How Migration Affects Mental Health

According to recent studies

The number of people born in other countries who immigrate to the United Kingdom is continuously increasing (Jayaweera, 2011). With a rising number, the well-being of immigrants has serious implications for the success of present and future generations. The immigration and accompanying relocation process is extremely stressful for a variety of reasons, including the obstacles of a new culture, diet, language, and abandoning family and friends, among others. The well-being and health of immigrants are thus of particular interest to the government and economic players, especially when the issues they experience are exacerbated by high unemployment levels. While there are recent studies that have attempted to compile data regarding the mental health conditions of immigrants, there are gaps in research that should be filled to enable the relevant agencies to have a vast database (Leong, et al., 2013). The rationale of this document is to critically review the existing literature about the health condition of migrants in addition to examining the various aspects connected to mental health. Such factors will include the stress levels and the prevalence of emotional issues. Further, the paper will explore the potential risk factors that may be related to mental health outcomes which include the socio-economic variables.

Evidence Based Practice

The nurses have the responsibility of providing the highest standards of care to the patients and the clients that need their services. This milestone is achieved by the nurses relying on evidence based practice (Burns, and Grove, 2010). To enable the provision of this best of care, the nurses and health practitioners in general must learn to appraise primary research to examine its quality. This evaluation is critical as it enhances the practice of health care professionals and improves their theoretical and clinical knowledge. A nursing practice that is based on evidence uses professional expertise, understanding of the needs of the patients and their relatives and the subsequent use of the best available evidence to achieve positive health outcomes for the entire healthcare system (Fineout-Overholt, et al., 2010, p. 48).

The Databases used

For this literature review, various databases were used to obtain the best articles and papers to be used. Such credible medical databases like the, PsychARCTICLES, the Sage Journals, Science Direct were used to select the articles. These databases provide literature that has been peer-reviewed on the mental health issues and behavioural science which is critical in completing this paper.

The Different Searches

This study will make use of various search techniques to come up with the articles to be employed in the review. Besides searching for the authors and the use of specific words, a truncation of certain words was also applied to come up with a diverse set of results after which the most applicable and quality papers were selected.

Steps in Reducing the Search

This literary search made use of the word combination together with the use of the logical operators. Specifically, the Boolean terms, AND, OR. Besides, I used the date range and limited the search to articles that were published between 2010 and 2017. This allowed the review to focus on the most recent data and information as articles published earlier may have slightly outdated information. The key words used in the search included, Mental Health; Migrant; Migration; Europe; Stress; Management

Quality of Research

There are various components that must be taken into account when determining the quality of research. The most significant factor is ascertaining whether the research is valid, trustworthy and reliable. In appraising primary research, the above criterion is determined by looking at various factors like the title of the study, the authors, and the journal where the article was published, the methods of research utilized by the authors (Coughlan, Cronin, and Ryan, 2007, p. 661). Besides, the sampling procedures, the size of the sample, identification of potential biases and listing of the ethical considerations are critical in determining the reliability, validity and generalisability of the findings of the study.

Results

According to the World Health Organization (WHO), mental health is a state of well-being where a person copes with the normal stressors of life, can realize his potential while is productive and fruitful in his or her work and makes significant contributions to the community. The state of mental health is a primary component to leading a good and quality life (Jayaweera, 2011). While the absence of mental disorders is one factor that helps define good mental health, other factors like the presence of coping skills like balance, flexibility and resilience are considered when assessing the mental condition of immigrants (Bhugra, et al., 2011, p. 3). It is, therefore, a complicated relationship between those factors that put the health at jeopardy and the social and psychological factors that guard it. The state of mental health is linked with various outcomes of integration that include educational achievements, building relationships and social networks, economic status as well as the physical well-being. These factors have a huge impact on the ability of an immigrant to settle in the community.

One of the risk factors

that are considered to cause various diseases including mental illnesses is stress. In the course of the immigrants uprooting, relocating and adapting, the acculturative stress may overwhelm them. These groups of people are usually exposed to a variety of stressors like pre-migration stress that may have resulted from exposure to catastrophic experiences in the refugee camps (Jayaweera, 2011). Besides, post-migrations stressors like unemployment, separation from families and poverty play a huge role in the mental health status. Other adjustment challenges that the immigrants are exposed to include, discrimination, change of identity and roles, and pressures of integration among others (Kirmayer, et al., 2011, p. 960). When these stressors are combined with poor or lack of social support, the psychological and well-being of the settlers may be adversely affected and lead to depression.

