Ethnicity, self reported psychiatric illness, and intake of psychotropic drugs in five ethnic groups in Sweden

‘We are inferior, we have no rights’: Statelessness and mental health among ethnic minorities in Northern Thailand

Research has shown that asylum seekers, refugees, and internally displaced persons, including stateless persons, are at increased risk of poor mental health. Yet, only a few studies explicitly focus on stateless persons. This article examines the association between legal status and mental health among Akha, Lahu and Tai-Yai people in Northern Thailand. A convergent parallel mixed-methods design was adopted and primary data were collected in June 2020 by face-to-face, semi-structured interviews with persons who do not hold a nationality (n = 108). A distinction was made between registered (nationalityless) and unregistered (stateless) persons since only the former have a legal status in Thailand. The correlates of mental health were analyzed using descriptive statistics and logistic regression. Qualitative thematic analysis was employed to gain deeper insights into the relationship between legal status, ethnicity and mental health. The quantitative results weakly suggest that stateless persons are more likely to have poorer mental health than nationalityless persons, who are recognized as habitually resident in Thailand and are recorded in the country's civil registry. The qualitative results, however, show that the legal status afforded to nationalityless persons is considered important as it gives rise to hope and increases livelihood opportunities. Yet, respondents also pointed out that it is not comparable to citizenship. The odds of having poorer mental health are significantly higher for Lahu and Tai-Yai respondents. The importance of ethnicity is confirmed by the qualitative results. These further indicate that citizenship problems and ethnicity are deeply interrelated. Stigma, discrimination, and lack of social support are key risk factors identified by respondents. Disaggregating data to better understand the heterogeneity of persons without nationality could play a key role in accelerating efforts to resolve protracted citizenship problems and close ethnic gaps.

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Legal recognition and ethnicity affect the mental health of persons without nationality.

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Stigma, discrimination, and lack of social support are key risk factors.

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Disaggregated data are essential for identifying and addressing existing gaps.

Validity and Reliability of the Sense of Coherence Scale among Korean Adolescents with Chronic Diseases

BACKGROUND

This study adapted the Sense of Coherence (SOC) Scale for Korean adolescents with chronic diseases and evaluated its psychometric properties.

PURPOSE

This study aimed to validate the Sense of Coherence Scale for Korean adolescents with Chronic Disease (SOC-AC).

DESIGN AND METHODS

This study employed the cross-sectional design. In total, 144 adolescents with chronic diseases (age: 15.07 ± 1.62 years; 58% male) responded to the study questionnaire, which included the 13-item SOC scale (SOC-13) and the 10-item Children's Depression Inventory. The SOC-13 was shortened to create the 10-item SOC-AC. Through an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA).

RESULTS

Following the EFA, two items (Item 8 and 13) with low factor loadings were deleted. Further, following the CFA, one item (Item 2) with a high modification index was deleted. The resulting 10-item SOC-AC exhibited a 3-factor structure comprising the subscales of meaningfulness (Item 4, 7, and 12), comprehensibility-manageability (Item 3, 5, 9, and 11), and resilience (Item 1, 6, and 10). The internal consistency of the SOC-AC was 0.868; the Cronbach's alpha values were 0.765, 0.78, and 0.529 for the meaningfulness, comprehensibility-manageability, and resilience subscales. The Pearson's correlation coefficient for the association between the SOC-13 and depression showed acceptable criterion-related validity (r = -0.436, p < .0001).

CONCLUSIONS

These findings indicate that the SOC-AC has satisfactory psychometric properties and that it is useful for assessing SOC in adolescents with chronic diseases.

PRACTICE IMPLICATION

This study revealed the utility of the examined scale to measure SOC as a means of health promotion and care in adolescents with chronic diseases.

Trajectories of antidepressant use before and after a suicide attempt among refugees and Swedish-born individuals: a cohort study

Background

To identify key information regarding potential treatment differences in refugees and the host population, we aimed to investigate patterns (trajectories) of antidepressant use during 3 years before and after a suicide attempt in refugees, compared with Swedish-born. Association of the identified trajectory groups with individual characteristics were also investigated.

Methods

All 20–64-years-old refugees and Swedish-born individuals having specialised healthcare for suicide attempt during 2009–2015 (n = 62,442, 5.6% refugees) were followed 3 years before and after the index attempt. Trajectories of annual defined daily doses (DDDs) of antidepressants were analysed using group-based trajectory models. Associations between the identified trajectory groups and different covariates were estimated by chi²-tests and multinomial logistic regression.

Results

Among the four identified trajectory groups, antidepressant use was constantly low (≤15 DDDs) for 64.9% of refugees. A ‘low increasing’ group comprised 5.9% of refugees (60–260 annual DDDs before and 510–685 DDDs after index attempt). Two other trajectory groups had constant use at medium (110–190 DDDs) and high (630–765 DDDs) levels (22.5 and 6.6% of refugees, respectively). Method of suicide attempt and any use of psychotropic drugs during the year before index attempt discriminated between refugees’ trajectory groups. The patterns and composition of the trajectory groups and their association, discriminated with different covariates, were fairly similar among refugees and Swedish-born, with the exception of previous hypnotic and sedative drug use being more important in refugees.

Conclusions

Despite previous reports on refugees being undertreated regarding psychiatric healthcare, no major differences in antidepressant treatment between refugees and Swedish-born suicide attempters were found.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01460-z.

Substance use among refugees in three Lebanese camps: A cross-sectional study

BACKGROUND

There is a strong link between conflict exposure and ill health, including substance use. However, this widely acknowledged problem has not been studied yet in refugee camps in Lebanon.

AIM

To investigate substance use among civilians following war or displacement, and to assess its association with socio-demographic characteristics.

METHOD

Cross-sectional observational study carried out in three Palestinian camps in Lebanon using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were Palestinian adults born in Lebanon and Palestinian and Syrian adults recently displaced from Syria due to war. The percentage of people reporting substance use and the associations between lifetime and last three months substance use and demographic features were assessed using a multivariate logistic regression.

RESULTS

In general, lifetime substance use was higher among Palestinians born in Lebanon compared to Syrians and Palestinians displaced from Syria (OR 7.241, 95% CI [3.781-13.869], P <0.0001). Results from ASSIST score during last three months showed that moderate and high-risk use of cannabis and cocaine were higher among Palestinians born in Lebanon than Palestinians and Syrians displaced from Syria. The multivariate analysis showed that women had lower lifetime (OR 0.188, 95%CI [0.080-0.442], P <0.0001) and lower last three months substance use than men, whereas single people were more likely to use substances than married people (OR: 2.78, 95%CI [1.588-4.866], P <0.0001). Tobacco was significantly associated with higher risk of substance use.

