Message from the president

Johannes Wancata, President

Dear IFPE members,

Recently Prof. Steffi Riedel-Heller has sent the

2nd Announcement for our next congress in

Leipzig in 2013. The title of the congress will be

“The uses of psychiatric epidemiology in

improving population mental health”. This

theme is an important and interesting next

topic after the last conferences focusing on

‘Happiness and well-being’ three years ago in

Vienna and ‘Global recession and mental health’

last year Taiwan. In nowadays world, psychiatric

epidemiologist face numerous challenges:

beside the usual epidemiological tasks of

identifying risk factors for mental illness and of

providing data for health service planning,

policy makers have new and urgent questions

such as how to prevent negative consequences

of unemployment, or how to increase

effectiveness of services but costing less money.

The congress in Leipzig will give the opportunity

to discuss all these topics. Beside these very

important issues the congress will explore the

most recent scientific methods and research

designs in order to positively impact mental

health across various populations.

Excellent researchers from all over the world

have announced to come to Leipzig and to give

lectures reporting their most recent findings.

Leipzig provides an exciting environment for

this meeting combining all advantages of

modern European cities with old traditions of

their culture.

An excellent local team coordinated by Steffi

Riedel-Heller is preparing the conference and

will provide an exciting congress. It is good to

know that preparations for the 14th

International Congress of the IFPE are well

underway in Leipzig.

I am looking forward to this exciting

opportunity to learn from each other and to

listen international top researchers presenting

their most recent findings.

I have two requests to all IFPE members:

1. Please, don’t forget to submit your

abstract(s)!

bulletin

International Federation of Psychiatric Epidemiology Volume 10(2) July 2012

2

2. Please, tell all your colleagues that we

are expecting an exciting and

stimulating conference in Leipzig!

I am looking forward to read the numerous

abstracts and to meet you in Leipzig!

Johannes Wancata

President IFPE

Migration and mental illness: an

update1

Andrew T.A. Cheng

One of the major aspects of social change

following rapid globalisation in the second half

of the last century has been in migration.

According to the International Organization for

Migration, there are now about 192 million

people living outside their place of origin, which

is about 3% of the world’s population. This

means that roughly one out of every 35 persons

in the world is a migrant. This number includes

26 million internally displaced persons, and 16

million cross-national refugees and asylum

seekers.1 In other words, at least one in every

400 people alive in the world today is a refugee.

Migration has been regarded as having

a substantial impact on people’s mental health,

either as a precipitating or as an aggravating

factor. Each stage of migration can involve

certain risk factors for mental health, including

individual personality and traumatic

experiences (such as violence and war during

pre-migration); duration of waiting period;

degrees of exhaustion; types of trauma during

the migration process; social adversity; racial

discrimination; poor living conditions and legal

status post-migration.

Methodological issues

Most studies have used a cross-sectional design

and assessed short- or long-term effects of

migration on mental health retrospectively.

Three types of comparative strategy have been

employed, namely comparisons between

immigrants and people in their country of

origin; between foreign-born immigrants and

their descendants born in the new country, and

between native-born persons and immigrants,

either first or second generation.

Use of the same cross-culturally valid

and reliable instruments in different languages

among the comparison groups is a fundamental

requirement in the study of migration and

mental health. Definitions of ethnicity, race,

nationality and place of birth in subject

recruitment need to be consistent across

studies. With these considerations in mind, the

main findings to date are summarised and their

implications discussed.

3

Migration and psychotic disorders

Earlier studies suggested a negative

immigration effect on people who were in the

incipient stage of illness, notably schizophrenia,

prior to migration. The classical study by

Odegaard2 explained the phenomena in terms

of a selective tendency to migrate among

vulnerable and insecure individuals who had

failed in interpersonal relationships in their

home country.

Several studies have since reported an

increased incidence of schizophrenia and other

psychotic disorders in selected immigrant

groups, including both first- and second-

generation African-Caribbean immigrants in the

UK.3 This finding remains robust after

controlling for potential confounding factors,

including ethnic demographic differences,

diagnostic bias and misclassification in ethnic

minorities; selective referral bias; differential

use of cannabis and other illicit drugs, and

problems in calculating the populations at risk.

