Perceived ethnic discrimination, suicidal ideation and mastery in a multi-ethnic cohort: the HELIUS study.

BACKGROUND: The association between perceived ethnic discrimination (PED) and mental health conditions is well studied. However, less is known about the association between PED and suicidal ideation, or the role of positive psychosocial factors in this association. AIMS: To examine the association between PED and suicidal ideation among ethnic minority groups in Amsterdam, The Netherlands, and investigate whether ethnicity and mastery (people's extent of feeling in control of their lives and environment) moderate this association. METHOD: Cross-sectional data from the multi-ethnic HELIUS study were analysed (n = 17 053) for participants of South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. PED was measured using the Everyday Discrimination Scale, suicidal ideation using item 9 of the Patient Health Questionnaire-9 and mastery using the Pearlin-Schooler Mastery Scale. RESULTS: Logistic regression analyses demonstrated a small positive association between PED and suicidal ideation (OR = 1.068, 95% CI 1.059-1.077), which did not differ among ethnic minority groups. Mastery did not moderate the association between PED and suicidal ideation among the ethnic minority groups. CONCLUSIONS: Our findings support the hypothesis that PED is associated with suicidal ideation and this association does not significantly vary between ethnic minority groups. Although higher levels of mastery were associated with lower suicidal ideation, mastery did not moderate the relationship between PED and suicidal ideation. Besides targeting ethnic discrimination as a societal problem, future longitudinal research is needed to investigate whether interventions aimed at improving mastery could reduce suicidal ideation in ethnic minority groups.

Evaluating the cross-cultural validity of the Dutch version of the Social Exclusion Index for Health Surveys (SEI-HS): A mixed methods study.

BACKGROUND: The recently developed Social Exclusion Index for Health Surveys (SEI-HS) revealed particularly strong social exclusion in non-Western immigrant groups compared to the native Dutch population. To qualify such results, cross-cultural validation of the SEI-HS in non-Western immigrant groups is called for. METHODS: A sequential explanatory mixed methods design was used, employing quantitative data from the Netherlands Public Health Monitor along with qualitative interviews. Data from 1,803 adults aged 19 years or older of Surinamese, 1,009 of Moroccan and 1,164 of Turkish background and 19,318 native Dutch living in the four largest cities in the Netherlands were used to test the factorial structure of the SEI-HS and differential item functioning across immigrant groups. Additionally, 52 respondents with a high score on the SEI-HS and from different background were interviewed on the item content of the SEI-HS and subjective feelings of exclusion. For each SEI-HS item the semantic, conceptual and contextual connotations were coded and compared between the immigrant groups and native Dutch. RESULTS: High levels of social exclusion were found in 20.0% of the urban population of Surinamese origin, 20.9% of Moroccan, 28.7% of Turkish and 4.2% of native Dutch origin. The 4-factor structure of the SEI-HS was confirmed in all three immigrant groups. None of the items demonstrated substantial differential item functioning in relation to immigration background. The interviews uncovered some methodological shortcomings, but these did not substantially impact the observed excess of social exclusion in immigrant groups. CONCLUSIONS: The present study provides evidence in support of the validity of the SEI-HS in adults of Surinamese, Moroccan and Turkish background and confirms the major social exclusion of these immigrant groups in the main cities in the Netherlands. Policy measures to enhance social inclusion and reduce exclusion are urgently needed.

[Health problems of migrants who don't have a valid residence permit: Somatic and psychiatric problems of migrants who are applying for shelter]. / Gezondheidsproblemen van migranten zonder geldige verblijfsvergunning.