CONCLUSION

These findings suggest a higher rate of lifetime substance use among Palestinians born in Lebanon than in Palestinians and Syrians recently displaced from Syria. Substance use is influenced by different socio-demographic factors in the two groups of refugees. However, many factors other than socio-demographic characteristics and refugee status may influence substance use, particularly quality of life and health status that should be assessed in future studies.

Chronic Severe Sleep Problems among Non-Nordic Immigrants. Data from a Population Postal Survey in Mid-Sweden

Sweden has a large population of both recent and established immigrants with high prevalence of risk factors for ill health. Here, we aimed to explore the prevalence of chronic severe sleep problems (CSSP) among non-Nordic-born persons, and to evaluate the risk for CSSP when fully adjusted for covariates. Our additional hypothesis was that lengthier time since immigration would reduce the risk for CSSP. We used data from a large-population postal survey covering life and health issues among inhabitants in mid-Sweden. Relationship between different countries of birth and CSSP was assessed in logistic analyses for more severe and longstanding pain, sex, employment, mental disability, gastrointestinal problems, and length of stay (short, middle time, and up to ten years of stay). Persons of non-Nordic birth reported significantly more often CSSP, regardless of short or long-term stay. Our findings indicate that non-Nordic birth, regardless of residence time and covariates, was an independent and significant predictor for CSSP. The findings may contribute to increasing awareness in healthcare personnel to recognize chronic sleep problems among immigrant patients. Thus, our study might contribute to developing strategies to enhance health for minorities.

Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis

BACKGROUND

The number of refugees is at its highest since the Second World War and on the rise. Many refugees suffer from anxiety, depression and post-traumatic stress disorder (PTSD), but exact and up-to-date prevalence estimates are not available.

AIMS

To report the pooled prevalence of anxiety and mood disorders and PTSD in general refugee populations residing in high-income countries and to detect sources of heterogeneity therein.

METHOD

Systematic review with meta-analyses and meta-regression.

RESULTS

Systematic searches (final search date 3 August 2019) yielded 66 eligible publications that reported 150 prevalence estimates (total sample N = 14 882). Prevalence rates were 13 and 42% (95% CI 8-52%) for diagnosed and self-reported anxiety, 30 and 40% (95% CI 23-48%) for diagnosed and self-reported depression, and 29 and 37% (95% CI 22-45%) for diagnosed and self-reported PTSD. These estimates are substantially higher relative to those reported in non-refugee populations over the globe and to populations living in conflict or war settings, both for child/adolescent and adult refugees. Estimates were similar over different home and resettlement areas and independent of length of residence.

CONCLUSIONS

Our data indicate a challenging and persisting disease burden in refugees due to anxiety, mood disorders and PTSD. Knowing this is relevant for the development of public health policies of host countries. Scalable interventions, tailored for refugees, should become more readily available.

Health and Socio-Cultural Experiences of Refugee Women: An Integrative Review

Approximately half of the global refugee population are women, yet they remain largely understudied from the perspective of gender. The aim of this review was to investigate the impact of refugee women's resettlement and socio-cultural experiences on their health. This review also explored factors promoting resilience in refugee women. Eight databases were searched for peer-reviewed manuscripts published from 2005 to 2014. Grey literature was also reviewed. Data were extracted for population, data collection methods, data analysis, and findings. The Resource-Based Model was used as an overarching framework for data synthesis. Following the screening of titles and abstracts, 20 studies met the study inclusion criteria. Cultural factors, social and material factors, personal factors, and resilience factors were identified as main themes influencing the health of refugee women. Promotion of factors that enables resettlement is important in promoting the health and wellbeing of refugee women.

Sense of Coherence and Gambling: Exploring the Relationship Between Sense of Coherence, Gambling Behaviour and Gambling-Related Harm

Understanding why some people experience problems with gambling whilst others are able to restrict gambling to recreational levels is still largely unexplained. One potential explanation is through salutogenesis, which is a health promotion approach of understanding factors which move people towards health rather than disease. An important aspect of salutogenesis is sense of coherence. Individuals with stronger sense of coherence perceive their environment as comprehensible, manageable and meaningful. The present study examined the relationship of individuals' sense of coherence on their gambling behaviour and experience of gambling related harm. This exploratory study utilised an archival dataset (n = 1236) from an online, cross sectional survey of people who had experienced negative consequences from gambling. In general, a stronger sense of coherence was related to lower problem gambling severity. When gambling behaviour was controlled for, sense of coherence was significantly related to the experience of individual gambling harms. A strong sense of coherence can be seen as a protective factor against problematic gambling behaviour, and subsequent gambling related harms. These findings support the value of both primary and tertiary prevention strategies that strengthen sense of coherence as a harm minimisation strategy. The present study demonstrates the potential value of, and provides clear direction for, considering sense of coherence in order to understand gambling-related issues.

Subjective Well-Being in Older Chinese and Korean Immigrants in the United States: Effects of Self-Rated Health and Employment Status

This study examined the effects of association between self-rated health and employment status on subjective well-being among older Chinese and Korean immigrants in the United States. Data were collected from 171 Chinese and 205 Korean older adult immigrants living in Los Angeles County. The primary variables included demographic data, subjective index of well-being, self-rated health, and employment status. Data support the association between self-rated health and subjective well-being for both groups. Employment, education, and age were associated with the level of subjective well-being only for older Korean immigrants. Similarities and differences were noted in these two Asian American subgroups. Findings suggest the need to develop health promotion services for both populations and employment opportunities targeted more so for Korean older immigrants to further support their subjective well-being. Results may have implications for other for older immigrants.

Socio-demographic factors and long-term use of benzodiazepines in patients with depression, anxiety or insomnia

Former studies that have attempted to characterize individual socio-demographic factors associated with long-term benzodiazepine use were based on relatively small sample sizes and/or self-reported data. Our aim was to clarify this using large-scale primary health care data from Sweden. The present study covered 71 primary health care centres containing individual-level data from a total of 919, 941 individuals who visited a primary health care centre (PHCC) during the period 2001-2007. From this database we selected individuals 25 years or older with depression, anxiety and/or insomnia and who were prescribed a benzodiazepine within 0-90 as well as 91-270 days after their first clinical diagnosis of depression, anxiety and/or insomnia. Older age (OR, 2.92, 95% CI, 2.28-3.84), middle SES (OR, 1.22, 95% CI, 1.08-1.38), being on social welfare (OR, 1.40, 95% CI, 1.23-1.62) and not being married were associated with higher long-term benzodiazepine use. The PHCCs only explained a small part of the individual variation in long-term benzodiazepine use. Awareness of the impact on long-term benzodiazepine use of certain individual-level socio-demographic factors is important for health care workers and decision-makers who should aim at targeting general interventions at all primary health care centres.

