Health professionals’ experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals’ attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals’ emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants’ needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.

La experiencia migrante en las crónicas de Gabriela Wiener

This article analyses a migrant’s experience – one that changes, and is fluid and dynamic – in the selected reportages by the Peruvian author Gabriela Wiener – El Gran Viaje, Teléfono malogrado conmigo misma and Del lado de acá y del lado de allá. Following the concept of the vagabond as coined by Zygmunt Bauman, we show how the migrant status of the narrator-protagonist changes. We argue that this process takes place at the level each of given space: Peru – fades away, and Barcelona, at first a hostile place, becomes the place where she manages to forge her identity as a writer. To illustrate this point, we make recourse to the theories of Henri Lefebvre, Michel Foucault and César Aira.

Migration and cultural integration in the early medieval cemetery of Finglesham, Kent, through stable isotopes

Debate over migrations to Britain during the fifth and sixth centuries AD is still rampant in archaeological discourse. Stable carbon, nitrogen and oxygen isotope values from multiple tissues in individuals buried at Finglesham in Kent during the first millennium AD demonstrate not only migration of individuals to the region but also highlight community integration through foodways and refute previous models of ‘invasion’ and replacement. This case study community suggests gendered differences in mobility into early medieval England, with males more likely to be migrants from cooler regions than women. It also challenges traditional narratives of social status in these furnished cemeteries being linked to diet or migrant status with no clear correlations found between funerary treatment and isotopic signatures. This multi-tissue and multi-isotope study tracks dietary changes in this multi-origin community throughout their lives and shows that they may have even changed their diets to adapt to Christianising influences in the region.

682Do job stressor—mental health relationships vary by migrant status? An Australian comparative analysis

Background Migrants may be more likely to experience occupational health inequities (OHIs) than native-born workers due to higher occupational exposure, higher vulnerability to exposure-associated health impacts, or both. This study explores migrant status-related differences in vulnerability to job stressor exposures in terms of mental health in Australia. Methods Data were from wave 14 of the Household Income and Labour Dynamics in Australia Survey. Migrant status was defined by country of birth (COB), the dominant language of COB, and the years since arrival in Australia. Job stressors included skill discretion, decision authority, and job insecurity. Mental health was assessed using the Mental Health Inventory-5 score (MHI-5). Data were analysed using linear regression, adjusting for gender, age, and education. Migrant status was analysed as the effect modifier of job stressor—mental health relationships. Results As expected, skill discretion and decision authority were positively, while job insecurity was negatively associated with the MHI-5 score. However, there was no statistical evidence of migrant status acting as an effect modifier of job stressor—mental health relationships even though the dominant language of COB and years since arrival in Australia have been taken into account. Conclusions The magnitudes of job stressor—mental health relationships do not differ between migrant workers and Australia-born workers. Key messages Differential exposure rather than differential vulnerability is a more important mechanism for generating occupational mental health inequities between migrants and Australian-born workers. Reducing job stressor exposures could reduce the OHIs among migrant workers in Australia.

“Let us define ourselves”: forced migrants’ use of multiple identities as a tactic for social navigation

Background The article examines how and why multiple identities are altered, used and discarded by forced migrants. Methods The research is located in the constructivist paradigm. We used thematic analysis to analyse data gathered through interviews with nineteen forced migrants. Results We found that, though individual migrants can make deliberate choices about which identities to be associated with, they are constrained in the process by external socio-economic factors that lead them to adopt identities that are perceived to be advantageous to navigate the new social system. Moreover, the construction of forced migrants’ identity includes significant contextuality, transactionality and situatedness. Conclusions Our research contributes to the literature on migrant identity practice concerning the stigma associated with forced migrant status and the extent to which migrants appraise their reception in exile as undignified. Additionally, examining migrant identities allows the researchers to apprehend the diverse facets of identity as far as migrants are concerned. Future research may draw a larger sample to examine other impactful dimensions of identity fluctuation, e.g. gender, education, social media, the extent of prior trauma, etc.

On Teaching Im/Migration in an Undergraduate Classroom

This article examines the urgencies, challenges, and rewards of teaching about migration, emigration, and immigration in our time of massive human movement across the globe. I describe and analyse the beginnings, structure, and takeaways from my undergraduate course on the literature of human movements (whether for reasons of refuge, asylum, choice, adventure, exploration, survival). I argue that despite growing collective acknowledgment of increasing human mobility across our planet, it is the power and wisdom of stories through which we best engage with the specific and multifaceted realities of persons losing home, making home, making other, and making own. I also suggest, from my classroom experience, that a slow, reflective, and immersed sharing of stories of those who have been displaced, misplaced, replaced, and strangely-placed is a key pedagogical aspect of discussing im/migration in the twenty-first century, and that especially in the United States, we owe it to ourselves and our students to know and interrogate the longer vocabularies and histories of othering and belonging in the English language. Through my discussion of the class activities and conversations, I show, similarly, the ways in which a literature class on the topic of im/migration functions also as a generative venue for intersectional considerations of race, gender, ethnicity, class, caste, disability, sexuality, nationality, and un/documented status. I also include reflections about future iterations of this course as I draw on summative comments from my students. Finally: although my pedagogy is informed by my own migrant status in the US, I offer means for pedagogues from a range of backgrounds and instructional levels to engage with and further this conversation in different parts of the world.

