Population based studies of mental health among migrants in Nepal and Norway: Migration and adversity in different contexts.

Thesis Report.

ABSTRACT: Migration has always been a significant social event and its frequency is unlikely to decrease in the near future. There is hardly any country in the world, which has not experienced migration. Migration is a very heterogeneous process as there are variations in terms of its nature, duration, direction, purpose, and distance. Migrants, however, can broadly be classified into two different groups: voluntary migrants and forced migrants. The mental health of migrants has been an important research topic but there remain many unanswered or partly answered questions. For example, it is still not clear whether migration as such is associated with poor mental health. Previous research is limited to particular groups of immigrants or refugees living in high income countries. I assessed mental health of forced migrants, namely Bhutanese refugees and internally displaced persons in Nepal, and diverse groups of immigrants in Norway through cross-sectional population based surveys. Furthermore, I studied different phenomenon such as acculturation, powerlessness, self-efficacy, social support, and discrimination in Norway and disability and transcultural issues related to epidemiological surveys among refugees and internally displaced persons in Nepal. The two different context with diverse populations gave me an opportunity to relate the findings according to the contexts. In Norway I found that immigrants from low-and middle-income countries had significantly higher rates of psychological distress than immigrants from high-income countries and native Norwegians. I also found that migration per se was not a risk factor for psychological distress when I compared the distress between immigrants from low-and middle-income, and high-income countries, and both the pre-migration (traumatic experiences) and post-migration factors (job, economy, powerlessness, negative life events, social supports) were more strongly associated with distress among the former group of immigrants. In spite of the almost equal levels of distress among male and female immigrants, there were gender based risk and protective factors. Unemployment, traumatic and recent negative life events, lack of visits by Norwegians and the experience of being denied a job were associated with psychological distress, among men. On the other hand, older age, Middle East background, unemployment, negative life events and the experience of being denied housing were associated with distress among female immigrants. These findings may have implications for their integration into Norwegian society. In Nepal I found much higher rates of psychiatric disorders among tortured Bhutanese refugees compared to non tortured refugees. However, the rates of disability were similar between these two groups. Post traumatic stress disorder, specific phobia and present physical illness were associated with disability among tortured refugees, whereas present physical illness, higher age and anxiety disorder were associated with disability among non tortured refugees. Similarly, I found very high rates of depression, anxiety and post traumatic stress disorder symptoms among internally displaced persons. Female gender and being between the age 41 and 50 were associated with depressive symptomatology. Illiteracy was associated with anxiety symptomatology whereas trauma, sudden evacuation, and higher caste were associated with symptoms of post traumatic stress disorder. Feeling miserable at arrival was the single factor associated with depression, anxiety and PTSD symptoms. The high rates do not necessarily ask for active medical treatments, but indicate that there is a need for general psychosocial interventions among these displaced persons.

Eng.