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The Relationship Between Immigration and Depression in South Africa: Evidence from the First South African National Income Dynamics Study

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Few studies have examined depression among immigrants in post-apartheid South Africa, and factors that strengthen the relationship between immigration and depression. The first wave of the National Income Dynamics Study was used to investigate links between immigration and depression (n = 15,205). Depression symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression (CES-D) Scale. Immigrants in South Africa had fewer depressive symptoms (CES-D ≥ 10) than locally-born participants (17.1 vs. 32.4 %, F = 13.5, p < 0.01). Multilevel mixed-effects logistic regression analyses found that among immigrant populations, younger age (adjusted OR 1.03, 95 % CI 1.01-1.05) and black African ethnicity (adjusted OR 3.72, 95 % CI 1.29-10.7) were associated with higher depression. Younger age was associated with lower depression among locally-born study participants (adjusted OR 0.98, 95 % CI 0.97-0.98). The varying relationship between certain demographic factors, depression and the different mental health challenges among these groups requires closer attention.
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ORIGINAL PAPER
The Relationship Between Immigration and Depression in South
Africa: Evidence from the First South African National Income
Dynamics Study
Andrew Tomita Charlotte A. Labys
Jonathan K. Burns
ÓSpringer Science+Business Media New York 2014
Abstract Few studies have examined depression among
immigrants in post-apartheid South Africa, and factors that
strengthen the relationship between immigration and
depression. The first wave of the National Income
Dynamics Study was used to investigate links between
immigration and depression (n =15,205). Depression
symptoms were assessed using a 10-item version of the
Center for Epidemiologic Studies Depression (CES-D)
Scale. Immigrants in South Africa had fewer depressive
symptoms (CES-D C10) than locally-born participants
(17.1 vs. 32.4 %, F=13.5, p\0.01). Multilevel mixed-
effects logistic regression analyses found that among
immigrant populations, younger age (adjusted OR 1.03,
95 % CI 1.01–1.05) and black African ethnicity (adjusted
OR 3.72, 95 % CI 1.29–10.7) were associated with higher
depression. Younger age was associated with lower
depression among locally-born study participants (adjusted
OR 0.98, 95 % CI 0.97–0.98). The varying relationship
between certain demographic factors, depression and the
different mental health challenges among these groups
requires closer attention.
Keywords Depression South Africa Immigration
Multilevel analysis
Introduction
South Africa, with its diverse cultures, languages, and
racial/ethnic groups, is in the process of redefining a
national identity of inclusiveness, with immigration rep-
resenting a difficult dilemma following the end of apartheid
[1]. Immigrants from across the continent seek refuge in
South Africa, pursuing new opportunities or fleeing diffi-
cult circumstances in their countries of origin, often trig-
gered by war and economic/political instability. South
Africa, however, has a history of income inequality, racism
and migrant labor, which undermined family cohesion and
engendered violence under the apartheid regime; these
factors have had a devastating impact on physical health
[2] as well as an enduring effect on mental health in the
post-apartheid era. South Africa has a population of
51.8 million, with approximately 4.4 % being foreign-born
[3], although an internal census of migrants is somewhat
indefinable. For many immigrants living in South Africa,
their struggles are often exacerbated by a climate of
xenophobia and discrimination [4].
The process of migrating and encountering different
cultures is stressful, with migration-related stress and
associated mental health outcomes including depression
often being inconsistent. In the United States, there has
been extensive debate and research examining the mental
health consequences of migration [5]. Surprisingly, those
studies, with a few exceptions, tend to indicate that
immigrants have a lower prevalence of mood disorders
compared to native or US-born individuals of the same
national origin [6,7]. On the other hand, a mental health
A. Tomita (&)C. A. Labys J. K. Burns
Department of Psychiatry, Nelson R Mandela School of
Medicine, University of KwaZulu-Natal, Private Bag X7,
Congella 4013, South Africa
e-mail: tomita@ukzn.ac.za
C. A. Labys
e-mail: labys@ukzn.ac.za
J. K. Burns
e-mail: burns@ukzn.ac.za
A. Tomita
Department of Epidemiology, Mailman School of Public Health,
Columbia University, 722 W 168th St, New York, NY 10032,
USA
123
J Immigrant Minority Health
DOI 10.1007/s10903-014-9987-9
study of 23 European nations found the prevalence rates of
depressive symptoms to be higher for immigrants from
certain countries [8]. In addition to the mental health dis-
parities between different racial and ethnic immigrant
groups [9], past studies often point to complex linkages
between immigration and depression, with age of migration
playing an important role. A number of studies suggest that
migration to the United States and Canada at a younger age
may constitute a greater risk for depression [6,10,11] and
psychotic disorders [12].
The relationship between immigration and depression
outcome is inconsistent with respect to country of origin
and host nation. While two studies have extensively
assessed the significant socioeconomic correlates of
depression as well as migrant characteristics in South
Africa [13,14], none to our knowledge has focused on
depression among immigrants in sub-Saharan Africa and
South Africa, especially at a population level. The purpose
of the current study was to address this knowledge gap by
examining the association between immigration and
depression, and by assessing the level of depression among
different race/ethnic groups of immigrants in post-apart-
heid South Africa at the population-level, with a specific
focus on age factors. These factors are hypothesized as
being contributory to significant depressive symptoms
among immigrant populations.
