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Disparities in mental health care provision to immigrants with severe mental illness in Italy

Published online by Cambridge University Press:  30 April 2014

P. Rucci ,
A. Piazza ,
E. Perrone ,
I. Tarricone ,
R. Maisto ,
I. Donegani ,
V. Spigonardo ,
D. Berardi ,
M. P. Fantini  and
A. Fioritti
P. Rucci*
Affiliation:
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
A. Piazza
Affiliation:
Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
E. Perrone
Affiliation:
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
I. Tarricone
Affiliation:
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
R. Maisto
Affiliation:
Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
I. Donegani
Affiliation:
Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
V. Spigonardo
Affiliation:
Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
D. Berardi
Affiliation:
Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
M. P. Fantini
Affiliation:
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
A. Fioritti
Affiliation:
Department of Mental Health and Pathological Addictions, Local Health Trust, Bologna, Italy
*
*Address for correspondence: Dr Paola Rucci, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy. (Email: [email protected])
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Abstract

Aim.

To determine whether disparities exist in mental health care provision to immigrants and Italian citizens with severe mental illness in Bologna, Italy.

Methods.

Records of prevalent cases on 31/12/2010 with severe mental illness and ≥1 contact with Community Mental Health Centers in 2011 were extracted from the mental health information system. Logistic and Poisson regressions were carried out to estimate the probability of receiving rehabilitation, residential or inpatient care, the intensity of outpatient treatments and the duration of hospitalisations and residential care for immigrant patients compared to Italians, adjusting for demographic and clinical covariates.

Results.

The study population included 8602 Italian and 388 immigrant patients. Immigrants were significantly younger, more likely to be married and living with people other than their original family and had a shorter duration of contact with mental health services. The percentages of patients receiving psychosocial rehabilitation, admitted to hospital wards or to residential facilities were similar between Italians and immigrants. The number of interventions was higher for Italians. Admissions to acute wards or residential facilities were significantly longer for Italians. Moreover, immigrants received significantly more group rehabilitation interventions, while more social support individual interventions were provided to Italians.

Conclusions.

The probability of receiving any mental health intervention is similar between immigrants and Italians, but the number of interventions and the duration of admissions are lower for immigrants. Data from mental health information system should be integrated with qualitative data on unmet needs from the immigrants' perspective to inform mental health care programmes and policies.

Keywords

Equityhealth services researchinterventionssevere mental illness
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 4 , August 2015 , pp. 342 - 352
Copyright
Copyright © Cambridge University Press 2014 

