H.W. Revollo

Acculturative stress as a risk factor of depression and anxiety in the Latin American immigrant population

This study explores acculturative stress as a risk factor for depressive and anxiety disorders as well as their symptomatology. It is hypothesized that perceived discrimination and general psychosocial stress will show the greatest association with psychopathology. The sample consists of 414 Latin American immigrant primary care patients in Barcelona. The instruments used are: the Barcelona Immigration Stress Scale (BISS) to evaluate acculturative stress, the Goldberg Anxiety and Depression Scale (GADS) for anxiety and depression symptoms, the Mini International Neurological Interview (MINI), a semi-structured interview, to detect psychiatric pathology, and a questionnaire for sociodemographic and attitudinal characteristics. The most elevated levels of acculturative stress were observed in the factors homesickness and general psychosocial stress. Acculturative stress is associated with depression and anxiety. With the covariants controlled, intercultural contact stress and general psychosocial stress maintain the relationship. Acculturative stress constitutes a risk factor for both depression and anxiety. General psychosocial stress and intercultural contact stress are related to psychopathology. Perceived discrimination and homesickness are not associated with psychopathology in the Spanish context, suggesting that cultural congruity plays a key role in the relationship between immigration and mental health.

S12-03 Cultural bias in psychiatric and psychological testing

Psychiatric and psychological testing are used extensively in both clinical and research contexts, with the goal of providing an objective indication of the construct being measured. At the same time, it has long been recognized that there is no such thing as a culture free or even fair test, to the extent that cultural bias-the constant and systematic statistical error due not to chance but to ethnic group membership-can seriously undermine the validity of a psychological or psychiatric test. The very construct being measured may not have a culturally compatible equivalent, or, relatedly, the behavior sampled in a given item or combination of items may not be associated with the construct in question in the same way across all cultures. In addition the means by which the behavior is sampled-the instrument construction, the sorts of questions or their structure, for example-can vary in familiarity across cultures. Finally, the individual items themselves may be poorly or ambiguously translated, may be predicated on specific cutlural norms, or, indeed, the meaning of the item can vary cross-culturally. Finally, sampling bias pertains to the representativeness of the sample, however, this is all the more complex given that constructs such as “race”, “ethnic group” and so forth are often poorly defined and ambiguous, and thus who is and who is not included in a given group may further undermine the validity of the test. Despite these difficulties, concrete steps can be taken to increase the cultural validity of the test used.

P01-470 - The impact of social context on the acculturative process: acculturative stress in Latin American immigrants

Introduction The relationship between immigration and mental health may in part be affected by factors related to social context in general and in relation to specific ethnic groups in specific social contexts. A growing body of research is exploring the impact of neighborhood context on the well-being of immigrants. The specifics, however, have yet to be identified. Aim To analyze the impact of social context on stress and acculturative stress in a hospitalised Latin American immigrant sample. Methods The study was part of a larger project concerning stress, coping, and psychosocial well being in Latin American immigrants hospitalised in both internal medicine and obstetrics in a large public hospital in Barcelona (Spain). 290 participants were evaluated with the PSS-10 for general stress, the BISS for acculturative stress and a sociodemographic questionnaire elaborated ad hoc for social context. Results Neighborhood socioeconomic level is related to general stress and acculturative stress. A lower socioeconomic level is associated with higher levels of stress and acculturative stress. High levels of ethnic density of Latin American immigrants is moderately associated with lower levels of homesickenss and intercultural contact stress, but are not related with perceived discrimination. Conclusions Social context is an important factor that should be considered in the acculturative process of Latin American immigrants and its impact on their mental health status. A low socioeconomic neighborhood level increases levels of stress and acculturative stress, increasing the risk of psychosocial distress. Own group ethnic density would appear to function as a protective factor.

P01-463 - Prevalence of psychotic symptoms: comparation of immigrants and native- born primary care service users