Methods
Participants
This study analyzed data from the first wave (version 4) of
the South African National Income Dynamics Study (SA-
NIDS). The SA-NIDS survey method is described in its
published report [15]. Briefly, it was designed as a longi-
tudinal panel survey of a nationally representative sample
of households in South Africa. The study involved an
estimated 16,800 continuous sample adult members in
approximately 7,300 total households across 400 primary
sampling units (areas) using a stratified, two-stage cluster
sample design.
Data Collection
The first wave of the interview was conducted in 2008 and
became publicly available in 2009. The target population
was private households, excluding living quarters such as
old age homes, hospitals, prisons and boarding schools.
Trained fieldworkers were instructed to interview all
available household members residing at the selected
address, and every household at a designated dwelling was
included. Four types of questionnaire were administered in
the SA-NIDS: household, adult, child and proxy ques-
tionnaires. Our study utilized publicly available data from
household and adult questionnaires. The household ques-
tionnaires were administered to the oldest woman or
another knowledgeable member in the chosen household to
obtain information related to household background and
living situation. Adult questionnaires were subsequently
administered to every household member aged 15 years or
older to obtain information related to personal background,
including a history of immigration (foreign-born status
based on self-report) and emotional health status.
The SA-NIDS questionnaires were available in all 11
of South Africa’s officially recognized languages. The
household-level response rate was 69 % and the adult-level
response rate was 93 % [15]. The SA-NIDS study was
approved by the Ethics Committee of the University of
Cape Town, and the use of the SA-NIDS data in the current
analysis was approved by the University of KwaZulu-Natal
Biomedical Research Ethics Committee.
Measures
Depressive symptom outcomes were assessed using the
10-item version [16] of the Center for Epidemiologic
Studies Depression Scale [17]. As a widely used self-report
scale to screen for depression with strong psychometric
properties [18,19], which has previously been used in a
number of South African studies [20,21], the shorter
version of the Center for Epidemiologic Studies Depression
Scale (CES-D) correlates well with little loss of psycho-
metric properties when compared to the original version
[22]. In the adult questionnaire, study participants were
asked how often they experienced symptoms associated
with depression over the past week by choosing from four
possible responses in a Likert format, where ‘‘0’’ is ‘‘rarely
or none of the time (\1 day),’’and ‘‘3’’ is ‘‘almost or all of
the time (5–7 days).’’ The depression outcome was asses-
sed as the sum of scores for the 10 items, where a cut-off
score of 10 or higher in the total score indicated the pre-
sence of depressive symptoms [16]. The internal reliability
using Cronbach’s alpha for the CES-D was 0.75.
Analysis
Following a descriptive analysis of baseline characteristics,
multilevel mixed-effects logistic regression models were
used to assess the association between immigration (for-
eign-born status) and depression outcomes. Multilevel
models were utilized as many of the covariates in the
regression were drawn from individual and household level
characteristics. Two adjusted models were further fitted,
each with a different aim. The first aimed to assess whether
immigration was associated with higher depression,
J Immigrant Minority Health
123
including an interaction term between age and migration to
determine the possible effect modification of age. The
second aimed to do the same using the interaction between
race/ethnicity and migration. All analyses were adjusted by
age, gender, race/ethnicity, marital status, educational
attainment, residence in urban areas and occurrence of
household hunger (as a measure of household financial
strain) within the past 12 months. All proportions in the
descriptive analysis and regression models were also
adjusted by the study’s post-stratification weight to match
the 2008 mid-year population estimates produced by Sta-
tistics South Africa [23]. Proportional differences in the
characteristics between immigrant and locally-born study
participants were based on Pearson Chi squared statistics,
adjusted using the post-stratification weight, with the sec-
ond-order correction method [24] that was converted into
Fstatistics. The data were analyzed using STATA 12 [25].
Results
The demographic characteristics analysis of our study was
based on complete and available information on 15,205
adult resident respondents (90.1 % of 16,879). Table 1
compares the demographic characteristics between immi-
grant (n =322) and South African-born (n =14,883)
study participants. Immigrant (foreign-born) study partici-
pants accounted for approximately 3.7 %, the majority
being black (69.5 %). Immigrant study participants were
mostly born in Africa (82.1 %) and two-thirds (67.4 %)
were from countries bordering South Africa: Zimbabwe
(26.3 %), Mozambique (20.4 %), Lesotho (10.4 %),
Namibia (7.1 %), Swaziland (2.1 %), and Botswana
(1.1 %). Outside Africa, the largest country of origin was
the United Kingdom (7.1 %). The proportion of immigrant
participants between the ages of 15–25 was low (14.8 vs.
