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Message from the president
Johannes Wancata, President
Dear IFPE members,
Recently Prof. Steffi Riedel-Heller has sent the
2nd Announcement for our next congress in
Leipzig in 2013. The title of the congress will be
“The uses of psychiatric epidemiology in
improving population mental health”. This
theme is an important and interesting next
topic after the last conferences focusing on
‘Happiness and well-being’ three years ago in
Vienna and ‘Global recession and mental health’
last year Taiwan. In nowadays world, psychiatric
epidemiologist face numerous challenges:
beside the usual epidemiological tasks of
identifying risk factors for mental illness and of
providing data for health service planning,
policy makers have new and urgent questions
such as how to prevent negative consequences
of unemployment, or how to increase
effectiveness of services but costing less money.
The congress in Leipzig will give the opportunity
to discuss all these topics. Beside these very
important issues the congress will explore the
most recent scientific methods and research
designs in order to positively impact mental
health across various populations.
Excellent researchers from all over the world
have announced to come to Leipzig and to give
lectures reporting their most recent findings.
Leipzig provides an exciting environment for
this meeting combining all advantages of
modern European cities with old traditions of
their culture.
An excellent local team coordinated by Steffi
Riedel-Heller is preparing the conference and
will provide an exciting congress. It is good to
know that preparations for the 14th
International Congress of the IFPE are well
underway in Leipzig.
I am looking forward to this exciting
opportunity to learn from each other and to
listen international top researchers presenting
their most recent findings.
I have two requests to all IFPE members:
1. Please, don’t forget to submit your
abstract(s)!
bulletin
International Federation of Psychiatric Epidemiology Volume 10(2) July 2012
2
2. Please, tell all your colleagues that we
are expecting an exciting and
stimulating conference in Leipzig!
I am looking forward to read the numerous
abstracts and to meet you in Leipzig!
Johannes Wancata
President IFPE
Migration and mental illness: an
update1
Andrew T.A. Cheng
One of the major aspects of social change
following rapid globalisation in the second half
of the last century has been in migration.
According to the International Organization for
Migration, there are now about 192 million
people living outside their place of origin, which
is about 3% of the world’s population. This
means that roughly one out of every 35 persons
in the world is a migrant. This number includes
26 million internally displaced persons, and 16
million cross-national refugees and asylum
seekers.1 In other words, at least one in every
400 people alive in the world today is a refugee.
Migration has been regarded as having
a substantial impact on people’s mental health,
either as a precipitating or as an aggravating
factor. Each stage of migration can involve
certain risk factors for mental health, including
individual personality and traumatic
experiences (such as violence and war during
pre-migration); duration of waiting period;
degrees of exhaustion; types of trauma during
the migration process; social adversity; racial
discrimination; poor living conditions and legal
status post-migration.
Methodological issues
Most studies have used a cross-sectional design
and assessed short- or long-term effects of
migration on mental health retrospectively.
Three types of comparative strategy have been
employed, namely comparisons between
immigrants and people in their country of
origin; between foreign-born immigrants and
their descendants born in the new country, and
between native-born persons and immigrants,
either first or second generation.
Use of the same cross-culturally valid
and reliable instruments in different languages
among the comparison groups is a fundamental
requirement in the study of migration and
mental health. Definitions of ethnicity, race,
nationality and place of birth in subject
recruitment need to be consistent across
studies. With these considerations in mind, the
main findings to date are summarised and their
implications discussed.
3
Migration and psychotic disorders
Earlier studies suggested a negative
immigration effect on people who were in the
incipient stage of illness, notably schizophrenia,
prior to migration. The classical study by
Odegaard2 explained the phenomena in terms
of a selective tendency to migrate among
vulnerable and insecure individuals who had
failed in interpersonal relationships in their
home country.
Several studies have since reported an
increased incidence of schizophrenia and other
psychotic disorders in selected immigrant
groups, including both first- and second-
generation African-Caribbean immigrants in the
UK.3 This finding remains robust after
controlling for potential confounding factors,
including ethnic demographic differences,
diagnostic bias and misclassification in ethnic
minorities; selective referral bias; differential
use of cannabis and other illicit drugs, and
problems in calculating the populations at risk.