OBJECTIVE Many healthcare professionals are confronted in their practice with migrants who don't have a valid residence permit. With this study, we want to provide more insight in the health problems and healthcare consumption of this group. DESIGN Retrospective file study. METHOD Data were taken from files created by municipal health-service physicians when medically screening people who present to the municipality to apply for 24-hour shelter on the basis of their health condition. Symptoms and disorders were coded according to the International Classification of Primary Care (ICPC), and use of medication according to the Anatomical Therapeutic Chemical Classification (ATC). RESULTS The study population consisted of 356 people, mainly men, 39 years of age on average (range: 18-80 years). Compared with the total population of people without a valid residence permit who presented to the municipality (n = 1010), in the study population both women (25.6%) and people in age categories above 45 years of age (32.0%) were overrepresented. At the time of screening, 45.2% had a regular, stable place of residence. Most people without a valid residence permit (98.6%) reported one or more health problems. Psychological symptoms, such as stress (78.5%), insomnia (69.7%) and feelings of depression, were the most common ones. At the same time, many people without a valid residence permit were receiving medical care (86.8%). CONCLUSION A majority of people without a valid residence permit who present to apply for 24-hour shelter have health problems. Stress and other psychological symptoms are the most common ones. At the same time, a large part is receiving adequate care. This means that barriers to care, at least in Amsterdam, do not seem too high.

Exploring Differences in Criminogenic Risk Factors and Criminal Behavior Between Young Adult Violent Offenders With and Without Mild to Borderline Intellectual Disability.

The relation between mild to borderline intellectual disability (MBID) and violent offense behavior was studied among a group of former juvenile delinquents currently in a diversion program for persistent young adult violent offenders from Amsterdam ( N = 146). Offenders were considered MBID if they had received juvenile probation from the local youth care agency specialized in intellectual disability (21%). A file study was used to estimate prevalence rates of criminogenic risk factors. Police data were used to depict recent criminal behavior. Nearly all offenders grew up in large and unstable multi-problem households and had psychosocial problems. More MBID offenders displayed externalizing behavior before the age of 12, were susceptible to peer pressure, and had low social-relational skills. MBID offenders committed more violent property crimes than offenders without MBID. Youth care interventions for MBID offenders should focus on the acquisition of social-relational skills and on the pedagogical skills of parents.

Pathways through care of severely mentally ill individuals experiencing multiple public crisis events: a qualitative description.

BACKGROUND: Patients experiencing severe mental illnesses (SMI) need continuing support and remain vulnerable in many domains. Crisis interventions and compulsory admissions are common, causing a huge burden on police, health workers, the community and patients. The aim of this retrospective case-file study is to determine profiles of SMI-patients and their pathways through care among those experiencing multiple public crisis events. METHODS: Data from a larger study of 323 SMI-patients in Amsterdam were used. These data were linked to data of the public mental health care (PMHC) in order to identify persons that experienced crisis interventions (CI's) between January 2004 and November 2012. The cut-off point for inclusion in the study population was set on three CI's, resulting in a group of 47 SMI-patients. PMHC and mental health care (MHC) data were linked in order to identify profiles in patterns of care. Qualitative content analysis was used to gather and analyze chronological timelines. RESULTS: Three profiles were identified: SMI-patients with CI's during continuous MHC, SMI-patients with CI's after discharge and SMI-patients with CI's during unstable MHC. For each profile events prior to, during and after a CI were identified. CONCLUSIONS: PMHC and MHC can possibly identify cases with a high risk of CI's and predict these events based on the results of this study. CI's seem inevitable for a group of SMI-patients in care but they do not only require acute psychiatric care. The collaboration between MHC, PMHC and police could be further developed in a quick and effective triage in order to tackle the complexity of problems of the SMI-patients.

Perceived ethnic discrimination and depressive symptoms: the buffering effects of ethnic identity, religion and ethnic social network.