Table 1 Baseline
characteristics on immigrant
versus South African-born study
participants
à
The word ‘Coloured’ is the
term used by Statistics South
Africa. % adjusted based on
post-stratification weight
Immigrant/Foreign born (n =322) South African-born (n =14,883)
n % CES-D C10 (%) n % CES-D C10 (%)
Gender
Male 180 61.5 18.3 5,909 42.7 27.6
Female 142 38.5 15.2 8,974 57.3 36.0
Race/ethnicity
African 229 69.5 24.2 11,699 79.1 35.2
Coloured
à
7 0.3 19.0 2,151 8.6 29.6
Asian/Indian 4 0.5 \0.1 216 2.6 22.2
White 82 29.7 0.8 817 9.8 15.2
Age
15–25 61 14.8 26.7 4,944 33.1 26.4
26–34 78 36.8 16.4 2,450 21.3 32.9
35–59 126 34.9 16.4 5,407 34.7 36.6
60?57 13.6 10.7 2,082 10.9 36.0
Education
\High school-level 30 5.4 20.7 2,020 9.0 45.6
Completed high school 178 49.3 24.0 9,593 62.0 34.5
[High school-level 114 45.3 9.2 3,270 29.0 23.8
Marital status
Married 174 54.3 14.4 4,207 30.1 28.5
Living with partner 41 13.5 23.5 1,222 8.5 39.6
Widow/widower 20 3.8 7.0 1,322 7.1 47.6
Divorced/separated 6 1.8 \0.1 395 3.2 40.4
Never married 81 26.6 22.0 7,737 51.1 30.9
Hunger
Never/seldom 286 92.4 17.0 11,082 76.6 29.7
Sometimes 33 7.1 19.4 3,014 18.7 39.6
Often/always 3 0.6 4.9 787 4.7 46.8
Current residence
Urban informal area 13 5.3 6.0 971 11.0 34.5
Overall
Depression symptom 322 100 17.1 14,883 100 32.4
J Immigrant Minority Health
123
Table 2 Multilevel mixed-effects logistics models for depression outcomes
Model 1 Model 2 Model 3
Adjusted OR SE pvalue 95 % CI Adjusted OR SE pvalue 95 % CI Adjusted OR SE pvalue 95 % CI
Age
à
0.98 \0.01 \0.01 0.97 0.98 0.98 \0.01 \0.01 0.97 0.98 0.98 \0.01 \0.01 0.97 0.98
Gender
Female 1.49 0.07 \0.01 1.35 1.63 1.49 0.07 \0.01 1.35 1.63 1.49 0.07 \0.01 1.36 1.64
Marital status
Living with partner 1.44 0.15 \0.01 1.17 1.77 1.43 0.15 \0.01 1.16 1.76 1.44 0.15 \0.01 1.17 1.77
Widow/widower 1.34 0.13 \0.01 1.11 1.61 1.33 0.13 \0.01 1.11 1.61 1.34 0.13 \0.01 1.11 1.62
Divorced/separated 2.06 0.31 \0.01 1.53 2.77 2.06 0.31 \0.01 1.53 2.78 2.07 0.31 \0.01 1.54 2.79
Never married 1.24 0.09 \0.01 1.08 1.43 1.25 0.09 \0.01 1.09 1.44 1.25 0.09 \0.01 1.09 1.44
Education
\High school-level 0.92 0.07 0.28 0.79 1.07 0.91 0.07 0.26 0.78 1.07 0.91 0.07 0.26 0.78 1.07
[High school-level 0.72 0.05 \0.01 0.64 0.82 0.73 0.05 \0.01 0.64 0.82 0.73 0.05 \0.01 0.64 0.83
Race/ethnicity
Black African 2.49 0.19 \0.01 2.14 2.90 2.47 0.19 \0.01 2.12 2.88 2.43 0.19 \0.01 2.09 2.84
Hunger
Never/seldom 0.63 0.05 \0.01 0.54 0.73 0.63 0.05 \0.01 0.54 0.73 0.63 0.05 \0.01 0.54 0.73
Often/always 1.59 0.23 \0.01 1.20 2.10 1.59 0.23 \0.01 1.20 2.10 1.59 0.23 \0.01 1.20 2.11
Living in informal urban area
Yes 0.98 0.12 0.85 0.78 1.23 0.98 0.12 0.84 0.77 1.23 0.98 0.12 0.85 0.78 1.23
Migration (foreign-born)
Yes 0.53 0.10 \0.01 0.36 0.77 1.67 0.85 0.31 0.61 4.54 0.19 0.09 \0.01 0.07 0.49
Interaction term
Age
à
9migration 1.03 0.01 0.02 1.01 1.05
Interaction term
Black African 9migration 3.72 2.01 0.02 1.29 10.70
All results are adjusted using the post-stratification weights (n =15,205). Reference category: male (gender), married (marital status), high school-level completed (education), non-black
African (race/ethnicity), sometimes (hunger)
OR odds ratio, SE standard error, CI confidence interval
à
Age is in descending value
J Immigrant Minority Health
123
33.1 %, F=18.1, pB0.01) with many being highly
educated (45.3 vs. 29.0 %, F=8.1, pB0.01) and married
(54.3 vs. 30.1 %, F=20.6, pB0.01), a contrast to
locally-born study participants. The proportion (17.1 vs.
32.4 %, F=13.5, pB0.01) of CES-D C10 were gener-
ally lower among immigrant study participants than the
locally-born study participants.
