Mental illness in Greek and Turkish adolescents

Aetiological research on the health of migrants living in Germany: a systematic literature review

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.

Migration status, emotional engagement, and social exclusion in Chinese schools

INTRODUCTION

Since migration has become one of the pressing issues of our time, the school engagement of migrant children in the destination cities has drawn increasing scholarly attention. While most existing studies have focused on the cognitive and behavioral dimensions of school engagement of migrant children compared to local children, the emotional dimension has received less scholarly attention. Using a large-scale, national representative, school-level longitudinal survey data conducted in 2014 in China, this study examined the effect of migration status on children's emotional engagement in school.

METHODS

This study was conducted with 15,872 Chinese junior high school students (mean age = 13.52, SD = 1.24) using ordered logistic regression. KHB mediation analysis was employed to explain migration-emotional engagement linkage.

RESULTS

Compared with urban local children, both rural and urban migrant children are less likely to feel closely connected to their peers in school and are more likely to feel bored and to express escapism. The KHB mediation analysis further suggests that compared with the number of friends and proportions of the same-school friends, the percentages of local friends at the same school mediate most of the effect of migration status on all three measures of emotional engagement, particularly for rural migrant children.

CONCLUSIONS

These findings revealed that although both social exclusion and the absence of friendship play statistically significant mediation roles, social exclusion is of vital importance in understanding the differences between migrant and local children in emotional engagement.

[Mental health in adolescents in Germany: A comparison with regard to migration background and country of origin]

Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.

The mental health of children of migrant workers in Beijing: the protective role of public school attendance

The present study aims to understand the mental health status of an understudied group of migrant children - children of migrant workers in China. A total of 1,466 children from Beijing participated in the study that compared migrant children (n = 1,019) to their local peers (n = 447) in public and private school settings. Results showed that overall, migrant children reported more internalizing and externalizing mental health problems and lower life satisfaction than local peers. However, public school attendance served as a protective factor for migrant children's mental health. The mental health status of migrant children attending public schools, including externalizing problems as well as friend and school satisfaction, was not different from local children. In addition, our data indicates that the protective effect of public school attendance for migrant children may be even more salient among girls than boys, and for younger children than older children.

Socio-economic status and emotional distress of female Turkish immigrants and native German women living in Berlin

BACKGROUND

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.

METHODS AND SUBJECTS

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.

RESULTS

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.

CONCLUSION

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.

Development and validation of the 48-item Symptom Questionnaire (SQ-48) in patients with depressive, anxiety and somatoform disorders

Self-report measures of psychological distress or psychopathology are widely used and can be easily implemented as psychiatric screening tools. Positive psychological constructs such as vitality/optimism and work functioning have scarcely been incorporated. We aimed to develop and validate a psychological distress instrument, including measures of vitality and work functioning. A patient sample with suspected depressive, anxiety, and somatoform disorders (N=242) and a reference sample of the general population (N=516) filled in the 48-item Symptom Questionnaire (SQ-48) plus a battery of observer-rated and self-report scales (MINI Plus, MADR, BAS, INH, BSI), using a web-based ROM programme. The resulting SQ-48 is multidimensional and includes the following nine subscales: Depression (MOOD, six items), Anxiety (ANXI, six items), Somatization (SOMA, seven items), Agoraphobia (AGOR, four items), Aggression (AGGR, four items), Cognitive problems (COGN, five items), Social Phobia (SOPH, five items), Work functioning (WORK, five items), and Vitality (VITA, six items). The results showed good internal consistency as well as good convergent and divergent validity. The SQ-48 is meant to be available in the public domain for Routine Outcome Monitoring (ROM) and can be used as a screening/ monitoring tool in clinical settings (psychiatric and non-psychiatric), as a benchmark tool, or for research purposes.

Prevalence of mental disorders among high school students in National Guard Housing, Riyadh, Saudi Arabia

BACKGROUND

Adolescents experience rapid biological, psychological, and social transitions that can be associated with mental health problems. During the high school period there are also more academic stressors.

OBJECTIVE

(1) To study the prevalence of mental disorders in high school (grade 12) students. (2) To study some related sociodemographic data.

