Mental Health and Mexico-U.S. Migration

描述(由申请人提供)：本申请是根据PA-07-082(使用现有数据集进行精神病理学的风险因素)提交的，目的是研究跨国墨西哥裔人口中移民到美国与心理健康之间的关系。先前的流行病学研究表明，在这一人群中，移民到美国与精神障碍风险的大幅增加有关。与此同时，对心理健康服务使用情况的研究发现，与大多数美国人相比，墨西哥裔美国人得到的待遇存在显著差异。然而，由于缺乏关于移民来源地人口的数据，在美国进行的研究在理解移民影响方面的能力有限。此外，墨西哥原籍人口是跨国人口，他们通过回返移民、寄给墨西哥家庭的现金汇款以及维护良好的社会网络相互传递文化和社会影响，跨越国际边界联系在一起。我们目前正在进行的初步工作表明，移民到美国对墨西哥人口的心理健康有很大影响。我们建议构建和分析跨国墨西哥裔人口的心理健康和精神健康服务使用情况的跨国数据集，利用一个独特的情况，即最近在具有全国代表性的墨西哥样本和具有全国代表性的美国墨西哥裔美国人口样本中完成了基于人群的精神障碍调查，使用相同的调查工具、一致的访谈方法和统一的采访者培训标准。研究小组由一个在美国有丰富研究墨西哥裔美国人心理健康经验的小组和一个在墨西哥有丰富研究墨西哥精神健康经验的小组组成。使用这一独特的数据集，我们将描述在这一跨国人口中与移民到美国相关的当前精神健康和精神健康服务的使用模式。然后，我们将研究移民对边境两侧心理健康的影响，测试移民到美国是否与在美国的墨西哥裔美国人患精神疾病的风险有关，以及返回移民或跨国家庭网络是否与在墨西哥的人风险增加有关。我们还将使用有关实际服务使用、感知的护理需求和为精神健康问题寻求治疗的意愿的数据，研究移民到美国是否影响将精神健康问题视为医疗问题的文化取向。这些分析的结果将有助于在当今世界最大规模的国际移徙背景下直接审查移徙与精神健康之间的关系，从而有助于从病因学上了解精神障碍，并有助于开展旨在改善这一服务不足人口的精神保健的政策研究。公共卫生相关性：精神疾病的风险和心理健康服务的使用在不同国家和美国移民及其在美国出生的后代之间存在巨大差异，但尚未有研究将移民到美国的心理健康与其原籍国人口进行比较。我们建议通过结合最近两项心理健康调查的数据来填补这一空白，这两项调查使用了一致的方法，一项是关于墨西哥人口的，另一项是关于美国的墨西哥裔美国人的。这项研究将有助于确定精神障碍病因中的环境因素，并为旨在改善墨西哥和美国服务不足社区的精神卫生保健的政策提供参考。

DESCRIPTION (provided by applicant): This application is submitted in response to PA-07-082 (Risk Factors for Psychopathology Using Existing Data Sets) to examine the relationship between migration to the US and mental health in the transnational Mexican- origin population. Previous epidemiological studies have shown that in this population immigration to the US is associated with large increases in risk for psychiatric disorders. At the same time, studies of mental health service use have found significant disparities in the treatment Mexican-Americans receive relative to the majority US population. However, studies conducted in the US are limited in their ability to understand the impact of immigration because of the lack of data on the immigrant source population. Moreover, the Mexican- origin population is a transnational one, tied together across the international border through return migrations, cash remittances sent to families in Mexico, and well maintained social networks that transmit mutual cultural and social influences. Our preliminary work, now in press, suggests that migration to the US has a large impact on mental health in the Mexican population. We propose to construct and analyze a cross-national dataset on mental health and mental health service use in the transnational Mexican-origin population, taking advantage of a unique situation where population based surveys of psychiatric disorders have recently been completed in a nationally representative sample of Mexico and in a nationally representative sample of the Mexican- American population of the US during the same time period, using the same survey instrument, consistent interview methodologies, and uniform interviewer training standards. The research team is comprised of a group in the US with extensive experience studying mental health among Mexican-Americans and a group in Mexico with extensive experience studying mental health in Mexico. Using this unique dataset we will describe patterns of current mental health and mental health service use associated with migration to the US in this transnational population. We will then examine the impact of migration on mental health on both sides of the border, by testing whether migration to the US is associated with risk for psychiatric disorders among the Mexican-American population of the US and whether return migration or transnational family networks are associated with increased risk among those in Mexico. We will also examine whether migration to the US affects the cultural orientation to mental health problems as issues of medical concern, using data on actual service use, perceived need for care and willingness to seek treatment for a mental health problem. Results of these analyses will contribute to etiological understanding of psychiatric disorders by directly examining the relationship between migration and mental health in the context of the largest international migration in the world today and to policy studies that aim to improve mental health care for this underserved population. PUBLIC HEALTH RELEVANCE: Risk for psychiatric disorders and use of mental health services vary dramatically across countries and between immigrants to the US and their US-born descendants, but no studies have yet compared the mental health of immigrants to the US with the population of their country of origin. We propose to fill this gap by combining data from two recent mental health surveys that used consistent methodologies, one on the Mexican population and the other on Mexican-Americans in the US. This study will help identify environmental factors in the etiology of psychiatric disorders and inform policies that aim to improve mental health care for underserved communities in both Mexico and the US.