The result of the multilevel mixed-effects logistic model
without interaction terms (Model 1) from Table 2suggests
that immigrants were less likely to have depression com-
pared to South African-born study participants (adjusted
OR 0.53, 95 % CI 0.36–0.77). The assessment of the model
containing the interaction term (Model 2) suggests that
younger age was associated with lower depression among
the South African-born study participants (adjusted OR
0.98, 95 % CI 0.97–0.98). Conversely, younger age was
associated with higher depression among immigrant study
participants (adjusted OR 1.03, 95 % CI 1.01–1.05). The
assessment of the model containing another interaction
term (Model 3) suggested that black African immigrants
were more likely to be depressed compared to non-immi-
grant and non-black African study participants (adjusted
OR 3.72, 95 % CI 1.29–10.7). Other covariates including
gender (female), non-married marital status, frequent
household hunger (as proxy for financial strain) and lower
educational attainment were significantly related to higher
depression symptoms.
Discussion
Overall, immigrants fared better than South African-born
study participants in the depression outcome. While our
finding is based on significant risk symptoms rather than a
depression diagnosis, it is consistent with other US-based
studies in that immigrants may be better off than natives
with regard to certain mental health outcomes [26,27],
including depression. Possible explanations include the
protective effects of retaining cultural traditions [28] and
possible availability of positive coping sources [29], as
reflected in the higher proportion of married status in these
study participants compared to South Africans. Lastly,
while there is limited data on the true prevalence of mental
disorders in sub-Saharan Africa, a number of studies have
suggested that depression in South Africa may be higher
than in other African countries, for example Nigeria [30,
31]. Thus, lower rates of depression in foreign study par-
ticipants’ home countries compared to South Africa may
potentially explain the lower depression symptoms out-
come in that group.
Our study also found that certain demographic factors,
such as age, alter the relationship between immigration
and depression. In particular, younger age was associated
with higher depression among immigrants, while older
age was associated with higher depression among South
African participants. Plausible explanations may be that
younger immigrants are more negatively impacted by
cultural conflict [32], residential instability, and geo-
graphic relocation, providing an unstable foundation for
development and, thereby, increasing the risk of psy-
chological distress [33] and depression [34]. Research on
psychological reactivity hypothesizes that older individ-
uals may be less susceptible to stress due to having
developed better coping strategies over time [35], which
may explain why older immigrant participants had lower
depression in our study. In addition to developmental
challenges, unmet expectations may contribute to immi-
grant depression [36]. Despite South Africa’s wealthy
status among fellow African nations, its poverty, income
inequality, and unemployment may mitigate the long-
term hope of young immigrants.
Studies on race/ethnic disparity often hypothesize that
discrimination adversely affects physical and mental health
through a stress mechanism guided by the biopsychosocial
model [37]. While the exact connection between stress and
depression remains uncertain, sustained stress leads to
elevated long-term cortisol levels, which is often linked to
depression [38]. Xenophobia towards immigrant Africans
in South Africa continues to be a major challenge, and we
would argue that discrimination towards such ethnic
minorities is a significant source of chronic stress that may
explain higher levels of depression [4]. While immigrants
of various race/ethnic groups generally had lower depres-
sion symptoms relative to their South African-born racial/
ethnic counterparts, the black African immigrants showed
the highest depression within this group; these findings
underscore the need for closer attention to racial/ethnic
disparities in mental health outcomes.
Gender, higher income, married status, and higher
educational attainment were found to be significantly
related to lower depression symptoms, similar to another
study that found these socio-demographic characteristics
to be protective factors against depression [39]. Many of
the immigrants were older, better educated and more
likely to be married, which may partially explain the
finding that immigrants generally had lower depression
symptom scores than South Africans. This study has
several limitations including: lack of data on the age at
emigration (which can affect migration and rates of
depression); and lack of reliable data on the length of
stay in the new host country (which can affect accul-
turation and depression). The cross-sectional nature of
our study prevents the establishment of causal relation-
ships; further studies utilizing a longitudinal design are
needed to assess the long-term effect of migration on
depression outcomes.
J Immigrant Minority Health
123
Conclusion
Immigrants had fewer depressive symptoms than South
Africans in our study. However, the relationship between
immigration and depression is often complex, and requires
closer examination as there are certain demographic factors
(such as age and race/ethnicity) that can contribute to
variations in depression. This is relevant to the multitude of
mental health challenges faced by diverse immigrants in
South Africa. Our study calls for more research into the
mental health challenges faced by young and ethnic
minority migrants, groups that may be susceptible to dis-
proportionately higher rates of depression. As we seek to
raise awareness and improve visibility of the mental health
issues confronting migrants in South Africa, we would like
to highlight their needs for access to treatment and recov-
ery support.
Acknowledgments The baseline study of South African National
Income Dynamics Study (SA-NIDS) was conducted by the Southern
Africa Labour and Development Research Unit (SALDRU) based at
the University of Cape Town’s School of Economics. The research
team is led by Murray Leibbrandt (SALDRU director/University of
Cape Town) and Ingrid Woolard (SALDRU’s chief research officer).
The data was accessed through Southern Africa Labour and Devel-
opment Research Unit. National Income Dynamics Study (NIDS)
2008, Wave 1 [dataset]. Version 4. Cape Town: Southern Africa
Labour and Development Research Unit [producer], 2012. Cape
Town: DataFirst [distributor], 2012. Dr. Tomita was supported by the
National Institutes of Health Office of the Director, Fogarty Interna-
tional Center, Office of AIDS Research, National Cancer Center,
National Eye Institute, National Heart, Blood, and Lung Institute,
National Institute of Dental and Craniofacial Research, National
Institute on Drug Abuse, National Institute of Mental Health, National
Institute of Allergy and Infectious Diseases Health, and NIH Office of
Women’s Health and Research through the International Clinical
Research Fellows Program at Vanderbilt University (R24 TW007988)
and the American Recovery and Reinvestment Act.