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References

Agudelo-Suarez, A, Gil-Gonzalez, D, Vives-Cases, C, Love, JG, Wimpenny, P, Ronda-Perez, E (2012). A metasynthesis of qualitative studies regarding opinions and perceptions about barriers and determinants of health services'accessibility in economic migrants. BMC Health Services Research 12, 461.CrossRefGoogle ScholarPubMed
Allardyce, J, Gilmour, H, Atkinson, J, Rapson, T, Bishop, J, McCreadie, RG (2005). Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. British Journal of Psychiatry 187, 401–406.CrossRefGoogle ScholarPubMed
Bhugra, D, Gupta, S, Bhui, K, Craig, T, Dogra, N, Ingleby, JD, Kirkbride, J, Moussaoui, D, Nazroo, J, Qureshi, A, Stompe, T, Tribe, R (2011). WPA guidance on mental health and mental healthcare in migrants. World Psychiatry 10, 2–10.CrossRefGoogle Scholar
Bhugra, D, Gupta, S, Schouler-Ocak, M, Graeff-Calliess, I, Deakin, NA, Qureshi, A, Dales, J, Moussaoui, D, Kastrup, M, Tarricone, I, Till, A, Bassi, M, Carta, M (2014). EPA guidance mental health care of migrants. European Psychiatry 29, 107–115.CrossRefGoogle ScholarPubMed
Braca, M, Berardi, D, Mencacci, E, Murri, MB, Mimmi, S, Allegri, F, Mazzi, F, Menchetti, M, Tarricone, I (2013). Understanding psychopathology in migrants: a mixed categorical-dimensional approach. International Journal of Social Psychiatry [Epub ahead of print].Google Scholar
Bresnahan, M, Begg, MD, Brown, A, Schaefer, C, Sohler, N, Insel, B, Vella, L, Susser, E (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity? International Journal of Epidemiology 36, 751–758.Google Scholar
Carpenter-Song, E, Whitley, R, Lawson, W, Quimby, E, Drake, RE (2011). Reducing disparities in mental health care: suggestions from the Darmouth–Howard collaboration. Community Mental Health Journal 47, 1–13.CrossRefGoogle ScholarPubMed
Cooper, B (2005). Schizophrenia, social class and immigrant status: the epidemiological evidence. Epidemiologia e Psichiatria Sociale 14, 137–144.CrossRefGoogle ScholarPubMed
Das-Munshi, J, Leavey, G, Stansfeld, SA, Prince, MJ (2012). Migration, social mobility and common mental disorders: critical review of the literature and meta-analysis. Ethnicity & Health 17, 17–53.Google Scholar
Fassaert, T, Hesselink, AE, Verhoeff, AP (2009). Acculturation and use of health care services by Turkish and Moroccan migrants: a cross-sectional population-based study. BMC Public Health 9, 332.Google Scholar
Fearon, P, Kirkbride, JB, Morgan, C, Dazzan, P, Morgan, K, Lloyd, T, Hutchinson, G, Tarrant, J, Fung, WL, Holloway, J, Mallett, R, Harrison, G, Leff, J, Jones, PB, Murray, RM, AESOP Study Group (2006). Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP study. Psychological Medicine 36, 1541–1550.CrossRefGoogle ScholarPubMed
Gaddini, A, Franco, F, Biscaglia, L, Di Lallo, D (2008). An urban Italian study on emergency room utilisation by immigrants suffering from mental disorders in Rome, 2000–2004. European Psychiatry 23, 118–124.Google Scholar
Grabovschi, C, Loignon, C, Fortin, M (2013). Mapping the concept of vulnerability related to health care disparities: a scoping review. BMC Health Services Research 13, 94.Google Scholar
International Classification of Diseases (2008). 9th revision Clinical Modification 2007. Versione italiana, Istituto Poligrafico e Zecca dello Stato, Libreria dello Stato: Roma.Google Scholar
ISTAT. Popolazione straniera residente in Italia. Rilevazione al 1 gennaio 2011. Retrieved 1 December 2013 from http://www.istat.it/it/archivio/39726.Google Scholar
Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB, Coid, JW (2008). Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry 193, 18–24.Google Scholar
Kirmayer, LJ, Weinfeld, M, Burgos, G, du Fort, GG, Lasry, JC, Young, A (2007). Use of health care services for psychological distress by immigrants in an urban multicultural milieu. Canadian Journal of Psychiatry 52, 295–304.Google Scholar
Koopmans, GT, Uiters, E, Devillé, W, Foets, M (2012). The use of mental health care services of migreants vis-à-vis Dutch natives: equal access? International Journal of Social Psychiatry 59, 342–350.Google Scholar
Lindert, J, Schouler-Ocak, M, Heinz, A, Priebe, S (2008). Mental health, health care utilisation of migrants in Europe. European Psychiatry 23, S14–S20.Google Scholar
McDonald, JT, Kennedy, S (2004). Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Social Science and Medicine 59, 1613–1627.CrossRefGoogle ScholarPubMed
Patel, V, Araya, R, de Lima, M., Ludermir, A, Todd, C (1999). Women, poverty and common mental disorders in four restructuring societies. Social Science and Medicine 49, 1461–1471.CrossRefGoogle ScholarPubMed
Penka, S, Kluge, U, Vardar, A, Borde, T, Ingleby, D (2012). The concept of ‘intercultural opening’: the development of an assessment tool for the appraisal of its current implementation in the mental health care system. European Psychiatry 27, S563–S569.Google Scholar
Piazza, A, Bruschi, C, Donegani, I, Maisto, R, Orsoni, R, Tomelli, A, Verlato, R, Merini, A (2010). Migrants and psychiatric care in Bologna. Psichiatria di Comunità 9, 80–92.Google Scholar