MATERIALS AND METHODS

A cross-sectional study, using GHQ-28, that included 354 students randomly selected from grade 12 in four high schools - two male and two female high schools - in the National Guard Housing (Iskan), in Kashmalaan (suburb of Riyadh).

RESULTS

The overall prevalence of mental disorders was found to be 48% (41% in males and 51% in females); more than 80% of these cases were mild to moderate. Females showed significantly more severe disorders than males (P = 0.017) and students with excellent performance degrees showed a significantly lower rate of mental disorders than others (P = 0.021). However, our study did not show a significant association between psychiatric disorders and other social variables (family size, birth order, and polygamous family) or smoking.

CONCLUSION

The adolescent age groups in our community had high rates of mental disorders, which required more attention from the family, as well as the educational and health institutes in our country.

[The care of people with a migration background in psychosomatic rehabilitation]

It was evaluated in an inpatient rehabilitation setting whether patients with mental or psychosomatic disorders people with a migration background are treated less frequently, profit less from the treatment, and have a higher risk for a negative outcome. On the basis of a prospective sample (n=25,066), the healthcare utilization of inpatient rehabilitation institutions, the level of mental stress, the quality of treatment, and the influence of risk factors were reviewed. Patients with a migration background show a lower level of health care utilization and a higher level of overall mental stress. Turkish patients and patients from the former Yugoslavia show the poorest treatment results. The regression analysis underlines clinical and sociodemographic factors as independent, negative predictors for good treatment results. Treatment concepts should be more strongly oriented to the needs of patients with a migration background and socioeconomically deprived patients.

Correlates of psychological wellbeing of children of migrant workers in Shanghai, China

BACKGROUND

It is estimated that approximately 20 million migrant school-aged children have accompanied their parents in relocating to cities in China. However, little research on the lives of these children has been conducted. The purpose of the present study is to identify the risk factors associated with the psychological wellbeing of children of migrant workers in Shanghai, China.

METHODS

A total of 625 children of migrant workers were recruited from ten primary and secondary schools in Shanghai through a survey design using the multistage cluster sampling method. Children of migrant workers were identified as mentally healthy or unhealthy using The revised child anxiety and depression scale. Socio-demographic characteristics, parent-child relationship, peer relationship and relationships in schools were explored as correlates of the psychological wellbeing of children of migrant workers.

RESULTS

Compared to overseas studies, children of migrant workers suffered from symptoms of separation anxiety, depression and generalized anxiety disorder. They were male (OR = 1.88, 95% CI 0.99-3.60), older in age (OR = 1.18, 95% CI 0.99-1.40), experiencing parent-child conflicts (OR = 1.92, 95% CI 1.28-2.89), discipline from teacher (OR = 2.29, 95% CI 1.26-4.16) and discrimination in school (OR = 4.53, 95% CI 1.11-18.48).

CONCLUSION

The findings provide information for the prevention of mental ill-health among children of migrant workers in China. The implications and limitations are also discussed.

Health status in immigrants and native early adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from "Health Behavior in School Aged Children", a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.

A screening instrument for psychological distress in botswana: validation of the Setswana version of the 28-item general health questionnaire

OBJECTIVES

To develop a Setswana version of the 28-item General Health Questionnaire (GHQ-28) for use in Botswana.

METHODS

A sample of 126 subjects attending primary healthcare clinics completed the GHQ-28, which contains four subscales of seven questions each for the following domains: somatic concerns, anxiety, social function and depression. All subjects were also interviewed with the Clinical Interview Schedule (CIS). Psychiatric casesness was ascertained by CIS scores greater than 20 and an overall severity of symptoms rating (OSR) of > or =2 on a 0-4 point scale. A receiver operating characteristic (ROC) analysis was undertaken to assess which GHQ cut-off score gave the best casesness yield as defined by the combined CIS and OSR assessments.

RESULTS

Of the 126 subjects enrolled, 122 completed the study, with 18 (14.5%) meeting criteria for caseness. There were no gender differences with respect to GHQ or CIS scores. The ROC analysis revealed that the GHQ threshold of 7/8 gave the best sensitivity (88%) and specificity (67%) results. The internal consistency of the translated GHQ was maintained with Cronbach alpha scores ranging from 0.76 to 0.91 for the subscales.