Conflict of interest All authors declare no conflict of interest.
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... About 1.7% (n = 454) of participants in our study population did not answer at least one of the 10 questions, and were excluded from the analysis of this outcome. Previous investigations of the CES-D-10 have used a cut-point of 10 to distinguish between those with and without depression (Andresen et al., 1994;Tomita et al., 2014Tomita et al., , 2015Zhang et al., 2012), and we similarly applied this classification in our analyses. We modelled non-linear associations between greenness and the CES-D-10 using cubic spline regression analyses. ...
... We modelled the CES-D-10 in two ways. First as a continuous measure, and second, as a dichotomous variable with cut-points of <10 and ≥ 10, with those having higher values classified as having depression (Andresen et al., 1994;Tomita et al., 2014Tomita et al., , 2015Zhang et al., 2012). ...
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Objectives Some studies suggest that residential surrounding greenness is associated with improved mental health. Few of these studies have focussed on middle-aged and older adults, explored the modifying effects of social determinants of health, or accounted for the extent to which individuals interact with their neighbourhood environments. Methods We analysed cross-sectional data collected from 26,811 urban participants of the Canadian Longitudinal Study of Aging who were between 45 and 86 years of age. Participants provided details on socioeconomic characteristics, health behaviours, and their frequency of neighbourhood interactions. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants’ residential addresses at a buffer distance of 500 m. Four self-reported measures of mental health were considered: The Center for Epidemiologic Studies Depression Scale (CES-D-10; short scale), past diagnosis of clinical depression, perceptions of mental health, and the Satisfaction with Life Scale (SWLS). Regression models were used to describe associations between greenness and these outcomes, and spline models were fit to characterize the exposure-response function between greenness and CES-D-10 scores. Stratified analyses evaluated whether associations varied by sociodemographic status. Results In adjusted models, we observed a 5% (Odds Ratio (OR) = 0.95; 95% CI = 0.90, 0.99) reduced odds of depressive symptoms in relation to an interquartile range increase of NDVI (0.06) within a 500 m buffer of participant's residence. Similarly, we found an inverse association with a self-reported clinical diagnosis of depression (OR = 0.97; 95% CI = 0.92–1.01). Increases in surrounding greenness were associated with improved perceptions of mental health, and the SWLS. Our spline analyses found that beneficial effects between greenness and the CES-D-10 were strongest among those of lower income. Conclusions These findings suggest that residential greenness has mental health benefits, and that interventions to increase urban greenness can help reduce social inequalities in mental health.
... Among its risk factors include migration (Flahaux & De Haas 2016;Vroman, Knoetze & Kagee 2011;Tessie 1995). Nonetheless, natives may suffer signs that are more aggressive than migrants are (Tomita et al. 2015). This can be explained by prior exposure by natives to risk factors of depression such as the case of apartheid in South Africa. ...
... This is similar to 's findings that the length of stay determines the mental health status of the migrants. However, first-time migrants with well-established relatives tend to settle faster than those without (Jurado et al. 2017;Tomita et al 2015). Age at migration is also a key factor for depression. ...
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Intra-continental migration has increased within Africa since the late 1980s. Africa to Africa migration ranks fifth globally. This study intended to review studies and document risk factors for depression, depressive symptoms, screening programs and coping strategies among voluntary African migrants within Africa. Online databases search was done to select journal articles published between 1980 and 2018 about the topic. PubMed generated only 8 relevant studies, Google Scholar 11, African Journals Online only 1 and international websites 3 relevant ones. Based on the keywords, Cochran protocol for quality assessment and PRISMA flowchart, 16 articles were systematically reviewed. Findings indicate few studies on depression among voluntary African migrants in Africa. Migration itself is a risk factor for depression. Other factors are trauma, poverty, forced or illegal migration, acculturation, loneliness, age, family separation, changing gender roles, and first-time migrants. It presents as insomnia, anxiety and social dysfunction. Most screening programs available are client initiated. Family support systems, problem-focused or emotions focused coping strategies can lessen depression. Conclusively, depression is a common scenario among migrants whether voluntary or involuntary but screening programs targeting voluntary migrants are very rare in most African settings. Culturally relevant and appropriate approaches targeting voluntary migrants would address the issue.
... Ajaero et al., 2017;Tomita et al., 2014). Young people and racially or ethnically marginalised individuals are very likely to experience mental disorders(Ajaero et al., 2017). ...
