response to the need to integrate the growing literature on acculturation and mental health status among Hispanics in the United States, and to identify points of convergence and new directions for research, 30 publications were examined. Points of convergence are identified, as are problems and limitations. The research needs new directions, proceeding from but not constricted by the assumptions and procedures in the work already done.
Synopsis
Data are presented from a study of acculturation and psychiatric disorder in 291 Greek Cypriot immigrants from the general population of Camberwell, south London. We hypothesized that ‘pre-acculturation’ would protect against mental disorder, that difficulties in the period immediately after migration would increase the risk of disorder, and that disorder would be least common among those in the middle range of the acculturation spectrum.
Of pre-acculturation factors, only previous knowledge of English was associated with reduced prevalence. Difficulties in the settling-in period were clearly related to current disorder. No relationship was apparent between present acculturation and disorder, but this disguised an interesting but unpredicted gender effect: in males, disorder was most prevalent in the highly acculturated; in females, in the least acculturated.
The study investigates psychosomatic disturbances in Turkish women patients treated in general practices. Our research-tools were the Giessen-List of psychosomatic complaints and the doctors' charts. 25 patients were extensively interviewed. The whole sample was divided into one subgroup of more, one of less acculturated women. There were significant differences between the groups: in the non-acculturated group we found more psychic symptoms (depression, loss of interest, hypersensitivity). Acculturated women tend to see the physician more frequently and are more often certified ill for physical symptoms. Compared with a German sample the Turkish women showed a significant higher prevalence of somatic complaints.
A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
International and national research has documented the relations between socio-economic conditions and health. Nonetheless, racial/ethnic group comparisons of health indices frequently are presented in the United States without stratifying or adjusting for socio-economic conditions that could affect interpretation of the data. This paper examines how racial/ethnic group identifiers have been used in past research. While some studies assume biologic differences; others presume that race/ethnicity is a proxy for socio-economic race factors. One consequence of these presumptions has been an underdevelopment of knowledge about racial/ethnic minority populations that could help shape public policies and preventive interventions to reduce disparities in health. Findings from studies that examine the influence of both race and social class on health are reviewed in an effort to clarify the state-of-knowledge. Although the findings vary for particular health indices, the studies provide considerable evidence that socio-economic conditions are a powerful, although not necessarily exclusive, explanatory variable for racial disparities in health. The findings are used as the basis for encouraging more theoretically grounded and methodologically rigorous research rather than avoiding an assessment of the influence of race/ethnicity on health.
Except for that of skilled and professional personnel, labour migration has practically ceased in Europe since the mid-1970s, and many of those who migrated as single males now have families in host countries. In Switzerland, among school-attending adolescents both of whose parents were born outside the country, some three quarters are children of labour migrants. Our hypothesis is that these adolescents present particular adjustment difficulties attributable to low socio-economic status and double cultural affinity.
To compare Swiss and labour-migrant adolescents in attitudes towards health risks, psychological adjustment and family relationships.
As part of the Swiss Multicentric Adolescent Survey on Health, an anonymous self-administered questionnaire was distributed in school classes among a national representative sample of 9300 fifteen- to twenty-year-olds. The subsample of labour-migrant youth includes 1200 adolescents both of whose parents are from Italy, Spain, Portugal, Turkey or former Yugoslavia.
Bivariate analyses show significant differences between Swiss and labour-migrant adolescents in health concepts and health behaviour (notably, sexual behaviour and substance use), general well-being and family relationships. Only alcohol consumption and drink-driving behaviour place migrant adolescents at a lower risk than their Swiss peers. When sociodemographic variables are controlled in multivariate analysis, less favourable perceptions of the future, more marks risk behaviours, symptoms of depression, and difficult relationships with parents all appear to be strongly associated with migrant status.
The findings of this study reflect the negative effects of lack of social stability and of clear opportunities and positive perspectives on the health and psychosocial adjustment of migrant adolescents.
Previous work has shown low levels of psychological distress among UK South Asians, but some argue that the distress is under-reported. The present paper assesses distress on one clinically validated measure (the 12-item General Health Questionnaire), a psychosomatic measure and a self-report measure.
Interviews of 159 South Asians in Glasgow aged 30-40 years, mean age 35 years and 319 from the general population, all aged 35 years.