An increased familial risk for
schizophrenia and also for non-affective
psychoses was found in the first and second
generations of Afro-Caribbean immigrants, and
in siblings but not in parents of the second
generation.4 This suggests that the increased
incidence in immigrants is not due solely to
genetic predisposition. Both biological and
social exposures
associated with immigration may provoke
psychotic disorders. As Broome et al5 comment,
‘A plausible model of the onset of psychosis
needs to draw not only on neurosciences, but
also on the insights of social psychiatry and
cognitive psychology’.
Migration and suicide
Suicide rates have consistently been found to
be higher among immigrants. Studies of
immigrants from 15 countries to Sweden6 and
from seven countries to Australia7 reported
higher rates among them than in the countries
of origin.
The relation of period of residence in a
new country to suicide rates is still unclear.
However, a recent U.S. study revealed an
increased suicide risk among immigrants and an
inverse relationship between shorter duration
of residence and a higher suicide risk,
suggesting that suicide should focus on recent
immigrants.8
Involuntary migration: refugees and asylum
seekers
Both hospital and population-based studies
among refugees and asylum seekers have
repeatedly observed high rates of psychiatric
disorders. The high morbidity has been
attributed to loss and traumatic events before
or during the migration process, and post-
migration stresses involving trauma, asylum
4
procedures, detention, social isolation and
readjustment in family, job, housing and living
conditions. A meta-analysis based on 59
control studies reported a poorer mental health
condition among refugees, associated with both
refugee personal characteristics and post-
displacement experiences. The former included
older age, higher education, feminine gender,
and a higher pre-displacement social status.
Post-displacement factors included institutional
accommodation, restricted economic
opportunities; internal displacement; forced
repatriation and unresolved initiating conflict.9
A much higher level of psychiatric
morbidity, especially PTSD, depression and
anxiety disorders, with a total prevalence
around 40-50%, has been reported among
refugee children.10 Contributing factors may
include direct experience or witnessing of
violence, loss of parents and family, and being
looked after by parents who themselves cannot
cope with the children’s needs. It has been
found that a stressful social life such as
discrimination in the new country predicts
subsequent psychological problems eight or
nine years after arrival.11
Studies of immigrants in general
Over the past two decades, U.S. studies have
consistently reported lower prevalences of
mood and substance use disorders among first-
generation Mexican, Hispanic, Asian and non-
Hispanic white immigrants than among U.S.-
born persons of the same ethnic origins. Such
lower rates, however, were observed only in
the early years following migration.12 It may be
that these groups score better in the initial
years than their second-generation
counterparts because of positive selection in
migration, but that this advantage is lost over
time, as a result of acculturation stress or
difficulties of adaptation to the host society.
One recent study among Mexican
citizens (n=5826) found that respondents with a
history of earlier migration to the U.S., or
having family members in the U.S., were at
higher risk for substance use disorders than
were other Mexicans. The authors speculated
that this type of migration may tend to increase
substance misuse and related pathology in
Mexico.13
Findings of studies which failed to
differentiate between refugees and voluntary
or economic immigrants have been
inconsistent. Some have reported higher rates
of anxiety and mood disorders among adult
immigrants, and both internalising and
externalising problem behaviours among
children; some found no differences, and some
conversely reported lower rates among
immigrants. These disparities may be explained
by differences in sample recruitment, case
definitions and identification methods, in period
5
of study in the migration process and in
heterogeneity of the study samples.
Internal migration: selective migration?
Stress associated with internal migration is
generally less severe and largely involves sub-
cultural adaptation, without a language barrier
or traumas such as detention. Rural-urban
migration is common in developing countries,
due to decline of rural economies and the
concentration of wealth and jobs in cities. A
community study in Taiwan found lower rates
of depressive symptoms in migrant urban young
women (0.4%) than among native rural
counterparts (9.8%).14 Difference in social
adversity (53% in rural vs. 25% among urban
young female cases) and selective migration
were both proposed to explain this difference.
Motivation for migrating to the cities is not
always or only economic: other reasons include
escape from social adversity and inequality of
status between husband and wife in rural
Taiwan.
An often neglected aspect of the
general problem is the movement of aboriginal
peoples from their ‘reservations’ (ethnic
territories) to the cities, occurring in particular
in the USA, Canada, Australia, New Zealand,
China, Taiwan, Japan and some countries in
South America. Few studies to date have
investigated the impact of such migration on
physical and mental health, related to
acculturative stress.
