Cross-Cultural Validation of the Barcelona Immigration Stress Scale.

The concept of acculturative stress has been the subject of debate, resulting in contradictory arguments regarding its measurement. Many of the existing acculturative stress instruments have been developed for use with specific migrant groups. The objective of the current study is to revisit the psychometric properties of the Barcelona Immigration Stress Scale, an instrument aimed at measuring stress levels associated with the migration trajectory in any migrant group. Using a sample of 915 migrants who consulted in primary care, we carried out principal component and confirmatory factor analyses as well as item response theory analyses applied both to the entire sample and to different migratory groups separately. The new reduced version of the scale has very good psychometric properties both in general and applied to the Latino migratory group, the largest in the area where the study was carried out. Results were acceptable among sub-Saharan, North African, and Asian groups but not among Eastern Europeans. These results are discussed through the specificities of each migratory group and the limitations of psychometrics to capture the complexity of immigration-related and acculturative stress.

El Contexto Escolar y la Salud Mental de Adolescentes Migrantes y no Migrantes en la Ciudad de Barcelona / School context and mental health of migrant and non-migrant adolescents in Barcelona

El constante flujo migratorio a nivel internacional invita a reinventarnos para crear sociedades inclusivas a nivel intercultural. La convivencia, como modelo basado en la integración mutua entre locales y migrantes, es todavía un desafío a enfrentar en Europa y España. Este estudio busca identificar qué variables de salud mental y resiliencia afectan a la integración escolar entendida como ejemplo del bienestar psicosocial, comparando una muestra de adolescentes migrantes con adolescentes locales. A través de una metodología cuantitativa, se estudiaron factores escolares, conductas problemáticas y factores de resiliencia en 132 estudiantes de entre 12 y 18 años. Los resultados revelan que los niveles de salud mental son semejantes en ambos grupos, pero la salud mental y la resiliencia contextual son más determinantes en la población adolescente migrante. Identificar con claridad las relaciones entre factores escolares y salud mental ofrece la posibilidad de diseñar intervenciones eficaces en el ámbito educativo. (AU)

The continuous international migration flow invites us to reinvent ourselves to create inclusive societies at intercultural level. Coexistence, as a model based on the mutual integration of locals and migrants, is still a challenge to face in Europe and Spain. This study aims to identify which mental health and resilience variables influence school integration used as a proxy for psychosocial well-being by comparing a sample of migrant and local adolescents. Through a quantitative methodology, school factors, disruptive behaviors, and resilience were measured in 132 students aged between 12 and 18 years old. The results reveal that although mental health scores are similar in both groups, mental health and contextual resilience are more critical for the migrant adolescent population than for the local one. Clearly identifying the relationships between school related factors and mental health offers the possibility of designing effective interventions within the educational context. (AU)

Treating immigrant patients in psychiatric emergency rooms.

We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician's comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient's geographical origin, while the full model evaluated the additional roles of patient's gender and language, the clinician's assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient's diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient's lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician's level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.

Development of a computerized adaptive substance use disorder scale for screening and measurement: the CAT-SUD.

BACKGROUND AND AIMS: The focus of this paper is on the improvement of substance use disorder (SUD) screening and measurement. Using a multi-dimensional item response theory model, the bifactor model, we provide a psychometric harmonization between SUD, depression, anxiety, trauma, social isolation, functional impairment and risk-taking behavior symptom domains, providing a more balanced view of SUD. The aims are to (1) develop the item-bank, (2) calibrate the item-bank using a bifactor model that includes a primary dimension and symptom-specific subdomains, (3) administer using computerized adaptive testing (CAT) and (4) validate the CAT-SUD in Spanish and English in the United States and Spain. DESIGN: Item bank construction, item calibration phase, CAT-SUD validation phase. SETTING: Primary care, community clinics, emergency departments and patient-to-patient referrals in Spain (Barcelona and Madrid) and the United States (Boston and Los Angeles). PARTICIPANTS/CASES: Calibration phase: the CAT-SUD was developed via simulation from complete item responses in 513 participants. Validation phase: 297 participants received the Composite International Diagnostic Interview (CIDI) and the CAT-SUD. MEASUREMENTS: A total of 252 items from five subdomains: (1) SUD, (2) psychological disorders, (3) risky behavior, (4) functional impairment and (5) social support. CAT-SUD scale scores and CIDI SUD diagnosis. FINDINGS: Calibration: the bifactor model provided excellent fit to the multi-dimensional item bank; 168 items had high loadings (> 0.4 with the majority > 0.6) on the primary SUD dimension. Using an average of 11 items (four to 26), which represents a 94% reduction in respondent burden (average administration time of approximately 2 minutes), we found a correlation of 0.91 with the 168-item scale (precision of 5 points on a 100-point scale). VALIDATION: strong agreement was found between the primary CAT-SUD dimension estimate and the results of a structured clinical interview. There was a 20-fold increase in the likelihood of a CIDI SUD diagnosis across the range of the CAT-SUD (AUC = 0.85). CONCLUSIONS: We have developed a new approach for the screening and measurement of SUD and related severity based on multi-dimensional item response theory. The bifactor model harmonized information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD. The CAT-SUD is highly predictive of a current SUD diagnosis based on a structured clinical interview, and may be predictive of the development of SUD in the future.

HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants.

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.

Los latino/as representan, tanto en Estados Unidos como en España, un porcentaje desproporcionado de los casos de infección por el VIH y, a menudo son diagnosticados más tarde que sus homólogos no latino/as. Conocer los factores que influyen en la realización de la prueba del VIH en diferentes contextos resulta fundamental para la promoción de dicha prueba, lo que se considera esencial tanto para la prevención como para el tratamiento precoz. Este estudio internacional explora las diferencias en las tasas de realización de la prueba de VIH entre participantes latino/as y que fue diseñada para examinar el estado de salud mental de los imigrantes latino/as. Para ello, se han recopilado datos sobre las pruebas del VIH y sus resultados en 407 latino/as - tanto inmigrantes como de ascendencia latina-en los Estados Unidos (Boston) y España (Madrid y Barcelona). La información fue recogida en entrevistas realizadas en clínicas y agencias comunitarias. Se evaluaron los factores que predicen hacerse la prueba de VIH y de tener resultados positivos en la misma, ajustando por género, edad y el sitio de reclutamiento del paciente, y empleando para ello un modelo de regresión logística multivariado. La tasa más alta de realización de la prueba de VIH fue la de la población de Boston, seguida por Barcelona y Madrid (82%, 69%, y 59%, respectivamente, p<.0001). Según los modelos de regresión multivariada, la probabilidad de que los pacientes de Barcelona y Madrid se hicieran la prueba fue significativamente menor que la de Boston. Entre los predictores positivos para realizarse la prueba estaban un grado de escolarización superior a la secundaria, el grado de preocupación por el VIH, el uso infrecuente del condón, el informar experiencias de discriminación y el uso elevado de benzodiacepinas. Las diferencias significativas entre las tasas de realización de la prueba del VIH entre las tres ciudades sugieren la necesidad de gestionar mejores prácticas para atraer a los pacientes hacia la realización temprana de la prueba.

Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial.