CONCLUSIONS

The Setswana GHQ-28 represents a valid instrument of screening for psychological distress in a primary healthcare setting in Botswana.

Measuring acculturation and symptoms of depression of foreign immigrants in the Athens area

BACKGROUND

Acculturation is the phenomenon that results when a group with one culture comes into continuous contact with a host culture and changes occur in the original culture of either one or both groups. Acculturation has also been linked with stress-related psychological disorder and depression.

AIMS

This article investigates the acculturation process and the depressive state of foreign immigrants living in the greater Athens area.

METHODS

All consecutive cases of 157 foreign immigrants who visited a nongovernmental organization (NGO) providing consultative services to immigrants were interviewed using a structured questionnaire including the Immigrant Acculturation Scale (IAS) and the Centre for Epidemiologic Studies - Depression (CES-D) scale.

RESULTS

Factor analysis of IAS yielded a three-factor solution and 17 items with loadings ranging from 0.74 to 0.41. This scale was also tested and proven to be reliable. The main finding is that the higher the acculturation level of the immigrant individual, the lower the CES-D scale score; the fewer the depressive symptoms are self-reported. Length of stay, existence of family in Greece, legal status of residence and employment were also found to have an effect on depressive symptomatology.

CONCLUSION

Acculturation could be seen as a beneficial mechanism protecting the individual to be exposed to stressful non-adaptive behaviour.

Culture and psychiatric symptoms in Puerto Rican children: longitudinal results from one ethnic group in two contexts

BACKGROUND

The development of youth psychopathology may be associated with direct and continuous contact with a different culture (acculturation) and to distress related to this process (cultural stress). We examine cultural experiences of Puerto Rican families in relation to youth psychiatric symptoms in two different contexts: one in which migrant Puerto Ricans reside on the mainland as an ethnic minority and another in which they reside in their place of origin.

METHODS

SAMPLE

Probability samples of 10- to 13-year-old youth of Puerto Rican background living in the South Bronx, New York City (SB) and in the San Juan Metropolitan area in Puerto Rico (PR) (N = 1,271) were followed over time. measures: Three assessments of internalizing psychiatric symptoms (elicited through the DISC-IV) and of antisocial behaviors (ASB) quantified through a six-point index were carried out. Independent variables included scales of adult and child acculturation and cultural stress, and other putative correlates.

DATA ANALYSIS

Within each study site, multilevel linear regression models were examined.

RESULTS

Parental acculturation was associated with ASB in youth at both sites, but youth acculturation itself was not related to psychiatric symptoms. At both contexts, cultural stress was a more consistent correlate of youth psychiatric symptoms than acculturation after controlling for nativity, maternal education, child gender, stressful life events and parental psychopathology. However, the strength of the youth cultural stress association decreased over time.

CONCLUSION

The association between cultural factors and child psychiatric symptoms is not restricted to contexts where an ethnic group is a minority.

Ethnic disparities in mental health and educational attainment: comparing migrant and native children

STUDY BACKGROUND AND AIMS: Ethnic disparities in mental health in adolescence may play a role in the development of ethnic disparities in educational attainment. The aim of this study was to assess the contribution of ethnic disparities in mental health problems in adolescence to ethnic disparities in educational attainment in adulthood.

METHODS

We followed two community samples of respectively 486 Dutch native and 168 Turkish migrant adolescents (11-15 years old) into adulthood (21-25 years old). Mental health was measured in adolescence, and educational attainment was assessed in adulthood. The contribution of mental health disparities to educational disparities was estimated by the degree of attenuation of the odds ratio (OR) for low education after adjustment for mental health problems.

RESULTS

Adult Turkish men more often had attained lower education than Dutch men (OR 1.81 (1.01-3.25)). Additional adjustment for mental health problems during adolescence did not change the OR. In Turkish women, however, the OR was 1.94 (1.04-3.62), and adjustment for mental health problems lowered it by 96% to 1.04 (0.51-2.14). The contribution was mostly due to ethnic disparities in internalizing problems.

