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Immigration--induced syndromes

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INTERNATIONAL JOURNAL of HEALTH SCIENCE
145
editorial
IJHS Volume II; Issue 1 January-March 2009
Immigration - induced syndromes
I
mmigration has been correlated widely with illness
throughout history for two reasons. One reason was that
people believed that immigrants carried illnesses from
their countries. The other was that immigrants used public
health services without paying for them, which was a problem
for the host countries and their governments. The “Immigrant
Syndrome'' or “Ulysses' Syndrome” has been used with the
purpose to cover all the immigrant health problems. However,
several migration patterns are nowadays revealing a number
of distinguishable syndromes that vary according to the coun-
try of origin, the host country, the age and sex of the immi-
grant, the duration of immigration, multiple host countries,
poverty, educational status, marital status, employment, etc.
Ulysses' Syndrome
The experiencing of extreme hardships and terror forms the
psychological and psychosocial basis of Immigrant Syndrome
with Chronic and Multiple Stress. The individual suffers cer-
tain stressors or afflictions and presents a series of symptoms
from several areas of psychopathology.1The most important
stressors are:
• loneliness and the enforced separation from one's loved
ones
sense of despair and failure
fight for survival
• fear related to the afflictions suffered during the journey to
the host country or/and hiding during the stay in the country.
These situations of extreme hardship can affect immigrants
for months on end, even years. The characteristic feeling of
learnt defencelessness1is defined as the feeling that whatev-
er the individual does he will not be able to change his situa-
tion. The symptomatology1includes symptoms of the area of
depression, anxiety disorders, somatic symptoms (above all
migraines, fatigue, osteoarticular complaints etc.) and symp-
toms of confusion as well as compulsive, often unreasonable
ideas or emotions (they may think that they are cursed, that
life burdens are directed by an unlucky destiny etc).
Immigration as a risk factor
Immigration has always been categorized among risk factors
that create chronic stress. It is used in epidemiologic studies
with the same protocols made for the study of imprisonment
(and slavery in the past), poverty, divorce, living in an orphan
foundation, etc. Immigration has also been seen in groupings
that include criminality and rape victims. Health is definitely
harmed in immigrants even if they are not poor.2
The critical period for immigrants' health
Recent immigrants seem to be more vulnerable in a wide spec-
trum of health hazards. The period of adaptation and integration
to the host country, the settlement period, is thought to be the
most critical period for the development of illness induced by
stress. It is noticeable that the duration of the critical period
depends on the age of the immigrant. Perceived stressors and
distress during a 1-year follow-up is significantly declined in
middle-aged immigrants as shown by Ritsner M3, however the
same does not happen in young and old aged groups.
Age and vulnerability of immigrants to illness
The so called “immigrant stress” varies according to per-
ceived age-specific adjustment problems. Older immigrants
have reported higher levels of health-related stressors, but do
not differ on total social support from younger immigrants.3
Specific predictors of elevated distress differ by age. For the
youngest, these include climate changes and anxiety for the
future. For the middle-aged immigrants, these include female
gender, lower education, unemployment, and longer time in
the host country. For the oldest immigrants, predictors of dis-
tress include being divorced, separated, or widowed, and per-
ceiving long-time residents of the host country as hostile.3
Ethnic differences - the healthy immigrant effect
It has been observed that particularly for countries of origin
distant from the United States and Canada and from which
most immigrants came voluntarily (as opposed to immigrating
as refugees), immigrants tend to have better health status
and better health practices than is the norm either in their
country of origin or among second-generation or later-genera-
tion persons sharing their national heritage.4This phenome-
non is known as the "healthy immigrant" effect.5
Obesity, metabolic syndrome, or diabetes
among immigrants
Obesity, diabetes and other metabolically related diseases
have been increased in low income and minority communi-
ties. Particularly, the thrifty gene hypothesis was introduced
to explain the high, and rapidly escalating, levels of obesity
and diabetes among groups newly introduced to western
diets and environments.
