Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care.
We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health.
The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations.
Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.
Canada received 22,873 asylum seekers in 2006. The screening of specific health problems in this population seems warranted. This study aims to estimate the prevalence of pathologies that were screened at the PRAIDA health service in Montreal, and to identify associations with certain risk factors.
A retrospective study was conducted on the files of patients who were screened between 2000 and 2004. Demographic and clinical information was compiled for computation of prevalence as well as multiple logistic regression analysis.
Of the 289 files reviewed, 56.7% are for male and 43.3% for female patients, with a mean age of 34 years; 53% are Asians and 38% Africans. 59.4% of subjects received a psychiatric diagnosis (mainly depression and post-traumatic stress disorder). The paraclinical work-up showed: 20.3% anaemia, 9% eosinophilia, 29.7% HBcAb+, 5% HBsAg+, 1.5% hepatitis C (RNA+), 2.5% HIV+ and 45.9% TST+. 10.5% of stool samples contained a pathogen, and serologies for strongyloidiasis and schistosomiasis were positive in 17.3% and 3.9% of samples respectively. Significant associations included female gender with anaemia, African origin with rates of HBcAb and TST+, age with HBcAb and hepatitis C positivity, longer length of stay in Canada with eosinophilia and strongyloidiasis, shorter length of stay with HBcAb, and Asian origin with psychiatric disorders.
This study suggests that the prevalence of screened pathologies as part of the PRAIDA health service work-up are high in this population and therefore warrant continuation of their screening until guidelines are constituted.