Priebe, S, Matanov, A, Schor, R, Straßmayr, C, Barros, H, Barry, MM, Díaz-Olalla, JM, Gabor, E, Greacen, T, Holcnerová, P, Kluge, U, Lorant, V, Moskalewicz, J, Schene, AH, Macassa, G, Gaddini, A (2012). Good practice in mental health care for socially marginalised groups in Europe: a qualitative study of expert views in 14 countries. BMC Public Health 12, 248.CrossRefGoogle ScholarPubMed
Razum, O (2006). Commentary: Of salmon and time travellers - musing on the mystery of migrant mortality. International Journal of Epidemiology 35, 919–921.Google Scholar
Rucci, P, Piazza, A, Menchetti, M, Berardi, D, Fioritti, A, Mimmi, S, Fantini, MP (2012). Integration between primary care and mental health services in Italy: determinants of referral and stepped care. International Journal of Family Medicine 2012; 2012:507464.Google Scholar
Sandhu, S, Bjerre, NV, Dauvrin, M, Dias, S, Gaddini, A, Greacen, T, Ioannidis, E, Kluge, U, Jensen, NK, Lamkaddem, M, Puigpinós, i, Riera, R, Kósa, Z, Wihlman, U, Stankunas, M, Straßmayr, C, Wahlbeck, K, Welbel, M, Priebe, S (2013). Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries. Social Psychiatry and Psychiatric Epidemiology 48, 105–116.CrossRefGoogle ScholarPubMed
Spigonardo, V, Piazza, A, Tarricone, I, Maisto, R, Nolet, M, Giancane, S, Campalastri, R, Magnani, G, Tenuzzo, C, Orsoni, R, Martelli, M, Donegani, I, Berardi, D, Fioritti, A (2014) Salute mentale, migrazione e competenza culturale: l'esperienza di Bologna. Politiche Sociali.Google Scholar
Stanciole, AE, Huber, M (2009). Access to health care for migrants, ethnic minorities, and asylum seekers in Europe.European Centre. Policy brief Retrieved 20 March 2014 from http://www.euro.centre.org/data/1254748286_82982.pdf.Google Scholar
Straßmayr, C, Matanov, A, Priebe, S, Barros, H, Canavan, R, Díaz-Olalla, JM, Gabor, E, Gaddini, A, Greacen, T, Holcnerová, P, Kluge, U, Welbel, M, Nicaise, P, Schene, AH, Soares, JJ, Katschnig, H (2012). Mental health care for irregular migrants in Europe: barriers and how they are overcome. BMC Public Health 12, 367.CrossRefGoogle ScholarPubMed
Swinnen, SG, Selten, JP (2007). Mood disorders and migration: meta-analysis. British Journal of Psychiatry 190, 6–10.CrossRefGoogle ScholarPubMed
Tarricone, I, Atti, AR, Salvatori, F, Braca, M, Ferrari, S, Malmusi, D, Berardi, D (2009). Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna. International Journal of Social Psychiatry 55, 203–213.Google Scholar
Tarricone, I, Atti, AR, Braca, M, Pompei, G, Morri, M, Poggi, F, Melega, S, Stivanello, E, Tonti, L, Nolet, M, Berardi, D (2011). Migrants referring to the Bologna Transcultural psychiatric team: reasons for drop-out. International Journal of Social Psychiatry 57, 627–630.Google Scholar
Tarricone, I, Stivanello, E, Ferrari, S, Colombini, N, Bolla, E, Braca, M, Giubbarelli, C, Costantini, C, Cazzamalli, S, Mimmi, S, Tedesco, D, Menchetti, M, Rigatelli, M, Maso, E, Balestrieri, M, Vender, S, Berardi, D (2012 a). Migrant pathways to community mental health centres in Italy. International Journal of Social Psychiatry 58, 505–511.Google Scholar
Tarricone, I, Mimmi, S, Paparelli, A, Rossi, E, Mori, E, Panigada, S, Carchia, G, Bandieri, V, Michetti, R, Minenna, G, Boydell, J, Morgan, C, Berardi, D (2012 b). First-episode psychosis at the West Bologna community mental health centre: results of an 8-year prospective study. Psychological Medicine 42, 2255–2264.CrossRefGoogle ScholarPubMed
Tarsitani, L, Pasquini, M, Maraone, A, Zerella, MP, Berardelli, I, Giordani, R, Polselli, GM, Biondi, M (2012). Acute psychiatric treatment and the use of physical restraint in first-generation immigrants in Italy: a prospective concurrent study. International Journal of Social Psychiatry 59, 613–618.Google Scholar
Tinghög, P, Hemmingsson, T, Lundberg, I (2007). To what extent may the association between immigrant status and mental illness be explained by socioeconomic factors? Social Psychiatry and Psychiatric Epidemiology 42, 990–996.Google Scholar
US Department of Health and Human Services (2001). Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services: Rockville, MD.Google Scholar
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, J-P, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 66–73.Google Scholar
Vick, B, Jones, K, Mitra, S (2012). Poverty and severe psychiatric disorder in the U.S.: evidence from the Medical expenditure panel survey. Journal of Mental Health Policy and Economics 15, 83–96.Google Scholar
Wahlbeck, K, McDaid, D (2012). Actions to alleviate the mental health impact of the economic crisis. World Psychiatry 11, 139–145.Google Scholar
Weiser, M, Werbeloff, N, Vishna, T, Yoffe, R, Lubin, G, Shmushkevitch, M, Davidson, M (2008). Elaboration on immigration and risk for schizophrenia. Psychological Medicine 38, 1113–1119.Google Scholar
World Health Organization, Regional Office for Europe (2010). How Health Systems Can Address Health Inequities Linked to Migration and Ethnicity. WHO: Copenhagen.Google Scholar
Zolkowska, K, Cantor-Graae, E, McNeil, TF (2001). Increased rates of psychosis among immigrants to Sweden: is migration a risk factor for psychosis? Psychological Medicine 31, 669–678.CrossRefGoogle ScholarPubMed