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Internal migration has been a long tradition in Nigeria. Culture is a significant aspect of internal migration in Nigeria as internal migrants move from one state to another. They, therefore, must adapt to a new culture, language, beliefs, and social identity. In addition, existing evidence showed that social, cultural, and economic factors were linked to a migrant’s status thereby impacting their mental health. Studies conducted in Nigeria identified the causation of mental disorders to supernatural causes and drug misuse with stigma towards people with mental disorders. This study identified and explored factors impacting the mental health of voluntary internal migrants in Nigeria. In addition, the study examined the perceptions, knowledge, and attitudes of Nigerian participants towards mental disorders. After a thorough search of existing literature on mental health in Nigeria, there were no studies exploring experiences of mental health among voluntary internal migrants in Nigeria. Therefore, a qualitative phenomenological study was conducted with nineteen voluntary internal migrant participants from Kaduna state, Federal Capital Territory (Abuja), and Lagos states in Nigeria. Semi-structured interviews were undertaken using the video conferencing platform Zoom©. The ‘silences’ theoretical framework was used as a guide in this study which explored the experiences of a marginalised and underresearched group of voluntary internal migrants in Nigeria. Five themes emerged from this study: ‘purpose of migration, ’ ‘experience of migration, ’ ‘coping strategies, ’ ‘knowledge of mental health, ’ and ‘impact of internal migration on mental health.’ The participants described the reasons for migrating as work, marriage, and wanting a better life. They described having accommodation issues, difficulties finding a job, language and cultural barriers, transportation problems, infrastructural challenges, and experienced challenges of lack of social support. In addition, they explained that insecurity challenges in the nation negatively affected them. These challenges resulted in significant stress, ultimately leading to poor mental health. Religion and perseverance helped them cope after relocating. Finally, there was an improvement in knowledge of mental health, but there were still high levels of stigma towards persons with mental disorders. This study contributes to existing knowledge by exploring the gaps in the body of knowledge regarding the experiences of voluntary internal migrants concerning mental health in Nigeria. In the long-term, this study will assist in creating further research to assist relevant stakeholders in providing more access and delivery of mental health services in Nigeria.
... Göçle birlikte birey alışkın olduğu toplumsal yapıyı, aile üyelerinden bazılarını, konuştuğu dili kaybetmekte; bireyin tutumları, değerleri, sosyal yapısı ve sosyal destek ağları değişmektedir (Bhugra ve Gupta, 2011;de Wit ve ark., 2008). Bhugra (2004) (Aronowitz, 1984;Breslau ve ark., 2007;Tam ve Lam, 2005;Fuligni 2003;Tomita, Labys ve Burns, 2014) da bu görüşü desteklemektedir. ...
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Bu araştırma, iç göç yaşamış ve yaşamamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzlarının anlamlı düzeyde farklılaşıp farklılaşmadığını incelemek amacıyla yapılan betimsel bir çalışmadır. Ek olarak, iç göç yaşamış ergenlerin göç üzerinden geçen süre açısından benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzları ile iç göç yaşamamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzlarının farklılaşıp farklılaşmadığı incelenmiştir. Bunun yanı sıra iç göç yaşamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzlarına, göç nedenleri ve hangi bölgeden göç ettikleri açısından bakılmış; iç göç yaşamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzları, bazı sosyo-demografik değişkenler açısından da ele alınmıştır. Araştırmaya İstanbul’un yoğun göç alan beş ilçesinde (Bağcılar, Bahçelievler, Esenyurt, Gaziosmanpaşa ve Ümraniye) Milli Eğitim Bakanlığı’na bağlı ortaöğretim kurumlarına devam eden 979 öğrenci (410’u iç göç yaşamış, 569’u iç göç yaşamamış) katılmıştır. Araştırmada ergenlerin benlik kurgularını ölçmek amacıyla Kağıtçıbaşı (2012a) tarafından geliştirilmiş, Özdemir ve Çok (2011) tarafından ergenlik dönemindeki bireylere uyarlanmış olan Ailede Özerk-İlişkisel Benlik Ölçeği (AÖİBÖ), uyum düzeyleri ve uyum sorunlarını belirlemek amacıyla Reynolds’ın (2001) geliştirdiği ve Meriç’in (2007) uyarladığı Reynolds Ergenler İçin Uyum Tarama Envanteri (REUTE), stresle başa çıkma tarzlarını ölçmek için Folkman ve Lazarus tarafından geliştirilen, uyarlama çalışmaları Şahin ve Durak (1995) tarafından yapılan Stresle Başa Çıkma Tarzları Ölçeği (SBÇTÖ) ve ergenlerin sosyo-demografik niteliklerine ilişkin bilgi toplamak için araştırmacı tarafından geliştirilen Kişisel Bilgi Formu uygulanmıştır. Araştırmada bağımsız değişkendeki kategori sayısı iki olduğunda ilişkisiz örneklemler için t-testi, ikiden çok olduğunda ise tek yönlü varyans analizi kullanılmıştır. Varyans analizinden önce kategorik değişkenlerin kategorilerindeki frekans sayılarının yeterli olup olmadığına bakılmıştır. Frekans sayılarının yeterli olmadığı durumlarda parametrik olmayan testlerden Kruskal Wallis Testi kullanılmıştır. Araştırma sonucunda, iç göç yaşamış ve yaşamamış ergenlerde, özerk-ayrık ve özerk-ilişkisel benlik kurgusuna sahip olma açısından anlamlı bir farklılığın olmadığı, buna karşın iç göç yaşamamış ergenlerde bağımlı-ilişkisel benlik kurgusunun, iç göç yaşamış ergenlere göre daha yaygın olduğu saptanmıştır. İç göç yaşamış ve yaşamamış ergenlerin uyum düzeyleri ve uyum sorunları (duygusal sıkıntı, antisosyal davranış, olumlu benlik ve öfke kontrol problemleri) arasında anlamlı bir fark olmadığı ve sosyal desteğe başvurma dışında, stresle başa çıkma tarzlarının da farklılaşmadığı görülmüştür. Sosyal desteğe başvurmaya dönük olarak ise iç göç yaşamamış ergenler lehine anlamlı bir fark olduğu saptanmıştır. Ayrıca göç üzerinden geçen süreye göre iç göç yaşamış ve yaşamamış ergenlerin bağımlı- ilişkisel benlik kurgularının ve olumlu benlik problemlerinin farklılaştığı, buna karşın stresle başa çıkma tarzlarının farklılaşmadığı belirlenmiştir. İç göç yaşamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzlarının, göç nedenleri ve hangi bölgeden göç ettiklerine göre değişmediği de araştırma sonuçları arasında yer almaktadır. Bunların yanı sıra araştırmada iç göç yaşamış ergenlerin benlik kurguları, uyum düzeyleri, uyum sorunları ve stresle başa çıkma tarzlarının, bazı sosyo-demografik değişkenlere göre değişebildiği sonucuna ulaşılmıştır.
