Depression and anxiety in labor migrants and refugees – A systematic review and meta-analysis

doi:10.1016/j.socscimed.2009.04.032

Social Science & Medicine

Volume 69, Issue 2, July 2009, Pages 246-257

https://doi.org/10.1016/j.socscimed.2009.04.032 Get rights and content

Abstract

Prevalence rates of depression and anxiety among migrants (i.e. refugees, labor migrants) vary among studies and it's been found that prevalence rates of depression and anxiety may be linked to financial strain in the country of immigration. Our aim is to review studies on prevalence rates of depression and/or anxiety (acknowledging that Post-traumatic Stress Disorder (PTSD) is within that class of disorders), and to evaluate associations between the Gross National Product (GNP) of the immigration country as a moderating factor for depression, anxiety and PTSD among migrants. We carried out a systematic literature review in the databases MEDLINE and EMBASE for population based studies published from 1990 to 2007 reporting prevalence rates of depression and/or anxiety and or PTSD according to DSM- or ICD- criteria in adults, and a calculation of combined estimates for proportions using the DerSimonian–Laird estimation. A total of 348 records were retrieved with 37 publications on 35 populations meeting our inclusion criteria. 35 studies were included in the final evaluation. Our meta-analysis shows that the combined prevalence rates for depression were 20 percent among labor migrants vs. 44 percent among refugees; for anxiety the combined estimates were 21 percent among labor migrants vs. 40 percent among (n = 24,051) refugees. Higher GNP in the country of immigration was related to lower symptom prevalence of depression and/or anxiety in labor migrants but not in refugees. We conclude that depression and/or anxiety in labor migrants and refugees require separate consideration, and that better economic conditions in the host country reflected by a higher GNP appear to be related to better mental health in labor migrants but not in refugees.

Section snippets

Background

The total number of migrants in 2006 was about 200 millions and is expected to rise until 2050 to 230 millions worldwide (Bhopal, 2007, Unites Nations, 2005, International Organization of Migration, 2008). The definition and range of persons defined as “migrants” are often unclear. A variety of persons may be considered ‘‘migrants'’, including those who migrated because of “pull” factors of the immigration country (i.e. labor migrants); as well as those who migrated because of “push” factors

Methods

Conflicting evidence exists on the reliability of self reported and of clinician administered questionnaires. We included studies conducted with both types of assessment methods. Reliability studies examining inter-rater reliability of self reported and of clinician administered questionnaires have shown good agreement between those methods (Ustun, Compton, Mager, et al., 1997). The included studies were evaluated for differences between the assessment methods in relation to the reported

Results

Fig. 1 presents a flow diagram outlining the systematic review process. A total of 37 publications including 35 migrant study populations addressing the prevalence of depression, anxiety and posttraumatic stress and/or respective disorders after migration were included in this review (Alegria et al., 2007, Allden et al., 1996, Bhui et al., 2003). Among these, 23 related to 20 refugee groups, 10 to labor migrants, and three to mixed groups. The studies included 24,051 migrants in total. Table 1

Discussion

Our assessment suggests that prevalence rates of depression are almost twofold higher in refugees than in labor migrants (Fig. 2, Fig. 3) (labor migrants 20 percent with 95 percent CI: 14, 26; refugees: 44 percent with 95 percent CI: 27, 62). The pooled prevalence rates of depression and anxiety among labor migrants are similar to the general US-population (22 percent for depression; 18 percent for anxiety) (Kessler, Chiu, Demler, & Walter, 2005). This review and meta-analysis is to our

Acknowledgements

This work was supported in part by the Intramural Research Program at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

References (114)

R. DerSimonian et al.
Meta-analysis in clinical trials
Controlled Clinical Trials
(1986)
M. Fazel et al.
Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review
Lancet
(2005)
J. Garcia-Campayo et al.
Mental health in immigrants: the new challenge
Medicina Clinic
(2002)
J.M. Gorman
Gender differences in depression and response to psychotropic medication
Gender Medicine
(2006)
F. Janssen et al.
Association between gross domestic product throughout the life and old-age mortality across birth cohorts: parallel analyses of seven European countries, 1950–1999
Social Science & Medicine
(2006)
Y. Lee et al.
Trauma experience of North Korean refugees in China
American Journal of Preventive Medicine
(2001)
S. Moussavi et al.
Depression, chronic diseases, and decrements in health: results from the World Health Surveys
Lancet
(2007)
L. Myer et al.
Social determinants of psychological distress in a nationally-representative sample of South African adults
Social Science & Medicine
(2008)
G. Roth et al.
A longitudinal study of PTSD in a sample of adult mass-evacuated Kosovars, some of whom returned to their home country
European Psychiatry
(2006)
Z. Steel et al.
Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study
Lancet
(2002)

