Abstract
Purpose
European studies about ethnic inequalities in depressive symptoms are scarce, show inconclusive results and are complicated by the discussion of what constitute (im)migrant and ethnic minority groups. Moreover, comparisons across countries are hampered by a lack of comparable measures of depressive symptoms. This study aims to assess the prevalence and determinants of depressive symptoms among immigrants, ethnic minorities and natives in 23 European countries.
Methods
Multilevel analyses are performed using data from the third wave of the European Social Survey (ESS-3). This dataset comprises information about 36,970 respondents, aged 21 years or older, of whom 13.3% immigrants and 6.2% ethnic minorities. Depressive symptoms were assessed with an 8-item version of the Center for Epidemiologic Studies-Depression scale. Main determinants are immigrant status, socio-economic conditions and the experience of ethnic discrimination in the host country.
Results
The results show that immigrants and ethnic minorities do experience more depressive symptoms than natives in an essential part of the countries. Moreover, socio-economic conditions and the experience of ethnic discrimination are important risk factors. Immigrant status seems irrelevant, once the other risk factors are accounted for. Finally, immigrant and ethnic minority groups do not consist of the same individuals and therefore have different prevalence rates of depressive symptoms.
Conclusions
The prevalence rates of depressive symptoms are higher for immigrant and ethnic minority groups in a substantial part of the European countries. A clear definition is indispensable for developing policies that address the right-targeted population.
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References
Lindert J, Schouler-Ocak A, Heinz A, Priebe S (2008) Mental health, health care utilisation of migrants in Europe. European Psychiatry 23:14–20
Boswell (2005) Migration in Europe. In: Global Commission on International Migration 3rd edn. Guilford Press, New York
Escobar JI, Nervi CH, Gara MA (2000) Immigration and mental health: Mexican Americans in the United States. Harv Rev Psychiatr 8:64–72
Breslau J, Aguilar-Gaxiola S, Borges G, Kendler KS, Su M, Kessler RC (2007) Risk for psychiatric disorder among immigrants and their US-born descendants—evidence from the National Comorbidity Survey Replication. J Nerv Ment Dis 195:189–195
Breslau J, Borges G, Hagar Y, Tancredi D, Gilman S (2009) Immigration to the USA and risk for mood and anxiety disorders: variation by origin and age at immigration. Psychol Med 39:1117–1127
Burnam MA, Hough RL, Karno M, Escobar JI, Telles CA (1987) Acculturation and lifetime prevalence of psychiatric-disorders among Mexican-Americans in Los-Angeles. J Health Soc Behav 28:89–102
Vega WA, Kolody B, Valle JR (1987) Migration and mental-health—an empirical-test of depression risk-factors among immigrant Mexican Women. Int Migr Rev 21:512–530
Levecque K, Lodewyckx I, Bracke P (2008) Psychological distress, depression and generalised anxiety in Turkish and Moroccan immigrants in Belgium—a general population study. Soc Psychiatry Psychiatr Epidemiol 44:188–197
Alegria M, Canino G, Shrout PE, Woo M, Duan N, Vila D, Torres M, Chen CN, Meng XL (2008) Prevalence of mental illness in immigrant and non-immigrant US Latino groups. Am J Psychiatry 165:359–369
Vega WA, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J (1998) Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry 55:771–778
Cheng ATA, Chang JC (1999) Mental health aspects of culture and migration. Curr Opin Psychiatry 12:217–222
Miranda J, Siddique J, Belin TR, Kohn-Wood LP (2005) Depression prevalence in disadvantaged young black women-African and Caribbean immigrants compared to US-born African Americans, pp 253–258
Bhugra D, Mastrogianni A (2004) Globalisation and mental disorders—overview with relation to depression. Br J Psychiatry 184:10–20
Nazroo JY (1997) The health of Britain’s ethnic minorities: findings from a national survey. Policy Studies Institute, London