An increased familial risk for

schizophrenia and also for non-affective

psychoses was found in the first and second

generations of Afro-Caribbean immigrants, and

in siblings but not in parents of the second

generation.4 This suggests that the increased

incidence in immigrants is not due solely to

genetic predisposition. Both biological and

social exposures

associated with immigration may provoke

psychotic disorders. As Broome et al5 comment,

‘A plausible model of the onset of psychosis

needs to draw not only on neurosciences, but

also on the insights of social psychiatry and

cognitive psychology’.

Migration and suicide

Suicide rates have consistently been found to

be higher among immigrants. Studies of

immigrants from 15 countries to Sweden6 and

from seven countries to Australia7 reported

higher rates among them than in the countries

of origin.

The relation of period of residence in a

new country to suicide rates is still unclear.

However, a recent U.S. study revealed an

increased suicide risk among immigrants and an

inverse relationship between shorter duration

of residence and a higher suicide risk,

suggesting that suicide should focus on recent

immigrants.8

Involuntary migration: refugees and asylum

seekers

Both hospital and population-based studies

among refugees and asylum seekers have

repeatedly observed high rates of psychiatric

disorders. The high morbidity has been

attributed to loss and traumatic events before

or during the migration process, and post-

migration stresses involving trauma, asylum

4

procedures, detention, social isolation and

readjustment in family, job, housing and living

conditions. A meta-analysis based on 59

control studies reported a poorer mental health

condition among refugees, associated with both

refugee personal characteristics and post-

displacement experiences. The former included

older age, higher education, feminine gender,

and a higher pre-displacement social status.

Post-displacement factors included institutional

accommodation, restricted economic

opportunities; internal displacement; forced

repatriation and unresolved initiating conflict.9

A much higher level of psychiatric

morbidity, especially PTSD, depression and

anxiety disorders, with a total prevalence

around 40-50%, has been reported among

refugee children.10 Contributing factors may

include direct experience or witnessing of

violence, loss of parents and family, and being

looked after by parents who themselves cannot

cope with the children’s needs. It has been

found that a stressful social life such as

discrimination in the new country predicts

subsequent psychological problems eight or

nine years after arrival.11

Studies of immigrants in general

Over the past two decades, U.S. studies have

consistently reported lower prevalences of

mood and substance use disorders among first-

generation Mexican, Hispanic, Asian and non-

Hispanic white immigrants than among U.S.-

born persons of the same ethnic origins. Such

lower rates, however, were observed only in

the early years following migration.12 It may be

that these groups score better in the initial

years than their second-generation

counterparts because of positive selection in

migration, but that this advantage is lost over

time, as a result of acculturation stress or

difficulties of adaptation to the host society.

One recent study among Mexican

citizens (n=5826) found that respondents with a

history of earlier migration to the U.S., or

having family members in the U.S., were at

higher risk for substance use disorders than

were other Mexicans. The authors speculated

that this type of migration may tend to increase

substance misuse and related pathology in

Mexico.13

Findings of studies which failed to

differentiate between refugees and voluntary

or economic immigrants have been

inconsistent. Some have reported higher rates

of anxiety and mood disorders among adult

immigrants, and both internalising and

externalising problem behaviours among

children; some found no differences, and some

conversely reported lower rates among

immigrants. These disparities may be explained

by differences in sample recruitment, case

definitions and identification methods, in period

5

of study in the migration process and in

heterogeneity of the study samples.

Internal migration: selective migration?

Stress associated with internal migration is

generally less severe and largely involves sub-

cultural adaptation, without a language barrier

or traumas such as detention. Rural-urban

migration is common in developing countries,

due to decline of rural economies and the

concentration of wealth and jobs in cities. A

community study in Taiwan found lower rates

of depressive symptoms in migrant urban young

women (0.4%) than among native rural

counterparts (9.8%).14 Difference in social

adversity (53% in rural vs. 25% among urban

young female cases) and selective migration

were both proposed to explain this difference.

Motivation for migrating to the cities is not

always or only economic: other reasons include

escape from social adversity and inequality of

status between husband and wife in rural

Taiwan.

An often neglected aspect of the

general problem is the movement of aboriginal

peoples from their ‘reservations’ (ethnic

territories) to the cities, occurring in particular

in the USA, Canada, Australia, New Zealand,

China, Taiwan, Japan and some countries in

South America. Few studies to date have

investigated the impact of such migration on

physical and mental health, related to

acculturative stress.