Sense of coherence and its determinants: A comparative study of the Finnish-speaking majority and the Swedish-speaking minority in Finland

Background: Despite similar living conditions among the Finnish-speaking majority and the Swedish-speaking minority in Finland, the latter is a more advantaged group e.g. in terms of socioeconomic status and health. This study investigated (1) the level of sense of coherence (SOC), (2) the structure of generalized resistance resources (GRRs), and (3) associations of GRRs with SOC among Finnish- and Swedish-speaking Finns. Methods: The data derived from the Health and Social Support (HeSSup) Study. The sample comprised 22,937 Finnish men and women aged 20—54, including an additional sample from the Swedish-speaking population (n=2,967). The response rate was 40%. Ordinary regression analysis was used. Results: Swedish-speaking women scored 0.9 (p=0.005) and men 0.6 (p=0.05) points higher on SOC scale compared with Finnish-speaking respondents. The minor difference in the SOC level between the language groups was explained by Finnish speakers' worse psychosocial living conditions in childhood and working conditions in adulthood. Only one interaction was found: parents' divorce during childhood was associated with a significant decrease of SOC scores only for Finnish speakers. Otherwise the same GRRs had similar effects on both Finnish- and Swedish-speaking men's and women's SOC. Conclusion: The only key difference between Finnish- and Swedish-speaking Finns concerned the unequal distribution of GRRs. An increase in GRRs among Finnish speakers would probably strengthen their SOC. However, the slightly stronger level of SOC among Swedish-speaking compared with Finnish-speaking Finns is unlikely to explain the possible differences in well-being between the two language groups.

The Association between Discrimination and Psychological and Social Well-being

Background

Discrimination is known to negatively affect the psychological well-being of migrants. Less is known on the association between discrimination and social well-being.

Aim

We examined the association between experienced discrimination and psychological (mental health, quality of life) and social well-being (loneliness, feelings of safety, trust towards society) in Russian, Somali and Kurdish migrants in Finland.

Methods

We used data from the Finnish Migrant Health and Wellbeing Study (Maamu). The participants comprised 1795 persons of Russian, Somali or Kurdish origin aged 18–64 years. Experiences of discrimination, loneliness, safety and trust towards society were measured using interview questions. Mental health symptoms were measured using the HSCL-25 and quality of life using EUROHIS-QOL. Logistic regression analyses were conducted to investigate the associations between discrimination and psychological and social well-being, separately for the three ethnic groups.

Results

Discrimination increased the odds for mental health symptoms and decreased the odds for quality of life among Russian and Kurdish migrants, but not Somalis. Discrimination was associated with feeling unsafe and decreased trust towards society among all migrants. Among Kurds, discrimination increased the odds also for loneliness.

Conclusions

Discrimination is an essential threat to the psychological and social well-being of Russian, Somali or Kurdish migrants.

Coalitional affiliation as a missing link between ethnic polarization and well-being: An empirical test from the European Social Survey

Many studies converge in suggesting (a) that ethnic and racial minorities fare worse than host populations in reported well-being and objective measures of health and (b) that ethnic/racial diversity has a negative impact on various measures of social trust and well-being, including in the host or majority population. However, there is much uncertainty about the processes that connect diversity variables with personal outcomes. In this paper, we are particularly interested in different levels of coalitional affiliation, which refers to people's social allegiances that guide their expectations of social support, in-group strength and cohesion. We operationalize coalitional affiliation as the extent to which people rely on a homogeneous social network, and we measure it with indicators of friendships across ethnic boundaries and frequency of contact with friends. Using multi-level models and data from the European Social Survey (Round 1, 2002-2003) for 19 countries, we demonstrate that coalitional affiliation provides an empirically reliable, as well as theoretically coherent, explanation for various effects of ethnic/racial diversity.

The impact of migration on the health status of Iranians: an integrative literature review

Background

Immigration, both voluntary and forced, is driven by social, political and economic factors. Accordingly, some discussions and debates have emerged in recent years about the impact of migration on the health status of migrants. The aim of this review was to identify the impact of migration on the health status of Iranian immigrants and present a conceptual framework to facilitate the design and delivery of services and supports for this particular immigrant group.

Methods

Data for this integrative review were collected from Medline, PsycINFO, Scopus, ProQuest, Academic Search Complete, CINAHL, and Google Scholar search engine. The database search was limited to peer-reviewed literature, published in English, between 1980 and 2013.

Results

Twenty six articles were included in the review. Analysis revealed several factors influencing the mental health of immigrants, including language insufficiency; unemployment; sense of discrimination; cultural shock; lack of social support; lack of information about health care services; and intimate partner violence.

Conclusion

Findings of this review have contributed to development of a conceptual framework that delineates the impact of migration on Iranian immigrants’ health. This conceptualization may also help in addressing the needs of other vulnerable groups during the transition phase of migration.

Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review

Background

Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.

Methods

We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.

Results

Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered “Hispano-Americans” as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.

Conclusions

Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1799-x) contains supplementary material, which is available to authorized users.

Duration of residence and psychotropic drug use in recently settled refugees in Sweden--a register-based study

Introduction

Recently settled refugee populations have consistently been reported to have high rates of mental health problems, particularly Post-traumatic stress disorder, depression, and anxiety disorders. The aim of this study was to investigate psychotropic drug use among young adult refugees according to duration of residence during the first 10 years in Sweden.

Methods

Cross-sectional register study of a national cohort of 43 403 refugees and their families (23–35 years old) from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan and a comparison population of 1.1 million Swedish-born residents. Logistic regression was used to assess the association between duration of residence in Sweden and the dispensing of at least one psychotropic medication during 2009 in four categories (any drug, neuroleptics, antidepressants and anxiolytics/hypnotics), adjusting for age, gender and domicile.

Results

Rates of dispensed psychotropic drugs among recently settled refugees were low, compared to the Swedish-born, with an increase with duration of residence. For refugee men and women from Iraq/Iran who had resided for 0–3 years the adjusted ORs compared to Swedish natives, were 0.83 (95% CI 0.77-0.90) and 0.48 (0.44-0.53) respectively; for men and women from the Horn of Africa the ORs were 0.50 (0.42-0.61) and 0.36 (0.30-0.41) respectively. After 7–10 years of residence, the ORs in these refugee groups approached the Swedish comparison population. Refugees from Afghanistan presented ORs similar to the Swedish-born, with no consistent trend by duration of residence. Women from the Horn of Africa and Iraq/Iran consumed less psychotropic drugs compared with men from these regions of origin, relative to the Swedish-born (p < 0.01). The ORs for dispensed neuroleptics were similar between the different refugee study groups, while the ORs for dispensed antidepressants differed fourfold between the group with the lowest (Horn of Africa) and the highest (Afghanistan).

