2.2 Empirical Literature Review
2.2.5 Mental Health Challenges among Migrants
The WHO 2004 summary report on promoting mental health: concepts, emerging evidence, practice, defines mental health as a “state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO, 2004, p.10). The joint release by the World Health Organisation, united for global mental health, and world federation for mental health during the World Mental Health Celebration in 2020 stated that close to one billion people suffer from mental health disorders leading to ill health and disability, yet a few people receive treatment for mental health challenges (WHO, 2020). This revelation is an indication that mental health is a global health concern needing global attention.
The WHO’s global estimate of common mental health conditions in 2017 identified common
22 types of mental disorders as depressive and anxiety disorders (WHO, 2017). According to the publication, people suffering from depressive disorder may experience sadness, loss of interest, feelings of guilt or low self-worth, disturbed sleep, among others. The report further revealed that depression is one of the most common psychiatric disorders in the world, affecting more than 300 million people worldwide. Anxiety disorders on the other hand may cause feelings of anxiety and fear with its associated symptoms ranging from mild to severe. It may occur without an identifiable triggering stimulus and affects about 11 per cent of the general population (American Psychiatric Association, 2018; WHO, 2017). Another mental health concern is stress which is defined by Lazarus and Folkman (1984, p. 19), as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being”.
There is ongoing theoretical debate on the development of mental health challenges due to international migration, social and environmental factors such as traumatic events, daily stressors, adversity, and chronic strain as having adverse impacts on mental health (Bhugra, 2004; Bhugra & Becker, 2005; Maggi et al., 2010). On the other hand, studies on the impact of internal migration on mental health have produced conflicting and sometimes contradictory results (Ajaero et al., 2017; Lin et al., 2011; Lu, 2012; Sudhinaraset, Mmari, Go, & Blum, 2012; Switek, 2012). For instance, Switek (2012) found that internal migration is accompanied by an increase in life satisfaction due to increase in income levels. In a related study in China, migrant workers reported a lower prevalence of depression as compared to non-migrant workers. It must, however, be noted that in the above studies, the migrants were gainfully employed which might have accounted for the increment in life satisfaction. In another study in Indonesia, by contrast, the results show that migrants tended to have mental health challenges such as depression (Lu, 2010). Notwithstanding these contradictions in the literature, there is no doubt that migrants are exposed to different forms of mental health challenges. In the following section, the literature on the risk factors associated with mental health challenges among migrants is discussed.
2.2.5.1 Socio-Cultural and Economic Risk Factors
One of the main determinates of the mental health of migrants is the ability to adapt to the new environment. As Lin et al. (2011) argued, there is an increased risk to mental health challenges as migrants face new lifestyles and need to adjust to the new socio-economic as well as socio- cultural environments. A study by Simich, Hamilton, and Baya (2006) on mental distress,
23 financial hardship, and expectations of life in Canada among Sudanese newcomers revealed that financial hardship is associated with psychological distress among the migrants. The study further reported that respondents who worry about the lack of money were more likely to be psychologically distressed than those who did not bother. Mental health challenges have also been associated with the disruption of family life and the loss of social support. Migration, therefore, creates disruption of social ties and reconstruction of other social networks, which is often compounded by difficult life circumstances and intensified stress in the migration and adjustment process, leading to decline in mental health (Kirmayer et al., 2011; Lu, 2010).
Social support is vital in promoting positive mental health outcomes through healthy behaviour.
It is especially useful if trusted family members and friends are available to provide emotional support, companionship, daily needs, and material support (Lu, 2010). In a study by Dai et al.
(2016), low social support was significantly associated with post-traumatic stress disorders (PTSD). Dai et al. (2016) further indicated that the availability of social support lessens the severity of psychological conditions such as (PTSD).
