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Migration, Stress and Mental Ill Health: Post-migration Factors and Experiences in the Swedish Context
Department of Medical and Health Sciences, Linköping University.ORCID iD: 0000-0001-6138-6427
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This predominantly empirical dissertation deals with how socio-economic living conditions and immigrant-specific factors can be linked to immigrants’ mental ill health. It is also explored how cultural representations can affect stress and whether mental ill health is expressed differently among immigrants from Iraq and Iran than among individuals of Nordic origin. Moreover, a conceptual analysis is conducted, where a phenomenological conceptualisation of stress is outlined with a special focus on how this stress approach can be related to culture and migration.

The empirical material consists of eleven in-depth interviews with Iraqi and Iranian immigrant women and two population-based surveys.

The main findings of this thesis suggest as follows: 1) Mental ill health is more common among foreign-born than among native-born Swedes and can to a great extent be attributed to their poorer socio-economic living conditions. 2) Immigrants’ mental health is independently associated with different types of factors, such as traumatic episodes, socio-cultural adaptation level and socioeconomic living conditions. 3) The self-reporting mental health instruments, HSCL-25 and WHO (ten) Wellbeing Index, produce scores that are comparable between Scandinavians and immigrants of Middle Eastern descent. 4) Nonuniversal representations that can be found in Iraq and Iran can amplify, or even be necessary ingredients in certain types of stressful experiences among immigrant women from these countries. 5) The distinctions between universal and non-universal stress, and between immigrant/minority and non-immigrant/nonminority stress appear to be crucial for an adequate comprehension of immigrants’ stressful experiences.

Abstract [sv]

Denna huvudsakligen empiriska avhandling behandlar hur socioekonomiska levnadsvillkor och invandrarspecifika faktorer kan kopplas till invandrares mentala hälsa. I avhandlingen undersöks även hur kulturella representationer kan påverka stressfulla upplevelser och huruvida mental ohälsa uttrycks annorlunda bland invandrare från Irak och Iran än bland nordbor. Vidare genomförs en begreppsanalys av stress skisserad utifrån ett fenomenologiskt perspektiv. Fokus ligger här på hur ett sådant perspektiv på stress kan relateras till kultur och migration.

Det empiriska materialet består av elva djupintervjuer med invandrarkvinnor från Irak och Iran, samt två populationsbaserade enkätundersökningar.

De huvudsakliga fynden i denna avhandling är följande: 1) Mental ohälsa bland utrikesfödda är vanligare än bland svenskfödda och detta kan till stor del ”förklaras” av ogynnsammare socioekonomiska levnadsvillkor. 2) Invandrares mentala ohälsa har ett direkt samband med olika typer av faktorer som traumatiska episoder, sociokulturell anpassningsnivå och socioekonomiska levnadsvillkor. 3) Självskattningsinstrumenten för mental hälsa, HSCL-25 och WHO (ten) Wellbeing Index, producerar värden som är jämförbara mellan nordbor och invandrare från Mellanöstern. 4) Icke-universella representationer som kan påvisas i Irak och Iran kan förstärka, eller till och med vara nödvändiga komponenter för vissa typer av stressfulla upplevelser bland invandrarkvinnor från dessa länder. 5) Distinktionerna mellan universell och icke-universell stress, och mellan invandrar/minoritets och icke-invandrar/icke-minoritets stress, tycks vara centrala för en adekvat förståelse av invandrares stressfulla upplevelser.

Place, publisher, year, edition, pages
Linköping University Electronic Press , 2009. , 81 p.
Series
Linköping Studies in Arts and Science, ISSN ISSN 0282-9800 ; 480
Keyword [en]
Cross-cultural equivalence, foreign-born, Hopkins Symptom Checklist (HSCL-25), Living conditions, mental ill health, migration, phenomenology, population-based, Risk factors, Stress, WHO Wellbeing Index
National Category
Social Sciences Interdisciplinary
Identifiers
URN: urn:nbn:se:rkh:diva-2149ISBN: 978-91-7393-627-9 (print)OAI: oai:DiVA.org:rkh-2149DiVA: diva2:901751
Public defence
2009-05-29, Aulan, Hus 240, Campus US, Linköping, Linköping, 10:00 (Swedish)
Opponent
Supervisors
Note

At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 2: In press (title: Immigrantand non-immigrant-specific factors’ association with mental ill health among immigrants in Sweden). Paper 3: Submitted (title: Cross-cultural equivalence of HSCL- 25 and WHO (ten) Wellbeing Index: findings from a population-based survey of immigrants and non-immigrants in Sweden). Paper 4: Manuscript (title: A phenomenological approach to the study of stress among immigrants – the case of Iraqi and Iranian women in Sweden).

Serie: Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 16

Available from: 2016-02-09 Created: 2016-02-09 Last updated: 2016-02-10Bibliographically approved
List of papers
1. To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors?
Open this publication in new window or tab >>To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors?
2007 (English)In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 42, no 12, 990-996 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Immigrants in Sweden have a higher rate of mental illness than the native Swedes. This study investigated to what extent the association between immigrant status and mental illness can be explained by a different distribution of known risk factors for impaired mental health between groups of immigrants and persons born in Sweden.

