Premigration persecution, postmigration stressors and resources, and postmigration mental health: a study of severely traumatized U.S. Arab immigrant women.

摘要

BACKGROUND: Competing theories exist regarding the importance of premigration trauma as compared with postmigration stressors and resources with respect to the risk to immigrant mental health. OBJECTIVE: To examine how type of premigration trauma, postmigration stressors, and postmigration resources differentially predict posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) symptomatology in Arab immigrant women who have been exposed to premigration trauma. DESIGN: Descriptive, using multinomial logistic regression to explain membership in one of four groups: (a) PTSD only (n = 14), (b) MDD (n = 162), (c) comorbid PTSD-MDD (n = 148), and (d) subclinical symptoms (n = 209). RESULTS: Parameter estimates for postimmigration-related stressors (as measured by the Demands of Immigration [DI]) indicated that a unit increase in DI scores was associated with a nearly 16-fold increase in the likelihood of being in the comorbid relative to the subclinical group, and a nearly 2.5-fold increase in the likelihood of being in the comorbid relative to the MDD-only group (p < .05). Odds ratios for social support, age, and type of premigration trauma ranged between 0.95 and 1.95 and only differentiated between subclinical and comorbid PTSD-MDD groups (p < .05). CONCLUSION: Postmigration stressors exert substantive effects on immigrant mental health outcomes. Nursing interventions are needed to reduce immigration-related stressors. Screening Arab immigrant women for depression and PTSD is important, given the high levels observed in this community-based sample.