CONCLUSION

In women, but not in men, ethnic disparities in mental health, especially internalizing problems, were a strong predictor for the development of ethnic disparities in educational attainment. Prevention or treatment of internalizing problems among Turkish girls will probably contribute to the prevention of educational disparities.

Development of ethnic disparities in internalizing and externalizing problems from adolescence into young adulthood

BACKGROUND

Little is known about changes in ethnic disparities in mental health during the development of adolescents into young adults. The aim of this study was to study the development of disparities in internalizing and externalizing problems between Dutch natives and Turkish migrant children from adolescence into adulthood.

METHODS

Turkish migrants (n = 217) and Dutch natives (n = 723) completed two comparable questionnaires about internalizing and externalizing problems: the Youth Self-Report at age 11-18 and the (Young) Adult Self-Report ten years later, at age 21-28. We used mixed linear regression models to model development of mental health problems and to test changes in disparities in mental health between Turkish migrants and Dutch natives.

RESULTS

Both in adolescence and in adulthood migrants reported more internalizing and externalizing problems than natives, most pronounced for internalizing problems. Disparities decreased from adolescence into adulthood for both internalizing problems (-52%, p < .0001) and externalizing problems (-67%, p = .01), independently of gender, age, country of birth of Turkish adolescents, and parental socio-economic position. The favorable changes in the disparities over time were due to more favorable development among Turkish migrants than among natives.

CONCLUSIONS

In this prospective study, ethnic disparities in internalizing and externalizing problems decreased as adolescents entered adulthood. Different explanations are discussed.

Ethnic disparities in problem behaviour in adolescence contribute to ethnic disparities in social class in adulthood

BACKGROUND

It is important for prevention of social class disparities to know how ethnic disparities in social class arise among migrant children. We contribute to this understanding by examining the role of problem behaviour in adolescence.

METHODS

Prospective observational study with 753 Dutch native and 217 Turkish migrant adolescents (11-18 year) followed for 10 years. Internalising and externalising problems were assessed in adolescence and employment status and occupational level were assessed in adulthood. The difference in odds ratios (OR) before and after adjustment for internalising and externalising problems was an indication of the predictive value of disparities in internalising and externalising problems for the development of social class disparities.

RESULTS

A total of 135 (62%) of the Turkish and 602 (80%) of the Dutch adults were employed. Internalising and externalising problems were not associated with employment status. Of the employed, 65 (48%) Turkish and 179 (30%) Dutch adults worked in low-level occupations (p < 0.0001). Internalising and externalising problems were associated with both ethnicity and occupation. The OR for low-level occupation for Turkish adults was 1.78 (1.19-2.65), indicating ethnic disparities. Adjustment for internalising problems lowered the OR with 36% to 1.50 (0.97-2.31), and adjustment for externalising problems lowered it with 8% to 1.72 (1.15-2.57). Findings were similar for men and women and did not vary by age.

CONCLUSIONS

Ethnic disparities in occupational level in adulthood could partly be attributed to disparities in mental health between Turkish migrants and Dutch natives in adolescence. Prevention of ethnic disparities in mental health at young age may therefore also contribute to the prevention of occupational differences in adulthood.

[Epidemiological research on migrant health in Germany. An overview]

In recent years, Germany has become an important immigration country. Health services in Germany thus have to face the needs of a growing migrant population. The health of migrants is affected by the process of migration in various--positive as well as negative--ways. Epidemiological research can help to reveal health inequalities between migrants and the majority population as well as to identify causes of disease. Standard epidemiological study designs may have to be adapted for migrant health research so they can be employed in migrant studies. While a large number of descriptive studies on migrant health have been conducted in Germany based on routinely available data sources, analytical migrant studies are still scarce. This paper presents an overview of methods and findings of epidemiological studies related to migrants in Germany. It also describes needs and challenges for future research.

Internalising and externalising behaviours in young adults: Dutch natives and Turkish migrants in the Netherlands

OBJECTIVE

To compare the prevalence of internalising and externalising behaviour of Dutch and Turkish migrant young adults in the Netherlands. We will also assess associations with socio-economic position.

