5. cultural

Health Risks of Migration

• Each type of migration presents specific health problems, risks, and medical care needs.
• Traumatic experiences can lead to loss of identity and autonomy, affecting mental and physical health.
• Migrants in deprived urban areas may face similar health risks as long-standing ethnic minorities.
• Globalization contributes to new health risks like obesity, substance abuse, HIV/AIDS, and mental disorders.

Case Study: Effects of Migration on Blood Pressure

• Studies show migrants often have higher blood pressure compared to those in their home countries.
• Increased blood pressure may result from genetic susceptibility to environmental influences and psychosocial factors.

Mental Illness Increased Risk

• Migration often increases the risk of mental illness.
• Factors include age, social class, occupational status, and ethnic group.
• Xenophobia, discrimination, and racial prejudices contribute to ill health.

Case Study - Australia

• Studies found higher rates of psychological instability among immigrants.
• Mental illnesses range from depression to psychotic breakdowns.
• Elderly migrants may have higher rates of depression and dementia.

Impact of Migration on Family Structure

• Migration can strengthen or fragment families.
• New family dynamics emerge, often leading to bicultural or multilingual households.
• Intergenerational and marital conflicts arise due to differences in language, cultural expectations, and shifting gender roles.
• Rural to urban transitions can cause inversions of previous life, social roles, and worldview.

“Inversions” of Migrant Family Structure

• Generational Inversion: Children know the new culture better than parents.
• Gender Role Inversion: Women gain education, careers, or become sole breadwinners.
• Time Inversion: Migrants focus on the past homeland.
• Space Inversion: Migrants feel more connected to their old country.

The Healthy-Immigrant Hypothesis

• Migrants tend to have a lower risk of psychiatric disorders compared to natives.

The Migration-Morbidity Hypothesis

• Migrants have higher rates of Common Mental Disorders (CMD).

Factors Associated with Common Mental Disorders in Migrants

• Sociodemographic and Psychological Characteristics: Migrant women are more likely to experience CMD.
• Older and younger age groups are more susceptible.
• Lower Socioeconomic Status (SES) is linked to poorer mental health.
• Protective factors: optimism, sense of control, resilience, self-worth.
• Risk factors: low self-esteem, perceived discrimination, external locus of control.

Factors Related to the Migration Process

• Forced Migration: Refugees are more likely to experience poor mental health.
• Voluntary Migration: Labor migrants have lower rates of depression and anxiety.
• Acculturation: Integration leads to better mental health outcomes.

Factors Related to the Social and Occupational Environment in the Host Country

• Social Support: Lack of social support is a significant risk factor for CMD.
• Discrimination: Leads to stress, low self-esteem, and social isolation.
• Employment and Working Conditions: Unemployment and poor working conditions are risk factors.
• Language Proficiency: Difficulties increase the risk of CMD.

Treatment Engagement

• Therapist Cultural Understanding: A significant predictor of engagement.
• Cultural competence involves more than racial matching.
• Race and culture are complex.

Key Recommendations to Improve Engagement

• Overcoming Power Imbalances: Shared decision-making.
• Focus on the Client's Concerns: Directly address the client.
• Sharing Social Identity: Clinicians should share aspects of their social identity.

Migration and Mental Illness

• Migration is often associated with a higher risk of mental illness.
• Social conditions and individual factors are critical.
• Common issues include depression, psychosis, substance abuse, and domestic violence.

Impact of Migration on Family

• Migration can strengthen or disrupt families.
• Generational differences and inversions can weaken parental authority and increase conflict.

Refugee Health

• Refugees experience forced migration with significant trauma.
• Common problems include anxiety, depression, PTSD, and substance abuse.

Theories of Causation: Migration and Mental Health

• Multi-Migration theory: Multiple transitions cause stress.
• Push-Pull theory: Voluntary or forced migration both cause stress.
• Selection-Stress theory: Mental health issues may lead to migration, and the stress of migration can trigger mental illness.
• Host vs. Migrant theory: Host community attitudes affect migrant mental health.
• Psychosocial Transitions theory: Migration disrupts a person's “assumptive world.”
• Cultural Bereavement theory: Migrants grieve for the loss of their homeland and culture.