Conclusion

The rates of dispensed psychotropic drugs in the newly settled refugee populations in this study were low, with an increase with longer duration of residence. This pattern suggests barriers to access mental health care. Interventions that can lower these barriers are needed to enable newly settled refugees to access mental health care on equal terms with the native population.

Physical inactivity is strongly associated with anxiety and depression in Iraqi immigrants to Sweden: a cross-sectional study

Background

Increasing evidence on associations between mental health and chronic diseases like cardio-vascular disease and diabetes together with the fact that little is known about the prevalence of anxiety/depression and associated risk factors among Iraqi immigrants to Sweden, warrants a study in this group. The aim was to study the prevalence of anxiety and depression in immigrants from Iraq compared to native Swedes and compare socioeconomic and lifestyle-related factors associated with these conditions.

Method

A population-based, cross-sectional study of residents of Malmö, Sweden, aged 30–75 years, born in Iraq or Sweden. The overall response rate was 49% for Iraqis and 32% for Swedes. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Associations were studied using multivariate logistic regression models. The outcome was odds of depression and/or anxiety.

Results

Compared to Swedes (n = 634), anxiety was three times as prevalent (52.6 vs. 16.3%, p < 0.001) and depression five times as prevalent (16.3 vs. 3.1%, p < 0.001) in Iraqi immigrants (n = 1255). Iraqis were three times more likely to be anxious and/or depressed compared to Swedes (odds ratio (OR) 3.02, 95% confidence interval (CI) 2.06-4.41). Among Iraqis, physical inactivity (<150 min/week) (OR 2.00, 95% CI 1.49-2.69), economic insecurity (OR 2.16, 95% CI 1.56-3.01), inability to trust people (OR 1.75, 95% CI 1.28-2.39) and smoking (OR 1.43, 95% CI 1.02-2.01), were strongly associated with anxiety/depression. Among Swedes, living alone (OR 2.10, 95% CI 1.36-3.25) and economic insecurity (OR 2.38, 95% CI 1.38-4.12) showed the strongest associations with anxiety/depression. Country of birth modified the effect of physical inactivity (P_interaction =0.058) as well as of marital status (P_interaction =0.001).

Conclusion

Our study indicates that economic insecurity has a major impact on poor mental health irrespective of ethnic background but that physical inactivity may be more strongly associated with anxiety/depression in immigrants from the Middle East compared to native Swedes. Preventive actions emphasizing increased physical activity may reduce the risk of poor mental health in immigrants from the Middle East, however intervention studies are warranted to test this hypothesis.

Tobacco and alcohol use among Arab adults in Israel: findings from a nationwide study

OBJECTIVE

This comprehensive study focuses exclusively on adult Arabs in Israel and is aimed at examining tobacco and alcohol use rates and their predictors.

METHODS

One thousand and two hundred Arab adults were randomly sampled via cluster sampling and interviewed using a structured questionnaire.

RESULTS

Forty-four per cent of respondents reported tobacco use while 39% reported alcohol use. There were notable gender gaps in use, as well as differences between Muslims and Christians. Odds of using both tobacco and alcohol increased with having a greater tendency towards risk-taking and more time spent partying. Odds of alcohol use also increased with having positive attitudes towards use, lower perceived risk and greater intention to use.

CONCLUSIONS

These findings add a more complete understanding to the phenomenon of tobacco and alcohol use among Arab adults in Israel and carry important implications for future research and practice.

Symptoms, comorbidity, and clinical course of depression in immigrants: putting psychopathology in context

BACKGROUND

Migration is considered a depression risk factor when associated with psychosocial adversity, but its impact on depression's clinical characteristics has not been specifically studied. We compared 85 migrants to 34 controls, examining depression's severity, symptomatology, comorbidity profile and clinical course.

METHOD

A MINI interview modified to assess course characteristics was used to assign DSM-IV axis I diagnoses; medical files were used for Somatoform Disorders. Severity was assessed with the Montgomery-Asberg scale. Wherever possible, we adjusted comparisons for age and gender using logistic and linear regressions.

RESULTS

Depression in migrants was characterized by higher comorbidity (mostly somatoform and anxiety disorders), higher severity, and a non-recurrent, chronic course.

LIMITATIONS

Our sample comes from a single center, and should be replicated in other health care facilities and other countries. Somatoform disorder diagnoses were solely based on file-content.

CONCLUSION

Depression in migrants presented as a complex, chronic clinical picture. Most of our migrant patients experienced significant psychosocial adversity before and after migration: beyond cultural issues, our results suggest that psychosocial adversity impacts on the clinical expression of depression. Our study also suggests that migration associated with psychosocial adversity might play a specific etiological role, resulting in a distinct clinical picture, questioning the DSM-IV unitarian model of depression. The chronic course might indicate a resistance to standard therapeutic regimen and hints at the necessity of developing specific treatment strategies, adapted to the individual patients and their specific context.

Anxiety and sense of coherence in Roma and non-Roma coronary heart disease patients

OBJECTIVE

Morbidity and mortality among Roma due to coronary heart disease (CHD) is high, but evidence on potential psychosocial pathways is lacking. This study aimed to assess the differences in the severity of anxiety symptoms and in the sense of coherence (SOC) between Roma and non-Roma CHD patients, crude and adjusted for age, sex, functional status and socio-economic status (SES).

DESIGN

We examined 607 CHD patients (mean age 58.0 ± 7.4, 28.7% female) scheduled for coronary angiography, 98 (16.1%) of whom were Roma. Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale and SOC using the 13-item Orientation to Life Questionnaire. Data were analysed using hierarchical regression.

RESULTS

Roma ethnicity was associated with more severe anxiety (B = 1.89; [95% confidence interval (CI) = 0.79; 2.98]) adjusted for age, sex, functional status and SES. Roma ethnicity was also associated with lower SOC (B = -4.77; [95% CI = -7.85; -1.68]) adjusted for age, sex and functional status. The latter association lost statistical significance after adjustment for SES.

CONCLUSION

Roma ethnicity is associated with more anxiety symptoms and lower SOC among CHD patients. Our findings indicate that Roma CHD patients have a worse position regarding psychosocial factors that increase mortality and thus require additional attention.

Latin-American Immigrant Women and Mental Health: Differences according to their Rural or Urban Origin

Spain is one of the EU countries that receive most immigrants, especially from Latin America. The process of migration implies a high level of stress what may have repercussions for the mental health of immigrants. The purposes of this study were: (a) to determine whether the degree of mental health of immigrant women differs according to their rural or urban origin, (b) to compare the mental health of immigrant women with that of the female normative sample of host population (Spain). A sample of 186 Latin American immigrant women (142 from urban areas and 44 from rural areas) was recruited in Barcelona by means of a consecutive case method. A structured interview and the SCL-90-R were administered. The results indicated that the immigrant women from rural origin reported higher levels of psychological symptomatology than those from urban areas. Immigrants reported higher levels of psychological symptomatology than the native female population and in most of the psychological symptoms exceeded 90% of the native Spanish population. Migration is a powerful stressor which may lead to psychological distress. Being female of rural origin and being in an illegal situation is related with an increase in symptomatology.