Once migrants arrive in a different country,

they are faced with barriers to accessing the services of the medical system in that nation. In most cases, the migrants are not informed about the health care structure which poses difficulties and discomfort. Besides, the medical structure may not be offering culturally sensitive care which poses further challenges. For example, while mental illnesses have uniform symptoms across races and cultures, how they manifest and the way people explain and understand the symptoms may differ among various cultures and ethnicities ((Kirmayer, et al., 2011, p. 962). This has the potential of incorrect diagnosis which leaves the problem untreated.

Some hypotheses have suggested

that stress exposure may be impacted by moderating forces like social and personal resources which ultimately affect the mental health status of immigrants. Personal characteristics like ethnicity and developmental life stage of the alien as well as contextual factors like socioeconomic status and circumstances of migration have a role in the adaptation ability of immigrants.

The available literature has also

identified protective factors that have a positive effect on stress like fluency of language, social resources, family and support for ethnic communities, increase the well-being of individuals. Social support is essential for it does not only offer protective effects, but it also enables persons to cope and overcome life challenges through empowering them (Kirmayer, et al., 2011, p. 966).

How Migration Affects Mental Health

The rates of mental illness differ from one migrant group to another, but the variance is not indicative of the levels in the country of origin. The frequency of particular types of health conditions, however, does indicate the course of the difficulty they experienced before migration, during, as well as after settlement (Rechel, et al., 2013, p. 1236). The effects of the factors that inform the mental health status of migrants vary with how severe they occur and what they mean to particular individuals, families, and communities (Carswell, Blackburn, and Barker, 2011, p. 111).

It has been established

that the health of migrants and refugees is superior than that of the host and sending countries’ general population. Of the reason is the ‘healthy immigrant effect,' which requires that an individual must go through various filters before they achieve migrant status. With time, however, the mental well-being of the migrants tends to deteriorate to equal that of the residents (Davydov, Stewart, Ritchie, and Chaudieu, 2010, p. 480). An analysis of data done in the United States recently revealed that there were lower rates of depression and other mental conditions among new immigrants, but increased with time and matched the rates of the general population. The analysis, further found out that the rates for persons that arrived before attaining the age of 12 years and for the kids of migrants, the rates were similar to those of the population.

There is evidence to suggest

that certain cohorts of immigrants have higher incidences of psychotic diseases after they migrate (Rechel, et al., 2013, p. 1236). Researchers have found elevated levels of schizophrenia among the first generation migrants the levels increasing among the second generation immigrants. The increased risk is associated with the migrants originating from developing economies where the majority of the inhabitants are black (Davydov, et al., 2010, p. 486). This statistic suggests that racism and bigotry play a role in the high rates of the disorders.

The migration process

consists of three major transitions: change of personal ties and rebuilding of the social relationships, the shift from one social and economic environment to another and the movement from one cultural set up to another. The trajectory of migration is, therefore, grouped into three phases: before migration, migration and after migration resettlement. Every one of the phases has particular risks and exposures associated with it. The pre-migration period is characterized by disruptions in the social and personal networks (Kirmayer, et al., 2011, p. 963). During the migration stage, the immigrants usually experience extended anxiety concerning their citizenship status and other conditions that may render them exposed to violence. This is especially frightening for those migrants that seek asylum and refugees who have to live in deplorable conditions and detention centers which leave them hopeless and with a sense of helplessness (Sandhu, et al., 2013, p. 108). These conditions can either provoke or worsen stress, depression among other psychotic illnesses.

Resettlement brings optimism,

which has an initial positive effect of well-being. However, the mental problems may develop later when the initially held expectations and hopes are not achieved and when the immigrant families face unending hindrances to development in their new community because of blockages of exclusionary policies and discrimination (Rechel, et al., 2013, p. 1239). Challenges like failing to have academic credentials recognized by the host jurisdiction compromise the ability for individuals to hold jobs that commensurate their education levels. Extensive research and analysis suggest that resettlement stress springs from strains in social and economic, loss of status, discrimination, and exposure to hostility.