METHOD

Dutch natives (1,236) and Turkish migrants (438), age 18-28, completed the Young Adult Self-Report. Scores above the 90th percentile of the distribution of the Dutch sample were defined as deviant.

RESULTS

Turkish migrants more often reported deviant scores than natives for internalising problems, especially for the Anxious/Depressed syndrome. For externalising problems, Turkish migrants less often had deviant scores for Intrusive Behaviour, whereas Turkish women more often had deviant scores for Aggressive and Delinquent Behaviour. Similar results were found for comparison between mean scores. After adjustment for socio-economic position, the disparities in men remained, whereas disparities in women largely disappeared.

CONCLUSION

Compared with Dutch young adults, Turkish migrant young adults reported more problems. Ethnic disparities were strongly associated with socio-economic disparities among women, but not among men.

Time trends in eating disturbances in young Greek migrants

OBJECTIVE

The study intends to measure time trends in eating disorder psychopathology in Greek adolescents in Veria (Greece) and migrant Greek adolescents in Munich (Germany). For this purpose, large samples of students were assessed at both locations in the 1980s and about two decades later. Our research question was whether the frequency of eating disorder-related psychopathology had changed over time and that there were differences between migrants and nonmigrants. The present-day prevalence of eating disorders in the Greek population was established.

METHOD

Greek adolescents were assessed in Munich and Veria in the 1980s (N = 2,631) and almost two decades later (N = 2,920). At both times, the Anorexia Nervosa Inventory for Self-Rating (ANIS) was used to assess eating disorder pathology and the General Health Questionnaire (GHQ-28) was used to assess mental health status. In the second wave, persons at risk for an eating disorder were interviewed using the Structured Interview for Anorexic and Bulimic Syndromes (SIAB-EX).

RESULTS

At both times and both locations, adolescent girls in comparison to boys had higher, more pathologic scores on the GHQ-28 and on all ANIS self-rating subscales. Females in Munich reported an increase over time in figure consciousness and their fear of negative effects of meals. In the 1980s, significantly higher scores of bulimic behavior were found in Veria as compared with Munich. In the second wave, bulimic behavior was considerably decreased in Veria for both girls and boys, and for bulimic behavior no significant differences were found between locations. The percentage of girls with a low body weight (<5th percentile) increased significantly over time in Veria and Munich. In the second wave, the current prevalence for girls with anorexia nervosa was 0.00% in Munich and 0.59% in Veria (lifetime 1.26% and 1.18%, respectively). For bulimia nervosa, current prevalence was 1.89% in Munich and 1.18% in Veria.

CONCLUSION

Differences between locations diminished over time. Bulimic syndromes are prevalent in both locations.

Migration and mental health in Europe (the state of the mental health in Europe working group: appendix 1)

BACKGROUND

This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

METHODS

The paper tries to describe the social, demographical and political context of the emigration in Europe and tries to indicate the needs and (mental) health problems of immigrants. A review of the literature concerning mental health risk in immigrant is also carried out. The work also faces the problem of the health policy toward immigrants and the access to health care services in Europe.

RESULTS

Migration during the 1990s has been high and characterised by new migrations. Some countries in Europe, that have been traditionally exporters of migrants have shifted to become importers. Migration has been a key force in the demographic changes of the European population. The policy of closed borders do not stop migration, but rather seems to set up a new underclass of so-called "illegals" who are suppressed and highly exploited. In 2000 there were also 392,200 asylum applications. The reviewed literature among mental health risk in some immigrant groups in Europe concerns: 1) highest rate of schizophrenia; suicide; alcohol and drug abuse; access of psychiatric facilities; risk of anxiety and depression; mental health of EU immigrants once they returned to their country; early EU immigrants in today disadvantaged countries; refugees and mental health. Due to the different condition of migration concerning variables as: motivation to migrations (e.g. settler, refugees, gastarbeiters); distance for the host culture; ability to develop mediating structures; legal residential status it is impossible to consider "migrants" as a homogeneous group concerning the risk for mental illness. In this sense, psychosocial studies should be undertaken to identify those factors which may under given conditions, imply an increased risk of psychiatric disorders and influence seeking for psychiatric care. COMMENTS AND REMARKS: Despite in the migrants some vulnerable groups were identified with respect to health problems, in many European countries there are migrants who fall outside the existing health and social services, something which is particularly true for asylum seekers and undocumented immigrants. In order to address these deficiencies, it is necessary to provide with an adequate financing and a continuity of the grants for research into the multicultural health demand. Finally, there is to highlight the importance of adopting an integrated approach to mental health care that moves away from psychiatric care only.

