1. 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)

2. 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

3. 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)

4. 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

5. 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

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

7. Inclusion Criteria
Publication from 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

8. 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

9. Study Selection Diagram

10. 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

11. 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

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

13. 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

14. 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

15. Labor Migrants

16. Refugees

17. 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

18. 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