According to Wang, Stanton, and Fang (2010), discrimination and perceived social inequity is associated with adverse mental health outcomes among migrants. Human migration has always been a complicated and stressful experience for the individuals involved, impacting negatively on both their physical and mental health (Corley & Sabri, 2020; Kirmayer et al., 2011; Wang et al., 2010). This situation may be further aggravated by the actual or perceived discrimination and stigmatisation of migrants. Migrants may be victimised due to lower socio-economic status and language barriers which are likely to heighten incidence of psychological distress, anxiety, and depression (Wang et al., 2010; Wilkes & Wu, 2019). The academic literature suggests that migrants do suffer from mental health challenges since people from different cultures and social groups behave differently when they move to a different environment. Migrants are often stigmatised because they are perceived by the host communities as different, which may lead to their devaluation by the host communities (Li et al., 2007; Link & Phelan, 2006; Wang et al., 2010). Other studies show that the actual or perceived unfair treatment by migrants has a considerable impact on their mental health. In a study by Lin et al. (2011), a negative relationship between health status and perceived social inequity and higher discrimination is associated with poorer health. The study also reported a significant relationship between perceived social inequity and mental health challenges.
Migration is often not a simple move from one location to another. It usually involves transiting different locations, searching for suitable opportunities before arriving at a final destination
24 (IOM, 2018). Studies have also found a relationship between economic hardships of migrants and physical and mental health challenges. There are often negative attitudes towards migrants and other marginalised groups in society which may contribute to the course and outcome of mental illness (Evans-Lacko, Knapp, McCrone, Thornicroft, & Mojtabai, 2013). In a study by Kiely, Leach, Olesen, and Butterworth (2015) on how financial hardship is associated with the onset of mental health challenges over time, the authors found that cash flow problems increased the risk of mental health challenges.
2.2.5.2 Migration Related Variables
Migration is linked to increasing risk of mental health challenges globally (Li, Stanton, Fang,
& Lin 2006; WHO, 2016). The increase in the risk has been attributed to migration-related variables such as high morbidity, increased substance abuse, sexually risky behaviour, and illicit drug abuse among other factors. In a study of rural to urban migrants in China by Li et al. (2006), they found that increased mobility was significantly associated with substandard living conditions, worsened employment conditions, suboptimal health status, low health- seeking behaviour, higher numbers of depressive symptoms, and decreased life satisfaction.
Another study conducted among 290 Syrian agricultural migrants in Lebanon by Habib et al.
(2016) showed a positive relationship between poor housing and multi-morbidity. Their study further indicated that 20 per cent of the respondents had acute chronic illness, 15 per cent had two health problems, while 13 per cent reported three or more. In addition to the high morbidity among migrants, other studies have also linked migration to an increase in risky sexual behaviour and substance abuse. A cross-sectional study among 408 Polish migrants in the United Kingdom by Ganczak, Czubińska, Korzeń, and Szych (2017) reported that 56.9 per cent of the women had unprotected sex in the United Kingdom. The same study found that more respondents engaged in sexual contact after the use of alcohol in the host country more so than in their home country (10.0% vs. 2.2%; p< 0.001). The cultural and psychological changes that follow migration can be physically and mentally challenging (Buchanan & Smokowski, 2009;
Horyniak, Melo, Farrell, Ojeda, & Strathdee, 2016). Buchanan and Smokowski further surmise that migrants might use drugs and other substances to conform to the norms of the host society and because migrants usually experience social and economic inequality, discrimination, and marginalisation that are all contributing factors to stress. This behaviour may in turn lead to substance abuse (Capps & Newland, 2015; Fozdar & Hartley, 2013; Viruell-Fuentes, Miranda,
& Abdulrahim, 2012). It is widely accepted that issues of social and economic inequalities are implicated in the health outcome of various societies (Williams, Priest, & Anderson, 2016). A
25 study by Borges et al. (2012) among 3432 Mexican migrants in the USA showed that migrants who migrated at the age of 13 and older were more likely to use alcohol when offered. They also had more opportunities to use drugs and were more likely to use drugs when having the opportunity to do so in comparison with the Mexicans in their home country.