Sole-Auro A, Crimmins EM (2008) Health of immigrants in European Countries. Int Migr Rev 42:861–876
Carta MG, Bernal M, Hardoy MC, Haro-Abad JM (2005) “Report on the Mental Health in Europe” working group Migration and mental health in Europe (the state of the mental health in Europe working group)
Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha IS, Bryson H, de Girolamo G, de Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lepine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbazadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martinez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacin C, Romera B, Taub N, Vollebergh WAM (2004) Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109:47–54
Claassens D, Ascoli M, Berhe T, Priebe S (2005) Research on mental disorders and their care in immigrant populations: a review of publications from Germany, Italy and the UK, pp 540–549
Weich S, Nazroo J, Sproston K, McManus S, Blanchard M, Erens B, Karlsen S, King M, Lloyd K, Stansfeld S, Tyrer P (2004) Common mental disorders and ethnicity in England: the EMPIRIC study. Psychol Med 34:1543–1551
Cantor-Graae E, Selten JP (2005) Schizophrenia and migration: a meta-analysis and review. Am J Psychiatry 162:12–24
World Health organization (2005) Mental health: facing the challenges, building solutions. Report from the WHO ministerial conference. The regional office for Europe of the World Health organization
Bhugra D, Still R, Furnham A, Bochner S (2004) Migration and mental health. Acta Psychiatr Scand 109:243–258
Mladovsky P (2007) Migration and health in the EU. Research note for the European Commission. DG Employment and Social Affairs
Swinnen SGHA, Selten JP (2007) Mood disorders and migration—meta-analysis. Br J Psychiatry 190:6–10
Levecque K, Lodewyckx I, Vranken J (2007) Depression and generalised anxiety in the general population in Belgium: a comparison between native and immigrant groups. J Affect Disord 97:229–239
Glaesmer H, Wittig U, Brahler E, Martin A, Mewes R, Rief W (2009) Are migrants more susceptible to mental disorders? An evaluation of a representative sample of the German general population. Psychiatr Prax 36:16–22
Wittig U, Lindert J, Merbach M, Braehler E (2008) Mental health of patients from different cultures in Germany. Eur Psychiatry 23:28–35
De Wit MAS, Tuinebreijer WC, Dekker J, Beekman AJTF, Gorissen WHM, Schrier AC, Penninx BWJH, Komproe IH, Verhoeff AP (2008) Depressive and anxiety disorders in different ethnic groups: a population based study among native Dutch, and Turkish, Moroccan and Surinamese migrants in Amsterdam. Soc Psychiatry Psychiatr Epidemiol 43:905–912
Dalgard OS, Thapa SB, Hauff E, McCubbin M, Syed HR (2006) Immigration, lack of control and psychological distress: findings from the Oslo Health Study. Scand J Psychol 47:551–558
Thapa SB, Dalgard OS, Claussen B, Sandvik L, Hauff E (2007) Psychological distress among immigrants from high- and low-income countries: findings from the Oslo Health Study. Nord J Psychiatry 61:459–465
Blomstedt Y, Johansson SE, Sundquist J (2007) Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study. BMC Public Health 7:27
Syed HR, Dalgard OS, Dalen I, Claussen B, Hussain A, Selmer R, Ahlberg N (2006) Psychosocial factors and distress: a comparison between ethnic Norwegians and ethnic Pakistanis in Oslo, Norway. BMC Public Health 6:182
Taloyan M, Johansson SE, Sundquist J, Kocturk TO, Johansson LM (2008) Psychological distress among Kurdish immigrants in Sweden. Scand J Public Health 36:190–196
Thinghög P, Hemmingsson T, Lundberg I (2007) To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Soc Psychiatr Psychiatric epidemiol 42:990–996
European Commission (2004) The State of the Mental Health in Europe
Berry JW (1997) Immigration, acculturation, and adaptation. Applied psychology—an international review-Psychologie Appliquee-Revue Internationale 46:5–34
Koneru VK, de Mamani AGW, Flynn PM, Betancourt H (2007) Acculturation and mental health: current findings and recommendations for future research. Appl Prev Psychol 12:76–96