PURPOSE: Perceived ethnic discrimination (PED) is positively associated with depressive symptoms in ethnic minority groups in Western countries. Psychosocial factors may buffer against the health impact of PED, but evidence is lacking from Europe. We assessed whether ethnic identity, religion, and ethnic social network act as buffers in different ethnic minority groups in Amsterdam, the Netherlands. METHODS: Baseline data were used from the HEalthy Living In a Urban Setting study collected from January 2011 to June 2014. The random sample included 2501 South-Asian Surinamese, 2292 African Surinamese, 1877 Ghanaians, 2626 Turks, and 2484 Moroccans aged 18-70 years. Depressive symptoms were assessed using the Patient Health Questionnaire-9. PED was measured with the Everyday Discrimination Scale. Ethnic identity was assessed using the Psychological Acculturation Scale. Practicing religion was determined. Ethnic social network was assessed with the number of same-ethnic friends and amount of leisure time spent with same-ethnic people. RESULTS: PED was positively associated with depressive symptoms in all groups. The association was weaker among (a) those with strong ethnic identity in African Surinamese and Ghanaians, (b) those practicing religion among African Surinamese and Moroccans, (c) those with many same-ethnic friends in South-Asian Surinamese, Ghanaians, and Turks, and (d) those who spend leisure time with same-ethnic people among African Surinamese and Turks. CONCLUSIONS: Ethnic identity, religion, and ethnic social network weakened the association between PED and depressive symptoms, but the effects differed by ethnic minority group. These findings suggest that ethnic minority groups employ different resources to cope with PED.

The relationship between acculturation strategies and depressive and anxiety disorders in Turkish migrants in the Netherlands.

BACKGROUND: Turkish migrants in the Netherlands have a high prevalence of depressive and/or anxiety disorders. Acculturation has been shown to be related to higher levels of psychological distress, although it is not clear whether this also holds for depressive and anxiety disorders in Turkish migrants. This study aims to clarify the relationship between acculturation strategies (integration, assimilation, separation and marginalization) and the prevalence of depressive and anxiety disorders as well as utilisation of GP care among Turkish migrants. METHODS: Existing data from an epidemiological study conducted among Dutch, Turkish and Moroccan inhabitants of Amsterdam were re-examined. Four scales of acculturation strategies were created in combination with the bi-dimensional approach of acculturation by factor analysis. The Lowlands Acculturation Scale and the Composite International Diagnostic Interview were used to assess acculturation and mood and anxiety disorders. Socio-demographic variables, depressive, anxiety and co-morbidity of both disorders and the use of health care services were associated with the four acculturation strategies by means of Chi-Squared and Likelihood tests. Three two-step logistic regression analyses were performed to control for possible, confounding variables. RESULTS: The sample consisted of 210 Turkish migrants. Significant associations were found between the acculturation strategies and age (p < .01), education (p < .01), daily occupation (p < .01) and having a long-term relationship (p = .03). A significant association was found between acculturation strategies and depressive disorders (p = .049): integration was associated with a lower risk of depression, separation with a higher risk. Using the axis separately, participation in Dutch society showed a significant relationship with a decreased risk of depressive, anxiety and co-morbidity of both disorders (OR = .15; 95% CI: .024 - .98). Non-participation showed no significant association. No association was found between the acculturation strategies and uptake of GP care. CONCLUSIONS: Turkish migrants who integrate may have a lower risk of developing a depressive disorder. Participation in Dutch culture is associated with a decreased risk of depressive, anxiety and co-morbidity of both disorders. Further research should focus on the assessment of acculturation in the detection of depression.

Ethnic density is not associated with psychological distress in Turkish-Dutch, Moroccan-Dutch and Surinamese-Dutch ethnic minorities in the Netherlands.

PURPOSE: Ethnic density, the proportion of people of the same ethnic group in the neighbourhood, has been identified as a protective factor with regard to mental health in ethnic minorities. Research on the putative intermediating factors, exposure to discrimination and improved social support, has not yielded conclusive evidence. We investigated the association between ethnic density and psychological well-being in three ethnic minority groups in the Netherlands. We also assessed whether a protective ethnic density effect is related to the degree to which each group experiences discrimination and social support at group level. METHODS: Using multi-level linear regression modelling, we studied the influence of ethnic density at neighbourhood level on psychological distress, measured with the Kessler Psychological Distress scale (K10), in 13,864 native Dutch, 1,206 Surinamese-Dutch, 978 Turkish-Dutch and 784 Moroccan-Dutch citizens of the four major cities in the Netherlands. Based on a nationwide survey among ethnic minorities on social integration, ethnic groups were ordered with respect to the intermediating factors. RESULTS: Ethnic density was not associated with psychological distress in any of the three ethnic minority groups. As a consequence, we found no support for either experiences of discrimination or for own-group social interactions at group level as intermediating factors. In all three ethnic minority groups, as well as in the native Dutch group, individual demographic and socio-economic factors emerged as the main explanations for individuals' mental well-being. CONCLUSIONS: These results suggest that individual demographic and socio-economic risk characteristics outweigh the influence of neighbourhood attributes on mental health.

