Migration and common mental disorder: An improvement in mental health over time?

Abstract

Global migration is reaching record high levels and UK migrant groups comprise an increasing proportion of the total population. The migratory process causes stress that can affect mental health. There is limited consistent empirical evidence of a longitudinal nature to explain the association between migration and mental health. This review aims to examine the evidence of a relationship between migration and common mental disorder (CMD) amongst migrants over time. A comprehensive search of medical and psychiatric databases for global quantitative empirical studies investigating incidence of CMD amongst adult migrants from 1975 to July 2012 was conducted. Declines in rates of CMD amongst migrants over time were reported by two thirds of the 18 studies reviewed, less than one third of which were statistically significant. On the contrary, three studies showed an increased rate of CMD, one statistically significant. Individual psychological resources, social support, the acculturation process, cultural variations and time since relocation are identified as statistically significant protective factors against the development of CMD amongst migrants. New enlightening points include the significant impact of varying patterns of psychological distress, of which negative is the most adverse for CMD. Migration is an extremely complex process. Further clarification is needed to gain deeper understanding of the relationship between migration and CMD to address contradictions in the literature and health inequalities amongst migrants.     

Impact of shared mental health care in the general population on subjects’ perceptions of mental health care and on mental health status

Objective A community survey evaluated whether the development of a shared mental health care intervention had an impact on health care perceptions and mental health status of subjects with common mental health problems (MHP). Methods Adults <70 years old with common MHP (DSM-IV/CIDI-SF major depressive disorder, generalized anxiety or MHI-SF 36 psychic distress diagnoses), were randomly drawn from the general population in the intervention area (IA, n = 349) and in a control area (CA, n = 360), and evaluated twice at an interval of 18 months (percentage of follow-up: IA = 69.3%, CA = 71.9%, P = .44). CA and IA groups did not differ for the criteria of interest at baseline. Results At 18 months, compared to CA, IA reported significantly different help-seeking attitudes or behaviours (P = .02 for all subjects and .006 for subjects with current MHP) and greater general satisfaction with care (P = .03 for both). Remission rates and daily life functioning did not differ. Conclusions After 4 years of development of a mental health network based on a consultation-liaison model, Shared Mental Health Care was associated with greater satisfaction and access with care among subjects with common MHP. The association was not found with mental health status, but the study lacked power to adequately address the issues.     

What do mental health professionals really think of family members of mental health patients?

Mental health professionals working at three rural public community mental health agencies were asked for their views on the families of mental health patients. Findings revealed themes that included families as supportive caregivers, as unsupportive agitators, as in pain, as uninformed, and as unequal partners. Implications for clinical intervention, education, and research are discussed.     

Is dementia a mental illness?

OBJECTIVE: To examine whether dementia is a mental illness. METHOD: An analysis of decisions in the Supreme Court of New South Wales that dementia per se was not a mental illness in terms of the 1958 Mental Health Act. A brief review of the extrusion of other diseases from psychiatry. RESULTS: Concepts in legislation are based on a dichotomy between mental infirmity and mental illness that has changed over time. This change is the result of shifting perceptions about the basis of illness and disease and the causation of mental symptoms. Mental health legislation is aimed as much at social control of feared behaviour as protecting the ill/incompetent. Guardianship legislation offers a more holistic response that better meets the patient's needs and could be extended to supplant mental health legislation. CONCLUSIONS: Dementia's departure from mental illness reflects psychiatry's continuing marginalization within medicine on an outdated mind/body or illness/disease split. This underlines one of the psychiatrist's roles as the vehicle to 'medically' explain abnormal behaviour. This model means that behaviour, once explained in terms of disease as opposed to illness, can be moved from the direct responsibility of psychiatry into other areas of medicine. Paradoxically, this suggests that the future of psychiatry will be in a completely different direction from its current biological focus.     

Do people recognise mental illness?

BACKGROUND: Mental health literacy has been defined as the public's knowledge and the beliefs about mental disorders enhancing the ability to recognise specific disorders. AIMS: Firstly, to determine whether the public recognises a person depicted in a vignette as mentally ill or as experiencing a crisis. Secondly, to reveal the factors influencing the correct recognition. METHODS: Multiple logistic regression analysis of an opinion survey conducted in a representative population sample in Switzerland (n=844). RESULTS: The depression vignette was correctly recognised by 39.8% whereas 60.2% of the respondents considered the person depicted as having a 'crisis.' The schizophrenia vignette was correctly identified by 73.6% of the interviewees. A positive attitude to psychopharmacology positively influenced the recognition of the two vignettes whereas a positive attitude to community psychiatry had the inverse effect. Moreover, for the depression vignette previous contact to mentally ill people had a positive influence on the recognition. For the schizophrenia vignette instead, rigidity and interest in mass media had a negative influence, respectively. CONCLUSIONS: The low knowledge about mental disorders, particularly depression, confirms the importance and the need to increase mental health literacy. Furthermore, professionals must openly discuss illness models with their patients, especially emphasising the differences between illness and crisis.     

Can research influence mental health policy?