Use of mental health services by immigrants
Studies of the use of mental health services by
immigrants, and evaluation of their effects, are
important for secondary and tertiary
prevention. Compared to indigenous
populations, non-European immigrants to
Canada and the U.S.A. tend to under-use
mental health services. The lower utilization by
immigrants cannot be explained by differences
in socio-demographics, somatic or psychological
symptoms, length of stay in the host country or
alternative sources of help. Possible
explanations include cultural and linguistic
barriers, inappropriate treatment and the
nature of illness causation. In some countries,
migrants without legal documents are not
eligible for public health care; hence access to
mental health services is limited by the social
framework and legal requirements of the host
country.15.
Conclusions
Cultural and social changes arising from
migration may put vulnerable persons at risk for
mental disturbance. Social support has been
consistently viewed as a protective factor in the
relationship between migration and mental
disorders. A plausible hypothesis is that early
life experience and culturally-bound attitudes
6
among immigrants strongly influence the
outcome for mental health in the new country,
but that this relationship is mediated by factors
of the migration process and moderated by
experiences in the country of destination.
Future research needs to apply cross-
culturally valid and reliable standardised
interviews and culturally valid measurement for
acculturation; the inclusion of representative
samples from the immigrant population with
clearly defined ethnicity; more detailed
collection of pre-immigration information ; a
clear history of the migration process and the
use of sibling-pair or longitudinal cohort study
design.
References
1. United Nations High Commission for Refugees
(2008). Global Trends: Refugees, Asylum-Seekers,
Returnees, Internally Displaced and Stateless
persons. http://www.unhcr.org/statistics.
2. Odegaard O (1932). Emigration and insanity.
Acta Psychiatr Neurol Suppl 4: 1-206.
3. Cooper B (2005) Schizophrenia, social class and
immigrant status: epidemiological evidence.
Epidemiol Psichiatr Soc 14: 137-144.
4. Harrison G, Glazebrook C, Brewin I et al (1997).
Increased incidence of psychotic disorders in
migrants from the Caribbean to the U.K. Psychol
Med 27: 799-806
5. Broome MR, Woolley JB, Tabraham P et al.
(2005). What causes the onset of schizophrenia?
Schiz. Res. 79: 23-34.
6. Ferrada-Noli M, Asberg M (1997). Psychiatric
health, ethnicity and socio-economic factors
among suicides in Stockholm. Psychol. Rep., 81:
323-332.
7. Burvill, PW (1998). Migrant suicide rates in
Australia and in country of birth. Psychol. Med.,
28: 201-208.
8. Kposowa, AJ, McElvain, JP, Breault, KD (2008).
Immigration and suicide: role of marital status,
duration of residence and social integration.
Arch. Suicid. Res., 12: 82-92.
9. Porter M, Haslam N (2005) Pre-displacement and
post-displacement factors associated with
mental health of refugees and internally
displaced persons: a meta-analysis. J Am Med
Ass, 294: 602-612.
10. Fazel M, Stein A (2002). The mental health of
refugee children. Arch. Dis. Childh. 87: 366-370.
11. Montgomery E, Feldspang A (2008).
Discrimination, mental problems and social
adaptation in young refugees. Eur. J. Publ. Hlth.,
18: 156-161.
12. Breslau J, Aguilar-Gaxiola S, Borges G et al
(2007). Risk for psychiatric disorder among
immigrants and their US-born descendants:
evidence from the National Co-Morbidity Survey
Replication. J. Nerv. Ment. Dis., 195: 189-195.
13. Borges G, Medina-Mora ME, Breslau J, Aguilar-
Gaxiola S. (2007). Effect of migration to the
United States on substance-use disorders among
returned Mexican migrants and families of
migrants. Am. J. Publ. Hlth., 97: 1847-51.
14. Cheng, TA (1989). Urbanization and minor
psychiatric morbidity. A community study in
Taiwan. Soc. Psychiat. Psychiatr. Epidemiol., 24:
309-316.
15. Lindert J, Schouler-Ocak M, Heinz A, Priebe S
(2008). Mental health, health care utilisation of
migrants in Europe. Eur. Psychiat., 23 (Suppl. 1):
14-20.