Importance: Immigrants are at an increased risk for co-occurring mental health and substance misuse symptoms; however, effective treatments are lacking. Objective: To evaluate the effectiveness of the Integrated Intervention for Dual Problems and Early Action (IIDEA) program compared with enhanced usual care. Design, Setting, and Participants: This effectiveness randomized clinical trial was conducted from September 2, 2014, to February 2, 2017, in 17 clinics or emergency departments and 24 community sites in Boston, Massachusetts, as well as in Madrid and Barcelona, Spain. Equal randomization (1:1) in 2-person blocks was used, assigning participants to either the IIDEA treatment group (n = 172) or the enhanced usual care control group (n = 169). Intent-to-treat analyses assessed effectiveness, and post hoc analyses examined whether results varied by symptom severity or treatment dose. Eligible participants were between 18 and 70 years of age, self-identified as Latino, screened positive for co-occurring symptoms, and were not receiving specialty behavioral health services. Interventions: Participants were randomized to a 10-session IIDEA treatment or to enhanced usual care. Main Outcomes and Measures: Primary outcomes were changes in alcohol and drug misuse and results of a urine test for drug metabolites but not for alcohol misuse. Secondary outcomes were symptoms of depression, generalized anxiety, posttraumatic stress disorder, and overall mental health. Results: In total, 341 participants were randomized to either the IIDEA treatment group (n = 172; 94 [54.7%] female, mean [SD] age, 33.5 [11.6] years) or the enhanced usual care control group (n = 169; 80 [47.3%] female, mean [SD] age, 34.3 [11.8] years). No statistically significant effects of IIDEA were found for primary drug and alcohol outcomes (ASI Lite-drug score: ß = -0.02 [SE, 0.69; P = .88; Cohen d, 0.00; 95% CI, -0.17 to 0.17]; ASI Lite-alcohol score: ß = -0.01 [SE, 1.19; P = .66; Cohen d, 0.00; 95% CI, -0.12 to 0.12]; urine drug test result: ß = -0.36 [SE, 0.43; P = .50; OR, 0.70; 95% CI, 0.30-1.61]), but statistically significant effects were observed for secondary mental health outcomes. The IIDEA treatment was effective in reducing depressive symptoms per the Public Health Questionnaire-9 score (ß = -1.14; SE, 0.47; P = .02; Cohen d, 0.20 [95% CI, 0.04-0.36]), posttraumatic stress disorder symptoms per the Posttraumatic Stress Disorder Checklist-5 score (ß = -3.23; SE, 1.59; P = .04; Cohen d, 0.25 [95% CI, 0.01-0.37]), and overall mental health symptoms per the Hopkins Symptom Checklist-20 (ß = -0.20; SE, 0.07; P = .01; Cohen d, 0.25 [95% CI, 0.08-0.42]) and composite mental health (ß = -3.70; SE, 1.75; P = .04; Cohen d, 0.19 [95% CI, 0.01-0.36]) scores at the 6-month follow-up. Exploratory analyses suggested that 6-month treatment effects occurred for patients whose drug misuse was moderate to severe at the baseline assessment. Among patients with moderate to severe substance misuse, IIDEA substantially reduced substance use per the urine test results (odds ratio, 0.25 [95% CI, 0.09-0.67]; P = .01). Treatment dose showed small to large effect sizes by outcome. Conclusions and Relevance: The IIDEA treatment did not change drug misuse but did improve secondary mental health and substance misuse outcomes for a heterogeneous population with moderate to severe symptoms; this finding provides a path for treating Latino immigrants with co-occurring mental health and substance misuse symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT02038855.

Successful validation of the CAT-MH Scales in a sample of Latin American migrants in the United States and Spain.

We examined cultural differences in the item characteristic functions of self-reported of symptoms of depression, anxiety, and mania-hypomania in a Latino population taking Computerized Adaptive Tests for Mental Health (CAT-MH) in Spanish versus a non-Latino sample taking the tests in English. We studied differential item functioning (DIF) of the most common adaptively administered symptom items out of a bank of 1,008 items between Latino (n = 1276) and non-Latino (n = 798) subjects. For depression, we identified 4 items with DIF that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to cheerfulness, life satisfaction, concentration, and fatigue. The correlation between the original calibration and a Latino-only new calibration after eliminating these items was r = .990. For anxiety, no items with DIF were identified. The correlation between the original and new calibrations was r = .993. For mania-hypomania, we identified 4 items with differential item functioning that were good discriminators for non-Latinos but poor discriminators for Latinos. These items were related to risk-taking, self-assurance, and sexual activity. The correlation between the original and new calibration was r = .962. Once the identified items were removed, the correlation between the original calibration and a Latino-only calibration was r = .96 or greater. These findings reveal that the CAT-MH can be reliably used to measure depression, anxiety, and mania in Latinos taking these tests in Spanish. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants.

