Mauro Braca

Migrant pathways to community mental health centres in Italy

Background: Many studies indicate that migrants in western countries have limited access to and low utilization of community mental health centres (CMHCs) despite the high prevalence of mental disorders. Aims: We aimed to compare migrant pathways to care across four CMHCs located in different Italian provinces and to identify pathway to care predictors. Methods: Migrants attending the four CMHCs between 1 July 1999 and 31 December 2007 were included in the study. Data were gathered retrospectively from clinical data sets and chart review. Results: Five hundred and eleven (511) migrants attended the four CMHCs, 61% were referred by GPs or other health services and 39% followed non-medical pathways to care (self-referral or through social and voluntary organizations), with important site variations. Younger age and being married were predictors of medical pathways to care; lacking a residence permit and having a diagnosis of substance abuse were related to non-medical pathways. Conclusions: Pathways to CMHCs are complex and influenced by many factors. Non-medical pathways to care seem to be frequent among migrants in Italy. More attention should be paid to developing psychiatric consultation liaison models that also encompass the social services and voluntary organizations.

Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna.

Background and aims: Social exclusion and reduced access to community health services can lead to urgent health problems among immigrants; this may explain their increasing rate of admittance to psychiatric inpatient units. This cross-sectional study aims to evaluate the prevalence of psychotic symptoms among Romanian immigrants living in very poor conditions at an abandoned hotel in Bologna and to highlight the possible correlation with general health status, distress and socio-demographic characteristics. Methods: The Psychosis Screening Questionnaire (PSQ) and General Health Questionnaire-12 (GHQ-12) were administered to all immigrants residing at the hotel during two index days with the help of a cultural mediator. Socio-demographic, migration and health characteristics were also collected. Results: Sixty eight subjects were evaluated. More than 80% had left Romania for economic reasons. Of immigrants, 57% exceeded the four-point GHQ-12 threshold of potential mental disorder and 19% scored positively at the PSQ. Immigrants with positive PSQ showed higher mean GHQ-12 scores (5.9 ± 3.5 vs. 3.8 ± 2.75; p = 0.02). The development of post-migration health problems significantly predicts positive PSQ cases even after adjusting for age, sex and GHQ-12 dichotomized score (OR = 21.2, CI = 1.1—169.4). Conclusion: This community of immigrants living in deprived conditions showed a high prevalence of distress and psychotic symptoms, related to health problems. Preventing excess of psychosis among immigrants and ethnic minorities in critical socio-economic conditions should mean, first and foremost, facilitating social integration and access to primary care.

Current cannabis use and age of psychosis onset: A gender-mediated relationship? Results from an 8-year FEP incidence study in Bologna

This study examined the relationship between gender, illicit drug use and age of onset of psychosis. We analysed data from an epidemiologically based cohort of 160 subjects with first-episode psychosis from community mental health centers. Cannabis was associated with an earlier onset of psychosis compared to other drugs, especially among women.

Understanding psychopathology in migrants: a mixed categorical-dimensional approach.

Background: Literature on mental disorders in migrants is constantly increasing. Only a few studies describe psychopathological dimensions in migrants over their nosographic diagnoses; however, there is a growing literature about the greater utility of a categorical-dimensional approach, rather than a solely categorical approach, in the understanding of mental disorders. The aim of this paper is to describe the phenomenology of mental disorders in migrants referred to the Transcultural Psychiatric Team of Bologna (BoTPT), by analysing the psychopathological dimensions that underlie their clinical diagnoses. Methods: We recruited all migrants who attended the BoTPT between May 1999 and July 2009. The psychopathological assessment was conducted with the Association for Methodology and Documentation in Psychiatry (AMDP) and clinical diagnoses were formulated according to ICD-10. We proceeded through a two-step analysis: (1) comparing the prevalence rates of psychopathological symptoms across diagnoses; then (2) conducting a factor analysis to assess how those symptoms configure psychopathological dimensions and how these dimensions underlie clinical diagnoses. Results: As expected, we found significant associations between diagnoses and the prevalence of their core psychopathological symptoms. Factor analysis revealed a strong polymorphism of the psychopathological presentation of mental disorders and unexpectedly showed that in each diagnostic cluster, the first extracted factor was not composed of core symptoms. Conclusions: A mixed categorical-dimensional approach seems to improve the description of the psychopathology among migrants, as it adds relevant information regarding psychopathological dimensions useful to the understanding of the peculiar clinical expressivity of our patients.

Migrants referring to the Bologna Transcultural Psychiatric Team: Reasons for drop-out

Background: Recent immigrants face various difficulties in adjusting to western countries and show a high prevalence of mental disorders. Access to a culturally appropriate community mental health centre (CMHC) is crucial for immigrants (Bhui et al., 2007). The Bologna West Transcultural Psychiatric Team (BoTPT, Tarricone et al., 2009) is one of the first projects in Italy that prioritizes cultural competence care. This paper aims to evaluate the effectiveness of this service and to describe what characteristics of patient and psychiatric intervention are related to ‘drop-out’. Method: All migrants who consecutively attended the BoTPT between 1 July 1999 and 30 June 2008 were included and evaluated at first contact and again six months later. Results: After six months we followed up 162 patients; 32 (17.9%) of these had interrupted treatment. Non-Asian origin, a recent history of migration and not receiving social intervention were the strongest predictors of drop-out cases. Conclusion: Psychiatric consultation services to migrants could be made more effective by enhancing: (a) cultural competence, through cultural mediator involvement; and (b) social support from the first psychiatric contact. These two characteristics of psychiatric consultation could be developed from resources ordinarily present in the context of a CMHC and could then become a cost-effective strategy for addressing mental health needs among first-generation immigrants.