Another aspect of concern

is that immigrants, especially the recent ones, are less likely to look for or be referred to mental health services compared to the general population even when they are exposed to comparable levels of health problems (Bhugra, et al., 2014, p. 108). This phenomenon can be explained by factors like cultural and structural challenges, also, to deal with tribulations on own, apprehensions that the health providers will not understand their problems because of language and culture or due to fear of stigmatization (Siriwardhana, and Stewart, 2013, p. 20). As a consequence of cultural explanations of illnesses, mental health diseases are highly stigmatized in majority of developing countries, and many patients shy from attributing symptoms to mental health illness.

Children and Adolescents

There is a wide variation from various research done on the mental health of teenage immigrants. While some studies from community samples and health providing facilities indicate that the adolescents are at a higher risk for disorders like depression, PTSD, conduct disorder and problems emanating from substance abuse, other research from larger samples and organizations shows that the rates are not any higher than that of youths born in the host country ((Davydov, et al., 2010, p. 488). It has been observed that some youngsters do exceptionally well and even achieve better grades than the native-born children.

Elevated levels of grief and depression

are prevalent in many young refugees, who had to experience disruptions to educational and social development. During migration, they lose the emotional, financial and material support from the relatives if they separate with their parents (Sandhu, et al., 2013, p. 106). In the last phase of post-migration, the youngsters are confronted with acculturative stress and paucity. Even after the adolescents are reunited with family, they still have to deal with discrimination, isolation, learn a new language, racism among other challenges (Sirin, et al., 2013, p. 736). As the youngsters acculturate, they come into conflict with relatives, parents, and seniors.

Women

Women are impeded in accessing mental health facilities because of the many roles immigrant women play in their homes and at work. These women are at two times at risk for post-partum depression than native-born women (Rechel, et al., 2013, p. 1236). Most women do not seek help for this depression because they lack knowledge about post-partum depression, unwillingness to share the emotional problems, fears of stigmatizing the family by disclosing mental health concerns (Kirmayer, et al., 2011, p. 960). Besides, there is fear of losing the children to the authorities as well as the reluctance to undertake treatment for psychosocial problems.

Research has shown that refugee women

that have been observed in dedicated clinics that have high levels of experience to fighting and PTSD that has not been clinically addressed sufficiently (Sandhu, et al., 2013, p. 108). Psychologists and experts in this area advice that exploration into the history of rape and sexual abuse should be done with massive sensitivity and be guided comfort and needs of the patient.

Older Adults

In first migration, the proportion of migrant seniors to the general immigrant population is very minute. The seniors arrive later to join the family after it has settled. These senior citizens are exposed to risk factors like female sex, unemployment, and chronic diseases like asthma, diabetes, cancer among others. Also, they normally have less education, are widowed, divorced, lack social; support and sometimes live alone all of which contribute to higher risks of developing or aggravating mental health disorders (Kirmayer, et al., 2011). In instances where the senior immigrants are joining a settled family, the issues they have to deal with include learning a new language, which takes a lot of time because of their advanced age, being separated from his extended family, familiar surroundings, and peers. They also experience reduced social support because of the lost natural family and community networks (Siriwardhana, and Stewart, 2013, p. 20). As a result, they have a high dependency in areas of language, mobility difficulties, reduced opportunities for work and productivity in addition to the loss of status as a respectable elder in the new cultural setup.

Conclusions

Migration is a stressful experience that if not monitored well, can lead to mental health problems to the migrating families. The three-tier process involves cutting off links and having to create new networks, having to adapt to a new culture during the migration and having to learn the experience of the culture after settling in the host country. In all these instances, there are many risks that are involved including separation from families, travel trauma and sometimes poor living conditions. However, it has been established that most migrants do not develop mental health problems during the initial stages; instead, it develops or is aggravated over time to reach the levels of the general population.

The factors that contribute to the mental health state of migrants

is classified into three categories; individual, structures of the mental health system of the host country and the policies of the host nation regarding migrant status. Some nations have very limiting policies that deny the migrant's access health insurance. For example, the United States passed a law in 2010 that does not allow an immigrant to access insurance until they finish five years in the country. Individual factors include the cultural differences and language barriers as well as the perception of mental illnesses of the immigrant which may be different from the new culture. Besides, the experiences of the immigrants before settling in play a huge role in determining the mental health status of the individual. Racism and discrimination and alienation are known factors that can increase the stress levels of migrants.

