Background
Intersectional approach to the correlates of mental health of immigrant populations
Methods
Concepts and definitions
Search strategy
Inclusion and exclusion criteria
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a) Samples completely or partially consisted of participants 18 years and older.
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b) Turkish and/or Moroccan samples from multiple or one of the European countries with large Turkish or Moroccan immigrant groups, specifically: United Kingdom, the Netherlands, Belgium, France, Spain, Portugal, Germany, Austria, Switzerland, Italy, Finland, Denmark, Norway, and Sweden [9].
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c) Samples exclusively consisted of Turkish or Moroccan immigrant individuals or samples that included Turkish or Moroccan immigrants in a larger, mixed sample of diverse immigrant groups.
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d) Provision of broad information on depressive disorders and symptoms, or relevant to the treatment of depression. Eligible studies included at least one instrument, subscale or measure of depression (objective clinical diagnoses of depression following DSM or ICD, as registered in primary/secondary/specialized care, were considered as well) and/or stated that all or at least the majority (> 50%) of the sample received treatment for depression or had depressive symptoms consistent with the reported instrument or the pertinent DSM or ICD diagnoses. The eligible studies are included in Additional file 2.
Data synthesis
Quality assessment
Correlates
Intersectionality
Results
Prevalence and comorbidity
Turkish (%) | Moroccan (%) | Native-born (%) | ||||||||||||
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Country | Type of prevalence | Study | Instrument (cut-off) / Diagnoses | Population | Age (Range/ M ± SD) | Male | Female | All | Male | Female | All | Male | Female | All |
Belgium | Current | Levecque et al., 2009g [49] | SCL-90 (90% cut-off) | Community-based | 18–65 | 15.4d | 14.2d | 9.1 | ||||||
Germany | Current | Morawa & Erim, 2014c,g [50] | BDI (≥ 18 cut-off | Community-based, Ruhr region | 40.0 ± 13.2 | 25.7d | 7.9 | |||||||
Sariaslan et al., 2014c,g [51] | BDI (≥ 18 cut-off) | General practice patients | 38.4 ± 12.3 | 19.3d | 7.9 | |||||||||
Bermejo et alh., 2016 [52] | PHQ-D (≥ 11 cut-off) | Community-based | 53.1 ± 11.0 | 30.4 | ||||||||||
Beutel et al., 2016h [53] | PHQ-9 (≥ 10 cut-off) | General population, Western-mid region | 35–74 | 14.8 | 35.1i | 21.6d | 6.8 | |||||||
Fassbender & Leyendecker, 2018 [54] | CES-D-10 (≥ 10 cut-off) | Cross-sectional, community sample | 35.9 ± 5.6 | 39.4 (lower income cluster), 43.3 (low education cluster), 28.1 (more advantaged cluster in terms of income & education) | ||||||||||
Reich et al., 2018h [55] | PHQ-9 (≥ 10 cut-off, moderate and severe symptoms) | Mixed general population, community and inpatient | 42.6 ± 12.8 | 40.7 | 6.0 | |||||||||
Morawa et al., 2020 [56] | PHQ-9 (≥ 10 cut-off) | Community-based, General population | 41.6 ± 11.3 | 26.4 | 33.2 | 29.2 | ||||||||
One-year | Janssen-Kallenberg et al., 2017 [57] | CIDI DIA-X Version 2.8 (section E) MDD and/ or Dysthymia | Community-based Hamburg Berlin | 18–65 | 23.2 | 33.2 | ||||||||
18–29 | 22.3 | |||||||||||||
30–49 | 27.3 | |||||||||||||
50–65 | 40.6 | |||||||||||||
