Emine Kale & Karin H. Hjelde Mental Health Challenges of Immigrants in Norway A Literature Review 2009-2017 NAKMI Report No. 1:2017 © Norwegian Centre for Migration and Minority Health (NAKMI) © Nasjonalt kompetansesenter for migrasjons- og minoritetshelse (NAKMI) Title: Mental Health Challenges of Immigrants in Norway, A literature review 2009–17 Authors: Emine Kale & Karin H. Hjelde NAKMI report number 1 2017 Oslo 2017 ISBN: 978-82-92564-32-5 Print: 07 Media AS Photo: Ram Gupta Contact Details: Norwegian Centre for Migration and Minority Health (NAKMI) Oslo University Hospital PB 4959 Nydalen 0424 Oslo [email protected] www.nakmi.no The PDF version includes minor typographical corrections. Pagination is identical to the print version Contents Summary ....................................................................................................................................................... 2 Abbreviations ................................................................................................................................................ 3 Definitions .................................................................................................................................................... 4 Authors contributions ................................................................................................................................... 5 Acknowledgements ....................................................................................................................................... 5 Introduction .................................................................................................................................................. 7 Part 1. Background ........................................................................................................................................ 7 1.1. Immigrant populations in Norway ................................................................................................................ 7 1.2. Migration and Health .................................................................................................................................... 7 1.3. Migration and Mental Health........................................................................................................................ 8 1.4. Mental health challenges of immigrants in Norway ..................................................................................... 9 1.5. Objectives .................................................................................................................................................... 10 Part 2. Methodology .................................................................................................................................... 11 Stage 1: Identifying the research question ........................................................................................................ 11 Stage 2: Identifying the relevant studies ........................................................................................................... 11 Stage 3: Selecting studies ................................................................................................................................... 12 Stage 4: Charting the data .................................................................................................................................. 14 Stage 5: Collating/summarizing and reporting the data .................................................................................... 14 Part 3. Results ............................................................................................................................................. 15 3.1. The extent and nature of empirical studies ................................................................................................ 15 3.1.1. Peer-reviewed publications ................................................................................................................. 15 3.1.2. Sample size, sex, age, migrant status in peer-reviewed articles ......................................................... 17 3.1.3. Immigrants’ country of origin in peer-reviewed articles ..................................................................... 18 3.1.4. Place of recruitment in peer-reviewed articles ................................................................................... 18 3.1.5. Research design in peer-reviewed articles .......................................................................................... 18 3.1.6. Instruments used in peer-reviewed articles ........................................................................................ 18 3.1.7. General characteristics of grey literature ............................................................................................ 21 3.2. Thematic presentation of the findings in peer-reviewed studies and grey literature (N=79) ................... 22 3.2.1. Children/Adolescents .......................................................................................................................... 22 3.2.2. Adults ................................................................................................................................................... 25 3.2.3. Intervention studies ............................................................................................................................. 32 3.2.4. Explanatory models ............................................................................................................................. 32 3.2.5. Access to and utilization of health services ......................................................................................... 33 3.2.6. Intercultural Competency among healthcare personnel .................................................................... 35 Part 4. Discussion—challenges and gaps in research and knowledge ............................................................ 35 4.1. Methodological limitations of the included studies ................................................................................... 36 4.2. Knowledge gaps and recommendations for future research ..................................................................... 39 4.3. Limitations of this review ............................................................................................................................ 40 Part 5. Conclusions and implications ............................................................................................................ 41 Part 6. References ....................................................................................................................................... 42 Part 7. Tables .............................................................................................................................................. 51 1 Summary In Norway and worldwide, the most frequent mental health problems—anxiety, depression and alcohol dependency—are perceived as some of the main public health challenges. In Norway for the time being, the health authorities emphasize the promotion of mental health as an important part of public health efforts. As migration is established as one of the determinants of health and previous research indicates higher rates of mental distress among immigrants, it is highly important to have updated research reviews on mental health challenges among immigrants. Therefore, the aim of this review is to map the empirical studies in Norway on mental health and related topics among immigrant groups, to summarize main findings, and to discuss the existing challenges and gaps in research and knowledge. To this end, a scoping review of studies published between January 2009 and June 2017 in Norway was conducted. The databases PubMed, MEDLINE, Psych INFO, EMBASE and Oria were searched. The data was charted and sorted according to key themes of interest. Results are reported as descriptive, quantitative and thematic summary. Sixty-five peer reviewed articles and 14 studies within grey literature were identified, totaling 79 published works; of these, the majority had adult samples. The studies included in this search cover a broad range of themes and are highly diverse in terms of the backgrounds of participants, sample size, outcome measures, study designs, research methods, recruitment methods and place of recruitment. This gives a wide spectrum of findings and insights, but it also complicates the comparison and discussion of research methods, samples and the main findings. The review indicates that immigrants to Norway are a very diverse group with differing—but often increased—risks for self-reported mental distress. However, knowledge about prevalence rates of mental disorders generally in immigrant groups, for all ages, is still lacking. In line with earlier studies, the review indicates an increased risk for mental distress and disorders with UAMA/URM/UR children/adolescents and in clinical samples of adult refugees, thus confirming that these groups stand out as especially vulnerable for mental health challenges after resettlement in Norway, also. However, the findings also underscore the importance of current life conditions on mental health, and the significance of health promoting interventions over previous traumatic life events. Lower utilization rates of mental health services—both primary and secondary—by several immigrant groups compared to the majority population, are reported in several studies. There are several methodological