Cultural identity, acculturation, and mental health among adolescents in east London's multiethnic community

STUDY OBJECTIVE

To investigate cultural identity as a risk factor for mental health problems among adolescents.

DESIGN

A cross sectional school based population survey. Mental health problems were measured using the strengths and difficulties questionnaire. Pupils were classified into one of four cultural identity types on the basis of friendship and clothing choices.

SETTING

East London.

PARTICIPANTS

2623 adolescents (aged 11-14) from a representative sample of 28 schools in east London.

RESULTS

In comparison with marginalised adolescents who chose friends from neither their own or other cultures, fewer mental health problems were found among adolescents making culturally integrated friendship choices (friends from own and other cultures: OR = 0.6, 0.4 to 0.9), boys making integrated friendship choices (OR = 0.45, 0.22 to 0.91), and specifically among Bangladeshi pupils with integrated friendship choices (OR = 0.15, 0.04 to 0.55).

CONCLUSION

As measures of cultural identity, integrated friendship choices overall, and specifically for boys and Bangladeshi pupils, are associated with lower levels of adolescent mental health problems.

Psychopathology and mental health service utilization by immigrants' children and their families

To investigate the psychopathology of immigrants' children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child's place of birth, current living conditions, parents' country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family's structure and parents' psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning 'cooperation with other services' No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psychopathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

Suizidsterblichkeit unter T�rkinnen und T�rken in Deutschland

BACKGROUND

Suicide mortality is usually higher among men than among women. In socially disadvantaged groups, this relationship can be reversed. We investigated whether this is the case among Turkish migrants in Germany.

MATERIAL AND METHODS

We calculated age- and sex-specific suicide rates for Turkish nationals residing in (West) Germany (1186 suicides) and for Germans aged below 65 years based on death registration data covering the period 1980-1997.

RESULTS

Age-adjusted suicide rates among Turks were lower than among Germans (relative risk 0.3). Among Turkish girls and young women under 18 years, however, the relative risk compared to Germans was 1.8 (95% confidence interval 1.4-2.3). The male-to-female ratio in this age group was 3.2 among Germans and 0.6 among Turks.

DISCUSSION

Overall, Turks living in Germany have a lower suicide mortality than Germans. Possible explanations include a high level of social coherence in the Turkish community and religious prohibitions. The high suicide rate among Turkish girls and young women could indicate the presence of social or cultural conflict situations.

Predictors of self-reported problem behaviours in Turkish immigrant and Dutch adolescents in the Netherlands

BACKGROUND

Although many studies have compared psychopathology in different cultures, not much is known about factors that contribute to the observed differences.

METHODS

We compared self-reported emotional and behavioural problems in 363 Turkish immigrant and 1098 Dutch adolescents in the Netherlands and we evaluated the contribution of adolescent, parent, family and stress-related factors to the observed ethnic differences. Data were drawn from the Dutch version of the Youth Self-Report (YSR), as well as from Dutch and Turkish parental questionnaires.

RESULTS

Turkish girls scored higher on four of the eight YSR syndrome-scales, on the Internalising broadband scale and on total problems than Dutch girls. Turkish boys scored higher on three syndrome scales and on the Internalising scale, but scored less on Delinquent Behaviour than their Dutch peers. Ethnic differences for both sexes were most pronounced on the Withdrawn and Anxious/Depressed scales. Socio-economic measures, in particular education of the parents, contributed most to the explanation of ethnic differences on the Somatic Complaints scale for girls and Social Problem and Internalising scales for boys. On most scales, however, ethnic differences could not be explained by other factors. The distribution of some factors appeared to be more favourable (i.e., less frequent) for Turkish than for Dutch youths, such as referral of family members to mental health services.