Nazroo JY (2003) The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism. Am J Public Health 93:277–284
Smaje C (1996) The ethnic patterning of health: new directions for theory and research. Sociol Health Illn 18:139–171
Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157:98–112
Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M (2007) Depression and socio-econornic risk factors: 7-year longitudinal population study. Br J Psychiatry 190:293–298
Robert SA, House JS (2000) Socioeconomic inequalities in health: an enduring sociological problem. In: Bird CE, Conrad P, Fremont AM (eds) Handbook of medical sociology. Prentice Hall, Upper Saddle River, New Jersy, pp 79–97
Gee GC (2002) A multilevel analysis of the relationship between institutional and individual racial discrimination and health status. Am J Public Health 92:615–623
Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, Nazroo J (2006) Racism and health: the relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med 63:1428–1441
Karlsen S, Nazroo JY, McKenzie K, Bhui K, Weich S (2005) Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychol Med 35:1795–1803
Krieger N (2000) Discrimination and health. In: Berkman LF, Kawachi I (eds) Social epidemiology. Oxford University Press, New York, pp 36–75
Williams DR, Mohammed SA (2009) Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32:20–47
European Commission (2007) Discrimination in the European Union. European commission, DG employment, social affairs and equal opportunities
Nazroo JY (1998) Genetic, cultural or socio-economic vulnerability? Explaining ethnic inequalities in health. Sociol Health Illn 20:710–730
Bhopal R (2004) Glossary of terms relating to ethnicity and race: for reflection and debate. J Epidemiol Community Health 58:441–445
McKenzie K, Fearon P, Hutchinson G (2008) Migration, ethnicity and psychosis. In: Morgan C, McKenzie K, Feron P (eds) Society and psychosis. Cambridge University Press, Cambridge, pp 143–160
Senior PA, Bhopal R (1994) Ethnicity as a variable in epidemiologic research. Br Med J 309:327–330
European Social survey (2007) European social survey. http://www.europeansocialsurvey.org
United Nations Statistics division (2010) Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings
Jowell R, and the Central Coordinating Team, European Social Survey 2006/2007 (2007) Technical report. Centre for comparative Social Survey, City University, London
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general. Appl Psychol Meas 1:385–401
Van de Velde S, Bracke P, Levecque K, Meuleman B (2010) Gender differences in depression in 25 European countries after eliminating measurement bias in the CES-D 8. Soc Sci Res 39:396–404
Chapela IB, de Snyder NS (2009) Psychometric characteristics of the Center for Epidemiological Studies-depression Scale (CES-D), 20-and 10-item versions, in women from a Mexican rural area. Salud Mental 32:299–307
Cheung CK, Bagley C (1998) Validating an American scale in Hong Kong: The Center for Epidemiological Studies Depression Scale (CES-D). J Psychol 132:169–186
Fountoulakis K, Iacovides A, Kleanthous S, Samolis S, Kaprinis SG, Sitzoglou K, St KG, Bech P (2001) Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) Scale. BMC Psychiatry 1:3
Spijker J, van der Wurff FB, Poort EC, Smits CHM, Verhoeff AP, Beekman ATF (2004) Depression in first generation labour migrants in Western Europe: the utility of the Center for Epidemiologic Studies Depression Scale (CES-D). Int J Geriatr Psychiatry 19:538–544
Lorant V, van Oyen H, Thomas I (2008) Contextual factors and immigrants’ health status: double jeopardy. Health Place 14:678–692
Paradies Y (2006) A systematic review of empirical research on self-reported racism and health. Int J Epidemiol 35:888–901
Whelan CT, Layte R, Maitre B, Nolan B (2001) Income, deprivation, and economic strain. An analysis of the European community household panel. Eur Soc Rev 17:357–372
Levecque K (2006) Generalized anxiety and depression in the general population: risk factors according to the Belgian Health Interview Survey 2001. Depress Anxiety 23:509–511