Association of Cognitive Impairment With Migrant Status Among Older Adults in India: A Cross-Sectional Study

Introduction Among various health implications for older adult, cognitive impairment and related dementias are significant public health concern in many low and middle income countries, including India and lack due attention in policy arena. Socio-economic and health vulnerability are associated with cognitive impairment among older adults. Therefore the present study explores the prevalence and determinants of cognitive impairment among older adults in India with special reference to migrant status of older adults. MethodsData for this study was utilized from recent release of Longitudinal Ageing Study in India (LASI) wave 1 2017-19. The LASI is a nationally representative survey over 72000 older adults age 45 and above across all states and union territories of India. The present study is conducted on the eligible respondent’s age 60 years and above. The total sample size for the present study is 31,464 older adults aged 60 years and above (Male-15,068; Female-16,366). Descriptive and logistic regression analysis carried to fulfil the objective of the study. ResultsOverall, the prevalence of cognitive impairment among male older adults was 6.4% and female older adults 19.8%. Non-migrant status (6.8%) was more likely to face cognitive impairment than migrant status (5.7%) among older adults. The high prevalence of cognitive impairment were found with increasing socio-economic, demographic and multi-morbidities among older adults. Older adults (male 6.7% vs. female 20.2%) with no social participation were more likely to be face cognitive impairment. The result of logistic regression of our study is supported the bivariate analysis. Older adults with migrant status were more likely to be suffered from the cognitive impairment with unadjusted [UOR; 1.57, CI: 1.45-1.70] & after adjusting with covariates [AOR; 1.14, CI: 1.03-1.26] as compared to non-migrant status. Among the individual factors, odds of impairment was very high for the oldest-older adults age group [AOR: 2.95, CI: 2.59-3.36] as compared to young-older adults and further, female older adults were more likelihood to be cognitive impairment [AOR: 1.99, CI: 1.77-2.24] than their counterparts. Similar findings were also found with socio-economic and health vulnerability among older adults.Conclusion The study demonstrates that female older adults need more care and support from community and government as they face higher cognitive impairment. Further, the results significantly varied across different socio-economically, demographically, regionally in cognitive impairment and those who were suffering with co-morbidities. Comprehensive primary health care with community health approach may improve the health status of older adults in later period of life.

The relationship between internal migration and the likelihood of high-risk pregnancy: Hukou system and high-risk pregnancies in China

Background China has one of the world’s largest internal migrant populations. The Chinese Hukou system is a unique household registration system that limits internal migrants in their access to basic urban public services, such as public health insurance and social assistance of their host city. In the case of female internal migrants, this may lead to high-risk pregnancies. The objective of this study is to assess the relationship between internal migrant status (Hukou) and the likelihood of high-risk pregnancies that occur in one large municipal-level obstetrics hospital in Shanghai, China. Methods Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013, to May 31, 2018, were used to analyze 133,358 live births for Shanghai natives (n = 83,872) and internal migrant women (n = 49,486). A propensity score matching approach was used in conjunction with logistic regression analysis to identify the role of internal migrant status (Hukou) on the likelihood of high-risk pregnancies. Results A greater likelihood of high-risk pregnancies were found among internal migrant women who moved from other parts of China to Shanghai. This effect was more obvious for women who gave birth for the first time and internal migrant women who were employed. Conclusion The results show the effects of internal migrant status (Hukou) and the elevated likelihood of high-risk pregnancies among internal migrant women relative to their urban counterparts in Shanghai even after accounting for self-selection by employing the propensity score matching method. China’s unique Hukou household registration system limits access to public services for internal migrant women and accordingly may account for the elevated likelihood of high-risk pregnancies.

Undocumented Migrant Communities in Cities: Negotiating Legal and Legitimate Status from Below

This paper examines the literature on cities, citizenship and performative rights claiming through the lens of undocumented migrant status, using ethnographic research of the Nigerian community in the city of Guangzhou, China as an example. It begins with a background of the research, delineating the context of migration in China and the factors shaping the perceptions of citizenship and undocumented status in that locale. Next, it delves into the literature on citizenship and rights claiming, looking at the approaches to citizenship and tries to situate undocumented migrant status in these approaches. It then relies on examples for the city of Guangzhou to illustrate how undocumented migrant communities perform citizenship and negotiate legal and legitimate status through alternative channels and resist hegemonic structures in big cities in real life. This paper unpacks the ways in which undocumented migrants exhibit citizenship, belonging and agency from below to demonstrate the different meanings and manifestations of agency, marginality and asymmetries of power in big cities in the Global South.