Immigrant women with mental health problems in a primary care setting

Immigration to Norway has been especially high the last two decades. Some immigrant groups appear to have poorer health and more psychological distress than the rest of the population. Together, this can have implications for healthcare services. In Norway, equity in health care services is an important goal but we have little information about immigrants' use of health care services for mental health problems. This project investigated immigrants (those born abroad with two foreign-born parents) use of primary health care services for mental health problems. Using national registry data from 2008, we found that 10% of immigrants compared with 12% of non-immigrants (those born in Norway to two Norwegian-born parents), had had at least one consultation with a general practitioner (GP) involving a psychological diagnosis (P-consultation). Focusing on the five large immigrant groups; those from Poland, Swedish, Germany, Pakistan and Iraq, we found large variation in use of service use for mental health problems by country background and gender, among other factors. After accounting for sociodemographic differences, all immigrant groups had lower odds of having had a P-consultation for a mental health problem than their non-immigrant counterparts, except for Iraqi men. These findings only consider the use of primary health care services for mental health problems, which does not necessarily reflect the actual prevalence of mental health problems among immigrant groups. For some groups, lower rates of service use may be an indication of better mental health, while for others, lower rates may be an indication of difficulties in accessing care or differences in help-seeking. To eliminate differences in help-seeking, we looked specifically at those who had had a P-consultation. For immigrants from war-torn countries, we found that both refugee men and women were more likely to have purchased anti-depressants than non-refugees, suggesting that refugees have poorer mental health than non-refugees, despite coming from the same country of origin. This could be due to a combination of greater pre- and during-migration trauma and post-migration stressors (associated with asylum period). We also compared immigrant women from Sweden, Poland, The Philippines, Thailand, Pakistan and Russia with non-immigrant women on the type of care they received. Women from non-EU countries were less likely to purchase psychotropic medicine and engage in conversational therapy with the doctor than non-immigrant women. This may suggest these groups experience both cultural and linguistic barriers to care. To investigate barriers to care, we conducted interviews with women from Thailand and the Philippines. A combination of the women?s beliefs and values, stigma, experiences with healthcare services in Norway and familiarity with mental health services influenced their perceptions of help seeking. However, the significance of each factor varied depending on the women?s own backgrounds, education and experiences. Help seeking for mental health problems was often seen as a last resort or only for serious mental health problems. Short appointment times and different expectations of the doctor-patient relationship made the GP less approachable for the women. Some women experienced a significant language barrier and not all were aware that they were entitled to use an interpreter. Waiting times and costs of services were also important structural barriers in the health care system that reduced the likelihood of seeking health care. Access to healthcare information needs to be improved for immigrants. This is important in terms of how the health system works, the right to healthcare and the right to an interpreter.

According to the Norwegian Health Plan (2007-2010), all patients should have equal access to health care regardless of their gender, ethnicity or social status. Norway has a growing immigrant population and immigrants have, on average, poorer socioeconomi c resources and health than natives. Immigrant women may be particularly disadvantaged. Mental health of immigrants is relatively uncertain since studies are typically based on small scale self-report surveys with few immigrants. Many immigrants report us ing primary health care services more than Norwegians, but seeing specialists less. This may suggest inequalities in accessing care, but this has not been studied at a national level. Immigrant women appear to be particularly underrepresented in acute men tal health care but we do not know if the same applies in primary care settings. The aim of this study is to better understand how immigrants, especially women use primary health care services for mental health problems. Both quantitative and qualitative methods will be used. Four high-quality nationwide databases have been linked together allowing us to study whether immigrants consult their GP to the same extent as Norwegians and what treatment they receive. The dataset is large enough to look at immigr ants from different countries, migrating for different reasons. In addition, socio-economic status, length of time in Norway and use of interpreter are just some of the factors we will investigate that may help explain differences in health care. We will also interview immigrant women from the Philippines and Thailand about their experiences of using primary care services and what barriers they perceive when consulting their doctor about mental health issues. These women are among the largest groups of im migrant women in Norway, yet are relatively understudied in both a national and international context. Identifying barriers to health care is an important step in ensuring equal access to care for immigrant women.