Investigation of factors related to anxiety and depression levels in elderly Syrian migrants: A survey study: Anxiety and depression levels in elderly migrants

Muhammed Atak; Mehmet Akif Sezerol; Mehmet Sait Değer

doi:10.5281/zenodo.8414010

Authors

Muhammed Atak İstanbul University İstanbul Faculty of Medicine, Department of Public Health, İstanbul, Turkey https://orcid.org/0000-0002-8545-3660
Mehmet Akif Sezerol İstanbul Medipol University Institute of Health Sciences, Epidemiology Program, İstanbul, Turkey https://orcid.org/0000-0001-6744-1343
Mehmet Sait Değer Hitit University Faculty of Medicine, Department of Public Health, Çorum, Turkey https://orcid.org/0000-0001-8862-1343

DOI:

https://doi.org/10.5281/zenodo.8414010

Keywords:

Anxiety, Beck Anxiety Inventory, Beck Depression Inventory, depression, elderly, immigrant

Abstract

Objective: The world's migrant population is nearing 300 million, leading to a growing migrant elderly population. Mental health problems affect the well-being and quality of life of migrant elders, resulting in serious costs globally. This study aimed to examine anxiety and depression levels and related factors in elderly Syrian immigrants.

Methods: This is a cross-sectional study. It included Syrian immigrants over the age of 65 years residing in Sultanbeyli, a district of Istanbul. The research was conducted face-to-face with elderly immigrants visited at home between January and July 2023. The participants completed a questionnaire consisting of sociodemographic characteristics, health and disease status, Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). The questionnaire was administered face-to-face by a team consisting of psychologists, social workers, nurses and Arabic interpreters.

Results: The mean age of the participants was 70.74±4.96 years. Of the participants,47.4% were female, 17.9% were 75 years of age or older, 80.7% had a primary school education or less, 64.1% were married, 51.3% had low income levels, and 47.4% lived in the same house with five or more people. In the study group, 76.2% were above normal weight (BMI≥25), 84.6% had chronic diseases (hypertension, diabetes mellitus, coronary artery disease, urologic problems), 39.7% had gait and balance disorders, and 56.4% had regular medication use. The median value of the BDI was 7 (min:0, max:31), and the mean±SD values of the BDI were 12.0±6.03. Anxiety and depression were found to be associated with sex, education level, BMI, gait-balance disorder, history of falls, chronic disease and polypharmacy (p˂0.05).

Conclusion: While 10.4% of the participants had a moderate or high risk of anxiety, 20.5% had moderate or severe depression. Sociodemographic characteristics and health problems, which increase in frequency with age, affect the mental health of immigrants. For effective mental health interventions for immigrant elders, it would be useful to conduct field studies with wider participation.

References

Moitra M, Owens S, Hailemariam M, Wilson KS, Mensa-Kwao A, Gonese G, et al. Global Mental Health: Where We Are and Where We Are Going. Curr Psychiatry Rep. 2023;25:301–11.

World Health Organisation (WHO). Global and Regional Estimates of Depression Prevalence. Depression and Other common mental disorders: global health estimates. Geneva. 2017;8-24.

Sousa RD, Henriques AR, Caldas de Almeida J, Canhão H, Rodrigues AM. Unraveling Depressive Symptomatology and Risk Factors in a Changing World. Int. J. Environ. Res. Public Health. 2023;20:6575.

World Health Organization (WHO). Health Conditions in Older Age. World report on aging and health. 2015;57-65.

Uysal-Bozkir Ö, Parlevliet JL, de Rooij SE. Insufficient cross-cultural adaptations and psychometric properties for many translated health assessment scales: A systematic review. Journal of clinical epidemiology. 2013;66:608-18.

Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community living elderly people: a systematic literature review. Social science &medicine. 1999;48:445-69.

Shibusawa T, Mui AC. Stress, coping, and depression among Japanese American elders. In Social Work Practice with the Asian American Elderly. 2018;63-81.

Black SA. The mental health of culturally diverse elderly: Research and clinical issues. In Handbook of multicultural mental health. 2000;325-39.