Use of mental health services by immigrants

Studies of the use of mental health services by

immigrants, and evaluation of their effects, are

important for secondary and tertiary

prevention. Compared to indigenous

populations, non-European immigrants to

Canada and the U.S.A. tend to under-use

mental health services. The lower utilization by

immigrants cannot be explained by differences

in socio-demographics, somatic or psychological

symptoms, length of stay in the host country or

alternative sources of help. Possible

explanations include cultural and linguistic

barriers, inappropriate treatment and the

nature of illness causation. In some countries,

migrants without legal documents are not

eligible for public health care; hence access to

mental health services is limited by the social

framework and legal requirements of the host

country.15.

Conclusions

Cultural and social changes arising from

migration may put vulnerable persons at risk for

mental disturbance. Social support has been

consistently viewed as a protective factor in the

relationship between migration and mental

disorders. A plausible hypothesis is that early

life experience and culturally-bound attitudes

6

among immigrants strongly influence the

outcome for mental health in the new country,

but that this relationship is mediated by factors

of the migration process and moderated by

experiences in the country of destination.

Future research needs to apply cross-

culturally valid and reliable standardised

interviews and culturally valid measurement for

acculturation; the inclusion of representative

samples from the immigrant population with

clearly defined ethnicity; more detailed

collection of pre-immigration information ; a

clear history of the migration process and the

use of sibling-pair or longitudinal cohort study

design.

References

1. United Nations High Commission for Refugees

(2008). Global Trends: Refugees, Asylum-Seekers,

Returnees, Internally Displaced and Stateless

persons. http://www.unhcr.org/statistics.

2. Odegaard O (1932). Emigration and insanity.

Acta Psychiatr Neurol Suppl 4: 1-206.

3. Cooper B (2005) Schizophrenia, social class and

immigrant status: epidemiological evidence.

Epidemiol Psichiatr Soc 14: 137-144.

4. Harrison G, Glazebrook C, Brewin I et al (1997).

Increased incidence of psychotic disorders in

migrants from the Caribbean to the U.K. Psychol

Med 27: 799-806

5. Broome MR, Woolley JB, Tabraham P et al.

(2005). What causes the onset of schizophrenia?

Schiz. Res. 79: 23-34.

6. Ferrada-Noli M, Asberg M (1997). Psychiatric

health, ethnicity and socio-economic factors

among suicides in Stockholm. Psychol. Rep., 81:

323-332.

7. Burvill, PW (1998). Migrant suicide rates in

Australia and in country of birth. Psychol. Med.,

28: 201-208.

8. Kposowa, AJ, McElvain, JP, Breault, KD (2008).

Immigration and suicide: role of marital status,

duration of residence and social integration.

Arch. Suicid. Res., 12: 82-92.

9. Porter M, Haslam N (2005) Pre-displacement and

post-displacement factors associated with

mental health of refugees and internally

displaced persons: a meta-analysis. J Am Med

Ass, 294: 602-612.

10. Fazel M, Stein A (2002). The mental health of

refugee children. Arch. Dis. Childh. 87: 366-370.

11. Montgomery E, Feldspang A (2008).

Discrimination, mental problems and social

adaptation in young refugees. Eur. J. Publ. Hlth.,

18: 156-161.

12. Breslau J, Aguilar-Gaxiola S, Borges G et al

(2007). Risk for psychiatric disorder among

immigrants and their US-born descendants:

evidence from the National Co-Morbidity Survey

Replication. J. Nerv. Ment. Dis., 195: 189-195.

13. Borges G, Medina-Mora ME, Breslau J, Aguilar-

Gaxiola S. (2007). Effect of migration to the

United States on substance-use disorders among

returned Mexican migrants and families of

migrants. Am. J. Publ. Hlth., 97: 1847-51.

14. Cheng, TA (1989). Urbanization and minor

psychiatric morbidity. A community study in

Taiwan. Soc. Psychiat. Psychiatr. Epidemiol., 24:

309-316.

15. Lindert J, Schouler-Ocak M, Heinz A, Priebe S

(2008). Mental health, health care utilisation of

migrants in Europe. Eur. Psychiat., 23 (Suppl. 1):

14-20.

1Based on: Liu, IC & Cheng, ATA: Migration and

Mental Health: an Epidemiological Perspective. In Bhugra D, Gupta S (eds): Migration and Mental Health. Cambridge University Press, 2011, revised from a paper presented at the XIXth Congress of the World Association for Social Psychiatry, Prague, October 21-24, 2007.