... Breslau et al. (2007) stated that migrants have fewer risk to develop psychiatric symptoms compared to non-migrants. Similarly, Tomita et al. (2014) stated that migrants develop less depressive symptoms than locals. On the other hand, a study by Erol et al. (2005) revealed that internal migrant adolescents experience more internalizing and externalizing behavior problems compared to non-migrants. ...
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Adolescents’ self-development processes, the problems they encounter, and the way they overcome these problems tend to vary based on the culture they are a part of. As internal migration is a phenomenon that brings change to the culture, this study explores adolescence self-construals, adjustment problems, and coping styles in the context of internal migration. A cross-sectional and correlational design was employed in the study. The study data was collected from 979 adolescents. Of those, 410 were internal migrants, whereas 569 were non-migrants from Turkey. 46% of the participants were female and 58% were male. The age range of the participants was 14–18. Results showed that heteronomous-related self-construal was observed more commonly among non-migrant adolescents who used social support to cope with stress more than their peers. There was no difference between non-migrant and internal-migrant adolescents in terms of their adjustment problems. However, there were statistically significant relationships between adolescents’ self-construals, adjustment problems and coping styles in the context of internal migration. The study results and implications were also discussed based on the related literature.
... Third, existing studies have primarily focused on mental health outcomes of migration. Some studies explored specific mental health problems in immigrants, such as depression [15,33,34], anxiety [3,14,35], self-esteem problems [4,24,27,36] and externalizing problems (e.g., alcohol abuse, delinquency and aggressive behavior [16,17,22,24,37,38]). In fact, except for some isolated studies [16,22,28,39,40], few studies have evaluated multiple adolescent behavioral problems of immigrant and non-immigrant adolescents. ...
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Although the impact of immigration on adolescent developmental outcomes has received extensive scholarly attention, the impact of internal migration, particularly in the Chinese context, on adolescents’ psychosocial development has not been scientifically investigated. This study examined whether mainland Chinese adolescent immigrants (N = 590) and adolescent non-immigrants (n = 1798) differed on: (a) psychosocial attributes indexed by character traits, well-being, social behavior, and views on child development, (b) perceived school environment, and (c) perceptions of characteristics of Hong Kong adolescents. Consistent with the healthy migration hypothesis, Hong Kong adolescents and mainland Chinese adolescent immigrants did not differ on most of the outcomes; Chinese adolescent immigrants showed higher perceived moral character, empathy, and social trust than did Hong Kong adolescent non-immigrants. Chinese adolescent immigrants also showed more favorable perceptions of the school environment and moral character, social trust and social responsibility of adolescents in Hong Kong. This pioneer Chinese study provides support for the healthy immigration hypothesis (immigration paradox hypothesis) but not the immigration morbidity hypothesis within the specific sociocultural context of Hong Kong in China.
... Immigration is stressful and fraught with several adjustment problems [6,9,10] and immigrants are very vulnerable to health disparities in the U.S. [11,12]. Immigrants are vulnerable due to several social factors including lack of access to health services, language barrier, stigma, and socioeconomic status [13]. ...
Article
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Migrants come to the United States from communities affected by war, conflict, or economic crisis. They are vulnerable to poor physical and mental health. To assess the prevalence of depression and related risk factors amongst immigrants in the United States. Data from the 2017 National Health Interview Surveys was analyzed using IBM SPSS Statistics for Windows. Of the 77,842 individuals aged 18 years and above who participated in the survey, 4676 (6.0%) were immigrants. Prevalence of depression among immigrants was 1.1% compared to 0.9% for U.S citizens. Being an immigrant reduced the odds of depression by 18%; [OR 0.82 (C.I) of 0.60–1.12]. However, males were more likely than females to be depressed [OR 1.20 (1.02–1.41). This study revealed that the prevalence of depression is low among immigrants. This underscores the need for more studies to understand why this population is doing better despite the stressful physical conditions they experience.
... For example, a study from South African National Income Dynamics Study (SA-NIDS) reported that the overall prevalence of depressive symptoms is 32.07%, with immigrants to South Africa having fewer depressive symptoms (CES-D ≥ 10) than locally born individuals (17.1% vs. 32.4%) [32]. Alegria et al. found the adjusted lifetime prevalence of MDE diagnosed by WMH-CIDI was 15.2% (95%CI: 13.5-16.8%) ...