Health, drugs and service use among deprived single men: comparing (subgroups) of single male welfare recipients against employed single men in Amsterdam.

OBJECTIVES: To aid public health policy in preventing severe social exclusion (like homelessness) and promoting social inclusion (like labour market participation), we aimed to quantify (unmet) health needs of an expectedly vulnerable population on which little was known about: single male welfare recipients (SIM-welfare). One of the main policy questions was: is there need to promote access to healthcare for this specific group? DESIGN: A cross-sectional study incorporating peer-to-peer methodology to approach and survey SIM-welfare. Sociodemographics, prevalence of ill health, harmful drug use and healthcare utilisation for subgroups of SIM-welfare assessed with a different distance to the labour market and exposed to different reintegration policy were described and compared against single employed men (SIM-work). SETTING: Men between the age of 23 and 64, living in single person households in Amsterdam. PARTICIPANTS: A random and representative sample of 472 SIM-welfare was surveyed during 2009-2010. A reference sample of 212 SIM-work was taken from the 2008 Amsterdam Health Survey. OUTCOME MEASURES: Standardised instruments were used to assess self-reported ill somatic and mental health, harmful drug use and service use. RESULTS: SIM-welfare are mostly long-term jobless, low educated, older men; 70% are excluded from re-employment policy due to multiple personal barriers. Health: 50% anxiety and depression; 47% harmful drug use; 41% multiple somatic illnesses. Health differences compared with SIM-work: (1) controlled for background characteristics, SIM-welfare report more mental (OR 4.0; 95% CI 2.1 to 4.7) and somatic illnesses (OR 3.1; 95% CI 2.7 to 6.0); (2) SIM-welfare assessed with the largest distance to the labour market report most combined health problems. Controlled for ill health, SIM-welfare are more likely to have service contacts than SIM-work. CONCLUSIONS: SIM-welfare form a selection of men with disadvantaged human capital and health. Findings do not support a need to improve access to healthcare. The stratification of welfare clients distinguishes between health needs.

Equity of access to mental health care for anxiety and depression among different ethnic groups in four large cities in the Netherlands.

PURPOSE: This study explored (in)equities between ethnic groups in the Netherlands regarding their access to health care for symptoms of common mental disorders (CMD). METHODS: Data were used from a health survey conducted in four Dutch cities in 2008, including 11,678 Dutch, 700 Turkish, 571 Moroccans, 956 Surinamese and 226 Antilleans/Arubans. The prevalence of a medium to high risk of having CMD per ethnic group and of health care consumption by ethnic groups of people, likely having CMD, was calculated, using SPSS Complex Samples weighting for gender, age and district. Logistic regression models were used for assessing the association between health care utilisation and need, demographic factors, social structure and enabling resources. RESULTS: The prevalence of a medium to high risk of having CMD was 42.9 % (Dutch), 50.3 % (Turkish), 37.3 % (Moroccans), 51.5 % (Surinamese) and 44.9 % (Antilleans/Arubans). The 1-year prevalence of contacts with the general practitioner by ethnic groups of people who were likely having CMD was 81.2 % (Dutch), 87.2 % (Turkish), 88.4 % (Moroccans), 88.6 % (Surinamese) and 76.6 % (Antilleans/Arubans). Concerning specialised mental health care, this one-year prevalence was 15.9 % (Dutch), 25.8 % (Turkish), 19.7 % (Moroccans), 17.1 % (Surinamese) and 20.5 % (Antilleans/Arubans). The elevated use of health care by some ethnic minority groups was partly associated with need and demographic factors. CONCLUSIONS: There are no indications for an inequitable access to health care for symptoms of CMD among different ethnic groups in the Netherlands.