Sense of coherence and depression in the framework of immigration: Turkish patients in Germany and in Turkey

The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.

Depressive disorder and social stress in Pakistan compared to people of Pakistani origin in the UK

PURPOSE

Depressive disorder is more common in low to middle than high-income countries, but the reasons for this have not been explicitly defined.

METHOD

We compared the results of two population-based studies of people of Pakistani origin: one living in rural Pakistan and one in UK. Both samples were screened with the self-reporting questionnaire followed by research interview to determine depressive disorders and social stress.

RESULTS

Logistic regression was used to compare the prevalence of depressive disorder in the two countries after adjustment for socio-demographic characteristics and social stress. The estimated prevalence of depression for men was 35.8% (95% CI 16.1-55.5) in Pakistan and 9% (5.0-13.0) in Manchester (p<0.001). Corresponding figures for women were 50.2% (40.8-59.6) and 31.1% (24.1-38.0) in Mandra and Manchester, respectively (p=0.006). The differences remained significant after adjustment for socio-demographic characteristics until we adjusted for either years of education (women only) or severe social stress (both sexes). 35% of women in Pakistan and 71% of those in UK had received 8 years or more of education. Extremely poor housing and marked poverty were experienced by 36.1% of women in Pakistan and 0.6% of those in Manchester. In Pakistan, housing and poverty predominated as correlates of depression, whereas in Manchester it was marked difficulties in physical health and close relationships.

CONCLUSION

The results suggest that the higher rate of depressive disorder amongst women in Pakistan compared to UK can be attributed to less education and frequent severe social difficulties. These differences have implications for treatment.

Factors of importance for self-reported mental health and depressive symptoms among ages 60-75 in urban Iran and Sweden

BACKGROUND

Depression is a common experience affecting 121 million people around the world. In high income countries, depression is one of the most common psychiatric conditions among the elderly. Studies show that immigrants are particularly at risk for mental ill health.

AIM

This study investigates the self-reported mental health among two Iranian groups; one born and residing in Iran and one consisting of Iranian immigrants in Sweden, as well as native Swedes living in Sweden. The study also aims to explore and compare self-reported depressive symptoms among three groups.

METHODS

This study is based on a cross-sectional design measuring self-reported health with a study specific questionnaire. The programme SPSS V.17.0 was used for all statistical analyses.

FINDINGS

1088 participants were approached (668 Iranians in Iran; 105 immigrated Iranians in Sweden; and 305 Swedes in Sweden). Factors effecting self-reported mental health was self-reported health, smoking, satisfaction with social life and also a sense of connection to ones cultural roots and traditions. Also demographic variables such as group belonging (Swedes vs. Iranians), sex and satisfaction with Income were shown to be important when performing the regression analysis. In the chi-square analysis the Iranian samples reported depressive symptoms to a larger extent than the Swedish group in all aspects of self-reported depressive symptoms. Self-reported depressive symptoms were reported to a greater extend in women compared to men. Our findings indicate that the Iranian populations living in both Tehran and Stockholm report depressive symptoms to an extent that merits concern. The findings indicate that Iranians living in Tehran and Iranians who have immigrated to Sweden require more attention regarding mental health care. Health care providers in both countries should be aware of the current state of mental health among Iranians in both Sweden and Iran.

Gender-related mental health differences between refugees and non-refugee immigrants--a cross-sectional register-based study

Background

Being an immigrant in a high-income country is a risk factor for severe mental ill health. Studies on mental ill health among immigrants have found significant differences in mental health outcome between immigrants from high income countries and low-income countries. Being an asylum seeker or a refugee is also associated with mental ill health. This study aimed to assess if there is a difference in mental ill health problems between male and female refugee and non-refugee immigrants from six low-income countries in Sweden.

Methods

A cross-sectional, population-based study design was used comparing refugees with non-refugees. The study size was determined by the number of persons in Sweden fulfilling the inclusion criteria at the time of the study during 2006. Outcome: Mental ill health, as measured with the proxy variable psychotropic drugs purchased. Refugee/Non-refugee: Sweden grants asylum to refugees according to the Geneva Convention and those with a well-grounded fear of death penalty, torture or who need protection due to an internal or external armed conflict or an environmental disaster. The non-refugees were all family members of those granted asylum in Sweden. Covariates: Gender and origin. Potential confounders: Age, marital status, education and duration of stay in Sweden. Background variables were analysed using chi square tests. The association between outcome, exposure and possible confounders was analysed using logistic regression analyses. Multiple logistic regression analysis was used to adjust for potential confounders.

Results

The study population comprised 43,168 refugees and non-refugees, of whom 20,940 (48.5%) were women and 24,403 (56.5%) were refugees. Gender, age, origin, marital status and education were all associated with the outcome. For female, but not male, refugees there was a significantly higher likelihood of purchasing psychotropic drugs than non-refugees (OR = 1.27, 95% CI = 1.15 - 1.40).

Conclusions

Female refugees from low-income countries seem to be a risk group among immigrant women from low-income countries, whereas male refugees had the same risk patterns as non-refugee immigrants from low-income countries. This underlines the need for training of clinicians in order to focus on pre-migration stress and the asylum process, among female newcomers.

"We are always asked; 'where are you from?'": Chilean women's reflections in midlife about their health and influence of migration to Sweden

AIM

This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences.

METHOD

Three focus group discussions (FGDs) were performed with 21 middle-aged Chilean women (40-60 years) who had lived in Stockholm for at least 15-20 years. In-depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape-recorded and transcribed data.

FINDINGS

Three main themes emerged from the data: (i) Chilean women's reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self-acceptance and awareness of power relationships.

CONCLUSION

The results illuminate the importance of awareness of influence of gender and socio-cultural aspects, power relationships and communication skills among health care providers on women's health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.

Stress and depression in Latin American immigrants: the mediating role of religiosity

OBJECTIVE

Migrating implies a high level of stress that may destabilise immigrants' mental health. The sense of spiritual fulfilment (feelings of faith, religiosity, and transcendence beyond ordinary material life) can mitigate the stress and benefit mental health. The objective of the present study was to analyze the relationship between migratory stress, religiosity and depression symptoms, as well as the mediating role of religiosity between migratory stress and depression symptoms.

METHOD

Participants were 295 Latin American immigrants living in Barcelona (Spain), 186 of whom (63.1%) were women and 109 (36.9%) were men. They were recruited from a Spanish NGO by means of a consecutive-case method.