Clinical features and pathway to care of migrants referring to the Bologna Transcultural Psychiatric Team

A total of 182 migrants were followed-up from 1999 until 2007 by the Bologna-west Transcultural Psychiatric Team (BoTPT). Most of these patients came from North and sub-Saharan Africa (54%), were suffering from adjustment disorders and were referred by social or voluntary services, while only 16% came through general practitioners. Clinical diagnoses, psychopathology and pathways to care were closely related to socio-demographic features and ethnic groups. More efforts should be made to ameliorate pathways to care among migrants. In particular we should provide ethnic minorities with information about mental illness and services and we should teach primary and secondary levels of care to acquire greater cultural awareness.

First-episode psychosis and migration in Italy (PEP-Ita migration): a study in the Italian mental health services

BackgroundIt has been frequently reported a higher incidence of psychotic disorders in immigrants than in native populations. There is, however, a lack of knowledge about risk factors which may explain this phenomenon. A better understanding of the causes of psychosis among first-generation migrants is highly needed, particularly in Italy, a country with a recent massive migration.Methods/DesignThe “Italian study on first-episode psychosis and migration (PEP-Ita)” is a prospective observational study over a two-year period (1 January 2012–31 December 2013) which will be carried out in 11 Italian mental health centres. All participating centres will collect data about all new cases of migrants with first-episode psychosis. The general purpose (“core”) of the PEP-Ita study is to explore the socio-demographic and clinical characteristics, and the pathways to care of a population of first-episode psychosis migrants in Italy. Secondary aims of the study will be: 1) to understand risk and protective factors for the development of psychotic disorders in migrants; 2) to evaluate the correlations between psychopathology of psychotic disorders in migrants and socio-demographic characteristics, migration history, life experiences; 3) to evaluate the clinical and social outcomes of first-episode psychoses in migrants.DiscussionThe results of the PEP-Ita study will allow a better understanding of risk factors for psychosis in first-generation migrants in Italy. Moreover, our results will contribute to the development of prevention programmes for psychosis and to the improvement of early intervention treatments for the migrant population in Italy.

La psicopatologia nel contesto transculturale e migratorio

La migrazione e un processo in se sempre traumatico, nel cui contesto qualsiasi individuo puo manifestare nuclei di vulnerabilita quali la perdita del quadro simbolico-culturale e del contesto sociale di riferimento, l’arresto dei costanti processi di riproduzione e metabolismo dell’identita, la paralisi della temporalizzazione e della possibilita di storicizzazione. Tali vulnerabilita, determinate da fattori che risiedono tanto nel processo migratorio stesso quanto nel tessuto ambientale, socio-economico, culturale e relazionale post-migratorio, possono presentare declinazioni psicopatologiche a espressivita polimorfa e iscriversi principalmente nella corporeita come modalita essenziale di essere-nel-mondo. La ricerca scientifica sui disturbi mentali nel contesto migratorio e transculturale verte prevalentemente sull’individuazione dei principali fattori di rischio pre-, intra- e post-migratori, concentrandosi in particolare su quest’ultima fase, risultata essere maggiormente associata all’insorgenza e alla strutturazione del disagio psichico nella popolazione migrante. All’interno del contesto migratorio si rilevano tuttavia anche fattori di resilienza e leve terapeutiche, che possono risiedere tanto nelle risorse dei singoli individui quanto nelle reti simboliche e sociali alle quali essi attingono per donare un senso alle proprie esperienze. Risulta quindi necessario implementare ulteriormente la ricerca sul rapporto tra psicopatologia e storia migratoria, onde poter meglio comprendere la vulnerabilita psichica nel contesto migratorio e rafforzare le politiche di prevenzione e promozione della salute mentale nei migranti.

Occupation and first episode psychosis in Northern Italy: better outcomes for migrants

Many studies show that migrants have a higher incidence of psychosis compared to natives, but the influence of migration on psychosis outcomes is little investigated. We aimed to evaluate the occupational outcomes of a first episode psychosis (FEP) sample in Bologna (Northern Italy).

Somatization among ethnic minorities and immigrants: Why does it matter to Consultation Liaison Psychiatry?

1 Department of Diagnostic-Clinical Medicine and Public Health, section of Psychiatry, University of Modena & Reggio Emilia, Modena, Italy 2 Department of Psychiatry, Psychotherapy and Psychosomatics, Evang. Hospital Königin-ElisabethHerzberge, Berlin, Germany 3 Department of Psychiatry and Psychotherapy, Charité University Medicine-Berlin, Campus Benjamin Franklin, Germany 4 University of Manchester and Lancashire Care Early Intervention Service, Manchester, UK 5 Department of Psychiatry, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Barcelona, Spain 6 Bologna Trans-cultural Psychosomatic Team, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy