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The Mental Health of Korean Immigrants in São Paulo, Brazil

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The Mental Health of Korean Immigrants in São Paulo, Brazil ARTIGO ARTICLE 819 The mental health of Korean immigrants in São Paulo, Brazil Saúde mental dos imigrantes coreanos em São Paulo, Brasil Sam Kang 1 Denise Razzouk 1 Jair Jesus de Mari 1 Itiro Shirakawa 1 Abstract Introduction 1 Departamento de This study investigated the frequency of lifetime Population studies have shown that immigrants Psquiatria, Universidade Federal de São Paulo, São mental disorders among Korean immigrants in are more vulnerable to mental health disorders Paulo, Brasil. the city of São Paulo, Brazil. Snowball sampling than the individuals in their countries of origin with multiple focuses was used to recruit Korean who have not emigrated. Among Mexican im- Correspondence S. Kang immigrants older than 18 years and living in São migrants in the United States, 33.8% had some Departamento de Psiquiatria, Paulo. A total of 324 Korean immigrants were se- form of lifetime psychiatric disorder, whereas the Universidade Federal de São lected and their mental status was evaluated us- prevalence rate among Mexicans in Mexico was Paulo. 1 Rua Dr. Mário Cardim 168, ing a structured interview, namely the Portuguese 24.7% . Italians in Paris had more depressive epi- São Paulo, SP or the Korean version of the Composite Interna- sodes (17.6% vs. 13.6%) and dysthymia (7.1% vs. 04019-000, Brasil. tional Diagnostic Interview 2.1. The diagnoses 4%) in their lifetime than the population in their [email protected] of mental disorders were made according to the country of origin 2. The estimated rate of minor ICD-10. The frequency of any lifetime psychiatric psychiatric disorders among Japanese-Brazilians disorder was 41.9%. The frequencies of main dis- in Japan was 17.8%, and 3.2% among Japanese- orders were: anxiety disorder, 13% (post-traumat- Brazilians in Brazil 3. ic stress disorder, 9.6%); mood disorder, 8.6%; so- Although population cross-sectional stud- matoform disorders, 7.4%; dissociative disorder, ies cannot show whether immigrants already 4.9%; psychotic disorder, 4.3%; eating disorder, had more mental problems before immigration 0.6%; any substance (tobacco, alcohol, drugs) use than individuals who stayed in their country of disorder, 23.1%. The frequency of any psychiatric origin, longitudinal studies may compare men- disorder except alcohol and tobacco use disorders tal disorder rates before and after immigration. was 26.2%. Korean immigrants have more psy- Jewish people that emigrated from the Soviet chiatric disorders than the Korean population in Union to Israel were followed up for five years, Korea, particularly post-traumatic stress disorder, and results showed that they had more depres- and almost the same rate as the Brazilian popu- sive and anxiety disorders after immigration: lation. Mental health authorities should promote major depression – from 1.9% to 3.2%; dysthy- a healthier integration and the development of mia – from 2% to 3.5%; and anxiety disorders culturally sensitive mental health programs for – from 3.9% to 5.2% 4. Korean immigrants. Studies with patients in psychiatric hospitals identified that different psychiatric disorders Mental Disorders; Mental Health; Imigrants were associated with immigration. Studies con- Cad. Saúde Pública, Rio de Janeiro, 25(4):819-826, abr, 2009 820 Kang S et al. ducted in American hospitals found a greater Method rate of immigrants among patients with bipolar disorder (20.6%) 5 and unipolar depressive disor- Sample population ders (19%) 6. A greater risk of schizophrenia was found among Afro-Caribbeans in England than São Paulo was selected because it has the largest among the local population (odds ratio – OR = Korean immigrant community in Brazil (98%). 5-18) 7. Among Iranian immigrants in Canada, The sample of Korean immigrants was recruited greater rates of psychiatric diagnoses were found from the community according to the follow- for depression and anxiety disorders (60%) and ing inclusion criteria: to be a Korean immigrant post-traumatic stress disorder (10%) 8. older than 18 years and living in São Paulo. The When immigrants leave their country of ori- minimum sample size (n = 257) was based on an gin and come into contact with a new reality, estimate of the proportion of respondents who they are faced with several changes: environ- were likely to have experienced a lifetime mental mental (place and type of residence, population disorder: 40% (standard error – SE = 3%) 13. characteristics); biological (food, local diseas- As no list of Korean immigrants in Brazil was es); cultural (political, economic, religious, lin- available, the subjects were recruited at immi- guistic differences); and psychological (identity, grant community churches and commercial values, internal references). These changes are businesses. Participants and the group of inter- experienced as stressors, which may increase viewers were asked to introduce their friends into vulnerability to mental disease 9,10. However, the survey. each group of immigrants should be investigat- ed with their particularities in mind, such as