Global prevalence of anxiety and PTSD in immigrants: a systematic review and meta-analysis

The prevalence of common mental disorders, stress, and sleep disturbance among international migrant workers: A meta-analysis with subgroup analysis

International migrant workers face an elevated risk of common mental disorders (CMDs), stress, and sleep disturbances due to various individual, psychosocial, and occupational factors. This meta-analysis systematically evaluated the prevalence of CMDs, stress, and sleep disturbance among international migrant workers. Two independent reviewers systematically searched the literature on five electronic databases from inception to June 2022. Random effects meta-analyses were performed to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, stress, and sleep disturbance among international migrant workers. Additionally, subgroup analyses were conducted to examine potential modifiers for the prevalence rates. Of 8461 records, 57 studies (n = 29,481) were included in this meta-analysis. The pooled prevalence rates of depressive symptoms, anxiety symptoms, stress, and sleep disturbance were 20.3 %, 17.8 %, 17.3 %, and 25.3 %, respectively. Subgroup analyses revealed that the prevalence of CMDs and stress was statistically significantly modified by country of destination and type of work, stress by gender and country of origin, and anxiety by migration type. Potential publication bias was observed only in the meta-analysis of stress. Most of the studies included were of moderate to high methodological quality. However, given that the included studies were predominantly cross-sectional and used non-probability sampling, the results should be interpreted with caution. This meta-analysis highlights that CMDs, stress, and sleep disturbances are prevalent among international migrant workers, posing a significant public health concern for host countries. These findings underscore the urgent need for tailored mental health interventions for specific subgroups within this population.

Bidirectional Relationship Between Nutrition and Mental Health and Its Impact on the Health of Canadian Immigrants: An Integrative Review

Background: Immigration is a key factor contributing to population growth in Canada, a trend that is expected to continue. Immigrants generally arrive with better health than the Canadian-born population, but this advantage often diminishes over time, partially due to dietary acculturation. Emerging evidence points to a bidirectional link between nutrition and mental health. Objective: To explore the bidirectional relationship between nutrition and mental health and its impact on the health of Canadian immigrants, with a specific focus on immigrants' mental health and the healthy immigrant effect. Methods: For this integrative review, two comprehensive literature searches were conducted in the databases MEDLINE, CINAHL, Embase, PsycINFO, Scopus, and Web of Science from inception to July 2024. The review adhered to Whittemore and Knafl's integrative methodology, with the Mixed Methods Assessment Tool used to assess the quality of the studies. Results: A total of 42 and 34 scientific articles were included from the first and second literature searches, respectively. Four main themes emerged from the literature: (1) food insecurity and mental health, (2) obesity and mental health, (3) diet quality and mental health, and (4) the gut microbiome and mental health. These themes were explored in the context of Canadian immigrants' health. Conclusions: The health of immigrants to Canada is likely shaped by complex, bidirectional interactions among various determinants of health, influencing both physical and mental well-being. As newcomers are expected to form an increasing proportion of the Canadian population, further research is needed to understand how the interaction between nutrition and mental health can help promote and safeguard the health of Canadian immigrants.

Posttraumatic stress disorder (PTSD) prevalence: an umbrella review

Posttraumatic stress disorder (PTSD) is one of the most serious and incapacitating mental diseases that can result from trauma exposure. The exact prevalence of this disorder is not known as the literature provides very different results, ranging from 2.5% to 74%. The aim of this umbrella review is to provide an estimation of PTSD prevalence and to clarify whether the prevalence depends on the assessment methods applied (structured interview v. self-report questionnaire) and on the nature of the traumatic event (interpersonal v. not-interpersonal). A systematic search of major databases and additional sources (Google Scholar, EBSCO, Web of Science, PubMed, Galileo Discovery) was conducted. Fifty-nine reviews met the criteria of this umbrella review. Overall PTSD prevalence was 23.95% (95% confidence interval 95% CI 20.74-27.15), with no publication bias or significant small-study effects, but a high level of heterogeneity between meta-analyses. Sensitivities analyses revealed that these results do not change after removing meta-analysis also including data from underage participants (23.03%, 95% CI 18.58-27.48), nor after excluding meta-analysis of low quality (24.26%, 95% CI 20.46-28.06). Regarding the impact of diagnostic instruments on PTSD prevalence, the results revealed a lack of significant differences in PTSD prevalence when structured v. self-report instruments were applied (p = 0.0835). Finally, PTSD prevalence did not differ following event of intentional (25.42%, 95% CI 19.76-31.09) or not intentional (22.48%, 95% CI 17.22-27.73) nature (p = 0.4598). The present umbrella review establishes a robust foundation for future research and provides valuable insights on PTSD prevalence.

Eating disorders among international migrants: a systematic review and meta-analysis

PURPOSE

Migrants may have elevated exposure to stressors, which can affect their physical and mental well-being. However, migrants often experience a healthy immigrant effect, the applicability of this phenomena to eating disorders is unknown. We aimed to synthesize the available literature and estimate a summary measure of prevalence odds ratio for eating disorders in migrant populations compared to local populations.