D. Summerfield

Trauma, post-traumatic stress disorder, and war

Lancet

(1998)

K. Sundquist et al.

Posttraumatic stress disorder and psychiatric co-morbidity: symptoms in a random sample of female Bosnian refugees

European Psychiatry

(2005)

M. Alegria et al.

Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups

American Journal of Psychiatry

(2008)

M. Alegria et al.

Prevalence of psychiatric disorders across Latino subgroups in the United States

American Journal of Public Health

(2007)

K. Allden et al.

Burmese political dissidents in Thailand: trauma and survival among young adults in exile

American Journal of Public Health

(1996)

American Psychiatric Association (APA)

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders

(1994)

T.F. Babor et al.

The alcohol use disorders identification test: Guidelines for use in primary health care

(1992)

P. Bebbington et al.

Psychiatric disorders in selected immigrant groups in Camberwell

Social Psychiatry

(1981)

A.T. Beck

Beck anxiety inventory

(1987)

A.T. Beck et al.

An inventory for measuring depression

Archives of General Psychiatry

(1961)

R.S. Bhopal

Ethnicity, race, and health in multicultural societies

(2007)

D. Bhugra

Migration and mental health

Acta Psychiatrica Scandinavica

(2004)

K. Bhui et al.

Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees-preliminary communication

Social Psychiatry and Psychiatric Epidemiology

(2003)

O. Blanchard et al.

Makroökonomie

(2006)

L. Bradley et al.

The physical and psychological effects of torture in Kurds seeking asylum in the United Kingdom

Torture

(2006)

M.A. Burnamm et al.

The Spanish diagnostic interview schedule: reliability and comparison with clinical diagnoses

Archives of General Psychiatry

(1983)

M. Carballo et al.

Migration and health in the European Union

Tropical Medicine & International Health

(1998)

B.L. Cardozo et al.

Mental health, social functioning and attitudes of Kosovar Albanians following the war in Kosovo

Journal of the American Medical Association

(2000)

M.G. Carta et al.

Report on the state of the mental health in Europe. Migration and mental health in Europe (the state of the mental health in Europe working group. Appendix 1)

Clinical Practice and Epidemiology in Mental Health

(2005)

M.G. Carta et al.

Psychiatric disorders in Sardinian immigrants in Paris: a comparison with Parisians and Sardinian residents in Sardinia

Social Psychiatry and Psychiatric Epidemiology

(2002)

M.G. Carta et al.

Depressive episodes in Sardinian emigrants to Argentina: why are females at risk

Social Psychiatry and Psychiatric Epidemiology

(2006)

J. Endicott et al.

The global assessment scale

Archives of General Psychiatry

(1976)

H. Fenta et al.

Determinants of depression among Ethiopian immigrants and refugees in Toronto

Journal of Nervous and Mental Disease

(2004)

E.B. Foa

Posttraumatic stress diagnostic scale manual

(1995)

E.B. Foa et al.

The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale

Psychological Assessment

(1997)

S.H. Fox et al.

The Sierra Leonean refugee experience: traumatic events and psychiatric sequelae

Journal of Nervous and Mental Disease

(2000)

C. Fuertes et al.

The immigrant in primary care consultations

Sistema Sanitaria de Navara

(2006)

A.A. Gerritsen et al.

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands

Social Psychiatry and Psychiatric Epidemiology

(2006)

R.J. Glover

The pattern of psychiatric admissions of Caribean-born immigrants in London

Social and Psychiatric Epidemiology

(1989)

D.P. Goldberg et al.

Psychiatric illness in general practice. A detailled study using a new method of case identification

British Medical Journal

(1970)

C. Gorst-Unsworth et al.

Psychological sequelae of torture and organized violence suffered by refugees from Iraq: trauma-related factors compared with social factors in exile

British Journal of Psychiatry

(1998)

B.F. Grant et al.