Mirowsky J, Ross CE (1986) Social patterns of distress. Annu Rev Soc 12:23–45
World Health organization (2000) Crossnational comparisons of the prevalences and correlates of mental disorders. Bull World Health Organ 78:413–426
Hovey JD, King CA (1996) Acculturative stress, depression, and suicidal ideation among immigrant and second-generation Latino adolescents. J Am Acad Child Adolesc Psychiatry 35:1183–1192
Mirowsky J, Ross CE (1992) Age and depression. J Health Soc Behav 33:187–205
Stordal E, Kruger MB, Dahl NH, Kruger O, Mykletun A, Dahl AA (2001) Depression in relation to age and gender in the general population: the Nord-Trondelag Health Study (HUNT). Acta Psychiatr Scand 104:210–216
Olsen KM, Dahl SA (2007) Health differences between European countries. Soc Sci Med 64:1665–1678
Lindert J, von Ehrenstein OS, Priebe S, Mielck A, Brahler E (2009) Depression and anxiety in labor migrants and refugees—a systematic review and meta-analysis. Soc Sci Med 69:246–257
Carlson P (2004) The European health divide: a matter of financial or social capital? Soc Sci Med 59:1985–1992
Bracke P (2000) The three-year persistence of depressive symptoms in men and women. Soc Sci Med 51:51–64
Nesdale D (2002) Acculturation attitudes and the ethnic and host-country identification of immigrants. J Appl Soc Psychol 32:1488–1507
Van Craen M, Vancluysen K, Ackaert J (2007) Voorbij wij en zij?. Vanden Broele, Brugge
Walters D, Phythian K, Anisef P (2007) The acculturation of Canadian immigrants: determinants of ethnic identification with the host society. Can Rev Soc Anthropol-Revue Canadienne de Sociologie et D Anthropologie 44:37–64
Feeney LK, Kelly BD (2008) Coping with stressors: racism and migration Larkin Feeney and Brendan D. Kelly. In: Bhugra D, Bhui K (eds) Textbook of cultural psychiatry. Cambridge University Press, Cambridge, pp 550–560
Brown TN, Williams DR, Jackson JS, Neighbors HW (2000) “Being black and feeling blue”: the mental health consequences of racial discrimination. Race Soc 2:117–131
Pavalko EK, Mossakowski KN, Hamilton VJ (2003) Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women’s physical and emotional health, pp 18–33
Ruggiero KM, Taylor DM (1997) Why minority group members perceive or do not perceive the discrimination that confronts them: the role of self-esteem and perceived control. J Pers Soc Psychol 72:373–389
Williams DR, Neighbors HW, Jackson JS (2003) Racial/ethnic discrimination and health: findings from community studies. Am J Public Health 93:200–208
Levecque K (2008) Armoede en depressie—Een (niet) evident verband?. Acco, Leuven
van Praag L, Bracke P, Christiaens W, Levecque K, Pattyn E (2009) Mental health in a gendered context: gendered community effect on depression and problem drinking. Health Place 15:990–998
Van de Velde S, Bracke P, Levecque K (2009) Gender difference in depression in 23 European countries. Cross-national variation in the gender gap in depression? Annual Meeting American Sociological Association
Fassaert T, De Wit MAS, Tuinebreijer WC, Verhoeff AP, Beekman ATF, Dekker J (2009) Perceived need for mental health care among non-western labour migrants. Soc Psychiatry Psychiatr Epidemiol 44:208–216
Mladovsky P (2009) A framework for analysing migrant health policies in Europe. Health Policy 93:55–63
Watters C (2002) Migration and mental health care in Europe: report of a preliminary mapping exercise, pp 153–172
Kirmayer LJ, Weinfeld M, Burgos G, du Fort GG, Lasry JC, Young A (2007) Use of health care services for psychological distress by immigrants in an urban multicultural milieu. Can J Psychiatr—Revue Canadienne de Psychiatrie 52:295–304
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Missinne, S., Bracke, P. Depressive symptoms among immigrants and ethnic minorities: a population based study in 23 European countries. Soc Psychiatry Psychiatr Epidemiol 47, 97–109 (2012). https://doi.org/10.1007/s00127-010-0321-0
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DOI: https://doi.org/10.1007/s00127-010-0321-0