Katie Galvin: Systematic Review Depression and Anxiety in Labor Migrants and Refugees – A Review and Meta-Analysis Lindert, von Ehrenstein, Priebe, Mielck, & Brähler (Social Science & Medicine, 2009)

Context The data is unclear on the impact of migration on the mental health of migrants Refugees Asylum seekers Labor migrants Focus on PTSD in refugees Studies on depression and anxiety remain sparse No focus on macro-social determinants

Study Objectives Address migrants’ mental health by systematically evaluating studies measuring the prevalence rates of depression and/or anxiety (including PTSD) Study a possible association between the GNP of the host country and prevalence rates of depression among refugees and labor migrants Compare the retrieved studies with regard to the sampling strategy used (random vs. non-random)

Variables Dependent Variables Independent Variable Depression Anxiety PTSD - included Self-report Clinician and/or lay-administered instruments Independent Variable Migration Refugees Asylum seekers Labor migrants

Review Protocol Databases Keywords MEDLINE EMBASE Mental, psych, depress, post-traumatic stress disorder, PTSD, stress, anxiety and mental health AND refugee, migrant, immigrant, asylum seeker, transient, ethnic, displaced person

Review Protocol Continued Time Frame 1990-2007 Peer-Reviewed Publications Contacted Authors Articles published in English Abstracts examined by two independent reviewers

Inclusion Criteria Publication from 1990-2007 in a peer-reviewed journal Study design: Cross sectional or longitudinal Language: English Participants : More than 50 Outcome measure: Prevalence rates of depressive and/or anxiety and/or post-traumatic stress disorder Assessment instrument: Validated self-clinician or lay administered questionnaires based on DSM or ICD

Exclusion Criteria No original research ( i.e. letters) Editorials Case-studies and reviews Assessment with unstructured interviews ~~~~~ Patients or clients Second generation immigrants Subjects younger than 16 or older than 65 at the beginning of the study Holocaust, torture, and concentration camps survivors

Study Selection Diagram

Participants N=24,051 Men and Women Included Nine and five studies (respectively) reported separate prevalence rates Ages Twenty-five studies included participants above 18 years old Three studies included participants above 16 years old Other studies participants above 19, 20 and 35 years Four studies did not specify age

Participant Countries–35 Studies Seven from Africa Eleven from Asia Six from Europe Six from South America Four from miscellaneous regions Eight from the United States Two from Canada Five from Australia and New Zealand

Labor Migrants vs. Refugees Twenty-three studies related to twenty refugee groups Ten studies related to labor migrants Three studies related to mixed groups

Data Analysis Prevalence rates for depression, anxiety, and PTSD were extracted from the studies Studies were grouped according to migration status (refugee vs. labor), sampling method (random vs. non-random), gender, and GNP of the host country. GNP from emigration countries was excluded as a potential indicator of depression prevalence because only two studies were conducted with countries with a GNP of below 10,000 USD – not enough variation

Findings Prevalence Rates Combined prevalence rates for depression: Depression (N=29 Studies): 3%-81% Anxiety (N=19 Studies): 5%-90% PTSD: 4%-68% Combined prevalence rates for depression: Labor migrants – 20% Refugees – 44% Combined prevalence rates for anxiety: Labor migrants – 21% Refugees – 40% Mean weighted prevalence rates for both anxiety and depression were twice as high amongst refugees as amongst labor migrants GNP in receiving country (immigration) seems to have some implications for prevalence of depression/anxiety

Labor Migrants

Refugees

Limitations of Study Migrants are often physically, linguistically, and culturally difficult for researchers to access – small sample sizes using non-random methods Instruments used are often used outside the population with which they were originally developed and normed Migration is considered itself a risk factor, without taking into consideration of macro-economic conditions of the host country

Reflections -KG Comparisons: What would the participants’ depression/anxiety be if they remained in their home countries? How do their rates of depression/anxiety compare to other populations? Small N (by comparison) for labor migration Inconsistency in reporting (i.e. sometimes include “asylum seekers” or “PTSD” in the discussion and sometimes don’t) Operationalization of variables is not clear