BACKGROUND: Early detection and intervention in primary care is integral to behavioral health. Valid, practical screening assessments are scarce, particularly for non-English speaking populations. We address this need by evaluating the psychometric properties of the Spanish version of the AC-OK Screen for Co-occurring Disorders for first and second generation immigrant Latinos in Massachusetts, USA, and Madrid and Barcelona, Spain. METHODS: 567 Latino participants were recruited in waiting areas of clinics or by referral from Primary Care, Mental Health, Substance Use, and HIV Treatment Clinics, as well as Community Agencies. We use confirmatory factor analyses to evaluate the factor structure, correlation analysis to examine concurrent and discriminant validity, and receiver operating curves (ROC) to determine the ability of the AC-OK to approximate a composite of established instruments designed to measure depression, generalized anxiety, post-traumatic stress disorder symptoms, alcohol, and drugs (including benzodiazepines) as external criteria. RESULTS: The original two factor structure was replicated in samples of Latino respondents in the US and Spain. Correlations with other measures followed the expected pattern. In both the US and Spain, ROC analyses suggested that the AC-OK scale was an adequate approximation to other specific measures of mental health (ROC=0.90) and substance abuse problems (ROC=0.83). CONCLUSIONS: The Spanish version of the AC-OK Screen has good to excellent psychometric properties in both its subscales. These findings are robust across sites, gender, and type of clinic. We recommend its use for clinical research and for routine screening at treatment centers.

Consumo de drogas entre los estudiantes de medicina: Una revisión de la literatura 1988-2013 / Substance Use among Medical Students: A Literature Review 1988-2013

El consumo de drogas legales e ilegales entre los estudiantes de medicina es un fenómeno parcialmente conocido. El objetivo de este trabajo es revisar la literatura internacional publicada, en los últimos 25 años, sobre el consumo de drogas legales e ilegales entre los estudiantes de medicina. Se realizó una búsqueda sistemática en MEDLINE y LILACS. Se evaluaron 106 manuscritos, que incluían 88.413 estudiantes de medicina. Se validaron 74.001 cuestionarios que representan el 83,7% de respuestas. La metodología y rigurosidad no son homogéneas en todas las publicaciones. Existen muchas variaciones regionales, siendo América y Europa las zonas en las que se han realizado más trabajos. Con la excepción del alcohol, en algunas zonas de occidente, los estudiantes de medicina consumen menos que los estudiantes universitarios en general y que la población general coetánea. Los consumos son principalmente de alcohol (24%), tabaco (17,2%) y cannabis (11,8%). También el consumo de fármacos hipnosedantes es frecuente (9,9%). El uso de estimulantes es del 7,7%, de cocaína es del 2,1%, siendo el de opiáceos muy reducido (0,4%). En algunas zonas de Latinoamérica hasta el 14,1% consumen inhalantes. Los estudiantes de los últimos años de carrera consumen más. El consumo de drogas es superior en los varones respecto a las mujeres, exceptuando los hipnosedantes. El consumo en estudiantes de medicina es un fenómeno que, por su prevalencia y posibles repercusiones, debe ser sistemáticamente evaluado

The use of legal and illegal substances by medical students is a phenomenon that is only partially known. The aim of this paper was to review the literature published internationally in the last 25 years about the use of legal and illegal substances by medical students. A systematic search was made of MEDLINE and LILACS. One hundred and six manuscripts were evaluated, which included a population of 88,413 medical students. We validated 74,001 questionnaires, which represented 83.7% of responses. The methodology and the rigor of its application are not the same in all the publications. There are many regional variations, most studies being made in America and Europe. With the exception of alcohol in some areas of the Western world, medical students use substances less than university students in general and the general population. The substances used are mainly alcohol (24%), tobacco (17.2%), and cannabis (11.8%). The use of hypnotic and sedative drugs also is common (9.9%). The rate of use of stimulants is 7.7% and of cocaine, 2.1%; opiate use being very low (0.4%). In some parts of Latin America, up to 14.1% use inhalants. Students in the last years of school have a higher rate of substance use. The use of substances, except for hypnotics and sedatives, is more common among men than women. The use of substances by medical students is a phenomenon that should be evaluated systematically due to its prevalence and potential impact

Substance Use among Medical Students: A Literature Review 1988- 2013.

The use of legal and illegal substances by medical students is a phenomenon that is only partially known. The aim of this paper was to review the literature published internationally in the last 25 years about the use of legal and illegal substances by medical students. A systematic search was made of MEDLINE and LILACS. One hundred and six manuscripts were evaluated, which included a population of 88,413 medical students. We validated 74,001 questionnaires, which represented 83.7% of responses. The methodology and the rigor of its application are not the same in all the publications. There are many regional variations, most studies being made in America and Europe. With the exception of alcohol in some areas of the Western world, medical students use substances less than university students in general and the general population. The substances used are mainly alcohol (24%), tobacco (17.2%), and cannabis (11.8%). The use of hypnotic and sedative drugs also is common (9.9%). The rate of use of stimulants is 7.7% and of cocaine, 2.1%; opiate use being very low (0.4%). In some parts of Latin America, up to 14.1% use inhalants. Students in the last years of school have a higher rate of substance use. The use of substances, except for hypnotics and sedatives, is more common among men than women. The use of substances by medical students is a phenomenon that should be evaluated systematically due to its prevalence and potential impact.