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PurposeObesity has been associated with an increased risk of the depression in the general population, but it is unknown whether this relationship applies equally to immigrants as well as non-immigrants. Furthermore, the nature of the relationship is uncertain, is it direct or curvilinear? The aim of this study is to examine the relationship between body mass index and major depressive episode among immigrants and non-immigrants.Methods To provide more statistically robust data, a series of cross-sectional health surveys of the Canadian population for the 5 years 2010–2014 were pooled to increase the number of immigrants in the study. Restricted cubic splines analysis was used to examine the nature of the association.ResultsImmigrants had lower 12-month depression and obesity prevalence rates than non-immigrants. In addition, it was found that non-immigrants were more likely to develop depression than immigrants, OR = 1.40 (95% CI, 1.16–1.67). Obese respondents were more likely to develop depression than normal weight respondents in both immigrant (OR = 1.55; 95% CI, 1.03–2.32) and non-immigrant groups (OR = 1.23; 95% CI, 1.15–1.32). A significant nonlinear elongated J-shaped association between obesity and depression was found for both immigrants and non-immigrants with increased risk of depression in obese individuals.Conclusion Culture-specific, clinical-based interventions should be developed to improve the early identification, treatment and recovery of individuals with a high BMI particularly among those with BMIs in the obese range.
Article
Immigration research has recently investigated positive adaptation outcomes such as psychological growth. This study tested actor and partner effects between fluid mindset and psychological growth, mediated by resilience, in 200 migrant mother-child dyads from Mainland China to Hong Kong. Mothers' fluid mindset had significant actor and partner effects on their own and their children's psychological growth, whereas children's fluid mindset showed an actor effect. For mothers and children, fluid mindset had significant actor indirect effects on psychological growth via resilience. Mothers' fluid mindset had a significant partner indirect effect on children's psychological growth via children's resilience. The findings have implications for enhancing immigrants' psychological growth by strengthening fluid mindset and considering mothers and children as the intervention unit in resilience programs.
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The aim of this study was to investigate the social determinants of depression in a large population-based survey in six of 11 provinces in South Africa. In a cross-sectional Community-level Social Dynamics Survey (CLSD) 4052 adults (median age 35 years, IQR = 20, age range of 18–100 years) in South Africa responded to a questionnaire. Depression was assessed with the Patient Health Questionnaire (PHQ-9). Results indicate that 35.0% of participants had no depression, 47.3% minimal or mild depression and 17.7% moderate to severe depression. In adjusted logistic regression analysis, low economic status (low income, lack of basic amenities, residing in informal settlements or traditional dwellings, and sharing their household in a dwelling), high religious attendance or social capital and high adverse life events (discriminatory experiences and perceived community violence) were associated with depression. Further, older age, being female and having been parented in their childhood by non-biological parents were associated with depression. In conclusion, the study showed various social determinants of depression, which should be included in strategies combatting depression in South Africa.
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Various authors have noted that interethnic group and intraethnic group racism are significant stressors for many African Americans. As such, intergroup and intragroup racism may play a role in the high rates of morbidity and mortality in this population. Yet, although scientific examinations of the effects of stress have proliferated, few researchers have explored the psychological, social, and physiological effects of perceived racism among African Americans. The purpose of this article was to outline a biopsychosocial model for perceived racism as a guide for future research. The first section of this article provides a brief overview of how racism has been conceptualized in the scientific literature. The second section reviews research exploring the existence of intergroup and intragroup racism. A contextual model for systematic studies of the biopsychosocial effects of perceived racism is then presented, along with recommendations for future research.
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In this paper we advance a heretofore underdeveloped interpretation of the commonly observed association between marital status and depression: that married people have comparatively low depression rates because they are, for several reasons, emotionally less damaged by stressful experiences than are nonmarried people. Most previous research has argued that marriage is associated with low rates of depression because it shields the individual from exposure to stress. However, our analysis shows quite clearly that more is involved. Studying a sample of role strains, we show that the emotional impact of these are less damaging than they are for the nonmarried. Analysis reveals that several different social and intrapsychic resources are implicated in this comparatively low emotional responsiveness.
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The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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The 10-item Center for the Epidemiological Studies of Depression Short Form (CES-D-10) is a widely used measure to screen for depression in primary care settings. The 10-item measure has demonstrated strong psychometric properties, including predictive accuracy and high correlations with the original 20-item version, in community populations. However, clinical utility and psychometric properties have yet to be assessed in an acutely symptomatic psychiatric population. This study examined the psychometric properties of the CES-D-10 in a sample of 755 patients enrolled in a psychiatric partial hospital program. Participants completed a diagnostic interview and a battery of self-report measures on admission and discharge. Exploratory factor analysis and confirmatory factor analysis suggested that a one-factor structure provided a good fit to the data. High item-total correlations indicated high internal consistency, and the CES-D-10 demonstrated both convergent validity and divergent validity. Previously suggested cutoff scores of 8 and 10 resulted in good sensitivity (.91 and .89, respectively) but poor specificity (.35 and .47). These data suggest that although the CES-D-10 has generally strong psychometric properties in this psychiatric sample, the measure should be primarily used to assess depression symptom severity rather than as a diagnostic screening tool.