the Instruments country of origin, the country of residence, the time and reasons of immigration. A standardized psychiatric interview, the Por- Brazil is a country that is largely made up of tuguese version of the Composite International immigrants and their descendents. According to Diagnostic Interview 2.1 (CIDI 2.1) 14 and the the latest Brazilian census (Instituto Brasileiro equivalent Korean version 15, was applied to the de Geografia e Estatística. Censo Demográfico immigrants together with a questionnaire about de 2000. http://www.ibge.gov.br, accessed on immigration-related issues specifically designed 15/May/2002), there are 685,000 immigrants in for this study. The CIDI 2.1 is a structured inter- Brazil, 87% of whom come from 15 countries. view schedule developed by the World Health Korean immigration to Brazil started in 1963 Organization (WHO) and based on the National with the arrival of a small group of individu- Institute of Mental Health Diagnostic Interview als (n = 92). The Korean immigrant community Schedule. It was designed to estimate the prev- grew over the following decades with the arrival alence of mental disorders across countries or of groups organized by the Korean government geographic regions. The interview can be used and illegal immigrants that entered the country by trained lay interviewers. The questionnaire through the borders of neighboring countries, has questions on socio-demographics and mi- such as Paraguay, Bolivia and Argentina. Illegal gration-related issues: age at emigration; time Korean immigrants were granted amnesty by in the country; language knowledge; self-rated the Brazilian government at four different times acculturation level; self-rated socioeconomic (1969, 1981, 1989 and 1998). There are about status according to two references – immigrant 50,000 Koreans in Brazil, representing about community and general society; perception of 20% of the total number of immigrants that have prejudice for being an immigrant; participation been in Brazil for less than 10 years. in immigrant associations. No surveys have been conducted about the mental health of Korean immigrants in Brazil. Procedure This population emigrated from a country with a lower prevalence of mental disorders (32.6%) 11 Eleven bilingual interviewers, fluent in Portu- than the country of resettlement (45.9%) 12. This guese and Korean, were recruited for this study. is a particularly appropriate time to study the All of them were college students with various mental health of first-generation Korean im- majors, and were trained at the CIDI Training migrants in Brazil and this study investigated Center in Brazil at the Universidade Federal de the frequency of psychiatric disorders among São Paulo. Korean immigrants in São Paulo and compared As no list of Korean immigrants in Brazil was it with rates found in Korea. available, the participants were recruited at im- migrant community churches. Two Protestant and one Catholic churches were selected from 44 Cad. Saúde Pública, Rio de Janeiro, 25(4):819-826, abr, 2009 MENTAL HEALTH OF KOREAN IMMIGRANTS 821 immigrant churches located in a city area with Results a high concentration of immigrants. At the first Protestant church visited, 100 subjects were se- There were different refusal rates in the 3 snow- lected from the list of 350 members and were ball focuses. At the religious institutions, about contacted by telephone. This procedure proved 3,700 immigrants were contacted through tele- to be complicated and to yield a very high refus- phone and fliers and only 124 (3.4%) accepted al rate. Subsequently, the field coordinator and to be interviewed. They indicated 36 friends/ principal investigator held a meeting with lead- relatives and 11 (31%) accepted to answer the ers of small groups from the church, in order to questionnaires. The refusal rate was 80% when explain the importance of the study and request subjects were contacted by telephone and 96.6%, that pamphlets be distributed to invite volun- when the contact was made through fliers. From teers. This method proved to be more efficient the 58 commercial businesses visited by a field and was used in all three religious institutions. coordinator, 23 subjects (40%) participated in Participants were asked to introduce one non- the survey. They indicated 12 friends/relatives, religious friend to be a control for sample bias and 11 (92%) agreed to participate. The group of associated with religiosity. This sampling project interviewers indicated 121 friends/relatives, and was based on the proportion of the population of 116 (96%) agreed to participate. These subjects Korea that is religious (50%). They had great dif- further indicated 55 friends/relatives, and 39 ficulty in indicating non-religious friend(s), and (71%) agreed to participate. Each snowball-sam- the authors decided to accept friends with a reli- pling effort ended up in the second stage due to gious background. difficulties or refusals to indicate friends. In the face of high levels of religiosity among the first sample, respondents were also recruited Demographic characteristics at commercial businesses run by Korean immi- grants in order to check immigrant religiosity.
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