CONCLUSIONS

Low educational levels of the parents play an important, yet not an exclusive role in explaining cross-cultural differences in emotional and behavioural problems in adolescents. In particular, differences in Withdrawn and Anxious/Depressed behaviour could not be explained by non-cultural factors. This study offers starting-points for future research on cultural-specific predictors of psychopathology in immigrants.

A review of the validity of the General Health Questionnaire in adolescent populations

OBJECTIVE

To comprehensively review the validity of the General Health Questionnaire (GHQ) [1] with adolescents (aged 12-19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic.

METHOD

Systematic review of the English language peer-reviewed literature.

RESULTS

Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version.

CONCLUSION

The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated.

IMPLICATIONS

Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.

Emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents

OBJECTIVE

The aim of this study was to compare levels of emotional and behavioural problems and competencies among immigrant and non-immigrant adolescents, and to determine factors that may contribute to any differences reported.

METHOD

Subjects were selected randomly from students aged 12-16 years attending a high school with a high proportion of immigrants in Perth, Western Australia. Parents completed the Child Behaviour Checklist (CBCL), and students completed the Youth Self-Report (YSR) and a Personal History Questionnaire.

RESULTS

On univariate analyses, non-immigrant adolescents had significantly higher CBCL and YSR scores than immigrant adolescents. Multivariate analyses suggested that CBCL scores were predicted by a number of variables other than immigration, including family intactness, socioeconomic status (SES) and gender. Higher YSR scores were predicted by non-intact families, school setting and non-immigrant status, and higher competencies scores were predicted by higher SES and parents not being immigrants.

CONCLUSIONS

In assessing the effects of immigration on adolescent mental health, it is important to control for factors associated with adolescent behavioural and emotional problems and to use multiple informants. Overall, immigrant adolescents report fewer total and externalizing problems and fewer competencies than native-born adolescents. This finding may reflect strict immigration policies or cultural differences in definitions of psychopathology and the social expectations for adolescents' behaviour.

Psychological symptoms among an immigrant population: a prevalence study

A community survey evaluating the prevalence of psychological symptoms among 1,953 Russian immigrants living in Israel was conducted. Symptoms of psychological distress were measured using a self-administered questionnaire, the Talbieh Brief Distress Inventory (TBDI). Criterial thresholds for six symptoms--obsessiveness, hostility, interpersonal sensitivity, depression, anxiety, and paranoid ideation--were established. Respondents with four or more psychological symptoms met the criterion for psychological distress syndrome (PDS) with a likelihood greater than 73%. A total of 13% of the respondents reported no psychological symptoms, and 21% reported all six symptoms of distress in the last month. One-month prevalence figures for distress-free and distress-related symptoms are presented. The prevalence rate for distress-free symptoms is 9% to 20%, and for distress-related symptoms, 38% to 43%. Sex differences were found regarding most symptoms, with higher prevalence rates in women than in men. No age differences were found for distress-related symptoms, whereas distress-free symptoms generally tended to change with age. The findings of this survey emphasize the importance of using our suggested quantitative approach when assessing psychological symptoms in further epidemiological investigations of stress-related psychopathology.

The Talbieh Brief Distress Inventory: a brief instrument to measure psychological distress among immigrants

The purpose of this study was to develop and test the Talbieh Brief Distress Inventory (TBDI), a 24-item self-report questionnaire that measures psychological distress among immigrants. The TBDI combines items from the Brief Symptom Inventory (BSI) and the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D). It includes a global score and six scales (obsessiveness, hostility, sensitiveness, depression, anxiety, and paranoid ideation). A convenience sample of 966 recent immigrants to Israel from the former Soviet Union were asked to complete a Russian-language version of the BSI and PERI-D as part of a study on immigrants' psychological adjustment. The TBDI is a combination of 13 items from the BSI and 11 items from the PERI-D. Items for inclusion were based on results of a separate factor analysis for the BSI and PERI-D and removal of repetitive items. We compared the total score with the total PERI-D and BSI and developed gender-specific cutoff points of caseness for the TBDI by comparison to known PERI-D and BSI cutoff points. We also checked for reliability using Cronbach's alpha. The TBDI correlated highly with the PERI-D (r = .93) and with the BSI (r = .82). Reliability of the scales and the overall instrument ranged from Cronbach's alpha of .60 to .89. TBDI caseness cutoff points were in close agreement with the BSI and PERI-D as reflected by kappa scores that ranged from .66 to .79. The TBDI is a promising instrument for screening populations for psychological distress and symptomatology. It is available in English, Hebrew, and Russian.