The use of the Dutch Self-Sufficiency Matrix (SSM-D) to inform allocation decisions to public mental health care for homeless people.

The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.

Composing a core set of performance indicators for public mental health care: a modified Delphi procedure.

Public mental health care (PMHC) systems are responsible for the wellbeing of vulnerable groups that cope with complex psychosocial problems. This article describes the development of a set of performance indicators that are feasible, meaningful, and useful to assess the quality of the PMHC system in Amsterdam, the Netherlands. Performance indicators were selected from an international inventory and presented to stakeholders of the PMHC system in a modified Delphi procedure. Characteristics of indicators were judged individually, before consensus on a core set was reached during a plenary discussion. Involving stakeholders at early stages of development increases support for quality assessment.

Similar associations between personality dimensions and anxiety or depressive disorders in a population study of Turkish-Dutch, Moroccan-Dutch, and native Dutch subjects.

It is well established that personality traits are associated with anxiety and depressive disorders in Western populations, but it is not known whether this is true also for people from non-Western cultures. In this study, we examined whether ethnicity moderates the association between personality dimensions and anxiety or depressive disorders or symptoms. In a random urban population sample, stratified by ethnicity, in Amsterdam, the Netherlands, we interviewed 309 native Dutch subjects, 203 Turkish-Dutch subjects, and 170 Moroccan-Dutch subjects. Dimensions of personality were measured using the NEO Five-Factor Inventory. Anxiety and depressive disorders and symptom levels were assessed with the Composite International Diagnostic Interview and the Symptom Checklist-90-Revised. The association between personality factors and disorders or symptoms of anxiety and depression was very similar in the three ethnic groups: all show the typical profile of high neuroticism and low extraversion, agreeableness, and conscientiousness.

Ethnic differences in the association between cardiovascular risk factors and psychological distress in a population study in the Netherlands.

BACKGROUND: There is growing body of evidence of an association between cardiovascular risk factors and depressive and anxiety symptoms. The purpose of this study was to investigate whether these associations are similar in ethnic minority groups. METHODS: A random urban population sample, aged 18+, stratified by ethnicity (484 native Dutch subjects, 383 Turkish-Dutch subjects, and 316 Moroccan-Dutch subjects), in Amsterdam, the Netherlands, was interviewed with the Kessler Psychological Distress scale (K10) in combination with measurements of several cardiovascular risk factors. The association of psychological distress (defined as a K10 score above cut-off of 20) with cardiovascular risk factors (obesity, abdominal obesity, hypertension, hypercholesterolemia, low HDL cholesterol levels or diabetes), ethnicity and their interaction was analyzed using logistic regression analyses, stratified by gender and adjusted for age. RESULTS: Cardiovascular risk factors were not significantly associated with psychological distress in any of the gender/ethnic groups, with the exception of a positive association of obesity and hypertension with psychological distress in native Dutch women and a negative association of hypertension and psychological distress in Turkish men. Interaction terms of cardiovascular risk factors and ethnicity were approaching significance only in the association of obesity with the K10 in women. CONCLUSION: In this cross-sectional multi-ethnic adult population sample the majority of the investigated cardiovascular risk factors were not associated with psychological distress. The association of obesity with psychological distress varies by gender and ethnicity. Our findings indicate that the prevention of obesity and psychological distress calls for an integrated approach in native Dutch women, but not necessarily in Turkish-Dutch and Moroccan-Dutch women, in whom these problems may be targeted separately.

Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996-2005.

PURPOSE: Several European studies have shown that migrants from non-western countries are at increased risk of psychotic disorders. This study examines how this is reflected in the risk of acute compulsory admission (ACA). METHODS: Information on all patients with an ACA in Amsterdam from 1996 to 2005 was linked to the Amsterdam municipal register. RESULTS: The incidence of first ACA in Amsterdam was 4.5 per 10,000 person years. The incidence risk of ACA for any psychiatric disorders and for psychotic disorders in particular showed a 2- to 3-fold increase in almost all migrant groups from non-western countries, and especially for second-generation migrants. In addition, all non-western migrant groups were at increased risk of being assessed as posing a danger to others. CONCLUSIONS: The relative risk of ACA for psychotic disorders was similar to that for the incidence of psychotic disorders in most ethnic groups from other studies, suggesting that the increased risk of ACA in non-western migrants can mainly be explained by the increased incidence of psychotic disorders in these groups. However, the relative risk of ACA for psychotic disorders among Moroccan migrants was lower than expected on the basis of incidence studies, which suggests that additional factors are relevant, such as illness-related expression and access to and quality of care.