Psychiatric, bevavioral disorders and addictions
among immigrants
"Ulysses' syndrome", depression, and dysthymia are the most
common mental health conditions described about immi-
grants. Suicidal behavior and suicide attempts are globally
investigated in immigrant populations, with positive findings in
first generation and second generation immigrants. The female
sex, adolescence and domestic violence are reported as risk
factors for the suicide attempters of immigrant populations.
Irene Christodoulou
Editor-in-Chief
Representative data from the U.S. National Health Interview
Survey were used to investigate the substance use patterns of
immigrants and compare them to those of the native born pop-
ulations. The information examined was from the 1991 supple-
mentary Drug and Alcohol Use Data File, which examined the
self-reported substance use behaviors of approximately 21,000
adults aged 18-44. Findings indicated that immigrants to the
U.S. in the late twentieth century were less likely to use alco-
hol and other drugs than were native born citizens. Additional
findings suggested assimilation processes by which exposure
to mainstream American society leads to patterns of alcohol
and illicit drug use among long term immigrants that approxi-
mates that of the native born population. The patterns of sub-
stance use observed among immigrants, however, are not
consistent with acculturative stress mechanisms. These find-
ings provide an important and representative profile of the sub-
stance use patterns of one of the largest international migra-
tion streams of the past one hundred years.6
Sexual behavior and perceived risk of HIV/AIDS
among young immigrants
Immigrants are vulnerable in sexually transmitted diseases
because they are not educated in safe sex practices (i.e. con-
dom use). If information on the possible consequences of
unsafe sex is inadequate, then the STI or HIV/AIDS risk is
mostly related with a low socio-economic status. For exam-
ple, interim living arrangements, such as refugee camps and
temporary shelters, provide ideal conditions for the spread of
infections. Migrants, asylum seekers and refugees are
thought as driving factors in the epidemiology of STIs and
HIV/AIDS. High risk sexual behaviours are related with low
socio-economic status.
When the immigrant is a child
The number of children immigrating to the United States has
increased steadily during the last decade. American families
are adopting a significant portion of these children, more than
20,000. Recently immigrated children face many different
health risks when compared to children born in the United
States. They are subject to many infectious diseases no
longer seen commonly in the United States such as malaria,
tuberculosis, and HIV. They are more likely to have inadequate
immunity to vaccine-preventable illnesses. Recent immigrants
have a higher likelihood of having malnutrition and develop-
mental delay.7
Immigration syndromes and the hyperactivity
of Hypothalamus-Pituitary-Adrenal axis
Distinguishing characteristic of the immigration health prob-
lems is the stress induced phenomena. The HPA axis (hypo-
thalamus-pituitary-adrenal axis) controls the body's response
to stress (the fight-or-flight reaction to physical or psychologi-
cal stress). The secretion of the corticotropin releasing hor-
mone (CRH) reflects this activity of the HPA axis and CRH
“instructs” the body to slow the activity in certain areas and
thus balances the reaction of the body to stress. Chronic acti-
vation of the HPA axis reduces the ability of cortisol to shut off
the release of CRH and ACTH (Adrenocorticotropic hormone)
and leads to syndromes that create the group of the HPA axis
hyperactivity syndromes.8Stress - induced depression is one
of the prevalent problems among them, and it has been sug-
gested to be categorized under the name “Endo- Depression”.9
Allostasis: the adaptation to altered environments
Allostasis is process of achieving stability, or homeostasis,
through physiological or behavioral change. This can be car-
ried out by means of alteration in HPA axis hormones, the
autonomic nervous system, cytokines, or a number of other
systems, and is generally adaptive in the short term.10 Immi-
grants are one of the categories preferred for the study of
allostasis and allostatic load.11 The concept of allostatic load
refers to the cumulative cost to the body of the stressful con-
ditions that occur in life. The role of allostasis is the stability
(homeostasis) of the human organ systems. However, this
stability is maintained through change. This change, which is
cumulative is represented by the allostatic load.
