“Big big problem, depression. It has no “Big big problem, depression. It has no solution”- Exploration of the perceptions of elderly migrants about depression Jeanine Suurmond Mirjam Fransen Academic Medical Centre / University of Amsterdam, Dept of Public Health 1st World Congress on migration, ethnicity, race and health, Edinburgh, 17-19 May 2018 Sociale Geneeskunde 1

Background Major depression disorder affects over 300 million people globally Higher prevalence rates of depression in elderly migrant groups Underdiagnosis and undertreatment  Why do elderly migrants in the Netherlands make less use of mental health care services? 2

Method Six semi-structured group interviews (in total n=48) and 11 individual interviews with Turkish, Moroccan, Surinamese and Dutch elderly (age 52-81). Analyzed by coding and comparing fragments and describing patterns. 3

Results – The identification of depressive symptoms (1) Headache When it is misty outside aggressive High blood pressure Loosing consciousness Menopause Forgetful Worrying about children 4

Results - The identification of depressive symptoms (2) Part of life “All people have those feelings at time, that you feel depressed” Not familiar with concept of mental disease Family members also do not know 5

Results -The identification of depressive symptoms (3) I: Do they know that themselves? R: Well, not really. I: Or do they hide it or eh? […] R: No they know what it is being ill. They will say, I cannot walk, I do not feel well. I am diabetic. [Moroccan men, group interview] 6

Results - Getting mental health care (1) Depression cannot be cured R1: Big problem, big problem depression. There is no solution (…) R2: Just hang in there and live until your last day R3: Yes I: Instead of finding a solution? R2: They don’t do that [Moroccan men group interview] 7

Results - Getting mental health care (2) Limited knowledge (also in the social network) where to find help: I: What does your husband think about the fact that you are seeing a psychologist? R: Erm erm he does not know anything I: Is that so? Why? R: He does not know what a psychologist is. [Turkish woman individual interview] 8

Results - Getting mental health care (3) Fear of stigma / ‘mad’ Look most people who are depressed, they do not tell this to others and do not accept it. (Turkish men group interview) Not wanting to burden others Children do not like their parents to be depressed Being open: “those who do not talk about their problems, will not be cured”. GPs are believed to be able to convince to seek help 9

Conclusions Symptoms were not recognized or with difficulty shared with others Limited knowledge about treatment but desire to be treated 10

Implications Care providers (eg GPs) should be aware that depression is not always recognized by patients. GPs are believed to be able to convince to seek help. Understandable and accessible information about depression for elderly and their families. 11

Questions? Information: j.suurmond@amc.uva.nl 12