The influence of medical student gender and drug use on the detection of addiction in patients.

Little is known about medical students' interest in their training on drug addiction, their personal experience of consumption, and whether these aspects influence the detection of addiction in patients. Eighty-eight and one half percent considered that drug dependence issues are important to their professional future. The students report consuming alcohol (69%), cigarettes (19.5%), and illegal drugs (15.8%). Female students consumed fewer illegal drugs than the men (p =.022). Male students consumed more illegal drugs more frequently (p =.005), knew more consumers (p =.023), and those who drink alcohol consumed more illegal drugs than women who drink alcohol (p <.005). Drug and alcohol consumption among medical students may serve to normalize consumption and thus, may prevent the detection of addicts. It is important to educate and raise awareness about drugs and alcohol use, as this may influence detection. The focus should be particularly on the male group.

Epidemiology of substance abuse among migrants compared to native born population in primary care.

BACKGROUND AND OBJECTIVES: Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACAT cross-sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia. METHODS: Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini-International Neuropsychiatric Interview. RESULTS: Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access.

Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5.

The Outline for Cultural Formulation (OCF) introduced with DSM-IV provided a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning. However, use of the OCF has been inconsistent, raising questions about the need for guidance on implementation, training, and application in diverse settings. To address this need, DSM-5 introduced a cultural formulation interview (CFI) that operationalizes the process of data collection for the OCF. The CFI includes patient and informant versions and 12 supplementary modules addressing specific domains of the OCF. This article summarizes the literature reviews and analyses of experience with the OCF conducted by the DSM-5 Cross-Cultural Issues Subgroup (DCCIS) that informed the development of the CFI. We review the history and contents of the DSM-IV OCF, its use in training programs, and previous attempts to render it operational through questionnaires, protocols, and semi-structured interview formats. Results of research based on the OCF are discussed. For each domain of the OCF, we summarize findings from the DCCIS that led to content revision and operationalization in the CFI. The conclusion discusses training and implementation issues essential to service delivery.

Observational study on medications prescribed to dual-diagnosis outpatients.

OBJECTIVES: To quantify the number of medications used for treating psychiatric and addictive disorders in a cohort of dual diagnosis with substance dependence outpatients and report the most frequent pharmacological groups used. METHODS: A descriptive, cross-sectional study was conducted. Demographic data, Axis I comorbidity diagnosis with substance dependence, and the medications prescribed were recorded. Diagnosis was assessed by the Structured Clinical Interview for DSM-IV (SCID). RESULTS: One hundred seven patients (mean age 37.7 years; SD = 10.2 years) were evaluated (76.6% men). On average, patients took 4.0 (SD = 1.8) medications. The pharmacological groups prescribed were antipsychotics (69.2%) followed by antidepressants (65.4%), antiepileptics (58.9%), anxiolytics (37.4%), alcohol-aversive drugs (15.9%), methadone (15.9%), lithium (3.7%), and naltrexone (2.8%). Older patients (>45 years old) were found to have a higher number of prescribed medications. Patients diagnosed with a dual psychotic disorder were prescribed a larger number of pharmacological agents (mean = 4.4; SD = 2.1) than patients with a mood disorder (mean = 3.7; SD = 1.3) or an anxiety disorder (mean = 2.9; SD = 1.2), K = 10.5, P = 0.005. CONCLUSIONS: Because polypharmacy is frequent in patients with mental illness and a co-occurring substance use disorder, specialized approaches need to be developed.

Epidemiology of psychiatric morbidity among migrants compared to native born population in Spain: a controlled study.