Psychiatric morbidity among repatriated Greek migrants in a rural area

This paper reports on psychiatric case identification by the application of the Structured Clinical Interview for DSM-III-R (SCID) in a sample of 198 Greek migrants repatriated from western europe in a northwestern province of Greece. The current (1 month) prevalence of psychiatric morbidity, based on the total number of diagnosed cases, was found to be 43.4%. Lifetime prevalence of psychiatric disorders was found to be higher (49.4%). The majority of the sample were diagnosed as suffering from anxiety disorders and dysthymia. Psychiatric disorders were found to be more prevalent among middle-aged respondents. Duration of stay in the foreign country was a factor correlated with psychiatric morbidity. Of short-term migrants 54% were found to suffer from specific nosological entities, whereas 32% of long-term migrants were diagnosed as cases. The results are discussed within the framework of the existing sociocultural context of emigration and repatriation.

Psychological problems of school-age German and Greek children: A cross-cultural study

This study investigated psychological problems of 466 Greek and 790 German non-referred, non-migrant children aged 6-11 years using the Child Behavior Checklist. Comparisons between the two countries on the total behaviour problem scores, the total number of positive codings, the externalizing and internalizing scales and the social competence scales revealed a number of cultural differences. Greek children displayed consistently higher problem scores and lower scores on social and activities competence scores than the German children with the one exception of school competence. These results are discussed in relation to different intercultural attitudes, meanings and expectations of parents on their children.

Immigrant status and gender effects on psychopathology and self-concept in adolescents: a test of the migration-morbidity hypothesis

Evidence for a relationship between immigrant status and psychological morbidity (which we shall refer to as the "migration-morbidity" hypothesis) in adolescents is variable and inconclusive. The present study tests this hypothesis and also explores gender differences in self-reported psychopathology and self-concept measures. Native-born Australians, Australian-born adolescent children of immigrants, and immigrant and refugee adolescents are compared on a number of relevant measures. The results do not support the migration-morbidity hypothesis. However, Vietnamese refugee adolescents had poorer self-concept than the other groups.

Anorexia nervosa in Greek and Turkish adolescents

Five samples of adolescents were assessed in three countries: (1) 867 Greek pupils in Munich (Germany), (2) 2,700 Greek pupils in Veria (Greece), (3) 567 girls in Ioannina (Greece), (4) 2,783 adolescents in Istanbul (Turkey), and (5) 157 adolescents in Upper Bavaria (Germany). A two-stage procedure was used for samples one, two and four using the Anorexia Nervosa Inventory for Self-rating (ANIS) for screening and a standardized interview (Structured Interview for Anorexia Nervosa and Bulimia) for personal exploration of possible cases and final case identification. Results of all samples were compared. Greek girls in Germany scored higher than Greek boys in Germany and Greek boys and girls in Germany scored lower than Greek girls in Veria in the ANIS factors figure consciousness, insufficiency, anancasm, negative effect of meals and bulimia in practically all age groups. The frequency distribution of the ANIS main factor figure consciousness was the same for both Greek samples in Greece, while the Turkish sample and the Greek sample in Munich had significantly lower scores. In the second stage the prevalence rates for anorexia nervosa according to Feighner criteria (modified for the purpose of a field study) were: 1.10% for Greek girls in Munich, 0.41% for Greek girls in Veria and 0.35% for Greeks in Ioannina. Thus, while Greek girls in Germany had lower scores in ANIS factors and other self-ratings (General Health Questionnaire) the actual rate of anorexic syndromes was highest among Greek girls in Munich. Socio-cultural influences and selection factors are discussed.