1Based on: Liu, IC & Cheng, ATA: Migration and
Mental Health: an Epidemiological Perspective. In Bhugra D, Gupta S (eds): Migration and Mental Health. Cambridge University Press, 2011, revised from a paper presented at the XIXth Congress of the World Association for Social Psychiatry, Prague, October 21-24, 2007.
IFPE Congress: June 05 08, 2013 Leipzig, Germany
Preparations for the 14th International Congress of the IFPE are well underway in Leipzig. Up‐to‐date information can always be found at our website http://ifpe2013.org including our second announcement and call for papers, as well as transportation and accommodation information. Further, the site provides a portal to on‐line abstract submission and congress registration.
The theme of next year’s meeting is: The uses of psychiatric epidemiology in improving population mental health. In addition to the latest research across the lifespan and within certain sub‐groups, we are interested in contemporary themes such as the uses of the latest technologies, as well as emerging trends in the diagnosis and treatment of mental disorders. We expect an interesting mix of well‐known researchers and rising starts in the field of psychiatric epidemiology. Some of the topics already in the works include: new research on stigma, causes of changes in patterns of psychopathology from child‐ to adulthood, challenges of adolescence and aging societies. We will explore a new generation of psychiatric case registries and talk about the use of the internet in assessing and managing population mental health. Mental health at the workplace and the growing interest of autism spectrum disorders are timely topics. Now that the event is less than a year away, it is time to prepare and submit your abstracts via our website http://ifpe2013.abstract‐management.de/.
In addition to the regular scientific programme, we will be offering a pre‐meeting workshop titled: SCAN training short course. The cost of the training is included in the regular registration, but, register early, as space is limited! Your local organizing committee is working hard to make sure that there will be a rigorous social programme to rival the scientific programme. The meeting will take place at the Westin Hotel Leipzig, a modern, world‐class hotel within walking distance to the city centre and Leipzig’s important historical and musical sites. Several theme‐based city tours will be available to fit a range of interests. Our congress dinner will be held at the Leipzig Zoo in Gondwanaland, a newly constructed portion of the zoo designed to replicate the tropical rainforests. Also, as the time gets closer, we will be providing information about musical offerings at the Thomaskirche (St. Thomas’ Church), Gewandhaus (Orchestra) and Opera.
We look forward to welcoming you to Leipzig, Germany!
Prof. Dr. med. Steffi G. Riedel‐Heller, MPH
IFPE Congress: June 05 08, 2013 Leipzig, Germany
The picture shows the newly reconstructed central univer‐sity building. Exactly at this place the old medieval univer‐sity church was dynamited in 1968 during the communist regime. The new buildings at the University's main campus are inspired by the form and shape of the old church.
Nikolaikirche (St. Nikolai Church), J. S. Bach worked here from 1723‐50. Today, the parish implements a concept of an "Open City Church" with exhibitions and concerts. With its Prayers for Peace (from 1982 onwards), St. Nikolai Church was one of the starting‐points of the Peaceful Revolution in 1989, leading to the reunification of Germany.
Thomaskirche (St. Thomas‘ Church) Johann Sebastian Bach worked here from 1723 until he died in 1750. His tomb has been in the choir of the church since 1949. St. Thomas' Church is also the home of the world‐famous St. Thomas' Choir.
Photo credits: Pressestelle Universität Leipzig /Randy Kühn Universität Leipzig/ Nils Mammen
Photo credits: LTM/Schmidt
Photo credits: LTM/Schmidt
9
Calendar of Events
Goa,India November 19-30, 2012
“Leadership in Mental Health” More information: http://www.sangath.com/details.php?nav_id=41
Leipzig, Germany June 5-8, 2013
International Federation of Psychiatric Epidemiology 2011: The 14
th International
Congress of IFPE More information: http://ifpe2013.org
Lisboa, Portugal June 29-July 3, 2013
World Association of Social Psychiatry, 21
st world
congress More information: http://www.wasp2013.com/
Editor of IFPE bulletin
Jens Christoffer Skogen, University of Bergen, Norwa
Editorial board of IFPE bulletin
Professor Andrew T. A. Cheng
Professor Brian Cooper
SUBMISSIONS
Submissions to the IFPE Bulletin — news or views — can be sent to Jens Christoffer Skogen, editor, University of Bergen, Norway. E-mail: jens.skogen@uib.no / jensskogen@gmail.com
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