Introduction Epidemiological studies reveal higher rates of psychotic disorders among immigrants of ethnic minorities. However, the variation in prevalence of psychosis differs, and the proposed explanations and risk factors vary across the literature. Objectives 1) to examine the prevalence of psychotic symptoms in a sample of immigrants and native-born in a primary care setting context 2) to explore the effect that certain socio-demographic characteristics have in the difference in prevalence. Aims It is expected that the presence of psychotic symptoms will be greater for the immigrant population than for the native-born population. Low educational level, a low socio-economic status and the presence of a physical illness will partly explain these differences. Methods 3000 patients (1500 immigrants and 1500 native-born outpatients paired in age and gender) were interviewed in a primary care setting. They completed the Mini International Neuropsychiatric Interview, including the psychotic disorders sections, and a questionnaire that probed demographic characteristics and physical health status. Results Immigrants showed significantly higher rates of psychotic symptoms than native-born patients in both sections of diagnosis: life-span psychotic symptoms only (9.8% in immigrants and 5.3% in native-born) and life span with current psychotic symptoms (7% of the immigrants and 4.8% of the native-born). Immigrants also showed a lower education level, and a lower socio-economic status. When controlling for these factors, a relationship between these factors and the symptoms was found. Conclusions Findings are discussed in the context of culture and etiology of psychotic symptoms, and suggestions with regard to future research are made.

P01-340 - Acculturation, acculturative stress and psychosocial well-being in the hospitalized immigrant patient

Objectives There is no direct relationship between migration and mental health, certain risk (e.g. acculturative stress) and protective factors of psychosocial well-being are inversely related with psychopathology. Acculturation strategies have been found to be related to psychopathology however this relationship has been minimaly examined with psychosocial well-being. The objectives of this study are to examine the relationship between acculturative stress, acculturation, and psychosocial well-being. Methods The sample consists of 150 immigrant inpatients hospitalized in tertiary care between 18 and 65 years of age. Acculturative stress, acculturation, social adaptation, anxiety and depression, as well as sociodemogrpahic and attitudinal items were evaluated. Results With general health situation controlled, the study found a negative relationship between acculturative stress and psychosocial well-being, as well as between the marginalization acculturation strategy and psychosocial well-being. A relationship was found between acculturation strategies and acculturative stress. There is no positive relationship between the integration acculturation strategy and psychosocial well-being, although the majority of the study participants preferred integration, followed by assimilation. The latter is associated with lower levels of acculturative stress and higher psychosocial well-being. Separation, on the other hand, is associated with lower levels of anxiety and depression, and with a higher quality of life. Conclusions None of the acculturation strategies demonstrates a clear advantage in relation to psychosocial well-being, however, marginalization appears to be the least adaptive. It may be useful to revise the notion of what constitutes the most adaptive acculturation strategy for an individual, taking into account his or her psychosocial well-being.

S19-01 - Migrants in crisis: a challenge for health service systems

Migration is perhaps best understood as a sociodemographic context that can increase vulnerability to both mental health problems and emotional crisis. Crisis can be understood as a specific moment of psychological upset that the individual experiences as beyond his or her capacity to cope with effectively. Migrants in crisis, from this perspective, are different from native born individuals on two major fronts. One has to do with the degree to which migration constitutes a stressor, and the other the degree to which culture and migration impact the stress process A contextual process model of acculturative stress will be presented as a means of making sense of migrants in crisis. Specifically, a crisis occurs with a sort of accumulation of stressors, that are appraised to constitute a grave danger to individual or collective well-being, and, in turn, the evaluation that the individual or collectivity does not have the necessary resources-psychological, social, and material—to mitigate the deleterious effects of the event or situation. Migrants may be more susceptible to crisis precisely because they have access to fewer social and material resources and because their psychological resources-particularly coping styles—may not be consistent with what is normative in the host culture. Effective response at both the clinical and institutional levels requires appreciation of the complexity of the issue without falling prey to cultural reductionism.

P01-62 Patterns of substance use in an immgrant population in Spain

Aims The relationship between immigration and drug abuse and its treatment is complex and poorly understood. The objective of this study is to gain insight into patterns of drug use and service access and how they are influenced by social factors and the migratory process in a population of foreign born drug users in Barcelona, Spain. Methods An interview protocol was developed for the study which examined drug use patterns, social and health factors, and treatment, and was administered to 118 foreign born users in harm reduction centers. 92% were male and 8% were female. 42% were from Eastern Europe, 35% were from the Magreb, 14% from the European Community, 6% from Subsaharan Africa and 3% from Latin America. Results With migration opium use decreased whereas cocaine, heroin, and speedball increased, which also constitute the primary drug used by this sample. Social support was correlated with greater consumption of heroin, cocaine, and alcohol, whereas lower social stress was predictive of higher cannabis use. Hard drug use was predicted by illegal status and a lack of stable housing. Acculturation and acclturative stress were not found to be related to substance use. Treatment was positively evaluated, with no perception of lower quality of care. Discussion Drug use patterns shift with the migratory process, and, it would appear, adapt to the dominant local ones. The unexpecting findings regarding social factors and acculturation and acculturative stress may indicate differences in the Spanish drug use context, and as such warrant further research.