RESULTS

The results showed an inverse relationship between religiosity and depression symptoms, but only in women. Likewise, in women, the sense of spiritual fulfilment had mediating value in buffering the relationship between stress and depression symptoms. This mediating value of spiritual fulfilment was not observed in men. For both genders religiosity was inversely related with stress. In addition, it was observed that the sense of religiosity decreases as the time since immigration passes.

CONCLUSIONS

These results may be of importance in clinical practice for prevention and therapeutic intervention with Latin American immigrants. As sense of transcendence and social support from the religious community are intertwined, it is difficult to specifically attribute the observed benefit of religiosity to the former versus the later.

The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden

BACKGROUND

It has often been shown that immigrants are particularly at risk for mental ill health. The aim of the study was to investigate the association of immigrant- and non-immigrant-specific factors with mental ill health within a diverse immigrant population.

METHOD

An extensive questionnaire was sent out to a stratified random sample of three immigrant populations from Finland, Iraq and Iran. The 720 respondents completed a Swedish, Arabic or Farsi (Persian) version of the questionnaire including the WHO (10) Well-Being Index and the HSCL-25.

RESULTS

The results indicate that mental ill health among immigrants is independently associated with non-immigrant-specific factors (i.e. high number of types of traumatic episodes, divorced/widowed, poor social network, economic insecurity and being female) and immigrant-specific factors (i.e. low level of sociocultural adaptation). These results were obtained regardless of whether mental ill health was operationalized as low subjective well-being or a high symptom level of anxiety/depression.

CONCLUSIONS

These findings support the notion that mental ill health among immigrants is a multi-faceted phenomenon that needs to be tackled within a wide range of sectors - e.g. the healthcare system, the social service sector and, of course, the political arena.

Reimbursement for drugs — a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions

Aims: Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs. Methods: The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved. Results: There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation. Conclusions: HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK

INTRODUCTION

We compared depression, social stress and treatment in people of Pakistani origin and white Europeans living in an UK city.

METHOD

In a population-based two-phase sample of 1,856 adults we interviewed 651 (77%) of eligible participants, using the schedule for clinical assessment in neuropsychiatry and life events and difficulties schedule. We identified 216 people with depressive and 208 with subthreshold disorder; after 6-months we re-interviewed 398 (94% response).

RESULTS

Depressive disorder was more common in Pakistani women only (31.1% [24.1-38.0] vs.19.3% [14.1-24.5]) and persisted more often in Pakistanis over 50 years of age (90 vs.66%, P = 0.023). New episodes of depressive disorder occurred in 17% of participants who had subthreshold disorder at baseline in each ethnic group. Persistent depression in the Pakistani group was associated with continuing problems of disabling physical illness and close relationships. Treatment was limited and not associated with persistent depression.

CONCLUSIONS

Persistent depressive disorder in older people of Pakistani origin is associated with potentially remediable factors.

Psychoactive substance use among Arab adolescent school dropouts in Israel: a phenomenon and its implications

This comprehensive study is the first to examine rates of legal and illegal psychoactive substance use and their predictors specifically among Arab adolescent school dropouts. It investigates the links between sociodemographic, interpersonal, cognitive and personality characteristics and use rates. Four hundred and seventy-six Arab adolescents aged 12-18 from throughout Israel, who had dropped out of school, participated in the study in late 2004. Sampling was done using a cluster method in order to choose specific localities. Participants completed self-report questionnaires assessing substance use and other variables. Legal substances--alcohol and tobacco--were used by 36% and 30% of the respondents, respectively, in the previous year. Being male, non-religious and having higher behavioural intentions and positive attitudes regarding use increased the odds of substance use. The best predictors of alcohol use were gender and religiosity, each raising the odds of use by 3.5. The best predictor of tobacco use was gender, raising the odds by 12.7. The best predictors of illegal use, behavioural intentions and risk perception, each doubled the odds of use. These and other results facilitate a better understanding of substance use among Arab adolescent dropouts and can foster the development of appropriate prevention and intervention programmes for this underserved population.

Psychological distress among Kurdish immigrants in Sweden

AIMS

To analyse whether there is an association between sex and poor self-reported health (SRH) and psychological distress in Kurdish immigrants.

METHODS

This cross-sectional study is based on a sample consisting of immigrants, aged 27- 60 years, with self-reported Kurdish ethnicity (n=111, men; n=86, women) in Sweden originating from Iran and Turkey. It is based on data collected in 1996 from the first Swedish National Survey on the living conditions of immigrant groups conducted by Statistics Sweden. The prevalences of reporting poor health, sleeping difficulties, general fatigue and anxiety were estimated by sex. The association between sex and SRH and psychological distress was analysed by an unconditional logistic regression model estimating odds ratios (OR) with 95% confidence intervals. The final model was adjusted for age, marital status, education, housing and employment. Immigrant-specific migration-related variables were used to explore possible reasons for the sex differences.

RESULTS

Kurdish men and women had a high prevalence of poor SRH and psychological distress. Age-adjusted odds ratios for anxiety were higher in Kurdish women. Sex differences in anxiety remained even when marital status, education, housing and employment were taken into account.

CONCLUSIONS

Kurdish men and women report a high prevalence of poor SRH and indicators of psychological distress. Women had a higher risk for anxiety than men. Negative experiences of pre-migration as well as post-migration experiences, such as economic difficulties, preoccupation with the political situation in the home country, perceived discrimination, and feelings of poor control over one's life, were associated with the outcomes.

Patterns of psychoactive substance use among Arab secondary school students in Israel

The current study examines patterns and trends in the use of psychoactive substances among Arab secondary school students throughout Israel. Data were collected in late 2004 using self-report questionnaires. The sample consisted of 2,944 students, Grades 7 through 12. Participants were sampled using a cluster method from schools throughout Israel. Results indicate higher use rates among males and among low-religiosity adolescents, as well as a strong link among attitudes, risk perception, behavioral intentions, and substance use. The study's implications and limitations, as well as possibilities for future research, are discussed. This study was funded by the Israel Anti-Drug Authority.

Global evidence for a biopsychosocial understanding of refugee adaptation

Early research on refugee mental health and adaptation has largely proceeded from a life-events/biomedical framework. That approach has helped elucidate the relationship between life events and psychiatric symptoms, but has been criticized as reductionistic or exclusionary. This article argues that the complexity of the social domain of refugee experience and the causal interactions among biological, psychological and social domains make individual effects difficult to study in isolation. A biopsychosocial approach could complement the more focal research to move the field forward. Evidence in support of this position is marshaled from new analyses conducted on a meta-analytic data set of five decades of the worldwide empirical literature on refugee mental health, reflecting data derived from 67,294 primary study participants (Porter & Haslam, 2005). Results demonstrate the importance of higher-order interactions between distal and proximal social variables, as well as associations among biological, psychological and community-level social functioning in refugees. Interdisciplinary research and novel analytic methods can complement more focal research. The presumed benefits of returning refugees to their country of origin are questioned in light of the important effects of social variables on refugee adaptation.