OBJECTIVE: The aim of this paper is to explore the prevalence of psychiatric morbidity in different immigrant groups in Spain. In keeping with prior studies carried out in Europe, it is expected that the immigrant population will have elevated levels of psychopathology, with some variation across immigrant groups. DESIGN: Multicenter, observational, cross-sectional study. SETTING: Primary care settings of two Spanish regions. SAMPLE: N=1.503 immigrants paired with the same number of Spanish controls, adjusted by gender and age. VARIABLES: Demographic variables, MINI International Neuropsychiatric Interview and Standardized Polyvalent Psychiatric Interview, somatic symptoms section. Student's t tests, ORs and logistic regressions were used to analyze the data. RESULTS: No differences in psychiatric morbidity were found (native born 30.9%, population vs. immigrants 29.6%, OR=.942, CI=.806-1.100) when comparing immigrants to native born Spaniards. Relative to Spaniards (30.9%), Latin American immigrants had significantly higher levels of psychopathology (36.8%), Sub-Saharan Africans (24.4%) and Asians (16%) had significantly lower levels, and Eastern Europeans (31.4%) and North Africans (26.8%) showed no significant difference. CONCLUSIONS: The hypotheses were only partially supported. Although overall immigrants did not differ from the native born population, when analyzed by geographic origin, only Latin Americans had higher levels of psychopathology. It is concluded that multiple factors need to be taken into consideration when studying the mental health of immigrants given that different immigrant groups have different levels of psychopathology.

The intercultural and interracial therapeutic relationship: challenges and recommendations.

Although research has demonstrated that mental health services function with patients from different cultural backgrounds, a variety of culture- and race-related factors can result in services being of lower quality than that which occurs when the clinician and patient are from the same culture. The provision of culturally competent care requires many institutional and organizational adaptations that lie beyond the control of most mental health professionals. The therapeutic relationship, however, remains a key factor of mental healthcare that can be attended to by individual therapists. The therapeutic relationship plays an important role in almost every therapeutic approach, and has been increasingly recognized as representing a means to the provision of quality intercultural and interracial treatment. At the same time, a host of cultural and racial factors relating to both the patient and clinician can compromise the development of the therapeutic relationship. This paper will explore some of the key issues that complicate therapeutic contact and communication, and will outline means by which to strengthen key components of the therapeutic relationship.

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.

Estrés aculturativo y salud mental en la población inmigrante / No disponible

El incremento en la inmigración observado en España en los últimos años ha abierto un debate sobre la relación entre el proceso mi-gratorio y el desarrollo de ciertos problemas psicopatológicos. Estudios realizados en Europa y Estados Unidos han mostrado resul-tados contradictorios; no queda claro si existe una relación directa entre la inmigración y la psicopatología. Cada vez se cuestionamás la existencia de este tipo de relación, aunque se reconoce que el proceso migratorio, la cultura y la pertenencia a un grupo mi-noritario influyen sobre la salud mental. El estrés relacionado con la inmigración, las diferencias culturales y la discriminación perci-bida son considerados factores de riesgo. Este artículo examina las relaciones entre psicopatología e inmigración, incidiendo,especialmente, sobre el concepto de “estrés aculturativo” y sus factores moderadores

The phenomenal increase in immigration seen in Spain over the past few years has opened up the debate concerning the relationshipbetween immigration and psychopathology. A large number of studies in Europe and North America have shown contradictory find-ings; it remains unclear if there is a clear relationship between immigration and psychopathology. Increasingly, a direct relationshipbetween immigration and the appearance of a mental disorder is questioned, although it is recognized that the migratory process,culture, minority group membership impact mental health. Stress related to immigration, cultural difference, and perceived discrimi-nation are recognized as risk factors. This article examines the relationship between psychopathology and immigration, with a focuson acculturative stress and its moderating factors (AU)

Construction and preliminary validation of the Barcelona Immigration Stress Scale.

In the study of mental health and migration, an increasing number of researchers have shifted the focus away from the concept of acculturation towards the stress present in the migratory experience. The bulk of research on acculturative stress has been carried out in the United States, and thus the definition and measurement of the construct has been predicated on that cultural and demographic context, which is of dubious applicability in Europe in general, and Spain in particular. Further, some scales have focused on international students, which down-played the importance of the migratory process, because it deals with a special subset of people who are not formally immigrating. The Barcelona Immigration Stress Scale was developed to measure acculturative stress appropriate to immigrants in Spain, using expert and focus group review and has 42 items. The scale shows acceptable internal validity, and, consistent with other scales, suggests that immigration stress is a complex construct.