The three distress measures were moderately correlated and at the thresholds chosen there was no hierarchy of severity between them. Distress on the GHQ12 was at similar levels for all the social groups assessed, but distress on the psychosomatic measure and self-assessment was higher for women, Muslims and limited English speakers.
Clinical measures may have under-estimated distress in several South Asian groups. The results may be due to a preference for a particular language of emotion in the affected groups or to a higher frequency of stressful situations which provoke distinctive reactions.
The present study focuses on the associations between self-rated long-standing psychiatric illness, ethnicity, all-cause mortality and violent death (accidents and suicide), in a sample of 39,155 Swedish-born and foreign-born individuals. The study was designed as a longitudinal follow-up study, covering the period between 1 January 1979 and 31 December 1996. The data were analysed by a proportional hazard model and the results are given as hazard ratios (HR) with 95% confidence intervals (CI). Self-reported long-standing psychiatric illness was a strong risk factor for total mortality: women had an HR of 2.13 (CI = 1.78-2.54) and men an HR of 1.84 (CI = 1.53-2.21), when adjusted for background factors such as country of birth, civil status and socio-economic factors. Finnish men had an increased risk of all-cause mortality compared to Swedes in the final model, when adjusted for socio-economic factors. Long-standing psychiatric illness was also a strong risk factor for violent death, with an HR of 3.51 (CI = 2.32-5.32). The risk of violent death was 2.4 times higher for men than for women. The conclusions of the present study are that self-reported long-standing psychiatric illness is a strong predictor of an increased all-cause mortality and increased mortality from violent death. The increased age-adjusted mortality risk for foreign-born men could be explained by disadvantaged social and economic conditions. Only Finnish men demonstrated an independent increased all-cause mortality risk.
This study uses data collected in 1996 by the Swedish National Board of Health and Welfare. By means of interviews with 1980 foreign-born immigrants, an attempt was made to determine the impact of a) migration status (country of birth/ethnicity), b) exposure to violence, c) Antonovsky's sense of coherence, d) acculturation status (knowledge of Swedish), e) sense of control over one's life, f) economic difficulties, and g) education, both on psychological distress (using General Health Questionnaire 12) and psychosomatic complaints (daytime fatigue, sleeping difficulties, and headache/migraine). Iranians and Chileans (age-adjusted) were at great risk for psychological distress as compared with Poles, whereas Turks and Kurds exhibited no such risk. When the independent factors were included in the model, the migration status effect decreased to insignificance (with the exception of Iranian men). A low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties were strongly associated with the outcomes, generally accounting for a convincing link between migration status and psychological distress. Furthermore, a low sense of coherence, poor acculturation (men only), poor sense of control, and economic difficulties in exile seemed to be stronger risk factors for psychological distress in this group than exposure to violence before migration.
This paper provides an overview of United States-based research on the ways in which racism can affect mental health. It describes changes in racial attitudes over time, the persistence of negative racial stereotypes and the ways in which negative beliefs were incorporated into societal policies and institutions. It then reviews the available scientific evidence that suggests that racism can adversely affect mental health status in at least three ways. First, racism in societal institutions can lead to truncated socioeconomic mobility, differential access to desirable resources, and poor living conditions that can adversely affect mental health. Second, experiences of discrimination can induce physiological and psychological reactions that can lead to adverse changes in mental health status. Third, in race-conscious societies, the acceptance of negative cultural stereotypes can lead to unfavorable self-evaluations that have deleterious effects on psychological well-being. Research directions are outlined.
For the Hospital Anxiety and Depression Scale (HADS) psychometric properties were tested and standardised values were calculated on the basis of a representative sample of the German adult population with 2037 persons. The main result was the evidence of age and gender differences for anxiety and depression. Females were more anxious than males. For both dimensions of the HADS a nearly linear age dependency was found which was more pronounced for depression (r = 0.36) than for anxiety (r = 0.14). Standardised values are given for different age and gender groups, and the results of regression analyses are presented. The psychometric properties were satisfying or good, the two-dimensional factorial structure could be replicated. By means of the standardised values and regression coefficients it is now possible to compare patient groups of different age and gender distributions with the general population.
Since 1989, Israel has absorbed over 700,000 Jewish immigrants from the former Soviet Union, among them about 375,000 women. Immigrants are known to have greater and/or different health needs than non-immigrant residents, and to face unique barriers to receiving care. However, research addressing the specific health problems of these immigrant women has been scarce.