2.2.5.3 Gender Differences and Mental Health
Gender differences in mental health has proliferated as a topic in academic research in recent years (Van de Velde, Bracke, & Levecque, 2010; Van de Velde, Huijts, Bracke, & Bambra, 2013). Studies have identified gender-specific risk factors associated with mental health outcomes. A study by Van de Velde et al. (2010), for instance, found a higher prevalence of depression among women than men. In a similar study, Jarallah & Baxter (2019) also found women reporting higher psychological distress than men. Furthermore, various studies on the impact of migration on mental health have indicated that after the initial health advantage of these rural-urban migrants, the migrants become vulnerable to multiple sources of stress, resulting in lower levels of mental health status (Chen, Davis, Davis, Pan, & Daraiseh, 2011;
Liang, Mays, & Hwang, 2017; Wong, He, Leung, Lau, & Chang, 2008). Various research studies have attributed the gender differences in mental health challenges to an interplay of biological, social, and psychological factors (Hopcroft & Bradley, 2007; Kuehner, 2003).
Venerable groups such as females, the widowed, and people with poor physical health are more likely to exhibit poorer mental health outcomes. Hopcroft & Bradley (2007) also found that younger women in countries with gender inequity have a higher prevalence of mental health problems than men. Migrant women especially play many roles in the workplace if they are employed. These women are also responsible for taking care of their own homes, thus putting so much pressure on them, leading to mental health challenges (Kirmayer et al., 2011).
Biological factors have also been found to play a role in gender differences in depression.
Scholars such as Cairney and Wade (2002) and Mirowsky (1996), used evolutionary theory to explain gender differences in depression. The theory indicated that being male is inversely related to the feelings of sadness and depression, females on the other hand are more prone to depression and sadness.
There are gender differences in education attainment between males and females especially in sub-Saharan Africa where parents in traditional societies tend to favour sending boys to school rather than girls (Dube, 2015). Studies have however found that education is positively associated with better mental health status in most countries studied (Niemeyer, Bieda,
26 Michalak, Schneider, & Margraf, 2019; von dem Knesebeck, Pattyn, & Bracke, 2011). A study by von dem Knesebeck et al. (2011) covering 22 European countries concerning education and depressive symptoms found that individuals with lower education have higher risk of experiencing symptoms of depression. In another study, Crespo, López-Noval, and Mira (2013) showed that an extra year of education decreases the probability of depression by 6.5 percentage points. These findings highlight the importance of education in tackling issues of mental health challenges. There is therefore the need to develop interventions targeting migrant workers. These interventions are needed to target the risk factors of migration including economic hardships, physical harm, poor living conditions, social isolation, and poor living conditions (WHO, 2018). Despite the existence of risk factors associated with internal migration, the review of academic literature showed that most interventions have targeted asylum seekers and refugees (Craig, 2015; Giacco & Priebe, 2018; Meffert et al., 2014;
Rahman et al., 2016; Stenmark, Catani, Neuner, Elbert, & Holen, 2013; Weinstein, Khabbaz,
& Legate, 2016). Most of these interventions have focused on education, vocational training reducing social isolation with the aim of promoting social integration and better mental health outcomes.
In Ghana, there has not been any known comprehensive intervention programme that targets the psychosocial needs of vulnerable groups in society such as the Kayayei. Due to this, some organisations such as the IOM in 2016 provided 200 solar lanterns to the Kayayei association to help protect them against gender-based violence, sexual harm, theft, exploitation, and abuse (IOM, 2016). Furthermore, to make health care accessible to the Kayayei, the Pamela Bridgewater Project, a non-governmental organisation that supports Kayayei and their children, in collaboration with the National Health Insurance Scheme (NHIS), enrolled 200 Kayayei in Accra (Daily Graphic, 2016). These interventions are, however, not sustainable in addressing the physical and mental health challenges of the Kayayei. There is, therefore, the urgent need to develop a compressive intervention programme targeting the needs of Kayayei and other vulnerable groups holistically, particularly the physical and mental health issues.