International Organization for Migration (IOM). World migration report 2020, https://publications.iom.int/system/files/pdf/wmr_2020.pdf, Date accessed: 08.23.2023

Gürbüz B, Altındiş E. Göç Sonrası Katmanlı dezavantajlılık: Yaşlı Göçmenler. Göçmen Refahı Disiplinler arası Bakış. 2022;105-07.

Coşkun E, Yilmaz Ç. Sığınmacıların toplumsal uyum sorunları ve sosyal hizmetlere erişimi: Düzce uydukent örneği. In Journal of Social Policy Conferences. 2018;75:269-305.

Yılmaz FK, Ergül S. Sağlık Politikası Analizi: Göçmen Sağlığı Kapsamında Suriyeli Sığınmacılar. Sağlık ve Sosyal Refah Araştırmaları Dergisi. 2021;3:119-28.

Virgincar A, Doherty S, Siriwardhana C. The impact of forced migration on the mental health of elderly individuals: A scoping review. International Psychogeriatrics. 2016;28:889-96.

Isaac M, Filipčić I. Refugees, immigrants and displaced populations need better mental health support. Current Opinion in Psychiatry. 2023;36:345-46.

Singh K, Dewan R. Depression and Stress among Tribal Immigrant Rural Women of Ranchi District in Jharkhand. IOSR Journal of Humanities and Social Sciences. 2018;23:1-8.

Foo SQ, Tam WW, Ho CS, Tran BX, Nguyen LH, McIntyre RS, et al. Prevalence of Depression among Migrants: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health. 2018;15:1986.

Stevenson K, Fellmeth G, Edwards S, Calvert C, Bennett P, Campbell OM, et al. The global burden of perinatal common mental health disorders and substance use among immigrant women: a systematic review and meta-analysis. The Lancet Public Health. 2023;8:e203-e16.

Lindert J, von Ehrenstein OS, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor immigrants and refugees–a systematic review and meta-analysis. Social science & medicine. 2009;69:246-57.

Andersson L, Hjern A. Ascher H. Undocumented adult immigrants in Sweden: mental health and associated factors. BMC Public Health. 2018;18:1369.

Antoniades J, Mazza D, Brijnath B. Efficacy of depression treatments for immigrant patients: results from a systematic review. BMC psychiatry. 2014;14:1-12.

Balsamo M, Cataldi F, Carlucci L, Padulo C, Fairfield B. Assessment of late life depression via self-report measures: a review. Clinical interventions in aging. 2018;13:2021-44.

Guo M, Stensland M, Li M, Dong X, Tiwari A. Is Migration at Older Age Associated With Poorer Psychological Well-Being? Evidence from Chinese Older Immigrants in the United States. The Gerontologist. 2019;59:865–76.

Deisenhammer EA, Çoban-Başaran M, Mantar A, Prunnlechner R, Kemmler G, Alkın T, et al. Ethnic and migrational impact on the clinical manifestation of depression. Soc Psychiatry Psychiatr Epidemiology. 2012;47:1121-29.

Mölsä M, Punamäki RL, Saarni SI, Tiilikainen M, Kuittinen S, Honkasalo ML. Mental and somatic health and pre and postmigration factors among older Somali refugees in Finland. Transcultural Psychiatry. 2014;51:499-525.

Abu-Siam IKS. Healthcare utilization among urbanized Syrian refugees in Jordan: exploring access, needs, barriers and adaptation strategies. Doctoral dissertation, Universidad de Granada. 2023;49-50.

Siddiq H, Darvishi M, Najand B. Self-Rated Health of US Older Adults in the General Social Survey (GSS) 1972-2021: Complexity of the Associations of Education and Immigration. Healthcare (Basel). 2023;11:463.

Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J. Pers. Assess. 1996;67:588–97.

Lipowski M, Walczak-Kozłowska T, Lipowska M, Kortas J, Antosiewicz J, Falcioni G, et al. Improvement of Attention, Executive Functions, and Processing Speed in Elderly Women as a Result of Involvement in the Nordic Walking Training Program and Vitamin D Supplementation. Nutrients 2019;11:1311.