Social structure and illness
Social conflict and other types of social dysfunction are relat-
ed with the type 2 allostatic overload. Type 2 allostatic load,
does not trigger an escape response as the type 1 allostatic
load does, but it can only be counteracted with learning and
social structure.11 This means that even with the improvement
of provided health services to the immigrants, their status
cannot be improved if the social mechanisms of rehabilitation
and social integration are not improved.
Immigration and cancer
Not only the risk factor of immigration itself but also the can-
cer care provided in the host country should be taken into
account. The various centers for immigrant health with the
goal to eliminate ethnic and racial disparities in health care
investigate and promote the access of underserved immigrant
communities to cancer care services. If the cancer screening
and intervention policies of the host countries are taking care
of the immigrant's needs then cancer may not be prevailing
disease among immigrants.
Depression may not contribute in the development of can-
cer, but it certainly affects the individual health policies (pre-
ventive measures, compliance and treatment adherence).
REFERENCES
1. Achotegui J. Immigrants living in extreme situation: immigrant syndrome
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2. Martin Spigelman research associates -The working group on Poverty.
Unfulfilled Expectations, Missed opportunities: Poverty among Immigrants
and refugees in British Columbia, 1998. Accessed at www.mosaicbc.com
/PDF_files/poverty among immigrants.pdf.
3. Ritsner M, Ponizovsky A. Age differences in stress process of recent immi-
grants. Compr Psychiatry 2003;44(2):135-41.
4. Singh GK, Siahpush M. All-cause and cause-specific mortality of immi-
grants and native born in the United States. Am J Public Health. 2001; 91:392-
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5. McDonald JT, Kennedy S. Insights into the 'healthy immigrant effect':
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6. Johnson TP, VanGeest JB, Cho YI. Migration and substance use: evidence
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7. Schwarzwald H. Illnesses among recently immigrated children. Semin
Pediatr Infect Dis 2005;16(2):78-83.
8. Irene Christodoulou. HPA axis hyperactivity syndromes. Thessaloniki,
Greece: Renaissance Medical Publishing, 2008.
9. Irene Christodoulou. Endo Depression. Thessaloniki, Greece: Renaissance
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10. McEwen BS, Wingfield JC.The concept of allostasis in biology and bio-
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146
INTERNATIONAL JOURNAL of HEALTH SCIENCE
... Several migrant health researchers have demonstrated that the healthy immigrant paradox eventually fades (Newbold 2009;Rivera, Casal, and Currais 2016;Wu and Schimmele 2005); however, there is little consensus as to when and in what contexts this deterioration is most likely to begin. While some studies highlight the initial settlement stages as the most critical period for immigrants' health (Christodoulou 2009;Newbold 2009), a number of others indicate that long-term immigrants tend to be of poorer physical and mental health than more recent immigrants (Rivera et al. 2016;Wu and Schimmele 2005). To be sure, the relationships between years since migration and immigrants' health profiles have always been complex. ...
... Indeed, migration is a major life event that disrupts the routines of premigration life and causes strain to the point of affecting psychosocial resources (Noh and Avison 1996). These include-but are not exclusive to-access to health care, linguistic familiarity, job stability and prestige, and social support (Christodoulou 2009;Finch, Bohdan, and Vega 2000;Finch, Reanne, and Vega 2004;Noh and Avison 1996). ...
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The number of children immigrating to the United States has increased steadily during the last decade. American families are adopting a significant portion of these children, more than 20,000. Recently immigrated children face many different health risks when compared to children born in the United States. They are subject to many infectious diseases no longer seen commonly in the United States such as malaria, tuberculosis, and HIV. They are more likely to have inadequate immunity to vaccine-preventable illnesses. Recent immigrants have a higher likelihood of having malnutrition and developmental delay. Finally, many will have suffered psychological trauma in either institutions or refugee camps. These children require specialized testing, care, and treatment in the pediatric office.
HPA axis hyperactivity syndromes
  • Irene Christodoulou
Irene Christodoulou. HPA axis hyperactivity syndromes. Thessaloniki, Greece: Renaissance Medical Publishing, 2008.