Self-reported anxiety, sleeping problems and pain among Turkish-born immigrants in Sweden

OBJECTIVES

To study whether symptoms of self-reported anxiety, sleeping problems and severe pain are more common among Turkish-born immigrants in Sweden than among Swedes, and whether age and socio-economic status can explain this hypothesised difference.

DESIGN

Two random samples were studied -- the Swedish National Board of Health and Welfare Immigrant Survey, and the Swedish Annual Level-of-Living Survey, both from 1996. A total of 526 Turkish-born immigrants in Sweden were compared with 2,854 Swedish controls, all aged between 27 and 60 years. Data were analysed by sex, in an age-adjusted model; and a full model also included age, education, marital status, employment and country of origin (logistic regression).

RESULTS

In the full model, odds ratios were 2.12 (1.43-3.15) for anxiety, 2.60 (1.82-3.72) for sleeping problems, and 2.14 (1.50-3.05) for severe pain among Turkish-born men, and 2.44 (1.69-3.53) for anxiety, 3.01 (2.09-4.33) for sleeping problems, and 2.59 (1.80-3.71) for severe pain among Turkish-born women, using the Swedish controls as references.

CONCLUSIONS

Being a Turkish-born immigrant in Sweden significantly increases the risks for self-reported anxiety, sleeping problems and severe pain, even after adjusting for age and socio-economic status (education, marital status and employment).

Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study

BACKGROUND

Enlargement of the European Union has caused worries about the possibility of increased migration from its new members, the former Soviet countries, and consequently increased demands on the health care systems of the host countries. This study investigated whether or not earlier immigrants from the former Soviet Bloc have poorer self-reported mental health, measured as self-reported psychiatric illness and psychosomatic complaints, than the host population in Sweden. It also examined the particular factors which might determine the self-reported mental health of these immigrants.

METHODS

The cross-sectional national sample included 25-84-year-old Swedish-born persons (n = 35,459) and immigrants from Poland (n = 161), other East European countries (n = 164), and the former Soviet Union (n = 60) who arrived in Sweden after 1944 and were interviewed during 1994-2001. Unconditional multivariate logistic regression was used in the analyses.

RESULTS

The findings indicated that the country of birth had a profound influence on self-reported mental health. Polish and other East European immigrants in general had a twofold higher odds ratio of reporting psychiatric illness and psychosomatic complaints, which fact could not be explained by adjustments for the demographic and socioeconomic variables. However, immigrants from the former Soviet Union had odds similar to those of the Swedish-born reference group. Adjustments for migration-related variables (language spoken at home and years in Sweden) changed the association between the country of birth and the outcomes only to a limited extent.

CONCLUSION

Since poor mental health may hinder acculturation, the mental health of immigrants from Poland and other East European countries should be acknowledged, particularly with the expansion of the European Union and inclusion of nine former Soviet Bloc countries by 2007.

Poor self-reported health and sleeping difficulties among Kurdish immigrant men in Sweden

This study explores the association between ethnicity and poor self-reported health and psychological distress, sleeping difficulties, and use of psychotropic drugs among immigrant Kurdish men and native Swedish men, based on data from the first Swedish National Survey of Immigrants and the Swedish Level-of-Living Surveys collected in 1996 by Statistics Sweden. The age-adjusted odds of poor self-reported health and sleeping difficulties among Kurdish men was about 3.5 times higher than among Swedish men. The odds ratio decreased to 2.1 and 2.7 respectively in a model adjusted for age and the other explanatory variables. Yearning for the home country, perceived discrimination and unemployment in the host country seem to be possible explanations for the higher levels of distress among Kurdish immigrants to Sweden.

Use of hypnotics in Sámi and non-Sámi populations in northern Norway

OBJECTIVES

Our knowledge of the impact of indigenous culture on drug consumption is scarce. Based on the Sámi Health Study, we compare the use of hypnotics among the Sámi and non-Sámi people, living in the same area at 70 degrees N in northern Norway.

STUDY DESIGN

Cross-sectional survey based on a cardiovascular screening, including questionnaires and a clinical examination.

METHODS

A total of 16 323 men and women born 1925 - 1967 in counties with a mixed Sámi and non-Sámi population responded to a questionnaire delivered at attendance of a health study. The response rate was 60%. The main analyses were restricted to 12 378 subjects with information on all relevant variables, including ethnicity and use of hypnotics.

RESULTS

The prevalence of insomnia and use of hypnotics was significantly lower in the Sámi compared to the non-Sámi population in northern Norway (p < 0.0001). Regardless of ethnicity and age, prevalence of use of hypnotics in women was twice that of men. People who consulted modern, or traditional healers had a higher prevalence of use of hypnotics compared to those who did not.

CONCLUSIONS

The stronger the Sámi affiliation, the lower the prevalence of use of hypnotics. In general, insomnia is less frequently stated in the Sámi than in the non-Sámi study population. This may reflect a different attitude to sleep as a phenomenon among the Sámi.

East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden

AIM

Research on the east-west health divide has provided extensive evidence of poorer health in Eastern Europe and the former Soviet Union than in Western Europe. This study focuses on immigrants from Eastern to Western Europe and analyses whether they have an increased risk of self-reported poor health compared with the host population and what determines that.

METHODS

This cross-sectional study is based on 373 immigrants from Poland, other East European countries, and the former Soviet Union, aged 25-84, who arrived in Sweden after 1944 and were interviewed during 1993-2000 along with their 35,711 Swedish counterparts.

RESULTS

Age- and sex-adjusted unconditional logistic regression showed in general a 92% higher risk of reporting poor health among immigrants than among Swedish-born respondents. The risk also persisted after adjustment for several potential confounders (living singly, having a poor social network, low socioeconomic status, and smoking) and after an additional adjustment for acculturation (language at home), and years in Sweden.

CONCLUSIONS

Being born in Eastern Europe or the former Soviet Union was an independent risk factor for reporting poor health. It is therefore suggested that it is important for primary and public care services to be aware of the health status and needs of immigrants from these countries.

[Perception of difficulties in family medicine in the delivery of health to economic immigrants]

OBJECTIVES

To find the problems, as seen by family doctors, in care for immigrants, with description of proposed solutions.

DESIGN

Transversal and descriptive.

PARTICIPANTS

262 doctors from 18 health centres in a district.

