Social determinants of psychiatric morbidity and well-being inimmigrant elders and whites in East London
E.R.T. Silveira
Bok Engelsk 1998
| Utgitt | 1998
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| Omfang | Side 801- 812
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| Opplysninger | Objectives. The social conditions under which migrants to the UK livemay be more significant than the experience of migration itself inleading to increased risk of mental illness. We aimed to compare theprevalence of mental, physical and social health problems in elderlySomalis, Bengalis and whites living in a deprived inner London areaand examine associations between environmental circumstances, socialsupport, physical health status, mood and life satisfaction in thesegroups. In addition, we wanted to test the hypothesis thatdifferences in mental health between immigrants and whites areexplained by social disadvantages rather than ethnicity.Design. Cross-sectional survey with participants drawn from age-sexregisters of general practices, augmented by other sources.Setting. East London-'first-generation' Somali and Bengali immigrantsand white British.Subjects. A total of 274 people aged 60 + years: 72 Somalis, 75Bengalis and 127 whites.Main outcome measures. Symptoms of Anxiety and Depression Scale(SAD), Life Satisfaction Index (LSI). High SAD scores indicate moreanxiety and depression symptoms; high LSI scores indicate greaterlife satisfaction.Main results. Highest SAD scores were found among Bengalis; lowestLSI scores were found among Bengalis and Somalis. The prevalences ofdepression (SAD score 6+) were 25% in Somalis, 77% in Bengalis and25% in east London whites. Physical health status and SAD scores wereassociated in Somalis (r = +0.31, p less than or equal to 0.01),Bengalis (r = +0.47, p less than or equal to 0.001) and east Londonwhites (r = +0.27, p less than or equal to 0.01). Physical healthproblems also related to lower LSI scores in Somalis (r = -0.24, pless than or equal to 0.05) and east London whites (r = -0.24, p lessthan or equal to 0.01). Social factors tie poor housing conditions,low family support and reported need of community services) werestrongly associated with SAD scores among Somalis (r = +0.5; p lessthan or equal to 0.001) and, to a lesser extent? among Bengalis (r =+0.33,p less than or equal to 0.01). Ethnicity tie being an immigrantas opposed to a non-immigrant) became a statistically non-significantrisk factor for high SAD scores after adjusting for the effects ofage, weekly income, physical health and social problems (OR = 0.71,95% CI = 0.5-1.1,p = 0.09). A residual, but much attenuated effectfor ethnicity on LSI scores persisted in the estimated model aftercontrolling for the same set of independent risk factors (OR = 0.7,95% CI = 0.4-1, p = 0.05).Conclusion. The marked variation in mental health between ethnicgroups in east London might be a reflection of socioeconomic andhealth differentials acting concomitantly and adversely. Inequalitiesin housing, social support, income and physical health statusaccounted for variation in mood observed between immigrants andwhites, and may partly explain differences in life satisfaction.These results seem to support a 'multiple jeopardy' theory of ageingin ethnic minorities in east London. Greater efforts are needed torecognize anxiety and depression in immigrant elders. Better socialsupport and housing among 'minority ethnic' elders who live alonemight be expected to alleviate social stress and improve mentalhealth and psychological well-being. (C) 1998 John Wiley & Sons, Ltd.
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