To compare self-reported health status and health care utilization patterns among immigrant and non-immigrant Israeli Jewish women; and to explore ways to overcome existing barriers to their care.
A telephone survey was conducted in September and October 1998 among a random national sample of women age 22 and over, using a standard questionnaire. In all, 849 interviews were completed, with a response rate of 84%. In this article we present comparative data from a sub-set that included 760 immigrant respondents from the former Soviet Union and non-immigrant Jewish respondents.
A greater proportion of immigrant versus non-immigrant women reported poor perceived health status (17% vs. 4%), chronic disease (61% vs. 38%), disability (31% vs. 18%) and depressive mood symptoms (52% vs. 38%). Lower rates of immigrant women visited a gynecologist regularly (57% vs. 83%) and were satisfied with their primary care physician. Lower rates of immigrants reported discussing health promotion issues such as smoking, diet, physical activity, HRT, and calcium intake with their physician. The article concludes with a discussion of the implications of the findings for designing services that will effectively promote immigrant women's health, both in Israel and elsewhere.
To analyse the association between ethnicity and poor self reported health and explore the importance of any mediators such as acculturation and discrimination.
A simple random sample of immigrants from Poland (n = 840), Turkey (n = 840), and Iran (n = 480) and of Swedish born persons (n = 2250) was used in a cross sectional study in 1996. The risk of poor self reported health was estimated by applying logistic models and stepwise inclusion of the explanatory variables. The response rate was about 68% for the immigrants and 80% for the Swedes. Explanatory variables were: age, ethnicity, educational status, marital status, poor economic resources, knowledge of Swedish, and discrimination.
Among men from Iran and Turkey there was a threefold increased risk of poor self reported health than Swedes (reference) while the risk was five times higher for women. When socioeconomic status was included in the logistic model the risk decreased slightly. In an explanatory model, Iranian and Turkish women and men had a higher risk of poor health than Polish women and men (reference). The high risks of Turkish born men and women and Iranian born men for poor self reported health decreased to non-significance after the inclusion of SES and low knowledge of Swedish. The high risks of Iranian born women for poor self reported health decreased to non-significance after the inclusion of low SES, low knowledge of Swedish, and discrimination.
The strong association between ethnicity and poor self reported health seems to be mediated by socioeconomic status, poor acculturation, and discrimination.
This article has no abstract; the first 100 words appear below.
In many parts of Chinese society, the experience of depression is physical rather than psychological. Many depressed Chinese people do not report feeling sad, but rather express boredom, discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue. These culturally coded symptoms may confound diagnosis among Chinese immigrants in the United States, many of whom find the diagnosis of depression morally unacceptable and experientially meaningless; this cultural pattern changes over time but continues to diverge significantly from the experiences of other groups. The pattern of somatization may be unfamiliar to U.S. clinicians and may further complicate the concept . . .
Source Information
From the Department of Anthropology, Harvard University, Cambridge, Mass., and the Departments of Social Medicine and Psychiatry, Harvard Medical School, Boston.
The aim of the study is the description of subjective morbidity, health care system utilisation and complaints of ethnic German migrants from the former Soviet Union at the beginning of migration. At present no data are available concerning aspects of health behaviour among this largest immigrant population in Germany.
300 ethnic German migrants and their families (mean age 37.2 and 51% female) were interrogated shortly after migration to Germany. They answered questions about prevalence of diseases, health care system utilization, actual health status and completed the Giessen Subjective Complaints List (GSCL-24). German standards exist for all questionnaires.
237 ethnic German migrants report to have suffered from at least one disease during the course of the last year. They see the gynaecologist and dentist as often as the German population, pay fewer visits to practitioners and specialists but seek more medical advice from the medical lay system. The majority of subjects are satisfied with their health. Migrants describe their health status as lower than the German population compared to which they also report more complaints (Overall distress in GSCL-24 : 17.2 for migrants and 14.0 for Germans) and different complaints (headaches, fatigue).
The different medical care system and differences in the treatment of patients could account for the less frequent use of medical services by ethnic German migrants. Actual stressors like language differences and acculturation problems are discussed as possible reasons for the increased rate of complaints among ethnic German migrants. Although they suffer from more complaints the German migrants do not seem to modify their help-seeking behaviour.
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