Mood and Anxiety Disorders and the Use of Services and Psychotropic Medication in an Immigrant Population: Findings from the Israel National Health Survey

Article excerpt

Objective: Using the Israel National Health Survey (INHS), we compared immigrants' 12-month prevalence of mental disorders and the use of services and psychotropic drugs with that of the general population.

Methods: A representative sample of noninstitutionalized residents, aged 21 years and older, was drawn from the National Population Register. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) disorders were assessed using a revised version of the Composite International Diagnostic Interview. Respondents were asked to report any health service and psychotropic drug use in the past 12 months.

Results: During the 12 months preceding the INHS, immigrants and Israelis (that is, those born in Israel or those who emigrated to Israel before 1989) were equally likely to have a common mental disorder (OR 0.9; 95% CI 0.7 to 1.1) and to use health services (OR 0.9; 95% CI 0.7 to 1.2). However, among respondents who did not meet the DSM-IV criteria for a specific mental disorder, the immigrants reported markedly more use of psychotropic drugs than the Israelis, in particular more anxiolytics, mood stabilizers, and hypnotics.

Conclusion: The results suggest that the common mental disorders and mental health service use among the immigrants are no higher than that among their Israeli counterparts. The higher use of psychotropic drugs by immigrants may be an indirect indicator of a higher level of psychological distress symptoms, such as anxiety, depression, and sleep disorders.

Can J Psychiatry. 2009;54(6):409-419.

Clinical Implications

* The mental health care needs of immigrants and their service use are no higher than those of Israelis.

* Immigrants use more psychotropic drugs.

* Timely detection of psychological symptoms in immigrants and their early treatment with psychotropic drugs may prevent the development of full-blown psychiatric disorders.

Limitations

* We did not divide the Israeli sample into native-born and older immigrant subsamples, and we combined immigrants from the former Soviet Union with those from elsewhere.

* We did not analyze data on the nonmedication treatment of psychiatric disorders.

* The appropriateness of the treatment received for each psychiatric disorder has not been evaluated.

Key Words: common mental disorders, health services, psychotropic drugs, immigrants, national survey, Israel

Abbreviations used in this article

AD antidepressant

CIDI Composite International Diagnostic Interview

DSM Diagnostic and Statistical Manual of Mental Disorders

INHS Israel National Health Survey

Immigrants' mental health has important implications for health provision in their host countries.1'2 While a large influx of healthy newcomers can improve the mental health profile of the general population,3,4 distressed and mentally ill immigrants are likely to increase the burden on health care and social welfare services.5'6

However, there is growing evidence that challenges the common belief that mental illness is more frequent among immigrants than indigenous populations.7 ~9 Schizophrenia, affective disorders, substance abuse, and posttraumatic stress disorder among immigrants have been areas of great research interest.10'11 However, the relation between immigration and stress-related anxiety disorders - which account for most psychiatric cases in the community - and the association between immigrant status, and affective and anxiety disorders have been studied far less.12

The past 2 decades have witnessed a huge wave of Jewish emigration from the former Soviet Union to the West. The vast majority of immigrants who arrived in Israel between 1989 and 2004 (n=\ 180 870) were Jews from the former Soviet Union (n = 962 458). 13 Such a massive migration may change service needs and health patterns in host societies substantially and to manage such a change successfully, information about the mental health of incoming immigrants is crucial. …