Research report
Depression and anxiety among migrants in Austria: A population based study of prevalence and utilization of health care services

https://doi.org/10.1016/j.jad.2013.05.081Get rights and content

Abstract

Background

Although migrants form a large part of the Austrian population, information about mental health of migrants in Austria is scarce. Therefore, we compared the prevalence of dysphoric disorders (depression and anxiety) and the corresponding utilization of health care services of Eastern European, western and other migrants with the non-migrant population in Austria.

Methods

We performed a telephone survey on a random sample of the general population of Austria aged 15 years and older (n=3509) between October 2010 and September 2011. Depression and anxiety were measured with the Patient Health Questionnaire-4 and utilization of health care services in the last 4 weeks was inquired.

Results

15.0% of our sample had a migration background. Female migrants from Eastern Europe, first and second generation, had a higher prevalence of dysphoric disorders (29.7% and 33.4% respectively) than Austrian women (15.2%) (p<0.001). The prevalence in the other migrant groups did not differ significantly from the Austrian population. There was no gender difference in dysphoric disorders in the Austrian population. After adjustment for age and chronic diseases, having a dysphoric disorder was associated with a higher utilization of health care services among migrant and Austrian women, but not among men.

Limitations

Because of the explorative nature of the study multiple testing correction was not performed. The reason for health care utilization was not assessed.

Conclusions

Mental health of female migrants from Eastern Europe should be studied in more detail; men could be an underserved group, both in migrants and Austrians.

Introduction

Dysphoric disorders, including anxiety and depression, are the most common mental disorders in European countries (Wittchen and Jacobi, 2005). Migrants are often thought to be at higher risk of dysphoric disorders as a result of the stress they have to endure before, during and after migration. Nonetheless, epidemiological evidence on the prevalence of dysphoric disorders among migrants in Europe is still limited and findings are contradictory. Whereas some studies found higher rates of depression and anxiety among migrants (Wittig et al., 2008, Tinghog et al., 2007), others assessed rates that were similar to the host population (Glaesmer et al., 2009).

The prevalence of dysphoric disorders among migrants has been shown to depend on several characteristics of the migrants and host countries. Lindert et al. (2009) showed in a meta-analysis that refugees had a significantly higher prevalence of depression and anxiety disorders than labor migrants and that a higher gross national product of the host country was related with lower rates of dysphoric disorders among labor migrants. Tinghog et al. (2007) and Missinne and Bracke (2012) demonstrated that the prevalence of mental illnesses among migrants in different European countries depends on their socio-economic situation. Studies about the effect of length of stay in the host country are inconsistent (Gonidakis et al., 2011, Breslau and Chang, 2006). Further, the rate of dysphoric disorders differs between migrants with different ethnic background within the same host country (De Wit et al., 2008, Levecque et al., 2007, Weich et al., 2004). Lastly, some studies showed that migration could have a different effect on the prevalence of dysphoric disorders for women and men (Sieberer et al., 2012, Weich et al., 2004, De Wit et al., 2008, Shaw et al., 1999).

Another important factor to consider when studying mental health of migrants is their access to and utilization of health care services. Several American and Canadian studies showed an under-representation of migrants in mental health care services compared to their needs (Chen et al., 2010, Kirmayer et al., 2007, Mcguire and Miranda, 2008). Information from European countries is more scarce, but a recent Dutch study showed the same pattern (Koopmans et al., 2012).

Despite a large number of migrants in Austria, information about their mental health is hardly available. In 2010 18.6% (1.543 million people) of the Austrian population had a migration background, which includes people who themselves or whose parents were born in a foreign country. Most of them come from Central or Eastern Europe, especially Germany, former Yugoslavia and Turkey (Statistik Austria, 2011). Only two studies provide some information about mental health of migrants in Austria. The health survey of Statistics Austria from 2006 to 2007 found a higher risk of depression and anxiety among male and female migrants originating outside the European Union and the European Free Trade Association (Statistik Austria, 2008). The questionnaire used in this study to measure depression and anxiety was not validated and only available in German, which makes the results less reliable. In contrast, Missinne and Bracke (2012), who compared the depression scores of migrants and natives in 23 European countries, did not find a significant difference between these groups in Austria.

In order to be able to adequately plan preventive and mental health care services for migrants, more knowledge about mental health of migrants in Austria is needed. Therefore our aim was to study: (1) the prevalence of dysphoric disorders among different groups of migrants (first and second generation from different regions) in comparison to the native Austrian population using a validated questionnaire; (2) the influence of gender, socio-economic factors, fluency of host language and length of stay in Austria on this prevalence; (3) the utilization of health care services of migrants and Austrians with and without a dysphoric disorder.

Section snippets

Sample

This study is part of the research project ‘Ecology of Medical Care—Utilization of Health Care in Austria (ECOHCARE)’ which is registered with the ClinicalTrials.gov identifier NCT01261845. The data for this study were gathered by a telephone survey of the general population in Austria aged 15 years and older. The survey was conducted by a professional Computer Assisted Telephone Interview (CATI) provider and carried out in four waves between October 2010 and September 2011. The sample was

Sample

A total of 3509 respondents participated in the study. Of them, 52 (1.5%) did not complete the whole PHQ-4 and 9 (0.3%) did not provide full information about their migration background. The data of the remaining 3448 participants were used in the analyses. Fifteen percent (n=518) had a migration background; 9.7% (n=335) were first generation immigrants and 5.3% (n=183) second generation immigrants. The number of men and women from each region can be found in Table 1. The group ‘other

Discussion

This study considerably extends the knowledge about mental health of migrants in Austria. We show that women from Eastern Europe, from both the first and second generation, are at high risk of dysphoric disorders compared to Austrian women. This cannot be explained by a lower socio-economic status and only partly by the fact that some women in this group experienced the war in former Yugoslavia. In the general population of Austria the prevalence of dysphoric disorders does not differ

Conclusion

In our study we assessed mental health and utilization of health care services of migrants in Austria using a large random sample and a validated questionnaire. We show that Eastern European women, from both the first and the second generation, are at higher risk of dysphoric disorders. Our finding that most of them visited a health care service in the last weeks implies that screening by physicians could improve detection. Men in general could be an underserved group in the care for mental

Role of funding source

The project ECOHCARE was supported by funds of the Oesterreichische Nationalbank (Anniversary Fund, Project number: 13683), which played no role in the design and implementation of the study.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

The first author acknowledges the support of the European Community Action Scheme for the Mobility of University Students (Erasmus Project/NPHC) and the Radboud University Nijmegen who made her work at the Medical University of Vienna possible. We thank Susanne Pitnik who was involved in the literature research that led to the formulation of the study protocol, Yuka Shibamori who helped with literature research and data handling and Sonja Zehetmayer who was involved in the calculation of the

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