METHODS

A literature search was conducted using MEDLINE, Embase, PsycINFO, and Web of Science with keywords on migration and eating disorders. Inclusion criteria involved using a validated eating disorder scale and having a comparator group. Two independent reviewers performed study screening and data extraction. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. Random-effects models of meta-analysis were applied to compare eating disorder prevalence between migrants and local populations.

RESULTS

There were 10 studies included in our review (meta-analysis = 6, narrative synthesis = 4). Studies provided prevalence estimates for: any eating disorder, binge eating disorder, anorexia nervosa, and bulimia nervosa. Among studies with a diagnostic instrument, the pooled prevalence odds ratio (POR) between migrants and local populations for any eating disorder was 0.45 (95%CI: 0.35-0.59). However, a subgroup analysis of eating disorder instruments among studies using risk assessment tools demonstrated inconsistent findings, with both increases and decreases in prevalence.

CONCLUSION

Migrants were found to have a lower prevalence of eating disorders compared to local populations, supporting the healthy immigrant hypothesis. However, this effect differs between diagnostic and risk assessment tools.

Heparin as a Potential Therapeutic Substance for Post-Traumatic Stress Disorder

In sexually mature male Wistar rats with modeled post-traumatic stress disorder, personalized characteristics of neurobiological reactions in the population of predator-induced stress-resilient and stress-susceptible heparinized animals were determined. Characteristics of the systemic response of immune mechanisms, hypothalamic-pituitary-adrenal axis, behavioral manifestations, as well as basic properties of the CNS (excitation/inhibition) are presented. The study demonstrated encouraging positive results of the course administration of unfractionated heparin at a dose below the therapeutic and prophylactic doses. The inclusion of heparin drugs into the clinical practice for the treatment of post-traumatic stress disorder will not require large-scale clinical trials, because many effects of heparin as a nonspecific adaptogen are well studied. Moreover, these properties were confirmed at a higher technological level during the COVID-19 pandemic.

Cultural competence of mental health practitioners in the Netherlands

BACKGROUND

The importance of providing mental health from a transcultural perspective in establishing a therapeutic alliance is recognized. However, it is currently unknown how many mental health practitioners in the Netherlands feel capable of providing mental healthcare from a transcultural perspective, or if they are familiar with the Cultural Formulation Interview (CFI). The CFI is a tool used in mental health care to gather culturally relevant patient information, enhancing cultural sensitivity in treatment. It is also unknown if there is a difference between psychiatrist and psychiatry residents in terms of their cultural competence.

AIMS

This study aimed to assess the self-appraised cultural competence of Dutch psychiatrist and psychiatry residents, including their knowledge of the CFI, and the need for further training.

METHODS

A cross-sectional study was conducted among psychiatrists and psychiatry residents by means of an online questionnaire.

RESULTS

Ninety-seven mental health practitioners completed the questionnaire. Of the psychiatrists 70% and of the residents 76% reported that treating patients from cultural backgrounds different from their own background is challenging. Only 44% of psychiatrists and 34% of residents considered themselves sufficiently culturally competent, and 56% and 47% respectively, were uninformed about the CFI. The majority of psychiatrists and residents (70 vs 84%) indicated a need for more training in cultural competence.

CONCLUSION

The majority of psychiatrists and residents in The Netherlands considered treating patients from different cultural backgrounds a challenge, reported feeling insufficiently culturally competent, lacked experience with the cultural formulation interview and reported a need for more training in cultural competence.

Individual, interpersonal, and organisational factors associated with discrimination in medical decisions affecting people with a migration background with mental health problems: the case of general practice

OBJECTIVES

Although people with a migration background (MB) have more unmet mental health needs than the general population, patients with a MB are still underrepresented in mental health care services. Provider bias towards these patients has been evidenced repeatedly but its driving factors remain elusive. We assessed the moderating effect of the individual (e.g. age and ethnicity), interpersonal (e.g. healthcare provider trust), and organisational (e.g. perceived workload) factors on general practitioners (GPs) differential decision-making regarding diagnosis, treatment, and referral for a depressed patient with or without a MB.

DESIGN

An experimental study was carried out in which GPs were shown one of two video vignettes featuring adult male depressed patients, one with a MB and the other without. Belgian GPs (n = 797, response rate was 13%) had to decide on their diagnosis, treatment, and referral. Analysis of variance and logistic regression were used to analyse the effect of a MB, adding interaction terms for the explanatory variables.

RESULTS

Overall, we found that there were ethnic differences in GPs' decisions regarding diagnosis and treatment recommendations. GPs perceived the symptoms of the patient with a MB as less severe (F = 7.68, p < 0.01) and demonstrated a reduced likelihood to prescribe a combination of medical and non-medical treatments (F = 11.55, p < 0.001). Those differences increased in accordance with the GP's age and perceived workload; at an interpersonal level, we found that differences increased when the GP thought the patient was exaggerating his distress.