Unclear | Erim et al., 2011 [58] | DSM-IV diagnosis MDD (code 296.2) | Psychosomatic outpatients secondary care | 39.41 ± 9.9 | 37.3 | - | - | |||||||
DSM-IV diagnosis Recurrent depression (code 296.3) | 7.8 | |||||||||||||
DSM-IV diagnosis All mood disorders (codes 296.2, 296.3, 300.4) | 78.4 | |||||||||||||
The Netherlands | Current | Van der Wurff et al., 2004g [37] | CES-D (≥ 16 cut off) | Community-based, non-institutionalized | 55–64 | 47.2d | 64.3d,i | 55.5d | 21.1d,e | 45.2d,e i | 31.9d,e | 13.6 | 20.0 | 16.9 |
65–74 | 64.4d | 73.5d | 68.8d | 40.0d,e | 46.3d,e | 42.7d,e | 2.6 | 20.2i | 12.8 | |||||
55–74 | 61.5d | 33.6d,e | 14.5 | |||||||||||
Ikram et al., 2015b,h [38] | PHQ-9 (≥ 10 cut off) | Community-based Amsterdam | 18–70 | 24.0d | 5.8 | |||||||||
Algorithm PHQ-9 | Community-based Amsterdam | 18–70 | 12.9d | 2.3 | ||||||||||
Galenkamp et al., 2017b,h [39] | PHQ-9 (≥ 10 cut off) | General population Amsterdam | 18–70 | 18.8 | 26.4 | 18.2 | 22.0 | |||||||
Snijder et al., 2017b [40] | PHQ-9 (≥ 10 cut off) | General population Amsterdam | 18–70 | 23.0 | 21.0 | |||||||||
Nieuwenhuijsen et al., 2015b [41] | PHQ-9 (≥ 10 cut off) | General population, working subset Amsterdam | 43.0 ± 12.0 | 13.0 | 21.0 | 16.0 | 10.0 | 17.0 | 13.0 | 3.0 | 6.0 | 5.0 | ||
Stronks et al., 2020b [42] | PHQ-9 (≥ 10 cut off) | General population Amsterdam | 18–70 | 19.5 (offspring), 24.5 (immigrants) | 15.5 (offspring), 22.0 (immigrants) | 7.2 | ||||||||
One-month | De Wit et al., 2008a [43] | CIDI 2.1 (section E) | General population Amsterdam | 18–65 | 14.9d | 6.6d,f | 4.4 | |||||||
Braam et al., 2010a [44] | CIDI 2.1 (section E) | General population Amsterdam | 19–82 | 18.0d | 6.0f,f | 5.0 | ||||||||
Schrier et al., 2010a [45] | CIDI 2.1 (section E) | General population Amsterdam | 47.3 ± 14.2; 49.6 ± 14.4; 54.1 ± 14.6 | 16.5d | 5.8d | 4.1 | ||||||||
Unlu et al., 2014a [46] | CIDI 2.1 (section E) | General population Amsterdam | 18–55 | 17.1 | ||||||||||
CIDI 2.1 (section E, D) Comorbid depressive and anxiety disorders | General population Amsterdam | 18–55 | 6.7 | |||||||||||
One-year | De Wit et al., 2008a [43] | CIDI 2.1 (section E) | General population Amsterdam | 18–65 | 22.4d | 9.8d,e | 10.3 | |||||||
Fassaert et al., 2010 [47] | ICPC diagnoses (codes P03, P76) | General practice patients | 38.7 ± 11.3; 35.7 ± 9.3 53.2 ± 18.6 | 3.3d | 2.5 | 2.5 | ||||||||
Schrier et al., 2012a [45] | CIDI (section E) MDD and/or dysthymia | General population Amsterdam | 47.5 ± 14.1; 49.5 ± 14.5; 54.1 ± 14.8 | 15.6d | 4.3d,e | 9.1 | ||||||||
CIDI (sections E, D) Comorbid depressive and anxiety disorders | General population Amsterdam | 47.5 ± 14.1; 49.5 ± 14.5; 54.1 ± 14.8 | 9.8d | 3.8e | 2.3 | |||||||||
Fassaert et al., 2010 [17] | DSM-IV diagnosis (codes 296.21–296.24, 296.31- 296.34) | Outpatient and inpatient secondary care | 35.4 ± 8.3; 35.3 ± 8.7; 40.6 ± 11.7 | 27.2 | 29.6d | 25.5 | ||||||||
Lifetime | De Wit et al., 2008a [43] | CIDI 2.1 (section E) | General population Amsterdam | 18–65 | 31.1d | 15.2d,e | 24.8 | |||||||
Point-prevalence | Fassaert et al., 2010 [17] | DSM-IV diagnosis Severe depression (codes 296.21–296.24, 296.31- 296.34) | Outpatient and inpatient secondary care | 35.4 ± 8.3; 35.3 ± 8.7; 40.6 ± 11.7 | 32.1 | 34.2d | 30.1 | |||||||
DSM-IV diagnosis Recurrent depression (codes 296.21–296.24, 296.31- 296.34) | Outpatient and inpatient secondary care | 35.4 ± 8.3; 35.3 ± 8.7; 40.6 ± 11.7 | 27.9d | 25.4d | 40.7 |