MEASUREMENTS

Each professional received a questionnaire containing social and demographic variables, number of immigrants seen per day, their place of origin, 6 items on accessibility, 5 on barriers to care, 6 on clinic, and 7 on solutions.

RESULTS

159 doctors, 57.2% women, replied. Average age was 41.1; 64% saw 2-3 immigrants a day. 52.3% (95% CI, 45.0%-61.4%) recognised that care for immigrants posed professional problems. They said that immigrants attended as an emergency more often (81.1%); they more often had no clinical records (74.7%); and they had difficulties obtaining a health card (53%). 67% expressed no difficulties for getting to the hospital. Perceived barriers were the mobility of immigrants (82.9%), language (82.3%), and culture (71.3%). Solutions suggested were translators (95.6%) or cultural intermediary (82.7%). Clinically, doctors saw no differences of pathology in immigrants (56.7%), and no greater psychiatric pathology (66%). Lack of skill in contagious pathologies hampered care (60.3%). 82.8% affirmed that specific protocols were needed. 80.3% argued for a unit of imported diseases. Among care priorities were information on health circuits and making the health card easier to obtain.

CONCLUSIONS

The difficulties sustained by a broad range of professionals are diverse, with access and linguistic-cultural questions standing out. To palliate them, sensitivity from health staff and action from management are needed.

The trend of cardiovascular disease in immigrants in Sweden

Little is known as to whether the declining trend in cardiovascular disease (CVD) and coronary heart disease (CHD) in the Western countries has reached the immigrant populations. Incidence rates of CVD and CHD between 1991-1993 and 1997-1999 were compared by analysing the relative risk (RR) using the Poisson regression model and the data from 1991-1993 within each group as a reference. The whole Swedish population aged 35-74 years was included and we focused on 12 different immigrant groups. The morbidity from CHD in men from Sweden, Finland and countries in the OECD decreased slightly in an age-adjusted model (RR: 0.91, 0.93, and 0.88, respectively) during the 1990s. The opposite results were observed in women from Southern Europe, Turkey and Iran, in whom CHD morbidity increased (RR: 1.35, 1.54 and 1.40, respectively). The declining trend in CVD and CHD is continuing among men from Sweden, Finland and the OECD countries, but it is unchanged for women from these countries and all other groups studied, and even with increases in some female groups. This might be a sign of a breaking trend in these diseases.

Mental symptoms, psychotropic drug use and alcohol consumption in immigrated middle-aged women. The Women's Health in Lund Area (WHILA) Study

This study aims to analyse mental symptoms, psychotropic drug use and alcohol consumption, in immigrant women born in Finland, the other Nordic countries, Eastern Europe, Western Europe and countries outside Europe, compared with Swedish-born women, and furthermore, to study if age at immigration may have an influence. All women (n=10,766) aged 50-59 years and living in the Lund area of southern Sweden received a postal invitation to a health survey named the Women's Health in Lund Area; 64.2% (n=6917) participated. The participants answered a questionnaire including prevalence of mental symptoms during the past 3 months, regular use of psychotropic drugs, alcohol consumption during an average week, country of birth and age at immigration. Severe mental symptoms were more common among most immigrant groups compared with native Swedes, but the association to country of birth was not significant after adjustment for possible confounders. Regular use of hypnotics was more common among Nordic immigrants only (odds ration, OR = 4.4). East European and non-European immigrants less often were alcohol consumers (OR = 1.6 and OR = 3.8). Heavy drinking was more common among non-Nordic immigrants who immigrated at a younger age than at an older age. Furthermore, it was found that although East European and non-European immigrants had a higher educational level, they were less often gainfully employed compared with native Swedes. In middle-aged women, country of birth as well as age at immigration are important factors to consider in relation to alcohol consumption, but these factors may be of less importance considering mental health.

Immigrants in emergency care: Swedish health care staff's experiences

BACKGROUND

During the past few decades Sweden has developed into a multicultural society. The proportion of patients with different cultural backgrounds increases, which naturally makes new demands on health care staff.

AIM

To identify whether staff in somatic and psychiatric emergency care experienced problems in the care of migrants, and if so to compare these.

METHOD

The study design was explorative. Focus group interviews of 22 women and 13 men working as nurses and assistant nurses at an emergency ward, an ambulance service and a psychiatric intensive care unit were held.

FINDINGS

The results showed that the main problems experienced in all wards were difficulties related to caring for asylum-seeking refugees. Some dissimilarities were revealed: unexpected behaviours in migrants related to cultural differences described by staff working in the emergency ward; migrants' refusal to eat and drink and their inactive behaviour in the psychiatric ward; and a lot of non-emergency runs by the ambulance staff because of language barriers between the emergency services centre and migrants.

CONCLUSION

The main problems experienced by the health care staff were situations in which they were confronted with the need to care for asylum-seeking refugees.

PRACTICE IMPLICATIONS

These emphasize the importance of support from organizational structures and national policies to develop models for caring for asylum-seeking refugees. Simple routines and facilities to communicate with foreign-language-speaking migrants need to be developed. Health care staff need a deeper understanding of individual needs in the light of migrational and cultural background.

Validity of Antonovsky's sense of coherence scale: a systematic review

STUDY OBJECTIVE

The aim of this paper is to systematically review and analyse the validity and reliability of Antonovsky's life orientation questionnaire/sense of coherence scale (SOC).

DESIGN

The study is descriptive and analytical with a systematic integration of the contemporary knowledge base on the salutogenic research published 1992-2003. The review includes 458 scientific publications and 13 doctoral theses.

SETTING

Worldwide, based on postgraduate scientific publications in eight authorized databases, doctoral theses, and available books.

MAIN RESULTS

The SOC questionnaire has been used in at least 33 languages in 32 countries with at least 15 different versions of the questionnaire. In 124 studies using SOC-29 the Cronbach's alpha ranges from 0.70 to 0.95. The alpha values in 127 studies using SOC-13 range from 0.70 to 0.92, and in 60 studies using a modified SOC scale range from 0.35 to 0.91. Test-retest correlation show stability and range from 0.69 to 0.78 (1 year), 0.64 (3 years), 0.42 to 0.45 (4 years), 0.59 to 0.67 (5 years) to 0.54 (10 years). The means of SOC-29 range 100.50 (SD 28.50) to 164.50 (SD 17.10) points and SOC-13 from 35.39 (SD 0.10) to 77.60 (SD 13.80) points. After 10 years SOC seems to be comparatively stable, but not as stable as Antonovsky initially assumed. SOC tends to increase with age. The factorial structure of SOC seems rather to be multidimensional than unidimensional. SOC predicts a positive outcome in a long term perspective, although there are divergent findings reported. The SOC scale seems to be a reliable, valid, and cross culturally applicable instrument measuring how people manage stressful situations and stay well.

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.