Comorbidity of anxiety and depressive disorders: a comparative population study in Western and non-Western inhabitants in the Netherlands.

BACKGROUND: Overlap of depressive and anxiety symptoms is supposedly more common in non-Western populations. This can lead to diagnostic uncertainity and undertreatment. AIMS: The aim of this study was to assess cross-cultural differences regarding the comorbidity of anxiety and depressive disorders in a comparative population study. METHODS: In a random urban population sample, stratified for descent, in Amsterdam, the Netherlands, diagnostic interviews were held by bilingual interviewers. Diagnoses of anxiety and depressive disorders, based on the Composite International Diagnostic Interview, were obtained for 307 native Dutch subjects, 205 Turkish-Dutch subjects and 186 Moroccan-Dutch subjects. RESULTS: The prevalence rate of comorbid anxiety and depressive disorders was higher in Turkish-Dutch (9.8 %) and Moroccan-Dutch (3.8%) subjects compared to native Dutch subjects (2.3%). However, this could be explained by differences in baseline prevalence rate and level of severity of the separate disorders. The onset order of anxiety disorders and depressive disorders was comparable in each ethnic group. CONCLUSIONS: The high prevalence rate of comorbid anxiety and depressive diorders in non-Western immigrants in the Netherlands necessitates assesssment and treatment of both disorders. There was no indication of a - culturally influenced - stronger overlap between anxiety and depressive disorders in non-Western immigrants in the Netherlands.

Acculturation and psychological distress among non-Western Muslim migrants--a population-based survey.

BACKGROUND: Political and social developments point at increasing marginalization of Muslim migrants, but little is known about its consequences for the mental health of this particular group. AIM: To explore the relationship between acculturation and psychological distress among first-generation Muslim migrants from Turkey and Morocco in the Netherlands. METHODS: A cross-sectional study. Respondents were interviewed in their preferred language. Acculturation was measured with the Lowlands Acculturation Scale (LAS) and psychological distress with the Kessler Psychological Distress Scale (K10). Data were complete for 321 subjects and analyzed with multivariate linear regression. RESULTS: Less skills for living in Dutch society was associated with distress (p = 0.032). Feelings of loss were related to distress among Moroccans (p = 0.037). There was an interaction between traditionalism and ethnic background (p = 0.037); traditionalism was related to less distress among Moroccans (p = 0.020), but not among Turkish. Finally, there was an interaction by gender among Turks (p = 0.029); conservative norms and values seemed to be related to distress among men (p = 0.062), not women. CONCLUSION: Successful contact and participation in Dutch society, and maintenance of heritage culture and identity were moderately associated with less psychological distress. Improving mastery of the dominant language in host societies, and allowing migrants to preserve their traditions, might be effective measures in improving the mental well-being of migrants.

Religious coping and depression in multicultural Amsterdam: a comparison between native Dutch citizens and Turkish, Moroccan and Surinamese/Antillean migrants.

