1. MIGRATION AND MENTAL HEALTH Hugo Salgado, MPH UCSD MMFRP September 29 th 2011

2. BACKGROUND  “Mental health is not just the absence of a mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” -WHO

3. BACKGROUND  Exposure to traumatic conditions, coupled with difficulties in acculturation  long-lasting psychological and behavioral problems, including depression, anxiety, posttraumatic stress disorder  Many immigrants experience traumatic circumstances in their native country, including extreme poverty, human trafficking, exposure to war, and natural disasters

4. BACKGROUND  Many immigrants have difficulty acculturating to their new environments in the U.S., which is exacerbated by experiences with prejudice and discrimination  Immigrants have less access to, and lower utilization of, mental health services

5. BACKGROUND  Many studies have examined the mental health status of Latino migrants. (Hummer et al. 2007; Palloni and Arias 2004; Lara et al. 2005)  Protective factors include Social Networks, Social Support -Day laborers in North San Diego/Acculturative Stress/Social Support

6. CURRENT DEPRESSION AMONG ADULTS --- UNITED STATES, 2006 AND 2008 Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm CharacteristicNo. in sampleMajor depressionOther depressionAny current depression % (95% CI) Total235,0673.4 (3.2–3.5)5.7 (5.4–5.9)9.0 (8.7–9.3) Age group (yrs) 18–249,9442.8 (2.3–3.4)8.1 (7.2–9.2)10.9 (9.8–12.1) 25–3427,0863.4 (3.0–3.9)5.6 (5.2–6.2)9.1 (8.5–9.8) 35–4439,4403.6 (3.2–4.0)5.0 (4.7–5.5)8.6 (8.1–9.2) 45–6497,6424.6 (4.3–5.0)5.4 (5.0–5.8)10.0 (9.5–10.5) ≥6559,2461.6 (1.4–1.8)5.2 (4.9–5.6)6.8 (6.4–7.2) Sex Men89,8422.7 (2.5–3.0)5.2 (4.9–5.5)7.9 (7.5–8.2) Women145,2254.0 (3.8–4.2)6.1 (5.9–6.4)10.1 (9.8–10.4) Race/Ethnicity White, non-Hispanic183,5633.1 (2.9–3.2)4.8 (4.6–5.0)7.9 (7.6–8.1) Black, non-Hispanic17,6044.0 (3.6–4.6)8.7 (7.9–9.7)12.8 (11.8–13.8) Hispanic18,3914.0 (3.4–4.6)7.5 (6.7–8.3)11.4 (10.5–12.5) Other**13,5284.3 (3.6–5.1)6.3 (5.5–7.3)10.6 (9.5–11.9) Education Less than high school diploma21,4636.7 (6.0–7.6)10.4 (9.5–11.4)17.1 (16.0–18.3) High school diploma68,2504.0 (3.7–4.3)7.2 (6.7–7.6)11.2 (10.6–11.7) At least some college145,0202.5 (2.3–2.6)4.1 (3.9–4.3)6.6 (6.3–6.9) Employment status Employed133,9512.0 (1.8–2.1)4.5 (4.2–4.7)6.4 (6.1–6.7) Unemployed8,9919.8 (8.7–11.0)11.6 (10.2–13.1)21.3 (19.6–23.2) Retired55,1721.6 (1.4–1.8)4.7 (4.4–5.1)6.3 (5.9–6.7) Unable to work13,05422.2 (20.7–23.8)16.9 (15.6–18.3)39.1 (37.3–40.9) Homemaker/Student23,4473.0 (2.6–3.5)6.2 (5.5–7.0)9.2 (8.4–10.1) Health insurance coverage Yes208,3232.9 (2.8–3.1)5.0 (4.8–5.2)7.9 (7.7–8.2) No26,2655.9 (5.4–6.5)9.0 (8.2–9.8)14.9 (14.0–15.8) California5,1773.7 (3.1--4.4)5.4 (4.6--6.3)9.1 (8.1--10.2)

7. SAN MIGUEL TLACOTEPEC/VISTA, CA. 2011 Literature  Studies of Migrant Mental Health  Very few studies compare mental health outcomes of migrants, non-migrants and returned migrants from the same sending and satellite community

8. SAN MIGUEL TLACOTEPEC/VISTA, CA. 2011  CESD-10 - Focuses on clinical depression - (feelings of sadness, loss, anger, or frustration interfere with everyday life for a period of two weeks or longer ) - Has been administered in rural communities across the - Mexican state of Jalisco, - High internal consistency

9. SAN MIGUEL TLACOTEPEC, 2011 Results: Mental health among Tlacotepense migrants is better than that of Tlacotepec residents, including return migrants. Reasons:  Family Separation  Social Networks  ‘Healthy Migrant’ Effect  ‘Salmon Bias’ Effect

10. SAN MIGUEL TLACOTEPEC/VISTA, CA. 2011 Non-migrants= 23% Return migrants=21% Migrants= 9%

11. CES-D SCORES Overall 16% with depressive symptoms Non-migrants = more likely to report depressive symptoms Men = less likely to report symptoms of depression Higher education = less depressive symptoms Women = more likely to report depression

12. REGRESSION ANALYSIS N=720. p< 0.001***; p< 0.01**; p<0.05 * Dependent Variable: CES-D Score

13. Self-Reported causes of depression

14. FORMAL SERVICES AVAILABLE SMT: Medical health clinic Psychologist in Juxtlahuaca Psychiatrist in Oaxaca Vista: Non-Profit organizations Independent practices

15. Migrants, return migrants, and non-migrants all show preference for medical and psychological services Migrants sought less formal treatments Lack of access to formal services = use of informal treatment TREATMENT

16. SERVICES SOUGHT FOR DEPRESSION

17. EXPLAINING OUR FINDINGS Family Separation in San Miguel Tlacotepec Social Networks, Social Support ‘Healthy Migrant’ Effect ‘Salmon Bias’ Effect

18. SIGNIFICANCE Mental health is a pressing public health issue Depression is “among the leading causes of disability worldwide” (WHO) Essential to understand health among a population that is the largest ethnic-minority group in U.S.

19. CONCLUSION Immigrant mental health promotion requires multi-sectoral action: 1) Government sectors 2) Non-governmental or community-based organizations 3) Civil society 4) Media Pay special attention availability of social support and social networks, social support, pre-migration conditions and migration experience itself

20. THANK YOU QUESTIONS, COMMENTS?