OBJECTIVE: This paper describes the processes involved in policy development and implementation with examples of how this can be influenced by the outcomes of research. METHOD: The author draws on his experience in the development and implementation of Australia's National Mental Health Policy and on the literature describing public policy analysis. RESULTS: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation is described. This process identifies how issues are considered, adopted and implemented by governments. CONCLUSION: An understanding of this process can inform mechanisms by which scientific research can impact on the issues considered and the decisions made in each step of policy analysis and development.     

From whence comes mental illness stigma?

BACKGROUND: This paper seeks to answer two fundamental questions: What is the basis of the current form of mental illness stigma? and Why do western cultures stereotype people with mental illness as dangerous, incompetent and blameful, rather than something else? MATERIAL AND DISCUSSION: We argue that a motivational model called system-justification offers several benefits for answering these questions. System-justification portrays stigma as a way of making sense of economic and political differences between the majority and stigmatized subgroups. We contrast system-justification with two cognitive models of stigma that seem to have strong support from naive psychology: mental illness stigma results as the normal perception of a group of people who are dangerous and/or blameworthy and there is a kernel of truth to the stigmatizing attitudes about people with mental illness. Although research supporting the latter two models is mixed, there are significant limitations to the models, as well as concerns that normal perception and kernel of truth might actually promote stigma. CONCLUSIONS: As an alternative, system-justification combines three paradigms that suggest its worthiness for future research: 1) a review of historical and economic forces that influence social phenomena; 2) the need of humankind to understand these forces and organize them into a unitary framework; and 3) the cognitive mechanisms that are essential for this comprehension. Implications of this model for stigma change are discussed.     

Planning in mental health--is it possible?

The author opens the subject by questioning "why" and "how" to plan for mental health. Planification is a public health process. This process made modern countries able to develop health care policies in accordance to scientific progress. This allowed to stop the transmission of communicable diseases. Mental health disorders are one of the 4 public health priorities along with cardio-vascular diseases, cancers an consequences of accidents. New care methods have to be found in order to be adapted to recent needs. In many countries, mental health care have been and still are on the way to be modified. These major modifications will be illustrated by the French "sectorisation" which will be replaced in the context of complete reconversion of the French mental health care system. Two research streams will be proposed: research focused on the health care system which will enlight the different systems, their characteristics, activities and adequation; epidemiological studies in order to measure population needs in term of mental health, to clarify how mental health disorders appear and what sort of care are used by the persons. To illustrate these themas, the author will present his own experience. For more than 25 years he was operating on complex private mental health care system using the resources of an epidemiological unit in order to plan the development of this care system.     

What makes a mental ill violent?

From numerous tests it is clearly to be concluded that between severe mental health problems and the act of violence exists a moderate, but reliable association. With this conclusion, neither old fears of "an unpredictable insane person" should be reactivated nor stigmatisation are to be carried out. Particularly since the whole of humans with psychological disturbances does not exhibit an increased act of violence risk in relation to the average population. It is however necessary to identify subgroups with increased tendency for self- and other aggressive behaviour, to describe aggression-aroused and reducing factors and to appreciate the positive influence of the psychiatric therapy and the social rehabilitation. After today's level of knowledge it is to be proceeded from the following risk indicators: Diagnosis of a paranoid disturbance, male sex, correlation with personality disorder and substance abuse, lack of treatment, increasing social disintegration with a longer treatment process and uncertain competence for the support. Extensive psychiatric treatments reduce the risk clearly. The deinstitutionalisation does not have negative influence with secured ambulatory support. The legal accommodation framework, which is discussed on the basis of the Austrian law situation, is an important modifying factor. Relating to the mental health problem there is just a little relation to the aggressive behaviour in comparison to the average population.     

Change in the mental health field?

An analysis of the current roles of the federally funded community mental health center and the public mental hospital suggests that despite the rhetoric about a community mental health revolution, the mental health field has yet to undergo significant change. Ideological, political, economic, and structural barriers-characteristics of the field itself-impede such change outside, inside, and across the centers and hospitals. Recent court decisions on patients' rights, however, have the potential for moving the field into a period where bold new action actually can occur.Preparation of this paper was supported, in part, by Research Grant No. 1 R01 MH23646 from the National Institute of Mental Health. The authors thank Al Imershein, Kent Miller, and Elane Nuehring for helpful comments on an earlier draft.     

Does smoking cessation improve mental health?

There is a possibility that cessation of smoking improves mental health, but there are no studies that have demonstrated this. A cohort study was performed for 1 year in 18 males who spontaneously stopped smoking (cessation group) and 173 who continued to smoke (smoking group). The mental health state was evaluated using the Japanese version of the 30-item General Health Questionnaire (GHQ-30) before the cessation of smoking and 6 months and 1 year after smoking cessation. Changes in the GHQ score were compared between the cessation and smoking groups. In order to control the effects of confounding factors, multiple regression analyses were performed using the GHQ score after 6 months and 1 year as dependent variables. The GHQ score in the cessation group significantly decreased 6 months and 1 year after smoking cessation (P < 0.04 and 0.01, respectively, by paired t-test). In the smoking group, the GHQ score slightly decreased. Repeated measure analysis of variance revealed that the decrease in the GHQ score in the cessation group was significantly larger than in the smoking group. Multiple regression analysis revealed significant effects of smoking cessation on mental health after controlling for other confounding factors. It can be concluded that smoking cessation may improve mental health.