Correlates of depressive disorders and symptoms
Association (+ , -, 0, ?) / Average quality per association type | |||||
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Category | Factor | Subscale | Turkish | Moroccan | Native-born |
Psychological characteristics | Personality | Neuroticism | + / 2 | + / 2 | + / 2 |
Extraversion | - / 2 | - / 2 | - / 2 | ||
Openness | - / 2 | - / 2 | - / 2 | ||
Consciousness | 0 / 2 | 0 / 2 | 0 / 2 | ||
Agreeableness | - / 2 | - / 2 | - / 2 | ||
Emotion regulation | Emotional intelligence | - / 3a | - / 3a | ||
Emotional coping (expression and emotional processing) | + / 3 | ||||
Positive coping (hope, optimism) | -, - / 3 | -, - / 3 | |||
Cognitive reappraissal | - / 3 0 / 3 | - / 3 0 / 3 | |||
Expressive suppression | + /3 - / 3 | + , + / 3 | |||
Self-appraisal | Positive—Self-esteem, self-efficacy | - / 3 | - / 3 | -, - / 3 | |
Negative—loss of status, self-deprecation (guilt), shame | + e, + e, + e / 3 | + e /3 0e, 0e /3 | |||
Sense of control | sense of coherencef and sense of mastery | -, -/ 1.5 | - /1 | ||
Attachment/ Autonomy | Independent self | - / 3 | - / 3 | ||
Autonomy-satisfaction | - / 3 | + / 3 | |||
Desire of independency | 0 / 3 | 0 / 3 | |||
Attachment/ Relatedness | Interdependent self | - / 3 | - / 3 | ||
Relatedness-satisfaction | - / 3 | 0 / 3 | |||
Separation anxiety | 0 / 3 | + / 3 | |||
Fear for intimacy | + / 3 | + / 3 | |||
Trusting problems | + / 3 | + / 3 | |||
Socio-demographic factors | Sex | Female | + , + , + , + , + , + , + , + , + e, + , + / 1.9 0, 0, 0, 0, 0, 0, 0, 0a, 0 / 2.3 ?, ?, ?, ?, ? | + , + , + , + / 1.8 0, 0, 0, 0 / 2.3 ? | + , + , + , + e /1.8 0, 0, 0, 0, 0, 0, 0, 0 / 2.1 |
Not specified | 0 / 1 | 0 / 1 | |||
Age | + , + , + , + / 1.8 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0a, 0, 0, 0 / 1.9 ?, ?, ?, ?, ? | + /1 0, 0, 0, 0, 0, 0, 0, 0 / 1.9 ? | + , + /1 0, 0, 0, 0, 0, 0, 0 / 1.9 ?e | ||
SES | Combined variable | -, - / 3 | |||
Education | -, -, -, -, -e, -, -, - / 2 0, 0, 0, 0, 0, 0, 0, 0, 0 / 2.3 ?, ?, ? | -, - / 1.5 0, 0, 0, 0, / 1.5 | 0, 0, 0, 0, 0, 0, 0, 0, 0/ 2 ?e | ||
Not specified education | + / 1 | ||||
Unemployment | + , + , + e, + , + / 2.2 0, 0, 0, 0/ 2.3 ? | + /2 0, 0 / 1.5 | 0 /2 | ||
Not specified employment status | + / 1 0a / 2 | 0 / 1 | |||
Occupational level (categories low to high) | - / 2 | - / 2 | |||
Income (unidimensional) | - / 2 0, 0, 0, 0, 0 / 1.4 | 0, 0, 0, 0 /1.3 | 0, 0 / 1.5 | ||
Negative financial indicator (financial problems, poor housing, no home ownership, retired, daily hassles) | + , + , + / 2.7 0, 0 / 1.5 | 0 / 2 | |||
Marital status | Not specified | + / 1 0, 0, 0 / 2.3 ? / 2 | 0 / 2 | 0, 0 / 2 | |
Single/living alone | + , + , + / 1.3 0, 0, 0, 0a/ 2 | + / 1 0 / 1 | + / 1 0 / 3 | ||
Marriage duration | 0 / 3 | ||||
Poor marriage quality, marriage problems | + , + , + / 2.3 0, 0 / 3 | ||||
Role functioning/disability | Physical limitations | + / 1 | + / 1 | + / 1 | |
Chronic illness | + / 1 | + / 1 | + / 1 | ||
Physical activity | ? / 2 | ||||
Daily functional performance | 0a / 2 + / 2 | + a, + / 2 | 0a /2 + / 2 | ||
Trauma/PTSS | + , + a / 2.5 | ||||
Perceived stress | + c / 2 | ||||
GAF | -e / 3 | ?e / 3 | |||
Clinical treatment duration | + e / 3 | ?e / 3 | |||
Attitude towards treatment (psychotherapy, medication) | 0 / 2 + / 2 | ||||