IFPE Congress: June 05 ­ 08, 2013 Leipzig, Germany 

Preparations for the 14th International Congress of the IFPE are well underway in Leipzig. Up‐to‐date information  can  always  be  found  at  our  website  http://ifpe2013.org  including  our  second announcement  and  call  for  papers,  as  well  as  transportation  and  accommodation  information. Further, the site provides a portal to on‐line abstract submission and congress registration. 

The theme of next year’s meeting is: The uses of psychiatric epidemiology in improving population mental health. In addition to the latest research across the lifespan and within certain sub‐groups, we are  interested  in  contemporary  themes  such  as  the  uses  of  the  latest  technologies,  as  well  as emerging trends in the diagnosis and treatment of mental disorders. We expect an interesting mix of well‐known researchers and rising starts in the field of psychiatric epidemiology. Some of the topics already  in  the  works  include:  new  research  on  stigma,  causes  of  changes  in  patterns  of psychopathology  from  child‐  to  adulthood,  challenges  of  adolescence  and  aging  societies. We will explore  a  new  generation  of  psychiatric  case  registries  and  talk  about  the  use  of  the  internet  in assessing and managing population mental health. Mental health at the workplace and the growing interest of autism spectrum disorders are timely topics. Now that the event is less than a year away, it  is  time  to  prepare  and  submit  your  abstracts  via  our  website  http://ifpe2013.abstract‐management.de/. 

In addition to the regular scientific programme, we will be offering a pre‐meeting workshop titled: SCAN  training  short  course.  The  cost  of  the  training  is  included  in  the  regular  registration,  but, register early, as space is limited!  Your  local organizing committee  is working hard  to make sure  that  there will be a  rigorous social programme  to  rival  the  scientific  programme.  The  meeting  will  take  place  at  the  Westin  Hotel Leipzig,  a  modern,  world‐class  hotel  within  walking  distance  to  the  city  centre  and  Leipzig’s important historical and musical sites.  Several theme‐based city tours will be available to fit a range of  interests.  Our  congress  dinner  will  be  held  at  the  Leipzig  Zoo  in  Gondwanaland,  a  newly constructed portion of the zoo designed to replicate the tropical rainforests.   Also, as the time gets closer, we will be providing  information about musical offerings at  the Thomaskirche (St. Thomas’ Church), Gewandhaus (Orchestra) and Opera.  

We look forward to welcoming you to Leipzig, Germany! 

Prof. Dr. med. Steffi G. Riedel‐Heller, MPH   

IFPE Congress: June 05 ­ 08, 2013 Leipzig, Germany 

The picture shows the newly reconstructed central univer‐sity building. Exactly at this place the old medieval univer‐sity church was dynamited in 1968 during the communist regime. The new buildings at the University's main campus are inspired by the form and shape of the old church. 

Nikolaikirche (St. Nikolai Church), J.  S. Bach worked here  from 1723‐50. Today,  the parish  implements a concept of an  "Open City Church" with exhibitions and concerts. With its Prayers for Peace (from 1982 onwards), St. Nikolai Church was one of the starting‐points of the Peaceful Revolution in 1989, leading to the  reunification of Germany. 

Thomaskirche (St. Thomas‘ Church)  Johann  Sebastian  Bach worked  here  from  1723  until he died in 1750. His tomb has been in the choir of the church  since  1949.  St.  Thomas'  Church  is  also  the home of the world‐famous St. Thomas' Choir.   

Photo credits: Pressestelle Universität Leipzig /Randy Kühn Universität Leipzig/ Nils Mammen

Photo credits: LTM/Schmidt  

Photo credits: LTM/Schmidt  

9

Calendar of Events

Goa,India November 19-30, 2012

“Leadership in Mental Health” More information: http://www.sangath.com/details.php?nav_id=41

Leipzig, Germany June 5-8, 2013

International Federation of Psychiatric Epidemiology 2011: The 14

th International

Congress of IFPE More information: http://ifpe2013.org

Lisboa, Portugal June 29-July 3, 2013

World Association of Social Psychiatry, 21

st world

congress More information: http://www.wasp2013.com/

Editor of IFPE bulletin

Jens Christoffer Skogen, University of Bergen, Norwa

Editorial board of IFPE bulletin

Professor Andrew T. A. Cheng

Professor Brian Cooper

SUBMISSIONS

Submissions to the IFPE Bulletin — news or views — can be sent to Jens Christoffer Skogen, editor, University of Bergen, Norway. E-mail: jens.skogen@uib.no / jensskogen@gmail.com