CONCLUSION

This paper showed that lower levels of trust among GPs' towards their migrant patients and high GP workloads contribute to an increased ethnic bias in medical decision-making. This may perpetuate ethnic inequalities in mental health care. Future researchers should develop an intervention to decrease the ethnic inequities in mental health care by addressing GPs' trust in their migrant and ethnic minority patients.

Structure and features of psychopathological symptoms in forced migrants and internally displaced persons

OBJECTIVE

Aim: To study the structure and characteristics of psychopathological symptoms in FM who left Ukraine as a result of the full-scale armed aggression of the Russian Federation against Ukraine, and internally displaced persons, in a comparative aspect.

PATIENTS AND METHODS

Materials and Methods: Examination was performed in compliance with the principles of biomedical ethics, based on informed consent. Research was provided on the basis of the Ternopil Regional Clinical Psychoneurological Hospital. Inclusion criteria were women who were forced to leave the territory of Ukraine as a result of hostilities after February 24, 2022, and who left for temporary residence in the territory of the Republic of Poland (Poland) (FM), and women who were temporarily relocated within Ukraine in connection with connection with hostilities (IDP). Exclusion criteria from the study were presence of language disorders, pronounced cognitive disorders, severe somatic condition. The examination was organized by the method of a semi-structured clinical interview according to the developed by us protocol and was conducted remotely. During the examination, depressive, anxiety-phobic, asthenic and dyssomnic disorders, addictive behavior and symptoms of PTSDwere identified and verified. Statistical and mathematical processing a was carried out using Fisher's exact test.

RESULTS

Results: The data we obtained indicate a significant spread of psychopathological symptoms in FM and IDP.

CONCLUSION

Conclusions: FM and IDP are characterized by a high incidence of psychopathological symptoms. The most frequent were: depressed mood (FM - 67.2%, IDP - 58.5%), feelings of anxiety and fear (FM -52.5%, IDP - 43.6%), obsessive thoughts (FM - 58.9 %, IDP - 49.5%).

A comparison of PTSD and traumatic event rates in a clinical sample of non-refugee immigrants and native-born individuals with a psychotic disorder: a case-control study

Background: Migration is a multi-stage social process linked to traumatic event exposure and a notably increased risk of psychosis. Although these conditions affect refugee and non-refugee immigrants, prior trauma research has focused mainly on the refugee population.Objective: To compare and describe the rate and the clinical characterization of PTSD and traumatic events between non-refugee immigrants and native-born individuals with psychotic disorder.Methods: 99 immigrants and 99 native-born individuals (n = 198) with at least one psychotic episode according to DSM-5 criteria were compared on the rate of PTSD diagnosis and traumatic events, using standardized and validated trauma scales.Results: In the non-refugee immigrant group, 31% met diagnostic criteria for PTSD compared to only 7.1% in the native-born group. Total scores in childhood trauma and last year stressful events were 1.5 and 2 times higher in non-refugee immigrants, respectively. Likewise, cumulative lifetime trauma was three times higher in non-refugee immigrants. Finally, non-refugee immigrants reported more violent and life-threatening traumatic events than native-born individuals.Conclusions: These results are relevant since they highlight that non-refugee immigrants with psychotic disorders are highly trauma-exposed, meaning a routine trauma assessment and a trauma-focused intervention for this population should be included in individualized treatment plans.

Assessing Quality of Life in First- and Second-Generation Immigrant Children and Adolescents; Highlights from the DIATROFI Food Aid and Healthy Nutrition Promotion Program

To compare first- and second-immigrant pediatric populations with a non-immigrant pediatric population in terms of quality-of-life metrics, a cross-sectional analysis using data from the DIATROFI Program was implemented. In total, n = 2277 students (mean age: 9(4) years) from public schools in Greece participating in the 2020-2021 school year were analyzed. The students' immigration status (first-generation/second-generation) was defined as per the standard definition. The students' health related-quality of life (HRQoL) was assessed using a parental-perceived quality of life questionnaire. The sample included 4.8% first-generation and 21.2% second-generation immigrant students. Compared with non-immigrants, the first-generation immigrant students were more likely to have poor HRQoL (odds ratio (OR) = 2.82; 95% confidence interval (95%CI) = 11.75, 4.53), physical (OR = 1.91; 95%CI = 1.18, 3.10), social (OR = 1.94; 95%CI = 1.16, 3.22) and school function (OR = 2.52; 95%CI = 1.54, 4.13). Similar results were observed for second-generation immigrant students regarding HRQoL (OR = 1.68; 95%CI = 1.28, 2.21), physical (OR = 1.60; 95%CI = 1.23, 2.10) and school function (OR = 2.09; 95%CI = 1.58, 2.77). Children with one parent having a country of origin different that the country of residence had elevated odds of having poor emotional health (OR = 1.19; 95%CI = 0.87, 1.64). The family's affluency level was interrelated with the connection of poor HRQoL and immigration status. The immigrant students have a poorer quality of life depending on their immigration generation and irrespective of their socioeconomic background.