Promoting mental health in migrants: a GHQ12-evaluation of a community health program in Sweden

Abstract

Background Research increasingly highlight post-migration factors for migrants’ mental health status. We investigated the association between participation in a health promotion program and changes in migrants’ mental health, and if socio-demographic factors and length of time in the new home country, Sweden, influenced a potential association. Methods A five-week health promotion program named ‘Hälsostöd’ [Health Support], led by community health workers, was offered to migrants, primarily asylum seekers and newly arrived immigrants (N = 202). The framework for the program was salutogenic psycho-education, which focused on health effects of migration experiences, lifestyle and health, and the health care system. Mental health was measured at the start and end of the program. We analysed this follow up by using the recommended clinical cut off (i.e. > 11 of maximum 36, with higher scores indicating possible mental illness) in the 12- item version of the General Health Questionnaire (GHQ12). Chi Square test was used to analyse statistical significance of changes, and multinomial logistic regression to analyse associations to sociodemographic factors and length of stay in Sweden. Results The number of participants scoring above the clinical cut off after participation in the program (N = 79, 39.1%) was lower compared to the corresponding number before participation (N = 111, 55.0%), Chi Square = 10.17, p < .001. The majority of the participants had no change 72.3 (N = 146), 21.8% (N = 44) had a positive change, yet 5.9% (N = 12) had a negative change, compared to before participation in the program. None of the investigated sociodemographic factors showed to significantly influence the association. Length of stay in Sweden was trending, with participants with longer stay being more likely to have possible mental illness. Conclusion We conclude that psycho-educative programs, similar to ‘Hälsostöd’, have potential for promoting asylum seekers’ and newly arrived immigrants’ mental health as the evaluation showed a considerable number of positive changes in participants. The result suggests the importance of offering immigrants health promotive programs in close connection with arrival to the new home country. Future research should clarify under what circumstances sociodemographic factors influence the effects of such programs.

Sexual risk-taking behaviors among young migrant population in Sweden

“…A possible pathway explaining our findings is acculturation stress theory which hypothesizes that the stressors associated with adaptation to a new country and culture (e.g., discrimination, language barriers, financial instability, cultural clashes, long waiting for the asylum process to be finalized, etc.) make migrant youth highly susceptible to negative coping behaviors such as selling or buying sex [ 34 , 58 , 59 ].…”

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“…Given that the scores of the GHQ12 scale are right-skewed and based on relevant literature, we dichotomised the overall GHQ12 scale using two cut off points for the GHQ12 (0–12): our sample mean GHQ12 (0–12) score = 1.8 ∼ 2 (GHQ0-12 ≥ 2) and the GHQ12 (0–12) score of greater than or equal to 4 (GHQ0-12 ≥ 4) as an indication of poor mental well-being [ 43 – 46 , 49 , 50 ]. The GHQ12 (0–36) score was dichotomised based on one cut off point of greater than or equal to 12 (GHQ0-36 ≥ 12) as an indication of poor mental well-being [ 47 , 48 ]. Therefore, GHQ0-12 and GHQ0-36 total scores were treated as binary variables: GHQ0-12 ≥ 2 (0 = scores <2, good mental well-being; 1 = scores ≥2, poor mental well-being); GHQ0-12 ≥ 4 (0 = scores <4, good mental well-being; 1 = scores ≥4, poor mental well-being); and GHQ0-36 ≥ 12 (0 = scores <12, good mental well-being; 1 = scores ≥12, poor mental well-being).…”

“…The first and most used method is the (0-0-1-1) method whereby responses for each of the 12 questions of the GHQ12 scale are dichotomised (0 and 1 into 0; 2 and 3 into 1) and then the 12 items are summed up resulting in a general mental well-being score ranging from 0 to 12 with higher scores indicating poorer mental well-being [42][43][44][45][46]. The second method aims to construct a Likert scale score (0-1-2-3) by adding up all the 12 items of the GHQ12 scale resulting in a total mental well-being score ranging from 0 to 36 with higher scores indicating poorer mental well-being [47,48].…”

“…Given that the scores of the GHQ12 scale are right-skewed and based on relevant literature, we dichotomised the overall GHQ12 scale using two cut off points for the GHQ12 (0-12): our sample mean GHQ12 (0-12) score = 1.8 * 2 (GHQ0-12 � 2) and the GHQ12 (0-12) score of greater than or equal to 4 (GHQ0-12 � 4) as an indication of poor mental well-being [43-46, 49, 50]. The GHQ12 (0-36) score was dichotomised based on one cut off point of greater than or equal to 12 (GHQ0-36 � 12) as an indication of poor mental well-being [47,48]. Therefore, GHQ0-12 and GHQ0-36 total scores were treated as binary…”

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“…A few community health promotion programmes conducted in Sweden do exist but are not common (34)(35)(36). Northern European states do have a well-established welfare sector, but given that the sector has been gradually shrinking, there is a growing gap between the citizens and government institutions providing services including social services and healthcare.…”