Quality of life, satisfaction with life | -, - / 2.5 | -/ 2 | |||
Ethnocultural factors | Ethnicity | + , + , + , + , + , + , + , + , + / 2 0,0, 0 / 2.3 | + , + , + , + , + , + / 1.7 0,0, 0 / 2 | 0, 0, 0, 0, 0, 0 / 2.2 | |
Religiousness | Positive religiosity all types | 0a, 0, 0, 0 / 1.5 | -, - / 1 0 / 1 | ||
Positive coping | 0 / 1 | 0 / 1 | |||
Practicing religion | 0a / 3 | ||||
Daily prayer | 0 / 1 | - / 1 | |||
Service attendance | 0 / 1 | - / 1 | |||
Negative coping all types | + , + / 1 0, 0, 0 / 1 | + , + / 1 0, 0, 0 / 1 | |||
Negative – coping without God | 0 / 3 | 0 / 3 | |||
Negative – doubt about God | 0 / 3 | 0 / 3 | |||
Negative – anger at God | + / 3 | 0 / 3 | |||
Believing being punished by God | 0 / 3 | + / 3 | |||
Believing being abandoned by God | + / 3 | + / 3 | |||
Acculturation | Unidimensional measure | -a, c / 3 0a / 3 | |||
Participation (incl. assimilation, integration, skills, social integration, satisfaction in the receiving country, citizenship, assimilated social network) | + a. + / 2.5 -a, -a, -, -, - / 2.4 0, 0 / 2 | 0a, 0a / 2 + / 2 | |||
Maintenance (incl. separation, marginalization, traditions, norms and values, feelings of loss, homesickness, same- ethnic contact, number of same-ethnic friends, same-ethnic visits, same-ethnic shopping, speaking mother tongue with friends, communication problems, frequency of visits to Turkey/Morocco, only negative reasons to stay in receiving country, marginalized social network) | +a, +a, +, +, +, +, +, +, +, +e, +, +, + / 1.9 -, - / 1 0a, 0a, 0a, 0a, 0, 0 / 2.2 | 0a, 0a, 0a, 0, 0, 0, 0, 0, 0 / 1.3 + , + , + / 1.7 | + e / 3 0e /3 | ||
Language proficiency (language of receiving country) | - / 2 0, 0, 0, 0, 0, 0 / 1.7 | ||||
Age of migration | 0,0 / 1.5 | ||||
Stay duration | 0, 0, 0, 0, 0 / 2.2 | ||||
Ethnic identity | -b, - , - / 20a / 1 | - / 2 0 / 1 | |||
Problematic migration | + , + e / 2 | 0 / 1 | 0e /3 | ||
Migrant status | 0 /2 | ||||
Generation | First | + / 2 0, 0 / 1.5 | 0 /2 | ||
Second | + / 3 | + / 3 | |||
Not specified | 0 / 1 ?, ? | 0 / 1 | |||
Social support | All types | -, -, -, -/ 1.5 0, 0, 0, 0/ 1.8 | -, - / 2.5 + / 1 0, 0 / 1 | - / 3 | |
Available | - / 3 | ||||
Perception of social support | - / 1 | - / 2 | |||
From friends and neighbors | 0 / 2 | ||||
From family members | 0 / 2 | ||||
In the spare time | 0 / 2 | ||||
Same-ethnic contactd | -, - / 1 0 / 1 | + / 1 0, 0 / 1 | |||
Assimilated social network (contact with natives)d | + / 2 | ||||
Problems with or within social network (psychological, medical treatment, departure, incarceration of family member, family problems) | + , + , + / 2 0 / 2 + e / 3 | + e / 3 | |||
Forced marriage (and related problems) | +a, + e / 3 | 0e /3 | |||
Loneliness, marginalized social networkd | + , + d /1.5 | + , + d /1.5 | + /1 | ||
Perceived ethnic discrimination | All types | + , + a, + , + , + , + , + , + e, + , + / 1.7 0, 0 / 1 | + , + , + , + / 1.3 0 / 1 | 0e /3 | |
Not specified discrimination | + , + . + / 1.3 | + , + / 1.5 | |||
Personal-level | + / 1 | + / 1 | |||
Group-level | 0 / 1 | + / 1 | |||
Open aggression | + / 2 | ||||
Passive /subtle discrimination (i.e., paternalism) | + / 2 | ||||
Everyday discrimination (neighborhood, doing groceries, at work, in public institutions) | + / 2 0 / 1 | ||||
Work environment | Recovery opportunities | - / 3 | - / 3 | 0 / 3 | |
Perceived stress | 0 / 3 | - / 3 | 0 / 3 |