BACKGROUND: Depressive patients may derive consolation as well as struggle from their religion. Outside the Western-Christian cultures these phenomena did not receive much empirical exploration. The current study aims to describe how positive and negative religious coping strategies relate to depressive symptoms in different ethnic groups in The Netherlands. METHODS: Interview data were derived from the second phase of the Amsterdam Health Monitor, a population based survey, with stratification for ethnicity (native Dutch N=309, Moroccan 180, Turkish 202, Surinamese/Antillean 85). Religious coping was assessed using a 10-item version of Pargament's Brief RCOPE; depression assessment included the SCL-90-R and the Composite International Diagnostic Interview. RESULTS: The five positive religious coping items constituted one sub-scale, but the five negative religious coping items had to be examined as representing separate coping strategies. Across the ethnic groups, negative religious coping strategies had several positive associations with depressive symptoms, subthreshold depression, and major depressive disorder: the most robust association was found for the item 'wondered whether God has abandoned me'. Other significant associations were found for interpreting situations as punishment by God, questioning whether God exists, and expressing anger to God. LIMITATIONS: Due to the two-phase design and low participation in this urban sample, the non-response was substantial. Therefore, the study focused on associations, not on prevalences. CONCLUSION: The more or less universal finding about 'feeling abandoned by God' may suggest how depression represents an existential void, irrespective of the religious background.

Similarity in depressive symptom profile in a population-based study of migrants in the Netherlands.

OBJECTIVE: Depression is a clinical syndrome developed in Western Europe and North-America. The expression of symptoms and the impact of symptoms on functioning may therefore be expected to vary across cultures and languages. Our first aim was to study differences in depressive symptom profile between indigenous and non-Western immigrant populations in the Netherlands. We hypothesized that differences in expression of depressive symptoms would be more likely in the domains of mood and cognitions, and less likely in the domains of psychomotor and vegetative symptoms. Our second aim was to study ethnic differences in the association of depressive symptoms and general functioning. METHOD: In a random community sample stratified for ethnicity in Amsterdam, the Netherlands, depressive symptoms were assessed by bilingual interviewers using the Composite International Diagnostic Interview (CIDI 2.1) and the Symptom Checklist-90-Revised (SCL-90-R). Impairments in functioning were measured by the World Health Organization Disability Assessment Schedule II (WHODAS II). Results were obtained from 812 subjects: N = 321 native Dutch, N = 213 Turkish-Dutch, N = 191 Moroccan-Dutch, N = 87 Surinamese-Dutch. Differences in depressive symptom expression were tested by differential item functioning. RESULTS: The prevalence of DSM-IV depressive disorder and the overall level of depressive symptoms were higher in the Turkish and Moroccan immigrant groups compared to native Dutch subjects. Ethnic differences in item functioning of depressive symptoms were rare, and equally unlikely in all four symptom domains. Depression was equally associated with functional impairment across ethnic groups. CONCLUSION: Although depressive symptoms were more common among migrants than in the indigenous population, both the depressive symptom profile and the associated functional impairments were comparable. These findings may help diminishing concerns about the validity of using existing diagnostic procedures among ethnic minority groups.

Uptake of health services for common mental disorders by first-generation Turkish and Moroccan migrants in the Netherlands.

BACKGROUND: Migration and ethnic minority status have been associated with higher occurrence of common mental disorders (CMD), while mental health care utilisation by non-Western migrants has been reported to be low compared to the general population in Western host countries. Still, the evidence-base for this is poor. This study evaluates uptake of mental health services for CMD and psychological distress among first-generation non-Western migrants in Amsterdam, the Netherlands. METHODS: A population-based survey. First generation non-Western migrants and ethnic Dutch respondents (N = 580) participated in structured interviews in their own languages. The interview included the Composite International Diagnostic Interview (CIDI) and the Kessler psychological distress scale (K10). Uptake of services was measured by self-report. Data were analysed using weighting techniques and multivariate logistic regression. RESULTS: Of subjects with a CMD during six months preceding the interview, 50.9% reported care for mental problems in that period; 35.0% contacted specialised services. In relation to CMD, ethnic groups were equally likely to access specialised mental health services. In relation to psychological distress, however, Moroccan migrants reported less uptake of primary care services (OR = 0.37; 95% CI = 0.15 to 0.88). CONCLUSION: About half of the ethnic Dutch, Turkish and Moroccan population in Amsterdam with CMD contact mental health services. Since the primary purpose of specialised mental health services is to treat "cases", this study provides strong indications for equal access to specialised care for these ethnic groups. The purpose of primary care services is however to treat psychological distress, so that access appears to be lower among Moroccan migrants.