Mental Health and Mexico-U.S. Migration

描述（由申请人提供）：本申请是根据PA-07-082（使用现有数据集的精神病理学风险因素）提交的，旨在研究移民到美国与墨西哥裔跨国人口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，移民到美国与精神疾病风险的大幅增加有关。与此同时，对心理健康服务使用的研究发现，相对于美国大多数人口，墨西哥裔美国人接受的治疗存在显著差异。然而，由于缺乏移民源人口的数据，在美国进行的研究在理解移民影响方面的能力有限。此外，墨西哥裔人口是一个跨国人口，他们通过返回的移民、寄给墨西哥家庭的现金汇款以及维护良好的社会网络在国际边界上联系在一起，传播相互的文化和社会影响。我们的初步研究表明，移民到美国对墨西哥人口的心理健康有很大的影响。我们建议构建和分析跨国墨西哥裔人口心理健康和心理健康服务使用的跨国数据集，利用一种独特的情况，即最近在墨西哥全国代表性样本中完成了基于人口的精神疾病调查，并在同一时期使用相同的调查工具，在美国墨西哥裔美国人口的全国代表性样本中完成了调查。一致的面试方法和统一的面试官培训标准。研究小组由一个在美国具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具有丰富研究墨西哥心理健康经验的小组组成。使用这个独特的数据集，我们将描述当前的心理健康和心理健康服务的使用模式与移民到美国的跨国人口。然后，我们将检查移民对边境两侧心理健康的影响，通过测试移民到美国是否与美国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墨西哥人患精神疾病的风险增加有关。我们还将研究移民到美国是否会影响将心理健康问题作为医疗关注问题的文化取向，使用有关实际服务使用、感知到的护理需求和寻求心理健康问题治疗的意愿的数据。这些分析的结果将有助于通过在当今世界上最大的国际移民背景下直接检查移民与心理健康之间的关系来了解精神疾病的病因学，并有助于旨在改善这一服务不足人群的心理卫生保健的政策研究。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之间以及在美国的移民及其在美国出生的后代之间存在巨大差异，但尚未有研究将美国移民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，一项针对墨西哥人口，另一项针对美国的墨西哥裔美国人。这项研究将有助于确定精神疾病病因中的环境因素，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信息。

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.