Factors Associated to the Onset of Mental Illness Among Hospitalized Migrants to Italy: A Chart Review

Prevalence of mental disorders and related risk factors in refugees and asylum seekers in Campania

Introduction

In recent years, the increasing presence of refugees and asylum seekers displaced from their country of origin, determined significant social, economic, humanitarian and public health implications in host countries, including Italy. These populations are exposed to several potential stressful experiences which make them vulnerable to psychological distress. In fact, the majority of studies addressing the topic found a higher prevalence of mental disorders, especially post-traumatic stress disorder and major depressive disorder, in refugees and asylum seekers with respect to the general population. However, heterogeneous prevalence rates have been reported among studies, due to methodological factor as well as to the impact of a variety of risk factors related to stressful experiences lived in the country of origin, during the migration journey and in the host country.

Objectives

The aim of the present study was to assess the prevalence of the main psychiatric diagnoses in a large group of adult refugees and asylum seekers (N=303) in the reception centers of two provinces of the Campania region, as well as to investigate the impact of potential risk factors on the occurrence of psychiatric disorders.

Methods

The diagnosis of psychiatric disorders and the identification of subjects at high risk to develop psychosis were carried out by means of structured diagnostic interviews. The following variables were explored as potential risk/protective factors to the occurrence of psychiatric disorders: socio-demographic variables, migration status (refugees/asylum seekers) and characteristics of the reception center,assessed by means of an ad hoc questionnaire; cognitive indices assessed by using standardized neuropsychological tests; traumatic experiences and level of political terror in the country of origin, assessed by means of reliable and valid self-report questionnaires.

Results

At least one mental disorder was found in 29.7% of the sample. Most prevalent diagnoses were depressive disorders, anxiety disorders and PTSD. Women showed, with respect to men, a higher prevalence of anxiety disorders, higher trauma levels, and came from more at-risk countries. Higher trauma levels, better cognitive abilities and unemployment and refugee status were associated to the presence of a current psychiatric disorder in the whole sample.

Conclusions

Our findings showed a higher prevalence of depressive disorders and PTSD in the sample of refugees and asylum seekers with respect to the general population and highlighted the role of potential risk factors whose identification may guide the implementation of preventive strategies and early treatments in these people.

The role of community resilience as a protective factor in coping with mental disorders in a sample of psychiatric migrants

Background

Over the past decade migration to Italy has increased significantly for various reasons including armed conflicts. Generally, the migration process is exposed to different risk factors during different periods of migration, which can compromise well-being and promote the onset or exacerbation of mental disorders. A community with resources and the perception of one's community as resilient can be important protective factor in the context of migration.

Purpose

This study aims to understand which variables in migration predict an increase in perceived community resilience and to understand the role of community resilience in the relationship between mental disorders and subjective well-being in a sample of 100 adult migrants at the first consultation interview in the ambulatories of Psychiatry Unit.

Methods

After defining the inclusion and exclusion criteria, migrants were asked to fill out self-report questionnaires to collect socio-demographic data and to assess perception of mental disorders, perceived community resilience and perception of subjective well-being. Descriptive analysis, simple regression, and moderation analyses were conducted to test the hypotheses.

Results

The results show that the variable meaning attributed to the community with reference to the host community, migration with someone, and longer duration of stay in Italy contribute to increased perceptions of community resilience. In addition, a direct negative effect of mental disorders on subjective well-being and the moderating role of community resilience in relationship between mental disorders and subjective well-being have been demonstrated.

Conclusions

This result underscores the importance of perceived community resilience in mitigating the negative effects of mental disorders on subjective well-being. Perceiving one's community as more resilient seems to protect against the impact of mental disorders on subjective well-being. Our results support an ecological model of migrants' mental health that values the community and its resources in coping with mental disorders in the context of migration.

Health and illness in migrants and refugees arriving in Europe: analysis of the electronic Personal Health Record system

BACKGROUND

The electronic Personal Health Record (ePHR) is a health information system that registers health data on newly arriving migrants and was implemented in eight European countries (Bulgaria, Croatia, Cyprus, Greece, Italy, Romania, Serbia and Slovenia). This is a cross-sectional study aimed to describe the health problems and health status of all migrants attended at health clinics as part of the health assessment programme established in the reception centres (2016-2019).

METHODS

Data were collected on demographics, clinical and laboratory findings and diagnostics performed, including medical records. We classified all diseases using pre-specified algorithms according to information on pre-specified variables from the ePHR questionnaire, ICD-10 codes, positive laboratory findings or review of medical records. Crude proportions were calculated and odds ratios (OR) estimated using logistic regression modelling.

RESULTS

The ePHR dataset contained a total of 19 564 clinical episodes in 14 436 individuals, recorded between January 2016 and October 2019. Most individuals (75%) were refugees or asylum seekers (22%) from 92 different nationalities. There were 2531/19 564 (12.9%) infectious diseases episodes reported during the study period, being 1283/2531 (50.7%) of them pharyngo-tonsillitis, 529 (20.9%) scabies, 158 (6.2%) viral hepatitis and 156(6.1%) lower respiratory infections. There were 2462 (17.1%) individuals with non-communicable diseases reported; including 821 (5.7%) cardiovascular diseases, 1183 (8.2%) neurological condition, 644 (4.5%) Diabetes mellitus and 212 (1.5%) kidney disease cases. Having Diabetes Mellitus (adjusted OR, aOR 3.3, [95% confidence interval, CI 2.7-4.1], P < 0.001), and neurological disorders (aOR 1.8, [95% CI 1.4-2.2], P < 0.001) were associated with cardiovascular disorders in the multivariable logistic regression model.Mental health problems were reported in 641/14 436 (4.4%) individuals and were associated with increasing age. Furthermore, 610 episodes of acute injuries were reported among 585/14 436 (4.1%) people, 517 (88.4%) of them in men (P < 0.001).

CONCLUSIONS

The ePHR is a valuable tool to efficiently collect health-related data to better address migrant health issues. We described a mostly healthy population with many acute infectious disease episodes particularly in children, but also with significant number of chronic conditions and less frequent injuries or mental health problems.

New approaches for mental health of social minorities

Mental health of social minorities is a challenge of modern psychiatry. It is largely described that people reporting sexual, cultural, religious variations are exposed to an amount of social stress deriving from the contrast between their minority status and the dominant societal norms and values. Minority stress leads to higher level of psychosocial distress and mental illness among these vulnerable populations. This conceptual research paper reports on evidences regarding the mental health issues related to the minority social condition and proposes a set of actions to address these challenges in a global perspective. Specifically, political, social and educational interventions are discussed in order to contrast stigma, discrimination, promote integration and health services for vulnerable populations. Policymakers are invited to deliver ad-hoc policies on minorities and homeless people with specific funding to address related public mental health issues. Educational programs are encouraged in the school setting as well as in the training of health care professionals in order to improve the level of acceptance and competencies in the treatment of minorities' health needs. We firmly believe there is no healthy society without healthy minorities.

Language proficiency and mental disorders among migrants: A systematic review

BACKGROUND

In this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders.

METHODS

MEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors.

RESULTS

The search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders.

CONCLUSIONS

Even though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants' language proficiency upon arrival.