Solís-Ortiz S, Arriaga-Avila V, Trejo-Bahena A, Guevara-Guzmán R. Deficiency in the Essential Amino Acids L-Isoleucine, L-Leucine and L-Histidine and Clinical Measures as Predictors of Moderate Depression in Elderly Women: A Discriminant Analysis Study. Nutrients. 2021;13:3875.

Dantas EHM, Figueira OA, Figueira AA, Höekelmann A, Vale RGS, Figueira JA, et al. The Association between Physical Activity and Anxiety in Aging: A Comparative Analysis. Healthcare. 2023;11:2164.

Yaylagül NK, Aslan M. Yaşlılık, mültecilik ve sosyal dışlanma: Suriyeli yaşlı mültecilerin deneyimleri. Çukurova Üniversitesi Sosyal Bilimler Enstitüsü Dergisi. 2020;29:406-22.

Elkin N. Yaşlılarda Polifarmasi ve Akılcı İlaç Kullanımına Aile Hekimliği Yaklaşımı. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi. 2020;11:279-90.

Rosenthal T, Touyz RM, Oparil S. Migrating Populations and Health: Risk Factors for Cardiovascular Disease and Metabolic Syndrome. Curr Hypertens Rep. 2022;24:325–40.

Kiropoulos LA, Klimidis S, Minas H. Depression and Anxiety: A Comparison of Older-Aged Greek-Born immigrants and Anglo-Australians. Australian & New Zealand Journal of Psychiatry. 2004;38:714-24.

Familiar I, Borges G, Orozco R, Medina-Mora ME. Mexican migration experiences to the US and risk for anxiety and depressive symptoms. Journal of affective disorders. 2011;130:83-91.

Tsetseri MN, Keene DJ, Silman AJ, Dakin SG. Exploring the Burden of Chronic Musculoskeletal Pain in immigrant Populations: A Scoping Review. 2023;1-20.

Apak E, Artan T, Ozucelik DN. Evaluation of biopsychosocial and sociocultural problems of Syrian elderly living in Turkey. Int J Soc Psychiatry. 2023;69:454-66.

Kurt G, Ventevogel P, Ekhtiari M, Ilkkursun Z, Erşahin M, Akbiyik N, et al. Estimated prevalence rates and risk factors for common mental health problems among Syrian and Afghan refugees in Turkey. BJPsych Open. 2022;8:E167.

Bedaso A, Duko B. Epidemiology of depression among displaced people: a systematic review and meta-analysis. Psychiatry research. 2022;311:114493.

Kim BJ, Linton K, Cho S, Ha JH. The Relationship between Neuroticism, Hopelessness, and Depression in Older Korean immigrants. PLoS ONE. 2016;11:e0145520.

Mirzaei M, Yasini Ardekani SM, Mirzaei M, Dehghani A. Prevalence of Depression, Anxiety and Stress among Adult Population: Results of Yazd Health Study. Iran J Psychiatry. 2019;14:137-46.

Kaiser BN, Keys HM, Foster J, Kohrt BA. Social stressors, social support, and mental health among Haitian immigrants in the Dominican Republic. Rev Panam Salud Publica. 2015;38:157–62.

Soriano E, Ruíz D, Cala VC. Perception of Health and Healthcare among Senegalese Immigrants in Andalusia. Procedia – Soc Behav Sci. 2017;237:70–6.

Vissandjee B, Desmeules M, Cao Z, Abdool S, Kazanjian A. Integrating Ethnicity and Migration As Determinants of Canadian Women’s Health. BMC Womens Health. 2004;4:S32.

Eleftherakos C, van den Boogaard W, Barry D, Severy N, Kotsioni I, Roland-Gosselin L." I prefer dying fast than dying slowly", how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese immigrants on Lesbos island following the implementation of EU-Turkey deal. Conflict and health. 2018;12:1-11.

Sayegh P, Kellough J, Otilingam PG, Poon CY. South Asian and Middle Eastern American older adults: Dementia, mood disorders, and anxiety disorders. Clinical gerontologist. 2013;36:216-40.

Liem A, Natari RB, Jimmy Hall BJ. Digital health applications in mental health care for immigrants and refugees: a rapid review. Telemedicine and e-Health. 2021;27:3-16.