METHODS: The study is based on data from the Swedish PART-study, designed to identify risk factors for, and social consequences of, mental illness. The study population consists of a random sample of 10,423 Swedish citizens, whereof 1,109 were immigrants. The data was collected in the year 2000. The immigrants were divided into three groups based on country of origin (Scandinavians born outside Sweden, Europeans born outside Scandinavia, non-Europeans). The occurrence of mental illness among immigrants and native Swedes were compared not adjusting and adjusting for indicators of socioeconomic advantage/disadvantage (education, income, labour market position, etc). Mental illness was approximated with the WHO (ten) wellbeing index scale and depressive symptoms were measured with the major depression inventory scale (MDI).

RESULTS: Immigrants' excess risk for low subjective wellbeing was completely accounted for by adjustment for known risk factors in all the immigrant groups. However, social-economic disadvantages could not account for the non-European immigrants' higher prevalence of depression (MDI), although the increased relative risk found in univariate analyses was substantially reduced.

CONCLUSIONS: The findings in this study suggest that the association between immigrant status and mental illness appears above all to be an effect of a higher prevalence of social and economic disadvantage.

Keyword
immigrants, mental illness, prevalence, Sweden, risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-1591 (URN)10.1007/s00127-007-0253-5 (DOI)17846697 (PubMedID)
Available from: 2015-04-09 Created: 2015-03-17 Last updated: 2016-02-09Bibliographically approved
2. The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden.
Open this publication in new window or tab >>The association of immigrant- and non-immigrant-specific factors with mental ill health among immigrants in Sweden.
2010 (English)In: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 56, no 1, 74-93 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: It has often been shown that immigrants are particularly at risk for mental ill health. The aim of the study was to investigate the association of immigrant- and non-immigrant-specific factors with mental ill health within a diverse immigrant population.

METHOD: An extensive questionnaire was sent out to a stratified random sample of three immigrant populations from Finland, Iraq and Iran. The 720 respondents completed a Swedish, Arabic or Farsi (Persian) version of the questionnaire including the WHO (10) Well-Being Index and the HSCL-25.

RESULTS: The results indicate that mental ill health among immigrants is independently associated with non-immigrant-specific factors (i.e. high number of types of traumatic episodes, divorced/widowed, poor social network, economic insecurity and being female) and immigrant-specific factors (i.e. low level of sociocultural adaptation). These results were obtained regardless of whether mental ill health was operationalized as low subjective well-being or a high symptom level of anxiety/depression.

CONCLUSIONS: These findings support the notion that mental ill health among immigrants is a multi-faceted phenomenon that needs to be tackled within a wide range of sectors - e.g. the healthcare system, the social service sector and, of course, the political arena.

Keyword
living conditions, mental ill health, migration, risk factors, Sweden, trauma
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-1589 (URN)10.1177/0020764008096163 (DOI)19592449 (PubMedID)
Available from: 2015-04-09 Created: 2015-03-17 Last updated: 2016-02-09Bibliographically approved
3. Cross-cultural equivalence of HSCL-25 and WHO (ten) Wellbeing index: findings from a population-based survey of immigrants and non-immigrants in Sweden.
Open this publication in new window or tab >>Cross-cultural equivalence of HSCL-25 and WHO (ten) Wellbeing index: findings from a population-based survey of immigrants and non-immigrants in Sweden.
2010 (English)In: Community mental health journal, ISSN 0010-3853, E-ISSN 1573-2789, Vol. 46, no 1, 65-76 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate whether the Hopkins Symptom Checklist (HSCL-25) and the WHO (ten) Wellbeing Index are cross-culturally equivalent by comparing Scandinavians with Middle Eastern immigrants in Sweden. The study population consisted of a stratified random sample of native-born Swedes and immigrants from Finland, Iraq and Iran. Both instruments loaded on a single factor in the respective populations. A few of the items did however not discriminate or predict equally well in the groups, nonetheless it was found to have marginally influenced the instruments' total scores in both groups. The analyses also revealed that the groups had similar intercept and slope when the exogenous factor traumatic episodes was used to predict the measurement scores, supporting scalar equivalency. In conclusion, the results support the use of these instruments in population-based surveys within multicultural Western societies.

Keyword
Cross-cultural equivalence, Immigrants, Hopkins Symptom Checklist (HSCL-25), WHO Wellbeing Index, Population-based
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:rkh:diva-1588 (URN)10.1007/s10597-009-9227-2 (DOI)19636706 (PubMedID)
Note

As submitted in dissertation

Available from: 2015-04-09 Created: 2015-03-17 Last updated: 2016-02-09Bibliographically approved
4. A phenomenological approach to the study of stress among immigrants: the case of Iraqi and Iranian women in Sweden
Open this publication in new window or tab >>A phenomenological approach to the study of stress among immigrants: the case of Iraqi and Iranian women in Sweden
(English)Manuscript (preprint) (Other academic)
Abstract [en]

This study begins with the outlining of a general phenomenological theory of stress, which subsequently is applied to eleven Iraqi and Iranian migrant women’s own accounts of life in Sweden. The analysis of the interviews suggested that domestic disputes and intergenerational conflicts may become particularly stressful in that they are often amplified by incompatible Western and Non‐Western representations. The detected stressful experiences are analysed and structured to elucidate their character. Finally, a typology of stressful experiences in the new environment based on the distinctions between immigrant/minority‐specific and non‐immigrant/‐ minority‐specific stress, as well as between culturogenic and non‐culturogenic stress, is presented and defended.

Keyword
Phenomenology, Stress, Immigrants, Women, Iraq, Iran
National Category
Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:rkh:diva-2146 (URN)
Note

As manuscript in dissertation

Available from: 2016-02-08 Created: 2016-02-08 Last updated: 2016-02-10Bibliographically approved

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