Migration and mental health

1. Migration and mental health Hugo Salgado, MPH UCSD MMFRP September 29th 2011

2. Background • “Mental health is not just the absence of a mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” -WHO

3. Background • Exposure to traumatic conditions, coupled with difficulties in acculturationlong-lasting psychological and behavioral problems, including depression, anxiety, posttraumatic stress disorder • Many immigrants experience traumatic circumstances in their native country, including extreme poverty, human trafficking, exposure to war, and natural disasters

4. Background • Many immigrants have difficulty acculturating to their new environments in the U.S. , which is exacerbated by experiences with prejudice and discrimination • Immigrants have less access to, and lower utilization of, mental health services

5. Background • Many studies have examined the mental health status of Latino migrants. (Hummer et al. 2007; Palloni and Arias 2004; Lara et al. 2005) • Protective factors include Social Networks, Social Support • Day laborers in North San Diego/Acculturative Stress/Social Support

6. Current Depression Among Adults --- United States, 2006 and 2008 Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm

7. SAN MIGUEL tlacotepec/vista, Ca. 2011 • Literature • Studies of Migrant Mental Health • Very few studies compare mental health outcomes of migrants, non-migrants and returned migrants from the same sending and satellite community

8. SAN MIGUEL tlacotepec/vista, Ca. 2011 • CESD-10 • - Focuses on clinical depression • - (feelings of sadness, loss, anger, or frustration interfere with everyday life for a period of two weeks or longer ) • - Has been administered in rural communities across the - Mexican state of Jalisco, • - High internal consistency

9. San Miguel Tlacotepec, 2011 • Results: • Mental health among Tlacotepense migrants is better than that of Tlacotepec residents, including return migrants. • Reasons: • Family Separation • Social Networks • ‘Healthy Migrant’ Effect • ‘Salmon Bias’ Effect

10. SAN MIGUEL TLACOTEPEC/VISTA, CA. 2011 • Non-migrants= 23% • Return migrants=21% • Migrants= 9%

11. CES-D SCORES • Overall 16% with depressive symptoms • Non-migrants = more likely to report depressive symptoms • Men = less likely to report symptoms of depression • Higher education = less depressive symptoms • Women = more likely to report depression

12. Regression Analysis N=720. p< 0.001***; p< 0.01**; p<0.05 * Dependent Variable: CES-D Score

13. Self-Reported causes of depression

14. Formal Services available • SMT: • Medical health clinic • Psychologist in Juxtlahuaca • Psychiatrist in Oaxaca • Vista: • Non-Profit organizations • Independent practices

15. treatment • Migrants, return migrants, and non-migrants all show preference for medical and psychological services • Migrants sought less formal treatments • Lack of access to formal services = use of informal treatment

16. Services sought for depression

17. Explaining our findings • Family Separation in San Miguel Tlacotepec • Social Networks, Social Support • ‘Healthy Migrant’ Effect • ‘Salmon Bias’ Effect

18. significance • Mental health is a pressing public health issue • Depression is “among the leading causes of disability worldwide” (WHO) • Essential to understand health among a population that is the largest ethnic-minority group in U.S.

19. Conclusion • Immigrant mental health promotion requires multi-sectoral action: • 1) Government sectors • 2) Non-governmental or community-based organizations • 3) Civil society • 4) Media • Pay special attention availability of social support and social networks, social support, pre-migration conditions and migration experience itself

20. Thank you Questions, Comments?