Opinion Connecting the Majority of the Research

To promote mental requires a holistic approach in order to address the social determinants at the social level. Research is one aspect that is required to fill gaps of perception of mental health among various age groups, how the mental health status changes over time and the intersections of the experiences of immigrants and addictions and homelessness. The mental health practitioners are responsible for establishing the negative effects of immigration on the mental health of the refugees especially women and children; they should also pay attention to the pre and post-migration experiences as well as the coping mechanisms and find the ways of enhancing their access to mental health care services. The professional should further look into their health care system and establish the actions that either inhibit or facilitate access to health care for immigrants. The education of mental health professionals should take into account the diversity of the ethno cultural groups and equip them to address the diverse needs. Above all, governments must develop a policy to enable the achievement of health equity and enhance the immigrant’s mental health.

References

Bhugra, D., Gupta, S., Bhui, K., Craig, T.O.M., Dogra, N., Ingleby, J.D., Kirkbride, J., Moussaoui, D., Nazroo, J., Qureshi, A. and Stompe, T., 2011. WPA guidance on mental health and mental health care in migrants. World Psychiatry, 10(1), pp.2-10.

Bhugra, D., Gupta, S., Schouler-Ocak, M., Graeff-Calliess, I., Deakin, N.A., Qureshi, A., Dales, J., Moussaoui, D., Kastrup, M., Tarricone, I. and Till, A., 2014. EPA guidance mental health care of migrants. European Psychiatry, 29(2), pp.107-115.

Burns, N. and Grove, S.K., 2010. Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.

Carswell, K., Blackburn, P. and Barker, C., 2011. The relationship between trauma, post-migration problems and the psychological well-being of refugees and asylum seekers. International Journal of Social Psychiatry, 57(2), pp.107-119.

Coughlan, M., Cronin, P. and Ryan, F., 2007. Step-by-step guide to critiquing research. Part 1: quantitative research. British journal of nursing, 16(11), pp.658-663.

Davydov, D.M., Stewart, R., Ritchie, K. and Chaudieu, I., 2010. Resilience and mental health. Clinical psychology review, 30(5), pp.479-495.

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B. and Williamson, K.M., 2010. Evidence-based practice step by step: Critical appraisal of the evidence: part I. AJN The American Journal of Nursing, 110(7), pp.47-52.

Jayaweera, H., 2011. Health of migrants in the UK: What do we know. The migration observatory, University of Oxford.

Kirmayer, L.J., Narasiah, L., Munoz, M., Rashid, M., Ryder, A.G., Guzder, J., Hassan, G., Rousseau, C. and Pottie, K., 2011. Common mental health problems in immigrants and refugees: general approach in primary care. Canadian Medical Association Journal, 183(12), pp.E959-E967.

Leong, F., Park, Y.S. and Kalibatseva, Z., 2013. Disentangling immigrant status in mental health: Psychological protective and risk factors among Latino and Asian American immigrants. American Journal of Orthopsychiatry, 83(2pt3), pp.361-371.

Rechel, B., Mladovsky, P., Ingleby, D., Mackenbach, J.P. and McKee, M., 2013. Migration and health in an increasingly diverse Europe. The Lancet, 381(9873), pp.1235-1245.

Sandhu, S., Bjerre, N.V., Dauvrin, M., Dias, S., Gaddini, A., Greacen, T., Ioannidis, E., Kluge, U., Jensen, N.K., Lamkaddem, M. and i Riera, R.P., 2013. Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries. Social psychiatry and psychiatric epidemiology, 48(1), pp.105-116.

Sirin, S.R., Ryce, P., Gupta, T. and Rogers-Sirin, L., 2013. The role of acculturative stress on mental health symptoms for immigrant adolescents: A longitudinal investigation. Developmental Psychology, 49(4), p.736.

Siriwardhana, C. and Stewart, R., 2013. Forced migration and mental health: prolonged internal displacement, return migration and resilience. International health, 5(1), pp.19-23.

Appendices

Search Summary

Database Searched

Date Searched

Search Strategy Used

(Keywords, phrases, subject terms)

Limits

(Date range, language)

No. Results

Notes

Search strategy saved (name)?

Files saved/exported (name/place)?

Keywords, authors for future searches?

Sage Publications

12/06/2017

Key words

2011-2017

749

migration stress and mental health in the UK

Science Direct

25/06/2017

Key Words

Lancet

59

migration stress and mental health in the Europe

PsychARCTICLES,

Key words

Immigration

47

stress and mental health of immigrants