The alcohol use disorder and associated disabilities interview schedule-DSM-IV Version

(2001)

B.F. Grant et al.

Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Archives of General Psychiatry

(2004)

B. Gushulak

Commentary. Healthier on arrival. Healthier on arrival? Further insight into the “healthy immigrant effect”

Canadian Medical Association

(2007)

E. Hansen et al.

Health issues of migrant and seasonal farm workers

Journal of Health Care for the Poor and Underserved

(2003)

L.K. Hemsi

Psychiatric morbidity of West Indian immigrants

Social Psychiatry

(1967)

J.D. Hovey et al.

Cognitive, affective, and physiological expressions of anxiety symptomatology among Mexican migrant farm workers. Predictors and generational differences

Community Mental Health

(2002)

International Organization of Migration

Migration and the right to health

A Review of European Community Law and Council of Europe Instruments

(2007)

Y. Kalafi et al.

Mental health among Afghan refugees settled in Shiraz, Iran

Psychological Reports

(2002)

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Depression and anxiety in labor migrants and refugees – A systematic review and meta-analysis

Abstract

Section snippets

Background

Methods

Results

Discussion

Acknowledgements

Controlled Clinical Trials

Lancet

Medicina Clinic

Gender Medicine

Social Science & Medicine

American Journal of Preventive Medicine

Lancet

Social Science & Medicine

European Psychiatry

Lancet

Lancet

European Psychiatry

Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups

American Journal of Psychiatry

Prevalence of psychiatric disorders across Latino subgroups in the United States

American Journal of Public Health

Burmese political dissidents in Thailand: trauma and survival among young adults in exile

American Journal of Public Health

DSM-IV: Diagnostic and Statistical Manual of Mental Disorders

The alcohol use disorders identification test: Guidelines for use in primary health care

Psychiatric disorders in selected immigrant groups in Camberwell

Social Psychiatry

Beck anxiety inventory

An inventory for measuring depression

Archives of General Psychiatry

Ethnicity, race, and health in multicultural societies

Migration and mental health

Acta Psychiatrica Scandinavica

Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees-preliminary communication

Social Psychiatry and Psychiatric Epidemiology

Makroökonomie

The physical and psychological effects of torture in Kurds seeking asylum in the United Kingdom

Torture

The Spanish diagnostic interview schedule: reliability and comparison with clinical diagnoses

Archives of General Psychiatry

Migration and health in the European Union

Tropical Medicine & International Health

Mental health, social functioning and attitudes of Kosovar Albanians following the war in Kosovo

Journal of the American Medical Association

Report on the state of the mental health in Europe. Migration and mental health in Europe (the state of the mental health in Europe working group. Appendix 1)

Clinical Practice and Epidemiology in Mental Health

Psychiatric disorders in Sardinian immigrants in Paris: a comparison with Parisians and Sardinian residents in Sardinia

Social Psychiatry and Psychiatric Epidemiology

Depressive episodes in Sardinian emigrants to Argentina: why are females at risk

Social Psychiatry and Psychiatric Epidemiology

The global assessment scale

Archives of General Psychiatry

Determinants of depression among Ethiopian immigrants and refugees in Toronto

Journal of Nervous and Mental Disease

Posttraumatic stress diagnostic scale manual

The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale

Psychological Assessment

The Sierra Leonean refugee experience: traumatic events and psychiatric sequelae

Journal of Nervous and Mental Disease

The immigrant in primary care consultations

Sistema Sanitaria de Navara

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands

Social Psychiatry and Psychiatric Epidemiology

The pattern of psychiatric admissions of Caribean-born immigrants in London

Social and Psychiatric Epidemiology

Psychiatric illness in general practice. A detailled study using a new method of case identification

British Medical Journal

Psychological sequelae of torture and organized violence suffered by refugees from Iraq: trauma-related factors compared with social factors in exile

British Journal of Psychiatry

The alcohol use disorder and associated disabilities interview schedule-DSM-IV Version

Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Archives of General Psychiatry

Commentary. Healthier on arrival. Healthier on arrival? Further insight into the “healthy immigrant effect”

Canadian Medical Association

Health issues of migrant and seasonal farm workers

Journal of Health Care for the Poor and Underserved

Psychiatric morbidity of West Indian immigrants